Bioidentical Hormones, Estriol, and the FDA
The Women's Health Initiative study revealed in 2002 that hormone replacement pharmaceuticals, like Premarin (estrogen) and Prempro (estrogen and progestin), increase the risk of stroke and other serious problems. As a result, many women and their doctors turned to compounded bioidentical hormone replacement therapy (BHRT). These custom-made drugs, available only with a licensed practitioner's prescription, consist of individualized doses of hormones, including estriol, that are chemically identical to human hormones. Estriol is a weak estrogen that gives some protection against breast and endometrial cancers. BHRT is believed to be safer than patented drugs, although no direct comparison studies have been performed. The shift from pharmaceutical products to compounded ones has not gone unnoticed by Wyeth, manufacturer of Premarin, Premphase, and Prempro. Sales of its menopause hormone drugs fell from $2.07 billion in 2001 to $880 million in 2004 (57%).

On October 6, 2005, Wyeth Pharmaceuticals filed a citizen petition with the US Food and Drug Administration (FDA) asking the agency to investigate and take action against compounding pharmacies that promote or dispense compounded bioidentical hormone replacement therapy drugs. The company asserts: "BHRT is a new drug and does not have FDA approval; the BHRT drug is/was compounded … in a pharmacy that is not required to comply with FDA current good manufacturing practice (CGMP) requirements; and that the BHRT drug has not been demonstrated to be safe or effective for any use, or safer or more effective than FDA-approved hormone therapy drugs."

Perhaps stunned by an onslaught of over 70,000 comments (most of them against Wyeth's petition), the FDA did not respond until January 9, 2008. The agency's response supports compounding pharmacies' important role as medicine providers for patients who need individualized prescriptions. But the FDA agrees with Wyeth that bioidentical hormone drugs are "new drugs" and "may not be introduced into interstate commerce without FDA approval." The FDA also agrees with Wyeth that BHRT cannot claim less risk or greater benefit than FDA-approved drugs because the agency is "aware of no adequate randomized, prospective, controlled clinical trials of compounded BHRT drugs that either demonstrate that they are better at relieving menopausal symptoms than a placebo, or that compare them to an FDA-approved drug and establish that the compounded drugs work equally well." FDA distinguishes between compounding pharmacies that make limited, individualized medicines and those that make bulk products. In a letter to Wyeth's lawyers, Margaret O'K Glavin, associate commissioner for regulatory affairs, concludes: "Although we share many of your concerns about compounded BHRT drugs, we cannot grant all your requests." She says that the agency will release a consumer article, press release, and FAQs document as part of a BHRT public awareness campaign.

On the same day as its response to Wyeth's petition, the FDA sent warning letters to seven compounding pharmacies for making unsupported claims about the safety and effectiveness of BHRT. The FDA considers these claims "false and misleading." In addition, the agency announced that the use of estriol in any compounded drug is prohibited unless the compounding pharmacy or prescribing doctor has an approved investigation new drug application. "No drug product containing estriol has been approved by FDA," the agency states, "and the safety and effectiveness of estriol is unknown." The restriction of estriol hamstrings compounding pharmacies and doctors. Before the FDA ban, an estimated 80% of BHRT drugs contained this weak estrogen. Estriol's effects and safety have been studied. The International Academy of Compounding Pharmacists' "Estriol Literature Summation" summarizes 35 clinically relevant studies culled from over 150 articles listed in PubMed and Medline OVID. In addition, estriol has had an official US Pharmacopeia ("USP") monograph since 1980. Estriol has been approved and marketed as a treatment for postmenopausal symptoms in Europe and Asia for over 40 years. Wyeth itself sells two estriol-containing menopause drugs in Germany.

Several pharmacist associations have protested against the FDA's ruling. The International Academy of Compounding Pharmacists (IACP) has published several fact sheets and lobbied Congress to reverse the FDA's restriction of estriol use. IACP has also met with FDA officials, helped IACP members who received warning letters, and considered possible legal strategies.

