CyberHealth 16

CyberHealth 16

CyberHealth 16


CyberHealth Index


  1. Beyond Premarin: seeking an optimal mix of estrogens
  2. Dr. David Zava comments on Premarin
  3. Male diet gurus and their pot bellies: it’s the glands
  4. Red clover phytoestrogens—is Promensil safe?
  5. Cole slaw and other magic anti-cancer tricks
  6. Against the grain: for safer beef
  7. Feed your face: Dr. Vangor’s second dark secret
  8. Care of the Soul: Don’t wait for the special occasion

Beyond Premarin

Over nine million American women take Premarin. Most appear to be satisfied with it. Some brave pioneers have been taking it for more than thirty years now, and appear to be thriving, with little if any bone loss, less heart disease and Alzheimer’s disease, less diabetes, less arthritis, less colon cancer, fewer cataracts, and so on.

On the other hand, some women have ended up with headaches, gallbladder problems, and elevated blood pressure. Blood clots are also a possible side effect (these problems are seen with ORAL estrogens, including oral contraceptives, rather than Premarin per se).

Premarin seems to be one of those love-it-or-hate-it products: women either say that Premarin is wonderful, or else they launch into stories of terrible headaches and other side effects (sadly, those women are often unaware that they would probably do well on either on triestrogen OIL caps or on transdermal estrogens, not necessarily the patch, which irritates the skin and, some argue, delivers too much breast-stimulating estradiol, but rather the various mixed-estrogen hormone creams and gels from compounding pharmacies; also, a confounding factor here is that some of those women may actually be having a bad reaction to Provera, not Premarin).

Premarin is obviously not politically correct due to the cruelty issue, but let us not get into that for a while. Let us only examine the scientific data on the main estrogens in Premarin. In keeping with the CyberHealth tradition, let us consider the heretical question: for those women who do not experience side effects, who so often call Premarin “wonderful,” could it be a physiologically correct blend of estrogens? Or, given the double-edged, good news/bad news nature of hormones, is it nevertheless possible that Premarin offers some unique benefits not provided by other estrogen products?

On the surface, it would seem that the answer should be a plain no, since horse estrogens are different from human estrogens and do not naturally occur in the human body. You know the “menopausal horse” jokes. But the undesirability of equine (horse) estrogens in the human body is merely a plausible-sounding argument, and not a proven fact. Using jokes about menopausal horses as an argument is somewhat similar to my endocrinologist’s trying to discourage me from Armour Thyroid by calling it “a slaughterhouse product.” In fact it’s only now that the unique nature of equine estrogens is being seriously researched. And the studies of what horse estrogens do in the human body have already yielded some interesting results.

Premarin is 50% estrone sulfate, 25% equilin, 15% eqilenin. The rest consists of numerous metabolites, some very biologically active. There may be trace amounts of hormones other than estrogens. Thus Premarin is a very complex blend of hormones. It also provides certain metabolites that are metabolized relatively slowly—in contrast to Estrace, for instance, which has a half-life of less than three hours. This persistence can be an advantage if the result is a steady level of energy and good sleep, or a disadvantage if a woman happens to have side effects.

One of the earliest such studies dealt with the antioxidant properties of human and horse estrogens (Subbiah 1993). Horse estrogens, equilin and equilenin and their numerous metabolites, have a unique structure: these are the so-called RING-B UNSATURATED ESTROGENS, which gives them some special properties and makes for a different metabolism—they are not converted to the arguably dangerous 16-hydroxyestrone, the precursor of estriol (women at higher risk of breast cancer, such as obese and/or hypothyroid women, produce more 16-hydroxyestrone, while high-thyroid women or regular exercisers produce less).

Can we thus conclude that Premarin is safer? Not so fast. Other studies have shown that certain metabolites of equilin release free radicals that can damage the DNA—and it possible (though not proven) that these metabolites are potentially more dangerous than certain metabolites of estradiol.

And then there is the plausible argument (based on massive Harvard Nurses and Iowa studies) that Premarin slightly increases the risk of breast cancer only in women who consume alcohol (Zumoff 1998).

Still others point out that Premarin is 50% estrone sulfate, and estrone is weaker by far than estradiol in its ability to stimulate breast tissue. Some women who have tried both Estrace and Premarin, or the patch and Premarin, decide that they like Premarin better because there is less breast tenderness, whereas pure estradiol feels “too strong.” Can we conclude that estrone is better? It’s not that simple. Dr. Zava (later in this issue) discusses this in a different light.

