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Calico

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Goddess Forever
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Reply with quote  #1 

Hey Constantine,

just when I thought I might do myself some good, bang!!!!

My PCP put in Estrogen testing (not estradiol) and it came back 278.
I go tomorrow or Friday to repeat the test at the same place.
Last time in Dec. it was 77 and I thought somebody made a mistake, at the same time at the local hospital it was 13 and again at 16 but as estradiol.

I love a veggie burger (has soy protein in it) a day most days for lunch (Morningstar, the larger version from Costco) and a smoothie (lots of berries with estrogenic pesticides???) with soy milk (1 cup, organic) and spinach (all that fiber should get estrogen out!)

You think this could be the culprit of 278????? I am fertile...

DD says the stuff kills me and is with you on the lightly tossed broccoli

I hope there is not a cyst somewhere in my tummy that produces estrogen again.

Onc refered me to endocrinologist, meanwhile I will have absolutely no soy anymore....sigh...
I am not really sure what I am asking but you are our Guru, yogi, master,
if you have any thoughts on this.....

I guess I will lift weights tomorrow, run my 5 miles like never before and eat chicken , or bread and water....

My dexa showed spine improvement by 3% and the hips are better to on Fosamax, so no Zometa for me.
(TM's are nice again at 19.5 and bilirubin is normal)


>^.^<


Edit:
I have lots of hotflashes....that does not make sense, right?

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~ There are lies, damned lies and statistics ~
edge

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Reply with quote  #2 

Calico:


Two things are beyond plausibility:

 

(1) that soy could contribute significantly to any putative abnormally high level of estrogen, and

 

(2) that the level you report - 278 (I am assuming of estradiol, as legitimate estrogen testing in breast cancer is solely of estradiol - is other than either a laboratory artifact, that is, fiction (error, or lack of quality control), or consequent to some ovarian or cystic disorder (and even here such a level is implausible); and you shrewdly observe that you are still experiencing vasomotor symptoms (hot flashes) which would be well-neigh impossible at estrogen levels of 278 (or even way less than that).

 

Despite widespread - and misinformed belief - soy consumption even at high levels (in the U.S. this rarely exceeds 20 grams/daily, and even that is rare, while in Asia 60 grams/daily is relatively common, and even higher in certain Japanese diets) does not significantly increase estrogen levels.  The latest comprehensive systematic review and meta-analysis of 47 studies by Lee Hopper and colleagues at the University of East Anglia found that in premenopausal women, soy or isoflavone consumption did not affect primary outcomes estradiol, estrone or SHBG concentrations, while in post-menopausal women, there were no statistically significant effects on estradiol, estrone, SHBG, FSH or LH, and although there was a small increase in total estradiol with soy or isoflavones in this population, it was statistically non-significant, and I should note that the fact that neither SHBG nor LH and FSH concentrations were affected argues against a physiologically important estrogenic effect.  The study in addition notes that there is a growing body of evidence that increased lifetime soy exposure lowers breast cancer risk, and that available clinical and epidemiological data fail to support the claim that soy isoflavone exposure increases breast cancer risk (independently confirmed in the studies from Anna Wu and colleagues at UCLA and Mark Messina at Loma Linda and colleagues).

 

On caution about soy milk: most products are sweetened, and there is wide variability of sugar and fiber and fat  content, and if sugars are high, this can influence glycemic parameters and insulin, which can be adverse on breast  health.  Westsoy Organic Unsweetened Soy Milk is an example of a product that avoids these pitfalls, with 4 grams of fiber, 4.5g of fat, and only 1 g of sugar. 

 

My advise would be to play the odds, which are that laboratory artifact is the most likely cause, so as I have previously advised, insist on an ultra-sensitive LC-MS/MS, aka, LC-MS-MS (liquid chromatography-tandem mass spectrometry) estradiol assay, which have now become widespread (even from chain laboratories like Quest), in order to assure that the estradiol readings are reliable.  Should that still return abnormally high estradiol levels, then testing for potential ovarian / cystic involvement would be required, but this can be avoided by such an ultra-sensitive test resolving the issue by returning a normal-range estradiol reading.




Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com

Calico

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Goddess Forever
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Reply with quote  #3 
[[[Constantine]]]


Thank you for taking the time to help me stay on the carpet, your thoughts are so much appreciated!!

I found the progesterone on there to be 0.3 and that is postmenopausal.
Onc didn't see that and in my anxiety I did not either.
Last fall I doubted their 77 Estrogen (I thought that was actually estradiol but I have to go and get a print out) when at the local hospital it was 13 or 16, 278 is just unthinkable, my postmenopausal LDL should be normal with the estrogen back in the fertile range.

I did the LC-MS/MS last summer, the local hospital sent it to Mayo and they report as under 10 that is as low as they go, no details like 2 or 5...

Monday I'll go again to have blood drawn at this military lab per onc request and will tell them to put down that I am post menopausal and on aromatase inhibitor.
I also will request ms/ms, will probably go through hoops, do the headless chicken dance......

But I also have cramps...don't want to dwell on it...fear of the unthinkable ovarian miracle cyst or colon cancer (sister has it) lol there is no way that there is another peace of ovary in there.