Biundo B, Rollins J, Shuman C. Estriol literature summation. February 2008. www.iacprx.org/site/DocServer/Estriol_Lit_Review.pdf?docID=3481. Accessed December 20, 2008.
FDA. FDA takes action against compounded menopause hormone therapy drugs. January 9, 2008. www.fda.gov/bbs/topics/NEWS/2008/NEW01772.html. Accessed December 20, 2008.
Glavin MO. Re: Docket No. 2005P-0411/CPI & SUP1. FDA website. www.fda.gov/ohrms/dockets/dockets/05p0411/BHRTletter.html. Accessed December 20, 2008.
International Academy of Compounding Pharmacists. Pharmacists: urge congress to support resolutions on Estriol. www.iacprx.org/site/Advocacy?pagename=homepage&id=173. Accessed December 20, 2008.
International Academy of Compounding Pharmacists. Congress should reverse FDA's action that restricts access to doctor-prescribed compounded hormones. www.iacprx.org/site/DocServer/CCH08Resources_Estriol_White_Paper_FINAL.pdf?docID=3421. Accessed December 20, 2008.
King LD. Re: IACP Response to FDA actions against BHRT. www.iacprx.org/site/DocServer/Letter_to_Eschenbach_RE_Estriol_WLs_FINAL_logo.pdf?docID=3441. Accessed December 20, 2008.
Tuttle D. Health freedom under attack! Life Extension. August 2006;41-45.
Wright JV. Taking the fear out of bio-identical hormone replacement therapy – one urine test at a time. Dr. Jonathan V. Wright's Nutrition & Healing. December 2007;14(10):1-6, 8.

Make Changes Using Emotional Learning
Have you ever sought to make a lasting behavior change in your life and failed? Too often, we end up berating ourselves for not having enough self-control or discipline; but it could be that we are not accessing an innate process that is far more powerful than self-control: emotions. Decisions based on analytical thinking and external prodding do not have lasting power, because they use volitional memory and self-control. For example, people know that smoking harms their health, or health-care workers know that hand-washing decreases the spread of disease; but "volitional memory tends to run out of gas … as soon as we are under stress or are distracted," writes Maja Storch, a psychologist at the University of Zurich. For long-term change, she advocates using emotional experiential memory or, as Michael E. Frisina, PhD, says, "emotional learning." Emotional experiential memory or learning, unlike volitional memory, operates unconsciously. "We change our behavior when we feel the consequences of failing to do so," says Frisina.

So how can we use emotional self-regulation instead of volitional self-control to make changes? Storch suggests becoming aware of somatic markers, such as tightness in the stomach and feelings of freedom or joy, and then jotting the marker and accompanying circumstances in a small notebook. As we become aware of events and circumstances that evoke emotional responses, we can make small changes to reduce the negative and increase the positive. What happens, though, when a self-defeating habit – like overeating or smoking a cigarette in response to stress – feels good emotionally? One solution is to find something that evokes stronger positive emotions. "We can fuel the fire," Storch writes, "by creating in our minds an intense representation of the desired goal that draws on as many of the senses as possible." How does it look and feel to lose extra weight? What dream is actualized when the negative behavior changes? Another possibility is to find a substitute behavior that incites stronger positive emotions than the habitual behavior that we seek to release.

Negative emotion can motivate change, too. For example, caring for a suffering loved one whose illness is due to smoking can provide a negative emotional memory that may be stronger than any positive emotional association. I suspect the power of emotional learning is why government agencies are having a hard time counteracting the antivaccination movement. Detailed parental accounts of infant deaths and behavior changes after vaccination conjure powerful negative emotions among listeners that no amount of analytical "we have saved lives" rhetoric can overcome.

Frisina ME. Emotional learning. Hospitals & Health Networks Magazine. June 24, 2008. www.hhnmag.com. Accessed January 2, 2009.
Storch M. Taking the reins. Scientific American Mind. May 2005:88-89.

