Jun
01
2003

Hormones After Menopause (HRT) Not For Everybody

Lately there have been several review articles published in the medical literature about hormone replacement therapy (HRT) after menopause for women. A number of longterm follow-up studies have shown that HRT with a combination of estrogen and progesterone hormones is associated with a higher risk of stroke, heart attacks, blood clots and pulmonary embolism. The WAVE trial has recently shown that estrogen replacement does not lead to protection from heart disease or strokes, however exercise and weight loss (from calorie restriction) does.

Two more recent studies add to the story: the one is a study showing that urinary incontinence (=bladder leakage) is much worse on estrogen replacement (HRT) than without it. The other study showed that estrogen replacement leads to dementia of the Alzheimers type.

Here are the details: Dr. Jodi Steinauer (University of California at San Francisco) reported about the findings during the American College of Obstetrics and Gynecology meeting at New Orleans. The study was designed to see whether estrogen/progestin hormone replacement would improve bladder function with aging. Episodes of urine loss when coughing, sneezing or running (urinary incontinence) were observed by the 1208 women from the HERS trial (Heart and Estrogen/Progestin Replacement Study) who were followed along for 4 years. The women were either given a hormone tablet (estrogen/progestin) or a “fake” pill with no hormones (placebo pill). To the surprise of the investigators the opposite of what was expected happened: The HRT group did much worse than the placebo group.

Hormones After Menopause (HRT) Not For Everybody

Hormones After Menopause (HRT) Not For Everybody

After one year urinary incontinence was up 2 to 3-fold in the HRT group and after 4 years this number was up 3 to 5-fold. Of the women who did not have stress incontinence in the beginning, only 38% of the placebo group developed it over 4 years, whereas in the HRT group 54% developed it. The authors concluded that HRT replacement therapy in menopause should be avoided (reported in The Medical Post, page 1 and 86, May 13, 2003).

Recently a new study (JAMA 2203;289:2651-62) showed that dementia was double the rate in older postmenopausal women on HRT than in the placebo group. 4532 postmenopausal women aged 65 years or older from the Women’s Health Initiative’s memory study (“WHIMS”) were followed by researchers for 4 years. The HRT therapy consisted of Prempro (Premarin and Provera). None of the women had dementia in the beginning of the study. After 4 years 21 of the placebo group had developed it (age related), the Prempro group developed 40 dementia cases. It is unclear why the HRT group had developed dementia, but the authors of the study theorize that perhaps a series of mini-strokes would be responsible for this.

In summary, it appears now with more evidence from the literature that HRT should only be given to postmenopausal women in a few selected patients under close medical supervision, but that the majority of women likely should not take it. Osteoporosis can be prevented by regular brisk walks, dietary changes with fat reduction and avoidance of refined sugar etc. as another powerful tool to achieve longevity. Keep in mind that these “hormone” replacement trials were regarding Premarine and Provera, both products of the drug industry. The body reads these hormone-like susbstances as estrogen-like substances and gets an overdose with the regular dosaging. Only bio-identical hormones in the right mix will be heart and brain protective and will work against osteoporosis. In short, the study described above was done with the wrong “hormones” and should have been done with bio-identical hormones. In menopause there are all kinds of reasons why a woman should use bioidentical hormones to return to her previous hormone balance, but it needs to be supervised by a knowledgeable physician with experience in this.

Read the truth about bio-identical hormone replacement under the “menopause” link below.

Here is a link to “menopause”: http://www.nethealthbook.com/articles/menopause.php

Last edited December 9, 2012

Jun
01
2003

Exercise Saves Lives In Women Over 65

A recent study released in the Journal of the American Medical Association (JAMA Vol. 289 No. 18, May 14, 2003) has found a profound effect of exercise on the survivial of elderly women. Dr. Gregg et al. have followed 9518 women aged 65 or older for a total of 12.5 years with a follow-up visit in between at about the 6 year point. They found that women who exercised (walking, aerobics etc.) and who were compared with a control group who was sedentary (no form of exercise), had the following improved survival rates.

These findings were independent of other factors up to an age of 75 years. In other words, age, smoking, weight and a number of pre-existing diseases did not influence these improved survival figures from the effect of exercise. However, when a woman had a significant chronic disease or was older than 75 years of age, the survival improval from exercise was not as strong as indicated in the table above. Also, the follow-up visits showed that those women who exercised continually, had the highest survival advantage.

