Participants: Eric Shadle, Don Mackintosh
Series Code: HFAL
Program Code: HFAL000115
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00:51 Hello and welcome to "Health for a Lifetime"
00:53 I'm your host Don Mackintosh 00:55 Today we're going to be talking about women's health issues, 00:57 and we're going to be talking about a subject 00:59 that we've entitled "Hormone Replacement Therapy" 01:03 Sounds like a BIG long thing, 01:05 but out guest today is going to be able to help us understand 01:08 more about this and how it relates to women's health issues 01:12 Dr. Shadle is with us today, Eric Shadle, 01:14 and you practice in a type of medicine that deals with women 01:21 day in and day out; obstetrics, I guess the way 01:24 we say this and gynecology, is that right? That's right 01:27 So we're dealing with women all day, every day, 01:30 and one of the things that we deal with as women, 01:34 or women deal with is hormones as they change 01:38 over the life cycle and I suppose that this is related to 01:41 what we're going to be talking about. 01:42 What exactly is hormone replacement therapy? 01:45 Well hormone replacement therapy refers to taking estrogen 01:50 and progesterone. 01:52 We call it replacement therapy because it's typically given 01:56 to a menopausal women after she has gone through the menopause 02:01 and isn't making estrogen and progesterone, 02:04 and so we talk about replacing both of those hormones. 02:10 As opposed to ERT or estrogen replacement therapy, 02:13 where we only give the estrogen. 02:15 So progesterone AND estrogen is what we're going to be 02:18 talking about primarily today. 02:19 Primarily, yes, both hormone estrogen and progesterone. 02:23 Are there any risks involved with taking hormones, 02:26 or replacing them? 02:28 Actually, there is... there are several risks 02:30 associated with a HRT or hormone replacement therapy. 02:35 The one that concerns women more than any other is 02:40 breast cancer but there is also thrombosis, 02:43 DVT which is deep venous thrombosis. 02:45 Which is like a blood clot... That's right 02:48 ...Gallbladder disease and hypertension 02:51 or high blood pressure. 02:52 Those are all risks associated with hormone replacement therapy 02:56 And what is the rationale then, to prescribe a medication 03:01 or a hormone like that if there are those 03:03 kind of risks involved? 03:04 Well that's an interesting question and one that 03:09 my colleagues in obstetrics and gynecology will debate 03:16 at about every seminar that I go to on 03:18 hormone replacement therapy... 03:20 But there is specific rationale for prescribing 03:25 hormone replacement therapy and the main one 03:27 is osteoporosis. 03:29 1.3 million women that have osteoporotic fractures each year 03:36 Half of those are vertebral or in the backbone; 03:41 25% of them are in the hip and another 25% are Colles fractures 03:46 which is that fracture in the wrist. 03:49 When you fall down and catch yourself. That's right 03:50 In 1995, the cost of these osteoporotic fractures 03:55 were 13.8 billion dollars, so this is a huge public health 04:00 issue in this country. 04:02 And that is the main rationale for giving women estrogen 04:07 because estrogen has been shown in many retrospective studies 04:12 to reduce the risk for osteoporosis. 04:15 I've also heard that it does something with 04:17 cardiovascular disease or reduces the risk some people say 04:21 There are many retrospective studies, again, that show that 04:26 we reduce the risk of cardiovascular disease 04:29 by taking estrogen but of interest is that there are 04:32 several studies that are ongoing very good prospective studies 04:38 that indicate that actually estrogen or 04:42 hormone replacement therapy not only does NOT 04:45 decrease the risk of cardiovascular disease, 04:48 but may actually INCREASE the risk of heart attack, stroke 04:52 those types of issues... 04:54 So it's not really a good reason to take it. 04:55 It's not a reason to take it at all. 04:57 So you're telling me the BEST reason to take either of 05:00 these would be osteoporosis, 05:02 progesterone or estrogen replacement therapy. 