The defenders of Premarin cite studies that show its remarkable safety, while its attackers cite studies to the contrary. For every point, there seems to be a counterpoint. For instance, Premarin lowers the insulin-like growth factor 1 (IGF-1). This is cited as an anti-carcinogenic effect.

Others point out that by lowering IGF-1, Premarin eventually leads to some loss of muscle mass, always an undesirable, pro-aging phenomenon (it can be prevented by simultaneous use of androgens such as DHEA). In common with other oral estrogens, Premarin also raises triglycerides; it’s been argued, however, that this rise is harmless, and anyway it can be prevented with correct doses of progesterone and androgens, or even with exercise.

But it is Premarin’s supposed superiority when it comes to protection against cardiovascular disease and Alzheimer’s disease that is the central issue here. Serum lipid peroxide levels go up after menopause, and this is one of the main mechanisms of accelerated postmenopausal aging (atherosclerosis is strongly implicated in Alzheimer’s disease). It has been suggested that horse estrogens are more potent antioxidants when it comes to protecting cholesterol.

Subbiah and colleagues (1993) looked at how well various types of estrogens protected LDL cholesterol against oxidation, using the formation of a compound known as malonaldehyde (MDA), a lipid peroxidation product, as a measure of antioxidant capacity—the less MDA formed, the better the antioxidant protection. Here are some figures:

Control 21 (units of MDA)
Estrone 14.74
Estradiol 10.40
Equilenin #9; 8.22
Equilin #9; 7.08

The researchers then checked for the oxidation of cholesterol as expressed in the percentage of oxysterol, a very harmful (cytotoxic) form of oxidized cholesterol. Here the results were also quite dramatic: Control – 8.87%; estradiol – 3.77%; equilin – 1.37%.

They also checked the formation of MDA in macrophages, immune cells that can be involved in plaque formation. Here the results were startling: compared to control (22.7) both estrone and estradiol INCREASED lipid peroxidation in macrophages (25.3 and 25.7); equilenin and especially equilin considerably reduced lipid peroxidation in macrophages (17.2 and 14.3).

Hurray for equilin? Not so fast. More recent studies, using different ways of measuring peroxidation, have reached different conclusions. One study found that the order of antioxidant potency is as follows: estradiol is more powerful than estrone, which in turn is more powerful than equilin, which is more powerful than estriol (McManus 1996). Another study followed the lead about strong antioxidant properties of the so-called “catechol estrogens,” metabolites of estradiol, estrone, and estriol found in greater abundance in women who exercise, eat a lot of cabbage-family vegetables, and/or have high levels of thyroid hormones.

One of these, 4-HYDROXYESTRONE, turned out to be “far more potent” as an antioxidant than equilin and its chief metabolite. At the same time, however, equilin and 17-alpha-dihydroequilin “strongly inhibited oxysterol formation, whereas 4-hydroxyestrone was ineffective.” The authors come to the obvious conclusion that IT TAKES A WHOLE TEAM OF ESTROGENS to obtain the best antioxidant protection (Tang 1996).

This conclusion seems to be further reinforced by the results of yet another study: while estrone had the best LDL-lowering action, equilin showed an outstanding ability to improve the action of insulin (Wilcox 1997).

If estrogens could be bought over the counter, I have no doubt that we would have multiple estrogen blends being touted as superior to single-estrogen products, the way body builders are now urged to buy balanced mixed androgens (have you seen those “androgen symphony”ads?).

Premarin, being a blend of more than twenty estrogens (more if we count those present only in trace amounts) does a pretty good job, but at least theoretically a better mix of estrogens could be designed specifically for cardiovascular protection. That mix would quite likely include equilin and its chief metabolites.

What about Premarin’s protection against Alzheimer’s disease? One study found that equilin was better than estradiol, estrone, or estriol in promoting the growth of nerve cells (Brinton 1997). Should we accept this as the final word on the subject? No—we must have more studies and test more types of estrogens, including perhaps designer estrogens not yet on the market, before we can draw any firm conclusions.

Besides, the release of nerve growth factor is not the only criterion that should be looked at. I suspect that just as different estrogens have different cardiovascular “talents,” so it will also take a whole complex team of steroids to provide maximum protection against various degenerative brain disorders (a horrible way to die).

Women keep dreaming of the kind of estrogen replacement that will do it all — protect bones, heart, blood vessels, nerve cells, and more, but without stimulating the breast tissue and the uterine endometrium. Well, Premarin contains 17-alpha-dihydroequilenin, which has been shown to be as effective as estradiol in benefits for the brain; it also lowers insulin and has cardiovascular benefits without affecting breasts or uterus. In fact this particular estrogen can even be given to men, since it has no feminizing properties (Washburn 1996). But somehow there is not much interest in it, just as there is little interest in 2-hydroxyestrone, a metabolite of estradiol that is not only an excellent antioxidant, but, according to some studies, also seems to be anti-carcinogenic.

