IS LOW-DOSE TRI-EST SUFFICIENT PROTECTION FOR HEART AND BONE?

Caroline writes,

“I visited the gyn in November, and I got my blood test results back. LOW estradiol, 33pg/ml – not surprising, I suppose on the 2.5mg of Tri-Est. I agree with you that 2.5 mg Tri-Est is probably too weak (by the way, my Gyn wants to raise the estradiol in my Tri-Est)

Ivy comments:

No, not surprising, and mere 33 pg of E2 is widely regarded as not enough to provide cardiovascular protection, and probably not enough for bone protection either. Anything under 50 is classified as deficiency levels. This may be OK if the woman is on the chubby side and/or takes sufficient DHEA (see the article that follows). If the woman is slender, I’d be immediately alarmed about what these low levels might mean for her bones. Brain function suffers also. I noticed a tremendous difference in mood and memory when my estradiol finally went above 100 pg/ml! Other women have also reported a huge difference between being on 1 mg estradiol versus 2 mg estradiol.

Yet another area of dramatic difference is the “aches and pains.” Estradiol is strongly anti-inflammatory, but it’s the higher dose that makes a wonderful difference.

Please remember: the European dosage starts at 2 mg. That’s considered the lowest effective dose. True, in tri-est we also have estrone and estriol, so 1.5 mg estradiol/day may work out fine for some women, given the help of the weaker estrogens in the cream or capsule, and whatever estrone they themselves produce. Experiment, experiment, experiment. Experiment safely, that is, by increasing your progesterone as you gradually increase estradiol.

Someone once asked me about “dangerous” levels of estradiol. During pregnancy, estradiol rises up to 25,000 pg/ml at near-term. Of course the levels of progesterone are sky-high also.

I just don’t see any virtue in the minimalist position. We should try for OPTIMAL levels, optimally balanced. These will probably differ from woman to woman, so there is no substitute for individual custom-tailoring of nhrt.

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Gail comments:

Suzanne S is taking 2mg Estrace, plus P and testosterone, and having good results in eliminating “fibromyalgia” symptoms.

Ivy replies:

Even less E2, plus P and testosterone, has eliminated my carpal tunnel, and has done wonders for my post-traumatic arthritis.

Gail comments further on estradiol levels:

I have read about one cause of bad symptoms in peri being a big peak in estradiol at midcycle as the ovary overreacts . . . I think what I saw said that bad PMS symptoms beginning at midcycle rather than closer to the period may be due to spiking estrogen.

Also, there have been several people on the menopause list recently who have had bad symptoms associated with higher levels of estrogen, even though they apparently had plenty of P to oppose. You do say that individuals must experiment to find out what works for them, of course.

Ivy replies:

I wonder if these women on the menopause list really had enough progesterone, or only thought so. I’ve had endless correspondence with women whose idea of maximum allowable dose of progesterone was 200 mg oral micronized P per day—then they wondered about their breakthrough bleeding and/or sore breasts. Typically simply switching to the 10% cream improves the response—not only because the cream appears to be more potent, but also because women discover its wonderful properties as a cosmetic, so they tend to use a tad more, I suspect. And it feels so luxurious! When you look at studies, serum P levels of women on replacement natural P are typically very low compared to the luteal peak. I thought I was using so much P I’d test at first-trimester levels. It was really sobering to see my results: barely 3 nanograms, about 4 hours after applying the cream (in a “generous” manner, I might add).

As for the “spiking” of estradiol: premenopausal women seem to feel best when their estradiol is RISING; many are positively radiant close to ovulation. What follows ovulation, however, is an immediate DROP in estradiol; if this swing is large enough, there may be a depressive effect.

Gail comments on the “minimalist” approach:

A minimalist approach may work fine for some people. I think you need to keep your mind open to the idea of lower doses for SOME, probably those of us most worried about breast cancer.

Ivy replies:

Thank you, Gail, for reminding me of my principle of “whatever works for you.” While my intuition remains that the minimalist approach is not the best, I can see that chubby women, for instance, might feel fine on a low dose.

As for the breast cancer concern, I still feel that the daily dosage of P is critical here. In birth control pills, we have both very high estrogen dose and extremely high progestin to balance that—and the pill is known to help prevent endometriosis, fibroids, and fibrocystic breasts in spite of its estrogenic content, and most likely thanks to its high progestin content (which also gives many users nasty side effects). But yes, I stand by “whatever works for you.”

