108: Estrogen Myths & Bioidentical Truths with Jeffrey Dach, MD (Part 2)

Welcome back.

Last week we had part one with Dr. Jeffrey Dash and if you haven't listened to that yet, please go back and listen to that first because otherwise you're going to be picking up in the middle. But you will still get tremendous value from listening in to this one alone because we talk about so many topics like the value or lack thereof of mammogram. We're talking all about bioidentical hormones and we're talking about symptoms, some really important nutrients or hormones that will safeguard your health. So make sure you listen to part one and then tune in today for part two of Dr. Jeffrey Dash. What about estrogen deprivation and why does that work?

That question was answered again by the Hungarian pathologist from Budapest, Susanna Suba. And what she says is the both estrogen depletion and estrogen treatment both upregulate estrogen signaling. Estrogen depletion, depletion from anti estrogen drug treatment causes upregulation of estrogen receptors and to the point where the estrogen receptors on the surface of the breast cancer cells are so upregulated that when the estrogen deprived patient is then given estrogen. And by the way this was, this was recognized early by V. Craig Jordan and he writes about this in many of his articles. The name for this is lte. Long term estrogen deprivation. After long term estrogen deprivation either by being menopausal or by taking an anti estrogen drug which mimics estrogen, you know, which mimics being menopausal. The when estrogen is reintroduced, the upregulation of the estrogen receptors, predominantly er alpha will then cause apoptosis of the breast cancer cell which is programmed cell death.

Programmed cell death, yeah, yeah.

And that's been well described in the laboratory preclinical studies. And also vcreg Jordan uses that as one of the explanations of why the premarin treated group in the Women's Health Initiative had such great results with reduction in breast cancer. So, so they were long term estrogen.

Deprived and because the average age in that study was 63 and the average age of menopause is 52.

Exactly.

So presumably they, they had long term estrogen deprivation. So estrogen reintroduced.

Yeah, reintroduced estrogen and whatever little nests of breast cancer cells that are present will undergo spontaneous apoptosis, which is a word which means programmed cell death, programmed cell suicide. And you know, the three doctors received the Nobel Prize in Medicine for discovering that One was Sydney Brenner who had a laboratory at Cambridge and that research was done in roundworms it turns out that the, the apoptosis mechanism molecular gene is identical in roundworms and humans. It's, it's conserved. Yeah, it's a conserved gene throughout, you know, all of these simple organisms. And so he, he said when he received the Nobel Prize, he said that was the eureka moment when his colleague figured out that they looked up the genetic sequencing and his colleague said it's identical to humans. And that was a big deal. The other funny thing about Sidney Brenner, which I have to mention, since we're talking about, he, he was like known for this like, very witty guy. So when he was receiving the Nobel Prize, he mentioned that his wife, when they received word, his wife was in the flower shop doing some shopping and another lady came up to her and said, oh, I heard that somebody with the same name as your husband got the Nobel Prize because they couldn't believe it. But yeah, he mentioned that. And that was cute.

I like that story.

So, you know, apoptosis, estrogen produces apoptosis under those conditions. And the, the, also testosterone will induce apoptosis. That's not widely known. But testosterone, well, for the estrogen deprived patient, the breast cells will switch to a testosterone alternative pathway which can also testosterone been studied and will bind to the estrogen receptor elements on the DNA. So it's like an alternate estrogen.

So how long is long term estrogen deprivation?

You know, vcreg Jordan says at least five years. I think it's probably less than that because one of the studies that was done in breast cancer survivors where they actually separated them in terms of length of estrogen deprivation, showed that all of the breast cancer recurrences occurred in patients who had less than two years of estrogen deprivation. It was more years, it was more than two years. That group did not have recurrences in that one study. So I would think it's probably, I don't think anybody really knows unless we do more, you know, some serious studies on the matter. But my guess, my speculation is probably two years.

So in women, in young women who get breast cancer, because this really only applies to premenopausal women because menopausal women already have that. So when young women who get breast cancer.

Yeah.

How do you balance the, the risk of the damage from estrogen depletion to the benefit of long term estrogen deprivation.

You know, that's a difficult question to answer. I mean, but the thing that I think about is most, most of the young women in that category who seek medical attention and are asking for hormone replacement have already been estrogen deprived. They've been on aromatase inhibitor along with a ovarian suppression drug. And many of them have been estrogen deprived, very severe estrogen deprivation for a period of time. And so I think that's probably long enough for most of them. You know, there are occasionally, very rarely, there's a patient who will have a lumpectomy, you know, with good margins, they're cured, negative axillary nodes. And they will just, they will insist on continuing their hormone replacement. You know, if those, you know, if they're pre menopausal, they will insist on going. A lot of them have already had chemotherapy which, which renders them, you know, early, early menopause and they, they will want, you know, they're miserable with menopausal, you know, menopausal symptoms. They're miserable and they want some relief. And the oncologist says no. Their oncologist is very opposed to the idea of taking hormone replacement and they insist they will seek out a physician who can prescribe hormone replacement to them.

