Participants: Eric Shadle, Don Mackintosh
Series Code: HFAL
Program Code: HFAL000113
00:51 Hello and welcome to "Health for a Lifetime"
00:53 I'm your host Don Mackintosh 00:55 and today we're going to be talking about 00:56 women's health issues. 00:58 And so, if you're a lady or have friends that are ladies, 01:01 this is the time to tune in. 01:02 And today, joining us to talk about women's health issues 01:05 is Dr. Eric Shadle and we're happy that you're 01:09 with us today and we're glad that you can join us 01:12 to talk about women's health issues. 01:13 Now I understand you've been in practice for about 01:16 15-16 years. That's correct, yes. 01:19 In obstetrics and gynecology, so you see all kinds of 01:23 women's health issues. 01:25 What do people or what do women 01:27 perceive as their largest health concern 01:31 especially when they reach the age of menopause. 01:33 Well the #1 cause for concern that women have is cancer. 01:39 Actually, a study was done where they questioned menopausal 01:43 women and 40% were concerned about breast cancer, 01:48 and another 15% were concerned about other types of cancer 01:52 as the #1 cause of death in women - 01:56 at least that was their perception. 01:58 So breast cancer being the big concern? 02:01 Their biggest concern... Actually, they asked them 02:05 what do you think you will die from, 02:07 and 40% said breast cancer. 02:10 But actually, that's NOT the most important problem of 02:17 women's health, though breast cancer 02:19 is a very significant one. 02:21 Of cancers, of women's cancers, breast cancer is only 02:25 the second leading cause of death - second to lung cancer. 02:29 So smokers and lung cancer. That's right, that's right 02:32 Okay, so then what IS the leading cause of 02:36 problems in women; the leading cause of death 02:38 for people or ladies after menopause? 02:41 Well the leading cause of death is cardiovascular disease. 02:44 It's actually responsible for more deaths than 02:47 all other causes combined. 02:50 So it's the #1 killer, just like it is with men. 02:53 It's the #1 killer just like it is with men, that's right. 02:56 It's the biggest public health problem that we face 02:59 in this country is cardiovascular disease. 03:02 The incidence of heart attacks rise with age with both 03:07 men and women and 40% who have a heart attack, 03:12 the first symptom is sudden death... 03:15 so it is certainly a scary issue and problem, 03:22 but I find it very interesting that women are still more 03:26 afraid of breast cancer than they are 03:29 of cardiovascular disease. 03:31 They seem to just be able to live with that 03:32 because everybody has that problem but... 03:34 I think that's right - I think they just see that 03:37 cardiovascular disease is something that we just live with 03:40 in this society, but cancer, the word itself brings 03:46 certain emotions to bear, I think. 03:51 Back to this issue of cardiovascular disease; 03:53 however, you know, some people or ladies that I hear talking 03:57 say that they've gone on estrogen replacement therapy 04:00 so that they will decrease their risk of 04:03 cardiovascular disease or because, I guess, 04:06 their physician says... "That's changing now" 04:09 Is that something we should talk about? 04:12 Absolutely! You've brought up a very good question. 04:16 We should look at estrogen replacement therapy 04:20 and the traditional risk factors that are talked about 04:24 in the medical community. 04:28 And, let's just list those risk factors... 04:30 These are the traditional risk factors that physicians 04:33 use today to give estrogen replacement therapy, 04:37 and the first is a personal history - a history of 04:41 heart disease; and increasing age. 04:45 As we get older, we have more risk. 04:48 Estrogen deficiency. 04:50 Dyslipidemia which simply means lipid disorders, 04:54 high cholesterol - we could say. 04:57 There are additional risk factors such as: 04:59 diabetes, smoking, high blood pressure, 05:03 peripheral vascular disease - that would be like 05:06 atherosclerosis - hardening of the arteries. 05:10 Now what I find interesting about this list... 05:13 This is the list that is published in all of our journals 05:17 It would be a list that is in our textbooks... 05:20 I find it very interesting that there are no lifestyle issues 05:25 there other than smoking. 05:27 Smoking is the only one that's a lifestyle issue 05:29 that they talk about as a risk factor. 