Exercise Saves Lives In Women Over 65

Exercise Saves Lives In Women Over 65

The bottom line: increasing and maintaining a physical exercise program will likely lead to a longer life. At the same time the exercise program needs to be started early enough to be of benefit to those who are older than 75 years of age.

Disease and death rate reduction from exercise in women aged 65 and over
Reduction of:
Effect of risk reduction:
overall death rates 48%
cardiovascular disease 36%
cancer 51%

Some of the Associations that were contributing to this important study were: The National Center for Chronic Disease Prevention and Health Promotion (Atlanta, Ga), the Graduate School of Public Health, University of Pittsburgh (Pittsburgh, Pa), the Prevention Sciences Group, Departments of Medicine and Epidemiology and Biostatistics, University of California (San Francisco) and the University of Minnesota and Section of General Internal Medicine, Veterans Affairs Medical Center, Minneapolis.

Here is a fitness link: http://www.nethealthbook.com/articles/fitness.php

Last edited December 9, 2012

Apr
01
2003

Menopause And Perimenopause In Women

In the February 19, 2003, issue of The Journal of the American Medical Association there was an extensive review of the topic of menopause and the time before and after menopause, called “perimenopause”.

The authors, Dr. Lori A. Bastian, from Duke University, and colleagues critically reviewed 1,246 articles on this topic and identified 16 studies that were accepted as being reliable regarding the review of this topic.

They were interested in finding menopause symptoms, signs and blood tests that would be reliable in terms of assessing whether a woman would be approaching menopause or would be in menopause. The result was that no single test or symptom was reliable, but that a number of tests and symptoms in combination were very helpful.

Menopause And Perimenopause In Women

Menopause And Perimenopause In Women

They measured reliability by “likelihood ratios (LRs)”. What this means is that any value above 1.0 is significant, but the higher the number, the more reliable and important is this fact or sign. I summarized the findings in table form below.

Results of a Review Study on Menopause in Women
(modifed according to Feb.19, 2003, issue of The Journal of the American Medical Association)
Findings:
Likelihood ratio (LR): Comments (by Dr. Ray Schilling):
self assessment of going through the transition 1.83 this is based on the effects of the changing hormones on the woman and how she feels it
is affecting her
symptoms of hot flashes 3.10 lack of estrogen from ovaries leads to a lability of the skin blood vessels with increased skin perfusion as well as stimulation of the sweat glands
night sweats 1.90
sleep pattern is changed and there is a loss of the day / night rhythm of skin perfusion
vaginal dryness 2.64 due to lack of estrogen
high follicle-stimulating
hormone levels
3.06 feedback from estrogen missing, which stimulates the hypothalamus of the brain to produce more
FSH hormone
low inhibin levels 2.05 this is a newer test, which is more specific than the FSH test and also has some importance in fertility work-ups
Self-assessment of perimenopausal status 0.25 this is not a reliable test as it is below 1.0. It was included to show how good the other tests are in comparison

The authors concluded that there is no need for blood tests for menopause diagnosis in a woman, if several points of the first 4 findings are positive (top part of the table).

Here is a link regarding menopause.

Last edited December 9, 2012

Feb
01
2003

Coffee — What’s The Scoop…

In a recent issue of The Medical Post, a weekly news magazine for Canadian Physicians (The Medical Post, Jan. 28, 2003), Dr. Suzan Biali has revisited what is medically known about the effects of coffee on health.

This doctor is a family physician in Vancouver/B.C., but also has a degree in dietetics. Here is a summary in table form of what this medical review found.

Dr. Biali also mentioned the recent publication in the November issue of the Lancet by the Dutch investigators that coffee consumption of more than 7 cups per day would cut diabetes in half.

Summary: It would appear that coffee consumption is better than previously thought of. Most people can benefit from it. But this is a personal preference issue. Some groups of patients should refrain from coffee consumption entirely such as patients with rheumatoid arthritis.

Coffee -- What's The Scoop...

Coffee — What’s The Scoop…

Others such as women in early pregnancy (particularly the first 3 to 4 months) should refrain from it. When infertility is a problem it is wiser to refrain completely from coffee as well. Patients with a tendency to ulcers likely should refrain or cut down the coffee consumption. The majority of the population likely could enjoy a cup of coffee and prevent degenerative neurological diseases (Alzheimers and Parkinsons disease). Some patients with psychiatric illnesses (phobias, anxiety disorders) likely should stay away from coffee as should patients with high blood pressure or heart rhythm irregularities.

