Placebo Beats Bioidenticals for Hot Flashes

There is a lot of hoo-hah surrounding so-called bio-identical hormones. Some people, such as Suzanne Somers, make a lot of money from the story they tell and are not likely to give you the true facts. She gets her face Photoshop-fixed to look young and then tells you it’s her herbal regime that keeps her young (I’m saying this because when you meet her in person she looks much older than her touched up photographs and to me using Photoshop is a kind of faking in this particular context).

The truth is, all bio-identicals don’t work as people wish they would. They are NOT natural. Most stuff you buy in that category has been processed in a factory, altered from what Nature made. So in what sense are these products natural?

The science is suspect: several studies have found that black cohosh can help to reduce hot flashes and night sweats, and also to improve mood, but most of this research was funded by companies that make the supplements. There’s also some evidence that red clover could have “modest” benefits for women experiencing hot flashes and night sweats, while improving mental function as well. But it’s not convincing to me.

Now a well-performed scientific study has thrown the cat among the pigeons. I’m sure there will be charges of bad science. But I am a doctor, sympathetic to the idea of herbs being effective and helpful, telling you to beware what you are being told, especially from people who are selling you products.

There is only one bio-identical I allow my wife to take (more of that later). The rest I don’t think work as claimed or could even be dangerous (black cohosh is not safe).

The new study, published in the journal Menopause (Nov/Dec 2009), explains a trial done by Dr. Stacie E. Geller, a professor of obstetrics and gynecology at the University of Illinois, Chicago. Dr. Geller is not at all hostile to the fact that herbal remedies may work.  Far from it. She says they could be helpful for some women.

But she also points to the fact that over-the-counter remedies are largely uncontrolled and variable and could expose a patient to dangerous levels of some substances. The quantities used in the clinical trial were carefully controlled; something you won’t get on the Internet. So be warned.

Her team looked at red clover, black cohosh and conventional pharmaceutical HRT for comparison and used a placebo for control. They randomly assigned 89 menopausal women to take either HRT, black cohosh, red clover, or placebo for a year. The women were experiencing anywhere from 52 to 71 hot flashes or night sweats every week.

The results were disappointing for enthusiasts of herbal therapy. Symptoms were reduced by 34 percent in women taking black cohosh, by 57 percent in women taking red clover; by 63 percent in women taking placebo, and by 94 percent in women on HRT, which was the only therapy significantly better than placebo.

Dr. Geller is aware of the dangers of HRT and specifically set out to test the damaging effect of each remedy on verbal memory among menopausal women. Black cohosh and red clover had no effect on any aspect of mental function, but there was evidence that HRT had detrimental effects on verbal memory.

Geller suggest that for women who are really suffering from menopausal symptoms and need help, HRT can be a safe option for some, but she says always take the smallest dose possible for the shortest period of time. For those who can’t or won’t take hormones, Dr Geller suggests black cohosh, with the caveat that you treat it just as you  would a prescription drug, consulting with your physician before starting to take it and seeking out a high-quality product.

Just remember, it causes liver damage, even in therapeutic levels. So take extreme care.

Me? I think you’d do well on red clover or placebo! 57- 63% of success isn’t bad for most drugs. The FDA allows drug companies to say “proven effective for…” when it scored only a few percent over placebo. Often that means as little as 35% response.

There is another answer and a very powerful one: Peuraria mirifica. We docs in the know call it “HRT”, meaning herbal remedy from Thailand, get it? This is the one my wife takes.

I’ll be interviewing the world’s number one expert Dr. I. Sandford Schwarz, from his home in Thailand, where he has been involved in the licensing and scientific study of this amazing herbal bio-identical substance for many years.