05:31 And when you say "lifestyle issue," you mean 05:33 something they could do something about. That's right 05:36 That the patient themselves, that the person would take 05:41 primary responsibility for their own health, 05:44 and I think the reason for that is that physicians today, 05:48 we are not trained to involve the patient themselves 05:52 in their own health and yet we all have, in our own power, 06:01 well the power to control our health. 06:04 To choose what is good to eat. 06:06 To choose to make the right choices. 06:08 In terms of lifestyle - so let's then talk more about that. 06:12 What kind of lifestyle things should we be doing, 06:17 or another way to put it is - 06:19 How does this relate to estrogens? 06:21 Can we eat foods that are high in estrogens? 06:23 Well, I do want to get to that 06:29 maybe a little later in the program, 06:31 but first of all, what we eat has the most important thing 06:36 to do with heart disease and that is our cholesterol. 06:40 We know that high cholesterol is one of the basic 06:44 foundation points for heart disease, 06:48 for cardiovascular disease, for hardening of the arteries. 06:51 And if you don't have a high cholesterol level, 06:53 you're not going to get hardening of the arteries, 06:56 and then you're not going to have a heart attack. 06:59 So you don't have to replace, supposedly, your estrogen... 07:01 You're really addressing a more fundamental issue. That's right 07:04 Is that what you're talking about? That's right 07:06 It's a much more fundamental issue. 07:08 Which I think - you talk about this or we've talked about this 07:11 is primary versus secondary prevention. Yes 07:15 And what do you mean exactly by that? 07:17 Well primary prevention of heart disease is someone 07:21 who has never had any known disease; 07:23 they've never had a heart attack and never had any symptoms, 07:26 and so you want to help that person prevent 07:30 heart disease from occurring... 07:32 Whereas secondary prevention of heart disease is 07:37 a person who has already had a heart attack, 07:39 but now you're trying to help 07:41 them prevent another heart attack. 07:43 Of course the second group would probably be 07:45 more highly motivated. Absolutely! 07:47 Since they already had a heart attack. Absolutely! 07:49 And the other ones, they probably are just looking 07:51 at you like you're from the planet somewhere - you know. 07:54 They've had their heart attack; 07:55 they've had their wakeup call, 07:57 and knowing that 40% will actually die 08:01 during their first heart attack. 08:03 So they're part of that 60% obviously, 08:06 and now we're very interested in secondary prevention. 08:09 Let's go back for a minute to PRIMARY prevention though. 08:12 What role does estrogen replacement therapy 08:14 have in primary prevention? 08:16 In other words, they haven't had a heart attack yet, 08:18 and they want to avoid it. 08:19 Well let me answer that by saying that the 08:23 pharmaceutical companies, the drug companies 08:26 in this country market estrogen very heavily as a way 08:30 to prevent heart disease and they make those claims 08:33 based on retrospective studies; 08:36 that is studies that look back at a patient's history, 08:41 and they don't have good control groups... 08:44 And so they've looked at these retrospective studies 08:48 that have indicated as much as a 08:50 50% reduced risk of heart attack, primary prevention, 08:55 in women who take estrogen replacement therapy. 08:59 And so they use that data and say... 09:01 "Wow, all women need to be on 09:03 estrogen in order to prevent heart disease. " 09:08 And it gets a lot of press; 09:11 it gets in the Ladies Home Journal, 09:13 and Time Magazine and all these things, 09:16 Good Housekeeping and all those, 09:18 and then we have women coming in and saying, 09:20 "Well, I think I need to take estrogen because 09:23 there is heart disease in my family. " 09:26 But interestingly enough, 09:28 there are a couple of very good studies that are ongoing 09:32 right now and one of them is the Women's Health Initiative. 09:35 "WHI" Study that has actually changed the recommendations 09:40 for estrogen in association with primary prevention, 09:45 and as a result of that study, 09:47 the American Heart Association does not recommend 09:50 HRT which is hormone replacement therapy 09:53 or ERT - that is estrogen replacement therapy, 09:56 just estrogen by itself - for the prevention of 10:00 coronary heart disease or heart attacks. 