If you are a woman, or love a woman, or want a textbook case of the corruption of our medical system by Big Pharma, you need to watch, and share, this video.
(Edit – sorry, I can’t the embed to work, so please follow the link.)
(Edit2: Adam here – I went in and fixed it for you.)
Reminds me of the recently revealed news about how the sugar industry, with the help of a couple of bought-off Harvard researchers, successfully derailed studies on the negative health impacts of sugar, almost certainly contributing to the illness and premature death of…thousands?…millions?
Related: a bunch of links from Dr. Greger (the guy narrating the video) about dietary links to breast cancer. Also, a large-scale study concludes that soy alleviates menopause symptoms and another useful link on that.
Fair Economist
Is the link missing? I don’t see it. Edit: Fixed between when I wrote and the time I posted.
Hillary Rettig
@Fair Economist: Just added it – sorry. For some reason I couldn’t get the embed to work.
Mary Jo
That first link contains a lot of misinformation and much re-writing of history. It’s bad science and you shouldn’t link to it.
I’m no apologist for big-Pharma. I’ve had breast cancer and care about this issue. Seriously, that video is pseudo-science and does not belong on this blog.
Hillary Rettig
@Mary Jo: i take your comment seriously, but example? everything he says is literally backed (on the video itself) by scientific journals.
Fair Economist
I think the video is a little strong. I remember back in the 80’s that HRT was sold as creating a risk of breast cancer, offset by the reduction in heart disease. The epidemiological studies seemed pretty clear, and remember we have long had to rely on epidemiological studies – I don’t think anybody ever has done, or will do, a randomized trial on smoking. With estrogen there’s the compelling additional fact that women *do* have something highly protective that goes away with menopause, and estrogen looked like it was it. Only in the 90’s did it become clear that at least for lifestyle issues the epidemiological studies were quite frequently wrong. For me the lesson came with the failure of all the vitamin studies. So I’m not horrified at the morality of the faulty decisions prior to 2002, although there’s some really important lessons to be learned going forward.
Today there are other reasons still. I’ve been trying to talk my own mother out of HRT for ages but she can’t stand the hot flashes and reproductive tract issues. And, yes indeed, she got breast cancer (which also runs in the family) but chose a double mastectomy so that is much less of an issue for her now. It was caught early and she probably will be fine.
Adam L Silverman
I fixed it for you. Just copy the link, paste it in (do NOT use the embed tool for youtube videos), and hit return to take you to the next line.
laura
I’m at high risk, and my mother’s breast cancer was estrogen fed and so am under orders to avoid soy.
I suffered for years from intense hot flashes. So intense that you could see the steam pouring off me in the wintertime.
I’m a very reluctant hrt user and routinely wean off, and sadly, the symptoms return.
It sucks.
Joel
If you want an honest discussion of the risks of HRT, you can start with this landmark paper and go from there.
I think it’s worth discussing similar pharmaceutical practices that have changed; for example, LABA (long acting beta adrenergic agonists) drugs have long been used for asthma maintenance (as well as COPD and other respiratory conditions). This practice was discovered to increase the moribidity of asthma some thirty years ago. The reasons are largely related to the chronic inflammation that accompanies asthma. Instead of discontinuing the practice of using LABA, the current consensus is to supplement them with inhaled corticosteroids. This currently used regimen is relatively safe and effective, although it has its own drawbacks.
Joel
@laura: The hypotheses that soy phyotestrogens can activate and/or block the human estrogen receptor are very weakly supported. There is no consensus on what (if anything) isoflavone/phytoestrogen consumption does to human health but it’s likely very little. The affinity (measure of binding strength) of phytoestrogens for the estrogen receptor is ~10000 times lower than that of estradiol.
Hillary Rettig
@Adam L Silverman: Thank you!
Cermet
Vitamin D has been shown in studies to reduce the risk of breast cancers. However, recent studies strongly indicate that levels above 75 ng/dL are not helpful and as levels rise higher, can be harmful to health. Levels below the 20’s is rather unhealthy and is typical of most people who do not get enough Sun or in the winter time. Ideal levels are in the low 70’s ng/dL and this level can often be achieved with 1000 – 3000 IU of Vit. D. However, without blood test, one will not know their levels so such tests are rather useful … .
