CyberHealth 23

23 April – May 1999

LAST ISSUE

CyberHealth Index

Contents:

CyberHealth archives are available
Is cyclic HRT “natural”?
Whirlwind tour of topics I wanted to write about
Miscellaneous Q&A
Care of the Soul: Neurosis as paying attention to the wrong things

My heartfelt thanks to all those who have written to me to express their regret about the end of CyberHealth, and to wish me well with my future projects. My articles will be appearing in Life Extension Magazine — you can subscribe to it without becoming a Life Extension Foundation member.

So far I’ve had articles on the last anti-aging conference and on the benefits of conjugated linoleic acid (CLA). Forthcoming: green tea, testosterone and depression, Lester Packer’s concept of the antioxidant network, glutamine, a review of Sears’ “The Anti-Aging Zone.” Not long ago I thought I’d be leaving the health field, but it seems I’ll be lingering on for a while. But I know nothing will be like producing CyberHealth for the wonderful, warm and responsive audience that I have been honored to have.

Thank you all.

Cyberhealth Archives are Available

Dr. Philip Miller, founder of the California Age Management Institute, has generously provided space on his website for CyberHealth archives. To look up any article in the past issues, go to AntiAging.com, then click on “CyberHealth Archives.”

Here is a quick look at the main topics you can look up in the CyberHealth Archives at this website:

CH 1 Age at meno, sugar & aging
CH 2 HRT and weight gain; alcohol and insulin
CH 3 Obesity a risk for breast, prostate cancer
CHW 1 Body fat, exercise, estrone
CHW 2 Exercise, metabolic rate
CHW 3 Bone cell death after Estrogen withdrawal
CHW 4 DHEA, meno; chocolate
CHW 5 Killer bras; low fat lowers Testosterone
CHW 6 Gray hair and osteoporosis
CHW 7 DHEA, bone; lymphatic breast massage
CH 8 Hormones and the brain
CH 9 Hormones and skin
CH 10 Hormones and hair
CH 11 HRT and voice; bloating
CH 12 Progesterone levels; soy toxicity
CH 13 Genistein, estriol, estradiol and breasts
CH 14 HRT and weight gain (detailed)
CH 15 Estrogens and bone (men too)
CH 16 Premarin – pro and con
CH 17 Hormones and sleep
CH 18 Cortisol and brain
CH 19 Hypothyroidism and heavy bleeding
CH 20 How to diminish heavy bleeding
CH 21 Neurochemistry of love
CH 22 Insulin and breast cancer

Of course there is much more in each issue than can be indicated in a brief heading. Dr. Philip Miller is going to have a more thorough index with hypertext links. A few issues are still missing at this point, but the archives should be complete next week.

IS CYCLIC HRT MORE “NATURAL”?
NOT ACCORDING TO DR. DAWN WILLIS

Let me simply quote Dr. Willis, best known for her massive study on HRT and breast cancer mortality: “A case could easily be made that a constant, low level of estrogen is much better for a woman than the fluctuating levels of a ‘normal’ menstrual cycle.” (‘Normal’ is in quotes because the biologically natural state for a woman of productive years is pregnant or lactating, not menstruating! Or else we must decide that it’s normal for a woman to have 400 or so menstrual cycles and only one or two pregnancies, or none; furthermore, it would likewise have to be declared that it is normal to have 400 more artificially induced cycles.

Note also that the only reason withdrawal bleeding had become the standard when using the contraceptive pill was that the male developers had a firm belief that women wish to menstruate. It’s only now that clinicians are discovering that the Pill can in fact be taken continuously.)

I found the statement about the preferability of constant rather than cyclic hormone levels in Dr. Willis’s guest editorial in Maturitas, a European journal devoted to menopause research (Willis D. Does estrogen replacement therapy reduce the risk of fatal breast cancer in postmenopausal women? Maturitas 1997; 27:106).

Dr. Willis is, in effect, “screaming to be heard” about the obvious: nature didn’t design woman to have one menstrual cycle after another for thirty to forty years. Nature designed woman to be pregnant. So those doctors who claim that cyclic HRT is “more natural” are completely off-base.

They may be dangerously off-base, too. There is more and more consensus that the more menstrual cycles a woman experiences, the higher her risk of breast cancer. It’s enlightening to consider that the steady-level birth-control pill (same dose of ethinyl estradiol and progestin every day) has been shown to dramatically reduce the risk of ovarian cancer and endometrial cancer and, if started early in reproductive life, to help prevent endometriosis and benign breast disease. In this type of pill, there is no phase of unopposed estradiol stimulating the proliferation of estrogen-dependent tissue.

If a woman for various reasons chooses not to get pregnant within a few years of becoming fertile, it is probably best for her to get on the Pill.

I know what many of you are going to say! But it is possible to design a contraceptive pill that would not have the side effects of the older-type pills with their hideous androgenic progestins.

Consider the side effects of simply having one menstrual cycle after another without getting pregnant. Developing endometriosis and fibrocystic breast disease is practically a sure thing, especially as progesterone production diminishes with age (or as progesterone is depleted through stress).

For those of you who are intrigued by the title of Dr. Willis’s editorial, let me quote another of her statements: “The evidence from many observational studies suggests that estrogen replacement therapy slightly increases the risk of developing in situ or other non-aggressive tumors, while at the same time it reduces the chances that an aggressive tumor will develop. In other words, estrogen may prolong tumors in a pre-metastatic state.”

Dr. Willis followed up 400,000 women for 10 years. She discovered that HRT users who had a natural menopause before the age of 50 showed a significantly lower breast cancer mortality than women who also had early menopause but did not use hormones (women who had really early menopause and began using hormone replacement before the age of 40 showed the greatest reduction in breast cancer mortality risk: 40%).

The exception to this rule was HRT users with a history of macrocystic breast disease. Their risk wasn’t reduced, but remained the same as that of non-users. Or rather, it could be said that even the risk of women with a history of macrocysts was somewhat reduced with HRT use, since these women have a slightly elevated breast cancer risk (depending chiefly on which hormones predominate in the cyst fluid). Benign breast disease increases breast cancer risk by 40 to 260%, depending on the category. A recent study (the Nashville Breast Cohort) found that estrogen replacement therapy does not further elevate this risk.

(Dr. Dan Gambrell is a great proponent of the use of hormones to REDUCE breast cancer risk. His is the proverbial “voice crying in the wilderness,” pleading that fibrocystic breast disease not be ignored, but treated with progestins—let’s amend this to “with natural progesterone,” since CyberHealth readers know that the natural hormone is better.)

A WHIRLWIND TOUR OF ALL THE THINGS I WANTED TO WRITE ABOUT,
BUT HAVE RUN OUT OF TIME

COFFEE FIGHTS CANCER

Coffee appears to lower the risk of breast cancer and colon cancer. Regular coffee has a more powerful protective effect than decaf, pointing to the anticarcinogenic powers of caffeine, a potent antioxidant.

There is disagreement as to whether medium roast or dark roast is more protective. The consensus is that roasting increases antioxidant properties of coffee, but medium dark might be best (why does this sound like something out of Woody Allen? I’m talking about serious research!) Besides the antioxidant action, another anticarcinogenic mechanism might be increased release of dopamine, our reward chemical, which also lowers insulin. Insulin is a tumor promoter. And coffee lowers iron levels, which might be yet another anticarcinogenic mechanism.

HEALTHY FATS FIGHT CANCER

For cancer prevention, it’s primarily the type of fat, not the amount, that matters. Both breast and prostate tumors produce huge amounts of inflammatory prostaglandins (PGE2). Inflammatory compounds are important tumor growth promoters. Olive oil, fish oil, and conjugated linoleic acid (CLA) are all effective inhibitors of inflammatory prostaglandin production.

Saturated fats (butter, coconut oil) appear to be neutral. Fat becomes a cancer risk when it’s excess levels of omega-6 fats, and/or when the overall consumption of calories is too great. Calorie restriction, particularly in the form of carbohydrate restriction, which lowers insulin levels, remains the most effective way to prevent most cancers, and most aging-related diseases in general.

Oleic acid in olive oil is an important antioxidant. In addition, extra-virgin also contains antioxidant polyphenols. EPA and DHA, the most active fatty acids found in fish oil, induce antioxidant enzymes, especially those related to glutathione.

BREAST CANCER VARIES BY REGION, WATER HARDNESS

Guess which place in the world has the highest incidence of breast cancer —

San Francisco. Aside from that, England leads the world in breast cancer incidence and mortality. In the U.S., there are large regional differences, with the Northeast having the highest incidence. Explanatory theories differ widely, and include not enough sunshine and selenium and iodine deficiencies.

