Estrogen, No Cure-No Pay service, Vitamin A

• Summer Schedule
• "Estrogen" in the News
• Is More Medical Care Always Better?
• Letter- Vitamin A and Hip Fracture
• No-Cure No-Pay Services

Summer Schedule

We will close at 1 PM from July 26th to August 2nd. I will be on vacation and Nurse Practitioner Mary Flick will be here for you every morning. We hope you are having as pleasant a summer as we are!

"Estrogen" in the News

One of the most common questions we've had recently has been about estrogen replacement in women. Everyone has heard on the news that estrogen replacement has proven harmful to women.

The Story in a Nutshell

Synthetic estrogen and synthetic progesterone cause you harm. This study in the headlines tells us nothing about the natural estrogen a woman makes on her own, which we and others have been promoting for years. Want to know more? Read on.

If Wyeth Doesn't Make It, It Must Not Be "Estrogen"

You would hope that our medical authorities would always exhibit clear thinking and precise expression, but no. For years they have used the term "estrogen" to describe any or all of the various estrogen-like hormones that women make. Hey, they also use the term to describe any estrogenic hormone made by a horse, or in a factory. We have a videotape showing what you need to know to use estrogen safely. We show you illustrations of over ten different types of estrogen, and that's in just a half an hour. All the hours of talk you've heard about this study from top officials and authorities- have you heard any of them tell you that you have some other option?

The Nitty-Gritty Details

The Journal of the American Medical Association (2002 July 2;288:58) reported on 16,000 women. About 8000 of them were given PremproÆ. This is the leading brand of conjugated equine estrogen (made from pregnant mares) and medroxyprogesterone (a synthetic progesterone). The other 8000 women got placebo.

After five years, they stopped the study. Each year, for every 10,000 women who took these hormones, compared to the women who took placebo, there were 7 more coronary events (such as heart attacks), 8 more strokes, 8 more blood clots going to the lungs, and 8 more invasive breast cancers. On the benefit side, there were 6 fewer colorectal cancers and 5 fewer hip fractures in women on the hormones.

Now, no one wants to experience any of these illnesses, but the researchers did report that when they looked at overall death rate in the two groups, there was no difference. It will be interesting to see what the story is there as time goes on. Five years is not long enough to see any difference that may be there.

Are Synthetic Hormones Always Fatal? (Wink ;-)

In this study, it took about three years or so to see an increase in breast cancer. The increased heart problems occurred more often in the first year, presumably among women who had some predisposition. The numbers were small, 37 heart attacks per year per 10,000 PremproÆ users and 30 heart attacks per year in placebo users. If I had hot flashes, I'd try everything else first, such as exercise, Black Cohosh, vitamin E, soy isoflavones, and I'd avoid alcohol, caffeine, and spicy food. If that didn't work, even if all my doctor knew about was PremproÆ, I might go for it.

It is Time to Learn More about Natural Hormones

Check out our web site for more about hormones, both natural and less natural.

A recent piece of evidence that your own natural hormones have a vastly different effect on you than the synthetic ones is a Dutch study that started in 1975. Researchers enrolled 9,450 women and tracked age of menopause and death from heart disease. The women were from 35 to 65 years old when the study started. After an average of 20 years of follow-up, they found that those women who went through menopause at the age of 52 or later had only 82% the cardiovascular death rate of those women who went through menopause at the age of 44 or earlier. The longer these women menstruated, the less heart disease they had. That means, the longer they were exposed to their own natural hormones, the less heart disease they had. That's from the American Journal of Epidemiology ( 2002 Feb 15;155(4):339-45).

As our videotape shows, there is a lot of evidence that the horse estrogens are too potent for humans. If we think we need to replace a hormone, it is safer to use the hormones we naturally make. However, there has not been any large study of natural hormone replacement to compare with the one above. We need to exercise caution and treat each woman as the individual she is.

To learn how to use folic acid and cruciferous vegetables to decrease your risk of breast cancer, come check out our videotape.

Is More Medical Care Always Better?

A recent article in The New York Times says "Research Suggests More Health Care May Not Be Better." I'm not sure how long this article will be available online for free, but this Dartmouth study proves what I have always suspected. When there are more specialists and hospitals, the result is that we use them more, producing higher costs. The surprising fact is that health doesn't seem to improve.

And now, the Mail... Vitamin A and Hip Fracture

Dear Doctor,
"According to the UC Berkeley Wellness Letter, new studies show that large quantities of Vitamin A, over 5000 IU, are associated with increased bone fractures in menopausal women. What would you say about this? I have been taking vitamins I purchase from your clinic that contain 25,000 IU Vitamin A, of which 10,000 is in the form of fish liver oil and 15,000 is beta-carotene. Doesn't that pose a threat to me?"

Sincerely, Carolyn L.

Dear Carolyn,
Well, it is not the threat it first appears. In the study, beta-carotene didn't influence fracture rate, only vitamin A as from fish oil, so your dose is 10,000 units, not 25,000. Second, as we'll explain in a moment, how much this applies to you is a bit unclear, and depends on several factors. Vitamin A deficiency is more common than vitamin A excess, and more hazardous. I'll make a recommendation at the end. Meanwhile, for both men and women, here's what you need to know...