Learn Before Choosing Cesarean Section
Because of its physical and emotional consequences, cesarean section has historically been performed only when a mother's or baby's safety is threatened; but elective cesarean deliveries (those performed in absence of a medical necessity) have greatly increased in recent years. In 2006, 31.1% of all births in the US were cesarean, a 3% increase from 2005, according to the National Center for Health Statistics. The Pan American Health Organization and US Department of Health and Human Services have set the medically necessary cesarean rate at 15%. A New England Journal of Medicine (NEJM) article (January 8, 2009) based on data from 19 academic medical centers in the US reported that 13,258 of 24,077 women who gave birth through a repeat C-section between 1999 and 2002 chose the procedure; medical necessity did not dictate the surgery. Many factors – including fetal monitoring – have boosted cesarean section rates. Part of the increase may be due to a 2003 policy statement by the American College of Obstetricians and Gynecologists that approves elective cesarean section as a way to support the mother's autonomy. Also, hospitals and doctors make more money with a cesarean delivery than with a vaginal delivery. The average cost of a cesarean delivery ($12,544 in 2005) is nearly twice the cost of a vaginal delivery ($6,973 in 2005), according to the US Agency for Healthcare Research and Quality.

Women's requests for an elective cesarean are too often based on incomplete, sometimes inaccurate, knowledge, according to an article in Nursing for Women's Health (December 2008/January 2009). The article discusses several reasons that healthy women choose to have surgery. Some women (and doctors) believe that cesarean deliveries are "more technologically advanced" and therefore safer. Sometimes fear, stemming from a previous, difficult vaginal delivery, or simply fear of pain associated with vaginal delivery, prompts women to seek an elective cesarean. Scheduling a delivery, whether to have a particular physician attend the birth or for family or work reasons, is seen as more convenient. Preservation of sexual function and concerns about incontinence or pelvic prolapse due to vaginal delivery are other motives.

Many times, doctors go along with a healthy woman's desire for cesarean delivery because they wish to avoid a lawsuit. Malpractice rates are very high in obstetrics. Women who are dissatisfied with their birth experience are more likely to sue. So, if a woman wants a C-section, her doctor accedes in the hope of avoiding legal costs. Doctors' fears that something might go wrong probably contributed to the high number of "elective" cesarean deliveries in the 2009 NEJM article as well. In reality, many of the women in that cohort of repeat cesareans may not have "chosen" to have a cesarean. Women who have had one cesarean are often strongly discouraged from having a second birth vaginally. As Jennifer Block wrote in her blog, "...many obstetricians now refuse to attend [vaginal birth after cesarean (VBAC)]." Some doctors believe that the risk is too great, even though research has not supported this belief.

Unfortunately, women too often decide to have a cesarean without knowing the risks of major abdominal surgery or its postoperative effects. Women undergoing cesarean sections have a morbidity rate 5 to 10 times that of women having vaginal births. Surgery complications include infection, venous thromboembolus, hemorrhage, and pain that outlasts the pain from a vaginal delivery. Recovery from a cesarean delivery takes longer than recovery from a vaginal birth. In addition, cesarean sections increase the risk of serious problems with subsequent pregnancies: placenta previa (the placenta blocks the opening to the cervix), placental accreta (the placenta invades the uterine muscle, making separation difficult), placental abruption (placental separates from uterine wall during labor and before delivery), and uterine rupture.

In deciding whether to have an elective cesarean, women also need to be aware of the surgery's effect on the infant. Women undergoing major surgery are unable to experience the early bonding with their babies that normal delivery allows. Also, breast-feeding tends to be more difficult. Women need to understand that bringing a child from the womb before it is ready can have health complications and financial costs. Cesarean-born infants have a higher risk of respiratory problems, particularly if they are born too early. "More than 15 percent of the babies delivered at 37 weeks suffered a complication, such as problems breathing, low blood sugar, infections or conditions that required intensive care, compared with about 8 percent of those delivered [by C-section] at 39 weeks. About 11 percent of those delivered at 38 weeks experienced complications. Babies born at 37 weeks were four times as likely as those delivered at 39 weeks to have breathing problems," according to the NEJM study.

Women can learn more about the birth process and their options by going to the website of the American College of Nurse-Midwives (vww.acnm.org) or Childbirth Connection (www.childbirthconnection.org).

Block J. Can we please stop blaming women for C-sections? [blog]. RH Reality Check website. http://www.rhrealitycheck.org/blog/2009/01/21/can-we-please-stop-blaming-women-csections. Accessed January 30, 2009.
Collard TD, Diallo H, Habinsky A, Hentschell C, Vezeau TM. Elective cesarean section. Nursing for Women's Health. December 2008/January 2009;12(6);481-488.
Stein R. Early repeat C-sections increase risks, study finds. Washington Post. January 8, 2009: A01. www.washingtonpost.com/wp-dyn/content/article/2009/01/07/AR2009010702919.html. Accessed January 8, 2009.

