Women's Health

Hormone Replacement Therapy: Is it for me?

Note: this is a lecture tape transcription. To obtain a copy of this tape, contact the RFHC.

What do you personally believe based on everything you have heard. The reason I want you to do that is because it will set us up in terms of the conversation. I would like you to know what you're thinking about this so that when I introduce ideas you can know whether that corresponds to what you have been taught by the media. Because we've been hearing more and more and more and more haven't we about women, menopause, and all of the different drug treatments available for menopause. It seems like it's the thing that's in the news more than anything else recently. I'll just give you folks just a couple of minutes here. So did most of you feel like you had a definite opinion on most of these questions? They're all false. Every single last one of them is false. And some of you may find that to be, "Oh, yeah, of courseÉ" and some of you may find that to be surprising. It would be surprising to those of you who get most of your information from the popular media because there's all this kind of misinformation floating out there. So we're going to go through now this evening and go through each of those different points.

"I have a bias." I have a huge bias, and since I have a bias, it's only fair that I share it with you. I'm totally anti-pharmaceutical treatment for menopause. Totally, okay? That's a result not only of my personal education, it is also a result of my personal life experience in terms of family members with breast cancer. I mean there's a whole bunch of things that feed into that for me. And what I hope to share with you tonight is the data about it. What has happened is that approximately 10 to 15 years ago menopause became a treatable disease. I remember when this happened. The drug companies started a public relations push to put over to the public the idea that every woman who is post-menopausal has a disease that requires treatment. Because they have this enormous ready made market after all. Women, sorry guys, live longer than men, right? And if you can treat them for the entire second half of their lives you have an instant cash machine, and that really is what's behind it all. And I'm going to share some information about that with you that I'm not the only person who holds this opinion. There's been a lot published about it lately. And the problem with it is that hormone replacement therapy is an untreated, unproven experiment that's being practiced on the women in America and we have not yet begun to reap the harvest of it. We don't have a clue what is going to be the outcome 20 to 30 years down the road. So the question for each of us becomes how much risk are you personally willing to accept? And we're going to talk a little bit tonight about the different choices, what the risks are, so that what my hope for you is, is that when you walk away from here tonight you will have enough information to make an intelligent decision. And that's basically where this whole lecture is heading. For those of you who've received my letter announcing this lecture I mentioned the fact that Dr. Dean Edell and I agreed on something. This is like a miracle. When I want to get my blood pressure up so I'm not so fatigued, I listen to your Dr. Dean. Because in general he and I are at polar opposites on everything. But he has a very conservative view around menopause. And I really approve of it because he asks some really timely questions. There was a recent study that was released about Alzheimer's disease and the effects of estrogen on Alzheimer's. Okay. Well as he pointed out this study is so flawed that you could drive semi-trucks through the holes in it, okay? In the first place it's not a controlled study. What it is is what they call a perspective study. They've gone back and analyzed statistics, alright? And in the first place women who are on hormone replacement therapy medical hormone therapy in general have a better health overall to begin with. They're more health conscious, they go to their doctors more, they're more proactive about their health. So you're working with a healthier population to begin with, okay? Then the second part of it is that they couldn't find any women who were willing to be the controls because everybody's terrified of Alzheimer's. So there was no way to perform this study in any kind of a meaningful way and it's an extremely small sample which is the other problem. When you have a statistical analysis, the smaller the sample, the bigger the deviations. Those of you who know math and statistics, I see you nodding your head. You don't get anything like a nice bell-shaped curve until you have huge sampling numbers and this was a tiny tiny sample. But of course the drug companies are so anxious to impress upon women the need to take their prescriptions that all of these things hit the news. They're being released by drug company researchers, that's the reason behind it. So the other thing that was said in this particular program when I went "cheer" is that they're pushing it now as a way to prevent cardiovascular disease, right? Well, we know so much about cardiovascular disease and how to prevent it. It isn't that, it's just that people aren't doing it. It's not hard to turn heart disease around. I've been doing it in my practice, I had a man walk in in late stage heart failure who's now doing fine just with the proper nutrition. I had another man setup for a valve replacement therapy, they said he'd die without it, he was back in just before I went on vacation, he doesn't need the surgery anymore because his nutrition turned it around, okay? It was so exciting. So we know how to do cardiovascular disease. Cancer is another story. And when you're talking hormone replacement therapy the risk you have to weigh is cancer. Because that's the tradeoff. So we're going to talk a little bit more about that. And let's go on to our next slide.

