Ivys Introductory Comments:

Some of CyberHealth readers are familiar with the Wren study, which showed that breast cancer survivors who took 50 mg of Provera (medroxyprogesterone acetate) every day, with or without estrogen replacement, had only half the rate of recurrence and zero mortality, in sharp contrast to the control group. Wren wrote a very compelling paper (available on Medscape), arguing for protective effect of continuous progesterone and progestins, and suggesting a preventive-type of HRT. But note that Wren used a dose of Provera thats ten times larger than the higher of the two doses commonly used in mainstream continuous HRT.

The well-known study by Chang (1993) has shown progesterone to be very effective at shutting down cell division in the breast tissue. But Chang used direct application of progesterone gel to the breast, which yields high local tissue levels.

We know that high doses of progestins can regress mammary tumor growth. The effect of low doses remains a matter of controversy, with many voices raising concern that these doses increase proliferation and cancer risk.

Thus there is still the unresolved issue of whether progesterone acts differently depending on concentration. Dose-dependent action is typical of hormones; THE SAME HORMONE CAN HAVE OPPOSITE EFFECTS (PROLIFERATIVE VERSUS SUPPRESSIVE) AT A LOW DOSE VERSUS A HIGH DOSE.

Obviously all women, and not just breast cancer survivors, would like to know just how much progesterone to take to lower their risk of breast cancer, whether its best to take it cyclically or continuously, and whether application of progesterone cream to the breasts is a beneficial (and possibly life-saving) practiceor, on the contrary, the most hormonally dangerous thing a woman could do (strictly a minority view, but it does exist).

Many women feel enraged, betrayed, and very bitter at the medical and scientific establishments for not having done the obvious basic research to establish the optimum doses and come up with a preventive anti-cancer hormonal regimen. Maybe we really should march topless on Washington (one of Dr. Loves best ideas).

While there are no clear answers yet, I think Dr.Zavas commentary throws some light on these urgent issues. ( For the newcomers: Dr. David Zava, PhD., is a biochemist with an extensive background in breast cancer research. Hes just finished writing a book on breast cancer prevention.)

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The issue of progesterone is a difficult one. I submitted a grant about 10 years ago that I think would have resolved this issue, but I could never get it fundedmany nights of no sleep over the myopic view of the reviewers.

What I believe, in a nutshell, is that PROGESTERONE AT VERY LOW DOSE ACTS IN SYNERGY WITH ESTRADIOL TO STIMULATE CELL PROLIFERATION. ONLY AT THE HIGHER DOSE DOES PROGESTERONE BEGIN TO DOWN-REGULATE ER AND SHUT DOWN ESTROGEN REGULATED CELL PROLIFERATION. (Ivy: emphasis mine) This is entirely in line with what we know about the actions of early luteal progesterone on mammary epitheliumi.e., progesterone works in synergy with estrogen and there is a burst of cell proliferation followed by differentiation.

Where RU486 [a synthetic anti-progestin] comes in is that it can block the facilitating actions of low dose progesterone on estrogen activated events and hence block cell proliferation. To get real technical, I proposed that progesterone helps estrogen shuttle high energy phosphate molecules along a cascade of protein kinases involved in activating gene transcription of messages controlling cell proliferation. To date, I sit on this information and the experiments I did to prove it.

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Ivy comments:

Because of Changs study, I used to lean to the idea that its simply the duration of exposure to progesterone that shuts off mitosis, but then the application of progesterone directly to the breast must produce high local levels, possibly as high or higher than those at luteal peak. As you can imagine, I do get asked what dose of P is best for preventing breast cancer, and I think what you say is very, very plausible, makes perfect sense, and could save lives. Im 99% sure you are right, and have the information that could save endless suffering and premature deaths of who knows how many thousands of women every year. Direct application to the breasts, however, might make serum levels less relevant. Perhaps not for breast surgery; perhaps then high P needs to be systemic (there seems to be a lot of contradiction in the studies). The trouble with high systemic levels of progesterone is that some women experience side effects such as depression, constipation, weight gain (progesterone is the most fattening hormone, as discovered by the cattle industry), or greater susceptibility to yeast infections. On the other hand, there are also women who thrive on high doses of progesterone; for them its the "feel-good" hormone, the serenity hormone. Ive often wondered if maybe the best solution, at least for some women, might be a dose thats just sufficient for endometrial protection, and an extra application of progesterone cream to the breastsperhaps not necessarily on a daily basis, but often enough to suppress cell division (dont ask me how often that would bebut often enough to prevent any soreness).

I feel Ive had excellent results with applying P cream to the breasts: my breasts feel much lighter, less glandular in spite of my non-timid E2 dose, loose and relaxed, and, very importantly, not any hotter than the surrounding areas (increased surface temperature appears to be a biomarker for increased proliferation). I had a lot of soreness and fibrocystic lumps pre-meno (in the words of my ob/gyn: "These are the lumpiest breasts I have ever seen"). Its all history thanks to progesterone.

Which brings me to this: women need to listen to their bodies because the way their breasts feel is an important signal. Is there any soreness, fullness, tension, swollenness? Do your breasts feel hot and tingly, tender to touch, and always as if "on simmer"? (A rise in the surface temperature of the breasts appears to coincide with the increased tissue proliferation during the luteal phase.)