10:03 So that's completely different than what they're saying... 10:05 That's exactly right! 10:07 So they're not recommending... 10:08 they don't think it really has any primary role in 10:11 preventing. 10:12 Absolutely... The American Heart Association does not, 10:15 and that's because this was a large prospective 10:18 placebo-controlled study designed to impact 10:24 on women's use of both unopposed estrogen, 10:27 and that is estrogen where you take it by itself, 10:30 as well as hormone replacement therapy which would be 10:33 estrogen plus progesterone. 10:36 Okay, so in other words, when you say - double-blind 10:38 and all controlled placebo and all that, 10:40 that means - they've looked at everything, 10:43 and now they're really getting real data instead of just 10:45 looking back and anecdotally maybe saying... 10:49 "Well, we THINK we see this," as a marketing tool 10:52 the drug companies were using that but now there are real 10:54 studies saying - "No, there is not really a role in 10:58 preventing cardiovascular disease. " 10:59 Not only is there not a role, but they actually 11:03 found that there is a small increase in the number of 11:06 cardiovascular events in those women taking 11:09 hormone replacement therapy. 11:11 Now it's not enough to stop the study, 11:12 the study is still ongoing, it's not due to be 11:15 completed until the year 2005. 11:18 But, you have to be concerned about those kind of findings. 11:23 Okay, so in other words, instead of finding that it prevents it, 11:25 it could even potentiate it or make it worse, 11:29 but it's not to the level where they had to stop 11:31 a study because it's really a dangerous thing. That's right 11:34 Okay - Wow, so that's completely different. 11:36 So again, everything you see on TV, 11:40 and, of course, we're on TV right now - 11:42 it kind of shoots us in the foot but everything you see on TV 11:45 or everything you hear on the radio, 11:46 or everything you read in whatever magazine or journal, 11:48 it doesn't necessarily match with the facts 11:53 if you're trying to avoid the #1 killer of women 11:55 which is heart disease. That's right 11:57 There is the Nurses' Health Study 12:01 which is another prospective study with over 70,000 12:06 postmenopausal women. 12:07 That study did show a small decrease in the 12:11 risk of coronary events; however, it wasn't enough 12:16 that the American Heart Association is convinced, 12:20 and that study is ongoing as well and we're going to see 12:24 what that has to say about some of these risks. 12:27 It looks like that the women that actually have a decreased 12:32 risk in coronary events in the Nurses' Health Study 12:36 are those who are also seeking medical care 12:41 and have better lifestyle as well, 12:43 and so there may be some confounding factors that 12:48 are making it difficult to tell whether estrogen 12:53 is having that much of an effect on cardiovascular disease or not 12:56 So the one study says - Absolutely no effect. 12:59 This next study says - Well there may be some 13:01 kind of increase or decrease but it's probably 13:03 related to some other kind of factor. 13:05 That's what they're saying. Yes, that's right 13:08 So the bottom line then and there is no 13:11 bottom line yet, is what you're saying... Yes 13:13 You can't give a bottom line yet, 13:14 but it appears to be that this is not really 13:19 estrogen replacement therapy in preventing heart disease 13:23 is not really the right tree to be barking up. 13:26 Yes and really, you think about it, 13:29 it doesn't make that much sense to be looking 13:33 at that anyway because there are so many other 13:36 lifestyle factors that we probably should be 13:39 talking about at some point, 13:41 but estrogen, I'm not sure is really one of those 13:45 lifestyle factors that we need to be looking at 13:48 certainly for cardiovascular disease. 13:50 So nobody, watching the program, needs to go out 13:52 and buy those pills and start taking them to prevent it. 13:54 Not to prevent heart disease, that's right. 13:56 Now what about secondary? 13:58 We were talking about primary prevention, 13:59 what about secondary prevention? 14:02 Should we be taking some hormones then or... 14:05 You know, you would think that secondary prevention, 14:08 if estrogen is going to decrease the risk for heart disease, 14:12 it would decrease it for secondary prevention 14:16 more certainly than primary... 