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Where I'm going in my lecture, this little hormone replacement therapy outline in your handouts is kind of an outline of how we're going to discuss this. We're going to start out by talking about a little tiny bit about the phases of a woman's life. Menstruation starts at menarche. Menarche currently in the United States is somewhere between 9 and 11 years of age. At the turn of the century it was 19. Okay? So what that means is that young girls are beginning to menstruate sooner and you're, we're having a longer effective time when the body is subjected to estrogen. Now the issue about onset of menarche is probably a nutritional one. Girls start menstruating at about 103 pounds, it's kind of like a trigger. That's enough body weight, enough body fat, to initiate the activity of the estrogen and so we now have younger girls that are much much heavier. We have an obesity problem in the United States because of all the fast foods that we eat. So little girls are much heavier than they used to be. And that's one of the reasons why the age has dropped the way it has. The other thing is we have a lot of synthetic hormones in our food supply, particularly in dairy products. And that period of menstruation continues until what we know as menopause, the menses stop. And as you go through each stage of a woman's life you have an ebb and flow of hormones. This is probably the piece about hormone replacement therapy that I find the most appalling. If you look at a graph of a woman's menstrual cycle it's like a symphony. It's a complex precisely timed thing where one hormone's going up and the other one's coming down and they interact with each other and they just kind of criss cross, it's beautiful. When we were studying it in school, my friend and I, this is a symphony, I mean, it's just gorgeous. We had great respect for it. We're trying to approximate that by giving people a single pill. It's like instead of a Tsaichovsky symphony you have a single note droning. That's the only comparison I can make and it just really doesn't make a whole lot of sense. During menstruation the menstruation phase of a woman's life you will have an ebb of flow with estrogen and progesterone peaking at different times. Those hormones are primarily produced by the ovaries but the entire cycle is initiated by the pituitary gland which also secretes hormones that begin the whole process of ovulation and as the egg is released then you get the high progesterone, right, mid-cycle, and at the first part of the cycle you're getting high estrogen to build up the internal lining of the uterus so that the baby can implant. And that's what's going on through the entire time that you're menstruating. What happens at menopause is that the ovarian production of these hormones starts to get less and less and less because if you're not ovulating you're not getting the progesterone surges and the estrogen production also drops. What's supposed to happen is that your adrenal glands are producing steroid hormones and those steroid hormones, you want the names? We go from pregnonolone into progesterone into androgen into estrogen. That's the cycle of steroid hormones all of which are made from the cholesterol molecule. And in a woman as you enter menopause you continue to product your androgen which is responsible for your sex drive, your libido, your adrenals make that, and they also then will produce the precursors to estrogen and in the fatty tissues of your body those will be activated into an estrogen that you can use, okay? That's why one of the things that happens as we age, we get fatty replacement in our breasts? The glandular tissue is gone and it's mostly fat tissue. Well that's where our bodies then can utilize part of what our body can utilize to make the estrogen that we need. So this is how we're designed. We're designed to start having less and less estrogen production, have our adrenals kick in, and then do the rest of our lives. That's the way it's always been. I think at this point in time I want to share an article with you that I have here, here it is. Sorry about that. This is a book that was actually written by Dr. Susan Love. Some of you may have heard of her? And the book is called The Hormone Therapy Book: Making an Informed Choice. And it was reviewed in the March 1997 issue of "Healthfacts" to which I subscribe. And she makes this point about it. That the gynecology textbooks in the United States talk about menopause as ovarian failure, okay? And it's a very male-oriented point of view that women's job is to reproduce. That's the medical viewpoint. And that no woman is supposed to ever outlive her menstrual years, her reproductive years. The medical profession has this point of view that before that women would die when their menses were done. Right? They have this mythology that because the average lifespan was shorter that meant that no woman lived passed her menopause and that's simply not true. Those