The point of my “good news/bad news” review of Premarin is to suggest that we do have the technology to do better. The use of horse urine is an absurd anachronism now that we can synthesize all types of estrogens and other steroids. Chemists also know how to modify the structure of various natural estrogens, horse or human, in order to enhance certain desired characteristics such as antioxidant power or bone-building ability, and/or diminish undesirable qualities, such as the ability to stimulate breast tissue.

But it’s not likely that a single estrogen, whether natural or a designer estrogen, can truly do it all. It is probably going to take a whole team of estrogens to produce an optimal hormonal mix for various categories of menopausal women (those at high cardiovascular risk as opposed to those at a high breast cancer risk, for instance).

It is high time to go beyond Premarin, and toward trying to design better mixtures of estrogens according to various women’s needs.

Note: Women who like the convenience of oral HRT, but object to Premarin and/or have not found Estrace to their liking, should consider getting the combined estrogens + progesterone OIL CAPSULES from a compounding pharmacy.

Research indicates very good absorption, excellent (dose-dependent) effect on cholesterol, excellent uterine protection, and patient satisfaction. In fact I know one doctor who prescribes ONLY oil-capsule HRT because of high patient satisfaction. To learn more about oil capsules (the newly FDA-approved Prometrium is an example, but it uses an inferior oil), write to [email protected] or call Women’s International Pharmacy, 800-279-5708.


Bhavnani BR. Pharmacokinets and pharmacodynamics of conjugated equine estrogens: chemistry and metabolism. Proc Soc Exp Biol Med 1998; 217: 6-16;

Subbiah MTR et al. Antioxidant potencies of specific estrogens on lipid peroxides. J Clin Endocrinol Metab 1993; 77: 1095-97;

Tang M et al. Superior and distinct antioxidant effects of selected estrogen metabolites on lipid peroxidation. Metabolism Clin Exp 1996; 45: 411-15;

McManus J et al. The effects of various estrogens and progestogens on the susceptibilitiy of lower-density lipoprotein to oxidation in vitro.

Maturitas 1996; 25: 125-31; Wilcox JG. Cardioprotective effects of individual conjugated equine estrogens through their possible modulation of insulin resistance and oxidation of low-density lipoprotein. Fertil Steril 1997; 67: 57-62;

Brinton RD et al. Equilin, a principal component of Premarin, increases the growth of cortical neurons via an NMDA receptor-independent mechanism. Exp Neurol 1997; 147:211-220;

Zumoff B. Alcohol, estrogens, and breast cancer. J Clin Endocrinol Metab 1997; 82: 1656-58. Research assistant for this article: Pamela Macon)


(Dr. David Zava, Ph.D., is a biochemist who has done a considerable amount of research in steroids, phytoestrogens, and breast cancer.) My opinion about Premarin is that it’s a pretty good estrogen product with an extremely bad karma (horse torture). Premarin is made up of a mixture of conjugated estrogens, one of which is equilin. Of the three “natural” sister estrogens (estradiol, estrone, and estriol), equilin is structurally similar to estrone. The exception in its structure is that it has a double bond in the B-ring. What this means is that, like polyunsaturated fats (also have double bonds), the molecule is more easily oxidized than estrone.

What we are learning about estrogens and cancer is that it’s the oxidation of the estrogen that renders it dangerous as a carcinogen. Estrone is most easily oxidized to a 4-catechol estrogen (Ivy: that’s 4-hydroxyestrone, which is also a potent antioxidant), and equilin is even more readily oxidized to the 4-catechol form. This may be why Premarin could be more dangerous than estradiol or estrone as regards cancer risk. On the other side of the coin, keep in mind that Premarin is a mix of conjugated estrogens (Ivy: conjugated means they are in the sulfate form, a biologically inactive storage form; the body desulfates these hormones according to need), and apparently some progesterone and androgens also, which may counterbalance any increase in cancer caused by the equine estrogens. I’m not aware of any epidemiologic evidence showing Premarin is any more or less dangerous than other estrogens as regards breast cancer risk. After 10 years of use the risk is anywhere from 1.3 to 2, depending on the study.


Ivy comments:

I am thrilled to have this explanation by an authority in the field of steroids and breast cancer research. This is the kind of information you don’t get from a typical book on menopause or a health newsletter, so I am very grateful that Dr. Zava has taken the time to write this.