In my experience with nhrt, there is absolutely no need to tolerate this kind of discomfort (and it might be downright dangerous). A higher dose of progesterone, or an application of P cream directly to the breasts, generally resolves the problem very quickly. The use of testosterone cream also helps, and does so in a dramatically speedy way if you apply a dab of T cream to the breasts.

What a tragic shame that Dr. Zava hasnt been able to pursue his projected experiments. We need this knowledge very badly, since here might lie a clue to saving thousands of lives. I think CH readers will be outraged at the myopic reviewers.

It seems entirely likely that the dose of Provera given to most women is unfortunately the kind of small dose that promotes proliferation. Some large studies have in fact found that a higher breast cancer risk in women using progestin than in women on estrogen replacement alone. In fact it seems that over a quarter of women on continuous HRT with Provera suffer from breast soreness and show an increase in glandular density, a known risk factor for breast cancer. Hence Dr.S. Love might have a point in accusing "progesterone" of being the most dangerous hormone, though she cant seem to figure out how it is that this allegedly highly pro-proliferative progesterone stops mitosis and initiates the apoptosis (cell death) of excess breast tissue at the end of the menstrual cycle (and there is a scientific consensus that progesterone does just that, even if its course of action in the breast differs from the way it protects the endometrium). Being monumentally confused about the effects of progesterone, Love decided to be even more hostile to it than she is toward all the other steroids, thus discouraging women from using the very hormone that shows the most promise in hormonal cancer prevention. Im really, really excited over the kind of research Dr. Zava has been doing.

(Sources: Chang KJ et al. Influences of percutaneous administration of estradiol and progesterone on human breast epithelial cycle in vivo. Fertility and Sterility 1995; 63: 785-91; Wren BG. Hormonal replacement therapy and breast cancer. European Journal of Menopause 1995; 2:13-19;

Simpson HW. A breast pre-cancer test? Preliminary results based on a breast temperature abnormality during the menstrual cycle. Breast Cancer Res Treat 1990; 16:51-55)

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Gail comments:

I think the more we try to understand this, the more complex we realize it is! I had an experience last fall when I had been using ProGest on my breasts regularly for some time, had a period, then my breasts (nipples especially), in spite of continued use of P after the period, got very sore, and hot. This worried me; Id read about increased breast temperature being associated with breast cancer.

Im not sure that the ProGest caused the breast pain; after all Ive been using ProGest for 16 months and putting it on my breasts a lot and this was my only experience of this nature.

Ivy replies:

Note that Dr. Zava plausibly theorizes that "PROGESTERONE AT VERY LOW DOSE ACTS IN SYNERGY WITH ESTRADIOL TO STIMULATE CELL PROLIFERATION. ONLY AT THE HIGHER DOSE DOES PROGESTERONE BEGIN TO DOWN-REGULATE ER AND SHUT DOWN ESTROGEN REGULATED CELL PROLIFERATION." With ProGest, you get what 16mg per gram, as Barry Mizes calculated? The commonly used prescription progesterone cream delivers 100mg/g.

Still, as Gail points out, this is insufficient evidence for concluding that the ProGest dose is in the wrong range to be safe for breast application. Possibly, during just that one cycle Gails own production of estradiol was just such that the ratio worked out the wrong way. During the perimenopausal stage, ovulation and hormone production are erratic, and breast soreness is quite common. Its a period of "hormonal chaos." My experience with breast application has been strictly with the prescription dose, and it has been 100% positive, i.e. I noticed the "shut-down" effect in the cooling down and quick disappearance of any soreness and tension in the breasts. By "quick" I mean within minutes! And if you really want to see "quick," try the male-dose T gel, if you are fortunate enough to have a mate whos using it. The soreness can disappear literally in seconds! No sooner youre putting the cap back on the little jar than youre asking, "Hey, where did the discomfort go?" Talk about an anti-estrogen.

Another factor here is that my experience with P cream has been strictly postmenopausal, and even with nhrt, the average levels of estradiol tend to lower than they are in a premenopausal woman. No more ovulatory surges, thats for sure!

Gail comments:

I assume you saw the tamoxifen story? I wonder how long it will take to have every woman in the country considered at high risk for breast cancer (including every woman over 60) on tamoxifen! I keep wondering about these anti-estrogens, and whether progesterone and other native hormones used in an optimal way (whatever that may be) might not be superior. But it seems that no one is doing the research comparing P use with anti-estrogens, at least that Im aware of . . .

Ivy replies:

Gail Sheehy put it best when she described the lack of such essential research as "the scandalous economics and politics of menopause." Obviously the drug companies can make a lot more money off tamoxifen than they can off progesterone, which, as a natural hormone, is not patentable. In France there is a DHT cream which I imagine would be incredibly anti-estrogenic when applied even in a tiny dose to the breasts (DHT has the advantage over T in not being aromatizable to estrogens). But DHT is a natural hormone also, so forget it so far as the American drug companies are concerned. So far studies have indicated that tamoxifen should not be used for more than five years. After five years, it becomes an estrogen agonist in the breast tissue as well (it acts as an estrogen agonist in the endometriumhence the markedly increased incidence of endometrial cancer in tamoxifen users).