HOW DHEA PROTECTS YOUR BONES

One of the physiological puzzles of aging is the fact that bone mass typically starts declining once a woman is past 35 — not as fast as after menopause, but why should it decline at all, given the still-adequate estrogen levels? The age-related loss of DHEA may be a big part of the answer.

It has been shown (Nawata and Tanaka, 1995) that the bone tissue converts DHEA to estrone. Estrone, then, stimulates the osteoblasts to build new bone. Thus DHEA acts basically as a precursor hormone.

However, this is not the end of the story. DHEA protects the bone also by decreasing the levels of inflammatory cytokines (special chemicals produced by the immune system). Cytokines such as interleukin 1, interleukin 6, and tumor necrosis factor tend to activate the enzyme collagenase, which breaks down bone. For reasons we don’t fully understand, the levels these inflammatory bone-destroying cytokines increase with age. DHEA reduces their levels to the normal, youthful state.

Thus it is not surprising that both Dr. Alan Gaby (“Preventing and Reversing Osteoporosis”, Prima, 1994) and Dr. William Regelson (“The Superhormone Promise”, Simon and Schuster, 1996) feel DHEA is of great importance in the prevention of osteoporosis, and quote studies that support this conclusion. Already animal and human studies have shown that DHEA can significantly increase bone density (this is summarized in Regelson’s book).

Does it mean that it would be fine for a woman to take nothing but DHEA as her sole hormone replacement? I don’t think so. True, sufficient DHEA might be enough to protect her bones, but as many women have discovered to their sorrow, DHEA can be quite androgenic. Facial hair and acne are common side effects. Without sufficient estrogens to balance the androgenic effects, the sudden doubling your serum testosterone (which is one thing that happens when a woman starts taking DHEA) can be felt in disconcerting ways, to put it mildly.

It seems plain that in a woman DHEA is meant to work in an estrogenic milieu. Hormones work best in a youthful hormonal environment, with the whole range of hormones interacting. I think Regelson is right in his philosophy of trying to restore the youthful hormonal state through multi-hormone replacement.

Just how do we orchestrate such a multi-hormone approach? We seem to be learning the hard way, through clinical trial-and-error. Nevertheless, there is one effective reply to those who nag that we don’t know the long-term effects of replacing hormones such as DHEA: we know very well what happens if you do nothing.

(Main source: “DHEA and Osteoporosis.” Life Extension Foundation Magazine, August 1996, 17-18, 10 references)

Gail comments:

Don’t you think that estrogen levels after 35 are not necessarily adequate at all? I wonder about the effect of xenoestrogens causing estrogen decline. Dr. Vliet and others clear feel that estrogen decline is a major problem in peri women, maybe beginning in the 30s for some women.

Ivy replies:

There are contradictory claims as to the age-related decline in estrogens. As FSH rises, the ovaries may respond with higher levels of estradiol production than at a younger age—hence also early ovulation and shorter cycles frequently seen in older premenopausal women.

Some women may become hypoestrogenic, others may overproduce; in any case, there is typically an imbalance in the ratio of estrogens to progesterone and androgens (DHEA and testosterone go downhill fast—no controversy about that). Hence the need for hormonal testing of premenopausal women, now still an exception. Doctors typically don’t even know on which days of the cycle it’s appropriate to check for estradiol and progesterone. Almost 70 years after the discovery of the sex hormones, we still don’t seem to to have mastered even the ABCs, or done the necessary basic research.

It’s possible that xenoestrogens (certain pesticides, plastics etc with estrogenic activity) interfere with the estrogen receptors.

Regardless of individual estrogen levels, DHEA seems to have a role in protecting bones—that’s the main point of the article. Specifically, the role of STRESS in bone loss has been largely disregarded—and DHEA protects against the bone-destroying effects of stress hormones and inflammatory cytokines.

I hope everyone also remember the article on the decline of DHEA as a possible contributing cause to the rise in FSH and hence the onset of menopause.

Gail comments on the multi-hormone approach:

I do think multi-hormone replacement is the wave of the future!! Tailored individually and adjusted over time to provide optimal benefits with minimal risks.