Permaculture and 'Transition Towns'
Permaculture may be a concept whose time has come. Unlike globalization, which focuses only on how much money is in the bank, permaculture factors in sustainability, efficiency, and the well-being of the environment and its inhabitants as part of a company's net financial gain.

"In Permaculture, a net economic return means that you are using the least input (time and energy) while obtaining the most productive output that benefits the entire system (self, society and the environment)," explains Jennifer Dauksha-English. "Because the world is diverse, every location is going to have a different technique that is appropriate and relative to the conditions of that system. It basically comes down to energy consumed versus energy created." Instead of focusing on separate factors, permaculture takes a wholistic view – much like wholistic medicine that addresses the function and energy of a person's cells, organs, and systems, as well as overall well-being. "Looking at separate details within a system without looking at the overall patterns of how the system interacts is dangerous …" writes Dauksha-English. "Fragmentation leads us away from self-reliance and towards dependency on specialists who are usually disconnected." In permaculture, waste of all kinds becomes an opportunity if people face the problem head-on and ask questions: "How can we (collectively) benefit from this problem? How can this be a blessing? Is there some [beneficial] way we can cycle it back into the system?"

I found two movements that are helping communities build new ways of being. Both look to local community and the individuals in them instead of big governments or global economics for solutions. As of December 3, 2008, 126 towns and cities have deemed themselves part of the Transition Initiative. These "Transition Towns" have set an intention of addressing the issues of peak oil and climate change on a local level. The individuals involved in the Transition Initiative are committed to educating others in their communities to look for new, sustainable ways of getting needs met that "significantly increase resilience (to mitigate the effects of Peak Oil) and drastically reduce carbon emissions (to mitigate the effects of Climate Change)." Most Transition Towns are in the British Isles, Australia, and New Zealand. The US has eight, mostly in Western states.

Financial permaculture, a close cousin of the Transition Initiative, has taken root in Hohnenwald, Tennessee. Organizers there have created a business plan designed to meet the local county's food, energy, and banking needs in a sustainable manner. Financial permaculture applies the principles of permaculture to economics. Instead of putting time, attention, and money into global investments, those same resources support local investments (particularly those that fit permaculture), cooperatives, and local currencies.

I grant that permaculture seems idealistic. It may be a backlash to globalization, or it may be an old idea whose time has come (or merely returned after millennia). Nonetheless, these turbulent times may provide the compost needed for a more responsible, humane, sustainable system to take hold. Meanwhile, we can each support our local community. Just as we need healthy cells to have healthy organs, we need healthy neighborhoods and towns.

Dauksha-English J. Principles of Financial Permaculture. Solari Real Channel website. http://solari.com/blog/?p=1730. Accessed October 20, 2008.
Financial Permaculture. Economics on our terms. www.financialpermaculture.org/definition. Accessed December 2, 2008.
Transition Towns WIKI. http://transitiontowns.org. Accessed December 31, 2008.

Self-Care for Caregivers
Surveys indicate that 20 million to 50 million people, 75% of whom are women, provide nursing and household care for disabled relatives in the US. Two-thirds of these caregivers also hold outside jobs. "Family caregivers supply about 80 percent of the care for ill or disabled relatives, and the need for their services will only rise as the population ages and modern medicine improves its ability to prolong lives," writes Jane E. Brody in the New York Times. Even though many caregivers report a "sense of purpose" and even gratitude for being able to help a loved one, this 24-hour, seven-day-a week responsibility can be very stressful – especially if the caregiver is also employed and raising children. Complicated or inharmonious family dynamics heighten the stress level. For most caregivers, self-care falls at the never-reached end of a long list of caretaking, household, and work activities. As a result, exhaustion, depression, health problems, and substance abuse are common among long-term caregivers.

