(Dr. Stephen Holt's 2nd visit to Power Surge) Dearest: My guest tonight is Stephen Holt, M.D. Dr. Holt has practiced medicine since 1972. A Professor of Medicine, Scientist, Board certified gastroenterologist and internist in the U.S., U.K. and Canada, with higher training in nutrition, clinical pharmacology and medicine of addictions. Most of Dr. Holt's referred patients have been seen by several physicians previously and they often have complex disorders. Dr. Holt is the author of 12 books including the Random House bestseller, The Soy Revolution and Combat Syndrome X, Y & Z. His newest book, "The MenoPlan: Women's Wellness - Natural Ways to Healthy Menstruation and Menopause", will be out in late January. It's a pleasure to welcome you back to Power Surge, Dr. Holt. Stephen Holt, M.D.: Thank you very much - It's a pleasure to be back. Dearest: In order that no one becomes confused, let me first explain that there's your upcoming book, "The MenoPlan" and a product of synergistic herbs, antioxidants and amino acids called "MenoPlan." How did you come up with the name, "The MenoPlan" and what, exactly IS your MenoPlan? Stephen Holt, M.D.: Thank you very much for that insightful question. I chose the name MenoPlan because I thought that the management of perimenopause and menopause had to be very holistic. Therefore, the word "plan". The events around menopause require many things such as social adjustments, health adjustments. What is needed is a viable substitute for hormone replacement therapy either using a combined estrogen and progestin, or estrogen alone. To my knowledge, I made one of the first dietary products for menopause about 12 years ago. At that time, I used primarily soy isoflavones and was called Phytoest and was very successful. It was linked to, and based on, two books I have written on the benefits of soybeans. One of those books was Soya for Health and the other was The Soy Revolution, on the National Bestseller list. Natural alternatives to HRT have been extensively researched over the past 10 years and we now have much more to offer in that we can combine many ingredients for nutritional approaches. This nutritional approach is what I've used in formulating MenoPlan. I want to stress that there are no magic bullets. My book discusses many complex issues that determine health and wellbeing in the menopausal transition. Dearest: What are the ingredients in MenoPlan, and how does each ingredient, and the synergistic formula, affect a woman's menopausal symptoms? Stephen Holt, M.D.: Let me explain the concept of synergy before we talk about the ingredients. Synergy is an approach where one takes a number of different natural substances which have benefit for a specific condition such as menopause and combine these in a formulation that may be more versatile and potent than single ingredient formulas. We have in the market single ingredient formulas that have become quite popular. I believe that synergy with many herbs and botanicals together can benefit the total effect. No single supplement is going to benefit all women. I apologize for my long answers, but I can review the ingredients in some detail. First, the good news. We have had some very serious news in conventional medical literature that dietary supplements can be viable as replacement for HRT at least in reducing symptoms. Furthermore, there is some precedence in using remedies of natural origin for both menopause and perimenopause. I have selected ingredients for the MenoPlan which I believe are routed in science which show benefit in a number of cases. One principal ingredient is black cohosh. When this botanical is used in a standardized extract form, a reasonably consistent help for menopausal symptoms such as hot flashes occurs. Black cohosh is not universally successful for everyone. It needs a little help from others of it's natural friends which can deal with some of the disturbed functions of the body which occur following the cessation of menstruation, in the first 12 months. Black cohosh must be used at a minimum of 2% standardized. This is also the base for Remimifemin, but that isn't as thorough as MenoPlan. MenoPlan also includes soy isoflavones. These are natural substances derived from soybeans which are a balancing act for estrogen. There has been a lot of discussion about how soy isoflavones work. They act as estrogen but are not estrogen. They can help to regulate estrogen downward, or act as an anti- estrogen. The real values behind soy isoflavones are not that well known. These have multiple health benefits. They are powerful anti-oxidants, they can interfere with enzymes that cause the growth of cancer tissue and they even have effects on stopping blood vessel growth which is an important factor in the causation of many diseases including cancer. In summary, soy isoflavones have many health benefits unrelated to any effects they may have on estrogen status. There are other complicated actions of soy isoflavones that are beneficial and the actions of soy are complicated. It has upset me greatly that members of the anti-soy movement have not portrayed isoflavones in their true perspectives with their many health benefits. There is much precedent for the use of soy isoflavones, especially in the dose used in the MenoPlan. There is no evidence whatsoever that soy causes toxic effects in adults and they do not play any role in promoting