statistics are artifically skewed by the fact that there was such a high infant mortality rate, so many women died in childbirth. The women who survived all of that? They lived to be 80, 85, 90, just like people do today. And they lived that way in a post-menopausal state. She makes the point here that the actual symptoms of menopause, the hot flashes and the acne and the bloating and the insomnia and all the things that we go through as we begin menopause are actually a result of the unevenness of the estrogen production. Our bodies have been accustomed to this certain amount and then you'll get very little and then you'll get a little bit more and it's this back and forth business that's actually causing the symptomatology. Which I think is a very good point. For people who have really severe hot flashes she recommends very short term therapy perhaps six months or so which used to be the medical recommendation in the Physician's Desk Reference. They've only recently changed it in the last edition. And then to taper it off and slow it down and take less and less and less so that then you can come to the point where you don't have the hot flashes and you are living without the drug, okay? I think that's a very interesting point of view and it is one of the ways I think that we should look at managing menopause more effectively. Because all those symptoms, the fuzzy thinking, you know, you can't sleep, all that stuff will eventually disappear as you adjust to having less estrogen in your system. I thought that was a very interersting and if anyone want s a copy of it if you could let us know we can make a copy and provide it to you, send it to you from the office. Let's go on to the next slide, please.

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There are three basic types of estrogen and I'm really going to go through this kind of rapidly, it's kind of technical. E1 is called estrone and it was discovered first but it's actually the second strongest estrogen, okay? It will stimulate the uterine lining to thicken so estrone is one of those that is considered to be very carcinogenic because of that. It also is the one that carries the highest risk of breast cancer because estrone is converted in the tissues to estradiol, I'm sorry, I read that backwards, the fatty tissues take your estradiol which is E2 in your testosterone and make into estrone. So the breasts have a very high concentration of estrone. What you have made as well as all the conversions. Because the body breaks estrogen down by going estradiol, estrone, estriol. Estriol is the least toxic and is the final breakdown product in the body. This one's about 7 times stronger than estriol. Let's go to our next slide which is E2, estradiole.

This is the strongest and longest acting of all the estrogens. It's 12 times stronger than estrone and 80 times stronger than estriol. It is the most carcinogenic because it's the longest acting and it is also the most toxic to the liver. You now cannot get prescriptions, medical prescriptions, for anything except estradiol and Premarin. Those are the two prescriptions that are available. You used to be able to get estrone, you can't even get it anymore. I recently reviewed my Physician's Desk Reference for one of my patients and it's just not available. So the pharmacologic point of view is the stronger the better, right? That's very typical of medical thinking so this is their favored estrogen. And then there is estriol. Estriol is a very interesting compound because it is very weak. It is in fact not a strong long lasting estrogen because it's very easy for the body to get rid of it. Um, the medical people don't like it very well because it is not long-acting, okay? I use a lot of this, it is available from plant source. Several plants produce it, licorice root, soy products, clover and alfafa and the product that I use is actually a soy based product. The fact is that you can't take one pill and have it work all day. It just doesn't work like that. Because the body can break it down relatively fast you have to taken it often through the course of the day, three or maybe even four times in small amounts to control the symptoms. See, what I'm talking about using anything for menopause I'm talking about the most natural thing at the smallest possible dose. And to stop it as soon as you can. To get it under control, get the body working better and then let go of it. But this is for those people who have really severe hot flashes or women who have really bad vaginal dryness which is a late stage effective menopause. You don't see that until women are in their 70's and 80's and for some at that point in time they need some help and then we provide them with the estriol. It doesn't stimulate the endometrial lining so it doesn't have any carcinogenic effects. The other thing about it is that it actually acts as an estrogen blocker and so therefore it is anti-carcinogenic in the way that tamoxifen is. You folks know what tamoxifen is, it's that