14:18 Because, if you look at these lifestyle live-in programs 14:23 that affect how we eat and they teach us... exercise, cooking, 14:32 decreased fat intake and that kind of thing, 14:35 what you want to find are the sickest people. 14:38 The people that have the heart attacks, 14:40 the people that have the most weight, 14:42 the people that have the worst cholesterol and diabetes 14:46 and all that - and you see dramatic change. 14:49 So you would expect to see the same thing with estrogen. 14:52 You want to find the sickest people to see the biggest change 14:56 if there is something that's going to affect it. 14:59 And so with estrogen, we certainly expected to 15:03 see that in secondary prevention studies, 15:06 and there is something called... "The HERS Study" 15:11 with a little over 2700 postmenopausal women 15:17 under the age of 80 who already had coronary heart disease, 15:23 and what we found with this study - was that they actually 15:30 had an increased risk for coronary events if they were 15:34 taking hormone replacement therapy during that first year. 15:37 So the women who were taking hormone replacement therapy 15:41 in the HERS Study, they've already had a heart attack, 15:45 you put them on hormone replacement, 15:47 that's estrogen and progesterone, 15:49 and you find that there is an increase in the number of 15:53 heart attacks in that first year! 15:55 Wow! So in other words, what does that mean? 15:58 It could mean, if playing off of what we said about 16:01 primary prevention, it could mean that 16:03 these are the type of people that think - 16:05 "Hey, I'm just going to take a pill - instead of changing 16:08 my lifestyle" That's right, that's right. 16:11 Is that the conclusion you're drawing? YES 16:13 We'd much rather take a pill 16:15 than have to change our lifestyle 16:17 because sometimes that seems too difficult to do. 16:22 And so, physicians shy away from talking about 16:25 those kind of things and certainly people - 16:27 if they can just take a pill, and still be having 16:29 whatever they want to eat, they're going to do that. 16:32 I think so... Physicians don't talk 16:34 about it much because - first of all most physicians 16:38 need to change their lifestyle, to be honest with you... 16:41 And so it's kind of hard to tell your patient to change 16:45 a lifestyle factor when you're not living that way yourself. 16:51 That's right, yes. 16:52 So it becomes very difficult. 16:55 So then what role does diet play in the prevention 16:59 of cardiovascular disease? What have you seen? 17:02 Well to me, diet is really the lifestyle factor that we 17:08 need to be talking about with cardiovascular disease, 17:11 and it affects so many parts of our lives, 17:15 and obviously it affects so many different diseases 17:20 that we might have. 17:22 We really need a cholesterol of under 160, 17:25 maybe even under 150 to reduce plaque that is 17:30 already in our arteries and to prevent cardiovascular disease, 17:36 and yet in this country, what we find is that 17:42 we actually have levels of 190 or 200 that is 17:49 considered normal in this country. 17:51 But we have multiple studies that definitely demonstrate 17:55 a link between diet and cardiovascular disease. 18:00 So you really then focus in on that... 18:04 You know, you can take drugs now, like your statins, 18:08 and all these different things; 18:09 statin medications that they make your cholesterol just 18:13 go down - that's another pill and it's not estrogen, 18:16 but it's another pill and are there any hazards 18:20 to just saying - "Hey, I took care of the problem that way" 18:22 Well, taking these statin medications which do lower 18:28 our cholesterol, does appear to decrease one's 18:32 cardiovascular risk. 18:33 You would expect it to if you can get your 18:36 cholesterol down. 18:39 The concern that I have, first of all, 18:43 it doesn't make much sense to be taking a medication 18:46 to lower cholesterol - when we're eating 18:49 a lot of cholesterol and when we're eating a lot of 18:51 saturated fats and animal proteins, 18:55 it is going to raise our cholesterol. 18:57 It seems to me much wiser to lower our 19:02 cholesterol by making a few simple changes in our diet. 19:08 We're talking with Dr. Eric Shadle 19:11 We've been talking about women's health issues. 