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Supplement Research Newsletter - Ray Sahelian, M.D.

Supplement Research UpdateNEWSLETTER Ray Sahelian, M.D.

Vol. 6, Issue 2 - February, 2009

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We had an unprecedented number of email responses to the last issue of the newsletter. Here is one example: "The January 2009 newsletter Supplement Research Update discusses the disastrous effects of conjugated equine estrogens and synthetic progestins uncovered by the Women's Health Initiative study in terms of increasing breast cancer risk. My understanding is that the WHI did not study the use of bio-identical human estrogens and progesterone at all. Everything I've read indicates that they have a completely different effect on women's bodies, and in fact progesterone (the real thing, not synthetic progestins) may be protective against breast cancer." Over the past few decades doctors have prescribed horse-derived estrogens and synthetic progestins to women in order to relieve menopausal symptoms and as a way to potentially reduce the risk for osteoporosis or heart disease. A few years ago doctors began suspecting that, in many or most women, the harm from this treatment in terms of increased breast cancer risk and heart disease risk outweighs the benefits. Many women stopped taking these medications, others turned to herbs and supplements, and still others turned to natural hormones such as bioidentical hormones. Many of you may not be familiar with this term. Bioidentical hormones differ from traditional hormone replacement therapy since they are chemically identical to hormones found within the body -- such as estradiol and progesterone -- rather than molecules that are similar, but not identical to human hormones (such as Premarin, derived from the urine of pregnant horses) or synthetic progestins (such as medroxyprogesterone). Many women believe that these bioidentical natural hormones are safe, or safer. These bioidentical hormones are promoted by compounding pharmacists, some alternative medicine practitioners and even a celebrity, Suzanne Somers. Estradiol is also available in many FDA-approved pills, patches, creams and gels from traditional pharma! ceutical companies. Is there evidence to support the safety or superiority of bioidentical hormones over standard hormone replacement approaches? I will focus most of this newsletter on this important issue.

PRODUCT DISCOUNTS at www.physicianformulas.com For the next few days all subscribers are eligible to a FREE bottle of CoQ10 50 mg, a value of 10 dollars. CoQ10 is an antioxidant used for energy and cardiovascular health. CoQ10 at 50 mg is a good dose for those who wish to take this popular nutrient a few times a week without overdosing.

The following products are on sale: Prostate Power Rx is a popular herbal formula for prostate health. Life Greens and Berries powder is a new formula that has dozens of extracts of fruits, vegetables, mushrooms, herbs, all with a high ORAC antioxidant value. Bioperine is a pure form of piperine, derived from the fruits of black pepper. Cinnamon 6 is a combination of several herbs to help with blood sugar management. Vitamin C, Ester C is always a popular vitamin, especially during the winter season.

Chondroitin, glucosamine and quercetin helpful for osteoarthritis

A new 2009 Japanese study finds a combination supplement of 1200 mg glucosamine hydrochloride, 100 mg of chondroitin (from 300 mg shark cartilage), and 45 mg of quercetin, taken daily, is helpful as a treatment for osteoarthritis. Forty-six osteoarthritis and twenty-two rheumatoid arthritis patients were given the glucosamine chondroitin quercetin supplement orally for 3 months. The osteoarthritis patients showed a significant improvement in pain symptoms, daily activities (walking and climbing up and down stairs), and changes in the synovial fluid properties. No such effects were observed in the rheumatoid arthritis patients. Comments: Over the past few years there have been numerous studies regarding the role of glucosamine and chondroitin as a treatment for osteoarthritis. Most, but not all, studies show these natural nutrients to have a benefit. Quercetin supplements are available by themselves and can be taken together with a joint formula that has chondroitin and glucosamine. See http://www.raysahelian.com/osteoarthritis.html

Hormone Replacement Controversies

Here are some of the emails we received and my responses.

Q. I think your information is great, but I strongly disagree regarding estrogen / progestin. First of all, both Premarin and progestins should be against the law, as we women are not horses and synthetic progestins are carcinogenic. However, bioidentical hormones are a different breed and I have been on them (low dose) for the last 5 years. I don't even think about cancer. I eat a very strict, clean, mostly organic diet and go to an MD who knows what he's doing. Yes, Western medicine is the problem---still giving women Premarin and progestins---it's a disgrace how mishandled most women are today at the hands of misinformed and arrogant doctors who don't want to learn what's new and better. A. All doctors, including me, are fallible and have the potential to make mistakes or give wrong advice. In the past few decades many doctors were just as assured and complacent of the safety of hormone replacement therapy with PremPro as many bioidentical hormone promoters are today. There are currently no long term studies with bioidentical hormones to prove their safety.