Ivy: Amen to that. Women should be tested long before menopause, so that with correct natural replacement hormonal balance can be maintained and problems such as bone loss, fibroids, fibrocystic breast disease, PMS, heavy periods and the like miseries can be prevented. Since we know that these are hormonal disorders, treating them with painkillers and Prozac seems rather besides the point.

Miranda writes,

“Yet another licorice story: after feeling like I was coming down with a bug and trying to fend it off for a week or two, I felt pain in my right breast and found to my horror that the CYST FROM HELL was on its way back. Aha! I said. There must be licorice in my life somewhere… and sure enough. I had been taking some innocent zinc lozenges from the natural foods store, and they contain a tiny amount of licorice root.

The stuff is powerful, all right. It makes me crazy when women on the Menopaus List recommend it to each other.

A fast question: can your brain be short on estradiol if your breasts clearly have too much (fibrocystic b.d.)? No fair! Actually, I don’t think I am brain-short, but so many women complain about “brain fog” and memory problems on the meno-list that I am beginning to feel left out. Do I have to choose between air in my head and lumps in my breast?

Ivy replies:

Let me give you a quick answer of what finally worked for me and eliminated cysts: keeping 3-E at the lowest dose (I’ve tried both oral 3-E and cream, and decided on the cream) to prevent hot flashes while taking 200-300 mg P (initially the oral P—sublingual worked much better—then switched to 10% P cream). It took 3-4 months (I didn’t keep exact track back then in 1994, but it was in that ballpark—a remarkably quick healing). The next ultrasound showed normal breast tissue.

But my brain wasn’t working too well. In fact, it felt as though I lost half of my IQ, and my sleep wasn’t as refreshing. I needed to increase my dosage of estrogens.

Here is one of my greatest health discoveries, which really is the #1 statement that I hope my book “Hormone Without Fear” gets across loud and clear: it’s safe to take higher doses of Es as long as the dose of P goes up correspondingly. If I take enough P, I never have tight, sore breasts. I had to experiment to find the dosages of each that work for me.

Since E2 (estradiol) is wonderful for mental sharpness, energy, and good cheer (as women so well know when they remember how they felt around ovulation), I am not willing to live without it. Since I too dread breast cancer as any woman does, I protect myself with a generous daily dose of progesterone.

There are days when I feel I need lots of E+P to cope with stress or heavy physical effort (which lowers hormone levels something fierce due to fast metabolism). I may take up to 4 mg E2 (between my triestrogen cream and sublingual Estrace) and 500-600 mg P (cream mostly, sometimes 200 mg sublingual).

Anyway, with heavy exercise, for instance while hiking in the Sierras, I can take double my usual E2 and it doesn’t seem to affect my breasts. Apparently the increased metabolism results in speedy clearance.

But if I go on automatic and try to sustain the vacation dose while sedentary back home, my breasts will let me know. So down goes E2 and up goes P. It’s all in the ratio.

In other words, you don’t have to choose. You need to experiment with the E/P ratio that’s best for you. It’s just that at first yes, I feel it’s best to choose breasts over brain for a few months, UNLESS you are willing to take a lot of P right away, rather than gradually ease into higher doses. I do have a friend who went to 600-800 right away, and felt great—for the first time in her life.

Get thee to a WIP-referred doctor! Why suffer from P deficiency?

You need the prescription stuff—so much more economical and effective (cream and sublingual forms are best; refuse oral capsules).

Iodine also helps—eat kelp!

Speaking of iodine, I am immediately reminded of the thyroid hormones. In my observation, women with fibrocystic breasts tend to be stressed-out, sedentary, and low on thyroid. They are often the one-child-late-in-life or childless professional women, working under the pressure of deadlines, often dealing with relationship-related stress on top of everything else.

As for GLA, it has been reported to help, though it didn’t seem to do too much for me back then. I’d suggest a GLA/EPA combination for a strong anti-inflammatory effect. The most powerful products are MegaEPA (400 mg EPA, 300 mg DHA per capsule) and MegaGLA (320 mg per capsule). Both are available from Life Extension Foundation, 800-544-4440.

Avoiding dairy has been recommended. Since perimenopause and menopause are periods of galloping bone loss, I am not happy with that recommendation.