Another interesting correlation has been drawn with water hardness. Soft water, deficient in calcium and magnesium, is associated mainly with cardiovascular disease, but to a lesser degree also with cancer. And it does appear that calcium has a protective action against breast cancer and colon cancer.

AN ONION A DAY

QUERCETIN is a bioflavonoid (a weak plant estrogen) that shows great promise in breast cancer prevention and treatment. Unlike soy phytoestrogens, QUERCETIN INHIBITS THE GROWTH OF MAMMARY TUMORS EVEN IN THE PRESENCE OF HIGH LEVELS OF ESTRADIOL.

Onions are a rich source of quercetin, followed by apples. Tea and wine also contain quercetin. You can take a quercetin supplement as well, especially if you want to use it against allergies or arthritis.

For cancer prevention, 300-600mg should be plenty. For treatment, larger doses (over 1g) are needed. More potent water-soluble quercetin caps should become available in the near future.

Quercetin could be called “the queen of bioflavonoids” (since it’s a plant estrogen, I think a female designation is appropriate). Combined with Vitamin C, quercetin works against allergies and asthma, besides having a wide range of protective action (cardiovascular, antioxidant, anti-inflammatory) typical of all flavonoids.

Large doses of flavonoids (over 2g/d) have been found to diminish heavy menstrual flow (an inflammatory condition; flavonoids are good anti-inflammatories). Unfortunately, due to the ridiculously small doses per capsule that we have now, this is a very expensive solution, forcing women to rely on less safe anti-inflammatories such as Advil.

Epidemiological studies have found that the higher the consumption of bioflavonoids, the lower the incidence of cancer at all sites.

Try this little experiment at home: triple or quadruple your current doses of lipoic acid, Vitamin E, CoQ10, and especially of any flavonoids you may be taking, such as ginkgo and bilberry. Watch what happens to the age spots on your hands, and keep checking the brightness and clarity of the whites of your eyes. After one month, there should be very visible signs of what the antioxidants are doing for you — and that’s of course just the tip of the iceberg.

HIGH BIRTH WEIGHT — BAD NEWS FOR THE CHILD AND THE MOTHER

Mothers who give birth to heavy babies have been found to have a higher cancer risk. This is probably due to their higher blood sugar and insulin.

Alas, the children too seem to suffer from this prenatal overnutrition: they end up more susceptible to obesity, diabetes, and cancer. High birth weight and tall size, if growth is finished in early rather than late teens, are among the documented risk factors for breast cancer.

MISCELLANEOUS HRT INFOBYTES

Less well-known benefits of HRT include faster wound healing, less tooth decay, protection against glaucoma, and better breathing capacity — hence less snoring (snoring, like flatulence, is one of those taboo effects of estrogen deprivation that no one wants to talk about).

The best predictor of HRT use is not the severity of menopause symptoms or any other physiological factor, but the woman’s education and place of residence. Educated women living on the West Coast and in the South are the most numerous group of HRT users. About two thirds of postmenopausal female MD’s use HRT.

Women with shorter menstrual cycles tend to have earlier menopause, as do childless women (unless they are obese — obesity tends to delay menopause). Note also the article below on galactose consumption and ovarian senescence.

GALACTOSE AND PREMATURE OVARIAN SENESCENCE

Lactose, found in milk and various milk products (cheese is pretty much free of lactose, but not yogurt) is a carbohydrate consisting of one molecule of glucose and one of galactose. Interestingly, since there are some clues leading scientists to believe that galactose can damage ovaries, it is galactose that has come under scrutiny in relation to premature or early menopause. (Early menopause correlates with faster aging and shorter life expectancy; I assume this is so only in the absence of HRT.)

FSH is a measure of ovarian senescence: the higher the FSH levels, the sooner menopause can be expected. Using FSH measurements and a diet questionnaire, researchers found that women consuming 6g or more of galactose per day had 29% higher FSH. This association held when age, smoking, and body mass were all controlled for. The women had no known metabolic disorder involving galactose. The authors suggest that there is an association between high galactose consumption (milk, yogurt) and early ovarian senescence.

Unfortunately there were no details as to whether the milk and yogurt consumed were the non-fat or the more natural, full-fat kind. I suspect that a moderate consumption of natural yogurt (nothing taken away, nothing added, especially no added corn syrup) would not have this effect. In other words, my intuition is that the natural products contain a balance of nutrients that counteracts the effect of galactose. A lot probably depends also on the presence or absence of excess glucose from heavy carbohydrate consumption.

Like all fat, milk fat slows down the rate of carbohydrate absorption. In addition, milk fat contains some CLA, a highly beneficial fat. The fat of cattle eating grass rather than commercial feed contains more of the protective CLA, and more omega-3 fats.

WHY ARE LATE SUPPERS SO FATTENING? THE SEROTONIN-DOPAMINE AXIS AND INSULIN

One reason the calories you consume close to bedtime are much more fattening than the same number of calories eaten during the day is that serotonin predominates in the evening and especially while you sleep, and serotonin raises insulin.

CAN GINKGO EXTEND LIFE SPAN?

Apparently the answer is yes, if you are a rat and are receiving 50mg/kg body weight. A 110-lb pound woman (we are all practicing calorie restriction, correct?) would be taking 2,500 mg. At the current pathetic doses available, that would be a lot of capsules and very expensive. Still, even one-tenth of that should at least improve microcirculation. I am very much in favor of consuming a lot of flavonoids — bilberry extract, green tea, grape seed extract, quercetin. Also try the delicious dose of phenolic antioxidants in a daily serving of berries. When you eat citrus fruit, be sure to eat the peel, a treasurehouse of those amazing polyphenols.

PREVENTING ALZHEIMER’S —
FISH, TEA, ANTIOXIDANTS, ESTROGENS, ADVIL, AND MORE

If anyone tells you that there is no way to prevent Alzheimer’s disease, the reply should be: “Are you kidding?” There is plenty anyone can do to prevent it — the problem is ignorance.

Dr. William Grant discovered that Hawaiian Japanese have 2.5 the rate of Alzheimer’s disease as people in Japan. He discovered that the native Japanese ate a lot more fish; in fact it is not unusual for them to eat fish every day. While epidemiological studies do not prove anything, they can provide plausible clues. Fish has long been regarded as “brain food.” Well, it actually is just that, though one could also call it the perfect “heart food.”

Dark cold-water fish in particular is rich in anti-inflammatory omega-3 oils and CoQ10. In addition, wild-caught fish is the only protein that is not a significant source of hidden omega-6 fats, of which we get a dangerous excess in the Western diet.

Was the public made aware of Dr. Grant’s findings? Not to my knowledge.

Maybe the idea that eating more fish might protect you from Alzheimer’s just wasn’t considered newsworthy enough. You would think the fishing industry might show some interest, but no — just as the Hershey people did not show any interest in the finding that men who eat chocolate live longer.

Personal advice: if Alzheimer’s disease happens to run in my family, have at least one fish meal every day — together with taking all the other preventive measures. Am I exaggerating? If you don’t believe me, visit any nursing home; I am willing to bet that what you’ll witness will motivate you to do everything you can to prevent this horror.

Even exercise is probably preventive, by improving cerebral blood flow and the cardiovascular profile.

Considering the catastrophic nature of this disease, and the lack of any effective conventional treatment, prevention is obviously the best policy.

We already do know a lot about how to prevent Alzheimer’s disease: it seems that it takes estrogens (and/or DHEA), anti-inflammatories (aspirin, ibuprofen), antioxidants (including polyphenols such as grape seed extract, green tea extract, and ginkgo), CoQ10, fish oil and increased fish consumption, staying physically and mentally active after retirement, learning new things, meditation (lowers neuron-destroying cortisol).

Sounds familiar? These are mostly the same things you’ve heard of as good for preventing cardiovascular disease and many types of cancer. Yes, there is a connection. True, the fine details of how brain degeneration happens have not yet been thoroughly researched, but are we to wait twenty more years to know for sure?

The point is — with the tremendous amount of knowledge we already have, what are we waiting for? For millions more women (Alzheimer’s disease affects primarily women) to die in a tragic, macabre way, mothers not recognizing their children, finally forgetting even their own name? Shouldn’t there be a public health campaign to make the already-known preventive measures better known to the public? Think of the benefits if some energy went into that, instead of the uproar about the high cost of keeping demented elderly women in nursing homes, and how this is going to bankrupt Medicare.

SUGAR, LACTOSE, AND HEART DISEASE

Speaking of Dr. Grant, he is currently best known for his research into dietary factors in cardiovascular risk. In a massive multi-country survey, Dr. Grant found that lactose (“milk sugar”) was a very significant risk factor. For both ischemic and coronary heart disease combined, the association was highest with the consumption of NON-FAT MILK for men over 45 and women over 75; for younger women, it was sugar and lactose. Dr. Grant emphasizes that lactose appears to affect primarily postmenopausal women.