Lynne comments:

My mouth is hanging open. I just watched Vicky Hufnagel (Ivy: a Los Angeles gynecologist famous for her stand against hysterectomies) on NBC say, "we should be looking at non toxic ways to prevent breast cancer like natural progesterone." She also said women should be profiled for the balance of Es to examine risk. I was a little shocked to hear somebody relatively famous take a stand on P.

Of course the other docs think Tamoxifen is wonderful and didnt let on they didnt know what she was talking about.

My ambition in life is to live long enough to say I told you so to these graduate student robots who become physicians never questioning the axiom that E causes bc!

Ivy replies:

Considering that there are SO MANY growth factors for any cancer, the reason E got singled out, and not high insulin, high cortisol, or something like faulty diet and toxic bowel, smacks to me to hostility to women, wanting to keep them hypoestrogenic.

And all the while there is a mountain of evidence pointing to the insulin-driven hyperandrogenicity as very common in bc cases. And of course the central fact that around 80% of bc is postmenopausal (mostly after the age of 60), and at this point mostly in women who have never taken hormones, and thus are severely hypoestrogenic postmeno, and androgen-dominant. Ah, what an unpleasant fact interfering with the simplistic E-based theory: breast cancer in a seventy-year-old whose E levels have been minimal for two decades. This a a lot more common than breast cancer in a premenopausal woman, especially a young (under 35) premenopausal woman, whose statistical risk is miniscule, in spite of her being at her hormonal peak.

When a very young woman develops breast cancer, its tends to be the very aggressive, lethal kind. Survival is best in premenopausal women over 35. The biggest risk factor for breast cancer is advancing age after menopause.

Ivys introductory comments:

Theres been excitement recently over a new abstract that appeared on Medline: Dr. Zavas research on "estrogen and progestin bioactivity of foods, herbs, and spices." Dr. Zava and two colleagues tested over 150 herbs (in the form of herbal extracts) for their ability to bind to estrogen and progesterone receptors in mammary tumor cells.

The six herbs that had the highest binding to the estrogen receptor were soy, licorice, red clover, thyme, turmeric, hops, and verbena. The herbs that showed the highest binding to progesterone receptors were oregano, verbena, turmeric, thyme, red clover, and damiana.

In terms of promoting or inhibiting the growth of cancer cells, it turned out that in general the herbs with the ability to bind to i the estrogen receptors acted like estradiol agonists, i.e. they promoted tumor growth. Yes, soy estrogens were found to promote tumor growth. The picture thats emerging from this and other studies is as follows: in low concentrations, soy isoflavones promote breast tissue proliferation and tumor growth. In high doses, they have the opposite action. This is consistent with what we know about dose-dependent effects of hormones and the need for high doses in hormonal cancer therapy.

I dont think anyone knows as yet at what point the suppressive dose starts, or to what extent it may depend on the levels of the womans own native steroids.

The herbs that could bind to the progesterone receptor were either neutral or acted as progesterone antagonists.

I have asked Dr. Zava to comment on these findings.

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The herbal phytoprogestins I have identified are all listed as abortifacents or emmenagogues (Ivy: an emmenagogue is an agent that can produce menstruation, whether or not fertilization and implantation has taken place), consistent with their being neutral or P antagonists. These chemicals could certainly, and I believe do, have other properties related to progesterones non-receptor mediated mechanisms. For example, progesterone binds GABA A sites in the brain, resulting in a calming effect. Some of these herbs could do the same. The phytochemicals in the herbs could also have other actions, such as those of glucocorticoids, androgens, mineralcorticoids, neurotransmitters, etc. etc. My work only scratched the surface of the multiple properties of phytochemicals. There is much left to be learned.

Bottom line, Mother Nature makes many estrogens that act much like estradiol, but she makes no progesterone-like molecules, at least I couldnt find any in the many herbs I screened. Every herbal extract that showed binding to progesterone receptors was either neutral (had no effect on the cell) or was an antiprogestin (blocked the actions of progesterone). Herbal literature tells us THAT EVERY HERB I FOUND BINDS TO PROGESTERONE RECEPTORS ACTS LIKE AN ANTIPROGESTIN (Ivy: emphasis mine). I think Mother Nature, in all her great wisdom, gave women these herbs to help them have control over their reproduction.

Soy, thats another big story. In my opinion, its not as healthy as weve been led to believe. Soybeans are actually quite toxic unless many of the antinutrients are first removed by fermentation or long cooking, soaking, pressing, and fortification with sea vegetables-in other words, consumed the Asian way. There are a big string of antinutrients in soybeans that remain in many of the "Westernized" soyfoods consumed by Westerners. Perhaps Im wrong and everyone eating soyfoods will live to 100. But they may do it without a fully functioning brain.

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Ivy comments:

This is fascinating: the herbs act as ANTI-PROGESTINS, possibly capable of causing a miscarriage in a sufficient dose; hence perhaps those miscarriages in sheep that graze on red clover.

There is a fascinating book on the millennia-long use of herbs for birth control: "Eves Herbs, A History of Contraception and Abortion in the West," by John Riddle (Harvard University Press 1997).

