What is the Number One Killer of Women?
HEART DISEASE KILLS 6 TIMES AS MANY WOMEN AS BREAST CANCER.
IT KILLS 8.6 MILLION WOMEN EVERY YEAR.
HEART DISEASE OR CARDIOVASCULAR DISEASE INCLUDES: CORONARY HEART DISEASE, HEART ATTACK, HIGH BLOOD PRESSURE (HYPERTENSION), STROKE, CHEST PAIN (ANGINA) & RHEUMATIC HEART DISEASE
DO YOU KNOW WHAT FACTORS INCREASE YOUR RISK?
IF YOU ARE YOUNG, DO YOU THINK YOU ARE SAFE FROM HEART DISEASE?
RISK FACTORS FOR HEART DISEASE (CIRCLE IF YOU HAVE THEM):
AGE – Older than 55 years…however, young women who have a family history of heart disease, high blood pressure, elevated blood sugar, are overweight, or take oral contraceptive pills are at higher risk as well. WHAT TO DO (WTD): Nothing you can do about this one.
FAMILY HISTORY OF A FIRST DEGREE RELATIVE WITH HEART DISEASE – A first degree relative is the generation closes to you: mother, father, sister, brother. For examples, an elevated risk would be having a 1st degree male relative with a Myocardial Infarction (MI, heart attack) at age younger than 55, or female relative with an MI at less than 65. WTD: Modify other risk factors if you have a strong family history. Take anti-oxidants and supplements.
DIABETES MELLITUS – However, even those without overt diabetes but with insulin resistance or glucose intolerance or pre-diabetes are at increased risk. WTD: Strive for good control of blood sugars and treat insulin resistance before it turns into diabetes.
SMOKING – 1-4 cigarettes/day doubles the risk, 25/day increases the risk of heart disease by 4 times. WTD: STOP!
ABNORMAL CHOLESTEROL/LIPIDS – A total cholesterol >240, HDL <50, LDL >130, Triglycerides >150. WTD: Improve diet, take supplements and possibly medications.
OBESITY/BODY COMPOSITION – A BMI of higher than 25 is considered overweight, a BMI of higher than 30 is considered obese. A waist circumference of greater than 35 for women and greater than 40 for men is a risk factor for heart disease. WTD: Reduce body weight/improve body composition through dietary modification and exercise.
SEDENTARY LIFESTYLE – Less than 30 minutes on most days of the week or less than 4 hours a week of moderate activity. WTD: Get up and move!
INFLAMMATORY MARKERS – Elevated C-reactive protein, elevated homocysteine, elevated Interleukin-6, elevated lipoprotein-a. WTD: Take supplements, take natural hormone replacement.
STRESS – People with elevated stress (high cortisol) tend to have higher levels of adrenaline which causes vasoconstriction, increasing blood pressure. WTD: Reduce stress, easy right?!
MOST IMPORTANT: TALK TO YOUR DOCTOR ABOUT YOUR PERSONAL RISK. THE MORE RISK FACTORS YOU HAVE, THE MORE URGENT IT IS TO IMPROVE YOUR HEALTH!
Some supplements to discuss with your doctor about taking if you have more than two risk factors for heart disease (and even if you don’t with some of these): Omega 3 fatty acids (fish oil, flaxseed), CoQ10, Folate (folic acid), B complex vitamins, Grapeseed extract, Vitamin E, Vitamin C, Zinc, Selenium, TMG, Glutathione, Methionine, SAMe. Don’t forget dietary superfoods: blueberries, wild salmon, barley, avocados, broccoli sprouts, pomegranates, almonds, walnuts, lean white fish, lentils, fiber of any kind, oats, kiwis, green tea, citrus fruits, broccoli, spinach, and kale.