He states, “It is primarily the lactose or carbohydrates in milk and yogurt that increase the risk of heart disease. It seems likely that lactose is easily converted to triglycerides, which are then incorporated into very low density cholesterol in the liver. The triglycerides and low density cholesterol are now seen as the primary risk factors for ischemic heart disease.

In addition, the methionine in milk may contribute to plaque through its metabolic product, homocysteine. Milk more than meat lacks adequate B vitamins to convert homocysteine to useful products. Lactose and calcium in conjunction with homocysteine from consumption of non-fat milk may also contribute to calcification of the arteries.”

Note the article on lactose intolerance in one of the earliest CyberHealth issues: lactose-intolerant women were found to have much better markers of cardiovascular health even if they consumed milk products. Simply not absorbing lactose seemed protective.

CAN HORMONES BE CLASSIFIED AS CARCINOGENS?

Women get frightened when they come across long lists of carcinogens, estradiol and progesterone listed among them. Could fertile women be so mis-designed as to produce high levels of carcinogenic compounds? Then why is cancer primarily a disease of aging, when hormone levels are low? Is it possible that hormones actually protect us against cancer? Over the years, I’ve received quite a bit of email on these topics, expressing dismay and confusion.

A carcinogen, strictly defined, is anything that can damage DNA. But in a looser usage, any substance that can promote tumor growth tends to be classified under that label. And yes, hormones can promote tumor growth.

This is true especially of insulin, which we keep ignoring. But under some circumstances, estrogens and progesterone can act as promoters also.

Dose is everything: Dr. Zava explained it well, I think, in his CH 12 post on low-dose progesterone acting as a synergistic breast-tissue growth PROMOTER. This is not the same as a carcinogen; it’s rather functioning as a GROWTH FACTOR. There’s the low, proliferative dose range, and there is the larger (as during the luteal surge) suppresive dose range.

There are also several studies showing that progesterone (in sufficient dose and sufficiently long exposure) prevented the growth of tumors in animals. Human studies indicate that it’s women with a history of progesterone deficiency who have a higher risk of breast cancer.

High-dose progestin is commonly used as a hormonal breast cancer therapy, to shrink the tumor. Interestingly, Provera is also sometimes used to treat leukemia, since progesterone has a strong anti-leukemic action (this perhaps accounts for less leukemia among women).

In Wren’s study, breast cancer survivors on high-dose progestins had half the recurrence rate and no mortality, compared to the considerable mortality among controls.

Whether exposure to very tiny residual doses of progesterone in meat etc is really any kind of danger remains to be shown.

Dr. Zava has discovered that there is no progesterone in plants; those supposed progesterone-like compounds are actually anti-progestins.

Neither progesterone nor estradiol and estrone by themselves are carcinogens in the strict sense of being able to damage DNA. In fact these hormones play a very big part in keeping the cells normal (differentiation).

There is, however, a class of estrogen metabolites called QUINONES, and quinones can damage DNA. Progesterone inhibits the production of quinones.

This may be the chief reason for progesterone’s ability to prevent not only breast cancer, but also prostate cancer, since we now know that estrogens are involved in the proliferation of prostate cells.

80% of breast cancer is diagnosed after the age of 50, i.e. breast cancer is chiefly a postmenopausal disease; considering the low use of HRT, especially in older age, we can still say that the overwhelming percentage of breast cancer is found in women who are severely depleted in progesterone.

One theory of breast cancer is that it’s due to the depletion of progesterone and androgens, our natural anti-estrogens, together with excess insulin and high glucocorticoids (stress hormones). Ovarian dysfunction (chiefly lack of ovulation, meaning no production of progesterone), high insulin (which drives the production of high levels of androgens, and manifests itself in androgenic “apple” obesity), and high stress hormones — this is the high-risk hormonal profile, characterized by a tremendous imbalance.

CREDIT WHERE CREDIT IS DUE

In my correspondence with some of you I have often spoken of the “mix-and-match approach,” especially in relation to estrogens. Simply put, this approach calls for the use of both dermal and oral (or sublingual) products in order to get the special benefits that go with that particular route of administration.

I realize that I have not always given credit to the woman from whom I learned this concept: Gillian Ford, the author of “Listening to your Hormones.” While I am acknowledging my influences, let me give credit to a few more people.

I wish to thank Pete Hueseman, then of Bajamar, now of College Pharmacy, for having said, “Triestrogen? Isn’t that awfully weak?” thus setting me on a path to seeking an effective, brain-sharpening dose of estradiol. I also thank Dr. Elizabeth Vliet, author of “Screaming to be Heard,” for further curing me of my estrogen phobia and making me understand that the minimal dose is not the optimal dose.

I wish to thank Dr. David Zava for pointing out the dangers of phytic acid if one eats excess grains, beans, and “junk soy food.” I thank him for all his contributions to CyberHealth, including that marvelous little article on the dimer nature of the estrogen-ER complex that provoked an outcry from the biochemistry-challenged and ecstatic praise from those fascinated by such cutting-edge stuff.

I wish to thank Louise Gittleman for her inspiring courage to “go beyond Pritikin” and say “Pritikin saw fat as a problem. I see it as the solution.” I am indebted to Dr. Barry Sears for pointing out the anti-inflammatory importance of EPA (fish oils) and of estrogens. (He doesn’t make a big point about estrogens, but it certainly registered on me in terms of arthritis!) Finally, I wish to thank Dr. Robert Atkins for turning my life around by explaining the action of insulin.

Although now I think his approach is too extreme, at the time it worked like a miracle in making me lose weight and stay slender, getting rid of chronic headaches and chronic fatigue, and endless other blood-sugar disturbances. In terms of diet, he pointed me in the right direction.

A million thanks to Gail Peterson, Monica Smith, Linda Dopierala, Ariel Heart, and Pamela Macon, whose labor of love helped produce CyberHealth. Special thanks to Dr. Andrea Vangor (Anatomy), for various features that she contributed, and for her unforgettable comment, “The obese make excellent cadavers.”

I thank Tom Matthews for generously sending me various abstracts, and for contributing his excellent article on the dangers of excess fructose. I have since learned that fructose cross-links with hemoglobin five times as readily as glucose. Think of all the processed junk food that is trying to pass as health food by boasting it is fructose-sweetened.

And I thank the countless women and men who’ve written to me over the years, encouraging me to carry on with my work, especially when I was under heavy attack by the anti-hormone camp.

Gail comments:

Well, it’s been fun and very educational!

Ivy replies:

Thank you, Gail, for your meticulous editing. Your kindness, generosity, and integrity have truly enhanced the quality of CyberHealth.

THE RAVAGES OF FAT DEFICIENCY:

Linda writes:

If fat is necessary for hormone production and function, I was running on empty. Except for a couple flax or salmon capsules, I shunned all fats. No butter, little margarine, fat-free cheese; fat-free salad dressings; fat-free sour cream; etc. And, I see now, that the more fat-free an item was (like ice-cream) the higher the carb count. I truly feel great now in many, many ways!

The palms of my hands used to be white in all the lines and I would get tiny painful cracks around the fingertips even though I applied lotions 2 – 3 x’s a day. I conditioned my hair morning and applied oil before bed, but my hair was still prone to brittleness.

Now it’s glossy and strong feeling! It’s only been a couple weeks but the changes are very noticable! I have neither lost nor gained any weight, except for about 3 pounds, right in the beginning – that was probably water weight due to cutting out the breads. I’m only consuming about 1 to 1 ½ Tb of coconut oil a day, plus a little olive oil and, yes, even butter sometimes.

Ivy:

I’d advise consuming at least as much olive oil (extra virgin only—that’s the only kind that has polyphenols) as coconut oil. Olive oil is apparently very protective against breast cancer. Coconut is probably neutral, but it may be protective considering that it is immune-enhancing.

It’s actually fat-deficient women who run a greater risk of many kinds of disease, including various types of cancer, especially if the fat deficiency goes hand-in-hand with high insulin.

In your case, fat deficiency probably produced deficiency in fat-soluble vitamins, A, D, E—even if you were taking supplements.

That’s again a breast cancer risk, with very strong evidence for vit A and D.

You’ve been probably losing bone mass and muscle mass, and hopefully this is reversing now. Few women are aware of how critical sufficient fat consumption is for bone building.

With low Vitamin A, yes, a lot of hormonal production would be impaired. But that always happens with low fat intake: you become hypohormonal, especially for steroids.

On men the impact is disastrous because testosterone production is strongly affected. To keep up T levels, a man needs to consume mono and/or saturated fats, with monos being probably best for the heart.

WHAT, NO DAILY BREAD?

Linda also writes:

The last few days I’ve had virtually no bread products and feel much better (and 3 lbs. lighter).