Q. Dear Dr. S, the horse urine estrogen and synthetic progestin that have been fed to women world wide has been the problem, not bioidentical estrogen and progesterone. I am 63, was never able to take the horse urine product without feeling ill, so I didn't, even after my hysterectomy at 33 with the inevitable negative results for my bones. Five years ago, my doctor started me on a bio-identical estrogen patch, along with additional magnesium and bio-identical topical progesterone cream. My annual DEXA scans have shown an amazing gain in bone strength, this includes both hip and spine. I no longer expect to end up with dissolving bones which is what other doctors have stated is the fate of most people who live to be very old. Since people in my family lines normally die between 85 and 95, I have been concerned about osteoporosis because the folks who did die earlier usually died from the results of a broken hip. It wasn't fast, usually a year, and it wasn't pleasant and isn't solved by hip replacement. The fact is bio-identical estrogen and progesterone protect your bones from osteoporosis. The incidence of some form of osteoporosis in the aged is very high. Which means MOST people will get osteoporosis. MOST WOMEN DON'T GET CANCER.... MOST WOMEN DO GET OSTEOPOROSIS. A relatively low percentage of women get cancer and die from it. A. This email summarizes one of the basic dilemmas regarding the benefits versus the risks of hormone replacement therapy. Does the benefit of decreased bone fractures outweigh potential harm from an increased cancer rate, heart attack, stroke, or other problems that are related to hormone replacement therapy? Would having an adequate intake of calcium and vitamin D, along with exercise and weight training reduce or eliminate the need for hormone replacement? Science does not have the full answers at this time.

Q. In your Jan. 2009 newsletter, you site an MSNBC news article that reports taking menopause hormones for five years doubles one's risk of breast cancer. The article clearly stated that the hormones studied were horse estrogen and synthetic progestin ingested by mouth. This is quite different than applying a cream of bio-identical hormones. It may be that these creams increase the risk, as well, but that is not part of the referenced study, and many contemporary studies indicate otherwise. A. Until long term studies are done testing bio-identical hormones in terms of their effect on breast cancer and how they compare to synthetic progestins and conjugated equine estrogens, it is premature to claim that one form has less risk than the other. What if bioidentical hormones end up being even more potent in stimulating certain cancers than synthetic progestins or equine estrogens? It took decades for the medical community to find out the full risks of hormone replacement and it may take a long time for women who are currently taking bioidentical hormones, under premature safety assurances by many natural hormone marketers and promoters, to find out that these medications have risks that we are currently not aware of. I did mention in the newsletter that if you were to use hormones as symptomatic relief for menopausal symptoms, my current impression is that it would be preferable to use natural hormones. If you are aware of long term studies regarding the safety of natural hormone use, please let us know.

Q. I received Dr. Sahelian's January 2009 newsletter article with his comments on using estrogens and progestins to help with menopause symptoms. I feel it is very important to point out that the HRT used in the WHI study contained horse estrogen which is not the same as human estradiol now available in products such as Estrace and the Vivelle patch. While the horse estrogen does bind to human estrogen receptors, it does not have the same action as the human estradiol, ie. It fits in the lock but you can't turn the key. Also, since the human body doesn't have the enzymes necessary to break down the horse estrogen, it can stay in the body attached to the receptors for several months. Human estradiol is essentially out of the body in 2 days after you stop treatment. I have read several books and studies indicating that replacing a women's estradiol with the so called bioidentical estradiol is very beneficial. I personally have found this to be the case. A. Scientists do get important clues by studying the effect of these hormones on receptors in a laboratory, but until actual human studies are done for several years with natural estrogens in varying dosages, their safety will not be known to their full extent. When ingested orally these hormones are altered by the liver before they make it to the cells. Therefore, cell studies in a laboratory do not give us the full picture. Also, what if we find out someday that natural hormones stimulate cancers in certain tissues of the body more potently that the horse estrogens? At this time we don't have any long terms studies that compare bioidentical hormones to Premarin.