cancer. Quite to the contrary, they have significant anti-cancer properties. AverageWoman: Hi. I wonder if you can provide suggestions for dealing with vaginal dryness and low libido. Vaginal estrogens caused yeast infections. I'm 52. Stephen Holt, M.D.: I have received many reports that soy isoflavones and black cohosh may cause reversal of vaginal dryness around menopause. There are some useful ways of helping to overcome vaginal dryness. Perhaps one of the simplest is the use of lubricating gel or jelly. I have found an article on Power Surge on this very subject. Dearest: It's in the Educate Your Body area of Power Surge. The article you'll want to read is at www.power-surge.com/educate/sexuality.htm Stephen Holt, M.D.: There is no doubt that mature women benefit from extended foreplay to overcome initial vaginal dryness. This may involve sensitive discussions with your sexual partner. The type of receptors that help vaginal dryness are helped by soy isoflavones. There are many products that are alleged to act as sexual stimulant in women. Viagra may help, but I prefer a first line of defense such as the natural remedies. Later in the discussion, I will mention herbs such as dong quai and chaste berry, both of which may assist in matters of feminine libido. I wrote a book several years ago called the Sexual Revolution and in that book I gave extensive information on natural approaches to healthy sex. I am rewriting it now. Of all natural substances that may help, I favor the use of amino acid arginine combined with a couple herbs. If you look for a natural product, find one containing arginine in significant amounts. Joannl1: Can I use your supplements for sleep, MenoPlan etc. while taking thyroid medication? What is the dose of soy isoflavones in MenoPlan? As I also take Revival Soy. Stephen Holt, M.D.: Many people suffer from sleeplessness at the time of menopause. I think that the Revival Soy is a good product and MenoPlan is compatible with Revival. MenoPlan has only 20 milligrams of soy isoflavones and the other ingredients complement Revival. Sleeplessness does not usually respond to natural substances used for menopause alone. I have good experiences with the use of the product Sleep Naturally. This is a versatile formula of herbs and substances. Go to sleepnaturally.com for a list of ingredients and for more information. Anyone who purchases this will get a copy of my new book on sleep. I discuss sleep and menopause and natural ingredients to use for sleep. Sleep is a major national health initiative. Without good sleep you cannot be healthy around menopause, but it is one of the first things to go. Disturbed sleep disturbs hormones. That is why sleep must be addressed around menopause. Dearest: Just out of curiosity, what are the ingredients in Sleep Naturally? Stephen Holt, M.D.: It contains a blend of herbs that have a good precedent for save induction of calming effects and sleep promotion. The herbal blend was developed by myself in a proprietary manner over 10 years. Valerian, passion flower, and chamomile with a couple herbs that are adeptogens, ashwagandha is one, and lemon balm. In addition, the product includes the the sleep hormone, melatonin, and magnesium and 5-HTP to balance chemical messengers in the brain. This product is unique and versatile. It is serious nutritional support for sleep, and so carries the usual warnings for sleep medications. There are no hangovers or side effects from this. If I may let me finish the formulation for MenoPlan. As everyone will recall, we had black cohosh and soy isoflavones. In addition, I have used L-theanine which helps to induce a natural relaxation response. I need not discuss the anxiety-provoking responses of menopause. This helps abolish anxiety. I am not a supporter of tranquilizers. L-theanine is an ingredient in green tea. Also in MenoPlan: evening primrose, dong quai, chaste berry and gingko biloba, which I believe make the formulation complete for menopause. SpiritedDove: There are many OTC (Over the Counter) preparations containing natural estrogen and progesterone How effective are these vs a prescription used transdermally? I am presently using a prescribed transdermal cream and while it is effective, is not cost effective. Thank You Stephen Holt, M.D.: I have become very concerned about the use of hormone replacements given by any means for the treatment of menopausal symptoms. I must stress that the very serious side effects of HRT are very clear with the combined use of oral estrogen and progestins. I would make a statement of the risks of this kind of HRT far outweighs any benefit. Recent studies show us some shocking adverse effects of HRT. In the million women studied in England, there were 20,000 new cases of breast cancer from combined HRT. At the same time, studies in the US showed that HRT does not prevent cardio problems and may increase heart attacks in some instances. Everyone knows that the WHI (Women's Health Initiative) was interrupted because of serious side effects from HRT. The news is getting worse. Recent studies show that HRT may actually increase the incidence of stroke and dementia in women who are about 10 years past menopause if they have taken HRT. Scientists are hoping that Estrogen therapy alone may not cause such problems, but I am beginning to think that the writing is on the wall when it comes to estrogen alone. I don't