Ivy:

At first it’s been difficult for me to eliminate bread completely. But I kept reading more and more negative information about bread.

What first caught my attention was someone saying that wheat (possibly he meant wheat flour, or both the whole grain and the flour) is stored for as long as 12 years before being used, and even though it’s heavily treated with fungicides, it still develops a certain amount of mold.

The long storage fit in with this quotation I found in Sally Fallon’s book (p.491):

“Recent, preliminary evidence suggests that partially rancid fats, rather than animal fat per se, may be one of the real villains responsible for atherosclerosis. Sources of stale fats include products such as bread, crackers, pastries and commercial cereals made from stored processed flour.” Then there was the Italian study where high consumption of bread and cereals was found to be a risk factor for breast cancer.

This rather ruins bread for me. The fattening, high-glycemic carbohydrates, the rancid n-6 fats, the hard-to-digest gluten, the enzyme inhibitors and phytic acid, the fungal and other contaminants. Old-style sourdough rye may be an exception, but it is not easy to find. What opened my eyes was going on the Atkins diet. Though it’s too extreme and I no longer recommend it, for the first time in my life I stopped eating bread and cereal, and experienced the high energy that resulted from eating a grainless diet. In my case at least, for high morning energy nothing beats a breadless, cereal-less breakfast.

Even if you have no trouble digesting bread, you should still be aware that bread is highly glycemic. It causes an insulin surge, and thus has the potential of being very fattening if you are sedentary. It’s not the calories per slice—it’s how high your blood sugar goes up, and thus your insulin.

Putting some fat on the bread actually makes it LESS glycemic and thus less fattening. Also, if you butter the bread, you are more likely to eat less of it, since you’ll feel sated sooner. And you won’t be hungry as soon after the meal, so ultimately you’ll be eating less and consuming fewer calories.

Such are the insulin-driven paradoxes of nutrition.

I once knew a woman who didn’t care to cook, so she practically lived on bread. She was growing fatter and fatter. The fact that she always ate “whole-grain” bread did not help. She also complained of constant bloating and fatigue. Being prone to extremes, she suddenly discovered protein and eliminated bread. The next time I met her, she was spectacularly slender and was taking ballet classes.

Another thing to remember about bread is that it contains phytic acid, a compound which intereferes with the absorption of vital minerals such as calcium, magnesium, and zinc.

Thus, I’m nostalgic for the days when I could tolerate bread a lot better.

I didn’t really have a problem with bread until my perimenopausal years. I guess the enzymes aren’t what they used to be.

If you eat too much bread, you could be depleting your calcium, magnesium, zinc, and other necessary minerals. (The American diet is richer in calcium than any diet in the world; but are Americans ABSORBING their calcium?) So while you may or may not decide to eliminate bread and breakfast cereals completely (try it: you’ll love it!), there are good reasons to urge lower consumption.

It’s just a Western cultural bias that we need special “breakfast foods.” The Asians don’t think so. Think of them and others—billions of people in the world do NOT have bread or cereal for breakfast, and they are the ones who do not typically suffer from obesity, diabetes, heart disease, dental decay, and similar “diseases of Western civilization.” Still, what about “once in a while”?

I discovered that I once in a while I can eat one slice of rye or sprouted grain bread for breakfast, sometimes (rarely) even two slices (on days when I am especially physically active, which for me usually means hiking in the mountains), or (2) a lime-treated corn tortilla with melted cheese. Sprouted multi-grain bread with raisins is a special occasional treat, and with one slice seem to suffer practically no bloating (OK, a tiny amount, if I really tune in).

Even one slice of bread containing regular wheat flour, on the other hand, does make me feel noticeably worse.

What’s the difference between wheat and rye? RYE HAS A LOWER PHYTATE CONTENT. That alone is enough to recommend it. Rye provides more fiber.

Dark rye is also closer to traditional bread, dense and chewy, rather than yeast-fluffy like a cake. Avoid the kind of rye bread that is rather “fluffy”; look for the traditional dense kind.

However, I still encourage everyone to try a breadless day. The results can be eye-opening.

PART II OF CYBERHEALTH 23

Again, thanks to those additional kind people who have sent me more thank-you’s and good wishes. Your words brought tears to my eyes and warmed my heart.

A BIT MORE OF THE WHIRLWIND TOUR

ORAL CONTRACEPTIVES INCREASE BONE DENSITY

A Swedish study (Reuters 4/29/99) found better bone density is one of the benefits of using the Pill. The scientists concluded, “Oral contraceptive users appear to reach menopause with a bone density two to three times higher than that of non-users.” The biggest impact was seen in women taking the Pill after age forty.

The forties are in fact a very good decade for taking oral contraceptives. And you can take the Pill continuously, to avoid withdrawal. That is the best way to prevent endometriosis, fibroids, and other nasties that make perimenopause so miserable.

Even if you take the Pill the traditional way, with one week off to allow withdrawal bleeding, you still get most of the benefits, and avoid the “floods,” the notorious and sometimes even life-threatening (as happened to me) heavy periods that are the bane of the years just before menopause.

Perhaps the most important benefit of oral contraceptives is the prevention of ovarian cancer. You have to take the Pill for at least five years to get the maximum benefits, but then it is even more effective than multiple pregnancies, the next best way to prevent ovarian cancer (rare but quite lethal). The risk of endometrial cancer is also lower for oc users. And now we’ve learned that so is the risk of osteoporosis. Obvious, isn’t it? But somehow nobody has thought of it before.

I have found only one brand to be compatible with my body, and it happens to be the brand also recommended by Dr. Vliet: OvCon. In retrospect, how I wish I’d stayed on it, instead of letting myself be persuaded to switch to the miserable Lo-Estrin, and the particularly revolting Micronor (progestin-only: ghastly side effects). I have not tried TriCyclen, but I do not care for the idea of variable hormone levels. I think that would only exacerbate the problems that women so often experience during the second half of the cycle, and amplify PMS.

BONES NEED A LOT MORE THAN CALCIUM; THE NEED FOR VITAMIN K

Consider this fact: the American diet is the richest in calcium in the world. Taking huge doses of calcium will do no good if your body can’t utilize that calcium because of insuffiency of hormones, fatty acids, and various micronutrients. You have already heard of the need for magnesium, boron, and D3. This information is all over the place in alternative health books and magazines. The newest discovery is that bones and teeth can profit enormously from supplementation with Vitamin K.

Vitamin K has not been paid much attention to because it was assumed that no one ever becomes deficient. After all, the bacteria in our intestines can synthesize it. But a lot of people do not have a healthy intestinal flora, since they don’t eat right, and/or they take antiobiotics. Vitamin K can also be obtained from egg yolks and leafy vegetables, but of course there are people who deprive themselves of both.

Fortunately supplements are very cheap. In addition, there is a common source of Vitamin K that should be acceptable to everyone: iceberg lettuce. True, romaine and other more chic lettuces may provide more nutrients overall, but iceberg is supposed to excel in Vitamin K content.

So don’t disdain the humble iceberg. Chomp on it to your heart’s (and bones’) delight. It protects your teeth against cavities, and is even supposed to protect against breast cancer. The more we learn about common nutrients, the more amazing they turn out to be.

Now, if I weren’t running out of space and time, I’d tell you about the incredible detox powers of parsley. Just take it from me: that decorative stalk that so often comes with your restaurant entree could be the best thing on the plate, a bit of natural chemotherapy to offset the rest.

DIFFERENT FORMS OF VITAMIN E AND CANCER

Lynne sent us a wonderful study from a recent issue of Nutrition and Cancer.

“Vitamin E” is actually a group name for the family of tocopherols and tocotrienols. Does it matter which form you use? (This question rings a bell, doesn’t it — Does it matter which estrogen you use?)

The study confirmed that only the succinate form of Vitamin E (as opposed to the acetate form) is active in inducing apoptosis (programmed cell suicide) of breast cancer cells, and so are three of the tocotrienols: alpha, gamma, and delta. Tocotrienols differ from tocopherols mainly in having unsaturated bonds; they are more active as antioxidants, and also longer-lasting, being readily recycled. As for alpha-tocopherol acetate, some studies suggest that it may actually even block the action of other anti-cancer compounds, such as the fatty acids in fish oil.

Of the four natural tocopherols, only delta tocopherol was found to have the ability to induce apoptosis. On the other hand, I have come upon a study which did find apoptosis with dl-alpha-tocopherol. I hate to use this cliche, but we certainly need more research.

Breast cancer patients appear to have normal-range alpha-tocopherol levels in both tissue and serum. Where they differ from controls is in the levels of CoQ10. The more severe the cancer, the lower the levels of CoQ10 tend to be.

Only poorly differentiated estrogen-negative tumors show low alpha tocopherol (but these are the tumors with bad prognosis).