05:05 Yes, even in the face of the side effects or risk factors 05:09 that we listed earlier which is the breast cancer, 05:13 and the thrombosis and those things, 05:17 the traditional view in the medical establishment 05:21 is to accept those risks in order to prevent the 05:26 osteoporosis because so many women suffer from osteoporosis. 05:31 I want to go on and talk a little bit more about this 05:34 osteoporosis and about how we can maybe avoid it 05:38 with other things other than estrogen and progesterone, 05:41 like diet but I wanted to ask why is it that the increase 05:44 comes for cancer risk when you 05:47 take an estrogen or a progesterone? 05:49 Specifically for breast cancer, there are estrogen receptors 05:54 in the breast as well as progesterone receptors, 05:57 and there is no question that if we give estrogen 06:01 to a woman who has breast cancer, 06:03 especially if that cancer has the estrogen receptors 06:07 then the cancer will grow... 06:09 But we also know, through multiple studies, 06:14 that estrogen actually does cause an increased risk 06:18 in the breast cancer risk and that's probably because of 06:22 these receptors. 06:24 So birth control pills - that's why that happens as well? 06:28 Birth control pills do increase the risk of breast cancer 06:32 slightly in a certain age group and that age group 06:37 happens to be the women in their 30s who are taking it... 06:40 But women who take it in their teens or in their 20s, 06:45 when we look at the risk of breast cancer when they're 06:48 in their 40s and 50s, we don't see an increased risk 06:52 unless PERHAPS, they continue to take it into their 30s, 06:56 and into their 40s, then there may be an 07:00 increased risk that we need to talk about... 07:02 But it's a little different than hormone replacement therapy 07:07 because the birth control pill is made of estrogens that are 07:13 totally synthetic and are high doses that turn the ovary 07:17 and everything else off... 07:18 And so they may not combine with the receptors in the breast 07:22 like hormone replacement therapy. 07:24 Okay, so it's a little different issue but... 07:26 So it's a little different issue and hormone replacement therapy 07:30 is actually more associated with breast cancer than 07:33 the birth control pill. 07:35 Let's look then back at this idea of 07:37 estrogens and progesterone in terms of osteoporosis... 07:40 You say they really do help to avoid that, 07:42 but are there other things we can do to avoid osteoporosis? 07:46 Absolutely - I think the most basic thing that we can do is 07:50 have a proper diet. 07:52 And when I say that, most Americans, 07:55 at least most people in this country, 07:57 and I know this program goes around the world, 07:59 and I don't know exactly what they're saying in Bangladesh 08:04 or in China or other places, but we find that diet 08:09 in this country is definitely associated with osteoporosis, 08:14 so that a high protein diet will 08:17 cause a loss of calcium in the bones... 08:19 And an animal protein actually causes a greater loss 08:23 of calcium than does plant protein. Interesting! 08:26 And then the plant sources of calcium, 08:29 as the graphic shows here, are absorbed more efficiently 08:33 than are animal sources to the tune of about 08:36 2/3 of the calcium that is in a green, leafy vegetable, 08:39 for example, will be absorbed as opposed to milk 08:43 where only about 1/3 of that calcium in the milk is absorbed. 08:48 So these high protein things are 08:52 really what is causing the problem. 08:53 We look at our diet, we can really be addressing a lot of 08:56 the issues with osteoporosis other than estrogen therapy. 08:59 Yes and that would be an alternative to hormone therapy - 09:02 is to simply change our diet to one that is compatible 09:07 with good bone function and the bone growth that we want to have 09:15 We hear a lot about - if you are going to be taking or eating 09:20 foods that are high in calcium or taking calcium supplements, 09:23 or these kind of things, that we need to be having 09:26 weightbearing exercise as well. That's right 09:28 Why is that and how does that work? 09:30 Well the bones are constantly resorbing - 09:36 that is taking calcium, taking bone out and depositing bone. 09:42 Actually, there are 2 different types of cells... 