Joel
The hypothesis that phytoestrogen consumption has any effect on human health (positive or negative) is very weakly supported. There is certainly no scientific consensus around that idea.
Pogonip
Those who can, try seaweed–it’s thought to be the reason the Japanese rarely have menopausal symptoms, although of course the soy would figure in too. I had one hot flash in my life, and I just happen to like hijiki in my salads. I eat a lot more hijiki than I do soy. If you’re worried about the arsenic level, soak and rinse as directed on package, then simmer about 5 minutes and rinse again.
Hillary Rettig
@Fair Economist: good insights, and I agree about the “lessons” moving forward, of course.
fyi, I talked to a dr about HRT about three years ago. I remember thinking it was weird to recommend a treatment with such a potentially serious side effect, to correct a problem that wasn’t all that serious. (I had an easier time than you mom, it sounds like.) Also, he didn’t really take a stand, just presented it as an option. I get that that’s what doctors do, but it still felt like an abdication of professional responsibility. And now it does more than ever – at the time, I didn’t have any first hand experience with breast cancer, and so the issue was kind of theoretical for me. Since then, however, a close relative has been diagnosed and treated and so it’s much more concrete. The idea that I could have raised my chances of getting it now horrify me.
Hillary Rettig
@laura: i only had mild symptoms and they sucked, so I wish you well with yours.
have you tried soy?
Hillary Rettig
@Joel: the links I provided say that there’s a weak-moderate effect, and provide some possible explanations. weak/moderate is worth pursuing I think if it helps and doesn’t hurt.
Hillary Rettig
@Pogonip: i love seaweed! thanks for the tip re arsenic; I didn’t realize it washed out.
raven
My boss just told me her PET scan wasn’t all that great. The cancer has grown in her bones but she still feels ok. They are going to try some illformed chemo next. I hope it helps.
Pogonip
@Hillary Rettig: She mentioned she had to avoid soy. Maybe seaweed? It doesn’t HAVE to be seasoned with Asian seasoning. Hijiki tastes great in a salad with any kind of dressing.
Hillary Rettig
@Cermet: another good reminder to do the D – thanks
Hillary Rettig
@raven: :-( wish her well
honestly I’m 57 and I feel like, just in the past couple of years, I’ve passed some kind of generational threshold and now cancer is everywhere. :-(
Joel
@Hillary Rettig: Yeah, I know. There are other papers that say the opposite. Generally speaking, the best papers tend to find nothing at all.
Hillary Rettig
@Joel: the list of sources for the video is here (you have to click on a tab). the one you mention doesn’t appear to be on it.
raven
@Hillary Rettig: Yep, the memorial I went o last week was for a friend who died from injuries from a motorcycle wreck but the word is he probably would have lived but the chemo weakened his heart and he died on the operating table.
Pogonip
@Hillary Rettig: I don’t like wakame, except in soup, for the same reason I don’t like okra. If God had meant me to get slimed he’d have made me a ghostbuster.
If I remember right you’d have to eat about 50 pounds a day of dehydrated, un-reconstituted hijiki to poison yourself.
Hillary Rettig
I have to leave for a while but will check in later this afternoon. I also asked Dr. Greger if he or someone he works with can check in here and address the more technical questions.
debbie
@Cermet:
Also asthma.
Mary G
I had to go on HRT because of problems worse than hot flashes, but my doctor took me off within a year or two, citing the possible dangers. So not all doctors.
Fair Economist
@Hillary Rettig:
Even given the fact that menopausal symptoms are distressing to a lot of women, I agree it’s very odd it gets prescribed as much as it does. It was one thing when it was thought (incorrectly) to reduce the risk of heart attack. But huge increases in the risk of cancer and embolism and measurable increases in the chance of stroke and heart attack? I’m a guy and don’t have that problem but it would take some ferocious symptoms to make me accept that.
Fair Economist
@raven: Sorry to hear that about your boss, raven.
raven
@Fair Economist: Thanks, she’s a fighter. She has a trip to Italy planned with her family and she is determined to make it.