Re: anti-progestins. Its one of the hormonal paradoxes that either progesterone, progestins, or anti-progestins can regress tumors. One key factor is dose, since the action is hormones is very dose-dependent. I think nature has given us a warning signal about soy by making us dislike the taste and the aftertaste. And the bloating that follows a large portion of tofu is also a clear signal that says: avoid. But then religions have always tried to tell people what to eat and not to eat, and we have a HEALTH FOOD RELIGION spreading like crazy, just as ideological and artificial as trying to eat kosher or macrobiotic. Except that its worse: some of the so-called health food is toxic. Most flax oil is extremely rancid, regardless of refrigeration and opaque containers; some of the herb teas are carcinogenic and/or damage the liver. But we have religion, we have fanaticism and a kind of holy masochism about it, and the idea of testing these things for safety is seen as heresy.

Another property of soy bioflavonoids that needs to be explored is their action as aromatase inhibitors. This means less estrone production from androstenedione, testosterone and DHEA. Maybe thats a benefit for some women, but not for others. Is it a benefit for brain function? In any case, the physiological impact of significant doses of soy flavones should be thoroughly investigated.

Sadly, sometimes the amount of commercial promotion seems in inverse proportion to the amount of research.

I am amazed that genistein is now being sold OTC in pretty potent doses (LEF) -- enough to constitute hormone replacement if several tablets a day are takenyet no clinical trials have been done on this kind of long-term intake thats far in excess of the known Asian intake.

Officially genistein is just a "nutritional supplement." Fortunately LEF is smart enough to tell women with breast cancer to stay away from soy, but I think its the only organization that has issued this warning. Other than Dr. Zava and a handful of scientists, to my knowledge Life Extension Foundation is the only alternative health source that has publicized the fact that small doses of genistein can promote mammary tumor growth. I think it would be best to have a decade of solid human-trial research before unleashing genistein capsules on the market. Right now its mail-order, but within a year or two we could see the hype that we witnessed with melatonin and DHEA.

I want to make it clear that genistein at any dose does not CAUSE breast cancer. Neither does estradiol, or estrone, or any other estrogen (there is some question about possible mutagenicity of a metabolite called 16-hydroxy-estrone, the intermediate step just before estriol). Its only IF a tumor is already present, and IF the conditions are favorable to tumor growth (e.g. hypothyroidism, elevated insulin and glucocorticoids [stress hormones], elevated prolactin, tissue hyperplasia associated with certain macrocysts and/or a history of ovulatory failure, excess n-6 polyunsaturated fatty acids) that estrogens MAY promote tumor growth. Let me emphasize this again: the action of hormones is DOSE-DEPENDENT. Its been known for decades, almost ever since hormones were discovered, that large doses of hormones can regress tumor growth. Thats the basis of hormone therapy in the treatment of cancer (pioneered by the great biochemist Casimir Funk, the discoverer of vitamins; Funk also studied the interactions between hormones and vitamins, stressing the need for balance). A variety of hormones have been used to regress mammary tumors: estradiol, DES, tamoxifen, testosterone, Proveraalways in large doses. Genistein is no different: its been shown to promote tumor growth in small doses, and to inhibit it in large doses.

What dose range is completely safe and protective? I wish we knew.

Lynne writes:

I am a poster child for estrogen dominance and its more than a theory to me. When I first started menstruating I heard periods would be irregular. But mine were wildly irregular until I was fortyoften months without any at all. I would blow up with tender breasts for months at a time. At twenty I began birth control pills for two years until I began to have horrible headaches.

They got better when I quit but I was never the same and noticed a cyclical pattern to the headaches which would start when my estrogen level climbed and waned during the latter part of my cycle.

I went from doctor to doctor. I was given estrogen shots, Clomid, cow ovaries concentrateall of which made me worse. Finally after a bout of hemorrhagic bleeding in my thirties my gyn put me on Provera. I never felt so awful. I stopped immediately even though it meant a D & C would be necessary. This was the first doctor to tell me I needed more progesteronewhich he wanted me to take every month. Since that meant Provera I passed.

I also never got pregnant during any of this time. Sometimes they would say I had PCO disease, sometimes not. One gyn swore if he cut a wedge in my ovaries Id be fine. Then a couple of progressive doctors brought progesterone suppository therapy to NY and I knew that was for me. I hunted them down like a dog and insisted that was what I needed. I felt so good on natural progesterone I wanted to take it every day. But being so young, that created 2 periods a month. So as a compromise, I fudged and tried to take them a few more days than was recommended so I could get more good days in a month.

When I got breast cancer 6 years ago, my alternative doc "looked into it" and recommended I continue but with the natural progesterone cream instead. I was so ignorant. I remember telling him, "I cant get along with that dinky amount of mgs," not realizing that I was getting less progesterone taking my suppositories or the micronized tabs, factoring in absorption differences. Ive taken P in so many forms since the early 80s. I took them on for a few months, then off, not consistently, which may have given me a yo-yo breast cancer inducing problem. I first started with suppositories. Another doc recommended rectal cream, claiming there was no way the vagina could absorb it because there were no blood vessels there! Then the year I spent in California, I took oral, not micronized yet. You had to take it every few hours because it wore off quickly. Then micronized tabs, then oil caps (I thought I had the fluhorrible), then cream, then sublingual P (with the cream) to quell the early morning wakeups.