We are barely beginning to study tocotrienols, but they already look extremely promising in terms of cardiovascular and anti-cancer benefits. A combination of CoQ10 with tocotrienols should work nicely for cancer prevention. Dr. Lester Packer, usually quite conservative in his dosage recommendations, suggests no less than 200mg of tocotrienols/day for postmenopausal women! I pray that the health-food industry responds by making available larger doses at an affordable price.

Vitamin E compounds belong to the larger family of ISOPRENOIDS, many of which have anti-cancer activity. Isoprenoids include retinoids (various Vitamin A compounds), deltanoids (Vitamin D compounds), tamoxifen, progestins, and monoterpenes (found in cabbage, carrots, citrus, yams, peppers, tomatoes, eggplant).

If you are wondering if tocotrienols are available from food, the answer is yes. Alas, the richest source, palm oil, is not available in this country, having been demonized by misguided diet gurus. Fortunately organic coconut oil is back (a marvelous source of medium-chain triglycerides); maybe palm oil will be next. Rice bran oil is another good source of tocotrienols.

Dr. Packer hints that tocotrienols are especially wonderful for the skin.

HOW PROGESTERONE PROTECTS AGAINST ATHEROSCLEROSIS

It has been a puzzle why women who use both estrogens and progestin (combined HRT) have a lower risk (.39) of heart disease than women using only estrogens (.60), especially considering that progestins counteract the estrogen-induced elevation of HDLs.

Studies using natural progesterone have shed some light on this. First, it was established that progesterone, like estrogens, inhibits the proliferation of smooth muscle inside blood vessels. Now it turns out that progesterone also reduces the formation of cholesteryl ester in macrophages, and inhibit the stress hormone-mediated enhancement of the synthesis of this harmful compound.

Macrophages (a category of immune cells) absorb LDL cholesterol and recycle it into cholesteryl ester. Excess production plays an important part of the development of atherosclerosis. Stress hormones enhance the process; progesterone counteracts it.

Now if we could only have a study that tests the effectiveness of natural progesterone against progestins.

By the way, the FDA-approved form of progesterone is called Prometrium, and is dreadfully expensive. Cream is still the cheapest and, in my opinion, the most effective.

ESTROGEN/ANDROGEN RATIO FOR GOOD BONE DENSITY

Idelle asks, “What estrogen/androgen ratio is best for good bone density?”

Ivy replies:

The trouble is that it’s only now that the best doctors are beginning to measure FREE estradiol, testosterone etc. Or even do any DHEA tests at all. And then each testing lab seems to have its own ranges, and the validity of the tests has been questioned. Yes, it’s a mess.

We need to establish good norms for healthy 20-25 yr old women, at least in terms of averages for various estrogens, P, DHEA, T — the free or bioavailable levels. This is the real story: the levels of ACTIVE hormones, not the total levels, which mostly reflect the protein-bound, inactive form. Once we have enough studies on the levels of free steroids in healthy young women, then we should have more of an idea of what to shoot for. At the same time, I agree with Pete Hueseman of College Pharmacy that blood levels are not the whole story either. We need to looks at everything that’s happening in response to a particular dose. Furthermore, the first three months are an adjustment period, and you need to wait a while to get a more accurate picture. Do you see how complicated this gets?

Maybe 30-yr-old women would actually be the best standard, since that’s generally the peak of bone density. Although I detest the phrase, “We need more research,” since it sounds like such a cop-out answer to everything, it is ever so true in the field of hormone replacement.

Right now, what we see is that free T is a very important biomarker for bone density in women. And the dilemma is that hyperandrogenic women have great bone density, but of course so many other health problems that we can’t advocate taking a lot of testosterone just so a woman can build thick, male-like bones. If a woman has total E2 levels over 100 pg, and androgens like T and DHEA that fall in the medium normal range, that seems to be adequate for good bones. Anything among androgens that goes over 90% of the normal range is probably undesirable. On the other hand, let me remind you that we should look at the FREE levels, since measuring total levels can lead to wrong conclusions.

Adequate nutrition and exercise are also a must — hormones may be the brick-layers, but we have to provide the bricks, including the right fatty acids (EPA, CLA, and even some saturated fat: butter is actually excellent for bones and teeth). These fatty acids play a very important role in the production of prostaglandins. Inflammatory prostaglandins — stimulated by excess insulin and excess omega-6 fatty acids — destroy bone tissue. Cortisol, our main stress hormone, is also an enemy of muscle and bone; hence the need to keep it in check with the right diet (adequate protein and adequate fat, low-glycemic carbohydrates from vegetables rather than the high-glycemic grains), and with stress-reduction techniques such as meditation.

Even with our very inadequate knowledge, it’s been shown that women on even merely Premarin for 30 years or so show minimal bone loss at best. But those women typically started at 1.25mg rather than the current .625mg, which has me a bit worried. OK, I know that .625 has been found to be the minimum that PRESERVES bone mass, but is minimum something to shoot for, rather than optimum? What if a particular woman is not a good absorber?

Higher than minimum hormone levels do provide a certain guarantee. Women in England with E2 implants, which yield around 125pg, show excellent bone density even in old age. Now, some American clinicians argue that for bone maintenance, 60 -70 picograms would be enough. Under optimal conditions, in relatively young women who do not have elevated levels of cortisol, perhaps. Also, at this point we are talking only in terms of total estradiol. We need to take a look at free estradiol. That’s the real story.

It could be argued that for bone density purposes, E2 is sufficient — but better density seems to result when some androgens are added. For one thing, then you really can afford to lower the dose of E, and that’s what many women want (whether lower doses of E2 really provide better safety in terms of breast cancer is not a resolved question, however).

Estrogens may be primary for bone health because estrogens increase the number of osteoblasts and maintain healthy osteocytes (mature bone cells). But remember that our knowledge is pretty fragmentary.

Obese women have good bones (and muscles too) because they have higher hormone levels (both estrogens and androgens) AND they get plenty of weight-bearing exercise without really trying. Afro-American women tend to have better bone density, probably because of genetically higher T levels.

One interesting finding is that there is a lot of OSTEOPOROSIS IN MEN as their T and DHEA levels decline (though actually free E2 is the best biomarker for bone density in men—there was an article on that in one of past CH issues). Men show bone loss chiefly in the spine; they are much less prone to pelvic fractures than women, but male spinal osteoporosis can be considerable. In fact, the newest thinking is that men and women are equally susceptible to spinal bone loss. Hence the need for T replacement for men — T will be converted to whatever metabolites are needed, including E2. For women, it’s more complicated, but a bit of androgen replacement seems desirable: if not T, then DHEA.

An important note on progesterone. A lot of women have swallowed the idea that progesterone alone can save their bones. True, there are progesterone receptors on the osteoblasts — just as there are estrogen receptors and testosterone receptors, and we assume that ALL these hormones play an important role in bone building (as for DHEA, according to present knowledge, in bone tissue DHEA is aromatized to estrone). But let us talk a bit more about hormone receptors. Obviously progesterone can’t do much good if there are not enough progesterone receptors. Now, as Dr. Zava taught me a few years ago, it is nature’s law of checks and balances that estrogens create the receptors for androgens (chemically, progesterone is an androgen), while androgens suppress estrogen receptors. When estrogens arrive, one of the things they do is induce the formation of progesterone receptors. Then when progesterone arrives, the receptors are abundant and progesterone can do its various lines of work (which includes downregulating estrogen receptors).

When a woman has been on unoppposed Premarin, say, and starts taking even a bit of progesterone, there are plenty of progesterone receptors available, and she soon starts feeling better: her breast soreness disappears, her thyroid kicks into a higher gear, she sleeps better, whatever. Seeing this, she may decide that all she needs is progesterone. When we revisit her half a year later, we may find that she is on some form unopposed estrogen again, and bitterly telling the story of how progesterone stopped working after a while. First a miracle, then feeling worse than before. Or she may have given up on hormone replacement altogether, another victim of too little knowledge, of having read only one book.

Remember: without a certain critical amount of estrogens (I don’t think we know how much for any particular woman; we have to proceed by individual trial-and-error), there just won’t be enough progesterone receptors, and progesterone alone will be ineffective. We need to think in terms of hormone balance, not in terms of this or that hormone being “all you need.” We need them all.

Last word on bone loss. It’s not just that you lose height and your spine becomes more and more deformed. Women also suffer terrible backaches as a result of osteoporosis. My mother started nhrt too late to reverse the spinal damage, and she continues to suffer. And, like so many women in her generation, my grandmother died as a result of a hip fracture. So when Dr. S. Love announced, in defense of her anti-hormone position, “Bone loss is natural with age. We need to accept it,” I wanted to scream. Just as vaccinations made smallpox history, so correct hrt should do away with bone loss. Someone should point out to Dr. Love that smallpox is natural, and vaccination isn’t. Nor is taking vitamins.