Help For Insulin Resistance
Our body’s cells need glucose as fuel to perform its many functions. The body obtains this glucose from sugar or carbohydrates that you eat. Once sugar or carbs come in by mouth, your liver senses it and release insulin. Insulin is the key to the door of your cells. That key opens the door and ushers in the carbs to be burned for fuel. The higher your activity level, the more fuel you need to burn to maintain your energy. Once the cells in the body are full of fuel (sugar), if insulin comes knocking with more sugar, the cells will no longer respond to the insulin, thus causing higher and higher insulin levels in the blood. This process is called insulin resistance.
Juvenile or Type I diabetics do not have any insulin. They have an auto-immune disease that has attacked the cells in their pancreas that make insulin, so they have to take insulin by injection or pump. Adult-onset or Type II diabetics have TOO MUCH insulin as outlined above. It is a hereditary disease made worse by dietary and lifestyle choices, mainly too many sweets and carbohydrates. Often other problems like age, hormonal imbalance or other medical problems can worsen this metabolic defect.
We are a carb-o-holic society with the worse culprits being excess sugar and refined carbohydrates. All carbohydrates are not bad, but in general, you have to watch the carbs carefully. I recommend eating real whole foods that are grown (preferably organic and local). Even whole grain carbohydrates need to be eaten in moderation. Our fast-paced society has gotten away from home-growing, home-cooking and moved into consuming large amounts of highly processed, refined and even genetically modified foods which are unhealthy for our bodies. In general, a good rule of thumb is to eat more hormone/steroid/antibiotic free meat, lots of fresh vegetables, good quality fats like olive, coconut and grapeseed oil, nuts, legumes and lentils, and whole grains in moderation.
For specific advice about your situation, you must consult your doctor because each patient needs different things that are related to their personal medical problems, family history and current medication. However, there are some supplements that are especially helpful for those who have insulin resistance. These include: cinnamon, fish or flaxseed oil, Co-Q-10, whole food or GTF chromium, Biotin, Magnesium, alpha lipoic acid, or selenium. In some cases, more specialized supplements like fenugreek, guar gum, apple pectin, milk thistle, or bittermellon are used. Again, please consult your doctor before just going out and buying supplements.
In some cases, medication for insulin resistance is necessary in order to bring your body into more metabolically sound functioning. And remember a normal blood sugar or HgA1C does not mean you don’t or can’t have insulin resistance. Blood sugars can remain normal or even low for many years in the presence of high insulin before they start to change. In general, if you have a family history of diabetes, have noticed middle abdominal weight gain, sweet or carbohydrate cravings, or feeling overly tired, especially after eating, you probably need to be tested for insulin resistance.
Are All Hormones Created Equal?
One of the common statements I hear in the press from “hormone/menopause experts” is how there is little difference between “natural” hormones and synthetic hormones. The safety concerns revealed by the Women’s Health Initiative study, which came out in 2002 and which studied the synthetic hormones Premarin (horse derived estrogen) and Prempro (horse derived estrogen, plus synthetic progestin), caused an uproar among women and doctors (some of whom, like me, were also women) alike. The Prempro arm, comprised of women with an intact uterus, identified a 26% increased risk of invasive breast cancer, 41% increased risk of stroke, 26% increased risk of cardiovascular disease and a 105% risk of dementia. The Premarin arm, made up of women who had undergone a hysterectomy, showed a statistically significant increased risk of blood clot, stroke and dementia.
The spin doctors, usually those who profited from the billion dollar sales of these drugs, immediately went to work trying to explain, rationalize and minimize the serious findings. Phones were ringing off the hook at doctors’ offices and pharmacies from concerned women about the safety of their hormone regimens. Most doctors were reeling from the awareness that the ingrained paradigm of hormone replacement was now seriously challenged. But the spin soon became almost as loud as the original announcement that synthetic hormones were far from benign and in many cases were in fact dangerous. “The women studied were older than the normal HRT patient,” they crowed. “They already had medical problems or risk factors which were just highlighted and not caused by the drugs,” they insisted. “Younger women are (probably) not at risk!” they proclaimed. “Millions of women take these drugs, the absolute risk is still small,” they reassured.
