The McDougall Newsletter
A six-to-eight page bi-monthly publication containing up-to-date and timely health-related information as well as some tasty McDougall Recipes. The cost is: $20.00 per year. Or $3.25 per single copy. The cost outside the U.S.A. is $24.00 per year. Send orders to: The McDougalls, P.O. Box 14039, Santa Rosa, CA 95402. Or call the McDougall Offices at 707-576-1654.


Below is an excerpt of one of the Articles from the November / December, 1995 issue of "The McDougall Newsletter" as well as a Recipe for Chinese Noodle Soup We will be changing this page every few weeks so keep checking back!

HORMONE REPLACEMENT THERAPY (HRT)

IS HRT FOR YOU?

Menopause is a normal, natural, stage of life, which women have been passing through without the aid of meddling doctors and pharmaceutical companies for at least 4 million years. Ending menstrual periods signals the end of child bearing. That's good. A mother will then have at least twenty years remaining to raise her children. After menopause stimulation of the hormone-sensitive organs (breast, uterus, and ovaries) by reproductive hormones is decreased. That's good, too. Over-stimulation causes diseases like cancer, uterine fibroids, and fibrocystic breast disease. (After menopause both the fibroids and the fibrocystic breast disease regress.)

Recently physicians all across America have waged war on menopause, promising to eliminate this scourge from women's lives. One reason for such widespread enthusiasm among doctors is we finally have a pill that works. HRT reduces the risk of osteoporosis-related fractures and possibly heart disease, as well as relieving hot flashes and thinning (atrophy) of the genital tissues.

All these benefits understood, you should never be placed in a situation where you feel forced to take hormones, because there is a price to be paid. HRT increases your risk of breast and uterine cancer, and gallbladder disease. A most distressing side effect is often the reintroduction of monthly menstrual periods. No more than 20-30% of eligible women ever start HRT and about 50% of those who start, stop in a very short time.

MENOPAUSE

Menopause is defined as the final episode of menstrual bleeding. However, the term is commonly used to refer to the transition period when the function of your ovaries is gradually lost. The decrease in production of hormones is due primarily to loss of the egg producing follicles from the ovaries--they are gradually lost as a natural part of aging. For women following the rich Western diet, the time of menopause is commonly between 50 to 51 years. Women following a healthy, low-fat diet commonly have their last period two to four years earlier (Am J Epidemiol, Proceedings of the Society of Epidemiology Research, 1988, p107). A small percentage of women keep menstruating up to the age of 60.

POSTMENOPAUSAL HORMONES

Female hormones are made in the ovaries, the adrenal glands, and many other tissues of a woman's body, including her body fat. The principle hormones are 3 kinds of estrogen, 1 progesterone, and several androgens (male hormones). The function of estrogen is to promote the development of a young girl into a woman, and to grow and maintain her uterus, vagina, and breasts. The most potent estrogen, estradiol, is secreted primarily by the ovaries. Estrone is the principle hormone after menopause. (Male hormones made in the adrenal glands are converted into estrone by the fat cells.) Estriol is the weakest estrogen and plays its role mostly during pregnancy. Because a major site of estrogen production is a woman's fatty tissues (adipose tissue), she may retain considerable estrogen activity after menopause.

Progesterone is referred to as the pregnancy hormone because it prepares the uterus for the implantation of the fertilized egg. Progesterone is produced after ovulation by the developed egg follicle (known as the corpus luteum). Although small amounts are made by the adrenal glands, the production of this hormone essentially ends at the time of menopause.

The ovary and adrenal glands also synthesize male hormones, known as androgens. Androstenedione, the most common androgen in women of reproductive age, is cut approximately in half at menopause. Testosterone continues to be produced by the ovaries, and a appreciable drop in levels is not seen until about 10 years after menopause. Male hormones stimulate sexual interest (libido) and help maintain vaginal tissues.

SIGNS AND SYMPTOMS OF MENOPAUSE

The most commons symptoms of menopause are hot flashes and problems caused by atrophy (thinning) of the genital tissues. Hot flashes are experienced by over 75% of women. More than half will have symptoms for less than 2 years and 15% to 20% will be troubled for more than 5 years. Common complaints associated with menopause are nervousness, anxiety, depression, fatigue, irritability, insomnia, night sweats, forgetfulness, pain with intercourse, and weight gain, especially in the lower abdomen. Weight gain is a consequence of a decrease in physical activity and a decrease in energy expenditure during rest (Ann Intern Med 123:673, 1995). Muscle tissues waste away and fat tissues enlarge. There is also a decrease in scalp, pubic, and axillary hair. After menopause thinner skin, a decrease in the size of the breasts and uterus, and osteoporosis are common.