Coffee — what’s the scoop?

Effects of coffee on: Comments:
first trimester pregnancy 5 or more cups a day can cause miscarriages
infertility women who drink 250 mg of caffeine per day (5 to 6 cups) experience infertility
no hip fractures a large Minnesota study showed in 2001 that there were NO hip fractures with coffee consumption
calcium in bones despite the rumors otherwise, there is NO link of coffee consumption to calcium loss
rheumatoid arthritis (RA) This is the patient group where osteoporosis has been found to be present with coffee consumption; a Finland study found a 2-fold risk with more than 4 cups per day, and a 15-fold risk with more than 11 cups per day (in RA patients only)
Alzheimers and Parkinsons the cells in the basal ganglia that produce dopamine get stimulated by coffee; this is also the seat of the addiction (though mild) to coffee and the cause for headaches when coffee is suddenly withdrawn. This effect  prevents Alzheimers and Parkinsons, both bad degenerative neurological disorders.
stomach problems anybody with a tendency for stomach ulcers or duodenal ulcers tends
to get worse with coffee. Arabian type coffee is less acidy than South American coffee. Coffee does not cause ulcers, but may stimulate existing acid production and in higher doses may stimulate
H.pylori growth.
panic attacks and insomnia more sensitive people tend to feel anxious with a single cup of coffee per day, others can tolerate many cups. When a patient complains about panic attacks or insomnia the physician will likely inquire about how much coffee the person drinks.
high blood pressure long term coffee users show almost no effect on blood pressure, it does not cause high blood pressure. Those with high blood pressure
or a history of a stroke still should refrain from drinking coffee

Last edited December 10, 2012

Jan
31
2003

February Readers’ Digest Edition… Poisons Used For Healing

In this February’s Readers’ Digest edition there is an article about the use of poisons of nature for healing purposes (article entitled “Healing Power of Poison”). For instance arsenic trioxide has been used recently in a trial with leukemia patients to get a remission of leukemia in 70% of cases. Arsenic, which normally is a powerful poison, has in the right dilution this healing effect in leukemia with less toxic side-effects than chemotherapy.

Dr. J. Michael McIntosh, a psychiatrist at the University of Utah, is researching the poisonous effect of a marine snail that attaches to and kills fish with a toxin. This poison is a powerful painkiller. It is several hundred times stronger than morphine, but is useful as it does not have any effect on the strength or functioning of muscles. This substance used in the right diluted dose, may one day be used for the treatment of chronic pain syndromes.

The bacterium Clostridium botulinum produced a powerful toxin, which causes botulism. Neurologists and plastic surgeons are using this poison in a diluted form as “Botox” to inject into wrinkles of skin to make your face look younger. It is also used for chronic spastic muscle conditions like cerebral palsy or tardive dyskinesia.

February Readers' Digest Edition... Poisons Used For Healing

February Readers’ Digest Edition… Poisons Used For Healing

Newer reference regarding the use of arsenic trioxide: http://bloodjournal.hematologylibrary.org/content/107/7/2627.abstract

Last edited December 10, 2012

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Dec
01
2002

Folic Acid In Cereal Reduces Abnormalities Of The Brain and Spine In The Unborn Child

In 1998 the Canadian government approved the mandatory addition of folic acid in cereal products as studies in the past had shown that pregnant women did not always take their prenatal folic acid supplements to prevent neural tube defects (abnormalities in brain and spine formation).

A total of 336,963 children of women who were either pregnant before or after the 1998 folic acid fortification program was institued, were screened for open neural tube defects. The result was that prior to the legislation there were 113 cases per 100,000 pregnancies. After 1998 there were only 58 per 100,000 pregnancies found.

Dr. Joel G. Ray from the Sunnybrook and Women’s College Health Sciences Center in Toronto who was the lead researcher stated that a food fortification program with folic acid in addition to the regular prenatal folic acid tablet supplementation is essential. To a large extent this will prevent these devastating congenital malformations that cause disabilities or death.

Folic Acid In Cereal Reduces Abnormalities Of The Brain In The Unborn Child

Folic Acid In Cereal Reduces Abnormalities Of The Brain In The Unborn Child

Based on: Lancet 2002;360:2047-2048.