When the natural response happened, and women stopped taking their HRT drugs, the real trouble began. Now it wasn’t just a safety concern, it was a serious financial concern. And credibility started to suffer. All those things we were trained to tell women were good for them, now they were being challenged, and patients (HOW DARE THEY) were questioning us and our judgment. So the experts convened and reconvened and came up with…”your doctor should make the decision about whether you should take the drugs.” Yes, they punted. Oh, and they suggested helpfully that women should take the lowest dose possible for the shortest amount of time.
When the next natural thing happened and women started asking for something safe, something natural to control their menopausal symptoms, because really you can only eat so much soy, the uproar was now more on the medical side. “Natural hormones are NOT better” and “one would expect the same side effects (outlined in WHI) from natural hormones” and “there is no evidence that ‘naturals’ are safer” so that essentially, the implication was that women should really defer to their doctors and quit asking for these products. So although naturals had already been available and had been commonly used (like natural estrogen patchs and oral progesterone), the prevailing paradigm was centered on the synthetics. You asked your patient one question and usually just one, “Do you have a uterus or not?”, and then you went to your drug sample closet and you handed her one synthetic product or the other, you wrote out a script and you waved goodbye to the patient, “See you in a year.”
Then the patients started to hear whisperings about these mysterious “bio-identical” hormones. They were plant based hormones that were the same chemical structure as in the human body. How come we didn’t know about these before, the patients asked? Did you have to knock on the back door in a dark alley and say a secret password to get them? There started to be more murmurings about testing, hormone testing, through of all things, saliva instead of blood. But what, my doctors never suggested testing my hormones, or they said testing is not accurate, especially that saliva testing that we never bothered to look into so it must not be valid or we would of heard of it by now. Then the patients heard that maybe there was some kind of customizing of hormones that could be done because maybe it was true that four women with hot flashes all had different hormone levels and needed different things? At first, it seemed only Suzanne Somers had access to these things but she told women they needed to go out and find it for themselves.
Some doctors like I where taken aback by the WHI findings and vowed not to prescribe the “synthetics.” But now what, I wasn’t trained on how to actually treat hormonal imbalances or how to pick and choose which hormone methods were more physiologic. Oh, yes, a little subject like physiology…so women were born with two main sex hormones, estrogen and progesterone, and they were supposed to be in balance with one another. And if we were worried about exposing a woman’s uterus to unopposed estrogen, why were we not concerned about exposing her breasts by giving her only estrogen after a hysterectomy? Why were we trained extensively on how to use synthetic progestins and not natural progesterone? How come smart doctors who wrote journal articles used these terms interchangeably? Why wouldn’t the body respond better to a hormone it recognized, then one that was foreign to it? Why did we not recognize that when we gave women estrogen by mouth, it would put them at risk for the same problems that we already knew about from birth control pills; heart attacks, blood clots and stroke? Why did we not concern ourselves much with all the weight gain, the drop of sex drive, all the sleeping problems, and, especially, all the mood problems we were seeing every day in our office? Especially when we just upped the estrogen dosage? Was it because we had a vast army of diet pills, water pills, sleeping pills and anxiety, depression and “mood” pills of every size and shape? Because, let’s be realistic, isn’t it easier just to prescribe Drug “XYZ” because the waiting room is full?