HORMONE COMBINATION: IS THERE A GENERAL FORMULA?

Melanie writes:

Ivy, what would be a generally good combination of hormones—I’m confused.

Ivy:

There is no general answer to this question. The principle of NHRT is that one size does not fit all. This means we need to find out, through individual experimentation (alas, there seems to be no other way than this kind of trial and error), different doses and different combos for different women.

For instance, while MOST postmeno women could use some DHEA (maybe 25mg/D) and a wee bit of testosterone cream for that PMZ drive and libido, women who are apple-obese tend to have high insulin and high androgen levels, and the last thing you’d want is have them automatically assume that they need DHEA. Their DHEA levels might be quite high. Now, while it would be a good idea for all women to get a DHEA and T test, sometimes it IS a major hassle, especially for DHEA, so I don’t absolutely insist on it for women who are on the thin side, and who show obvious signs of androgen deficiency such as libido loss, decrease in sexual sensation, thinning of pubic and underarm hair, or flat, non-erectile nipples.

As for clearly hyperandrogenic women, the most important hormone that they must deal with is insulin. They should try to lower it through low-carbo diet, exercise, and sometimes drugs such as Metformin. Natural estrogens also help improve the insulin picture, esp if taken dermally (even Premarin can help, but dose is critical—too much can raise insulin). The excess male hormones are really a side-effect of too much insulin.

Thin women are typically the most hormone-deficient, and need help across the board: estrogens (I favor MIXED estrogens), progesterone, DHEA, testosterone, pregnenolone. Things do get a little tricky with progesterone, because a minority of women are just not tolerant of progesterone no matter what, and to them it is a necessary evil to be taken in the smallest possible doses for the shortest possible number of days that will still yield endometrial protection. Most women, however, do fine on a continuous regimen (no artificial periods) once they find the doses of E and P that really work for them, keeping them on a steady keel of good energy and happy mood.

There are many individual nuances here: there are women who want libido to the max because they are married to a younger man, and there are those who want to minimize it because they have no partner and fear that unsatisfied longings would be a torture to them; women whose major concern is genital atrophy; women who want only a weak hormone cream to rejuvenate their skin; women who already have osteoporosis; women who have a family history of breast cancer and are wondering if they could use only progesterone or only DHEA, and so forth.

I go into all this, together with suggestions for good starting doses and ways to cautiously experiment to find your optimal doses, in my book, HORMONES WITHOUT FEAR, second edition, revised and expanded, available from College Pharmacy, 800-888-9358. Every hormone is discussed in detail, together with the kind of knowledge that comes the hard way: from experience, my own and that of other women. It’s a woman-to-woman book. I hasten to say, however, that there are many other books on HRT, and it’s best to get acquainted with different points of view and get as much information as possible.

The point is: practically no one gets it right right away. It generally takes a year or so before you figure out through trial-and-error what your best doses and combinations are. It may sound like a hassle, but ultimately it is worth it.

HORMONAL BIOMARKERS FOR BREAST CANCER RISK

Lynne writes:

Did you write something about older women having excessive amounts of estrone? I think I was always curious why estradiol-depleted women got the lion’s share of breast cancer .

Ivy replies:

The greatest risk for breast cancer, besides being a woman, is age. Eighty percent of breast cancer is found in women over 50. Furthermore, the older the woman, the greater the risk, up to 85 or so. If you manage to survive beyond 85, then your risk becomes somewhat lower (on the other hand, your risk of dying of either heart disease or Alzheimer’s becomes huge).

There used to be the so-called “estrone theory of breast cancer.” Since most breast cancer is found in postmenopausal women, and since estrone is the dominant native estrogen in postmenopausal women, and in women taking oral HRT, some people jumped to the conclusion that estrone is the estrogen that causes breast cancer. But studies failed to bear this out. Then a hypothesis arose that perhaps women more prone to breast cancer were producing more estrone in their breast tissue.

Only in the breast tissue. And the range is just immense. Some women make a lot, others little.

However, if I remember the study correctly, you couldn’t predict breast cancer on the basis of E1 in the breast tissue. And this was the main point: estrone levels were not predictive. There was a huge overlap between breast cancer cases and healthy controls.

Now, there is suspicion that measuring total estrone is pointless, and we should be looking at free (bioactive) estrone. There is some reason to think that breast cancer patients have inadequate conversion of estrone to the inactive estrone sulfate.

A correlation with obesity was found, but we already know that abdominally obese women have a higher breast cancer risk. These women have body fat not only around the waist (the notorious pot belly), but also on the upper body in general, usually including a substantial bosom. But obviously it isn’t so simple that we can say only obese women with C cups and above get breast cancer. There are plenty of exceptions. So that ruins the simple equation that was hoped for: big bosom = lots of estrone production in the breasts = high breast cancer risk. There are all those DD cups outliving the oncologists.

In premenopausal women, E1 in breast reflected the phase of the menstrual cycle. In postmenopausal women, it reflected obesity more than anything else. Some women not on HRT had higher E1 than some women on HRT.

Maybe it’s one of the factors, though. As you point out, it’s embarrassing to the E2 crowd to be faced with the fact that octogenarians with nearly undetectable serum E2 can be diagnosed with breast cancer (one does wonder if there is any point; at that age, they are not likely to survive the current treatment). The talk about “lifetime exposure” and how these elderly women must have had early menarche and/or late menopause doesn’t seem too convincing. Most women with breast cancer do not have any of the classic “hormonal” risk factors forever quoted: early menarche, late menopause, late-life pregnancy etc. We’re probably chasing the wrong risk factors, not shown by the majority of breast cancer patients.

Having breast cancer before the age of 35 has the worst prognosis. The chances of having breast cancer before 35 are extremely low, I must add, but if a young woman is unfortunate enough to develop it, she has a poor prospect of survival. The best survival rate is seen in women diagnosed after the age of 35 but still before menopause.

Postmenopausal women who have used HRT also generally have a better-than-average prognosis; like the older premenopausal women, they tend to have less aggressive, more differentiated tumors than non-HRT users. This is true especially of women who have used the combined regimen rather than Premarin alone. They have the advantage of more differentiation of the ductal tissue, since estrogens and progesterone synergize in this function. Remember that the less differentiated, or more embryo-like, the tumor tissue, the greater the lethal potential.

The closest we have to a hormonal biomarker for breast cancer is free testosterone. If the native levels are in the highest 20%, then the breast cancer risk is 7 times that of the population at large. In other words, we are probably dealing with hyperandrogenic obesity.

Zumoff and various other researchers tried to get the overall picture of the breast cancer endocrine profile, but since they typically look only at sex steroids, it’s a very incomplete picture. Through a lot of searching, though, you can find this: premenopausal progesterone deficiency (often classified as ovarian dysfunction, or irregular cycles), high androgens (probably due to high insulin), and high stress hormones. It is easy to recognize that this is basically the pattern of hyperandrogenic “apple” obesity. While this type of obesity is a well-documented risk for breast cancer, we know that a woman does not have to be obese to develop the disease; there are a lot of unknown factors here.

Also, it seems to me that those breast cancer studies that bother to list the age range of the subjects indicate that it’s the relatively younger women who tend to be enrolled in those studies. I think breast cancer in the severely steroid-depleted elderly might be different in some important ways from breast cancer in the 40-60 age group. And yet the older you are, the higher the risk — up to age 85, when it starts declining again.

To end on a more positive note, let me point out that no matter what your risk, no matter how severe your premenopausal progesterone deficiency, in most cases you can still count on your body’s well-designed defenses. In terms of external protection, the inclusion of generous doses of progesterone in your hrt, consuming phytochemicals, and practicing calorie restriction (which usually means eliminating refined carbohydrates and thus lowering insulin) all seem to be very protective.

Breast cancer terrifies us mainly because the conventional treatment is so barbaric, and ironically, is itself carcinogenic, sometimes resulting in lethal secondary cancer such as leukemia. Fortunately more biological approaches are emerging, and by the time we turn 60-70, I expect great changes in detection and treatment. Even oncologists believe that within twenty years breast cancer will be regarded as eminently treatable and survivable.

ATTITUDE IS #1: MENTAL STATE CAN
AFFECT THE ACTION OF NUTRIENTS AND DRUGS

Christopher from Australia writes this:

I have no formal training in medicine or health but have been deeply involved since I was 18 ( 31 now) because of family health problems. I have been involved with a very powerful biochemist/healer for the past ten years who has made some remarkable discoveries about the human body. His expertise is with the brain, as this is the most important organ, but of course the rest of the body’s functions have to be working properly for it to be at its peak.