I do think that there is a distinction between have breast cancer and had breast cancer.

Yes, of course, and that's a good point. That's a good topic to get into.

And so let's hear your, your thoughts.

You know, and you know, we sort of danced around this idea, this topic before. Patient has active breast cancer. The estrogen is a growth factor. So you know, we want to look at that as a, as a different scenario. And we don't want to give, we do not want to give growth factors. You know, there are other growth factors. There's TGF beta, there's you know, epithelial growth factor, EGF and you know, there's a whole list of them. And insulin.

Insulin like growth factor.

Yeah, yeah. So here we're, we're, we're talking about treatment for active breast cancer. Mainstream medicine treatment for breast cancer we all know is, is.

Surgery, surgery, radiation.

Radiation, chemotherapy, blockade, etc. Etc. And then the, the anti estrogens as an adjuvant therapy. Then you have integrative. Oncologists will have a different approach. A lot of them are now using repurposed drugs that have anti cancer activity. Iodine is an excellent adjuvant treatment which I think every breast cancer patient undergoing chemotherapy should also be taking adjuvant iodine. Those studies have been done in clinical studies have been done in humans and they have much better outcomes if they take the, you know, those studies are.

Done and fast and you know, and they fast, right?

Like, yeah.

And then you Know, the war for Balter Longo and.

Exactly.

More stuff that's not trickling down to the.

Yeah. And so, you know, there are two separate worlds. There's mainstream oncology and then there's integrative oncology. And you know, we. I did actually have an entire book devoted to repurposed drug treatment of cancer. Let's see, here it is right here. I don't know if you've seen this one.

No.

Tracking cancer toolkit. This came out in 2020 and it's £3. 550 pages.

I love that. You know how much it weighs.

Yeah, well, it's. I carry it around so it's, you know, you can, you know, do your weight lifting.

Hefty. That's good because we know the importance of lifting heavy things.

Yes. Heavy lifter. And a lot of the integrative ecological, you know, they're now using, you know, the book came out five years ago, really before it became popular. And it's much more popular now, especially ivermectin, which became popular during COVID as an antiviral. It turns out ivermectin is also a very good anti cancer drug. It had very, you know, extremely safe profiles. And so, you know, There are about 300 drugs in the corner drugstore that have anti cancer activity and also 3,000 botanicals. So there's just a lot of these things to choose from. And the big problem is not having enough. The problem is how to put them together in a synergistic way. So that's what we deal with in the book, how to create synergies so they can use them in combination. And there's an ebook which is very reasonable and then the paperback is available. I do not treat cancer patients in my office. I'm not a cancer specialist. I'm not an integrative oncologist. And we do get a lot of calls from patients looking for integrative oncology treatment over the years. Know, I go to meetings, I make notes and come across good integrative oncologists. So we've compiled a list over the years and we provide, you know, we provide the list of integrative oncologists to anybody who's interested. And that's how we deal with patients, you know, looking for that. And by and large, they get very good results. And you know, Rebecca Glaser is, you know, she has her own unique method of treatment with the testosterone and aromatase inhibitors and, you know, for active breast cancer. Exomestane is, I think, an excellent drug along with you know, there are other growth factors which can be, can be dealt with in addition to estrogen. But you know, also skin cancers are very sensitive to anti estrogens because the skin is very hormonal. And so you know, with, for active, active breast cancer I think exomestane along with some of the other repurposed drugs such as phenofibrate, itraconazole, ivermectin and then for botanicals you have sulforaphane. Sulforaphane and dipyranamol which is the platelet inhibitor. Remember, TGF beta is a very big growth factor for cancer and its platelets are little bags of TGF beta. Most of the TGF beta is in the platelet compartment. So an antiplatelet drug is a very valid anti cancer strategy. And those studies have been done. Studies on cancer studies using platelets, platelet inhibitors have been done and showing dramatic improvements in outcomes using platelet inhibitors. But anyway, the cancer book is probably topic for a whole separate podcast.

Yeah, absolutely. And then what about people who had breast cancer? Because this is where the rubber meets the road for a lot of people. Because medical oncologists and primary care doctors and, and gynecologists all have the same attitude towards hormone replacement in women with a history of breast cancer. And it doesn't even have to be hormone positive breast cancer like they think if you had breast cancer you cannot take hormones.