I am also thrilled when I reflect on the fact that CH readers have joined a handful of biochemists in knowing that there exist saturated and unsaturated estrogens—like saturated and unsaturated fats—but please don’t jump to the conclusion that one kind or another are therefore “bad estrogens.” Each group has its pluses and minuses. I especially wouldn’t want anyone to conclude that catechol estrogens — 2-hydroxyestrone and 4-hydroxyestrone—are monstrously carcinogenic.

These are above all wonderfully beneficial compounds. They inhibit the inflammatory prostaglandins of the E2 series. They also inhibit the synthesis of pain-producing leukotrienes. Possibly it is chiefly thanks to these metabolites that estrogen replacement has turned out to be such a godsend to arthritis victims.

With hormones it always seems to be the old “good news and bad news” story. But now that we know that even Vitamin C can under some circumstances damage DNA, and that a lot of antioxidants can turn into pro-oxidants, I think we are getting used to the idea.

If easy oxidation of certain estrogens is possibly a risk factor, this points to the obvious steps women can take to protect themselves: use a lot of ANTIOXIDANTS, including the sulfur-containing N-acetyl-cysteine (NAC has been receiving more and more attention as a crucial antioxidant), and be sure to aid the methylation process by providing METHYLATING AGENTS (donors of the methyl group) such as folic acid and/or methylcobalamine (available from Life Extension Foundation, just discovered to have a powerful protective activity against breast cancer), and/or trimethylglycine.

As we grow older, neither our antioxidant defenses nor our methylation are as good as before, as thus is might be a good policy for all women on HRT to increase their intake of antioxidants and methylating agents. Since breast cancer is largely a disease of aging (80% of the cases are diagnosed after age 50, and the risk increases dramatically with advancing age), anything we do that helps the body preserve youthful physiology should also lower the cancer risk.

We also should pay attention to Zumoff ‘s suggestion that women taking oral estrogens should minimize their alcohol intake, and either eat a lot of cruciferous vegetables (cabbage family) or take indole-3-carbinol, the active ingredient which positively affects estrogen metabolism.

One of our readers, Katie, has suggested that women on Premarin and other oral estrogens should be taking MILK THISTLE to insure liver health.

Finally, women taking oral estrogens in general, and Premarin in particular, should be encouraged to engage in regular daily exercise in order to prevent the rise in triglycerides, and to gain further protection against breast cancer.

Overall, it seems that some women do better on Premarin than on other forms of HRT. I would vastly prefer a product that does not involve horses, and one that is truly optimized for postmenopausal women’s health needs. But until we have something “beyond Premarin,” there seems to be a way to take Premarin with reasonable safety: limit alcohol, take plenty of antioxidants and methylating agents such as folic acid, engage in regular exercise, and eat those broccoli sprouts. And of course be sure to balance the estrogens with progesterone (not Provera) and androgens.


Lynne comments:

I like all the provocative new information, like the lowering of IGF-1.

Also the trig-raising properties. Does it have the same effect on pregnant mares?

I have just stumbled on to the Zumoff findings suggesting alcohol is the missing link for those women who take estrogen replacement therapy and get breast cancer. I wasn’t aware of what estrogens he was referring to. Was this just Premarin? Please discuss this as it is quite explosive information if it is true. I wonder what other things we’ll find out from this kind of study review. With nine million (eek!) people taking Premarin, it is quite staggering that this is just now being discovered.

The cruelty issue still remains dominant in my mind. I can’t understand why the drug companies haven’t synthesized it. Certainly, it has got to be easier and most cost-effective than depending on warehousing animals and withstanding the “Say Neigh to Premarin” boycott. Any ideas why?


Ivy replies:

As for pregnant mares, let us remember that they do not TAKE Premarin. Their estrogens are produced by their ovaries and especially by the placenta, so the effect on the liver is presumably not quite as pronounced as when ORAL estrogens are taken.

However, I am very interested in the finding that equilin excels at improving the action of insulin. This may be something of great importance to horses, and of course is important to women also, since insulin resistance is part of the overall “menopausal metabolic syndrome” and one of the key elements of accelerated postmenopausal aging.

Studies usually combine women taking Premarin with women taking Estrace or using the patch, calling everything simply “estrogen,” as though neither the type nor the administration route made any physiological difference. But I have seen studies that concluded that it is basically only oral estrogens that show a very strong response to alcohol—probably because of the much greater involvement of the liver. And as for women taking oral estrogens, we know that in this country it’s mostly Premarin. Nevertheless, you raise a very good point—we need comparative research that separates Premarin users from Estrace users.