Dietary calcium is vastly superior to supplements (we’ll have an article on this in the future). I do agree that cow milk is problematic. Hence my newest solution is GOAT MILK. It’s fabulous, and so soothing and easy to digest! No wonder it used to be given to infants. It is in fact more similar to human milk than cow milk is. Goat cheese—well, a salad without feta is like a day without sunshine. Yogurt (with no added fruit) is another healthy way to enrich your diet with calcium. Being politically incorrect, I also recommend eating eggs: grandmother was right as usual, and eggs remain nature’s most perfect food (not to mention making your hair grow like crazy).

There is no need to skimp on the supernutritious foods like yogurt, goat milk, and eggs out of fear that they will raise your estrogen levels. THE POINT IS NOT TO LIVE IN A HYPOESTROGENIC STATE, BUT TO OVERCOME PROGESTERONE DEFICIENCY. Then you can eat whatever your body guides you to. Sure, lowering your fat intake will lower hormone production. Celibacy can do it just as effectively, perhaps even more so—yet sexually active women, whose average estradiol levels may be as much as twice those of celibate women of the same age, have a significantly lower risk of breast cancer compared to that of celibate women.

Are lower levels of beneficial steroids what a woman needs at this time of life? No, she needs BALANCED HORMONES, estrogens correctly opposed with progesterone and androgens, not lower levels. She needs to maintain her bone mass, clean arteries, and sharp brain. This can be done safely.

And she needs to eat plenty of HEALTHY FAT. I can’t recommend extra virgin olive oil highly enough. It is known that women consuming more olive oil and fish oil have a lower breast cancer risk—see the section on the Cretan diet in the Fats Without Fear article (CH 3; if you don’t have it, let me know).

Can we talk? When your skin and hair start looking great because of higher intake of healthy fats, it is a sign of health. Don’t let any “expert” try to brainwash you into a really low-fat, strictly vegetarian diet for the sake of relief from fibrocystic breast disease.

Again and again, you need progesterone—and health-sustaining levels of all the other steroids.

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Lynne comments:

Flax oil caps (8 a day) eliminated my severe menstrual cramps after one month. I don’t think one need take that much. I was using it for anti-cancer properties (taking it with yogurt).

Ivy replies:

Flax oil in any form never did a thing for me. Fish oil has worked wonders in terms of being anti-inflammatory. Just shows that some people can convert flax oil to the needed EPA much better than others. Dr. Sears comments on the superiority of fish oil in some detail. But if flax oil works for you, great.

Gail comments:

Be cautious about how you promote large doses of progesterone, keeping in mind that women are so variable in their responses to any given hormone or hormone combo that it’s hard to predict what will be best for an individual.

Ivy:

Thanks for the reminder. I’ve known only one woman who’s had a negative response to P; for me and many others it’s been such a miracle that we only wish we’d had access to it long ago, even beginning in our teens (I had deficiency symptoms starting at 16; a doctor I interviewed once stated that some women never produce enough progesterone; it might even run in the family).

I personally can take as much as 1 g of P a day, and feel great, even euphoric. I know I am not an exception. On the other hand, give me the tiniest bit of Provera, and my body freaks out with multiple side effects.

Another way of preserving breast health is breast massage. The practice was introduced by the Taoist healers centuries ago; recently, there has been an upsurge in so-called lymphatic breast massage in the West. One of its proponents is Dr. David Williams, who publishes a health newsletter called Alternatives. Dr. Williams believes that the release of oxytocin during partner-assisted breast stimulation (pardon the phrase) may be an important reason for the lower breast cancer risk seen in sexually active women.

Fortunately, a woman doesn’t have to rely on a partner to obtain the benefits of breast massage. It is quite easy to perform.

The Taoist breast massage is simplicity itself:

The Taoist healers recommend doing 36 times circles. I don’t know the mystical significance of this, but it seems like a nice number, female and earthy. You can think of it nine months of pregnancy (nothing is as protective against breast cancer as pregnancy) multiplied by the four seasons, or four directions.

This type of outward motion is called “dispersal.” Think of the lymph carrying away waste products away from the breasts.

Some women like to use liquid Vitamin E, evening primrose oil, or progesterone cream as part of the Taoist breast massage.

