Dr. Kathy Maupi his is episode 29 of the BioBalance Health podcast. I’m Dr. Kathy Maupin. Brett Newcom nd I’m Brett Newcomb. Today we’re going to be talking about a new article that came out in JAMA, the Journal of the American Medical Association, which contradicts what has been the perception of hormone replacement therapy for the past seven years. And that perception came from the Women’s Healthcare Initiative (WHI) in 2004. It’s really had a significant impact on the medical care that men and women receive as they reach later middle age and go through menopause and andropause. Kathy, you know all about this. Dr. Maupi his came out and I had my phones filled. Everybody was calling me because I then believed, and I still believe even more, that replacing hormones is very important to people being healthy. The headline was “Hormones Cause Breast Cancer”. That’s what they had in the headline. And throughout the paper it was like a press release from the people who did the WHI. But it was a misinterpretation. Dr. Newcom hat was in 2004? Dr. Maupi ight, but now we have a revision of that which correctly evaluates the study, looks over all the things that were put out in the press, and interprets them in a way that is proper. Dr. LeCroix, a woman, was the researcher. She worked with a group of women that did this research. The Women’s Healthcare Initiative did not tell us what it should have. The results were different than the press release. Dr. Newcom o why were the results different? The Women’s Healthcare Initiative basically, as I remember it, as I understand it, made the announcement that hormone replacement therapy, particular for estrogen, was an unsafe medical practice, that it would lead to increased examples or incidents of breast cancer in women. And the current research says that’s all incorrect and it’s incorrect for some specific identified reasons. What are those reasons? What do women need to know today, and their doctors? Dr. Maupi omen need to know, and your doctors need to know, that estrogen is not the problem. Estrogen in this study was paired with a progestone. So Premarin is estrogen and Provera is a progestone. They were put together and in that part of the study where all the women took that, those people had a slightly higher risk of breast cancer. But in the arm of the study where the women who had hysterectomies only took Premarin, which is estrogen, they had a lower risk of breast cancer. For them to leap from these results to the results that say estrogen causes breast cancer is absolutely wrong. That’s not what the study said. Dr. Newcom ell there are two fundamental flaws in that. One is the sort of globalization or generalization to the term “estrogen”. So, all the derivative forms of estrogen are labeled incorrectly in the mass media and mass communications. Dr. Maupi f you say “estrogen”, it doesn’t mean all estrogens because every single estrogen is different. Every single estrogen that you take is different in terms of what it’s made of, it’s different in terms of how you take it. So it could be bio-identical, that’s much less risky than Premarin which is horse urine estrogen. I’m not saying anything about Premarin in terms of disliking it for that reason. However I didn’t write it. But it’s still very safe in terms of breast cancer and heart disease. That part of the study documented that, but no one in America was told that. So it’s not just estrogen, they’re not all the same. They’re talking oral estrogen. Dr. Newcom ell that’s the second issue, the delivery method. Dr. Maupi ow they get it. If you take oral, that’s a little more risky than transdermal which is more risky than vaginal, which is more risky than pellets. And pellets are the safest estrogen form, which is why that’s what I use. Because it’s the safest and most effective. Dr. Newcom hat makes it safest? Why are pellets safe? Dr. Maupi ecause it doesn’t go through your stomach. Because you aren’t taking it orally. We call it the “first-pass effect”. If it goes through your stomach, it’s absorbed by the liver and changed into multiple things. Then when it comes out . . . Dr. Newcom o the metabolic process from taking it orally is different from the metabolic process from the pellets that are injected under the skin? Dr. Maupi ight. They’re under the skin and your body picks up pure estrogen or pure estrodial, excuse me, and pure testosterone from the pellets and it takes it to your body, it crosses the blood-brain barrier as a pure form. When you take it as a pill it goes through your liver and makes all kinds of other forms of estrogen and it’s not good for you. Dr. Newcom o the digestive process and the chemistry process of the liver for what it normally functions to do impact on the estrogen if you take it orally and they don’t impact on it if you take it under your skin as a pellet. Dr. Maupi ight, and that’s documented in many studies. In between those two generalizations, I mean the oral verses the pellets, between those is transdermal which is much safer than oral because when it goes through your skin . . . Dr. Newcom o, transdermal is a lotion or a cream that you rub on your skin? Dr. Maupi r a patch. Dr. Newcom r a patch that you wear and it’s absorbed through your skin tissues. And how do the breakdowns on that compare to the pellets that are inserted? Dr. Maupi hat creates a lot more of the estrone which is an old lady estrogen which is the source of breast cancer. And blood clots. So, that’s why the risk. Dr. Newcom t’s a higher risk. Is that what the Women’s Health Initiative was actually referring to? Dr. Maupi hat’s what they were referring to. But really what they found was just a slight elevation. It was amazing. It was really due to the Provera. They gave estrogen a bad name because Premarin was in the study. But truly what was really wrong was the pill going through the stomach with a progestone in it (that was Provera). That was changed into all kinds of other metabolites that created a higher risk of breast cancer. Dr. Newcom o initially in 2004 why did the medical community take that at face value and why did the “bad rap” for estrogen or for hormone replacement therapy continue for seven years? Dr. Maupi he medical community got kind of blindsided. We didn’t get the information on the WHI study until it was out to the public. They sent a press release that was absorbed by everyone before it came out in the Journal of the AMA. So doctors didn’t even know it was coming. We usually get information a week ahead so we can research it and give our patients the proper advice. Dr. Newcom ou know they used to do that in the early days of television when Marcus Welby was a national show, doctors were told about the Marcus Welby syndrome because it would run on Sunday night and then every Monday morning they’d get