09:44 Osteo - that's bone Clast - which takes bone out 09:49 Osteoblast - which actually puts bone down... 09:52 And so there's this constant mottling of bone 09:55 between these 2 different cells, 09:56 and exercise, weightbearing exercise actually 09:59 stimulates those osteoblasts to lay down more bone tissue... 10:04 And so we can prevent osteoporosis by exercising 10:09 at least 20 minutes every day and it does have to be 10:14 vigorous exercise, it can be continuous walking, 10:18 especially if we can get our heart rate up 10:22 even to say 60, just 60% of target heart rate. 10:28 That will definitely be benefiting our bones 10:32 because we are putting the pressure 10:33 on the bones that we need to be. 10:35 Now, I remember while I was on a trip to Romania, 10:37 a mission trip, and I was supposed to take 10:39 a bunch of calcium to help the people there that were 10:42 supposedly having problems with their bones... 10:44 When I got there, the doctor said, 10:46 "That's not going to help them at all because it didn't have 10:48 any phosphorous in it" Is there any truth to that? 10:51 Yes there is! We do need phosphorous 10:53 in order to absorb our calcium, 10:58 and, in fact, that's probably one of the reasons... 11:02 we need phosphorous, but there is something else 11:05 in our diet called "phosphates" that actually leach calcium out. 11:11 So we need to be careful... we need phosphorous, 11:13 but we don't need phosphates which are in cola drinks, 11:16 and which are in meat. 11:20 Animal protein has a lot of phosphate and that 11:23 typically acts as a diuretic to get the 11:26 calcium out of our bones. Gets rid of it. 11:29 I've heard of Fosamax, a medication that's supposed 11:33 to increase, I guess, bone density or something like that. 11:36 Is there anything to that? Is that helpful? 11:38 Yes, well getting back to the idea of alternatives 11:42 to hormone replacement, Fosamax would be one of those. 11:45 Actually, it's a bisphosphonate, I think we have a graphic here. 11:51 Bisphosphonates is a class of medications that Fosamax 11:54 is actually an example of and it's actually not a hormone. 12:00 And, it increases bone density. 12:05 There are very good studies that show that it actually 12:08 will increase bone density rather than losing bone 12:11 that we typically see in older folks. 12:15 It can be used to either prevent or it can also be used to 12:20 actually treat osteoporosis. 12:21 So there are some other options other than just taking 12:24 estrogens or the progesterones. 12:26 that can help with the osteoporosis. 12:28 What about so-called, "designer estrogens" 12:31 What are they? 12:32 In other words, they don't supposedly, I guess 12:34 maybe impact one area of the body but the other... 12:37 Tell us a little bit about that. 12:39 Designer estrogens, one example would be - Evista or raloxifene. 12:45 Raloxifene is actually the chemical name for it, 12:49 and what they do is actually increase bone density, 12:54 but they don't increase the risk for breast cancer... 12:57 and the reason that they don't increase the 13:00 risk for breast cancer, like estrogens do, 13:03 is because they act as an anti-estrogen on some receptors; 13:09 in other words, they will bind to an estrogen receptor 13:12 but they won't stimulate it... 13:15 So that's like an anti-estrogen and on other receptors, 13:19 they do act like an estrogen. 13:22 So, for example, if we take raloxifene or Evista, 13:26 and we give it to a patient, it will bind with the 13:30 estrogen receptors in the bone and, thus, increase bone density 13:35 without increasing the risk of breast cancer... 13:39 But I should hasten to say that there is no medication 13:45 that is on the market that has no side effects, 13:50 and though the drug companies would make us think or 13:54 like us to think that we can take these medications 13:58 and never worry about anything, 13:59 that they are the answer to all our problems; 14:02 we know that there is always some problem somewhere... 14:07 And one concern I would have with raloxifene or Evista 14:12 is that one of its cousins is Tamoxifen. 14:16 Tamoxifen is a treatment for breast cancer, 14:19 and so it does help to prevent breast cancer, 14:23 but we found that Tamoxifen, given for more than 5 years, 14:27 may not prevent breast cancer anymore, 14:30 and it may actually increase at that point. 