Dr. Williams recommends yet another form of lymphatic breast massage. Here are the directions:

Lymphatic circulation is also stimulated every time you exercise. It is obstructed by tight bras. I think we should not only march topless on Washington, but should also make a huge bonfire and burn all tight bras.

Some women say that they can’t practice breast massage because their breasts feel too sore. That’s a sign of progesterone deficiency. Get some progesterone into your system. If you are postmenopausal and using nhrt, the continuous regimen seems to afford best protection against breast cancer.

Above all, stay slender. Sounds difficult? Not at all, if you understand the principle of low-glycemic diet as outlined in Barry Sears’s “Zone.” Essentially, you substitute veggies and salads for most of your potatoes and grains (bread, white rice), and you eat enough healthy fat (olive oil, avocadoes, fish oil). This kind of diet keeps insulin low, and insulin is a potent growth factor for tumors.

Breast massage, exercise, correct nhrt, and a low-glycemic diet: these are some of the chief prevention measures. Add to it immune-strengthening POSITIVE EMOTIONS, and you should live your “second fifty years” in near-perfect health.

I’ve received an interesting tip on cold prevention from a CH reader:

Whenever he feels a cold coming, he DOUBLES HIS DOSE OF VITAMIN E from 400 to 800 mgs. He says he now gets only one third the colds he used to get before he discovered the immune-strengthening property of Vitamin E.

Since other sources keep recommending extra Vitamin A, C, zinc, CoQ10, and NAC (the acetylated form of cysteine, an antioxidant aminoacid), perhaps the gist of it is: increase your intake of antioxidants. Lower the oxidative stress on your body.

I’ve made two anti-cold discoveries recently: shark-liver oil and Citridal (grapefruit extract) nasal spray.

SHARK-LIVER OIL contains squalene and alkylglycerols, two compounds known to stimulate the immune system. Alkylglycerols have a direct anti-viral effect, among their several interesting properties. Squalene acts as an antioxidant, disarming the hydroxyl radicals, superoxide radicals, and singlet oxygen.

The first time this year when I felt a cold coming, I started using shark-liver oil in the recommended “acute” dose (minimum 600mg of alkylglycerols). The cold never got a chance; two days later there was no trace of it. The second time, I was both under enormous stress and got more exposure to the bug; this time I did succumb in spite of shark oil, but the cold turned out to be surprisingly mild. And it didn’t morph into sinusitis, which then takes antibiotics, which lead to a candida yeast infection—some of you may know the miserable cycle. Not this time, and that dear ancient marine animal, the shark, famous for its immune system, probably deserves the credit.

The GRAPEFRUIT EXTRACT NASAL SPRAY (mine comes from Nutri-Biotic) is a joy to use, and cleans out nasal passages as no other spray I’ve ever tried, while delivering a potent natural antibiotic.

I’ve also found relief in ELDERBERRY LOZENGES. I don’t know if they do very much (elderberry bioflavonoids are supposed to inhibit the enzyme that allows viruses to penetrate cell membranes), but my throat loved them, and my tastebuds liked them too.

Finally, it is my intuition that CRANBERRIES, when prepared with a bit of fructose rather than sugar (sugar is immuno-suppressive), also provide cold-fighting bioflavonoids (as do blueberries and strawberries; berries are one of nature’s greatest gifts to our health). There are also dried cranberries in health-food stores—delicious!

RAISINS are another antioxidant miracle. Don’t overdo.

I’ve also discovered the joys of GOAT-MILK, which is supposed to provide various immune substances (being fairly close to human milk).

And again, POSITIVE EMOTIONS are probably the most powerful stimulant of the immune function available to us. According to an old European saying, “A woman in love doesn’t catch a cold.” Be always in love—not necessarily with a person, though that’s nice; be in love with your work, with books, with art, with ideas, with trees and birds, with the rain and the sun—with life itself.

I know many of you still simply cannot bring yourselves to believe that chocolate is chockful of powerful antioxidants and may be even more beneficial than red wine. I know: a lot of people still avoid eggs, salt, red meat, butter, cheese, and coffee, having been totally brainwashed into giving up some of nature’s greatest gifts. They won’t even touch the more nutritious chicken or turkey drumsticks (the muscle that works; dark fish are those that keep swimming) in favor of white meat. Then they wonder why they feel so chronically washed out. Well, that’s what happens to people who do not listen to their grandmothers.