WereBear
Studies are almost impossible to evaluate because they do not distinguish from progestin (patented in a lab and molecularly different) and progesterone (the bio-identical form which must be rubbed into the skin.) Likewise estrogen, but it’s a rare woman who doesn’t have enough estrogen.
In any case, yes, menopause symptoms can be serious and threaten one’s job and quality of life though depression, memory issues, and lack of sleep. I suffered for over a year with perky assurances that this was a totally natural function and I just had to ride it out. Down to two hours of sleep a night. Went in to the doctor, shot flame out of my eyes, and got HRT… Which worked… Until it stopped.
I had to go on bio-identical progesterone, which did work wonders, thanks to the ladies online who patiently spell out the differences. Medical science does not believe it. But myself and so many others have experienced otherwise.
So… Medicine. Not the exact science we wish it was.
CaseyL
Re seaweed – for quite a while I was crazy about snack seaweed and ate it in mass quantities. Snack seaweed is heavily pressed, oiled and salted, so I don’t know if any nutritional value/health benefits remain… but it sure is tasty!
Villago Delenda Est
To paraphrase Vince Lombardi, “Profit isn’t everything, it’s the only thing.”
Fair Economist
@CaseyL: Seaweed is certainly a good source of some trace minerals, notably iodine, but there are others. That would survive most processing short of reduction to components and reconstitution. I suspect the body has the ability to detect shortages of specific nutrients and the sources for those nutrients, and some cravings are driven by the need to address these shortages.
KC
@WereBear: I was just about to mention this. This video is talking about the artificial HRT. My wife’s menopause wasn’t too bad until she started suffering from severe insomnia. She didn’t want to take HRT because of the dangers. After much research she settled on bio-identical HRT. She takes a tiny amount of estrogen and also uses the progesterone cream, as it turns out she’s been “estrogen dominant” for years.
Stella B.
What Joel said. There are studies that show a slight increase in risk of breast cancer with HRT use, studies that show a slight decrease (particularly looking at mortality), and a lot of studies that show no real change in risk. At worst, there may be a slight increase in risk, but breast cancer was a common cancer in women who were lucky enough to make it to that age, long before HRT was invented.
The WHI showed an increase in thrombotic events, but included a lot of older women (60s and 70s) and 1/3 of the women in the study were smokers. Additionally, recent studies seem to indicate that women with more severe menopause symptoms are at increased risk for heart disease. While it’s true that HRT isn’t right for everybody, it’s not true that it is therefore wrong for everybody.
They’ll have to pry that patch off my cold, dead body.
Here’s a good discussion of the sugar paper.
Mel
While I despise Big Pharma (Epi-pen user here!!!) I have to say that this is a complicated issue, and I don’t believe that there is one clearcut answer that applies across the board to every patient.
As with most medical issues, no two patients and no two human bodies are exactly alike. Hormone replacement is a very individual issue, and many elements must be taken into consideration: a woman’s current health status, her family and personal medical history, conditions that might put her at greater risk of side effects from hormone replacement therapy, the condition(s) which hormone replacement therapy will be used to treat, the risk v. benefit assessment, etc.
Hormone therapy isn’t just used to ease the symptoms of menopause. Women with health conditions such as Polycystic Ovarian Syndrome, hormone related alopecia, and various quite serious autoimmune illnesses which impact or damage the endocrine system might at some point in their lives need to consider hormone balancing or hormone replacement to help manage a debilitating illness.
There are definitely risks associated with hormone replacement. However, the risks are greater for some women than for others, because of genetic or lifestyle factors. For example, I cannot take estrogen (this includes HRT and birth control pills) due to an autoimmune clotting factor issue which would greatly increase my risk of stroke or heart attack. However, taking an extremely dose of progesterone 10 days a month has stopped related problems of excessive bleeding and ensuing chronic anemia (as well as helping to greatly lessen the severe symptoms of PCOS). After much research, it was determined that the risk of using progesterone in this fashion was very low in my case. My physician and I mulled it over for several months, tried several other options (none of which were effective); importantly, I was given the right to choose whether to try hormone therapy. there was no pushing of that particular treatment, no promise of a “magic pill” – just a lot of research by all involved, an in-depth discussion of and assessment of all the available treatment options, and an informed decision made by an informed patient and caregiver.