14:33 So it works for a time but then it maybe potentiates it. 14:35 Yes, so do we want to be taking Evista for 10, 15 or 20 years? 14:41 I think the jury is out on that but it's certainly 14:44 an alternative to hormone therapy that may be promising. 14:48 So we really need to think closely about 14:50 hormone replacement therapy before we get involved, 14:53 and try and do the basic underlying things 14:55 like diet and exercise, weightbearing and all that stuff 14:59 What about the so-called natural progesterone? 15:01 Some people say it's natural so it must mean it's safe... is it? 15:05 Well, if it's natural, it's got to be, right? 15:09 Sound's good! It sounds good... 15:12 Well natural progesterone actually is not associated 15:16 with breast cancer - that's the good thing about it. 15:19 It's also not associated with heart disease. 15:22 And, what I mean by that is that if we look at 15:25 synthetic progesterones, 15:29 it increases both of them probably. 15:32 But this one doesn't. 15:34 There is no convincing data, however, to confirm 15:37 that it will increase bone density. 15:40 So I can't say that it will prevent osteoporosis, 15:44 though some claim it will, especially those that are more 15:49 familiar with natural remedies, 15:50 but there have been a lot of studies that have been done 15:55 that have not shown it to increase the bone density... 15:59 So in other words, why would you take it - if it doesn't help one 16:01 and it doesn't help the other? 16:03 Well what natural progesterone will do is, as an alternative 16:07 to hormone replacement therapy... 16:09 We've been talking mainly about osteoporosis, 16:12 and I don't think it's going to do much for that, 16:14 but what it can do is, it can help a lot of other 16:17 menopausal symptoms - some that we haven't 16:20 really talked about such as hot flashes. 16:23 And natural progesterone, I think if a woman is 16:28 to take progesterone, she really wants to take 16:31 natural progesterone because synthetic progesterone has been 16:35 shown to actually increase the risk of breast cancer. 16:39 You know, it wasn't too long ago that we thought estrogen 16:42 was the only culprit in increasing breast cancer. 16:45 And, a study came out not too long ago within the last year 16:50 that showed that if a woman took estrogen by itself, 16:54 her increased risk of breast cancer 16:58 was as much as 33% increased risk, 17:01 but if she took estrogen with a synthetic progesterone, 17:05 her risk was 66% increased for breast cancer... 17:09 And so we find that synthetic progesterone is something 17:14 we want to avoid but natural progesterone, 17:17 it doesn't appear that it has the same effects. 17:20 And it probably doesn't have an adverse effect on 17:25 heart disease - whereas synthetic progesterone does. 17:27 Again, synthetic progesterone, what it does is it lowers 17:34 the good cholesterol, that HDL - it lowers that, 17:37 and then the bad cholesterol, the LDL, it RAISES that. 17:43 Heart disease is a big issues too then. 17:45 Heart disease is a big issue if you take progesterone, 17:48 but it doesn't appear that natural 17:50 progesterone will do that. 17:51 Does any of this stuff give you a headache - 17:52 thinking about all the different 17:53 things and trying to help people out? 17:55 Yeah - you have to balance a lot of different things... 17:59 We're talking with Dr. Eric Shadle 18:02 We're talking about hormone replacement therapy, 18:05 women's health issues. 18:06 When we come back, we're going to look at some 18:07 more things that are involved in this whole scenario. 18:11 We hope you join us when we come back. 18:19 Have you found yourself wishing 18:21 that you could shed a few pounds? 18:23 Have you been on a diet for most of your life, 18:25 but not found anything that will really keep the weight off? 18:28 If you've answered "yes" to any of these questions, 18:31 then we have a solution for you that works. 18:33 Dr. Hans Diehl and Dr. Aileen Ludington 18:36 have written a marvelous booklet called... 18:38 "Reversing Obesity Naturally" 18:40 and we'd like to send it to you FREE of charge. 18:44 Here's a medically sound approach successfully 18:46 used by thousands who were able to eat more, 18:48 and lose weight permanently without feeling guilty or hungry 18:52 through lifestyle medicine. 