Menopausal Signs/Symptoms

Vagina
  • Painful intercourse
  • Blood-stained discharge
  • Itching
  • Smaller size
  • Psychological
  • Anxiety
  • Depression
  • Insomnia
  • Altered libido
  • Bladder
  • Frequency/urgency
  • Stress incontinence
  • Bacteruria
  • Skin
  • Dryness/itching
  • Easily injured
  • Hair loss
  • Facial hair
  • Dry mouth
  • Uterus
  • Uterine prolapse
  • Skeleton
  • Fractures
  • Breasts
  • Reduced size
  • Drooping
  • Heart
  • Coronary disease
  • Elevated cholesterol
  • HEALTHY WOMEN NEED LITTLE HELP

    Trim women who exercise and eat a nutritious, starch-based diet have much less trouble going through menopause than women in poor health. This is best demonstrated by the fact that Japanese women living in Japan rarely complain of unpleasant side effects through their change of life. (Lancet 339:1233, 1992; Lancet 337, 1270, 1991). One author recently wrote in the Journal of the American Medical Association, "There appears to be no 'midlife crisis' for the majority of Japanese women, who regard the end of menstruation as one small part of a normal midlife transition associated simply with aging, which few women approach with dread" (JAMA 274:1265, 1995). In fact, hot flashes are so rare for Japanese women living in Japan that there is no word in their language to describe them (Clin Endo Metab 7:17, 1993).

    The reasons for this lack of illness, commonly referred to as the "menopausal syndrome," lie in their rice and vegetable-based diet. In addition to providing overall good health, their diet has some very specific effects. Plant foods contain metabolically active compounds, known as phyto-estrogens (classified as isoflavones). These compounds bind to estrogen receptors found inside the cells, providing a weak estrogenic effect. Three of these compounds--genistein, daidzein, and equol--have been found to be 60 to 100 times higher in the urine of Japanese women compared to Finnish women (Lancet 339:1233, 1992). They are also excreted in 100 to 1000 times higher amounts than the estrogen synthesized by a woman's body. Therefore, even though they have weak activity, because of the large quantities, they produce an important effect.

    In women of all ages these phyto-estrogens are helpful. The growth of human breast cancer cells are inhibited in laboratory tests by phyto-estrogens (Biochem Biophys Res Com 179:661, 1991). Supplementation of a menstruating woman's diet with 60 g of soy protein daily has been found to change her hormone makeup to one that is less favorable for the development of breast cancer (Am J Clin Nutr 60:333, 1994). Elevated levels of estrogen produced by a postmenopausal woman's own body are associated with the short-term risk of breast cancer--a two-fold variation in estradiol levels was associated with a three fold variation in breast cancer risk (J Natl Cancer Inst 87:190, 1995). The rich American diet and resulting obesity elevate estrogen levels.

    Soy products, such as tofu and miso, and boiled beans are known to be excellent sources of phyto-estrogens. However, most plant foods have biologically active substances beneficial to a woman's hormone sensitive organs and her overall well being. Vegetarians are found to have much higher levels of these substances than meat eaters (Scan J Clin Lab Invest 215:5, 1993). When macrobiotic followers (like the McDougall diet), lacto-ovo-vegetarians, and meat-eaters were compared, the macrobiotic women had the greatest production of these protective substances and the meat-eaters the least (J Steroid Biochem 25:791, 1986). You should not be mislead to believe soy foods are the only sources of helpful substances. There are many beneficial biologically active substances in all kinds of plants foods.

    MEDICAL HRT

    I feel HRT is of definite value, especially if you are having unpleasant symptoms that detract from the quality of your life. But there are risks to be taken and prices to be paid for the benefits.

    HRT does not mimic the natural hormone production that occurs during reproductive life, therefore, it is more accurately referred to as "hormone treatment," rather than "replacement therapy." There is no agreed upon clinical or laboratory way to assess the proper dose of estrogen to be given. The amount and type needed varies greatly among patients. Reduction of the hot flashes and improvement in vaginal symptoms are the most reliable indications that the treatment is right.