More than half the fat in cocoa butter is STEARIC ACID, which does not raise cholesterol levels (neither does eating two eggs a day, for that matter). In fact, in two popular sources I’ve read that stearic acid (also found in lamb and venison) actually lowers cholesterol (alas, no references were provided).

But for those who remain unconvinced, there is a very low-fat chocolate solution: cocoa powder. You can use it to prepare hot chocolate or mocha. A marvelous way to start your day with first-rate polyphenols (remember that in the Lancet study, chocolate placed ahead of wine in preventing the oxidation of LDLs).

The Chinese and the Japanese get their most potent polyphenols from green tea; the French get theirs not just from red wine, but also from many forms of their excellent chocolate.

Let me remind you that polyphenols are more potent antioxidants than Vitamin C and Vitamin E.

It was a cold, stormy night before Thanksgiving, and deep November in my soul. Suddenly, like a miracle, the voice of Dr.Walter Willet came through, calmly stating that what matters is not how much fat you eat, but the kind of fat you eat. The worst kind is trans-fatty acids, abundant in margarine and commercial vegetable oils, and the partially hydrogenated oils used in baked goods and many other processed products.

“But studies showed that margarine was good for the heart,” a spokeswoman for the American Heart Association nervously protested. Dr.Willet smiled a beautiful wise man’s half-smile, and very calmly, very gently pointed out that as a matter of fact no studies ever showed that margarine was good for the heart. That was pure assumption. When studies began to be done, the opposite was found. Transfats damage blood vessels, among their many harmful effects.

“But studies showed that eating a lot of fat leads to cancer,” the AHA person continued, twitching and writhing. Dr. Willet’s voice grew even softer as he explained that on the contrary, no studies had ever shown any such effect (with some question mark about prostate cancer). “But fat makes you fat,” the AHA person kept trying, her mascara-laden eyelashes in a flutter of nervous blinking. Dr. Willet countered that people who lower their fat intake and substitute more carbohydrates are in much worse shape. “We are witnessing an explosion of obesity in this country,” he said, and went on to recommend higher consumption of olive oil.

He should have specified extra-virgin olive oil—that’s the UNREFINED kind shown to lower cholesterol. If olive oil is heated above 300 degrees F during the refining process (or during frying), its health benefits are lost. A reminder: buy olive oil in small containers and use it quickly. If you use it for frying, never use more than medium temperatures.

I wish Dr.Willet had mentioned the recent Kohlmeier study of European women: those with the highest levels of transfatty acids in their tissues had a 40% higher risk of breast cancer. It is estimated that American women consume twice the amount of transfatty acids than is typical for European women.

High consumption of olive oil, on the other hand, is associated with lower risk of breast cancer (Lancet, May 18, 1996, p.1351). Olive oil contains polyphenols and squalene, known to be potent antioxidants and anticarcinogens.

Though I was charmed by Dr.Willet’s intellectual poise, I couldn’t help wishing that someone would scream about such findings, and put the warning “Poison” signs over not just on packages of margarine but on most high-temperature-processed commercial vegetable oils and baked goods made with hydrogenated oils (hydrogenation creates transfatty acids). The findings are clear: transfatty acids are associated with atherosclerosis and cancer. These are “the fats that kill,” to use the phrase of Dr. Udo Erasmus.

I also wish Dr.Willet had mentioned something that a biochemist told me almost thirty years ago: the most dangerous fats are are those denatured by freezing or frying (french fries should make you think of chemotherapy).

Searing meat at high temperatures (those black grill marks on steak) also transforms the fat found in meat into toxic carcinogenic compounds.

In the end, Dr.Willet did not dare to be truly politically incorrect. You see, it’s not only that good fats such as olive oil lower the risk of breast cancer. One of the dangers of a truly low-fat diet (less than 15% of calories from fat) is that it actually slightly raises breast cancer risk.

The indirect cause here is that women who lower their fat intake tend to compensate by eating insulin-raising starchy carbohydrates—the very ones that the 1996 Lancet study found to be associated with increased risk.

