From: Guy R. Schenker, D.C. January, 2001 Dear Doctor, Do you have any patients who are worried about osteoporosis? Are there any women under your care who are considering estrogen replacement therapy as protection against osteoporosis? Then, here is one important study you will want to look into. Kassem M., et al. Potential mechanism of estrogen-mediated decrease in bone formation. Proc Assoc Am Physicians 1996, Mar; 108(2):155-64. Yes, you read that correctly ... "Estrogen-mediated decrease in bone formation." "What exactly is going on here?" you may be wondering. Everyone "knows" that the one beneficial effect of estrogen is that it prevents post menopausal bone loss. The fact is (as is clearly shown in the scientific literature) that the truth is not only different than we are led to believe, but the exact opposite of the propaganda we have been fed. Here is another study which shows that estrogen is a causative factor in osteoporosis: Bauer, et al. Skin thickness, estrogen use and bone mass in older women. Menopause 1(3), 131-136, 1991. This study found that estrogen was associated both with thinning skin and with decreased bone mass in older women. Here is more evidence implicating estrogen as a destroyer of bone mass: Schlechte, et al. Bone density in amenorrheic women with and without hyper prolactinemia. J Clin Endocrin & Metab 56,1120, 1983. This study demonstrated a direct damaging affect of prolactin on bone. And then this next study ... Dannies. "Control of prolactin production by estrogen," Chapter 9 in Biochemical Actions of Hormones I Academic Press, 1985. ... showed that estrogen is a primary stimulus to prolactin production. Prolactin is a stress hormone produced by the pituitary which many studies have shown causes osteoporosis. Furthermore, many studies also show that estrogen promotes the secretion of prolactin. These studies make it clear that something that increases something that causes osteoporosis can not possibly prevent osteoporosis. How can the pharmaceutical establishment get away with promoting estrogen as protection against osteoporosis when research clearly shows that the opposite is true? They have spent zillions of dollars in a propaganda campaign that is entirely based on a half truth (evidence which was subsequently proved to be false, showing a damaging, not a protective role of estrogen -- but which was then quickly replaced by another half truth on which they still base their dishonest claim). The original half truth employed by the estrogen propaganda machine was the discovery forty or more years ago that estrogen can cause a positive calcium balance -- in other words, retaining some of a calcium test dose, rather than dumping it all into the bowel and kidneys for excretion. The estrogen promoters argued that this fact showed that the retained calcium was being stored in bone. But very quickly endocrine physiologists showed that estrogen causes the retention of calcium by soft tissues, not by bone. The accumulation of calcium in soft tissues is, of course, an accurate marker of stress and aging. (In other words estrogen just makes you old -- as expressed in sclerotic calcium deposits all through the body.) This, of course, set the estrogen promoters scrambling to suppress the nasty little details about calcium retention, and frantically look for another excuse to peddle estrogen as a protector against osteoporosis. They seized upon another discovery -- namely, that estrogen can reduce the activity of osteoclasts, the cells that continuously break down bone in their complimentary and cooperative role to osteoblasts, the cells that then rebuild the bone. Be certain you understand this so that you can explain it clearly to your patients. There are two types of cells continuously at work in bones, making bone a dynamic, continuously evolving living tissue. There is one type of cell that continuously breaks down bone structure, while the other type of cell continuously rebuilds it, and the two are in constant balance. In reading the last two issues of this Letter you have come to know that estrogen is a destructive stress hormone that interferes with the normal function of many types of cells. One of the cell types whose function estrogen particularly destroys is the osteoclasts -- the cells that tear down bone. And, as it turns out, estrogen is more destructive to the osteoclasts than it is to the osteoblasts. The estrogen peddlers seized on this fact and began to promote it as proof that estrogen was good for the bones because it inhibited osteoclastic activity. Of course it is never mentioned that estrogen does nothing to help rebuild the bone. It merely slows down and destroys the balance of the normal remolding process of bone. But at any rate, the estrogen promoters now had their half truth on which they could base their case for estrogen. Now that they could say (with tongue in cheek) that estrogen "prevents bone loss," never again was mentioned the original half truth about estrogen promoting a positive calcium balance. Positive calcium balance had been the essence of the first argument for using estrogen to prevent osteoporosis -- but when it was recognized by everyone that calcium wasn't being stored in the bones as a result of estrogen, it was convenient for the estrogen industry to forget all about the positive calcium balance produced by estrogen since it really meant that estrogen was causing aging, tissue damage, and degeneration. The second half truth enabled them to tidy up their fraudulent case for estrogen replacement therapy. "Surely," I can hear you wondering, "There must have been some evidence in support of estrogen rebuilding bone for the pharmaceutical establishment to contrive such a huge campaign in support of the bone protecting benefits of estrogen." No. Again, there is only scant research showing that estrogen slows bone loss, and none that it rebuilds bone. Furthermore, the studies purporting to show benefits resulting from estrogen were done using the Dexa method of measuring bone density. Here is an interesting study which shows the poor validity of Dexa: Schneider and Reiners. Dual-energy x-ray absorptiometry for bone density can lead to false conclusions about bone mineral content, because of alterations in tissue fat or water content. JAMA 277(1), 23, 1997. This study showed that the influence of fat distribution on bone mass measurements with DEXA can be of considerable magnitude and ranges up to 10% error per two centimeters of fat. It also showed tremendous variability in bone mass measurement due to changes in fluid retention. Now, ask yourself, what are the most immediate effects on a woman's body of estrogen replacement therapy? There is an immediate and steadily progressing increase in body fat, and, there is a tremendous increase in fluid retention. As described