    Estrogen Pills: The most popular way to administer HRT is by pills. To help prevent osteoporosis 1 to 2 mg of estradiol must be taken (similar doses of .625 to 1.25 mg of conjugated estrogen). Too much results in headaches, nausea, breast swelling and tenderness, and vaginal bleeding. Improvement in the genital tissues can usually be accomplished by a smaller dose. Estrogen therapy relieves stress incontinence in about 50% of women and reduces the risk of bladder infections (Maturitas 7:335, 1985). Oral estrogen treatment is associated with weight gain, and the patient often feels fatter (Clin Ther 12:447, 1990). Oral estrogen increases body fat by inhibiting the burning of the fat (N Engl J Med 333:669, 1995).

    Women who have undergone a hysterectomy will usually be prescribed estrogen alone for part of or the entire month. The risk of cancer of the uterus is increased by estrogen, therefore, women who have their uterus will also always be prescribed progestins.

    For women with their uterus "sequential therapy" has been the most common way to prescribe estrogen and progestins. Estrogen is taken for the first 25 days of each month; progestins are added for the last 10 to 14 days of the 25 day cycle. Although progestins reduce the risk of endometrial cancer, they do not reduce the risk of breast cancer. Synthetic progestins increase the risk of breast cancer (Epidemiol Rev 15:98, 1995). Synthetic progestins also have an adverse effect on the blood lipids (cholesterol and triglycerides) Menstrual periods commonly occur with this form of therapy. Some women prefer to continue having periods--most don't.

    "Continuous therapy" is becoming more popular these days because it eliminates the common side effect of a monthly period that occurs with sequential therapy. Doctors prescribe the estrogen and progestins together throughout the entire month. However, the long-term effects of continuous therapy are unknown. I am worried the even more unnatural hormone environment created by continuous hormones all month long may cause problems (naturally a woman's hormones cycle through the month--a pattern simulated by sequential therapy).

    Transdermal Estrogen Patches: Administrating hormones through the skin avoids metabolism of the hormone by the liver that occurs when the drug is taken by mouth. One benefit that is lost by this route of delivery is improvement of blood lipids (HDL "good" cholesterol goes up and LDL "bad" goes down) by liver metabolism of the drug with oral therapy. The transdermal route causes less elevation of triglycerides and also avoids weight gain seen with oral estrogen (N Engl J Med 333:669, 1995).

    Transdermal gels and creams: These formulations are made up by a pharmacist for the specific needs of the woman. Skin absorption provides the same advantages as the patches. Estradiol is added to a gel base. The usual dose is 1.5 mg in 2 cc (measured in a syringe and applied to the skin). The maximum dose is 3 mg in 2 cc. The gel base allows for a prolonged absorption throughout the day. Creams are absorbed much faster.

    Vaginal Estrogen Creams: Delivery of estrogen directly to the vaginal tissues is particularly effective for atrophy (thinning) and for inflammation of the urethra. However, these hormones are rapidly absorbed into the body, which must be taken into account. Twice the dose of vaginal estrogen (1.25 mg) is required to raise the blood level of estrogen as much as an oral dose (.625 mg). Because it is absorbed, the creams effectively relieve hot flashes. As little as .3 mg of conjugated estrogen will strengthen the vaginal tissues. This lower dose will have a proportional lower risk for cancer and other side effects (breast tenderness, headache, etc.). There are conjugated (Premarin, .625 mg/gram) and synthetic estradiol (Estrace, .1 mg per gram) vaginal creams. Half a gram daily used 2 to 4 times a week will usually be enough to improve the strength of the vagina and surrounding tissues.

    Progestins: Progestin is a generic term used to refer to any substances, natural or synthetic, that effects some or all of the biological changes produced by progesterone. Provera is a synthetic progestin--it is not the same as progesterone which is a natural hormone. Preparations are available in oral pills, skin patches, creams, and vaginal suppositories. The synthetic progestins have more adverse side effects than natural progesterone; for example, synthetics raise triglycerides and lower HDL "good" cholesterol, where as natural progesterone does not (JAMA 273:199, 1995). Synthetic progestins are believed to act synergistically with estradiol to increase the risk of breast cancer (Epidemiol Rev 15:98, 1993).