Yeah, that's you know, mainstream, you know medicine. That's the dogma. And my approach in my little office, my little universe is if, if the patient is, and we review the pathology reports, we want to, you know, we want, for example, if they've had a lumpectomy, we look at the Ki67. We want to have a, we want a low key i67. We want good margins around, around the nodule. We were interested in the size of the, of the, of the nodule, good margins, negative axillary nodes, that patient should be cured and is a candidate for hormone, for hormone replacement in my opinion. You know, a lot of the breast cancer survivors are patients who've had DCIS which is a 98% survival without 10 year survival without treatment. And the treatment of DCIS really took off when screening mammography was invented in the early 80s. And it's the little punctate calcifications that will trigger a biopsy. And. The autopsy study which I mentioned earlier before when we were chatting is, was done in, in 1980, was published in 1987 by Pathologist from Copenhagen by the name of Maya Nielsen, she did 110 medical legal autopsies, women, younger women below the age of 50. And she. She basically did the autopsies looking at breast tissue in a way that emulates screening mammography. What they did was they did thin sections through the breast tissue and then did specimen radiographs. It's like a super mammogram. If mammography was perfect, you would come up with the same findings that she found. They would do these specimen X ray and then circle where the calcifications were on the slide. They could find it on the slide. And. And then what if you do that? That's like the perfect mammogram technique. If you do that, you'll find what she found. What she reported in 1987 was 20%, 22 patients had cancer, breast cancer. 22 out of the 110, which is 20%, had breast cancer.

Studies are women who did not die of breast cancer. Obviously.

Yeah. They died of car accidents.

Yes.

I think 1. Only one patient had a known active breast cancer before death, which came out later. But out of the 20%, 18% was in situ cancer, breast cancer, and the other 2% was invasive breast cancer. So we know that the incidence of breast cancer is not 20% of the population. So what happens to. It's a. It's roughly 0.1%, depending on which study you look at. So what happened to the other 19.9% of women? Yeah, what happens to them? They don't get breast cancer. So when you do screening mammography, you're finding breast cancer in a reservoir of indolent disease that doesn't become active disease. It's very similar to doing screening for prostate cancer and thyroid ultrasound looking for thyroid nodules. There's all three types of cancer have an indolent reservoir of indolent disease, and then you have a smaller amount that can become very aggressive. So that's one of the problems with screening mammograms, which I'm sure you've come across and you're familiar with, which is when you detect DCIS. And 60,000 cases of DCIS are detected every year with screening mammography. There's no reduction in advanced breast cancer or mortality from breast cancer. When you do that, it doesn't contribute to reduction in national mortality of breast cancer. We still have roughly 42,000 women dying annually of breast cancer today. The same as it was in 1980, 1970. Yep.

And not impacted the bottom line at all.

Yeah. That's one of the reasons why I would guess that you're interested in ultrasound rather than submitting women to screening mammograms.

Right.

I used to read them mammograms and I was a radiologist at the hospital. I, I did everything. I did ultrasound, I did angiography, I was an interventional radiologist.

Yeah.

And the, you know, the, the other problem with screening mammograms besides, you know, you have this big problem of over diagnosis and over treatment. And the, of course the other problem which isn't discussed much is the radiation exposure can cause cancer. And you know, that's, that's overlooked, it's pretty much ignored, but it's, it's probably also another factor to.

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20% off back to our show. Without question. But why do you think that that is such. I mean, this has become an issue of morality, right? Because the facts aren't there. We know that screening with mammogram does not impact survival. It just doesn't.

Yeah. I mean, then the study that we look at that shows that is the Jorg Sweden, the Jotoburg mammography clinical trial, which was published in 2003. They found a 20% reduction in mortality from breast cancer. However, there was no reduction in all cause. Mortality in that study. And the fact of the matter is there is no study showing reduction in all cause mortality utilizing screening mammography. And. The suggested reason for that is because of the over diagnosis, over treatment, which counteracts the, you know, the benefit. You know, the other thing, when they look at screening mammography, they find the screened group as a roughly 20% increase in invasive cancer detected compared to the non screen group.

Yes.

So Gilbert Welch looked at that and published a study on it. And he suggested that, you know, what happened to that 22% of invasive cancers in the non screen group. And so he came up with the idea, well, they must have regressed spontaneously. So that's the idea of spontaneous regression of breast cancer. A lot of it is just, you know, indolent DCIs that never becomes life threatening, never becomes clinical attention.

Yeah.

And so that's what we're dealing with with screening mammography. It's become, you know, it's $8 billion industry. And you know, when you have entrenched financial interests like that, it's very difficult to, to change that.

Yeah.

And the thing is, the radiologists who are reading, they are not necessarily part of that 8 billion dollar industry in that they don't see, they're not motivated by that. They don't realize that they work for employers who are very much motivated by that. So what they see and what they believe is that they are doing their best to diagnose cancer very early in order to prevent progression, prevent being able to give people lesser treatment options. But what they don't know or don't realize, or both, is that first of all, breast cancer is neither linear nor predictive.

Right.

So if you find something as dcis, you, you, you're assuming that that would go on to become invasive, that that would go on to become node positive, that that would go on to become metastatic. But that's not the way breast cancer works. It is what it is from the beginning.

Exactly.