think that estrogen alone is safe, either, because it is shown to promote blood clotting and cancer in some cases. We do not have information yet on HRT given by cream or implant, but I have no reason to believe that altering the way that it is administered will make HRT any safer. I am sorry for this depressing news, but it it scientific fact. I see only a few cases where HRT is justified. Take control of yourself, talk to your doctor, know the risks. Now you can see why I am passionate and have written the MenoPlan. In the MenoPlan, I discuss the recent studies. Some radical opinions in medicine have stated that HRT may be the biggest uncontrolled experiment on women in the past 40 years. Please do not panic, but it is time to rethink our approaches to the natural transition of menopause. I reject the idea that menopause is a disease. While it causes trouble, for many women first line management should be natural, simple and safe before jumping to HRT and other drugs such as anti-seizure drugs and antidepressants. These drugs should not be used for menopause. I have discussed these matters with Dearest in great detail and we are both very concerned. Try to take the natural route as the first option. Dearest: When you are talking about HRT, are you including naturally compounded, bio-identical hormones made from soy and yams? Stephen Holt, M.D.: In my new book, I have addressed the issue of bio-identical hormones. What we are talking about is hormones that can be given that have the correct natural identity of the original hormones rather than those of horses' urine and synthetic hormones. There has been much speculation that using a bio-identical hormone is a much safer approach than using foreign hormones. I believe that natural hormones must be preferred over the traditional HRT; however, I think we need to know much more about optimal dosing, even if they are natural. Pharmaceutical companies have argued that a hormone is a hormone is a hormone. I don't agree. If they are to be used, I highly recommend bio-identical which make common sense. I do believe that when hormones can be avoided, they should be. That is the basis of my holistic approach to menopause, using natural substances to deal with menopause and PMS. The bio-identical hormone movement is a definite step in the right direction. Dakota: In perimenopause and after menopause some women develop Buddha bellies. Is this due to hormonal imbalances, or just bad eating habits and lack of exercise? Stephen Holt, M.D.: I love this question! Weight gain around menopause is hell for many women. Many things act to tip the balance around menopause, but I want to pick on one issue that is the number one health initiative of the nation. This relates a condition called Syndrome X, otherwise known as the metabolic syndrome. I have written 3 books on this subject. Now you can see that my wife describes me as a stranger! Syndrome X is every day after dinner conversation. It is the combination of obesity, high blood cholesterol, high blood pressure linked to the hormone insulin which relates to simple sugars in the diet. I argued for many years with my dear friend Dr. Robert Atkins, but I have changed my mind. Low carbohydrate diets are probably the best way to go. All low carb diets require some modification, in my opinion. New research shows that the Atkins diet was effective, and does not enhance heart disease. I am sorry that Robert Atkins was not around to see his own vindication. He was attacked in a merciless manner by hide-bound conventional physicians who were both ignorant and, on occasion, quite vicious. However the Atkins diet is not perfect and Atkins did not claim perfection, but he was brave in the face of much ill-founded criticism. My new work focuses on making low carb diets more effective and even healthier by using methods to overcome insulin resistance. My new book describes nutritional factors. It will be called Nutritional Factors for Syndrome X and Pre-Diabetes and it will come out in a few weeks. Beyond Low Carb Diets explains how to make a low carb diet more beneficial in general. The recent research on the Atkins diet shows failure after 6-12 months. We have to find a way to sustain weight loss. There is no easy way out. Weight loss occurs only with calorie restriction, exercise and behavior modification. If I say this in a different way, a lightbulb should go on. Obesity never comes alone. It always comes with complications, especially in the form of Syndrome X with blood pressure problems, cholesterol and pre-diabetes. Please take note - about 60% of all African-American women have Syndrome X at about age 60; 50% of Hispanic and 40% of Caucasian women, also. Menopause loads the gun and Syndrome X pulls the trigger. These are more reasons for lifestyle adjustments around menopause and for natural intervention. The initial period after menopause can be full of symptoms. The real issue of menopause is the fact that it is a milestone for the development of heart disease, osteoporosis and age-related cancers in women. WE can now see how menopause is really a mixed can of worms. Dearest: It has been my observation over the years that, what with all the drugs on the market, invariably most of us all come back to what's "natural." Do you agree? Stephen Holt, M.D.: Yes, I have to agree since I spent much of my career prescribing drugs, I now spend much of my time