Too often caregivers, running on adrenaline, discount their stress because they see no options; but they need to understand that the best way to take care of their loved one is to take care of their own health and well-being. Family Caregiver Alliance uses the analogy of an oxygen mask during airplane travel in its excellent article "Fact Sheet: Taking Care of YOU: Self-Care for Family Caregivers." During an emergency, passengers are instructed to put their own oxygen masks on before helping a child or other person: "Only when we first help ourselves can we effectively help others." The American Medical Association has a short caregiver self-assessment questionnaire to gauge stress level. Signs of caregiver stress include sleeping problems, change in eating habits and weight, ongoing fatigue and lack of energy, loss of interest in enjoyable activities, tendency to irritate or sadden easily, frequent headaches or stomachaches, and other health problems. Caregivers need to take care of themselves before they become physically ill or exhausted. They need to make self-care a priority before they crash.

In the article "Caring for Family, Caring for Yourself," Jane E. Brody makes several excellent suggestions for self-care and refers caregivers to groups like Family Caregiver Alliance (www.caregiver.org) for additional support. Eating nutritious meals and getting enough sleep are basic. If sleep is interrupted throughout the night, taking naps while the relative sleeps during the day is more important than finishing another household task. Exercise, such as a leisurely walk, and enjoyable social activities (out of the house, if possible) also provide stress relief. Family Caregiver Alliance and Brody urge caregivers to ask for help. Friends, other family members, even neighbors may be willing to take over a household chore or stay with the disabled relative for a brief period.

Family Caregiver Alliance also encourages caregivers to ask for and accept help from community, church, and online support groups. Organizations like Family Caregiver Alliance, National Family Caregivers Association (www.nfcacares.org), and its Community Action Network (http://www.thefamilycaregiver.org/our_state_volunter_network_ccan) teach caregivers how to relieve their burdens. These sites also recommend other resources such as Area Agency on Aging (www.aoa.gov) and the Eldercare Locator (800-677-1116 or www.eldercare.gov). In addition, caregivers who work at companies with 50 or more employees may be eligible for up to 12 weeks of unpaid leave per year to care for relatives under the federal Family and Medical Leave Act.

American Medical Association. Caregiver self-assessment questionnaire.
www.ama-assn.org/ama/pub/category/5037.html. Accessed December 20, 2008. (May 2009: Try http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/caregiver-health/caregiver-self-assessment.shtml )
Brody JE. Caring for family, caring for yourself. New York Times. November 18, 2008. www.nytimes.com/2008/11/18/health/18brod.html. Accessed January 7, 2009.
Brody JE. When families take care of their own. New York Times. November 11, 2008. www.nytimes.com/2008/11/11/health/11brod.html. Accessed January 7, 2009.
MedicineNet. Caregiving. www.medicinenet.com/caregiving/article.htm. Accessed December 20, 2008.
Family Caregiver Alliance. Fact sheet: taking care of YOU: self-care for family caregivers. http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=847. Accessed December 20, 2008.

Chaste Tree Fruit Helpful for PMS
Vitex agnus-castus L., otherwise known as chaste tree or monk's pepper, has a long history in Western herbal medicine. Hippocrates reported its effect on female reproduction and fertility. In the Middle Ages, monks used it to decrease their sexual desire (hence the common names). In recent years, research has shown that the shrub's small fruit is an effective treatment for premenstrual syndrome and infertility. The German Commission E approved chaste tree for menstrual cycle irregularity, premenstrual syndrome (PMS), and mastodynia (breast pain). (The German Commission E is a committee set up by the German government in 1978, consisting of scientists, toxicologists, pharmacists, and doctors, to review safety and efficacy of herbs sold in that country.) Human and animal research shows that constituents in the herb bind to "dopamine2 receptors in the anterior pituitary and decrease both basal- and thyrotropin-releasing-hormone-stimulated secretion of prolactin. This decrease in prolactin leads to increased progesterone production in the luteal phase of the menstrual cycle, which reduces symptoms of PMS," explains Mary L. Hardy, MD.

German researchers have performed several studies on Vitex and PMS. In a randomized, double-blind, placebo-controlled study, 170 women with PMS (mean age 36 years) were followed over three menstrual cycles. Eighty-six of the women received one 20 mg dry chaste tree extract tablet each day, and the other 84 took a matching placebo. In the extract group, 52% of the women had at least 50% reduction of PMS symptoms at the end of three cycles. Four in this group reported mild adverse events (details unreported). In comparison, 24% of the placebo group reported a 50% or more reduction of PMS symptoms with three mild adverse reactions. Another German study, involving 1634 women, evaluated the effectiveness of a German Vitex product called Femicur (Loch E-G, Selle H, Boblitz N. Journal of Women's Health & Gender-Based Medicine 2000; 9[3]:315-320). At the end of three menstrual cycles, 42% of the participants told doctors that PMS symptoms had disappeared. Another 51% reported that symptoms had decreased; 6% found no change; and 1% experienced an increase in symptoms. No serious adverse events were reported. About 6% of the women experienced reactions that included mild skin reactions and gastrointestinal upset.