18:54 Dr. Diehl and Dr. Ludington have been featured on 3ABN 18:58 and in this booklet, they present a sensible approach 19:00 to eating, nutrition and lifestyle changes 19:03 that can help you prevent heart disease, diabetes, 19:05 and EVEN cancer. 19:07 Call or write today for your free copy of... 19:09 "Reversing Obesity Naturally" 19:11 and you could be on your way to a healthier, happier YOU! 19:14 It's ABSOLUTELY free of charge, so call or write today. 19:25 Welcome back, we're talking with Dr. Eric Shadle 19:28 and we're talking about hormone replacement therapy. 19:30 We've talked about the fact that a lot of people 19:33 hear a lot about needing to take estrogen and progesterone 19:36 especially when they get past that time in their life 19:39 when they are no longer having a monthly cycle, 19:41 and all of those different things. 19:43 We've talked about the fact that there are great risks with that. 19:46 There are some risks - I don't know if you would say great, 19:49 but some people would say "great" the increased 19:51 risk of breast cancer and different things like this 19:54 that we've talked about, but ALSO we talked that 19:57 even though there are those risks, 19:58 there are some real things that cause us to think about 20:01 maybe those are positive things to do like - 20:03 how the effect of estrogen on osteoporosis 20:08 so it doesn't effect this as much, 20:10 but you talked about a more excellent way, 20:12 in a sense than even those. 20:14 I'm not saying that they don't have a place, 20:17 but we've talked about diet and we've talked about exercise 20:19 and about osteoporosis, and we've talked about 20:21 hot flashes and how we can be involved in helping 20:27 those things in other ways 20:28 other than hormone replacement therapy. 20:31 What are some other things that can be used 20:36 to help with hot flashes other than hormone replacement therapy 20:41 Well, hot flashes are a big problem for many women 20:47 who go through the menopause. 20:49 But I should say that not all women have hot flashes, 20:52 and so women don't necessarily 20:56 need to dread going through the menopause. 20:59 But hot flashes are a significant issue, 21:02 and one of things that we can use as opposed to 21:07 traditional estrogen replacement therapy 21:10 would be natural progesterone, 21:12 and we've talked about that before, 21:14 but natural progesterone cream... 21:17 It's a transdermal - you put it on the skin, 21:24 it can significantly decrease hot flashes. 21:28 Studies have shown an 85% response rate. 21:31 Clonidine is another medication, actually it's a centrally active 21:38 ...to be technical, an alpha-2-adrenergic agonist, 21:42 and so what it does, it's actually given for 21:45 high blood pressure many times, 21:47 but it also has an 80% effectiveness rate 21:53 in reducing hot flashes. 21:55 Medications such as selective serotonin reuptake inhibitors - 22:00 These people know these like Zoloft and Prozac, 22:05 they are antidepressants. 22:07 And then a natural remedy would be black cohosh. 22:11 That is an herb and that has been shown to reduce 22:16 hot flashes - probably most studies would say 60-70% 22:21 Well how much do you take of black cohosh? 22:27 Well that's at a food store or at a natural food store, 22:32 you can find this - they come in tablets 22:35 and you can take a couple of those a day. 22:37 Take one in the morning and one in the evening, 22:40 would be a fine way to do it. 22:42 So, again, then the natural progesterone cream 22:46 you have said it's always better than the synthetic. 22:49 That's right, and I think that's probably a good rule 22:53 of thumb, that we want to stay with natural things 22:55 rather than the synthetic ones as much as possible. 22:59 Now another thing that sometimes ladies deal with is 23:03 severe vaginal dryness after menopause, 23:06 and sometimes hormone replacement therapy is 23:10 shown to help that. 23:12 I guess as you described before, maybe tell us how that works, 23:16 and then what can we do in place of hormone replacement therapy? 23:20 Well what we can do is... 23:24 the first thing we can do is moisturizers which should be 23:31 water-soluble - there are things called Astroglide or Replens, 23:35 but it needs to be water-soluble. 