It's not a linear progression through a predictable mechanism. So finding something as DCIS does not save that woman's life because you have no way of knowing if that was even going to go on to become invasive disease or life threatening. And just having found a small tumor also doesn't guarantee that you are saving that woman's life because that tumor might not have gone on to become anything at all. Or if it's meant to be metastatic, it's metastatic from the very beginning. So finding small tumors does not impact overall survival and it also doesn't lessen Treatment. Because treatment is based on biology. And many of these women out of 50 fear go on to have mastectomy.

Yes.

Or because there are multiple things found in the breast and they're kind of exhausted with the evaluation and they just don't want to go through it. Or they get a recommendation for mastectomy because there are multiple things found in the breast. And so screening with mammogram has only increased the mastectomy rate by 20%.

Yeah, of course. Of course. Yeah. It's, you know, it's mainstream medicine. You know, they're. They're a giant megalopolis. It's controlled by the drug industry. They're not. They're not ever going to change, or if they do, it's not going to be in my lifetime. And that's a good thing. That's a good thing. Because otherwise I'd have nothing to do with.

We have the exact opposite attitude about this. I'm like, can everyone just see it so I can retire?

Yeah. It's, you know, integrative medicine. There are two worlds in medicine. There's mainstream medicine, institutional medicine, hospitals, insurance companies, drug industry. And then there's, you know, the integrative medicine practitioner, functional medicine, integrative medicine. And, you know, they have their own separate types of meetings, and they are a much smaller population, much smaller group, and they see things differently than mainstream medicine. And thank goodness for that, because otherwise I'd have nobody to talk to.

Oh, God. I think I need to put you on speed dial so you have something to talk to. Okay. I want, before we leave, hormones, because I know that we moved on to mammograms. I want to talk about timing of hrt. We touched on breast cancer. And if you are in the category of had breast cancer, you don't have evidence of having breast cancer. You're okay with prescribing those.

I think every patient has to be evaluated. Full evaluation, reviewing pathology reports, reviewing all the information. And as we mentioned earlier, KI67 is very important. Negative axillary nodes and good margins on the. On the resection and also the patient's history. And, you know, patients vary quite a bit on a receptivity and how com. You know, the comfort level and taking hormones after breast cancer diagnosis. So there's a lot, you know, there are all these different factors and. But for the most part, you know, if they're cancer free, you know, in my opinion, they're cured surgically. A surgical cure, which I think happens, is very, I think, very frequent. You know, I think surgery is a Very good treatment for breast cancer. And it's cure. It can be curable.

Yeah.

And patients who do not have metastatic disease. You were, I'm sorry, you were going to say something.

No, I actually, I agree with you and I, I think that there are so many people who come to me and say, can I reverse this without surgery? I think by the time people are presenting clinically there, the tumor has created its own microenvironment that is a very estrogen rich microenvironment. And, and again, I am not saying that estrogen causes breast cancer. I want to be very, very clear. It does not. However, once a tumor is there, it does, it does create its own estrogen rich micro environment. And the way that the tumor cells have mutated. They have mutated so that they have upregulated that er, alpha receptor. They have more er, alpha receptors. And that' way that the tumor continues to proliferate. That is a survival mechanism.

Yes.

So where was I going with this? Well, you want, this is my estrogen deprived brain.

Yeah. You want to talk about the, the, you know, how does a physician decide which patients to treat with hormones after diagnosis of breast cancer? And it's the differential, you know, do we differentiate between active disease and patient is now cured? There's no, no active disease. At least. You know, we know that 20% of women will harbor either DCIS or invasive cancer based on the autopsy study by Maya Nielsen from Copenhagen. But, you know, that's one out of five women walking around with breast cancer. They have little cancer cells in their breast.

Yeah, I knew where I was going. I just remembered, okay. People ask me all the time, like, can I reverse this situation without surgery? It is very hard if you have clinical disease to reverse the situation without surgery. I'm not saying impossible. I'm not saying people don't have remissions. They do without.

Some of those cases that you're talking about where they do, you know, maybe perhaps it's an elderly patient or. And they decline chemotherapy and she, she finds, you know, complete regression using her treatment program.

Yes. Which she does. Testosterone pellets along with anastrozole pellets.