Ideally, that is how all medical decisions should be made. In the real world, it is not how it often happens, unfortunately, as some practitioners are severely rushed to see a high volume of patients per day or rely on incomplete or biased info supplied by pharmaceutical companies or insurers, or in some cases rely on outdated info. this brings me to the next point: I beware of “all-or-nothing” claims from any source, and strongly recommend going to original sources to see if the interpretation being made truly and fully reflects the data and findings of the entirety of the studies being referenced. Sometimes it does. Sometimes it does not. Knowing ALL the implications of a study’s findings is critical to making an informed health choice, I believe.
My physician and I read through the Nurses’ Study and several ensuing studies, and noticed what some researchers noticed as well: that the risk of stroke or vascular / coronary incident seemed to be, overall, greater for women whose HRT was started well after they were in full menopause. The risk appears to be reduced for women whose HRT is started if severe symptoms begin during perimenopause or at the onset of full menopause. Again, each woman is different, and there are exceptions to this trend. But it was a factor that mattered greatly in assessing my particular case.
Some women’s symptoms might be very mild, and definitely not worth incurring any additional risk to treat. Others might have severe symptoms, but have risk factors so high (smoking, history of breast or uterine cancer, clotting factor issues, history of stroke or heart attack, etc.) that although treatment might alleviate much discomfort, the risk is clearly too high to outweigh the benefits. Others might have low-risk, but symptoms that greatly impact their quality of life. I believe that as long as these women are fully informed, and they have proactive, involved medical caregivers, they should absolutely have the right to decide whether they choose HRT or not.
Sometimes studies are used, cited, or quoted by people on either side of an issue in a way that highlights only the portions that support that one side of the argument. I am a big believer in patients and doctors reading the studies themselves, in order to understand the full range of implications that the studies’ findings assert.
Soy, for example has been found in some studies to help alleviate mild to moderate symptoms of menopause in some women. For those women, it is a great solution. For others, it is ineffective. Some women cannot use soy-based products due to a soy allergy. Some women do not get the necessary relief from soy products. Meanwhile, a study conducted by Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College found that, in some women, eating only a “moderate amount” ( about 52 grams ) of soy protein to their diet very day actually turned on genes that can encourage cancer cell growth. As with many studies, this one had it limitations: the study’s longevity did not allow for following the subjects over many years to see if the genetic changes triggered by soy led to an actual increased incidence of cancer in the subjects. the study was published in the September 4, 2014 issue of the Journal of the National Cancer Institute.
If one looked only at headlines or blurbs associated with that study (Eating Soy Turns On Cancer Causing Genes!) one would assume that eating soy is unsafe or unhealthy for women, especially for those at high- risk for hormone-related cancers. But that isn’t the case, thank goodness for people like me who love a soy latte!!! The study’s results were much more subtle and complicated than a cursory look would reveal, and merely indicate that there is great need for more research to clarify the findings and determine if soy’s estrogen in properties do or do not increase cancer risk, and if they do, which women are vulnerable to the impact genetically and which are not. It does go to show that natural remedies also need to be looked at with end eye towards risk-benefit assessment.
You would be surprised how many physicians rely on just blurbs and headlines to “keep up” with the latest research in their fields.
karen marie
@Hillary Rettig: I’m 60 years old, never had HRT treatment, never even discussed it with a doctor. I’m not even clear what hot flashes are. Sometimes I feel overheated, so I turn on a fan. I’ve lived in Arizona for the last five years, which is like a living hell and I spend a LOT of time feeling overheated, but 110 temperatures will do that to a person. Perhaps you or someone else could describe a hot flash – length, for instance. Is it a flash? Is it a series of flashes? How long do they last? My attitude is if it ain’t broke, don’t fix it. And it just never made sense to me to treat a natural process (menopause) as a disease, because it’s not – it’s part of being female.
Mel
Oops in previous comment – “extremely low dose of progesterone”, not “extremely dose of progesterone”.
Also “soy’s estrogenic properties”, not “soy’s estrogen in properties”.
Friday brain + autocorrect = AHG!!!