Yes, it is staggering that it is only now that some very basic research on hormone replacement is finally being done. It is only recently that it has dawned on us that HRT has different effects depending on how much alcohol is consumed (and the kind of alcoholic beverage may have an impact also; hard liquor may be quite different than wine).

The effects may also differ depending on whether or not the user smokes, how much coffee she drinks, how much exercise she gets, what drugs and supplements she takes, how much fiber she consumes, how much body fat she has and where (abdominal obesity vs gynoid), the health of her liver and her adrenals, and so on.

It is also high time to investigate the interaction between various hormones and commonly taken antioxidants, wine, tea, and various other substances.

Yes, the cruelty issue remains and for many women it is enough to make them turn against Premarin, even if they do not do very well on Estrace (usually because of taking it only once or twice daily; remember that Estrace is very quickly metabolized and needs to be taken at more frequent intervals). There have been attempts to synthesize a replica of Premarin, but the makers of Premarin have managed to win court cases against competitors by claiming that some minute components were missing.

It might be cheaper even for Weyth-Ayerst to synthesize the hormone blend, but after a while their patent would run out, and then anyone could replicate the product. As is, W-A has a very profitable monopoly. W-A knows that no one else is going to set up horse farms and mess with extracting hormones from urine. Considering that Premarin is the #1 pharmaceutical best seller, i.e. billions and billions of pills are sold, here and abroad, we can see why the manufacturer is trying to block competition. The fact that they are getting away with it is a travesty of the law, and part of the scandalous economics of menopause.


Monica writes:

When the alternative med docs had a big conference in NYC last year with my doc and two other famous hot shots—Atkins was one—a brave woman in the audience said, “If you three are so gung-ho nutrition, how come you are all 40 lbs overweight?”

Whitaker, by the way, for all his marathon biking, was the largest. Their uniform answer to why they hit the trough: “It’s hard to always practice what you preach.”


Ivy replies:

What? Atkins having a bagel on the sly? Whitaker looking at his several fiber supplements and deciding that enough is enough?

Whitaker’s “health resolution” to eat an apple before each meal reminds me of the “apple diet.” My mother tells me that one of her schoolfriends once went on a “apple diet.” Instead of losing weight, she rapidly put on pounds. She explained that all the did was eat two apples before lunch, according to the directions. The girls read the directions again, and discovered that it was two apples INSTEAD OF lunch.

Seriously, however, I suspect that the answer about not practicing what you preach was a largely a cop-out. In this case, it’s easier to say, “I have sinned,” than to admit that one’s diet doesn’t work as promised, at least not in the long run. Most likely the diet gurus, Atkins especially, are trying to eat according to their beliefs . . . and it’s just not working very well. Whitaker supposedly consumes a record amount of fiber and exercises more than the average person, and that’s not working for weight control either. Why?

The simplest answer is aging and aging-related hormone deficiencies. Sure, the diet gurus are no doubt on testosterone replacement in addition to DHEA, not to mention carnitine, pyruvate, and various other fancy supplements that are supposed to keep body fat down, and yet . . . something is missing. We all agree that the current hormone replacement regimens are only a crude beginning; the MULTIPLE HORMONE DEFICIENCIES OF AGING cannot be corrected by taking just one hormone, or two or three.

And it’s commonly assumed that we haven’t even discovered all the hormones yet. So it’s not that the carbohydrate-restricted or the high-fiber diet is of no use in weight control—it’s that the aging process is such a powerful pro-obesity factor that diet is not enough (unless the diet is very very restricted, which leads to a multitude of problems—including the notoriously rapid regaining of all that body fat, and then some, when you go off the diet). I think even the diet gurus would agree with the statement that diet is not enough, and that only a small percentage of dieters, maybe 10% at most, succeed at maintaining their new weight. Nor is exercise alone enough (unless you train very intensely, which also creates problems such as a huge production of free radicals, ultimately leading to health problems and shorter life expectancy).

Young men are famous for being able to eat mountains of food, and not gaining an ounce—but only when they are in their teens and early twenties. After 25, the anti-obesity hormones—testosterone, DHEA, multiple other androgens, and growth hormone—all begin to decline. With them vanishes the ability to consume a staggering amount of calories without paying the price.

A young man can usually eat all he wants; the extra calories will be used for the production of heat (thermogenesis) and for muscle-building. But only as long as the levels of testosterone, DHEA, and growth hormone stay above a certain threshold.