A systematic review of chaste tree's adverse events, carried out by Daniele and colleagues at University of Rome La Sapienza (Italy), confirms that side effects tend to be mild and reversible. Common reactions include nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, itching, and rashes. Although no negative drug interactions have been reported, the Italian researchers warn that Vitex may theoretically interfere with dopaminergic antagonists. Also, women who are pregnant or breast-feeding should not use this herb.

Daniele C, Thompson Coon J, Pittler MH, Ernst F. Vitex agnus castus: a systematic review of adverse events [abstract]. Drug Saf. 2005;28(4)319-332. Available at: www.ncbi.nlm.nih.gov/pubmed. Accessed January 2, 2009.
Hardy ML. Women's Health Series: Herbs of special interest to women. J Am Pharm Assoc. 2000:40(2):234-242. Available at: www.medscape.com/viewarticle/406683_3. Accessed December 17, 2008.
Leigh E. Vitex improves symptoms of PMS. Herb Research Foundation website. www.herbs.org/current/vitexpms.htm. Accessed January 2, 2009.
Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study. BMJ. January 20, 2001;322:134-137. www.bmj.com/cgi/content/full/322/7279/134. Accessed January 2, 2009.

Estrogen Dominance, Premenopause, and PMS
Estrogen dominance accounts for many health complaints in women during their 30s and 40s as ovulation and progesterone secretion become inconsistent in the years before menopause. Estrogen dominance occurs when estrogen levels remain normal or high while progesterone secretion declines. Symptoms of estrogen dominance include breast swelling and tenderness, abdominal cramping, backaches, bloating, headaches/migraines, irritability, anxiety, depression, food cravings, brain fog, sleep difficulties, and/or lowered sex drive. These symptoms characterize premenstrual syndrome (PMS), which is linked to estrogen dominance.

In her book Dr. Susan Lark's Hormone Revolution, Lark advocates a Mediterranean-type diet, exercise, and supplement program to address estrogen dominance. The program is designed to decrease estrogen production, increase the hormone's breakdown and elimination, and increase progesterone levels. Lark advocates using weakly estrogenic herbs, such as soy, to decrease estrogen production. Soy isoflavones in tofu, tempeh, soy milk, and edamame prevent the conversion of testosterone and androstenedione into estrogen by hooking onto relevant enzymes and rendering them ineffective. Flaxseed oil and flaxseed meal also inhibit estrogen production and promote ovulation (encouraging progesterone production).

Encouraging the breakdown and elimination of estrogen is another way to decrease estrogen dominance. Normally, the liver metabolizes estrogen into inactive compounds that are then secreted with bile into the small intestine and eliminated in bowel movements. Several nutrients support this process, according to Lark. Calcium d-glucarate supports liver detoxification of excess estrogen. Diindolylmethane, a compound found in Brassica vegetables (broccoli, cauliflower, bok choy, cabbage, and brussels sprouts), encourages the breakdown of estrogen into "good" metabolites. The liver also needs B vitamins, particularly B6, to detoxify excess estrogen. Lark refers to research by Guy Abraham, MD, in which PMS symptoms (menstrual cramps, pain, weight gain) decreased in women who took 500 mg of B6 daily for three months. "According to Dr. Abraham," says Lark, "vitamin B6 helped to change the blood levels of both estrogen and progesterone and bring them into balance."

Increasing progesterone levels is the other part of the solution to estrogen dominance. Chaste tree berry (Vitex) increases progesterone levels and ovulation, and restores menstruation. Lark says that this herb tends to work slowly and may take three or four months to show its full effect. She also suggests encouraging progesterone production by supporting the nervous system and organs with glandulars from a company like Standard Process. Biochemically identical natural progesterone is another option.