    Progesterone Pills: Natural progesterone is made from soybeans, and is the same chemical as the progesterone made by a woman's ovary. Taken as 200 mg pill daily it can relieve many of the menopausal symptoms. Taken orally, much of the progesterone is metabolized by the liver before it can reach the tissues, therefore the effects can vary greatly. Progesterone is given to help offset the cancer-promoting side effects of estrogen on the endometrial tissues of the uterus. Assessment of the cancer protection is made by ultrasound or endometrial biopsy. Breakthrough bleeding may be one sign you're not taking enough progestin.

    Since the principle hormone lost at menopause is progesterone, and there is often plenty of estrogen present, restoration of levels of progesterone will often result in all the benefits you are looking for; with relief of hot flashes and complete restoration of your feelings of well being. Progesterone reverses some of the adverse effects of estrogen, relieving breast tenderness and lumps associated with fibrocystic breast disease. Vaginal progesterone creams were found to relieve breast pain in 65% of menstruating women (J Endocrinol Invest 15:801, 1992). Progesterone may also be beneficial for fibroids, PMS, and endometriosis. This hormone is active in the building of bone and preliminary work also suggests osteoporosis might be reversed using progesterone cream (Endocrine Rev 11:386, 1990; Int Clin Nutr Rev 10:384, 199; Lancet 336:1327, 1990). Progesterone does not favorably effect vaginal atrophy.

    Progesterone cream: This form is readily absorbed through the skin, passing via the blood stream directly to the hormone responsive organs; avoiding metabolism by the liver A recent study using progesterone applied to the skin (a dose of 25 mg for 10-13 days) prevented estrogen-induced pre-cancerous changes in the breast tissue of women (Fertil Steril 63:785, 1995). The cream was well absorbed and effective. Your doctor can write a prescription for progesterone creams and gels delivering 25, 50, or 100 mg/daily dose.

    However, many effective preparations can be bought without a prescription. For example, Pro-Gest cream can be purchased in natural foods stores or call directly at (800) 866-9085 or (800) 648-8211. Using one ounce of this cream over a 24 day time period (20 mg/day) will be effective for postmenopausal women. Increasing the progesterone effect for premenopausal women is accomplished by using the cream only from day 12 to day 26 of the menstrual cycle. In practical terms, the dose is approximately 1/4 teaspoon daily--a large dab on the tip of your finger--rubbed into a soft area of the skin. Preliminary research suggests that progesterone cream will help rebuild lost bone due to osteoporosis . (Further information on progesterone cream can be obtained from a book by John Lee M.D. BLL Publishing. PO. Box 2068, Sebastopol, CA 95473--$9.95 plus $2.00 S&H plus $.75 tax in California ).


    Check the accuracy of this information with your doctor before applying information in this newsletter to your health care. Don't change your diet or medication without your doctor's advice.
    Thank you!
    John McDougall, M.D.


    If you would like to read more about Hormone Replacement Therapy or the other articles in this issue:

    More Blood Pressure Pills Kill

    Legitimate McDougall Article In "Journal of the American College of Nutrition" .

    Call and order the November / December 1995 back issue of The McDougall Newsletter for $3.50.


    Here is one of eleven Recipes you will find in the November / December, 1995 issue.

    CHINESE NOODLE SOUP

    Servings: 4

    Preparation Time: 5 minutes

    Cooking Time: 15 minutes

    6 cups vegetable broth

    2 tablespoons soy sauce

    1/2 teaspoon minced garlic

    1/2 teaspoon minced ginger

    5 ounces Chinese noodles

    4-5 green onions, sliced into 1/2 inch pieces

    Place the broth, soy sauce, garlic and ginger in a saucepan. Bring to a boil, and add remaining ingredients. Reduce heat and simmer for 10 minutes, stirring frequently to break apart noodles. Hint: To add a bit more character to this soup, I like to add a few canned straw mushrooms, some canned baby corn and a handful or two of fresh chopped spinach. The brand of noodles that I use is China Bowl Select, by China Bowl Trading Co. These can be found in a natural food store.

    The other Recipes are:

    Mexican Pizza

    Southwest Four Bean Chili

    Black Bean Soup

    Asparagus and Mushroom Sauce

    Asian Rice Salad

    Festive Pumpkin Stew

    Creamy Pumpkin Soup

    Easy Pie Crust

    Pumpkin Pie

    Chocolate Cream Filling


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