drug they give to people who have breast cancer to block their own estrogen production so that it doesn't stimulate the cancer growth? Estriol has a very similar effect to that and there's a doctor in Europe his name is Aldercruts?, he's written 250 articles on estriol, researching it in terms of use with breast cancer to see if it can be used as a natural plant source to help women with this increased risk of breast cancer we have been experiencing. You are aware that the tamoxifen study that they were doing in the U.S. as a prophylactic for breast cancer was discontinued? Tamoxifen was being touted as a way for women who have a very high family incidence of breast cancer to avoid getting the disease. So they did a double blind controlled study and they gave women with no cancer the drug and they had a controlled study and they had to stop it because the women were developing cancer, particularly endometrial and uterine cancer. And so therefore they just had to get rid of it and tamoxifen is only approved for 5 years of use so if you have a friend who has had breast cancer and who is on tamoxifen they're only supposed to be taking it for 5 years. That's a very important point because many times they aren't ever taken off of it. It's the same way with Premarin, women are put on Premarin with no understanding that those estrogens are only approved for 6 months of use. And part of the problem with this is that the medical people aren't informed about these limitations by their drug reps in a lot of instances and they just don't know. Estriol is the active ingredient in soy products as I've already mentioned: tofu, miso, soy milk, and all that stuff? Interestingly, you may be aware that women in the Orient have the lowest incidence of breast cancer in the world. Their urinary output of E3, estriol, is 1,000 times that of American women. American woman have almost none in their urine because we don't eat those products. And where these products are eaten freely the urinary output is very very high. So is there a connection? You know, do they know something that we don't? I suspect that they do, given that when Japanese women come to the United States and adopt a Westernized diet their incidence of breast cancer matches ours. So there's definitely some kind of a connection. How many of you have heard that breast cancer risk is increased by certain lifestyle things like, never having had children or not having breastfed, or having had an abortion before your first pregnancy went to completion? There's all those factors that increase the risk of breast cancer. What they found is each and every one of those decreases your natural production of estriol, E3, and that there's a connection to those, uh, that this is the common factor between all of those seemingly unrelated statistics. Okay/ Let's look now at progesterone.

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Yeah, I want to look at progesterone next. As you may be aware, if anyone is on hormone replacement therapy and has an intact uterus, if you're taking high doses or if you're taking estrogens, they want to put you on progestins so that you'll bleed every month so that they'll reduce that risk of endometrial cancer. That's the reason behind it. But what you're taking is not progesterone, which is the female hormone, it's a progestin, which is actually a male hormone. And they're very different, they're very different in their metabolic effects, especially on a woman's body. We now know that estrogen is not what is responsible for increasing bone mass. It is the progesterone. On the other hand, progestin has been shown to have no such effect. It is a male hormone, that's what the word androgenic means. Progesterone will lower blood pressure whereas progestins increase it. Progesterone decreases water retention and progestin increases water retention. Progesterone for most women is very very calming and progestins can make a woman very aggressive. And if you've heard of Provera or Depoprovera that is what the active ingredient is, it's this progestin. Now there's a reason again why this is used medically. It's the same reason that we talked about with the estriol, the E3, natural progesterone is relatively short-acting, you can't take it orally because your liver drinks it, it just instantly takes it and converts it to all these other things that you need. And so unless you're going to do like a transdermal route where you rub it on your skin or an injectable, natural progesterone is really hard to get the benefit from. Um, the other thing is there's no financial incentive for progesterone, you can't patent it, it's a natural product, and so the profit margin on it is very very low if you want to talk in terms of commerce, which, when we're talking pharmaceuticals, we need to do that. And the reason I bring this up is because natural progesterone is now widely available and it is available in these transdermal creams, and it's very effective taken that way. Let's go to our next picture.