Comments: It is also important for women to know that folic acid tablets need to be taken already before, around and after conception to be most effective with regard to preventing brain and spinal malformations. The nervous tissue is one of the fastest growing tissues in the first few weeks of pregnancy. Any deficiency of cell differentiation, for which folic acid is an essential ingredient, has devastating longterm consequences for the child.

Last edited December 10, 2012

Nov
01
2002

WAVE Trial Failed To Show Benefits Of Estrogen (Premarine) And Vitamins

Dr. David D. Waters of the University of California at San Francisco reported in Chicago at the American Heart Association’s Scientific Session 2002 about the WAVE trial. This stands for “Women’s Angiographic Vitamin and Estrogen” trial.

The results of this study were simultaneously published in the Journal of the American Medical Association(JAMA 2002;288:2432-2440). It was a “carefully designed randomized study” where 423 women with established blood vessel damage to their hearts (established by angiography) were put on a therapy and then followed for an average of 2.8 years. Essentially the question was whether or not estrogen (Premarine) and vitamins (Vit.E and C) would have a protective effect on the blood vessels. Surprisingly the worst outcome was in the group with estrogen replacement and vitamins. The placebo group (=no estrogen, only vitamins) had the lowest death rate. The authors felt that the beneficial effect of estrogen (speak “Premarine”) on heart vessels could not been verified in this study. The take home message to the physicians at the conference was that they should concentrate on lowering the known risk factors: weight reduction, blood pressure control, cholesterol lowering and increasing exercise. Estrogen should be given in low doses (Premarine 0.625mg per day) only to those women who are symptomatic with hot flashes, but not to every postmenopausal woman.

WAVE Trial Failed To Show Benefits Of Estrogen (Premarine) And Vitamins

WAVE Trial Failed To Show Benefits Of Estrogen (Premarine) And Vitamins

NOTE : This group of postmenopausal women is a selection of women more likely suffering from hyperinsulinism with a higher rate of cardiovascular disease (and also arthritis and possibly a higher risk for cancer as well). The most logical therapy for these women is to work on weight loss, to increase exercise and to change their diet to a zone diet as this is known to lower cholesterol. Hoping to cure these women with estrogen or vitamin manipulation alone does not make “medical common sense” to me. Also, those women who had not had a hysterectomy were not dealt with as a separate group, although they were put on medroxyprogesterone acetate (Prempro). This is called a “confounding bias” and should have been openly discussed, which it was not. This means the WAVE trial made waves, but it was not a properly designed randomized study.

You may want to read these useful related links to chapters of my free Internet based Nethealthbook: For links to arteriosclerosis, heart attacks and strokes see this link: http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/
For a link to hyperinsulinism follow this link:
http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Last edited October 25, 2014

Oct
01
2002

Endometriosis Is A Cause Of Infertility, Even Without Scarring

When the lining of the womb grows into the Fallopian tubes, this can be a cause of scarring of the tubes and lead to infertility of the woman.

Up to this point in time medical science had no explanation for cases where the surgeon found only a few spots of endometriosis on the surface of the womb inside the abdominal cavity without any disease in the fallopian tubes. Dr.Ovrang Djahanbakhch and his coworkers from the The Royal London Hospital in London found that there is a factor contained in the abdominal fluid of women who have endometriosis (article published in the Lancet 2002;360:p.1221-1222). These investigators looked at fallopian tubes of hysterectomy samples (=wombs that were surgically removed) and studied the movement of the cells lining them under a special microscope.

Hair cells can be seen that are lining the Fallopian tubes and are normally responsible for the transport of the released egg at the time of ovulation. They found that when they added abdominal fluids from women who have endometriosis, the wave like pattern of these hair cells (=known as “ciliary movement”) came to almost a standstill. Abdominal fluids of women with no sign of endometriosis did not cause such a slowdown. This finding sheds important new information on our understanding of the nature of endometriosis and may some day lead to the development of new fertility drugs.

Endometriosis Is A Cause Of Infertility, Even Without Scarring

Endometriosis Is A Cause Of Infertility, Even Without Scarring

At this point the chemical factor from patients with endometriosis that is responsible for the slow-down of the normal ciliary movement has not yet been isolated. The authors will pursue this line of research further. Here are some links that are related to this topic:

Endometriosis: http://www.nethealthbook.com/articles/painfulperiods.php

Infertility: http://www.nethealthbook.com/articles/infertility.php

Last edited December 10, 2012