Excerpt
Estrogen: The Natural Way
Introduction
The Estrogen-Diet Connection
by Barry Elson, M.D., Joyce Duncan, M.D., and Samuel Gladstone, M.D.
Women need estrogen. But how much estrogen do they need? And for how long? Medical science cannot answer these questions with certainty. While a growing body of research suggests that estrogen may protect hearts and bones, other research points to possible increased risk of breast cancer from overexposure to estrogen. Nature has programmed women’s bodies to produce less estrogen as they grow older. We do not fully understand why estrogen levels diminish naturally. We do not know what levels of estrogen will benefit women without endangering them.
This uncertainty leaves women with a distressing dilemma: Estrogen pills appear to protect many women against some of the discomforts and diseases of aging, but these same pills may place them in harm’s way. Medical research indicates that to secure the long-term benefits of conventional hormone replacement therapy, long-term use may be required. With long-term use seems to come increased risk of breast cancer. Amid the confusion, women are looking for ways to replace lost estrogen without endangering themselves—for ways to maintain the health of their hearts and bones while protecting themselves from breast cancer.
The estrogen decision is a medically complex individual choice—one not to be taken lightly. Estrogen and progesterone may be helpful to some women, but these same drugs may be harmful to others. For some, they alleviate discomfort. Hot flashes cease. Emotions stabilize. Languishing libidos reawaken. Minds sharpen. For others, hormone replacement therapy increases discomfort. Nausea, headaches, anxiety, irritability, moodiness, abdominal bloating, fluid retention, vaginal discharge, rashes, itching, nasal congestion, depression, breast tenderness, and increased appetite may accompany the ingestion of estrogen and progesterone. While hormone replacement therapy appears to decrease the risk of heart disease and osteoporosis, other health problems may result from its use. In The Estrogen Decision, Susan Lark, M.D., points out that increased risk of liver and gallbladder disease, high blood pressure, blood clotting, diabetes, uterine fibroid tumors, endometriosis, and, most important, breast cancer may be side effects of pharmaceutical estrogen. Isaac Schiff, M.D., chief of obstetrics and gynecology at Massachusetts General Hospital, sums up the predicament clearly: “Basically, you’re presenting women with the possibility of increasing the risk of getting breast cancer at age sixty in order to prevent a heart attack at age seventy and a hip fracture at age eighty. How can you make that decision…?” The pros and cons of hormone replacement therapy weigh heavily on all menopausal women.
Most women believe that taking estrogen pills is the only way to obtain the health benefits of estrogen after menopause. Few know that plants contain different forms of estrogen. These plant estrogens—called phytoestrogens, isoflavones, or lignans—appear to provide estrogenic effects while reducing the risk of breast cancer. Soy and flaxseed contain substantially larger quantities of plant estrogens than other foods. Exciting new research suggests that consuming soy and flaxseed may provide estrogenic benefits while decreasing the risk of breast cancer.
Not long ago, any suggestion that dietary changes might provide health benefits comparable to medication would have sounded like the ravings of a health-food fringe. Today, research has changed that perception. The beneficial effects of diet on heart disease are now widely acknowledged. New studies point to the possibility that certain cancers, as well as osteoporosis, may also be affected by diet. The New England Journal of Medicine, the Journal of the National Cancer Institute, Lancet, the Journal of Steroid Biochemistry and Molecular Biology, Maturitas: Journal of Climacteric and Postmenopause, Cancer Research, and the British Medical Journal are just a few of the prestigious medical journals that have published articles pointing to the potential protective effects and health benefits of soy and/or flaxseed.
In this important book, Nina Shandler shows women how to reap the potential benefits of plant estrogens. By taking her own self-care seriously, she has paved a path for other women. Using reputable medical and nutritional research, she has put an estrogenic dietary program within the grasp of every menopausal and postmenopausal woman. By clearly charting how much soy and flaxseed have demonstrated specific health benefits, Shandler enables women to plan their diets to meet their own needs. Her nondogmatic approach encourages women to use estrogen-rich foods as either an alternative or complementary form of medicine. Women who wish to avoid hormone replacement therapy will find Shandler’s personal story and her approach reassuring. Women who decide to take hormone replacement therapy will find a measure of comfort as they examine the potential breast cancer-protective benefits of soy and flaxseed. Best of all, the author’s estrogen-rich recipes are fun, fast, and delicious. We can personally attest to their mouthwatering goodness. Everything from Shandler’s kitchen, from breakfast to dessert, tastes like pure indulgence. Women will not have to sacrifice their taste buds to comply with this diet plan!
THE MANY FACES OF ESTROGEN
Before sitting down to consume daily doses of dietary estrogen, women need some questions answered. If estrogen is estrogen, then what difference does it make whether it comes from pills or plants? Why is it that the estrogen in hormone replacement therapy places women at greater risk for breast cancer, while the estrogen in soy and flaxseed protects women from breast cancer?