The most common prescription for hormone replacement therapy in the United States is Premarin. I'm sure everybody's heard of it, it's almost like a watchword. Well, Premarin contains about 100 conjugated equine estrogens. It's made from pregnant mare's urine and they distill it out to get these estrogens. None of them are human, they're all horse, and they're conjugated. What that means is that the liver can't break them down. So they are very very very long-acting. And because of them being so long-acting, it's increasingly carcinogenic. Premarin, all the studies that have been done on Premarin show it to be the most carcinogenic of all of the pharmaceutical estrogen preparations. And Depoprovera which is becoming increasingly popular, is a combination of Premarin together with that progestin that we just discussed, whose chemical name is methoxyprogesterone acetate. Had to say it, I've got it written down. Okay? So let's go to our next slide.

One of the important facts that I've already mentioned and I want to reiterate is that all of the original studies on estrogen, it was only approved for short-term use. The FDA approved it for use for no longer than six months. And there was a reason. Because at six months the carcinogenicity begins to go up, alright? And estrogen replacement therapy doesn't cure menopause symptoms. What it does is it allows those symptoms to be suppressed and if you cold turkey the estrogen it will all come right back. This is why I found Dr. Love's suggestion so fascinating: I'm beginning to manage menopause in a way that I never did before because as with all of us you have what your teachers tell you and then you have personal experience. And I started menopause six weeks ago, like that! All of a sudden, I had hot flashes. I hate them by the way, don't you hate them? Anyway, and I've gotten now a really good first hand idea about how to manage dosages and all of that sort of thing. The interesting thing is that when I was in Wales I had almost none. And there was less stress, right, and my adrenals were not overworked, and so I immediately noticed a change in all of that. So this reinforces my, what I've been teaching and treating, which is that you have get good adrenal function in place so that you don't have the symptoms of menopause, right? And the stronger and healthier your body is then you can start cutting back on your estrogen replacement and get to the point you don't have to take it anymore. Because I'm really a firm believer that you shouldn't have to take it indefinitely for the rest of your life, okay? Now because of the carcinogenicity of estrogens, they went to a combined therapy which is this estrogen with progestins so that you have the monthly bleeding and you don't have endometrial cancer, right? But the problem that nobody was addressing was this issue about breast cancer. The incidence of breast cancer was directly related to the length of estrogen exposure during a woman's lifetime. So, for example, we know that never having been pregnant will increase your risk of breast cancer. That means you had estrogen production through your entire reproductive cycles, you've never had that period when you had the high progesterone and you didn't have the excess estrogen. Everytime you were pregnant, your body was not being subjected to estrogen, folks, it was just progesterone at that point. And the newest studies that we have show that putting progestins with estrogen now are believed to increase the risk of endometrial cancer, not lower it. There was a journal article, New England Journal of Medicine, in fact there were two of them in 1989, the risk of cancer in long-term perimenopausal treatment with estrogen is not prevented by the addition of progestins, especially after a few years. And then the second article was that it actually may be increased. So we now have problem. If you're a pharmaceutical person, and you're trying to prescribe estrogen for women for the rest of their lives because this is 50 percent of the population and you have just been demonstrated that it's not doing what it's supposed to, now what? Cardiovascular disease and osteoporosis, there's our answer, that's what we'll go for. So if you've noticed, the tenor has really changed. That's now where the emphasis is, it's in osteoporosis and cardiovascular disease. Let's go to our next slide.