Perhaps growth hormone is the main missing piece of the anti-obesity puzzle here. Or perhaps something else that hasn’t even been discovered yet. Trouble is, devouring huge portions is seen as macho. Men long past their hormonal peak (early twenties) pride themselves on being “hearty eaters.” Aside from that, one simply gets used to a certain amount of food and eats more than necessary just out of habit. Visitors from abroad are startled when they see the portions typically served in American restaurants.

Likewise, mothers do their children a great disservice by pressuring them to eat more—although that’s probably a minor factor in the current epidemic of childhood obesity: we need look no further than the constant snacking on junk food and sweet fruit juices, combined with endless hours in front of the TV set.

But back to the overweight diet gurus. First they make millions selling their diet books, cookbooks, diet candy bars, carnitine-enriched diet drinks and the like, and then they and many of their followers are even fatter than before, causing other experts to loudly ridicule yet another ineffectual regimen and to insist that diets don’t work. The fact that the diet gurus suffer from middle-age spread like everyone else serves as yet another illustration of the hormonal control of body fat (see CyberHealth 14). In youth, we are typically slender; as middle age advances, we get more and more overweight; as we get really old, we begin to lose weight due to atrophy. Yes, it’s the glands—to a much greater extent than it is fashionable to admit.

You can see the same phenomenon with pets: young dogs and cats are active, sleek, and slender in spite of a hearty appetite; the older the animal gets, the more sluggish and obese it generally becomes, even though it is consuming exactly the same diet as before.

Men are luckier than women when it comes to anti-obesity hormone replacement because androgens are well known to build muscle and help reduce body fat. Here is where DHEA can come to the rescue. Men can take a supraphysiological dose of DHEA (over 50mg) without suffering any apparent side effects (doses as high as 4g/D have been used under medical supervision without causing any liver damage). There have been reports that taking 90-200mg of DHEA will produce some loss of body fat (see CyberHealth 14 for Katie’s and Tom’s accounts).

Now that the non-androgenic 7-KETO-DHEA is available, it’s possible that many women will benefit from this marvelous anti-obesity hormone without paying the price of acne and other androgenic side effects. One CH reader is already testing this for us, and reports experiencing slow weight loss without a change of diet. We’re waiting to see if she stabilizes at a desired level, close to what she weighed before menopause.

By the way, I’m not surprised that Whitaker is the most overweight, given his misguided insistence on lots of carbohydrates, and his strange ignorance of the role that elevated insulin plays in weight gain. Or rather, I suspect he does know about insulin but stays in denial since carbohydrates are so politically correct, being vegetarian.

As I often point out, politically correct and physiologically correct are often oppposites. If you want to gain weight fast, eat a lot of bread, rice, potatoes, and pasta. Keep protein and fats to a minimum—you’ll be more hungry this way, ready for more carbohydrates every 2-3 hours. Have high-carbo grain-based veggie-burgers instead of meat. That, and guzzle plenty of sweet fruit juice. Actually just the fruit juice will do it, the really sweet apple juice for instance. Guaranteed.

On the other hand, there is now such a thing as “resistant starch,” used in the products for diabetics. It’s not supposed to raise blood sugar. Who knows, maybe we will eventually have all kinds of “fake starch” products the way we now have low-fat products (the introduction of which was the start of the obesity epidemic of the last decade). I don’t know if fake starch will be good for us any more than Olestra is.

One thing for sure: if we want to live a long time and enjoy good health in our older years, we have to wage the battle to preserve or increase our muscle mass and keep down the fat mass. There are no obese centenarians.


Fiona writes:

In CH 13 it was stated: “THE COMBINATION OF ESTRADIOL AND GENISTEIN WAS BETTER THAN EITHER ESTROGEN ALONE. So the conclusions were to take your estrogen replacement therapy and soy.”

My question then is why does the product information for Promensil (red clover phytoestrogen pills) contain the following language:

Novogen – Consumer Health – Promensil

“(i) Contraindications & Interactions

No interventional studies or epidemiological studies of individuals with high dietary isoflavone levels have been reported that test whether estrogenic isoflavones are either agonistic or antagonistic towards steroidal therapeutics. However, as weak estrogens, isoflavones do exhibit anti-estrogenic effects through competitive inhibition.

In the absence of definitive research data, care should be exercised in supplementing the diet with estrogenic isoflavones during therapy with reproductive hormones including estrogens, progestogens, or androgens.” That is really the only warning that comes with this product.

I am searching and confused about all of this just like everyone else.