TroubleMaker
Say what you will about “big pharma”, but even a simple review of this website (nutritionfacts.org) suggests that Michael Gregor has a pretty serious agenda of his own as an evangelist for veganism. He doesn’t seem as nakedly quacky as Mercola or Hyman, but he’s definitely pushing fringey stuff like “leaky gut syndrome” as well as his book sales. I wouldn’t be so credulous to take him at face value.
TriassicSands
And, thus, climate change is a hoax perpetrated by scientists on the take. The damage that a small number of crooked scientists can do is immeasurable.
JR in WV
@karen marie:
Mrs J radiates heat sometimes, at 67. It’s a flash as in starts instantly, feels like she is glowing hot. Sweats profusely. No covers even with a very cool bedroom, still yet.
Not interested in hormonal treatments of any sort, even so.
laurax
Unlike most topics on BJ, this actually is in my wheelhouse. A big part of my job is to explain menopause– and multiple approaches to managing symptoms– to future healthcare providers. The reason soy studies show varying efficacy may be genetic; about 30% of the North American population can metabolize daidzein from soy into equol, a non-steroidal estrogen with B-receptor affinity (that helps with vasomotor symptoms). The rest of us apparently can’t. FWIW, I would refer folks to the North American Menopause Society for current, evidence-based resources about the pros and cons of estrogen +/- progestogens after menopause. I completely agree there is no one-sized-fits-all answer here…and while the absolute risk for breast cancer does slightly rise with estrogen + progestin, we see no increase with estrogen alone in the biggest RCT we’ve had to date. Also, estrogen + progestin decreases colon CA risk, so it pretty much depends which cancer you’d rather take your chances with. Shout-out to Mel’s clinician, who seems to be doing it right. (It being individualized, woman-centered care with a lot of emphasis on specific patient needs and preferences.)
Stella B.
@karen marie: I’m 57, I turn red and sweat literally drips off me. It’s very embarrassing. For almost two years, I tried to wait the symptoms out, during that time I woke multiple times per night, every night, and spent most of the day feeling fatigued and sluggish, often napping for much of the afternoon. I had an assortment of other related problems to add to my misery. Not everyone is as lucky as you are to have an easy menopause. Although menopause is a normal process, its symptoms and time course vary greatly from woman to woman.
A couple of months ago my blood pressure was 100/60 with no medication, so I don’t know why other people take medication for blood pressure … oh wait, I do know that I just happen to be luckier in the matter of BP than many people! We’re all different.
Hillary Rettig
@Pogonip: fyi in case you hadn’t seen it – a great New Yorker article on seaweed as the next “miracle crop,” healthy and uber sustainable.
re okra, my African foster kids turned me onto it. if you ever have chance to have it prepared well – like at a good Indian restaurant where it comes out crispy – it’s great and could change your mind.
Hillary Rettig
@Mel: great detailed perspective – thanks
Hillary Rettig
@karen marie: personally it was like this: I’m sitting around, minding my business, and all of a sudden – whoa! – it’s like somewhat lit a fire and I’m sweating. Also, a lot of putting on sweaters, taking them off a minute later, and putting them back on, etc. not terrible – but not particular pleasant either. still, i think my experience was mild compared with many.
Hillary Rettig
@laurax: thanks! the second link I mentioned regarding soy mentioned that metabolic path.
Hillary Rettig
@TriassicSands: in pretty much every area of life, if someone sets out to deliberately defraud us we have very little protection. (kind of the plot of every Jane Austen novel).
WereBear
@Mel: You are utterly correct: that is how it should work, but rarely does.
The explosion in genetic studies has indicated that there is far more variation in how our bodies work than anyone had ever suspected. This makes Big Pharma’s testing procedures even less defensible, as they tend to eliminate anyone who gets side effects, and then work with a very small pool. Then, when it is prescribed to a much larger population, things can get very bad, very fast.
A serious issue is the statin drugs, which are handed out like candy yet if someone has a particular genetic profile, they can trigger ALS. All for what turns out to be a very tiny advantage. In men. Who have already had a heart attack.
For everyone else, they risk serious side effects for absolutely no benefit.