calls from people all over America that had watched the show reporting those symptoms. So that whole mass distribution communication process got involved. Dr. Maupi t’s very important and the journalistic community has a burden to actually read the research and make sure what they’re giving to the public is actually true. Dr. Newcom ut what they tend to do is not read it and go to “experts” and ask for a sound bite. And actually my understanding is that that’s what happened in St. Louis. When this new study broke in JAMA, and LA times broke it, and it hit the internet everyone was going, “oh my gosh, maybe replacement of hormone therapy isn’t such a bad thing.” Dr. Maupi his was a retraction of the WHI study. Dr. Newcom aybe we should go and look at that or reconsider that and then the news media went to the research hospitals in St. Louis and asked a male physician and said, “What do you think about this?” Dr. Maupi nd he said “Oh that retraction is all bunk.” He didn’t give us any reason. He didn’t read it. Dr. Newcom ased on not reading the article. And not doing the research. But he didn’t just say it’s all bunk. He said women don’t need it. Women, who have those issues, don’t need it. Dr. Maupi ell, he’s not a woman, he has no idea how much we need that or not. Most of my patients wouldn’t be living a real life if they didn’t have their hormones. Dr. Newcom o we have the issues with the way the research was done originally, the way the media covers the issues, the way doctors absorb and reflect the communication back to their patients. And then you have some recommendations that when women go and see their doctor or when people go and see their doctor complaining of symptoms, complaining of issues there are certain, (three or four), criteria that you say people ought to look at when the conversation isn’t real clear for them. Can you run through what those points are? Dr. Maupi ell, some of those things have to do with making sure you ask the question the doctor can answer. And if he can’t answer it and says ‘you don’t need to know about that’ or dismisses you, you probably need to find another doctor. Or pursue the question a little bit more safely. Are you talking about all the estrogen questions or are you talking about any question? Dr. Newcom ’m just talking in general. If I go see the doctor and the doctor is dismissive of my concerns and the doctor tries to placate me and say “oh well that happens when you get old” or “that happens sometimes and you just have to learn to deal with that.” You know I have a tendency to think doctors know what they’re talking about so I’ll just go away and suffer. Dr. Maupi ight, it’s a wastebasket term for doctors. It means ‘I don’t have enough time to explain this to you and I don’t have a good answer for this so you need to1 get out of my exam room’. Dr. Newcom e did a podcast a couple weeks1 back on the process for making good medical decisions. And one of the things that you1 said at that point was that you should ask yourself and you should ask your doctor. “If1 I don’t take a particular medicine or do a particular intervention what happens? What1 happens if I don’t act or don’t move any differently than I have acted and moved? And1 if I do this intervention what happens? What are the costs or benefit ratios for doing1 it and not doing it?” Dr. Maupi he risk of either doing it or1 not doing it. Dr. Newcom nd in looking at the estrogen1 research the two pieces, the two ends of that, I think one of the things that really shouts1 out is look for global generalizations of a generic type of drug as opposed to a specific1 drug or a specific intervention. And the other is, ask your doctor to slow down and talk1 to you. Ask them if they have done the research, if they’ve actually read the study.1 Dr. Maupi f they’ve actually read the study. It’s very important that they read1 the study. And that was my problem with advising my patients when the WHI study came out. All1 of a sudden I’m flooded with phone calls and no information. And that’s because I1 wasn’t given the whole study. I actually read the whole study and realized that it1 had been done poorly. Dr. Newcom n specific to the practice that1 you have and the hormone replacement therapy that you do, one of the points that you constantly1 make when you talk to your patients is if you don’t do this then what other kinds1 of issues might you have or what other kinds of medicines might you be taking? Because1 one of the tradeoffs is if this works for you, you can come off of this medicine, that1 medicine, the other medicine. So when you calculate cost benefit ratio, those things1 need to be considered as well. Dr. Maupi ight, so it’s cost, but it’s1 more risk. The answer to the “if you don’t take hormones” question is you increase1 your risk of Alzheimer’s, you increase your risk of heart disease. If you take estrogen1 or estrogen in particular forms, it doesn’t increase your risk for heart disease, it decreases1 it. All of that and you don’t have depression, you don’t have anxiety. In general if you’ve1 had depression/anxiety enter your life after 40 it fixes that. You can get off all those1 medicines. Dr. Newcom nsomnia.1 Dr. Maupi t helps Insomnia and that’s amazing. That’s one of our subjects we’re1 going to be talking about. Dr. Newcom o depression, anxiety, insomnia.1 Dr. Maupi t prevents Alzheimer’s, and heart disease, it actually prevents muscle1 shrinkage, and decreases your risk of possibly being in a nursing home and being cared for1 as you’re older. You maintain your muscles and your bones. No osteoporosis medicine.1 Dr. Newcom t isn’t a panacea and it doesn’t guarantee those things. But statistically1 there are reductions of risk and there are improvements for most of the patients that1 have had hormone replacement therapy. Dr. Maupi hat’s right. And if you don’t1 take it increases your risk. In the end it’s really important to ask what happens if I1 don’t? What happens if I do? Almost with every treatment. Especially in hormone replacement1 therapy. Dr. Newcom asically what we’re saying1 is look at the information that’s out there. Take the time to talk to your doctor. Make1 sure that you get your questions answered. But also talk to yourself about the cost benefit1 ratio. If I do this, if I don’t do this, what are the trade offs? And, if you have1 specific questions about this or any of the other podcasts that we have done please email1 those questions to us at podcasts@biobalancehealth.com. And also if you have time I’d like you to1 go out and look at my blog which is brettnewcomb.com where I talk about what I believe about good1 therapy and how to get and do good therapy. Dr. Maupi nd if you’d like to know more1 about BioBalance Health or Bio-identical hormones visit our website biobalancehealth.com or1 call 314-993-0963.