Naturopathic Medicine/CAM
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Dr Labriola
Many women have turned to natural forms of hormone replacement for menopause since learning that conventional hormone replacement therapy (HRT) may increase their risks of breast cancer and other health problems. Most women have assumed that “natural” or “bio-identical” HRT is safer than conventional HRT. However, recent research has shown that this is not the case, and that – in fact – the risks are probably similar.
Bio-Identical Hormone Replacement Therapy
Bio-identical HRT refers to products that are derivatives of plant extracts and are modified to be chemically similar to hormones naturally produced in the body. They are often compounded into custom formulations that combine the three major types of estrogen – estriol, estradiol and estrone – in varying proportions. These preparations are marketed under a number of trade names including Bi-Est and Tri-Est.
Other bio-identical HRT products have names without estrogen-like words in the title, yet they still contain estrogen. Additionally, some natural hormone replacement therapies include a “bio-identical” form of progesterone called “oral micronized progesterone,” or OMP. Women who have not had a hysterectomy are frequently advised to take progesterone along with estrogen.
None of these bio-identical preparations has been well-studied for safety and efficacy, but they are promoted as safe and effective in the popular media.
Phytoestrogens
Plant hormones, known as phytoestrogens, are also commonly recommended to help women with menopausal symptoms. Phytoestrogens come from plants with naturally occurring estrogen-like chemicals. Soy is a common source, along with several herbs such as black cohosh and Dong Quai (see list of herbs below). Generally phytoestrogens are not as strong as conventional or “bio-identical” HRT, but they do act like estrogens in the body.
What are the Risks?
A large national research study, known as the Women’s Health Initiative, showed that women who took conventional HRT had a higher risk of breast cancer, blood clots and stroke. Estrogen use was also found to increase the risk of gallbladder disease. Women in this study used the HRT products Premarin or PremPro.
The hope among experts was that “bio-identical” hormones would be safer than conventional HRT because they are purported to be more similar to the hormones naturally produced by a woman’s body. Unfortunately, there is little reason to believe this is true. In fact, a recent clinical trial published in Sweden in early 2008 demonstrated a higher risk of breast-cancer recurrence in patients using “bio-identical” estrogen compared with women who did not use estrogen.
For women who have had breast or ovarian cancer, or who are at high risk for those cancers, any type of estrogen – whether pharmaceutical or plant-based – is risky. The risks are apparently less for women who have not had a hormone-driven cancer or who have other risk factors. However, even those at decreased risk use should use the lowest possible dose for the shortest duration and under the guidance of a doctor. Because there is very little research about bio-identical HRT, erring on the side of safety is the best practice at this time.
Fortunately, there are other natural remedies and strategies that can help relieve menopausal symptoms without adding estrogen or increasing the risk for cancer and heart disease. For more information contact your doctor or Naturopathic Services Program.
What Does the Human-Safety Evidence Say?
Clinical trials and data from the National Cancer Institute, the Women’s Health Initiative and others have shown that using HRT increases risks for breast, uterine and other cancers, cardiovascular disease and other health problems
• There is no human evidence that clearly demonstrates a safety advantage for using “bio-identical” HRT such as estradiol only
• In the Women’s Health Initiative study, progesterone actually increased cancer risk in some cases.
• A British study of the effect of soy supplementation showed that this phytoestrogen stimulated breast tissue in a way that was similar to pharmaceutical estrogen, thus potentially increasing cancer risk.
Summary
• Current evidence suggests that addition of any HRT has the possibility for increasing the risk for some cancers, cardiovascular disease and other problems.
• With the exception of women with estrogen positive cancers and those at increased risk for breast or other estrogen related cancers, short-term use may be less risky but should be administered carefully and under the guidance of a knowledgeable doctor.
• Until better clinical data is available, we advise women to err on the side of safety and avoid all forms of HRT including the “natural” products.
• Clinical decisions need to be made on a knowledgeable, individual patient basis.
Our Clinic Policy
Rather than use HRT, women with menopausal symptoms are treated with a combination of non-estrogenic therapies and strategies customized for each patient.
-Dan Labriola, N.D.
-Kathleen Pratt, N.D.
-Patrick Bufi, N.D.
Commonly Used Estrogenic Plants and Herbs
Black Cohosh (sold as Remifemin)
Angelic species including Dong Quai
Leonurus species including Mothers Wort
Fo Ti Tieng
Physostigma species (calabar bean)
Saccharomyces species
Dioscorea (yam extract)
Agave species (sisal)
Salvia species (sage)
Soy (including tofu, miso etc.) and soy derivatives including isoflavones genistein and dadzein
Lignans, especially from highly processed flax seeds
Red clover
Sesame
Fennel
Fusarium
Alfalfa
Hops
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Thank you so much for this article. I will discontinue my use of Black Cohosh immediately. What an incredible source of information this site is. Foxy
foxy
OK nobody seems to be bringing this up for some reason, but what is to be made of all of the recent news about vitamin D? I’ve not heard even 1 negative nor even a single neutral study regarding this vitamin, it been all good news.