I found each to have its own absorption characteristics. Barry told me once that even with cream some people metabolize it very quickly, others very slowly. I prefer a predictable, short period of duration so if I overdose I dont have to wait 12-24 hours to recover. (pregnenolone took ages to wear off too) I have had to watch the cream in that regard because I am a slow metabolizer of it. Initially, one pharmacist told me to take t of the 10% npc FOUR times a day. It had me fogged out for 24 hours after only TAKING THE FIRST DOSE. Since then Ive been playing with it. I remember one of the meno list women from Hong Kong had a lot of trouble with it, sluggish, depressed etc. I only had that experience when Ive taken too many suppositories for too long. It created a PMS feeling.

Ivy replies:

Thanks, Lynne, for pointing out the INDIVIDUAL VARIABILITY. Its a constant reminder of our biochemical individuality. One size doesnt fit all. That concept doesnt work too well in fashion; in pharmacology, its potentially disastrous. One womans optimal dose may be another womans underdose or overdose.

Is this important when it comes to progesterone? Potentially, if it is indeed true that a dose thats too low may increase breast cancer risk. Usually it takes the interaction of multiple pathological factors for breast cancer to develop: elevated insulin and cortisol, hypothyroidism, a genetic or immune weakness, inflammatory conditions, exposure to chemical carcinogens and/or radiation, insufficient intake of anticarcinogenic phytochemicals, intestinal dysfunction, and probably other factors we dont yet understand. Ovarian dysfunction, including failure to ovulate and chronic progesterone deficiency, is one of the endocrine pathologies associated with premenopausal breast cancer (Zumoff 1995; Kodama 1992). After a miserable history of premenopausal progesterone deficiency, I seem to enjoy progesterone very much. On occasion Ive taken one gram or even more. Its interesting that in such high doses progesterone seems to produce exhilaration rather than sedation. A friend has also experienced this, and Ray Peat likewise confirms it. Its like being pleasantly, mildly drunk, without any hangover to follow.

Once or twice when I just started using the cream and was very happy with it and using it generously, I got drowsy in daytime, which is unusual for me (I never nap; it just doesnt happen to me). But now only sublingual progesterone has that effect, and only if Im already pretty drowsy. Im too used to it, alas, for it to work well as a sleeping pill; those benzodiazepene receptors are pretty down-regulated in a P junkie like me (I too had a life-long progesterone deficiency, judging by my symptoms). But for a while, yes, SL P was very effective to get me back to sleep in case of early morning awakenings. Once those started happening very often, and finally every morning, SL P lost its effectiveness.

As for oil caps, Wally of WIP told me that they are FOUR TIMES as powerful as plain micronized progesterone. He warned that taking too much "would absolutely knock you out."

P cream remains my favorite. The real importance of P cream, the enormous importance of it, even if you have an effective source of progesterone such as oil caps, is as a potent backup source of P in case of breakthrough bleeding (can happen under stress even with oil P; under stress P is just devoured for stress hormone production), and for use on the breasts in case of breast soreness.

I think I am a pretty fast absorber of dermal P. In fact, within minutes of application I can usually taste the bitter P taste in my mouth. Interestingly, this happens especially when I apply P cream heavily to my hands (but also, say, to my belly), but doesnt happen when I apply it to the breasts only. The breasts seem to intercept the hormone for their own local use.

Another interesting phenomenon Ive experienced a few times is a dramatic change in mood and thinking after using P cream in a time of high anxiety. About half an hour after the application, Id notice a remarkable cessation of anxiety, with "can do" thoughts replacing the thoughts of helplessness and hopelessness.

The first time this happened, I was absolutely stunned. A hormone can change my THOUGHTS? Then, pondering about the mechanism of depression and the well-known phenomenon of AUTOMATIC NEGATIVE THOUGHS (ANTS), I acquired all the more respect for the biochemical substrate of brain function. After a post I wrote on hormones and depression, I received email from a woman who said that she received my post just as she was descending into suicidal depression, and she feels the information in the post saved her life. Never underestimate the effects of knowledge arriving just when it is needed.

The action of progesterone against agitated depression is called ANXIOLYTIC, and has been well established through research. DHEA has some of the same effects. (If you are feeling "down" and lethargic, however, you need an energizing hormone like E2 or T, and a high-protein meal.) And in case you never need the P cream for the purposes I just mentioned, it is still a fabulous cosmetic! Makes your skin very very soft. It is my unscientific observation that if a man touches this luxuriously progesterone-soft skin, hes hooked for life.

