Dr. Michael Murray- Black Cohosh as HRT Substitute

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Dr. Michael Murray- Black Cohosh JoAnn Guest Aug 14, 2003 12:20 PDT

 

Newsl-

1:16:2003

Black Cohosh -

Is There Really A Concern?

 

Black cohosh (Cimicifuga racemosa) is without question the most popular

natural approach to menopausal symptoms. Its popularity has been

increasing in part because of all of the negative press on Hormone

Replacement Therapy.

 

Specifically, last year the National Institutes of Health (NIH) halted a

major clinical trial designed to help settle the debate over whether HRT

benefits postmenopausal women.

 

This study was part of the Women's Health Initiative and was published

in The Journal of the American Medical Association.

 

The study concluded that the risks of taking combined estrogen and

progestin outweighed the benefits and increased the risk of stroke,

coronary heart disease and breast cancer.

 

In case you missed it, here were some of the more recent headlines on

the potential dangers of HRT:

 

August 8, 2003 - HRT Linked to Breast Cancer

 

A study published in the Lancet found that of more than one million

women in Britain aged 50 - 64 found that women who used HRT drugs faced

a 22% increased relative risk of death from breast cancer compared to

women who had never used hormones.

 

August 7, 2003 - HRT Could Increase Risk of Coronary Heart Disease

 

Two studies in the New England Journal of Medicine found that HRT does

not protect women from heart disease, as doctors once believed and one

of the studies found that giving HRT to women actually increases their

risk of heart attack.

 

June 25, 2003 - HRT Linked to Breast Cancer

 

The Journal of the American Medical Association published two studies

that show HRT not only appears to stimulate the growth of invasive

breast cancers, but also makes it harder to spot the potentially deadly

tumors on mammograms.

 

May 27, 2003 - HRT Linked to Dementia

 

The May 28 issue of the Journal of the American Medical Association

cautions that post-menopausal women who took HRT have twice the risk of

developing Alzheimer's as those who do not. A related study found that

HRT also increases the risk of women sufferring from stroke.

 

Some Bad Press on Black Cohosh

 

While black cohosh has an exceptional safety profile, two conflicting

reports came out last month. The first, a negative study entitled " Black

Cohosh and Breast Cancer a Dangerous Mix, " was picked up by almost all

news services as it was headlined in newspapers and on the television

news.

 

 

However, the second, a more comprehensive study that provided tremendous

reassurance on the safety of Black cohosh in relieving menopausal

symptoms was mostly ignored.

 

Is the reason to be concerned regarding the safety of black cohosh? I

don't believe so.

 

Let's first take a look at the " negative " study before we examine the

weight of the evidence on black cohosh's safety.

 

The yet to be published study in question was a twelve-month study done

at Duquesne University in Pittsburgh, on mice, not people.

 

The information regarding the detailed aspects of the study were not

released so not much is really known.

 

What is known is that the mice used were specially bred to be more

likely to develop breast cancer.

 

Half were given a regular diet, while the other half had a regular diet

along with the equivalent of 40mg a day of black cohosh extract, the

amount generally used by women with menopausal symptoms.

Although the chance of getting cancer proved to be equal in both groups,

of the mice getting cancer, 27.1% of the mice that had the black cohosh

had their cancer spread into the lungs, while 10.9% of the mice not

taking the Black cohosh had the cancer spread to the lungs.

 

The results of this study were presented on July 12, 2003, at the annual

meeting of the American Association for Cancer Research held in

Washington. D.C. Immediately concern was voiced about women taking Black

cohosh.

 

Lead researcher of this study, Vicki Davis, PhD, said in a statement,

" Our findings suggest that women who may be at a high risk of having an

undetected breast tumor, and certainly those who do have breast cancer,

should proceed with great caution - or simply avoid - taking Black

cohosh until we learn if there are ways to circumvent these adverse

effects. "

 

Obviously, I don't agree with this position at all. First of all, the

effects of compounds in mice and humans can be quite different.

 

Second, there is considerable evidence of black cohosh's safety and

test tube studies on various types of human breast cancer cells have

shown an *inhibitory* effect - not a promotion--

of breast cancer cell growth.

 

Is Black Cohosh Safe?

 

While the second report provided considerable more science it did not

seem to get the same degree of press coverage as the negative study.

 

The lead researcher was Tieraona Low Dog, MD is Clinical Assistant

Professor at the University of New Mexico and an advisor to the NIH

Center for Complementary and Alternative Medicine.