reflecting on how ineffective these drugs have been. My main training for the last 30 years has been in conventional medicine, but I am proud of my new way of looking at things. Dearest: You talk about Syndrome X with such passion, but do you have a product that addresses the issues of Syndrome X? Stephen Holt, M.D.: About 30 years ago, I started work on the way glucose is absorbed. Over the years, I have thought about dealing with glucose in a natural way. I have developed Syndrome X nutritional factors, in addition I have developed Low Carbohydrate Facilitator. Awoolsock: I am 49 and heavy very heavy, irregular periods complicated by fibroids. Would MenoPlan help reduce the fibroids,regulate the period and/or provide any other noticeable benefits? Thanks Stephen Holt, M.D.: Yes. You are suffering from amenorrhagia which does happen with fibroids. Fibroids have mechanical effects because of their placement in the wall of the uterus. It is probably not a good idea to use estrogens which can actually make fibroids worse. Unfortunately, when fibroids become the main problem, then surgery may be necessary. That doesn't mean hysterectomy necessarily because there are new surgical procedures that can be focused on the fibroid itself and there are procedures that can be done in the cavity of the womb. I see no reason why you may not benefit from these nutritional supplements. PeriLinda: I don't know any other way to put it, but when a woman goes through perimenopause and having irregular periods, I find it very expensive and annoying to stay "protected" while going to bed. I guess there is nothing I can do but hope to have a period when that period might never happen. It's a strange feeling to have periods since age 13 and then at age 48 have them stop or be late. I'm not sure how to deal with this. I don't even know what my question is except to say I am beside myself. Also, I do not have vaginal dryness. I have TOO much secretions daily and driving me to itch but I do not have yeast. It's the extra moisture that makes me itch. I was checked for yeast infection and it came back negative. Am I unusual with my symptoms? I also do not sleep well at all. Melatonin helps though some of my Alcoholics Anonymous gurus think it's not good to take any kind of pill, but Melatonin is something we manufacture in our bodies, right? I also experience BIG TIME anxiety. I haven't done caffeine in years because of that. I want products that will produce calming effects only. Also, it sounds like we can get these ingredients in health food stores? (primrose, gingko, etc). Sorry for so many questions. Thanks. Stephen Holt, M.D.: Your question is very complicated but the answer may be very simple. Everything you described can occur in a variable degree in perimenopause. I do have some concerns about the severity of some of your symptoms and I detect that you may have some substance abuse problems which may effect your symptoms. I would be concerned that you could become pregnant, and I understand the concern with the irregularity of your periods. Try a barrier method to avoid an unwanted pregnancy. I believe that MenoPlan may help but will not help with all your problems. Make a list of your symptoms and take it to your doctor. PMouse: I have extreme irritability and emotional swings along with other common symptoms due to perimenopause. The mood swings and irritability bother me and my husband, boss, co-workers, neighbors, etc. the most. My doctor has prescribed 40 mg of Prozac which seems to have little or no effect. Would MenoPlan be a good replacement for this type of prescription drug and at what dosage? Would I need to be weaned off the Prozac? Stephen Holt, M.D.: I am not able to compare dietary supplements with drugs. One must question the Prozac prescription because it is not working. Mood swings can be a big issue in perimenopause. I advise you to read my book and examine the obvious in your life including, but not limited to, social circumstances, lifestyle habits, measures of psychological wellbeing, and your diet. There are natural substances that have been shown to stabilize mood. One effective method is fish oil. I am not encouraging you to stop medication without talking to your doctor, but Menoplan may be of help. Dearest: You can read more about Menoplan here PMouse: Would the fish oil be in addition to the MenoPlan? Stephen Holt, M.D.: I do not believe it can be of any harm. Talk to your doctor and sit down and think about your issues after you have read my book. Education is very important. Yes, the fish oil would be in addition to the MenoPlan. The amount might be quite high. Start with at least 1,000 mg daily. There is a fish oil product that I developed and is in every health food store. My name is on the box and it's made by Nature's Way. It's called Fisol. Incidentally, I don't have any commercial benefit from this product. Aunt: I have not taken any HRT of any kind for my menopausal symptoms. I did not like the risks that I read about. It has been my experience that when I am upset about something my symptoms are worse. Also, I watch what I eat. Too much sugar and chocolate set it off. Also salt. I watch my carbs and also do exercises 5 times a week. This seems to help me tremendously. I still have symptoms but they are much more tolerable. I quit taking birth control pills when I was 42 for a reason. I could not see going back on