And I would have to say that the recent news about this supplement is a much different from all of the other studies we’ve seen about magical mushrooms and herbal compounds killing cancer in petri dishes.
We are talking about a lot of major medical US Universities conducting this research about this vitamin.
Especially enouraging is that this is a really cheap vitamin, and naturally can be made by our own bodies, so really there can be no conflict of interest in these studies - nobody is going to make any money from their results.
I’ve also read that the AMA is asking the FDA to reconsider the RDA of vitamin D in light of all of the recent postiive studies so it seems that even the AMA is buying into it at least a little.
So this leads me to wonder, will the measurement of the blood levels of this vitamin, and vitamin D supplementation become standard practice soon?
At the very least, adequate levels will help ensure that we all have strong bones, which will help us all as we grow older. So just for this reason alone I would think that testing blood levels of this vitamin should become standard practice soon.
I realize it’s not an immediate cancer or heart disease cure, but even if there is only a very tiny edge against these terrible ailments by using vitamin D supplementation, we could be talking about saving thousands of lives in the US each year due to the toll these take terrible diseases take on us annually.
What’s the Good Doctor’s take from these studies? Are any colleagues testing blood levels or recommending some minimal vitamin D supplementation to patients yet? Or what is it going to take to change practice - is promoting strong bones enough?
Jim
dadawg001
Here’s an example of a recent study in which a vitamin D supplement that we thought would potentially help cancer patients actually led to a higher rate of death:
http://cancergrace.org/general/2007/11/06/ascent-2-closed-in-pca/
To me, this shows that we don’t know as much as we think we do, and that it’s probably not a good idea for oncologists and maybe anybody to presume that a vitamin, even with good background evidence, is going to help. I don’t think we’re at a point right now where we can or should be making a recommendation about vitamin D supplements or levels.
-Dr. West
Ah, I missed that post somehow. Thanks for the update.
It looks like there are 50+ clincal trials going on for Cholecalciferol for various diseases including a few for various cancers, with 23 studies going into phase 3 and 4 trials (though none relating to cancer yet.)
On a postive note, if there is any benefit to vitamin D, at least we don’t have to wait patiently for someone to decide to conduct the studies like we do with other agents.
We should know a little more in a couple of years.
Jim
dadawg001
Hello to all,
Hope your July 4th was as sunny as mine. Speaking of sun…
Vitamin D is certainly big on the radar now days. Back in my 1971 pre-med college days vitamin talk would often come up especially the fat soluble A, D, E, and K. No real human studies from actual medical journals but many articles found in science, research, experimental, and veterinary journals and magazines. Since Vitamin D is fat soluble mega-dosing will cause excess to be stored in the liver just like any fat. Now back to present day 2008…research trials using very high dose vitamin D with certain types of chemotherapy have shown some disturbing results. Possibilities exist that high dose vitamin D increased pathway activities for liver detoxification. This mega-dosing of vitamin D may have caused an unwanted and unfortunate increase in the degradation and elimination of the chemo drug. I do not really know, yet as I have mentioned before in past posting, “We certainly are a country of more when less may actually be beneficial.” Too much may also cause hypervitaminosis D and increased serum calcium (hypercalcemia).
Studies using lower dose vitamin D may show to be more useful. Recent studies have included anything from the vitamin being used as some sort of physical fitness marker for lung cancer survival to survival and prognosis of colorectal cancer. Even as an assessment in women with gynecologic or breast malignancies.
My associates and I have do some random and routine testing for vitamin D levels and I have not been surprised at the low levels found in both women and men. The measurement of the blood levels of vitamin D may become a standard sooner than later. It is important to note that there are various test as well, some to check level of serum vitamin D and some to check actual vitamin D activity.
Vitamin D is actually a steroid hormone precursor. A hormone is a substance that is produced in one part of the body with action in another part of the body. A precursor in an inactive molecule that must be activated for meaningful use. In the case of Vitamin D, it is stored mainly in the skin as a precursor. Sunshine, mainly ultraviolet B rays, will activate the inactive precursor stored in the skin. Protective clothing and sunscreens can reduce vitamin D production and research has shown that wearing sunscreen continuously can reduce the amount of active vitamin D a person is able to generate. If sun exposure is limited because of northern latitudes vitamin D levels can be significantly reduced. On a cloudy day expect at least a 50% reduction of necessary UV rays essential to form Vitamin D. For example, the city of Seattle gets an average of 58 sunny days per year with about 226 cloudy days. Also, excessive exposure to sunlight does not lead to overproduction of vitamin D. So most people do need the sunshine in order to avoid deficiency. Maybe that is why so many popular songs sing about it!
More later,
Dr. Patrick Bufi
With associates…
Dr. Dan Labriola and Dr. Kathleen Pratt.
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