As I’ve already mentioned, Dr. Willet was frank in warning that those who compensate for lower fat content by increasing their carbohydrate consumption end up in worse shape than before—in the literal sense as well, since they are more likely to become obese. The low-fat, high-carbohydrate diet, perfected for fattening farm animals, produces the same effect in humans.

Convinced by his own research and the results of other studies, Dr. Willet himself follows the Mediterranean diet. He goes so far as to suggest dipping bread in olive oil, as is the custom in Mediterranean countries.

As for the AHA diet, by now it is well known that it should be tossed in favor of the Mediterranean diet. In the Lyons Heart Diet Study of 605 cardiac patients who have already had one heart attack, there were 14 “major cardiac events” among the half on the olive-oil rich Mediterranean diet, and 59 major cardiac events among those on the low-fat AHA diet or doctor-modified AHA diet.

Speaking of tossing, the only place for margarine is in the carbage can.

And speaking of olive oil, in Greece the average per capita consumption is close to 40 pints a year.

Source on trans-fats and breast cancer:

Kohlmeier L et al. Adipose tissue trans fatty acids and breast cancer in the European community multicenter study on antioxidants, myocardial infarction, and breast cancer. Cancer Epidemiology, Biomarkers & Prevention 1997; 6: 705-710;

Ultra-low-fat diet slightly increases cancer risk: Hunter D et al. Cohort studies of fat intake and the risk of breast cancer. New England J Med 1995; 334 -39;

The Lyon Heart Study: De Lorgeril M et al. Effect of a mediterranean type of diet on the rate of cardiovascular complications in patients with coronary heart disease. J Am College Cardiol 1996; 28 (5): 1103-08)

REVISIONING EVE: 
KABBALAH’S REVOLUTIONARY 
INTERPRETATION OF THE GARDEN OF EDEN STORY

In his book “God, Sex, and Kabbalah,” Rabbi Allen S. Maller explains how the Kabbalah sees Eve not as morally inferior and the source of all evil, but, on the contrary, as “the mother of morality and civilization.” I am so thrilled with this interpretation that I would like to quote Rabbi Maller directly, rather than dilute his words with a paraphrase.

“It is important to recognize that the woman took the fruit not because she was curious like a baby, but because she desired to be wise. She wished to become like God. The fruit of the Tree of Good and Evil, moral knowledge, is the essential difference between man and the other animals. Animals cannot be held responsible in a moral sense for their actions. Animals have physical attributes, but they lack knowledge of morality. God has moral knowledge, but no physical attributes. Humans, alone in the world, are both like animals and like God. They are physical beings possessing moral knowledge.

Nevertheless, according to the story, when man consumed the fruit, it was not with the same motivation as the woman had. So man cannot receive the same credit for bringing mankind into the civilized state of law, social responsibility, and morality. Thus, the Torah teaches that woman has been the mother of morality and civilization. Children’s attachment to a parent they want to please is the ground without which the gradual switch from outside control to self control does not occur.

Psychiatrists now realize that it is nearly impossible to “give” someone a conscience in later life. During the first few years of life, babies learn to restrain their impulses through interaction with their mother’s reward and punishment reactions. All of societies’ later development depends on the mother’s teaching of good and evil during this formative period. Thus, it is truly through Havah, mother, that all the children of mankind learn morality.” pp. 88-89

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It’s really only common-sense, isn’t it? It sounds so obvious once someone dares to say it. Think how long women have been waiting for this kind of interpretation instead of the usual blame-the-woman attitude. They yearn to be acknowledged for their contributions to the building of civilization.

Women have indeed been an enormous civilizing force, a source of a gread deal of good rather than evil. But it still takes an exceptional man to acknowledge that.

Gail comments:

Yes, and I love it! I think women are responsible for the moral fiber of the nation, and that a lot of men are constnatly having to be reminded of right and wrong. Although, this suggests to me that their mothers didn’t do such a good job on them. . . . Hmmm.

Ivy:

Mothers are great, and they make civilization possible, but let’s not forget that “it takes a village.” Let’s acknowledge the civilizing contribution of mothers, but also let us wish that society at large does everything possible to reinforce those early moral teachings.

This newsletter is presented as a free service for women and healthcare professionals interested in women’s health. Publication schedule will be more or less weekly.

Editorial assistants: Gail Peterson, Monica Smith

The material contained herein is intended as information only, and not as medical advice.