Q: My doctor said that even though estrogen therapy has a downside, it?s still useful for depression in some women. Is this true?
A: That doesn?t generally seem to be the case. As is now well-known, various studies—including, most prominently, the National Institutes of Health?s Women?s Health Initiative—have shown that there are significant health risks associated with hormone replacement therapy. However, one of the less well-publicized findings of WHI was the effect of HRT on mood.
HRT has long been thought to have a mood-elevating effect or to generally make a woman feel better. The WHI study looked at this by measuring quality of life through standardized questionnaires of women taking HRT versus those taking placebo. The researchers reported that the combination of estrogen plus progestin compared with placebo resulted in no significant effects on general health, vitality, mental health, depressive symptoms or sexual satisfaction. When they broke down the data to look only at women who had significant hot flashes and night sweats, HRT did show a small benefit in terms of easing sleep disturbance, but no benefit in terms of the other quality-of-life outcomes.1
In a more recent study, estrogen alone was shown to be no better than placebo for depressive symptoms in postmenopausal women diagnosed with depression.2 These two studies strongly suggest that HRT or estradiol not be given to improve general quality of life.
Q: I?ve been taking black cohosh and find it helps with hot flashes, but I?m worried about its possible estrogenic effects.
A:The rhizome of black cohosh (Actaea racemosa, syn. Cimicifuga racemosa) has a history of use to improve symptoms associated with menopause. The literature on its clinical efficacy is mixed, but recently, questions have been raised about whether it has estrogenic effects. Current studies support that black cohosh has no estrogenic effects, though results are not completely definitive. In a clinical trial, a group of women were given black cohosh for six months. They had no changes in serum hormone levels nor vaginal cytology, both indicating no estrogenic effects.3 Generally, cell culture and animal studies indicate that black cohosh does not induce cancer cell proliferation4,5,6 (which can be induced by estrogens). However, there is no agreement on this, and at high dosages there is some suggestion it might.7
Overall I would say these results suggest a relatively good short-term safety record. But it does not mean that black cohosh should be taken for years, because there are really no good long-term controlled studies of which I?m aware. A woman may need this type of support for only a few months to a year while her body adjusts and ?re-equilibrates? to changes in menopausal hormone patterns and levels. Then she should discontinue this herb.
Q: Should I take supplemental folic acid if I have elevated blood pressure?
A:It might be a good idea. Most people are aware of the association between homocysteine, risk for cardiovascular disease and folic acid. However, it may be that extra folic acid helps to specifically control blood pressure. High levels of homocysteine may, among other things, alter the elastic properties of the vascular wall and thus increase arterial pressure.8 Since folic acid can lower homocysteine, it may therefore help lower blood pressure.
At the American Heart Association annual meeting in October, researchers reported that younger women who consume more then 800 mcg of folate per day reduce their risk of developing high blood pressure by almost a third compared to those who consume less then 200 mcg/day. They also found that older women (43 to 70 years old) had a modest decrease in risk if consuming over 800 mcg/day. The benefit of folate remained when other risk factors such as salt intake and exercise were controlled.
This was an epidemiological study, looking retrospectively at 150,000 women and their dietary intakes. So while a placebo-controlled trial has yet to be completed, this particular study gives another reason for taking higher levels of folic acid?particularly for individuals at risk for or dealing with high blood pressure.
Dan Lukaczer, N.D., is director of clinical research at the Functional Medicine Research Center, a division of Metagenics Inc., in Gig Harbor, Wash.
1. Hays J, et al. Effects of estrogen plus progestin on health-related quality of life. N Engl J Med 2003;348(19):1839-54.
2. Morrison MF, et al. Lack of efficacy of estradiol for depression in postmenopausal women: a randomized, controlled trial. Biol Psychiatry 2004;55(4):406-12.
3. Liske E, et al. Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med 2002;11(2):163-74.
4. Bodinet C, Freudenstein J. Influence of Cimicifuga racemosa on the proliferation of estrogen receptor-positive human breast cancer cells. Breast Cancer Res Treat 2002;76(1):1-10.
5. Amato P, et al. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause 2002;9(2):145-50.
6. Zhang L, et al. In vivo effects of black cohosh and genistein on estrogenic activity and lipid peroxidation in Japanese medaka (Oryzias latipes). J Herb Pharmcother 2003;3(3):33-50.
7. Liu ZP, et al. Estrogenic effects of Cimicifuga racemosa (black cohosh) in mice and on estrogen receptors in mcf-7 cells. J Med Food 2001;4(3):171-8.
8. Rodrigo R, et al. Implications of oxidative stress and homocysteine in the pathophysiology of essential hypertension. J Cardiovasc Pharmacol 2003;42(4):453-61.
Natural Foods Merchandiser volume XXV/number 12/p. 46