Yeah. And you know, for active disease, I think that's reasonable. For breast cancer survivors without active disease, I think the aromatase inhibitor is probably not a good idea and may actually make things worse. That's based on a study by Soren Cold from, I think he's also from Denmark and he found that women using vaginal estrogen had a roughly 20% reduction in, in Breast cancer recurrence. However, if they also, these are breast cancer survivors, in his study, if they also used an aromatase inhibitor and he kept track of that, they had a 34% increase in recurrence. So his study was pretty good evidence that adding an aromatase inhibitor onto your hormone treatment for breast cancer survivors leads to great increased, not doesn't help, it makes it worse, leads to increased recurrence. And by the way, we discussed the, the animal model studies by the professor in El Paso, Texas, Rajkumar Lakeshwamy, he found the same thing in the animal studies that adding an aromatase inhibitor made it worse. Which goes along with again, the idea that estrogen is important to maintain the integrity of the genome. And when you block estrogen receptors, you end up with really bad outcomes. The worst outcome that we've ever seen in a breast cancer survival hormone replacement study, which you probably are familiar with, was the habit study done in Sweden by Lars Holmberg. And in that study they use estradiol along with a synthetic progestin called norethisterone which is used in Scandinavia, not used much in the US but it turned out they had a 300% increase in breast cancer recurrence in the hormone treated group compared to the non hormone treated group. And so what, how can we explain that? And the explanation is all of the women with breast cancer recurrence were also taking tamoxifen. So they had, they developed tamoxifen resistance because remember when the, when you give some breast cancer survivor a estrogen blocking drug, they switch to the testosterone, the androgen pathway to maintain estrogen signaling. And guess what? Norethisterone and all the synthetic progestions are testosterone blocking drugs. So we're blocking both the main pathway with the tamoxifen and the alternative pathway with the synthetic progestin. And that's how you get the 300% increased recurrence. And so again, that's very supportive of Dr. Suba's thesis that the, you know, she describes this as the three phases of estrogen resistance, the final phase leading to florid progression of cancer and metastatic disease and early mortality. Yeah, and so that's, you know, that's, you know, all in the book, you know, the, the habits study receives a lot of attention in the book and because I think it's, you know, it's, it's sort of a cornerstone, it's, it's key to understanding what's going on with breast cancer survivors and estrogen anti, estrogen, you know, that, you know, what is the correct thing you know what.

They.

Only saw that increase in the population that took tamoxifen.

Exactly. The. All, Every, every patient who had a recurrent cancer was also taking tamoxifen.

Yeah.

And I think it was between 50 and 70. 70% of the patients were on to. Not all of them, but. And then, you know, there are other few interesting facts about that. All of the patients on Premarin alone, without the synthetic progestin, none of them had a recurrence. None of them.

Yeah.

And that, that parallels what we found with the Women's Health Initiative.

Exactly, exactly. And so, you know, when, when, when patients or anybody asked me, you know, what caused the increased cancer in the Women's health initiative, the 2002 First Arm Study, it was the synthetic. Synthetic progestin, which is known to be carcinogenic.

Yeah.

We even have animal models that the. Where it's called the MPA mouse model of breast cancer. You know, if you go to the university and ask, well, how do you give mice cancer? They say we inject them with. With medroxyprogesterone. With mpa, we inject them with. That's the same drug they use in the Women's Health Initiative study.

Yeah.

It's astounding.

Yeah. And, you know, you look in the molecular biology literature and what, what they found is progestin is a proliferative break on ER Alpha. However, if you switch to medroxyprogesterone or synthetic progestin, that actually upregulates ER alpha and activates the oncogenes cyclin D1 and C mic, the oncogenes. So that's why there's increased breast cancer, is it activates oncogenes. Yeah, so. So that's all in the molecular biology literature. You know, in vitro preclinical studies, which of course, you know, practicing physicians don't have time for that. So it's, you know, it's nice to put it in a book.

That's the main problem is that most of the time practicing physicians.

Yeah. They don't have time. They're busy. So it's all in the book. All those ladies are in the book.

Yeah, but I took the time to do it. You took the time to write that. But how many, how many practicing physicians are really going to take the time, especially when they truly believe that estrogen causes breast cancer?

And then, you know, they're working, you know, they're working in the insurance model. The of, you know, the insurance model of medicine is, you know, the insurance company squeezes them and they get, you know, a very small amount per patient, so they have to increase patient volume, which means less time per patient. So they. They basically have to simplify their. Their evaluation and treatment as simple as possible. And, you know, they don't really have time for a nuanced, sophisticated look at hormone formulas. They just want to know, can I give this pill, take this pill every day? Or, you know, or, you know, the birth control pack, this little circular pack with the pills in it, you know, that's perfect for the ob, gyni, or mainstream practicing physician, because they just give them the pack and say, follow the directions and bingo, they're done. They go to the next. They can go on to the next patient.

I know, but then there's the Denmark stuff study of 1.8 million women that shows a direct linear relationship between the time that you're on birth control pills and the development of breast cancer. And it's because of the progestins that are in the birth control pills.

Yeah. The synthetic progestins are carcinogenic. And, you know, the birth control pills also are oral estrogens, which cause blood clotting. Part of my job as an interventional radiologist, I did the angiograms on young women who had strokes from taking birth control pills. Yeah. And it was sad because, you know, these beautiful young women, they look like ballerinas, and they're. They're sitting in the. In the waiting room with a paralyzed arm or a paralyzed leg. There's a doctor who did a study on just calculating the number of women taking oral estrogen, including birth control pills, annually. And if they switched to topical estrogen from oral to topical, he estimated that that would prevent 3,000 strokes annually in the United States. So in terms of a public health measure, that would be a successful public health measure if the FDA had an advertising campaign for women switched from or from your oral estrogen to your. To topical. And that would be a good idea to. To. To pop. To advertise that.