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I'm going to skip that one, let's just not do it, it's too technical, I think we've covered that far enough. We're going to talk just a moment here about the side effects of estrogen therapy, because there are really a lot of them, and it isn't something that's generally shared with people. If you use estrogen for longer than a year, your risk of endometrial cancer is quadrupled and that increase in risk continues for up to 10 years after you stop it. If you take estrogens for longer than two years, the incidence of gallbladder surgeries where they have to take your gallbladder out because it stopped working increases double or even triple from the unmedicated woman. Blood clots, also the incidence of blood clots increases. Do you guys remember when the birth control pill first came out and there was all of that uproar? ÉSo when birth control pills were first developed they were very high dosage estrogen, unopposed estrogen, and that's what was causing the pulmonary embolisms and the strokes and the blood clots in the brain and all the stuff that went on in the very beginning. It's kind of been hushed up but it's still the effect of estrogen therapy, that's what it will do. And in fact estrogen therapy increases the risk of heart attack. Now does that astonish you when we're being told to take it to be protected from cardiovascular disease? Here's the study, okay? Researches at the Lyden? University Hospital in the Netherlands analyzed 18 large hormone replacement studies. In other words, they took the statistics from 18 huge studies that had been done elsewhere and put it all together. And their report was actually published in the Harvard Health Letter. They couldn't get into a peer-reviewed journal but they got it in as a Letter to the Editor. Um, hormone replacement therapy doesn't protect against breast cancer or heart disease. Their conclusions were 1) it increases the risk of breast cancer and 2) that women who take the hormones are actually healthier than non-users and have had a lower risk of heart disease before they ever started the therapy so it's an artifact. It's an artifact of the populations that they're studying. And that makes the claims that are being made meaningless. And Danforth, which is the leading obstetrical journal, obstetrical textbook in the United States, actually has a statement in it that estrogens increase good cholesterols (HDLs) and they decrease (LDLs) which lowers your cardiovascular risk, so that should be a good thing. But the statistics show that women on estrogen therapy actually have a higher mortality from cardiovascular disease and heart attack in the epidemiologic studies. So cardiovascular disease is not well-served by estrogens. This is a, there've actually been no studies which demonstrate anything other than that estrogen replacment therapy is carcinogenic. We've had a lot of stuff in the press about you can use hormones to reduce the risk of both cardiovascular disease and osteoporosis but we have studies in 1989 that I've already read to you and then in 1994 in a monograph of the National Cancer Institute there was overwhelming evidence that shows that breast cancer risk is closely related to exposure to synthetic estrogens and progestins. And in 1993 Cancer Journal, that's the name of the cancer, estrogens are implicated in breast and endometrial cancer, synthetic progestins can cause some estrogen-like effects, and some formulations place women at actually greater risk of having breast cancer. I think it's really important that you know these things and you know that they come from scientific journals that are well-respected in the medical community, we're not talking here to try and sound like we're some kinds of alarmists. This is the data that is out there in the literature. And as women you're entitled to know that when your doctor hands you a prescription. You're entitled to know the effects of it. And in many cases you don't' get informed about that. I remember when I was much longer I took birth control pills for a number of years because I had such horrible horrible dysmenorrhea, I couldn't stand up, and in order to keep a job I had to do something to manage that. And nothing had worked, so they put me on them. And I asked specifically about the cancer risk, I was pretty young and ignorant at the time, I didn't know any of this stuff. My doctor pulled down a notebook that she had with all of these reassuring things, they were all promo pieces prepared by the drug companies, but no hard data, okay? So I feel my job is to inform you so you know where you stand. So let's look at the myths of menopause for a moment and explode some of these myths. Menopause is not a disease, first of all. You're not sick if you're in menopause. It's a natural part of the lifecycle. Taking hormones for the rest of your life will increase your risk of cancer. That's a fact. And osteoporosis and cardiovascular disease are lifestyle issues best treated by diet and nutrition. I'm going to spend just a little bit, a moment here with each of these issues, because actually I have two whole lectures, a lecture on osteoporosis, a lecture on cardiovascular disease, but we'll just hit the high spots, okay? Um, have you guys heard about Fosamax? The newest and latest drug for osteoporosis? You've heard of it. I've gotten a lot of people coming in and asking me about it. Because now they're saying that, now I can take this drug and I won't get osteoporosis. And I just read an article about it , I just got a book about the side effects of drugs. It's fascinating. What it does is it locks your skeleton into a static state. In other words, our skeletons are constantly changing, constantly being broken down and built up depending on the stress we put on it, right? Like, if you're a runner, you're going to have really strong leg bones because you're constantly are pounding because your body is responding to that stress. Fosamax doesn't do that. It totally shuts down the body's ability to break down bone and remodel and create it where it's needed. So the bones get very very brittle and the concern is is also that where it's needed is not where you're getting the bone. It isn't going to be the hip that's going to be strong and that's like 85 percent of all women who have fractures, it's hip fractures that are the big problem. Um, the other piece about this is that most women will not suffer a hip fracture in old age and most women who would do that anyway will do that in spite of taking long-term estrogen