them or any kind of HRT. Have I done the right thing by just staying away from all of these drugs? All of friends that are going through meno say that I am crazy for not taking something. Stephen Holt, M.D.: I think that you have done the right thing. You do not need to compromise your lifestyle if you are having problems. I believe that the natural ingredients in products such as MenoPlan can assist you at difficult times. I also have recommendations such as you have suggested in my book The MenoPlan. Scientific studies have shown us that healthy women, with good lifestyle, have an easier menopause. You are definitely on the right track. Marlo: Hi! Dr. Holt. Everything sounds great in your meno plan. Gingko Biloba tends to thin your blood if you take too much. How many milligrams are in your plan? I take Revival which has helped me tremendously. Stephen Holt, M.D.: Your statements about gingko are correct. Gingko biloba is an herb that is associated with the nervous system. It helps memory which is a big issue for some women following menopause. Studies show that the blood thinning is not apparent in the doses in MenoPlan. The Revival Soy that you mentioned will cause blood to clot, so those soy isoflavones will help. The amount of milligrams is a small amount and blood thinning should not be a problem. But if you're having surgery, let your doctor know about your supplements. In general, blood thinning is quite beneficial in many people. That is why many people take aspirin. However, to put your questions in perspective, the blood thinnning of gingko is much less than that of aspirin. MenoPlan has much more to offer than soy alone - it is complementary to soy. they can be used together. Chaithere: Any special suggestions for coping with perimenopause with PCOS? I take Revival and Healthy Women multi vitamins. Stephen Holt, M.D.: Let me explain PCOS for everyone. PCOS is polycystic ovary syndrome which is a very common condition. Let me shock you. PCOS is Syndrome X of the ovaries. Please reflect on my comments on Syndrome X. Insulin resistance causes excess insulin. Excess insulin tells certain cells in the ovaries to secrete certain male hormones which results in cysts in the ovaries and other problems such as acne, irregular menstruation, unwanted body hair and weight gain. The modern treatment of PCOS in conventional medicine is to use drugs that are used for diabetes. These drugs are insulin-sensitizers or the drug Metformin. These drugs have side effects. In my book on Syndrome X entitled Combat Syndrome X, Y and Z I talk in detail about the natural way to combat PCOS. Dearest: See the transcript of Dr. Holt's chat about Syndrome X, Y and Z at www.power-surge.com/transcripts/holt.htm Stephen Holt, M.D.: First line options are restriction of sugar and the use of Syndrome X Nutritional Factors. Now you can see how America's expanding waistline caused by Syndrome X is causing other common diseases such as PCOS. PCOS is very common in women between 18 and 24. Sometimes the cyst can't be easily felt on a vaginal exam, but will show up on ultrasound. It is the most common disease in perimeno women, more so than thyroid. It is a fact of modern lifestyle. Please exercise and read my book. SoManyQuestions: Hello Dr Holt. I, like "Aunt" (when she was 42), have been taking birth control pills and they were the only product the doctors in the Menopause clinic and my GP (I'm in the UK) found were at all helpful for my severe menopause symptoms. I am 52 now and would like to stick to natural products, but there seem to be so many I need to take and I find this very confusing and difficult to remember to take. What could I try please? Should tell you I have ALL the symptoms when not taking birth control pills. Dearest: You can also read more about Syndrome X in an article Dr. Holt has given me permission to reproduce on Power Surge. Stephen Holt, M.D.: Thank you for your question. I have made many natural supplements for menopause for many different companies. The product MenoPlan is my most recent formulation and I belive that it is the most versatile product available. It is the most complete, to my knowledge, and you do not need to remember all the ingredients I discussed. Discuss all supplements with your doctor, especially if you are coming off hormone pills. Many gynecologists are now very interested in natural ways to healthy menopause and menstruation, given the concerns about hormones. Dearest: Dr. Holt, thank you for an excellent chat tonight. I strongly recommend everyone read Dr. Holt's new book as soon as it hits the bookstands by the end of January, "The MenoPlan: Women's Wellness - Natural Ways to Healthy Menstruation and Menopause." You can read more about Dr Stephen Holt. Stephen Holt, M.D.: Thank you so much for having me. Read Dr. Stephen Holt's first transcript Read Dr. Stephen Holt's third transcript Read Dr. Stephen Holt's fourth transcript Disclaimer: Every guest in Power Surge is a highly respected professional whose opinions are his/her own. An appearance in Power Surge does not constitute an endorsement of a guest's views. None of these transcripts may be reprinted or reproduced without the express permission of Power Surge™ and the respective guest. Read other transcripts by returning to the Library. Dearest aka Alice Stamm Power Surge Founder, Facilitator, Host Copyright©1994- by Power Surge. All Rights Reserved.