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Recent news accounts have highlighted the increased breast cancer risk caused by post-menopausal Estrogen Replacement Therapy. Are we, however, missing the forest for the trees? If a high estrogen level is dangerous after menopause, what about before menopause? Shouldn’t women be worried about their estrogen levels during their reproductive years?
Ingram, et al (1987), Goldin and Gorbach, (1988), and others showed that high-fat diets fuel the body’s mechanisms for producing estrogen. Most women in western nations consume such a diet, resulting in an over consumption and an over-production of estrogens. The activity of the principal estrogen hormone, estradiol, also increases. Estradiol is carried in the blood on special carrier molecules. On high-fat diets more estradiol breaks free from its carrier molecules and becomes biologically active, like soldiers jumping off a jeep and starting their attack. The result is an increased risk of breast cancer and other disorders caused by too much estrogen.
Carrying a low estrogen level has many benefits. Not only is there dramatically less cancer risk, but it reduces the need for Hormone Replacement Therapy following menopause. The reason? Women on high-fat diets have a high estrogen level during their reproductive years. This level then takes a precipitous drop during menopause, when estrogen production is shifted from the ovaries to the adrenals and fat cells. The drop causes many of the symptoms associated with menopause, including hot flashes, mood swings, and vaginal dryness. On the other hand, women who are adapted to a lower level of estrogen before menopause have less of a transition at menopause.
Population studies have shown that a low-fat, vegetarian diet is the ideal way for women to stabilize their estrogen levels throughout life. In Japan, where such diets are common, breast cancer is rare. However, Japanese women who move to the United States soon have the same risk of cancer as American women — at least 400 per cent higher than in Japan. The differences in cancer risk are not due to genetics or the environment. As Armstrong (1975)and Hirayama (1978) showed, the critical factor is the amount of fat, particularly animal fat, in the diet.
So why are so many doctors prescribing Hormone Replacement Therapy? Most of the push relates to osteoporosis and heart disease.
Osteoporosis is very common in Caucasian women, less so among other races. About a quarter of white women over sixty have compression fractures of their vertebrae, and many develop hip fractures due to the gradual loss of bone. But, estrogens are not nearly as good at protecting the bones as women may be led to believe, and they rarely arrest bone loss. At best, estrogens simply slow the rate of bone deterioration.
Other approaches are much more effective, and they do not cause cancer. For example, a major article in the American Journal of Clinical Nutrition reported last year that eliminating meat from the diet can cut urinary calcium losses in half, resonating with other studies showing that populations that follow plant-based diets have enviably low rates of hip fracture. Cutting salt intake can reduce calcium losses even further. Limiting caffeine consumption will hold onto still more calcium, and if patients don’t smoke, they will avoid the 10% loss of bone that plagues chronic smokers.
For heart disease, hormones are no match for lifestyle changes and supplementation. As Dr. Dean Ornish’s pioneering work has shown, a combination of a low-fat vegetarian diet, mild exercise, stress reduction, and smoking cessation is powerful enough to actually reverse heart disease in 82% of patients in one year. But Americans want pills, and they don’t want to be told to change their diets, say many doctors. Many feel that’s nonsense. It is patronizing to assume that every postmenopausal woman is too wedded to her current diet and lifestyle to listen to competent advice.
The real problem is, she is not likely to find such advice. Many doctors still know little about how diet affects health, even when a mountain of research has already been done, and is gathering dust in medical libraries. They rely instead on the traditions of prescribing, which is continually encouraged by drug manufacturers’ aggressive promotions. It is encouraging, however, to witness many brilliant doctors broaden the use of all the tools their medical bags, including prescriptions for diet and lifestyle changes. According to Dr. Andrew Weil, this holistic approach to health will be of benefit to the physician and their patients.
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