Yeah.

And just to be clear, so people understand there is no stroke or clotting risk when you use estrogen topically.

Exactly.

And only with oral estrogens.

You know, instead of that type of useful advertising campaign, what we got was, you know, a campaign against ivermectin. Are you taking ivermectin? Are you a horse?

Yeah.

Are you a horse?

Yeah.

Campaign, which, of course, they had to retract that eventually. There was a doctor in Texas who actually sued the fda and they. And won against, and they had to retract that ad.

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What about timing of HRT in that? Is it ever too late? Because I get this question all the time from women who are 60 and women who are 70 and even women who are near 80.

Well, you know, for the cardiovascular protection, the answer to that is yes. But for the other organ systems, it's never too late. And the study that is supportive of that is the, the million women, million women study.

I exceeded my time limit with you.

Well, that was. My office is calling me. They want to know where I am. The, the, there's a recent study that showed that was done. They looked at Medicare age women and they did show tremendous benefits, health benefits, even in the elderly over the age of 70. So, and I think that's understandable, it's reasonable, you know, it's logical because we know, you know, you have many, many, you know, all of the major organ systems need estrogen, you know, it's involved in mitochondrial function, bioenergetics, it's involved in, you know, genome integrity. It's involved in so many things. And so yeah, you know, we, of course, you know, the dosage has to be reduced and you know, you have to take into consideration the age of the patient. And, but I think we've seen benefits even in, you know, the 60s, the 70s. We haven't really had very many in their 80s. Just a few handful of patients in their, in their 80s. Usually they've been taking hormones for years and they want to continue.

Yeah, well, we have, we have a mutual colleague, Dr. David Rosensweet, who does in his book, talk about a couple of patients who were starting to show signs of dementia and who did improve with the careful, slow introduction of bioidentical hormones.

Okay. Yeah, that, you know, they, you know, there's tremendous benefit, I mean, we've had, we've seen very dramatic improvements in, for example, osteoarthritis. I remember a patient, a pharmacist, lady pharmacist, who, you know, they stand up all day and she had arthritis in her knees and she couldn't, she was having pain. And we gave her topical estrogen in an oil base to rub into the, the painful areas of the knees. And within six weeks she was pain free. And she's calling back saying, thank you, I feel so much better. And we've used that topical technique for arthritis patients. Estrogen deficiency causes osteoarthritis. And the animal studies, it's very easy to render an animal estrogen deficient with surgical removal of the ovaries. Then you can give estrogen back by giving an estrogen pellet to the animal. They've done all the studies, There are about 40 studies now, animal studies, different animals, showing that estrogen deficiency induces cartilage degeneration and induces osteoarthritis and give the estrogen back to the animal. The cartilage will regenerate. And so, you know, that, that's an area that is completely ignored by conventional medicine. You know, and that's, you know, we were talking earlier about, you know, what benefits the drug industry. Fear of estrogen will, the patient will then avoid hormone replacement, develop osteoarthritis and they become a customer for anti inflammatory nsaid, nonsteroidal anti inflammatory drugs. And, you know, go to the orthopedic surgeon, eventually, eventually get a joint replacement. So that's feeding into the drug industry. You know, more and more profits for the drug industry, more profits for institutional medicine and just go through all the categories, you know, insomnia, you know, menopausal women with estrogen deprivation can't sleep because estrogen is needed for sleep. So that they are now a good customer for sleeping pills, which by the way, are chemically addictive. They get depressed because they have no energy because they're estrogen deficient. So the primary care doctor gives them an SSRI antidepressant. It's more likely that a menopausal woman going to her primary care doctor asking for hormone replacement is more likely, as you mentioned earlier, that they will receive an SSRI antidepressant, which is sad because there's no estrogen in an antidepressant drug, which is what they really need. And, you know, you could just go down the list. I mean, it's just. Keep going.

Bisphosphonates, beta blockers, statins. So, you know, I mean, I, I can come up with a list of 9 pharmaceuticals without really trying too hard.

The. It's, it's a. You know, it's. You don't have to be a genius to figure out the drug industry profits from the fear of estrogen. So the, you know, you could call me a conspiracy theorist, but it looks to me like, you know, that's what's going on.

Yeah, for sure. Okay, so here's my last question for you, and then I'll let you get back to the work that you are so inspired to do. So I have on a number of occasions said that I don't believe that breast cancer is a disease of hormone excess. I believe that breast cancer is a disease of hormone deficiency. How do you feel about that statement?