19:13 We've been talking about cardiovascular disease; 19:15 talking about estrogen replacement therapy, 19:18 and the doctor has just said, 19:20 "Look, we need to take a closer look at lifestyle issues" 19:22 And when we come back, we're going to look at some 19:25 practical things about what you can do to decrease 19:28 your risk of the #1 killer of women, #2 killer of women, 19:31 all those are related together, so join us when we come back. 19:40 Have you found yourself wishing 19:42 that you could shed a a few pounds? 19:43 Have you been on a diet for most of your life, 19:45 but not found anything that will really keep the weight off? 19:49 If you've answered "yes" to any of these questions, 19:52 then we have a solution for you that works. 19:54 Dr. Hans Diehl and Dr. Aileen Ludington 19:57 have written a marvelous booklet called... 19:59 "Reversing Obesity Naturally" 20:02 and we'd like to send it to you free of charge. 20:04 Here's a medically sound approach successfully 20:07 used by thousands who were able to eat more and lose weight 20:10 permanently without feeling guilty or hungry 20:13 through lifestyle medicine. 20:15 Dr. Diehl and Dr. Ludington have been featured on 3ABN 20:18 and in this booklet, they present a sensible approach 20:21 to eating, nutrition and lifestyle changes that can 20:24 help you prevent heart disease, diabetes and EVEN cancer. 20:28 Call or write today for your free copy of... 20:30 "Reversing Obesity Naturally" 20:32 and you could be on your way to a healthier, happier YOU! 20:35 It's ABSOLUTELY free of charge, so call or write today. 20:46 Welcome back, we've been talking with Dr. Eric Shadle, 20:49 and we've been talking about women's health issues. 20:51 We've been talking about heart disease; 20:52 we've been talking about how 20:54 estrogen replacement therapy relates to that... 20:56 And you kind of shocked me but what you suggested, 21:00 and you've had the studies and whatnot is that 21:02 although the bottom line is not yet known, 21:05 it appears that it's not as helpful as we've been led 21:07 to believe over the last couple of years. That's right 21:09 And so we need to look at more than just taking a pill 21:12 because there maybe are some problems with pills. 21:16 Are there problems with pills? 21:17 I mean, one of the things you do a lot as a physician, 21:19 is help people access what's behind that nice little 21:23 counter at the pharmacy. That's right 21:25 Are there any problems with that? 21:26 And part of it is that patients have an expectation for that... 21:29 So they come in - they're not expecting me to tell them 21:32 "well maybe you could eat more fruits and vegetables" 21:36 They're wanting me to take out 21:37 my prescription pad and write them... 21:39 And help you get behind that counter! 21:40 And then all their problems will be solved, 21:43 but the problem with medications is that every single medication 21:47 has side effects and the statins, 21:51 the medication that you were talking about earlier 21:54 that lower our cholesterol certainly have problems 21:57 with our liver and perhaps the kidneys, 22:01 and they really should be taken as the very last resort. 22:05 I've got to tell you that I had many of the same views 22:10 about 5 years ago as most of my medical colleagues 22:13 do in town and that is that you give every 22:19 menopausal woman estrogen and you'll help her 22:22 with heart disease and all this 22:24 until Dr. Diehl came to Rockford, Illinois 22:27 and put on the CHIP Program; 22:29 the "Coronary Health Improvement Project" 22:31 and I can just give a personal testimony that it absolutely 22:35 changed my life and as I have looked at research 22:40 looked at these studies, I just am absolutely convinced 22:45 that what we need to be doing is changing our lifestyles 22:49 particularly in the area of our diet, 22:53 and we need to be eating less fat, less animal protein. 22:57 We need to eat the grains and the vegetables, 23:02 and the fruits, nuts - those types of things 23:09 And we're going to get everything that we need, 23:12 and it's going to impact so many different levels. 23:16 Here today, we're talking about cardiovascular disease, 23:18 and it definitely impacts that, but it also impacts 23:24 so many other areas of our health as well. 23:26 So instead of just taking the pill... 23:28 I mean what we've talked about so far is women 23:32 #1 think that the thing that's going to get them is 23:35 breast cancer. That's right 23:36 But if you take these plant foods and whatnot, 23:39 that has been shown to have protective things 23:41 even against cancer. 23:42 Even against breast cancer, absolutely! 