So some of us decided to say, wow, maybe we were wrong this whole time and maybe there is something better for our patients. I personally said, isn’t it my job to make my patients feel better and protect them, rather then make them feel worse or God forbid, cause a problem they didn’t have before? After all, H. pylori turned the ulcer paradigm on its head and HPV turned the cervical cancer paradigm on its head. So I turned to the books and the literature and guess what I found out? This “natural” stuff was out there the whole time, it’s just with the exception of some very progressive (and usually stubborn) people who were using them, most of us and you were not told. So I started trying to be logical about hormone therapy. So what started to seem logical based on my research was: test first using a reliable, easy test (turned out to be spitting, who knew), give only what the woman or man is deficient in (you mean this stuff could help men too, who knew), use a hormone the body was already familiar with (I mean this is challenging stuff), use the safest route of administration (transdermal or through the skin seemed to be associated with fewer side effects, oh and lower dosages). Then, radical idea, have the patient come back and see how they are doing! Maybe retest if things aren’t quite right? Maybe try different routes of delivery or check some other hormones (like thyroid, adrenals, blood sugar/insulin, and vitamin levels) and address diet and lifestyle issues like stress. Again, to me it didn’t seem so radical, just, well logical and physiologic.
I wasn’t the only one who was having this epiphany. In fact, those of us willing to suspend our egos but not our brains started using this approach and getting good results, better than we had ever seen with the synthetics. And patients were telling other people, and they were coming in. And compounding pharmacies (pharmacies who make preparations rather than retail pharmacies who just dispense them), who had really been involved all along, began to gain confidence and come out in the open and tell women what was available to them in the form of customized hormonal therapy. And the women started dumping their old regimens and started embracing this new approach. And then…..
And then Big Pharma (jargon for the big pharmaceutical companies, makers of synthetic drugs) noticed, got angry, talked to their lawyers (many, well-paid) and then….they pounced. Wyeth (the maker of Premarin and Provera, remember them from WHI?) took their bevy of well-paid lawyers to the FDA and said, “Do you know what’s happening out there? Do you know that some people with medical degrees are actually out there talking to people with pharmacy degrees and coming up with individualized hormone therapy for women and claiming it can do things they can’t prove! Did you know that one of the things they are doing is prescribing a natural human estrogen called estriol to treat menopause, you know, that corner of the market that we used to have?”
And instead of the FDA saying, “Oh, estriol, we know about that naturally occurring weak estrogen in humans because it has a USP monograph (United States Pharmacopia). So that means Congress states that any drug that has a USP monograph, well, doctors can prescribe it and pharmacies can make it and women can take it. Oh, and there used to be a product on the market with estriol in it. Oh and they’ve used estriol-containing products in Europe for decades including two products made by Wyeth, the very company who is now complaining to us. Oh, and there has never been one safety report about estriol reported to us.” They instead said…and I am paraphrasing and being extreme for dramatic effect, of course, “Oh, my goodness, look at this large herd of well-dressed lawyers. They are really scaring us. We can’t afford to have any more bad press. So we have to come out strong and say…compounding pharmacies cannot use estriol because it is not FDA approved. There is no FDA approved product on the (American) market containing estriol.” And when we get hundreds of thousands of letters from women using these medications and benefiting from them, we are going to ignore them because are more concerned about these bothersome lawyers. And we are aware that when the insurance companies pick up on this, they are going to stop paying for compounded hormones containing estriol. And we can see that American women are likely to more concerned about their co-pays than their general health and well-being and they are going to discontinue these hormones because we scared them into thinking that they must be bad if they are not FDA approved. And we are going to hope that these women are going to be so miserable that they are going to go back to the FDA approved drugs Premarin and Provera, which should make the lawyers of the manufacturers and the stockholders of that company happy, and oh yeah, increase their profit margin.
So those of us who still think for ourselves decided that the drug companies and the insurance companies were not going to dictate our therapy to us. We decided that the doctor-patient relationship was sacred and should not be subject to someone else’s financial gain (or losses). And we started writing letters. To our senators and representatives and to our insurance companies because we knew in our hearts that the only way to go up against deep pocketed companies and well-paid lawyers was to start at the grassroots and appeal to people’s common sense and logic. In the meantime, we would continue to practice excellent evidence-based medicine, yes, you heard me, evidence-based medicine, that supports the use of bio-identical hormones. And we pray that in America, we are never so far gone that the rights of the people are surpassed by the desires (and the bank accounts) of the corporation.