Vitamin A and Hip Fracture

The study you refer to was published in the Journal of the American Medical Association (2002 January 2;287:47). A total of 72337 nurses aged 34 to 77 years were followed for 18 years. During that time, 603 women suffered a hip fracture not explained by trauma. Women were categorized by their intake of vitamin A, and those in the highest fifth of consumption were compared with those in the lowest fifth.

Study Results did not Apply to Women taking Estrogen Replacement

Those women consuming the least vitamin A experienced 63 fractures over the period of 18 years compared to 97 fractures in those consuming the most. The figures were then adjusted for other factors known to influence fracture rate, such as weight, smoking, and intake of estrogen, vitamins D and K, calcium, and alcohol. After these adjustments, the researchers found that there was no significant difference in the fracture rate in those women using estrogen.

For those Women not on Estrogen, Fracture rate Increased

What was significant was that for every 1000 women who were not taking estrogen, those who were in the highest fifth of vitamin A consumption from both food and supplements had, over each ten year period, 15 fractures versus only 6 fractures in those consuming the least amount of vitamin A. That is, the fracture rate increased about two and a half times.

Study Group not Representative of the General Population

The editorial which accompanied this article pointed out that this group of nurses was not representative of the US population as a whole. Those in the group that consumed the least vitamin A actually consumed as much vitamin A as the average US woman, and those nurses in the highest fifth of vitamin A consumption were in the top ten percent of consumption when considering the US as a whole. Excluding women who use hormones, it would be more accurate to say that those in the top 10 percent of consumption have a higher fracture rate than those consuming an average amount. Remember too, the statistics showed an increased risk only when vitamin A consumption from both food and supplements was combined together. When they applied the statistics just to supplemental vitamin A, there was an insignificant increase in the hip fracture rate. This could be because diets high in vitamin A are different in some undiscovered way from a diet lower in vitamin A. Or it could be that if you give women enough supplemental vitamin A, you'd create a strong enough effect that they would suffer a statistically significant increase in hip fracture rate.

Vitamin A Deficiency, however, is Common

The US Department of Agriculture Nationwide Food Consumption Survey and the National Health and Nutrition Examination Surveys both found that over 20% of the US population come up about a third short of obtaining even the recommended daily allowance of vitamin A. Vitamin A deficiency can impair our immune system (therefore our resistance to cancer and infection), result in visual damage, and cause many other problems. For example, one US hospital reported that women with localized cervical cancer were more likely to consume less than 3450 IU vitamin A per day, compared to women who did not have such cancer.

High Doses of Vitamin A are Helpful in Some Situations

Women with breast cancer respond better to treatment when they have higher blood levels of vitamin A. The eye disease retinitis pigmentosa responds favorably to 15,000 IU vitamin A daily. Men who chew tobacco develop precancerous lesions in the mouth called leukoplakia. In one study, about 57% of these men experienced complete remission with 200,000 units vitamin A a week for six months. Vitamin A 150,000 IU daily for three months proved helpful for some women with fibrocystic breast disease. I could go on. You get the idea. Remember, in all these cases people were monitored for side effects and I recommend the same for you.

What We Really Need to Know

While this study teaches us that the highest levels of vitamin A intake are associated with an increased rate of hip fracture in women, I would like to see a study looking at both men and women across the entire spectrum of vitamin A intake. In addition, we need to look not just at hip fractures, but at overall quality of life and at death from all causes.

The Other Side of the Sword

As the editorial that accompanied this study comments, "Other populations, with diets less rich in vitamin A will require further study to avoid confronting the other, even more hazardous side of the sword-vitamin A deficiency."

Beta-carotene and Vitamin A

Carolyn, you report you are taking "25,000 IU Vitamin A, of which 10,000 is in the form of fish liver oil and 15,000 is beta-carotene." To repeat, those 15,000 units of beta-carotene are made into vitamin A only if you are low in vitamin A. If you have enough, the beta-carotene is used only as a carotenoid, and does not add to the 10,000 units of vitamin A in the supplement. You cannot overdose on beta-carotene or any of the carotenes. To learn why, and to learn more about beta-carotene, click here. (In the study you mention, Carolyn, there was no increase of hip fracture with higher doses of beta-carotene.)
So, you are taking not 25,000 units of vitamin A, but 10,000 units. Yes, this is above the amount that increased the fracture rate noted above, but it is also at the current "safe upper limit" set by the Institute of Medicine, even for pregnant women. For more information about vitamin A, click here.

Whan about Men?

Men, like women, develop osteoporosis when they live long enough. We men just start to lose bone a decade or two later than the ladies. So, men, I'd pay attention to this issue as well.

My Final Recommendation

In response to this study, our favorite manufacturer, Thorne Research, is looking at the amount of vitamin A in all of their multiple vitamins. We may start to carry their "Women's Supplement" with about 5000 units vitamin A. We currently have their wide-spectrum supplement that contains 7500 IU vitamin A as well as mixed carotenoids, which I prefer to straight beta-carotene. While I think long-term multivitamin supplementation is effective in lengthening life and improving the quality of life, we don't want to take any chance that those supplements might cause harm. Based upon the study above, and to avoid any possible danger, we are discontinuing the multiple vitamin that you mention above.

Thank you for your helpful question!

Yours for good health!

Douwe Rienstra, MD