Contrary to popular belief, estrogen has many forms. Some appear to increase the risk of breast cancer, others to reduce it. Some estrogens are produced by the body, and some are found in animal foods, some in the environment, and some in plants.
Within the body, estrogen takes three primary forms. A growing body of research indicates that two forms promote cancer and one appears to protect against cancer. When women take conventional pharmaceutical estrogen replacement therapy, they ingest the two cancer-implicated forms of estrogen. When women eat soy and flaxseed, they consume weak plant estrogens that may actually guard against breast cancer.
ESTROGEN: CANCER PROMOTER OR
CANCER PROTECTION?
To understand how estrogen can both promote cancer and protect against cancer requires untangling its multiple forms. The estrogens produced by the body come in different strengths, comparable to the octane levels of gasoline. Estradiol, the highest octane, is eighty times more potent than estriol, the weakest. Estrone, the midgrade octane, is twelve times stronger than estriol. All three grades do largely the same work. All keep hearts healthy, bones strong, skin young, and vaginal linings moist. All permeate cells from head to toe, beginning at conception. Different forms of estrogen are more or less active at different stages of life.
In childhood, women’s bodies produce small quantities of estrogen. Then in adolescence, the ovaries activate, producing twenty times as much estradiol as in childhood. As menopause approaches, estradiol production slows. In menopause, the ovaries stop producing estradiol, but other organs and tissues, primarily the adrenal glands and fat cells, generate limited amounts of the midgrade estrone for as long as twenty years.
Both the estradiol generated by the ovaries and the estrone manufactured by the adrenals, fat, and other tissues have cancer-promoting potential. It seems to be largely the responsibility of the liver to regulate estrogen, to provide protection from the estradiol and estrone. The healthy liver appears to transform estradiol and estrone into a benign mix by changing a portion of the estradiol and estrone into estriol. This transformation seems, at least in part, to disarm the cancer threat. Systematic and intensive investigation by H. P. Lemon, M.D., reported in the Journal of the American Medical Association, indicates that the balance of all three estrogens may be a key to lowering breast cancer risk. Evidence suggests that if the balance is thrown off—if the proportion of estradiol and estrone outweighs the proportion of estriol too heavily—the risk of breast cancer increases. Given this research, some nutritionally oriented physicians prescribe an unconventional form of hormone replacement therapy. These pills include all three forms of estrogen in proportions adjusted to mimic a low-risk premenopausal balance.
Nevertheless, the earlier women start menstruating and the later they stop—in other words, the longer their exposure to strong estrogens—the greater their likelihood of developing breast cancer. Prolonged exposure to strong estrogens contributes to greater breast cancer risk.
Excess weight appears to endanger women in much the same way. Fat cells produce estrone. Overweight women are exposed to a lifetime of strong estrogen, increasing their risk of breast cancer.
There is another way women prolong their exposure to the two strong cancer-implicated estrogens, estradiol and estrone: They take estrogen replacement pills.
Estrogen replacement proved risky to our mothers. A generation ago, doctors believed estrogen replacement would keep our mothers eternally youthful. Unfortunately, the enthusiastic experiment in staying young forever backfired: Estrogen replacement resulted in a tenfold increase in uterine cancer.
Researchers designed a new regime. Women in the 1990s take progesterone to limit the devastation wrought by the two strong estrogens. The currently advised hormone replacement regimen—the addition of progesterone—has eliminated the increase in uterine cancer. Some concern now exists, however, that progesterone may also limit the heart-helpful effects of estrogen even while it seems to increase protection from osteoporosis.
Given past misjudgments, continued wavering, and periodic reassessments, many women feel insecure about their doctors’ advice regarding hormones. They wonder if another deadly cancer risk accompanies their prescription medicine.
Breast cancer is the greatest concern, and women have good reason to worry. Breast cancer plagues one in eight women at some time in their lives. Christiane Northrup, M.D., a gynecologist and the author of Women’s Bodies, Women’s Wisdom, explains: “Since breast tissue has estrogen receptors in it and is estrogen sensitive, it makes sense that in a woman at risk for breast cancer, estrogen replacement therapy (estradiol and estrone) could start a tumor growing that might otherwise have been dormant.”
In the summer of 1995, these fears found more confirmation. Harvard researchers documented the long-term effects of hormone replacement therapy on 120,000 women. They found that estrogen replacement pills increased the risk of breast cancer by 30 percent. With the addition of progesterone, the risk increased to 40 percent. The study’s primary researcher, Graham Colditz, offered clear advice: “Don’t take hormones for a long time if you can avoid it.”
The truly critical question is this: Can women replenish their diminishing estrogen supplies with a potentially cancer-protective form of estrogen rather than a potentially cancer-promoting form?
The simple answer to this question is yes. Potentially cancer-protective estrogen can be found in food.