therapy and that means that you've taken the estrogen for no return. And with the Fosamax there's no information about its safety for longer than three years, that's all, three years of study on it. And it puts more bone in the spine than it does in the hip. So all of those are factors to consider when somebody tells you oh, here, let's take this, now. One of the other very very interesting things about osteoporosis and estrogen hormone replacement therapyÉin 1993 in this medical journal called Maturitas which is a study of the geriatic population, they both start with a G, that's why I came up with gynecologic, um, they found in their study that hormone replacement therapy actually decreases the amount of minerals in your bone. It decreases bone density. And there was an article, it was a study in 1992, in the Journal of Obstetrics and Gynecology, which showed that stopping estrogen therapy stops the bone loss. That's an interesting thing that hasn't hit the public yet, isn't it? And it becomes, in the New England Journal of Medicine in 1993 there was an article which I found was really, probably the crux of this whole thing. That estrogen therapy becomes increasingly irrelevant at the age at women are most at-risk for fracture, which is 75 years of age and above. If you are a woman who has had menopause at the average age which is 51, at 75 if you had been taking estrogen that entire time you've been on estrogen for over 20 years, going on 25 years. Enormous risk for very little return. Because in fact, the statistics show that it doesn't do anything for you. So why on earth would you want to be taking estrogen into your 70's and 80's? My very first chiropractic assistant when I worked with Dr. Patt?, she was 72 and she was still having menstrual cycles because they had her on those, what do they call them, cycle pills? And she was still bleeding. And she hated it, by the way, but didn't know that there was an option. Osteoporosis, we just kind of accept it as a known fact that it's menopause and estrogen loss that causes osteoporosis. The truth is is your bone loss begins before menopause, well before, that's been documented. And that estrogen therapy as we've said increases that bone loss. It's a different story when a very young woman like in her 30's or 40's has an ovarian removal like it's a surgical castration. Those women lose a lot of bone mass as a result of that but that's not true for the average woman who goes through menopause naturally. And the mainstays of prevention where osteoporosis is concerned is nutrition, nutrition, nutrition, weightbearing exercise and lifestyle modification, okay? Your nutrition consists of calcium and the co-factors needed to metabolize it, and that's different for everyone. Some people need vitamin D in greater amounts, some people need parathyroid complex in greater amounts, that can all be determined from the blood test, it's really not very hard to figure that out. But you have to customize that to the individual. You also have to customize it to urinary pH so that the person doesn't develop kidney stones. And it has to be the right kind of calcium, one that's absorbable. Weightbearing exercise, particularly like using ankle weights from walking or little wrist weights, not heavy ones, maybe a pound or so, that has really been shown to increase bone mass. Twenty minutes of sunshine a day, doesn't have to be at the height of the summer sun if you're worried about skin cancer, it can be late in the day, it can be 3, 4 o'clock. Reduce coffee, no cigarettes, no sodas, and a diet that is heavy in dark green leafy vegetables like broccoli and kale and all that stuff, great magnesium and great calcium, okay? You can evaluate your own bone density, there's bone density studies that can be done and you're, as I already mentioned the blood chemistry panel profile will show what your calcium needs are. And that's the real story on osteoporosis. It's perfectly safe and non-invasive. Where cardiovascular disease is concerned, hm, I've lost my page, but that doesn't really matter, I'll just tell you about it. That's not the one, that was the one I just was talking on but it doesn't matter. Cardiovascular disease is strictly a matter of nutrition and lifestyle. I'm going to share with you a graph that I put together for one of my other lectures, my cardiovascular lecture, this is a really interesting set of statistics. They come from the National Center For Health Statistics, that's the deaths per 100,000 from heart disease, okay? And on the right hand side, we have vitamin sales, in billions of dollars, and that graph comes from the U.S. Department of Commerce, right? What's really interesting is when you put them side by side. Do you notice that as this whole movement with natural foods and the information about vitamins and the vitamin sales started to skyrocket in 1970, the deaths started to plummet? There is a direct correlation between proper nutrition, specifically vitamins and minerals and all the co-factors that are needed and the deaths from heart disease. I've said this many times before and I'll just repeat it in a nutshell right here, heart disease in this country is a matter of too much refined carbohydrate, not enough B vitamins, not enough trace minerals, not enough of the proper nutrition that our bodies really need. It makes sense, doesn't it? The heart is the hardest working muscle in your body. It works constantly and it's going to show before anything else these nutritional deficiencies and I'm really excited about how effective it is to treat heart disease with the proper nutrition because all of our cardiovascular drugs are terrible. And so this is a real boon to people and it's not even hard to do. So in summary I'm going to share with you an article from, it's a professional publication put out by one of the many companies that I work with, and they're talking about the risks of hormone replacement therapy and I just want to share one thing with you. "The promotion of hormone replacement therapy as a positive health option for all post-menopausal women has been one of the most successful publicity campaigns of this decade. However, the fact that the long-term safety is not proven seems to have been overlooked. Clearly, long-term hormone replacement therapy should not be given to a woman known to be at risk for either lupus or breast cancer." Because they were quoting a study which shows the increase in lupus, skyrockets with hormone replacement therapy. So what are our alternatives? Let's talk about natural alternatives.