Well, I think, I think you're very correct because, you know, 80% of breast cancer is postmenopausal and 20% is premenopausal. When hormone levels are high, it's only 20%. When hormone levels are low, it's 80%. So. And hormone, you know, if estrogen controls the integrity of the genome, estrogen deficiency is a state of genomic instability, which can lead to cancer. You know, the big question, you know, what causes cancer? A lot of that work was done by a researcher at the University of Nebraska who died in 2021 by the name of Ercole Cavallari. And he studied the estrogen metabolism pathways, and he found that the. The two estrogen metabolites, two hydroxy metabolites, lead to the good pathway. They lead to the two methoxyesterdiol metabolite, which is. Which is actually a anti cancer drug. You know, it's a microtubule inhibitor type drug. And then the other pathway with the CYP1B1 leads to the four hydroxy metabolites, which can then, assuming we're talking about.

Estrogen breakdown products for all of those who don't recognize what we're talking about.

Yeah, this is maybe more technical than your audience is used to, but. But the four hydroxy metabolites then attach to DNA and cause oxidative damage to DNA, which is carcinogenic. So those are the carcinogenic metabolites normally not present in humans, but under certain circumstances, the four hydroxy metabolites can become DNA adducts and that will cause cancer. And a number of researchers who've looked into this will have studied four hydroxy metabolites in urine samples. And they will say that it's the most sensitive and accurate marker for breast cancer risk is the presence of elevated 4 hydroxy estrogen metabolites in urine samples. And they've actually found that in breast cancer patients. Very elevated levels in the urine of breast cancer patients. So that's an entire area of all by itself. And that to me, that's very convincing as a underlying cause of breast cancer in the population. Genetic abnormalities where you have bottlenecks and accumulation buildup of four hydroxy estrogen metabolites. So when estrogen levels are high and they stay high, you're going to have more estrogen metabolites and the greater chance of bottleneck appearing. The.

But how does that tie into deficiency?

It doesn't. It doesn't. It. We're talking about, you know, Gilbert syndrome, where they have hepatic genetic abnormality in metabolizing not only estrogen but, but other drugs. And then there are other genetic abnormalities in, for example, the COMT enzyme, which is catechol o methyltransferase. You know, they have methylation abnormalities and they can't methylate the metabolites to eliminate them. And they end up as four hydroxy carcinogenic reducts. And so our breast cancer prevention program takes that into consideration. Turns out that iodine is an excellent way to divert the metabolic pathways away from the four hydroxy bad ones and towards the two hydroxy good ones. So iodine has been studied. That study was done by Stoddard, who worked with the Eskin group. And also dim diindylmethane, which is a broccoli extract, it also affects estrogen metabolism in a very favorable way. So that's part of our breast cancer prevention program. And then Ercole Cavallari published a study showing that both resveratrol and NAC and acetylcysteine are very good at reversing DNA adduct formation and preventing, you know, that whole, that whole, that whole process. So, you know, I think any, any physician who's interested in practicing with using bioidentical hormones should be familiar with Ercole Cavallari's work on estrogen metabolites there's an entire chapter devoted to that. And the utilization of iodine and diminishing and a few other types of supplements.

We didn't talk about selenium today.

Selenium, actually, the first edition of the Biodental Hormones 101, which came out in 2011. There are four chapters on selenium in the first book. The first book. The first edition is free, by the way. Just go to my website and click on Books. You can download a PDF of the entire book for free. Yeah, that's it. And then there are four chapters on selenium, which. And so we do test everyone. That's one on our routine panel. Serum selenium. We don't use the lab range. We use a cutoff of 135, which is explained in the book. And you know, selenium deficiency, the big study was done, it's called the NPC trial at the University of Nebraska. And they recruited selenium deficient patients from dermatology clinics in the southeast. Turns out that skin cancer patients, a lot of them have low selenium levels. And so they. About 1200 patients with low selenium levels below, you know, the average selenium is around 110. And they randomized them, gave them half selenium supplements. And then at the end of the, I think it was two or three years follow up on selenium, the selenium treated group had 50, 60% reduction all cancers. It was a huge reduction in cancer. And the reason why selenium is so important is because the cancer surveillance system, the DNA repair system in our body, remember we're constantly getting, we're constantly damaging our DNA just through normal oxidative, you.

Know, metabolism, living and breathing.

Reactive. Yeah, breathing. And so we have a repair system to, to and that's seleno proteins. And so, you know, the, the, the BRCA gene women's study, which was done in Poland by Kowalski, shows that if you give selenium to women with BRCA gene mutations, that can reverse the risk of breast cancer to that of their normal siblings. And so selenium is huge and I think it should be routinely tested on every patient. Also, the vitamin D is part of our breast cancer prevention program. We know that vitamin D deficiency is an increased risk for all cancers, including breast cancer. And higher levels of vitamin D. It's a cancer preventive agent. So we do check for that and supplement with vitamin D. And that's, you know, so, you know, we put a lot of thought into the breast cancer prevention and then we do all of those things.

Yeah.