(Sources on failure to ovulate and breast cancer: Cowan LD et al. Breast cancer incidence in women with a history of progesterone deficiency. J Epidemioli 1981; 114: 209-17; Kodama M et al. The genesis of breast cancer is a two-step phenomenon. Anticancer Res 1992; 12: 153-160; Zumoff B. Hormonal profiles in women with breast cancer. Obstet Gynecol Clin North Am 1994; 21: 751-72)

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Lynne comments:

Good replyespecially liked the references to ovarian dysfunction. Why wont people call it that??? When I was young I was told that irregular periods are normal for some people. Thats like saying having a bowel movement once a week is normal for some. Ive heard that toofrom an oncologist when I accompanied my friend Ann to the doctor for bladder cancer. Shes had one bm a week for years, is overweight and seems hypothyroid. I did read someplace that that women with bc report more of a history of constipation than others. I dont know whether has been documented as a risk factor in the lit.

Ivy replies:

Its interesting that you brought up this analogy. Constipation is a documented risk factor for colon cancer, another cancer that kills a lot of older women. And it wouldnt surprise me one bit if it did turn out to be a risk factor for breast cancer also. Holistic doctors suspect that "toxic bowel" and "dysbiosis" (pathological intestinal flora, such as Candida overgrowth) both play a role in the genesis of many types of cancer. Calling pathology "normal" just because a certain percentage of people manifest it is sheer medical irresponsibility. Its denial, and a cover-up for ignorance. Its like saying that older people need less sleep just because they cant maintain sleep for as long as in youth, and that for some people four hours is "normal." Its never normal; its just that the doctor doesnt know what to do about it.

Melissa writes:

Well let me tell you!!!!!!!!!:):):):):)

Ivy I found the Activated Charcoal. I couldnt find the Enzyme. The Charcoal worked it worked it worked it worked. Oh thank you so much. We are all smiling. And no one wants me to sleep outside. That was me I couldnt even stand myself. WHEW!

:):):):):):):):):):):):):):):):):):):):):):):):):):):):):):):):):):):):):):):

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Ivy:

My grandmother would love to hear this. Her favorite remedy. Sometimes low-tech solutions are best.

Activated charcoal is an effective detoxifier and de-gasser, and may even be a life-extension agent, according to a Russian study. In larger doses, it seems to lower cholesterol as well as expensive cholesterol-lowering drugs. Its great stuff to keep on hand. And so inexpensive! But I must also sound a note of caution. Activated charcoal treats the symptoms, not the cause. One drawback is that its so wonderfully absorbent that it can absorb some of the nutrients along with the toxins. So dont let this immediate relief prevent you from working on resolving the CAUSES of bloating. See the article below. As Lynne pointed out, the title sounds like a sequel to a horror movie. Well, indigestion is a horror, and some people live with it for decades. There is no need to.

Do you remember the bloated sales clerk I mentioned in CyberHealth 11? Recently I happened to see her again. She looked a lot more healthy and energetic, her belly protruded somewhat less, and her jeans were buttoned. She said shed changed her diet; she eats more protein now. But she was still afraid to eat red meat, so she ate beans instead. "Beans can be very hard to digest," I said. She fell silent, then all of a sudden opened up. "Every time I eat beans, I feel just awful afterwards," she admitted in a half-whisper. "And if you eat them during PMS, they just kill you," I said. "Oh, oh," she groaned, holding her stomach. "Those male experts who tell women what to eat have no idea how hormones influence womens digestion," I remarked. She angrily agreed. I told her about Sally Fallons ideas on enzyme-rich nutrition, and other things along those lines.

At home I pondered how come its OK to discuss genital atrophy and urinary incontinence as symptoms of menopausal hormone deficiency, but gassy bloating, constipation, and other digestive problems that become so common after menopause are still not only largely ignored, but to make matters worse older women are urged to consume large amounts of hard-to-digest beans, tofu, milk (for calcium), whole-grain pasta and the like. And women tend to obey to the point of masochism.

Men seem to have more common sense; they may try a so-called health food, but if it tastes terrible and/or makes them gassy, thats the end of it. Women are often terribly intimidated by health advice, and continue to torment themselves in a good-girl fashion. They naively assume that such advice is based on solid science, so of course anyone who can write an article must know more about what is good for them than they do! To make womens digestive problems worse, even young women suffer from flatulence and worse during the perimenstrual phase, and after menopause of course the digestive function deteriorates in parallel with sleep, mood, memory, urinary continence, muscle tone and so on. Yet newly menopausal women often seem particularly unprepared for digestive changes, and keep asking in a state of shock: "Why am I so gassy all the time? Why does my belly stick out so much?" They dont seem to have made the hormonal connection.

But I have already discussed the hormonal influences in the Part I: chiefly the salivary, pancreatic, and intestinal insufficiency associated with being hypoestrogenic. Now I want to go over some further dietary points.

 

• Excess fiber. Fiber is wonderful, but some women simply overdo it. The right amount seems to be around 20g a day; more than that can irritate the intestines and cause flatulence.

   

   

• Excess cruciferous vegetables. Again, broccoli is wonderful, the whole cabbage family has tremendous merit in preventing cancer, but our digestive system doesnt seem to be quite adapted to it.

   

The good news is that there are ways to get the anti-carcinogenic compounds in crucifers with much less intestinal discomfort. We now have the fabulous broccoli sproutsno, I dont mean that they taste fabulous, but they are edible, and the best thing is that you need to eat just a bit of them instead of the recommended 4 oz serving of mature broccoli! And, as a free bonus, all the potent enzymes of a young sprout are there, undestroyed by cooking.