PST
@TroubleMaker:
I never heard of Dr. Greger, but he has a remarkable ability to inspire skepticism based on tone and emphasis alone. The snark and sarcasm in his voice detract from any dispassionate consideration of his argument. Persuasive people don’t sneer. It’s like he’s trying to play on the insecurities of his listeners, making us worry we’ll be thought idiots if we disagree. To me, he is a lesson on how to be unconvincing, completely aside from the merits of the case.
Denali
My gynecologist assured me that he would prescrible HRT therapy for his own mother. I was on it for 10 years. When studies correlated the increase in rates of breast cancer with the rise in use of HRT, I stopped using it. I haven’t been back to that doctor. I deal with the hot flashes. For me, they are managable. HST is not worth the risk.
Stella B.
@PST: Dr. Greger is also an “expert” on an incredibly wide range of topics. I can predict what his opinion will be without even listening to his boring yet snotty presentations.
@TriassicSands: Those “bought off” researchers recommended That saturated fat be reduced before they were “bought off” and recommended that added sugar intake be no more than 10% of caloric intake after they were “bought off”. Apparently Big Sugar didn’t get any value for their money.
karen marie
@Stella B.: Thanks. I greatly appreciate my (so far) apparently iron constitution!
laura
@Hillary Rettig: I’m directed to avoid soy.
karen marie
@Hillary Rettig: That’s my experience. Alternating cold/hot, more some days than others. It gets confusing living with air conditioning in the godforsaken desert. I never know if it’s me or the air. I constantly check my indoor mercury thermometer to see if I am losing my mind.
laura
@karen marie: here’s my hot flash experience. It feels like a freight train of heat in my chest, neck head and arms. It is sudden, and lots for at least 10 to 15 minutes. I was unable to cool off, beet red, feeling out of control.
They increased in frequently throughout the day and through the night. Sleep was sporadic, interrupted and unsatisfying until early in the morning around the time I’d need to get up.
Could not wear a sweater for years.
In 2011, I had an opportunity to go the Harvard for a winter semester. It was the year in which 3 storms such down the East Coast. I literally threw myself in a snowbank to cool off. While every one else was bundled up for dear life, I was stripped down to bare essentials.
I held out for years and years, but had no alternative to hrt and am a very reluctant user. Sadly, my menopausal symptoms may last the rest of my life.
I wouldn’t wish it on my worst enemy with the exception of that filth dick Cheney or Henry kissinger.
StringOnAStick
@WereBear: I did not know about the stasstastin/gene/ALS connection, thanks. Statins are grossly over prescribed here.
I am lucky enough to have a doctor like Mel’s, not only does she get hrt right for me, she’s the one that figured out my severe vitamin D deficit. The hint was my telling her about soul crushing exhaustion, and yet most insurance will not pay for a blood test to check that as part of your annual physical. My cousin the internist only requests that test if the patient complains of tiredness and they understand that it will cost them an extra $40. It changed my life, that’s for sure, and I live in an extremely sunny state and spend a lot of time outside; some of us just lose our ability to absorb it from the gut as well as we used to. And yet I’ve heard other doctors say it is impossible for someone living here (CO) to be low on vitamin D, while I and a friend have laboratory proof otherwise. Just because someone is a doctor doesn’t mean they know the correct information about everything. Educating yourself and being willing to change practitioners is critical.
Starfish
@karen marie: I am not menopausal. My mother-in-law had SEVERE hot flashes, and she used hormone replacement therapy. After cancer, she had to be on some medicine that made her have even more severe hot flashes.
The people having hot flashes can go from perfectly normal to completely sweaty while sitting in a room that has not changed temperatures in a very short period of time. When my mother-in-law was having her hot flashes, she would stick a cloth or paper or tissue to her head to remove the sweat because she was sweating so badly. This temperature ramping would happen to her multiple times in a day. I
In addition to hormone-replacement-therapy, some of the hormones associated fertility drugs were implicated in breast cancer. A family friend who had multiple instances of breast cancer in her family who took fertility drugs in the 1990s died of breast cancer when she was 34 years old.
Julia Grey
HRT is also useful in treating urinary incontinence and chronic UTIs in older women. Plumps up the relevant tissues, helps close the urethra more securely.
It’s also used in cream form to ameliorate vaginal atrophy, because dryness and thinness in the vaginal wall encourages bacterial invasion.