He works alot with herbal preparations and just simple formula like vanilla/chlorophyll/vit c/vit e/ etc. Things that help the bodies own healing mechanisms, the immune system, bacteria etc. He is big on hydration of the body since dehydration is the cause of many problems. Catalysts are used to get water into the organs etc. Caffeine/Dandelion are two very good hydrators.

You are on the right track with Inositol. It is the most abundant B vitamin in the body and the most important to over-all health. It has a similar structure to sugar and many times sugar cravings, brain sugar problems are inositol related. Lecithin containing inositol is a vital nutrient and is the main component of the human brain. The only major negative side effect of coffee consumption is it leaches inositol out of the body. Lecithin consumption will counteract this. When people get the shakes or jitters from coffee consumption, it is inositol related. Breast tenderness can be alleviated by inositol consumption.

I have cured a personal epilepsy problem by working on my kidneys and stress factors/mental. My mother cured explosive rheumatoid arthritis through nutrients/exercise, rest/relaxation, philosophy in about 6 months after being prescribed very nasty strong chemicals that would have killed her. She couldn’t walk before and is now perfect at 60 and looks 45. I have therefore had first-hand experience with his work and know that it works.

He of course says that the mental state is the most important. You must be in the right frame of mind to be cured. You can give two different people the same nutrient and get different results.

Did you know that chocolate and coffee have very powerful antioxidants in them and healing powers. Strawberries and chocolate together feed beneficial bacteria in the intestines, which has much benefit in the body. Keep working on inositol; it is a very important nutrient.

Ivy replies:

Biochemistry is decades ahead of clinical practice. Think of all the information we received in CyberHealth from Dr. David Zava — no MD I know is aware of this cutting-edge information. If you want to learn about the real foundations of health, get interested in biochemistry. A fascinating field, the frontiers of learning about life itself.

I am particularly interested in the statement: “You can give two different people the same nutrient and get different results.” This makes sense. It’s called “biochemical individuality.” Also, as Ariel recently pointed out to me, just because a book says that a cup of spinach contains so much Vitamin C, iron, potassium and so on does not mean that you will absorb these amounts. Every person will react differently, and even you will absorb differently on different days, depending on a lot of factors. So going “by the book” and imagining yourself to have scientific precision is pure nonsense.

And I thank Christopher to reminding us that attitude is all-important. Experienced clinicians are quite aware that if a patient doesn’t believe in a drug, there may be a worsening rather than improvement. To put it in a very simple language, bad thoughts equal bad chemicals. These bad chemicals, if abundant enough, can overwhelm the effects of drugs and nutrients. Some smart clinicians have observed that in order to overcome serious illness, a person needs to undergo a major mental/emotional change, something akin to religious conversion. The chemistry of negativity has to yield to the chemistry of joy and hope.

* * CARE OF THE SOUL *

HEALING AND SPIRIT; NEUROSIS AS PAYING ATTENTION TO THE WRONG THINGS

I got this wonderful quotation from Deena Metzger (LA poet/healer):

“The healer acts on behalf of spirit, calling people forth, opening the path between the individual and spirit, removing the obstacles to the spiritual life.”

This immediately struck me as getting to the core of things. When we are in touch with the our spiritual essence, there is no space for disease.

And of course art (real art, deep creativity) and spirituality are the same. And humor, even black humor, like Julia Sweeney’s comic account of cancer, is a great survival mechanism (we keep saying that laughter is the best medicine, but do we really believe this? Do we apply it in our lives?)

Can even cancer be seen as material for comedy? Since I grew up hearing concentration-camp humor, this doesn’t surprise me at all. If you don’t think that at least some Auschwitz inmates had the strength of spirit to make fun of their guards, think again. Even in the depths of hell, if you can still crack a joke, then the devil has not destroyed your soul.

Recently I found quite an extraordinary book, by Dr. Daniel Amen (a name like that has to be real). He discusses how various parts of the brain become dysfunctional, and how we must “exterminate ANTS.” ANTS stands for “automatic negative thoughts.” If you let even one ANT parade around, soon the whole army is marching on, brain-generated with only slight relation to reality. It was so refreshing to have a psychiatrist take a route different than digging into the negative. Ultimately, he could almost be saying, “Think positive.” Focus on the positive, count your blessings, imagine a positive future rather than review the traumas of the past.

We need to train the brain to generate APT perception—my coinage for “automatic positive thought” (to my knowledge that’s my coinage, but it’s so obvious that others might have come up with it too). Takes huge rewiring of the well-worn negative circuits—tho maybe just not touching them and building the new positive circuits instead is a more appropriate metaphor. Maybe the task is not even possible without spirituality—or art — or maybe dedication to a humanitarian cause would be an equivalent.

Another idea I like a lot is that “neurosis is an attention disorder: paying attention to the wrong things.” Depression is a sort of masochistic self-centeredness (and I speak from long personal experience). Concentrating on something bigger than oneself, or even simply anything outside of oneself, is of great help. If instead of writing articles with some potential to help others I’d let myself fall into a paralyzing depression, analyzing a terrible relationship I had 25 years ago, and how that damaged my self-esteem, and how could he have done this to me, and so on — and everything that went wrong then and since, every mistake I ever made, all the times I got “no respect,” etc, that to me would be an example of paying attention to the wrong things and suffering the consequences.

And I know that every single human being could produce a long list of “wrongs” also. “Life is suffering” — no one has ever questioned Buddha’s most famous saying, because everyone knows what suffering is. The Victorian solution was to concentrate on work and duty (“We are here to do good, not to feel good”). I feel it’s actually a very effective solution, and only want to add lots of joy to it, giving oneself permission to pursue beauty and delight. Krishnamurti’s advice was also along the lines of changing the focus away from one’s problems: “Look at the sky. Look at the trees.”

Or, as a Native-American poem suggests, here we are, feeling sorry for ourselves, and all the while a great wind is carrying us. And, if you pardon my Victorian upbringing showing here, there is so much to read, so much to do, so many people to whom we could be of loving service.

Here is a saying I love: “Get off the cross, we need the wood.”

This is supposed to be “The Age of Anxiety.” I think it’s high time for us to rebel against anxiety, victimology, and woundology. It is time to create a positive vision and build a positive future. Debby, one of our readers who happens to be a much sought-after psychotherapist, sends us this wise statement: “When you are overwhelmed by doubts and fears, take just one step in the direction you want to go, and the fear is gone.”

LETTING GO

The experience of being penniless can be enormously educating. It’s only when I was utterly poor, in my twenties, that I learned what it is I possess that is of true value. And it wasn’t anything I could carry in my two suitcases, but only that which I could carry in my head — my knowledge, skills, treasured memories, the life-sustaining imprint of all the affection I’d ever received, the degree of personal development I’d reached. I was privileged to realize fairly early in life that my mind was my only real wealth, and that education in any form was what was worth investing in — not fancy clothes or such. And in a moment of light, when it seemed that I’ve truly reached the bottom of physical misery, I suddenly felt enormously grateful for having this wealth, and for all the rich gifts that life has given me.

But to lose that — to lose being able to enjoy the richness of one’s mind — even the memory of who you are, as in Alzheimer’s disease — that is the ultimate terror. As though we really knew who we are in the first place!

I don’t know how to deal with the thought of the ultimate letting go. I am just another human being carrying the burden of the questions. Maybe the answer is tied in with the concept of humility: our work is important, our contributions to the greater common good are important, but we aren’t. Some might disagree and say that our lives aren’t about what we DO, but what we ARE, or perhaps what we EXPERIENCE. I simply don’t know.

For now, I prefer to stay with the easier subject: letting go of what ultimately turns out not to have been essential after all — whether possessions, or youth, or certain illusions, like having to have a certain kind of mate before we can be happy, or having to look like a supermodel.

Adrienne Rich has written marvelous lines about that:

Stripped,
you are beginning to float free

– – –

after the last collapse
of primary color
once the last absolutes were torn to pieces
you could begin

Gail sends us a lovely poem by Mary Oliver:

IN BLACKWATER WOODS

Look, the trees
are turning
their own bodies
into pillars
of light,
are giving off the rich
fragrance of cinnamon
and fulfillment,
the long tapers
of cattails
are bursting and floating away over
the blue shoulders
of the ponds,
and every pond,
no matter what its
name is, is
nameless now.

Every year
everything
I have ever learned
in my lifetime
leads back to this: the fires
and the black river of loss
whose other side
is salvation,
whose meaning
none of us will ever know.

To live in this world
you must be able
to do three things:
to love what is mortal;
to hold it
against your bones knowing
your own life depends on it;
and, when the time comes to let it go,
to let it go.