As for cabbage itself, there is no need to cook it. Cole slaw is an honorable way to eat cabbage (skip the sugar, or any sugary dressings), as is sauerkraut, an example of naturally lacto-fermented food so praised by Sally Fallon as actually improving digestion.

 

• Beans. Some people can handle them, others cant, at least not before social occasions. Sally Fallon recommends long soaking and very slow cooking. Ive tried it, and while it did work, I decided the taste just wasnt worth the hassle when I could simply have more salad (but see Jorges recipe below).

   

Beano never worked for me.

But again, there is no denying the good nutrition in beans. They also help keep insulin low. The simplest solution may be keeping the portion small, and eating them in the evening when you are relaxed and digestion is automatically better.

Wondering about the tradional ways of cooking beans, Ive asked Jorge, one of our Brazilian readers, for a recipe. Here it is:

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Ivy: Please note the soaking and long cooking, and the considerable use of spices; Ive heard that some spices make beans more digestible. If anyone knows more about this, please write me.

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• Milk. Its not just the lactose; casein, the chief milk protein, is also hard to digest. And those long-chain fatty acids arent easy either. Pasteurized milk doesnt have any enzymes left, so it creates a heavy digestive burden. Goat milk is easier to digest because of a better fatty acid profile, but if you dont have enough lactase, even goat milk can be bloating.

   

Solution: fermented milk products. Luckily, I find plain kefir and buttermilk delicious. Kefir cheese (Altadena makes it) is my latest discovery. I find it easier to digest than yogurt, which still contains a lot of lactose and for some women is just as bloating as milk. Fermented milk products have a slightly laxative effect, so they help to shorten the amount of time food stays in the intestines. Shorter passage automatically means less chance to produce gas.

Quick passage through the intestines also means a lower risk of colon cancer. As for lactose drops, I havent found them any more effective than Beano, but maybe others have found an effective brand. If so, please write me.

 

• Overcooked vegetables. Most vegetables can be eaten raw, semi-raw (Chinese style stir-frying), or lacto-pickled (youll have to get Sally Fallons book to really understand what this means). Overcooking destroys both enzymes and nutrients, and makes the vegetables more glycemic, and thus potentially fattening.

   

   

• Meat cooked at high temperature. High temperature cooking, such as charcoal grilling, makes meat both carcinogenic and difficult to digest, since it denatures the proteins and fats.

   

   

• Fried foods. I think enough has been said about frying to make you realize its as suicidal as smoking cigarettes. This is an instance where the official line is correct. Especially when polyunsaturates are used, the meal becomes downright toxic. Have some respect for your blood vessels and your liver; dont fry anything. (I dont mean brief stir-frying at moderate temperature, using a stable fat. I mean the really destructive high-heat frying.)

   

   

• Sugary foods. Sugars feed Candida. They fuel fermentation, including alcoholic fermentation. You risk turning into a walking brewery! Women seem to have a particular problem with sugary foods. Many women are on a diet thats insufficient in protein and fats, so they feel hungry within two hours or a meal, sometimes even sooner. Some women report that they feel constantly hungry. Since its not yet time for a regular meal, women will therefore eat snacks. Snacks are suicide foodtypically very high carbo. Women know that eating junkfood is killing them, but they just cant control their hunger.

   

Dr. Atkins said something absolutely revolutionary on this topic: "Snack on protein and fat." I used to carry a chunk of cheddar cheese in a little plastic baggy in my purse whenever I had to be away from home for several hours. Then I tried the Zone bars. Neither solution proved satisfactory. A hard-boiled egg or two and a green apple (green apples are less sweet) turned out to be the best emergency meal for me. Note that I say "meal," because a whole range of nutrients are present: protein, fat, carbohydrates, and fiber.

My hard-won philosophy is this: when hungry, eat real food. Dont eat snacks. Snacks kill. They dont give you real energy; they keep you chronically hungry and chronically fatigued. Have a regular meal, even if the time of day is culturally incorrect. Then there will be no need for snacking.

But if snack you must, remember that processed carbohydrates feed yeast. An apple, or sometimes simply drinking water, can give you a temporary lift so you can manage to fix yourself a meal, or get to the nearest place where you can have some real food.

 

• Whole grains. Its rarely mentioned how hard to digest whole grains are, like all seeds that havent been properly prepared. One solution I found is sprouted wheatberries. They taste amazingly good, and dont seem to bloat me at all. Of course its difficult to eat more than a few spoonfuls at a time, which may be a factor.

   

   

• Almonds and other nuts. Nuts are known to be "heavy on the stomach."

   

   

• Yet the nutrition is excellent, and it woud be a shame to avoid eating nuts. Fortunately there is an effective solution. Simply soak them. Soaked almonds are delicious. Youll never care for "dry" almonds again.

   

   

• Oatmeal. Sally Fallon recommends soaking it overnight.

   

   

• I have already mentioned the importance of keeping the passage of food through the intestines relatively brief. Obviously constipation is to be avoided. Besides fermented milk products such as buttermilk and plain kefir, you can try some whey powder dissolved in water, a small amount of psyllium (too much will cause very nasty bloating), or calcium ascorbate powder (youll have to experiment with the amount; flatulence and/or diarrhea may result from excess).