Okay, this is really my last question for people who don't want to do tamoxifen and don't want to do aromatase and in inhibition, either they just don't believe in it or they don't tolerate it. What do you say to those people.

You know, if they're coming into the office and they're asking for hormone replacement, if, if they're, you know, if they're postmenopausal or if they have, you know, early menopause and, you know, they're miserable, they have menopausal symptoms, they may have genital urinary syndrome. They may have, you know, insomnia from hot flashes and night sweats that wake them up two or three times a night, and they are seeking relief. And if they're cancer free, you know, based on evaluation of their medical records, they're cancer free. In my opinion, they're candidates for hormone replacement using bioidentical hormones. We want to avoid the carcinogenic progestins, of course, and we also employ the more complete testing, evaluation of all those things that we do discussed. And in addition to the hormone replacement, we have an active breast cancer prevention program using the iodine, the dim, the selenium supplementation if needed, vitamin D if needed, et cetera. And I consider those patients excellent candidates for hormone replacement. If, you know, and again, we discussed this earlier, if the patient has active disease, they are, then they are not, you know, hormone replacement is. Estrogen is contraindicated. And in those patients, you know, they need, you know, careful. They need, they need, number one, if it's, if it's a, it's a nodule that can be removed, they need a lumpectomy. If it's, you know, if it's multi, multinodular or, or a larger mass, then they may need a mastectomy. If they have bilateral disease, then they probably have underlying genetic abnormality and they're, you know, they're prone to develop breast cancer. You know, they may have some abnormality in estrogen metabolism based on genetic abnormality in one of the enzymes. The, you know, like this. They may, the CYP1B1 may be upregulated and the CYP1A1 downregulated. The, you know, the ability to methylate is. There are people with genetic abnormalities and those enzymes and, you know, there are other, you know, other genetic things going on. We haven't been looking at estrogen metabolites in detail, although if I was going to do that, if a patient wants to do that kind of a study, I would probably use the lab that David Rosensweet uses, which is the Rhine Rhin lab. They do the 24 hour urine, which I think is pretty good for looking at estrogen metabolites. You know, the downside is, you know, it's an additional fee and the patient has to carry around a bucket for 24 hours.

It is a little cumbersome.

Yeah. So we haven't really started doing that in a big way.

Okay. We talked about so much today. I just want to try to summarize and make sure that everyone walks away with a clear vision. So estrogen does not cause breast cancer.

Correct.

Breast cancer is much more likely a disease of hormone deficiency. Mammograms don't save lives. And screening with mammograms only leads to 20% more cancer cancer diagnoses. Protection is afforded with iodine, dim vitamin D, selenium, and that these, these are things that everyone should be thinking about taking. Overall, the studies prove that estrogen is protective and leads to a reduced number of breast cancer cancer diagnoses. And for anyone that wants more information, you have a number of books to refer to. So this is the one that I'm reading right now. It's Bioidentical Hormones 101. The previous version from 2014, is that correct?

2011.

2011 is available on your website for.

Anyone that's for free. You can download, just click on the. There's a menu at the top. Just click on books. The menu selection books. It'll take you to all the lists of the books and then you'll find the, the COVID of the book with the link on the bottom for, for that, for the 2011 first edition, there's a link that says download free book.

Okay. And then there's the Cracking Cancer toolkit.

Yes.

And, and how do people find you?

My website is jeffrey-md.com-is D A C H D A C H. And I, you know, I also have a free newsletter. Please, you know, everyone should stay in touch with the office by signing up for the free newsletter. It comes out once a month. You can also sign up for the blog which you, you get an automatic notification whenever there's a new blog entry. And the, you know, easy way to do it is just put my name into any search engine, you know, Jeffrey Dash D A C H and go from there, you know. But the, you know, you can go to Amazon, put my name at the Amazon. The books will pop up.

Yep, they sure will.

Yeah.

Dr. Dash, thank you so much for spending this time with me and providing all of this invaluable information. I do hope that by putting our voices together, we can impact change, even if it means that you won't have quite as much to do. But there are still always going to be millions and millions and millions of women to help, because as we know, women survive long past menopause, decades past menopause. And we need to change the paradigm. It needs to shift. Because women and men, everyone, needs to have a life worth living. And that often means hormones, and they need to be done safely.

I agree with you 100%, Jen. It's been a pleasure and an honor to participate with you on the podcast. And thank you so much for everything that you do and looking forward, maybe in the future we'll do it again. I'm looking forward to the next time we have a chance to do it again.

We for sure will do it again. And thank you all for joining us and listening in on this conversation today. Because while there are many people who are not ready to hear what we spoke about today, I know that if you're here, you're here because you want validation. And I am here to validate you because we're speaking a lot of truths here every single week. And know that I will continue to bring you those truths and to help people to see, because that is my mission. So thank you so much for joining me today. Share it with a friend. Know that I will be back next week, same time, same place. It's Dr. Jen.