Ivy replies:

Some of you may appreciate a translation of the statement “No interventional studies or epidemiological studies of individuals with high dietary isoflavone levels have been reported that test whether estrogenic isoflavones are either agonistic or antagonistic towards steroidal therapeutics.” This means we have no studies that would show whether taking phytoestrogens together with HRT enhances the benefits of HRT, or, on the contrary, interferes with those benefits.

The third possibility is that it does both, but the agonist (helping) or antagonist effect depends on the type of tissue.

We simply don’t know.

There is increasing evidence, however, that various phytoestrogens are good for the cardiovascular system, and some appear to be biologically active in promoting bone growth (though IPRIFLAVONE is actually a derivative of one of the soy estrogens, tweaked by biochemists for more effectiveness). It is likely that in the case of bone and blood vessels, the right phytoestrogens in the right dose increase the effects of HRT.

What needs to be done is research aimed at establishing the correct dose ranges of various phytoestrogens so that the benefits outweigh possible adverse effects, such as adverse impact on the thyroid.

Phytoestrogens could be more important for men, since there are no feminizing effects that we know of (at least at relatively low doses; it wouldn’t surprise me if there was impotence and/or diminishment of libido at really high doses. Also, my guess would be that if a boy consumed a lot of phytos while crucial developmental changes are taking place, his voice maybe wouldn’t get quite as deep, the genitals would be smaller etc. [I have also heard that women who daily consume large amounts of soy have begun reporting dimished libido.])

There seems to be a consensus that consuming dietary phytoestrogens, at least in doses not exceeding those common in Asia, is beneficial for both men and women. As for some plant estrogens specific to red clover, however, we simply don’t know. We are flying blind. Humans have no experience consuming red clover, so there is little to go by.

We are barely beginning to explore the effects of the INTERACTION of various hormones, human, equine, or phytohormones. Dr. Zava is one of the pioneers in this field, and he does caution women against having blind faith in phytoestrogens of any kind, in any dosage range.

Note the statement: “In the absence of definitive research data, care should be exercised etc.” My translation of this is: stick to products with which there has already been a lot of experience. And rather than pay a lot for Promensil, why not have a delicious cup of miso?


We’ve all heard that vegetables of the cabbage family are excellent at fighting cancer. Does it matter how you prepare cabbage? Yes, according to our treasured research assistant, Pamela Macon, who discovered information that points to the superiority of shredded cabbage. The trick is to increase the amount of cancer-fighting compounds called glucosinolates.

Pamela quotes Nan Fuchs, Ph.D.:

“glucosinolates are water soluble and you can lose up to 50 percent of them when you boil cabbage. But when you chop cabbage, something magical happens — some glucosinolates increase as much as 400 percent. Cutting the plant may trigger a defense mechanism to produce more of these anticarcinogenic substances.”

Other foods particularly strongly associated with lower breast cancer risk are carrots and spinach. Again, it is good to eat shredded carrots, because the shredding makes the carotenoids more bioavailable.

Throw in a few raisins into your cole slaw—they too are wonderful antioxidants, and provide resveratrol, proven to fight cancer.

I do not use mayonnaise—I use creme fraiche, French-style all-natural sour cream. Not only is it delicious, but, being a naturally fermented milk product, it too is in the category of foods that lower the risk of breast cancer.

Now, what about pepper and other spices? Yes! Spices are anti-carcinogenic, and that includes black and red pepper.


Here is a quotation from the Sept 28 1998 Newsweek, “Safer Food for a Tastier Millennium,” p. 14: “Meatpackers can (. . . ) use healthy bacteria to crowd out pathogens in animals’ intestines. Two weeks ago microbiologists at Cornell University reported that simply switching cattle from a diet of grain to one of hay or fresh grass for five days before slaughter dramatically reduced the incidence of harmful strains of E. Coli.”

Remember the CH articles on how to reduce bloating? One key principle was:

NO GRAIN. I also pointed out that a grain-free diet (no bread, pasta, cereal, pastry, or any other grain products) is used to flatten the bellies of bikini models. It’s only partly a matter of losing abdominal fat. A very large benefit comes from reducing harmful bacteria that produce the belly-distending gas, reflected in that postmenopausal pregnant look.

Fattening cattle with grain is a harmful practice I’d gladly see outlawed, and not only because it increases the risk of bacterial contamination. The fat in grain-fed cattle is less good for us, containing more of the cancer-promoting omega-6 fatty acids and dramatically less of the anti-inflammatory omega-3 fatty acids, as well as of the anti-carcinogenic, muscle-building CONJUGATED LINOLEIC ACID (CLA), than the fat of grass-fed cattle.