Other points to keep in mind:How do we know the right dosages for these bioidentical hormones in terms of long term use? How many years should one take them? When should one stop using them?How do we know which form of estrogen is best: estriol, estradiol, estrone, and in what proportions? How do we know whether slow steady release / absorption of these hormones is better or worse that a quick absorption with a high peak and low valley? How are we to know for sure whether compounding pharmacies are preparing the correct bioidentical hormones since there is little or no oversight? How do we know which is better, oral or topical hormone use?How do we know whether saliva testing is reliable? How is one to know the right hormone dosage to use based on saliva testing or blood testing? There is little evidence that a blood level or saliva level of a hormone can predict exactly the actual hormone amount a woman needs to take. The dosage of these hormones is most likely best managed through symptom relief of hot flashes, mood swings, sleep problems, and other symptoms rather than relying on blood or saliva levels. Could natural progesterone have a protective effect on breast cancer but potentially cause other health issues such as an increased risk for heart rhythm disturbances?

My opinion as of February 2009The bottom line is that every woman has to decide for herself whether the benefits of hormone use, in terms of menopause symptom relief and potential reduction of osteoporosis or treating other medical issues, outweighs the potential risks for cancer, heart attack, stroke, or other serious conditions from HRT use. Does the use of hormone replacement increase or decrease mortality? The answers are not yet in. Keep in mind that there is a physiological reason why hormone levels drop with age. The human body was not meant to be exposed to high levels of certain hormones with aging. Therefore, any form of hormone replacement through pills, creams, or shots, and whether synthetic or bioidentical, is not something the human body is genetically adapted to. Humans have lived on this planet for a long, long time but it has been only in the last few decades that doctors started prescribing hormone replacement therapy to such a large number of women. If, a decade or two from now, research shows bioidentical hormone use to be safe, I will wholeheartedly promote their use. Until then, women who are using these hormones, particularly in high dosages and for prolonged periods, are taking a gamble. If natural hormone replacement is the only solution to reducing your menopausal symptoms or taking care of other health issues you have, use the least dosage that works and for the shortest period of time. Exercise, weight training, calcium and vitamin D are a few good options in reducing the risk for osteoporosis. The risk for heart disease, stroke, and mental decline can be reduced through diet, exercise, low stress, yoga, deep sleep, and by taking certain natural herbs and supplements. See http://www.raysahelian.com/menopause.html and http://www.raysahelian.com/diet.html I want to emphasize that I am not in favor, nor am I again! st, the use of hormone replacement therapy. I just want women to be aware of all the benefits and risks and make an informed decision. The quality of life of many women has improved through HRT, whether synthetic or bioidentical, while other women have discovered the use of hormones has caused more problems than benefits. I support a woman's decision, no matter what, as long as she is informed and knows all the options, benefits and risks. I came across an interesting article that you may appreciate: http://online.wsj.com/article/SB123362356236541855.html

E-Mail Questions:

Q. Many herbalists I know suggest that supplements should be taken a half-hour before meals or 1-2 hours after meals on an empty stomach. In contrast, supplement bottles often state on the label to take with meals. When should supplements be taken, with or without meals? A. It depends. As a general rule, if you are taking a supplement in order to experience a quick mental, sexual, or physical effect from it, it is best to take it on an empty stomach so that it is absorbed quickly and without interference from food. For instance, Mind Power Rx can provide quicker and more noticeable mental enhancement when taken on an empty stomach, but it is also possible that the side effects would be more pronounced, such as restlessness, if the contents of the capsule are absorbed too quickly. When taken with a meal, the effects become more subtle and steadier. Another option is to take it a few minutes before a meal to get both a quick and slow absorption. Older people may wish to take them with a meal to cushion the effects. Passion Rx would fall in the same category as Mind Power Rx. As far as taking supplements for long term health, where an immediate reaction is not needed, for instance antioxidant pills or multivitamins, one can take them with a meal, usually breakfast. These are just guidelines and each person would need to try their supplements with a meal or on an empty stomach to determine which method works best for them.

PRODUCT DISCOUNTS at www.physicianformulas.com For the next few days all subscribers are eligible to a FREE bottle of CoQ10 50 mg, a value of 10 dollars. CoQ10 is an antioxidant used for energy and cardiovascular health. CoQ10 at 50 mg is a good dose for those who wish to take this popular nutrient a few times a week without overdosing.

The following products are on sale: Prostate Power Rx is a popular herbal formula for prostate health. Life Greens and Berries powder is a new formula that has dozens of extracts of fruits, vegetables, mushrooms, herbs, all with a high ORAC antioxidant value. Bioperine is a pure form of piperine, derived from the fruits of black pepper. Cinnamon 6 is a combination of several herbs to help with blood sugar management. Vitamin C, Ester C is always a popular vitamin, especially during the winter season.

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