23:44 And then the second one, we talked about 23:46 cardiovascular disease as it relates to 23:48 estrogen replacement therapy and you're saying... 23:51 "Hey, the things are not behind the counter, 23:54 they are down the aisle and they're all different colors" 23:56 That's right! That's right! 23:58 And so Dr. Hans Diehl - tell me a little bit more 24:01 about this - the "Coronary Health Improvement Project" 24:05 or they sometimes call it "CHIP" 24:08 And this has been really now effective in helping patients 24:12 in your practice. That's right 24:14 Actually, our church - we are currently doing our third 24:18 CHIP Program and I'm involved in it because I like 24:22 to refer my patients to the CHIP Program. 24:25 I have patients that have concerns about heart disease; 24:29 they have menopausal symptoms; 24:30 they have all these issues; they're overweight; 24:34 they might have high blood pressure... 24:36 And instead of just giving them a pill, 24:39 I can sit down and talk to them about - 24:41 There might be some changes that they could do 24:44 to simplify their lives... 24:45 And I can send them to the CHIP Program 24:49 which is a program that we do over the course of 30 days - 24:54 that changes peoples lives in ways that I've never 24:58 seen before in my medical career. 25:01 So it's addressing - you mentioned these things... 25:03 You mentioned hypertension, high blood pressure, 25:06 you mentioned overweight, you mentioned diabetes, 25:09 you've mentioned all those different things 25:10 which I guess the reason you're mentioning those 25:12 is because this program we've been saying... 25:14 Hey, estrogens are supposed to protect us from this, 25:16 and they don't really protect us from heart disease, 25:19 and these other things, but if you really want to 25:22 get a handle on what to do about that, 25:24 these are the things to do and the CHIP Program 25:25 sort of covers that. That's right 25:27 That's right and in our particular program, 25:30 we find 20% decrease in cholesterol levels 25:34 in just 4 weeks. 25:35 So here we are having people come in to the program 25:40 and in 4 weeks, by making a few simple lifestyle changes 25:45 including cutting out the meats and the high fats, the dairy, 25:50 and some of that that we so readily consume, 25:53 their cholesterol goes down, their weight comes down, 25:59 they find the pounds coming off, 26:01 and they all have so much more energy, 26:03 and it's just a tremendous program. 26:05 That's really quite a testimony and really it puts 26:08 the individual in the driver's seat when you address 26:10 these major components of heart disease 26:13 like a CHIP Program or other programs mentioned here on 3ABN. 26:17 They can really be involved! That's right 26:19 That should reduce their stress 26:21 which is one thing I want to ask you about... 26:23 What's the role of stress in 26:24 cardiovascular disease and how can we reduce it? 26:26 Well, that's an interesting question because a study at 26:30 Duke University which involved patients who had heart disease 26:34 found that negative emotions such as tension, 26:38 sadness, frustration actually could triple 26:42 the risk of significant decreases in blood supply 26:45 to the heart muscle and thus cause more heart attacks. 26:50 Whereas positive emotions could actually improve 26:53 blood supply to the heart muscle... 26:55 And so, I think the spiritual life - here's another 26:59 example of where one's spiritual life 27:01 getting in connection with God, 27:03 can actually have a positive physiologic effect 27:06 on our beings and actually make us healthier. 27:13 I think what you've shared with us today, 27:15 in terms of women's health, has HOPEFULLY REDUCED 27:18 the STRESS of a lot of people watching 27:20 because, really, what you're saying is... 27:22 We so often want to take pills and potions and lotions 27:26 and this and that, but really, God has provided 27:28 all kinds of things for us to help us - 27:30 that are not behind a counter in some sort of 27:33 most holy place, but they are out there 27:36 in the supermarket where you can be involved 27:38 and as you come to know Him and His plan for your life 27:42 both in diet and in stress reduction, 27:45 and all these different things, 27:48 you can live longer and healthier as a result. 27:51 Thank you so much for being with us, 27:53 and thank you for being with us at home. 27:55 We hope you join us on the 27:56 next episode of "Health for a Lifetime" |
Revised 2014-12-17