   

Gelatin is also reputed to help digestion. I mean plain gelatin of course, and not sugar-loaded Jello.

ACTIVATED CHARCOAL is a very inexpensive and amazingly effective remedy against gas. Once youve tried it, youll never waste your money on Gas-X and the like (which dont seem to make it down to the intestines; the problem is in the intestines, not in the stomach).

Life Extension Foundation, 800-544-4440, has just announced that it has a new mushroom-derived product that detoxifies the intestines by eliminating toxic and odor-producing compounds such as ammonia and hydrogen sulfide. Its supposed to be a particular blessing for the elderly. Life Extension Foundation also recommends an extra dose before social occasions. Lets hope it works. If it turns out to be a disappointment, there is always dear old reliable activated charcoal for pennies a dose.

Life Extension Foundation stresses that reducing toxic compounds such as ammonia, mercaptan, and hydrogen sulfide helps prevent both colon cancer and a variety of degenerative disorders. This is a sobering reminder which should make us stop making silly jokes and concentrate instead of finding solutions to intestinal malfunction, which typically gets worse and worse with aging. If you are in bad shape at fifty, ask yourself what it will be like at eighty, unless you do something now.

FISH OIL is wonderful at calming down intestinal inflammation. I recommend "Mega"-type EPA supplements, such as the Trader Joes brand. Ordinary fish oil caps provide too much soybean oil and not enough EPA. "But I dont have inflammation, just gas," you may be thinking. Youll be surprised at the difference fish oil can make by healing the intestinal lining. Folic acid and glutamine also help fight intestinal inflammation. Folic acid is known to help prevent colon cancer.

Butter, goat milk, and coconut oil contain short and medium-chain fatty acids that nourish the intestinal mucosa. Caprylic acid is especially important since it fights yeast infections.

Coconut oil is the cheapest source of caprylic acid. Thanks to the information from Jorge, one of our Brazilian readers, I started using coconut oil and can attest to its benefits. So can several other devotees I know. If you want to put to rest your fears about the alleged "badness" of this oil, read Sally Fallons book and/or call Omega Nutrition, 800-661-3529, for a detailed summary of the health benefits of this remarkable oil. I can also send you Ray Peats very convincing article on the same subject.

FOS stands for Fructo-Oligo-polySaccarides, a type of carbohydrate that our bodies dont digest for energy, but friendly bacteria thrive on. The taste is pleasantly sweet. There is now a new supplement from Enzymatic Therapy called Enzydophilus. It combines FOS with live lactobacteria and with pancreatic enzymes.

I have tried FOS, and was pleasantly surprised at the considerable improvement in digestion that resulted within two weeks or so. Considering that the friendly bacteria not only fight yeast infections, but also help with hormone metabolism and thus help lower the risk of breast cancer, FOS is vastly underused. But then it could be argued that you can get comparable results with buttermilk at a fraction of the price. Do I need to remind anyone that THOROUGH CHEWING is the first step toward good digestion? In fact, it amounts to PRE-DIGESTION. Yet so many of us have become eat-on-the-run workaholics with no respect for our physiology. Our saliva contains digestive enzymes. Digestion doesnt begin in the stomach; it begins in the mouth. Give your saliva a chance. Elementary. (Please note: low saliva production can be a sign of estrogen deficiency.) Swallowing large chunks of food means a greater digestive burden, and more possibility of gas. Elementary.

Eating slowly rather than in a rush, and being as relaxed as possible can make all the difference between gassiness and cramps versus that contented and energized feeling when the digestive system works well. The secret is that digestion is a parasympathetic function; the parasympathetic nervous system has been called the "rest-and-digest" system. If the sympathetic fight-or-flight system is switched on instead, blood and energy are diverted away from the GI tract, digestion stops, and food begins to fester. Eating in a rush can also cause us to swallow quite a bit of air as we eat, and that air will cause every bit as much pressure and discomfort as the gas produced by intestinal fermentation. Here good manners are actually very functional: keep your mouth fully closed when you chew. Dont try to eat and talk at the same time.

And, as mother said, dont stuff yourself. Eat slowly and savor. Then youll clearly hear the "enough" whisper from your body. Anything else? Ah yes: Swedish bitters. Mint extract. There are all kinds of digestive herbal remedies. But ultimately there is no substitute for good dietary habits.

Took her name after Teresa of Avila, who said, "Christ has no body now on earth but yours; yours are the only hands with which he can do his work, yours are the only feet with which he can go about the world, yours are the only eyes through which his compassion can shine forth upon a troubled world." And Mother Teresa was famous for saying about those made repellent by extreme poverty and illness that this is "Christ in a most distressing disguise."

But we need to confine ourselves to Christian terminology to understand this attitude. Deepak Chopra, drawing on ancient Indian spirituality, said, "Every relationship is ultimately a relationship with God."

The same idea is expressed in "A Rabbis Proverb":

Editorial Assistants: Gail Peterson, Monica Smith

Research Assistant for this issue: Monica Smith

The information contained herein is meant for information only, and not as medical advice.