23:38 There are also very low dose estrogens. 23:42 If you take an extremely low dose estrogen intravaginally, 23:47 it does not appear to increase the risk for breast cancer, 23:52 and there are many low dose estrogens on the market... 23:57 And I should say - that there is a difference, in my opinion, 24:01 between natural products in hormones such as estrogen now, 24:09 as opposed to bioidentical. 24:13 I think bioidentical is what we want to be focusing on 24:16 for the female - the human female that is 24:19 because there are 3 types of estrogen that a 24:22 woman's body makes; estradiol, estriol, and estrone, 24:28 and those are the types of estrogens 24:33 that a woman should be taking. 24:35 So that we may call something "natural" 24:38 such as - say, Premarin, the most commonly prescribed 24:42 estrogen in this country. 24:44 It gets its name "Premarin" from its source, 24:49 and that is - it comes from pregnant mares' urine. 24:53 So Pre-mar-in is coming from pregnant mares' urine... 24:58 I kind of wish I didn't know that! 24:59 ...And it is natural because it's coming from a horse, 25:04 but is that what a woman needs? 25:07 Actually, there's about 21 different types of estrogens 25:10 in a horse and they are then in the urine, 25:14 and they concentrate those and put it in a pill. 25:17 And that could technically be called "natural" 25:20 but obviously that's not the natural 25:22 that we're talking about here. 25:23 So you want to get into what's really natural for the lady. 25:26 It's what I would call bioidentical. 25:29 It is what our body makes and 25:33 that would be either the estradiol, estriol or estrone, 25:37 and there are a lot of products out there, 25:38 even though they might be synthetically made, 25:40 they are bioidentical to the estrogens 25:44 that our own body makes. 25:45 I think that's probably true in almost everything you get 25:48 over-the-counter, even these vitamins and different things 25:51 that they have a lot of... 25:54 You never really know what's going to work 25:56 unless you get what is bioidentical... That's right 25:59 ...figuring that out. 26:00 Well, we've talked about this hormone replacement therapy 26:03 but again, it seems that God's way of dealing with things is 26:07 always better. 26:08 Why don't we end up by talking a little bit more about diet 26:10 and how it relates to all these issues. 26:13 Yes, actually if we had the right diet, 26:15 I'm not sure we'd even need to be talking about this 26:17 because if you look at Chinese women out in the rural parts 26:21 of the country, they don't have menopausal symptoms, 26:24 and they don't have osteoporosis and why is that? 26:26 Because they're living on a simple diet; 26:30 one that is primarily plant-based; 26:33 one that doesn't have any or just a very little bit of 26:38 animal protein and so they don't have the problems 26:41 with the osteoporosis... 26:43 And the fat that is in the Western diet is what 26:47 increases the amount of estrogen that a woman produces 26:51 and she gets used to this high level of estrogen 26:54 throughout her life and then she goes through the menopause 26:57 and the symptoms often are due to the degree of change 27:03 in the estrogen rather than the 27:04 actual level of estrogen itself. 27:06 So you were running on high octane and then you went to 27:08 nothing and it's like the car just STOPPED! That's right 27:14 Well again, it sounds like hormone replacement therapy 27:17 and all these things that God designed 27:19 us with hormones in our bodies, the best thing for our bodies 27:23 if we are women or for men, 27:25 is to eat what He told us to eat to begin with. That's right 27:28 ...And that solves a lot of problems. 27:30 That is the balanced way to do it, 27:32 and it's the way that I think God wants us to do. 27:35 He gave us that diet because He knows best. 27:38 He is the One that created these wonderful machines 27:42 that He has given us. 27:43 Thank you so much for spending time with us, doctor, 27:45 and for helping us again be reminded of 27:48 what we can do if we have a problem, 27:50 and what really the best is God's way. 27:52 And we're thankful that you joined us as well. 27:54 We hope that as a result of today's program, 27:56 you have Health that Lasts for a Lifetime. |
Revised 2014-12-17