As for the use of grain to fatten people (“the curse of the Pyramid,” meaning the infamous food pyramid), in my view that is just as scandalous as the American Heart Association’s promotion of margarine, long after it has been shown that the olive-oil based Mediterranean diet is vastly superior for the prevention of cardiovascular disease and cancer.


(Dr. Andrea Vangor has a PhD in anatomy. Her first “dark secret” was facial exercises using the principle of resistance)

Here ‘tis. I found this in an ancient book of lore—The Handbook of Natural Beauty, 1975, Rodale Press, Virginia Castleton. Also, one of the “natural” cosmetic lines uses yeast flakes in their emergency youthifying mask.

Simply, you take a TB or so of yeast flakes and mix them with water, milk, or cream; slop them on face and neck with upward strokes, and lay backwards (tub is great if you have head support) and let the stuff dry.

It has different effects: as it dries and contracts, it works the face muscles against resistance—you can feel them twitch. So it is a great firmer and toner. Secondly, there is this notion that the high nucleic acid content might penetrate and do some good—well, we can always hope.

The stuff is high in B vits too.

I find it to have a definite effect on skin: improves circulation, tone, color, but does not dry skin out. Work carefully around the eyes. Don’t apply on lids, or inside the orbit more than a wee bit, thin layer. Smooth against lines to pull them out. Keep lying flat so gravity works with you.

Lift your chin to let the stuff tighten under the chin.

Remove carefully with lukewarm water, massaging in the yeast as it liquifies, and then pat dry, apply some moisterizer (I use an oil carrier mixed with milk, water, — how about cultured Bulgarian goat milk? Love it.) Anyway, it is cheap.

Have fun.

**** CARE OF THE SOUL ****

Chris has sent us this:from “A Story To Live By” by Ann Wells (Los Angeles Times) My brother-in-law opened the bottom drawer of my sister’s bureau and lifted out a tissue-wrapped package. “This,” he said, “is not a slip. This is lingerie.” He discarded the tissue and handed me the slip. It was exquisite; silk, handmade and trimmed with a cobweb of lace. The price tag with an astronomical figure on it was still attached. “Jan bought this the first time we went to New York, at least 8 or 9 years ago. She never wore it. She was saving it for a special occasion. Well, I guess this is the occasion.” He took the slip from me and put it on the bed with the other clothes we were taking to the mortician. His hands lingered on the soft material for a moment, then he slammed the drawer shut and turned to me.

“Don’t ever save anything for a special occasion. Every day you’re alive is a special occasion.”

I’m still thinking about his words, and they’ve changed my life. I’m reading more and dusting less. I’m sitting on the deck and admiring the view without fussing about the weeds in the garden. I’m spending more time with my family and friends and less time in committee meetings. Whenever possible, life should be a pattern of experience to savor, not endure. I’m trying to recognize these moments now and cherish them.

I’m not “saving” anything; we use our good china and crystal for every special event—such as losing a pound, getting the sink unstopped, the first camellia blossom.

I wear my good blazer to the market if I feel like it. My theory is if I look prosperous, I can shell out $28.49 for one small bag of groceries without wincing. I’m not saving my good perfume for special parties; clerks in hardware stores and tellers in banks have noses that function as well as my party-going friends’.

“Someday” and “one of these days” are losing their grip on my vocabulary. If it’s worth seeing or hearing or doing, I want to see and hear and do it now. And every morning when I open my eyes, I tell myself that it is special. Every day, every minute, every breath truly is … a gift from God.



“Every day you are alive is a special occasion.” This piece of wisdom really resonates with me. I used to be super-thrifty. “Best clothes” were to be saved for gala events. The result was that I’d wear my best outfits maybe three times in five years — and then they’d be hopelessly out of fashion. What terrible waste!

Clothes are only the tip of the iceberg. When one is in the “special occasion” mentally, all the good things are put away for that special time. The saddest story that comes to my mind is of a young man who didn’t believe in saying “I love you.” He explained that he was saving it up for that “special person” who comes into one’s lifetime only once—not for an ordinary girlfriend. “If you save yourself up for great love, then it’s going to be really fantastic,” he said. He died a tragic death at only 28, apparently never having said “I love you” to anyone. When you hear the word “special,” red flags should go up in your mind. I agree: don’t save the best things for a special occasion. Dance while you can, sing while you can, love while you can, dress beautifully while you can . . . because every day is a special occasion.

Notice and disclaimer

This newsletter is presented as a free service for women and healthcare professionals interested in women’s health.

Editorial and research assistants: Gail Peterson (not this issue), Monica Smith, Pamela Macon

The material contained herein is intended as information only, and not as medical advice.