in the study noted above, both increased fat and fluid retention give a false increased bone density reading using Dexa. So, after a woman has been on estrogen for six months, she has gained five pounds of fat and five pounds of water. She puts her now squishy body in front of the Dexa and, presto! -- her bone density number is improved. What we are saying is that it has never been demonstrated that estrogen helps rebuild or remineralize bone. At best, it slows bone loss. Furthermore, even the rate of slowing the bone loss is over- estimated by bone scans because the increase in fat and particularly fluid retention due to the estrogen gives a false increase in the density measurement. If falling estrogen at menopause does not cause osteoporosis, then what does? There are some hormonal factors involved, and there are many nutrition and other lifestyle factors involved. In the hormonal category consider this study: Johnston, et al. "Age-related bone loss," in osteoporosis II, Grune and Stratton, NY, 1979, pp 91-100. In this study it was found that progesterone, but not estrone, estradiol, testosterone, or androstedione, was significantly lower in those losing bone mass most rapidly. Progesterone actually promotes bone rebuilding, rather than just slowing its loss. One mechanism by which progesterone protects bones is that it is an antagonist to catabolic stress hormones such as glucocorticoids which destroy bone (as well as skin, brain, etc.) tissue, and which increase with aging. The other hormones supporting bone density maintenance in old age are DHEA, testosterone, pregnenolone, and thyroid. Now, you may still be wondering, "But if the drop in estrogen at menopause doesn't cause osteoporosis, then why does it begin with the onset of menopause?" It doesn't. And that is the greatest lie of all. Bone density actually begins decreasing during early adulthood and progresses steadily until a woman reaches her mid 40's, when progesterone levels typically start to drop, at which point the rate of mineral loss accelerates. Here are the facts: Between the ages of 21 and 40 there is a considerable increase in women's estrogen production. However, bone loss has been shown to actually begin around the age of 23, and progresses through the years when estrogen levels are actually rising. In fact, most women lose two thirds of the bone loss that they are ultimately going to lose in their life before they even reach menopause. Do you begin to see how absurd it is to blame menopause-related hormone changes for osteoporosis? Re-read that last paragraph, and memorize it. You are going to recite it over and over again with patient after patient for years and years until the estrogen hoax is fully exposed. Each time a post-menopausal patient comes to you explaining how she just had a bone scan which showed, "the beginnings of osteoporosis," you must make her understand that that loss of bone density has been going on since she was 23 years old, and had nothing to do with low estrogen (and probably much to do with too much estrogen and too little progesterone throughout her 20's, 30's and 40's). If she shows osteoporosis today it is because of lifestyle choices she made over a period of several decades including: insufficient exercise, insufficient sunlight, insufficient trace minerals, along with excess stress hormones such as glucocorticoids, cathecolamines, and estrogen, whose excess is generally associated with the various NUTRI-SPEC metabolic imbalances. Notice, I didn't say anything about a calcium deficiency. Here is another critical piece of info. It has been clearly shown that many of the aging, tissue damaging and degeneration effects caused by estrogen are exacerbated by calcium, and opposed by magnesium. In this light it is seen that excessive calcium supplementation actually potentiates the damaging effect of estrogen - including the damaging effect of estrogen on bone - while magnesium has a protective effect against excess estrogen, including a protective effect against osteoporosis. The two studies you want to check in support of this are: Abraham and Grewal. A total dietary program emphasizing magnesium instead of calcium. Effect on the mineral density of calcanius bone in post menopausal women on hormonal therapy. J Reprod Med 1990, May; 35(5):503-7. Muneyyirci-Delale, et al. Serum ionized magnesium and calcium in women after menopause: Inverse relation of estrogen with ionized magnesium. Fertil Steril 1999, May; 71(5):869-72. It is interesting to note that both men and women lose minerals from their bones at a rate of about 1% per year. Men have lower estrogen in youth than women do, and their bones are much heavier. During aging, however, as their bones get thinner, men's estrogen levels (unlike women's) keep rising. After about age 54 the average man actually has higher estrogen than the average woman. Similarly, muscle loss occurs at about the rate of one percent per year. Women's muscles, like their bones, are normally smaller than men's during youth, and estrogen, which inhibits muscular development, explains much of this difference. With aging, as men's estrogen levels rise, they begin to lose their muscular advantage over women. Reiterating our comments from the last two issues of this Letter, estrogen is a damaging stress hormone to both men and women. Accelerating the loss of bone and muscle strength is just one of its many devastating effects. As regards the proper treatment for your patients with osteoporosis consider the following: Hochberg. Preventing fractures in post-menopausal women with osteoporosis. A review of recent controlled trials of anti-resorptive agents. Drugs Aging 2000 Oct; 17(4):317-30. This study was a review of all the recent work done on treatments for post-menopausal osteoporosis and reached several conclusions, including that, "there is insufficient published evidenced from randomized controlled trials to convincingly support the anti-fracture efficacy of ... agents ... including ... estrogen ... at this time." Interestingly, this study did show clear objective evidence supporting calcium plus vitamin D in reducing fractures. In other words, your patients are not likely to benefit from either estrogen replacement or any other form of medical intervention for osteoporosis. The answer is in NUTRI-SPEC. It is certainly not in estrogen replacement, nor in mega dose calcium supplementation. The only adjunct you need to each patient's NUTRI-SPEC QRG protocol is the judicious use of progesterone or DHEA or pregnenolone or thyroid, along with some extra vitamin D. We will give you protocol for the proper use of these therapeutic agents in our next Letter. Meanwhile, do everything you can to keep your patients off any form of estrogen. ESTROGEN MAKES YOU FAT, DEPRESSED, AND OLD! Sincerely, Guy R. Schenker, D.C.