If you're not going to take drugs, what are you going to do? Right? What can you do for yourself? One of the most important things is to stay healthy and sexually active. All the evidence indicates that vaginal dryness is kept at bay by sexual activity. If in the late stages as we were mentioning a woman in her 70's or 80's where she's been menopausal a long time, if there is some vaginal dryness at that point, you can then use the natural estrogen cream directly onto the vagina. That can be used immediately before intercourse and have a very positive effect. The other thing is you want to improve your endocrine system, which is thyroid, adrenal and liver. Those three together balance a woman's hormones throughout her entire life. And if you optimize that function then you won't suffer so much from the menopausal symptoms. I personally believe that our modern society is very counterproductive for a woman's lifecycle, right, because we have all these pressures and all these schedules and like myself, I run a business and I do all of these things and I have all of these demands on me, which puts my adrenals at stress, I admit it, and for that reason I'm not able to be as body conscious as I would like to be. I got really in tune with that when I was on vacation. I very often push myself because I have things I must do. And I think all of us live in kind of a pattern these days. Those of us who don't are very fortunate. There are also Chinese herbal formulas which are used to balance a woman's system and again the Chinese approach is very much like what we're discussing here, it isn't about taking estrogen or a single pill, it's about balancing your entire system. I have here a description of the menopausal formula, Chinese herbal formula, that we use in our office. Some women do well with the estrogen cream, some women do wonderfully with this. So it's just a question of who does best with which one. This one in the traditional formulation, it says, "It strengthens the body. It clears heat from the body and it disperses stagnant chi." And unless you know something about Chinese medicine that might not mean a lot to you. Modern terminology is that is strengthens the complete body, the overall body, and reduces hot flashes in menopausal disturbances. And it does that by supporting the liver and thyroid and the adrenals and actually your whole system. And lastly, lifestyle and dietary change, and by that I mean reducing your overall stress. Allowing your body to function as it is intended to and getting away from those things which we mentioned, coffees and sodas and processed foods and too much carbohydrates, and eating a relatively healthy raw foods diet. One of the things that's really missing in our diet is a lot of raw fruits and vegetables. Most of us eat either frozen or canned or cooked to death kinds of things because that's what's most available. If you want to do anything for yourself that's really simple and easy, just avoid processed foods. If it comes in a box or a microwave container don't eat it, it's not food anymore, it's processed, it's a product, not a food. So I hope that this evening's presentation has given you some food for thought. There's a lot of what sounds like negative data in it but my feeling about this topic is that there's so much misinformation out there that it's really important that you hear the rest of it, the other side, and that you know that there's an option, something you can do for yourself. At our Center we do this all the time, we provide people with programs based on their own personal body chemistry and symptomatology that just kind of makes them healthier, get them better. So we can open this, uh, up to questions at this point, if there's any lack of clarity, I'll be happy to clarify it.

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