"Clearly, estrogen dominance is a complex condition," says Lark. "And it's one I know first-hand. When I was in my 20's, I too suffered from estrogen dominance. By following the program I've outlined. … I can happily report that my hormone levels have been balanced for several decades now."

Lark, SM, Day K. Dr. Susan Lark's Hormone Revolution. Portola Press, LLC;2008:59-94.

Strontium, Vitamin K2 Can Help with Osteoporosis
The nutrients strontium and vitamin K2 are effective additions to calcium and vitamin D supplementation for the prevention and treatment of osteoporosis. Any nontoxic strontium salt (not radioactive strontium-90) can strengthen bone, according to Jonathan V. Wright, MD. German researchers first noticed that strontium increases bone formation in the early decades of the 20th century. German researchers also found that strontium and calcium have a synergistic effect. In 1952, Cornell University researchers confirmed that these two minerals stimulate bone formation more effectively when used together than calcium alone. Seven years later, Mayo Clinic physicians reported that 84% of a group of 32 people with severe osteoporosis experienced "marked relief of bone pain" when taking 1,700 milligrams of strontium lactate each day, according to Ward Dean, MD. The other 16% reported "moderate improvement." These Mayo researchers also detected "probable" increase in bone mass in 78% of the patients from X-ray, the only technology available to measure bone mass at that time. In a 1981 study, Dr. Stanley C. Skoryna (McGill University) used 274 mg/day of strontium gluconate to rebuild bone and relieve subjective symptoms in patients with metastatic bone cancer. A small 1985 study conducted by Skoryna resulted in a 172% increase in bone formation and less pain in six people (3 male; 3 female) with osteoporosis. These patients took 600 to 700 mg/day of strontium carbonate. In his clinical practice, Wright uses strontium citrate to increase bone density in patients. Recent strontium studies have used strontium ranelate, a patented compound made by European manufacturer Les Laboratoires (Servier). Wright says that no significant side effects have been reported concerning strontium salts – with one caveat. "Always take more calcium than strontium." Wright says that studies in which animals were given high doses of strontium while on a low-calcium diet developed bone deformities.

Vitamin K2, like strontium, encourages bone-building; but it also decreases bone resorption (breakdown). K2 (menaquinone), produced by bacteria in the GI tract, has a stronger effect on bone than vitamin K1 (phylloquinone), a blood clotting promoter found in green leafy vegetables and algae. Vitamin K2 has beneficial effects in osteoporosis, regardless of the underlying cause of the bone loss: menopause, Parkinson's disease, biliary cirrhosis, inactivity due to stroke, drugs such as leuprolide or prednisolone, or anorexia. Steven M. Plaza and Davis W. Lamson have listed several vitamin K/osteoporosis studies in their article for Alternative Medicine Review (2005;10[1]:24-35). Most of the cited studies show results at a dose of 45 mg/day. Animal and human studies indicate that K2 does not increase blood coagulation or platelet aggregation. Nonetheless, K2 supplementation is contraindicated in people taking warfarin (Coumadin). People with celiac disease (one in 266) or who have difficulty absorbing fats probably need K2 supplementation. Vitamin K2, which is fat soluble, is rarely included in multiple vitamin and mineral supplements.

Dean W. Strontium: Breakthrough against osteoporosis. May 5, 2004. Available at www.worldhealth.net/news/strontium_breakthrough_against_osteoporo. Accessed January 2, 2009.
Delvaux GM. A Barefoot Doctor's Guide for Women. Berkeley, California: North Atlantic Books; 2007:44-53.
Denver Naturopathic Clinic. Changing treatments for osteoporosis. DNC News. www.denvernaturopathic.com/news/osteoporosis.html. Accessed December 17, 2008.
Plaza SM; Lamson DW. Vitamin K2 in bone metabolism and osteoporosis. Altern Med Rev. March 2005;10(1):24-35. Available at: http://findarticles.com/p/articles/mi_m0FDN/is_1_10/ai_n13557316?tag=artBody;col1. Accessed January 2, 2009.
Wright JV. Fight – even prevent – osteoporosis with the hidden secrets of this bone-building miracle mineral. Available at: www.tahoma-clinic.com/strontium.shtml. Accessed January 2, 2009.