 

Dr. Low Dog concluded " This paper supports a growing body of evidence on

the safety of Black cohosh, an herb used by Native Americans for

centuries.

 

The findings should reassure the increasing number of women, who cannot

or choose not to take HRT that safe options exist to treat their

menopausal symptoms. " 1

 

The opinion of Dr. Low Dog and her group was based on the most

comprehensive review of black cohosh safety data to date, and includes

pre-clinical and clinical research in estrogen-sensitive populations,

including women at risk for breast cancer and breast cancer survivors,

as well as human cell lines most relevant to breast cancer.

 

This review of the human use of black cohosh clearly contradicts the

theoretical concerns suggested by the study done with mice.

 

In addition, the BGA, the German equivalent to the FDA in the United

States, includes no contraindications or limitations of use for black

cohosh in cancer patients and another recent review concluded " that

extracts of black cohosh do not bind to the estrogen receptor,

up-regulate estrogen-dependent genes, or stimulate the growth of

estrogen-dependent tumors in animal models. " 2 The mechanism of action is

thought to be via action on control centers in the brain and vascular

system rather than through any estrogenic effect.3

 

 

 

The bottom line is that black cohosh has been substantially proven to be

*safe* and *effective*, even for those with breast cancer, and in spite

of the study with mice, to date there are no " valid " *concerns* to worry

about or warrant discontinuing its use.

 

A key consideration when using any herbal product, however, is to make

sure to use a high quality standardized extract from a *reputable*

manufacturer.

 

My Recommendations for Menopause and Beyond

 

As I have previously described, I am a firm believer in building a

strong foundation. In that goal, there are three key dietary supplements

that I recommend to provide a strong foundation for a proper nutritional

supplement plan:

 

A high-potency multiple vitamin and mineral formula .

A " greens " drink product (Enriching Greens).

A pharmaceutical grade fish oil supplement (RxOmega-3 Factors).

The specific multiple vitamin and mineral formula that I recommend for

women during and after menopause is MultiStart for Women Plus. This

formula was specially designed to provide full-spectrum for menopause

and beyond.

 

As far as a specific formula to address some of the challenges of

menopause, I recommend MenoSense from Natural Factors. This formula was

designed with my assistance by L Lorna Vanderhaeghe co-author of the

book No More HRT - Menopause: Treat the Cause. MenoSense contains not

only standardized black cohosh extract, but additional herbal extracts

and phytochemicals beneficial in supporting a smooth transition through

menopause.

 

How to Get Off HRT?

 

The best method for getting off any medication including HRT is gradual

reduction - a slow weaning process.

 

Since menopause is not a disease per se, you can stop cold turkey, but

in my clinical experience doing so is usually associated with rebound

symptoms.

 

In other words, the severity of menopausal symptoms seemed to be much

worse than ever before. Black cohosh and other natural approaches are

simply not strong enough to lessen these symptoms sufficiently right off

the bat.

 

Instead, it is best to begin your natural supplementation program to

support your health during menopause and after 2 weeks of use cut the

dosage of HRT in half.

 

After two more weeks start taking it every other day. After an

additional two weeks discontinue use.

 

How Long Can Black Cohosh Be Taken?

 

Although the German Commission E monograph has recommended that

treatment with black cohosh be limited to six months (the standard

recommendation for hormone replacement therapy as well), this

recommendation was made because the Commission did not feel that it was

appropriate for anyone to be taking an herbal product for any reason in

an unsupervised fashion not because of any real concern of toxicity.

 

Based upon detailed toxicology studies it appears the black cohosh

extract is appropriate at recommended levels for long-term continued

use. The no effect dosage in studies in a six-month chronic toxicity

study in rats was at 1,800 mg/kg body weight - or roughly 90 times the

human therapeutic dose. A six-month toxicological study in rats is

comparable to an unlimited treatment time in humans.

 

 

 

Key References:

 

Dog TL, Powell KL, Weisman SM. Critical evaluation of the safety of

Cimicifuga racemosa in menopause symptom relief. Menopause

2003;10(4):299-313.

Mahady GB. Is black cohosh estrogenic? Nutr Rev. 2003 May;61(5 Pt

1):183-6.

Borrelli F, Izzo AA, Ernst E. Pharmacological effects of Cimicifuga

racemosa. Life Sci. 2003;73(10):1215-29.

 

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