In a lighter vein, I also like this quotation:

“The key to knowing whether our little obsessions are healthy or not is whether we’re having fun. If we complain about any area of our lives that involves material possessions, it’s a signal we don’t have the right balance. One way or another, we must learn to let go, downscale, or lower our standards just enough so we can manage to enjoy ourselves.

Alexandra Stoddard, “The Art of the Possible”

I also treasure this statement: “If our pleasure feels particularly deep, it is a sign that we are nourishing our soul” (Thomas Moore, “Care of the Soul”). That kind of DEEP PLEASURE, a serene soul pleasure, is a good guide as to which things are worth holding on to for a while — and then, when the time comes to let them go, to let them go.

PARTING WORDS; HOW TO SUBSCRIBE
TO LIFE EXTENSION MAGAZINE

Though writing CyberHealth has been a pleasure, it’s been a lot of work also. If not for letters from you, I wouldn’t have had the spirit to continue for almost two years. We started with 60 suscribers; now the list is around 600. It warms my heart to think that CyberHealth has been a friendly, supportive presence for so many.

Remember, you can always look up past CyberHealth issues on Dr. Miller’s website, <antiaging.com>

Lynne writes:

Dear Ivy,

The impact you and CYBERHEALTH have had on my life and those around me cannot be measured. I am fortunate to live in a metropolitan area and have wonderful medical insurance but I never got the information from any of the doctors that I have gotten from you. Your research has radically improved my health and those around me. My husband credits you with saving his life when the best doctors in New York were shaking their heads not knowing what to do with his heart disease and Lyme infection. He has gone from an invalid to a spring chicken!

One of your great strengths is raising questions about the prevailing myths of our time regarding hormones. As a breast cancer survivor, this has been particularly helpful to me. You have never once steered me wrong. If you say something is true, the medical literature is there to support it!

I hope Life Extension Magazine realizes what an asset you are, how you can bring together all your resources and create a dynamic, groundbreaking article for their publication. Their gain is our loss. I hope there is some chance that CYBERHEALTH is not over, that you will bring out bulletins occasionally. Thank you for everything, your skill, your tireless energy and the wisdom with which you make poetry of medical facts.

Monica Smith

Ivy replies:

Thank you, Lynne, for this wonderful letter. I am so glad I’ve been able to produce CyberHealth. I don’t yet know about special bulletins. But you will be able to find my reviews of alternative health books and articles on various topics in Life Extension Magazine. You don’t have to become a Life Extension Foundation member to subscribe. Simply call 800-544-4440, and explain that you want only the subscription, at the special introductory rate.

Before you do that, you might want to check out the Life Extension Foundation website: www.lef.org. I realize that many criticisms have been levied at this organization, and I readily admit that some of these are quite justified. But nobody is perfect. For all its problems, Life Extension Foundation is still a very good source of anti-aging information, at least in the field of supplements. And it does sell some products, such as gamma-tocopherol or CoQ10 combined with tocotrienols, that to my knowledge can’t be obtained anywhere else. Anyone seriously interested in escaping the horrible ravages of aging such as Alzheimer’s disease should become acquainted with what Life Extension Foundation has to offer.

One thing I know I will dearly miss when my health writing becomes limited to articles for LEMagazine is the personal tone I often like to use when talking to my readers, trying to convey my sense of empathy, supportiveness and caring. Being able to inject humor and sundry observations about life in general has also been precious. Ah, nothing like being your own boss as a writer! But life urges me to move on.

My main goal in starting CyberHealth was to empower women with knowledge. Years ago I read the statement, “Knowledge commands respect,” and it etched itself on my mind forever. I saw the futility of complaining about “getting no respect,” and in a flash I also saw the solution. Once your knowledge is deep enough, it simply cannot be dismissed.

How do you attain such knowledge? Well, first let me share a joke. Two Texans in New York stop an old Hassid and ask him, “How do you get to Carnegie Hall?” He replies, “Practice.” It’s the same with acquiring knowledge. You read one book, then another book. Then maybe an article in a specialized journal. Little by little, you progress. It takes time and effort, but it’s an adventure also. Getting deep into anything leads you into all kinds of unexpected terrain, into insights you never dreamed about.

It works most of the time! Occasionally you meet a person who feels threatened when it becomes obvious that you truly know something of his/her field of supposedly impenetrable expertise, but that’s simply not the person you really want to deal with. That’s likely to be a know-nothing or know-little bully, with no love for his field and no dedication. Seek whoever is smart enough, dedicated enough, and secure enough to appreciate your knowledge. This applies especially to MD’s.

Judge Judy has come up with the acronym DNA: Do Not Abdicate. Do not abdicate your active partnership in matters concerning your health, or any vital matters. Do not be a doormat, letting an “expert” dictate to you, or a bully intimidate you into doing something contrary to your spirit. It is your body, it is your life, and you are the boss. Before any intimidating encounter (and even some medical receptionists have mastered the art of intimidation), repeat to yourself as many times as it takes to feel confident: “I am the boss.” Repeat it hundreds of times, if need be. Another helpful motto is, “I pay, I demand.” You have the right to receive the best. And the best will come to you when you fully accept that it is your right.

Jane Austen has a marvelous passage in which a male character tries to point out to the heroine how helpless women are. The heroine replies, “But do not underestimate the power of refusal.”

If all else fails, you can always say something along the lines, “Thank you for your time, but I am not going to take Provera. I will take only natural progesterone. If you do not wish to prescribe it for me, I will go to another doctor.” Say it quietly, politely, but with unshakable conviction, empowered with your knowledge and your spirit of being in charge of your own life and health. Do not slam the door. Anger is the emotion of a victim. Transcend it. Have a referral list from WIP or College Pharmacy handy, so you know where to turn. Knowledge really is power. So is networking.

And here I want to acknowledge Monica Smith as a terrific inspiration. I have no end of admiration for her assertiveness around MD’s, and in general. She had the courage to refuse radiation therapy and chemotherapy, and seek an alternative treatment. Then she organized a newslist for other brave souls who did not wish to damage their immune system and risk secondary cancers due to the current barbarous and carcinogenic treatments.

Have no fear: if communism fell, so will other oppressive institutions, including obsolete oppressive medicine (as one WONDERFUL innovative physician said, “Medicine is a paramilitary organization”) — if people refuse to be intimidated, and educate themselves instead. And if they network, exchanging information and giving each other emotional support.

My “last CyberHealth words” are: read, read, read, network, and spread the light.

As always, health and joy to you, Ivy

The information contained herein is not intended as medical advice.

23 April – May 1999

LAST ISSUE

Cyberhealth Archives are Available

IS CYCLIC HRT MORE “NATURAL”? NOT ACCORDING TO DR. DAWN WILLIS

A WHIRLWIND TOUR OF ALL THE THINGS I WANTED TO WRITE ABOUT, BUT HAVE RUN OUT OF TIME

HIGH BIRTH WEIGHT — BAD NEWS FOR THE CHILD AND THE MOTHER

MISCELLANEOUS HRT INFOBYTES

GALACTOSE AND PREMATURE OVARIAN SENESCENCE

CAN GINKGO EXTEND LIFE SPAN?

PREVENTING ALZHEIMER’S — FISH, TEA, ANTIOXIDANTS, ESTROGENS, ADVIL, AND MORE

SUGAR, LACTOSE, AND HEART DISEASE

CAN HORMONES BE CLASSIFIED AS CARCINOGENS?

CREDIT WHERE CREDIT IS DUE

THE RAVAGES OF FAT DEFICIENCY:

A BIT MORE OF THE WHIRLWIND TOUR

ORAL CONTRACEPTIVES INCREASE BONE DENSITY

HOW PROGESTERONE PROTECTS AGAINST ATHEROSCLEROSIS

ESTROGEN/ANDROGEN RATIO FOR GOOD BONE DENSITY

HORMONE COMBINATION: IS THERE A GENERAL FORMULA?

ATTITUDE IS #1: MENTAL STATE CAN AFFECT THE ACTION OF NUTRIENTS AND DRUGS

* * *CARE OF THE SOUL * *

PARTING WORDS; HOW TO SUBSCRIBE TO LIFE EXTENSION MAGAZINE

IS CYCLIC HRT MORE “NATURAL”?
NOT ACCORDING TO DR. DAWN WILLIS

A WHIRLWIND TOUR OF ALL THE THINGS I WANTED TO WRITE ABOUT,
BUT HAVE RUN OUT OF TIME

PREVENTING ALZHEIMER’S —
FISH, TEA, ANTIOXIDANTS, ESTROGENS, ADVIL, AND MORE

ATTITUDE IS #1: MENTAL STATE CAN
AFFECT THE ACTION OF NUTRIENTS AND DRUGS

* * CARE OF THE SOUL *

PARTING WORDS; HOW TO SUBSCRIBE
TO LIFE EXTENSION MAGAZINE