I get white coat syndrome as soon as I set foot into a docs office, I thought they will have to put me on blood pressure medicine

awww...good catch on the sugar in my soy milk....I was asleep....everything is organic in my soymilk, even the evaporated cane juice a fancy word for the evil sugar, 4 gramms of fat and 6 gr sugar....that slipped by me...
Admitt it, you snuck into my fridge and looked!!!

As in veggie burgers, they have veggies and some soy protein and isolates, I looked that stuff up, I think the way it's made is they take the protein and toss the rest of the bean, the carbs, slightly.....into the trash??? Why would an isolate be bad, carbs are bad, protein is good insulinwise??

I miss my veggie burger and smoothies  may I start on the Merlot again (just kidding hehehe)...okay...organic carrot juice then

I have to check on the Zometa but don't know with whom or how,
I looked over my DEXA and my L 4 is minus 2.7 even though they report the average of all four of the vertebrae to be -1.7 (-1.3, -1.4, -1.1, -2.7), L 4 is bad!!!!
(With a 2.3 to 3.2 percent gain in my hip/femur, I think Fosamax is great but why on earth is the lowest vertebrae soooo thin)?

Sorry, I am ranting!!!

You are very kind and patient!

>^.^<







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Calico

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Goddess Forever
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Reply with quote  #4 
Constantine,
how does one make sense of this at all??
I wonder if my spine is some sort of nut case for a spine doctor.

I checked my old Dexa's...what a joke...After treatment (chemo, rads, no femara yet, in March 2006) my L 4 was at a minus 2 already (while the other three where minus 0.7, 0.4, 0.1 sweet and healthy), then in Sept 2008 the L 4 is minus 2.5 (osteoporosis?) radiologist didn't say anything on the summary report and that is what the onc reads only and now April 2010 at minus 2.7, again, the summary goes by the overall 0.7%  'gain' even though L 4 is more in the pits....onc didn't see this.

How common is a single L 4 deterioration? Do I get a rod soon?? Can Zometa help one lonely disc??
Do I have to give up running the trail?
I do have lower back pain but I thought it was my 'sack of potatoe' posture while running or something......gracious like an elephant
Yikes!!!!

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edge

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Reply with quote  #5 

Calico:


Nothing as dire as rods and canes, and keep on running.  Here's how  to understand the numbers used in the BMD (bone mineral density) game.  When you were reported as having L4 at -2 (minus 2) - and note that all T-scores are minus, because they represent standard deviations of how much your bone density is above or below normal, where normal is defined as the peak bone mass young of a healthy 30-year-old adult - this was a T-score, not a point-decline from some previous baseline, and a T-score of -2 constitutes low BMD, called osteopenia.  Then your T-score for L4 went to -2.5 in September of 2008, which is still osteopenic, but we say, "at the boundary", because any score below -2.5 id definitionally osteoporosis.  You then went from borderline osteopenic (-2.5) to mild osteoporotic - but only for L4, so you are not  considered overall osteoporotic, just L4-focal osteoporotic - by virtue of a T-score of -2.7.

 

Now, a couple of things to note about this:

  1. Yes bone loss at L4 is extremely common as it is a lower vertebrae and sustains more stress from weight;
  2. The drop from -2.5 to -2.7 T-score is a .2 point loss, and if you asked how serious is that in terms of actual bone loss, here's what it really means. A 1 point drop, say from -2.0 to -3.0, or from -2.5 to -3.5, is a difference of 1 standard deviation, and such a deviation is associated with a 10% to 15% decline in BMD.  Therefore a drop from -2. 5 to -2.7, a 2/10 or one fifth decline, represents a real world bone loss of about 2 to 2.5% in L4 only (and a 10 - 15% bone loss from your 2006 -2.0 T-score), although again overall you were in positive territory (0.7% gain) for aggregated T-score across all vertebrae, leaving you not overall-osteoporotic.      

 

What to do? 

 

Optimal Vitamin D3

The single most critical goal, even more than calcium intake, is to assure an optimal Vitamin D3 level (required for optimal calcium metabolism), the target being at least  66 ng/ml on the 25(OH)D vitamin D assay. 

 

Calcium Absorption and Bioavailability

Second, would be to have an NTX (N-telopeptide cross-links) assay which can help assess calcium absorption and bioavailability, a well-respected technique to assure calcium adequacy, in widespread use by endocrinologists including Donald Bergman at Mount Sinai (personal communication) who helped develop the distinguished AACE medical guidelines for the clinical use of dietary supplements and nutraceuticals.  Should sequential NTX readings suggest poor absorption / bioavailability, a switch to a highly available liquid preparation like Cal-Quick (Twinlab) might be beneficial. Cal-quick is used by many bone physiologists and endocrinologists when it's necessary to circumvent issues of digestibility, availability and dissolution to assure maximal calcium assimilation and absorption, and it also delivers a highly concentrated calcium source - just one teaspoon delivers 500mg of immediately utilizable calcium.  And although many people  prefer tablets or capsules for portability, taking Cal-quick at home is certainly not onerous.  This takes away the uncertainty of variable absorption and utilizability (and bypasses excipients, binders, fillers, disintegrants, coatings and other non-active ingredients).  But regardless of calcium form, make sure your total daily intake is 1500mg, from supplemental plus dietary sources combined. 

 

Calcitonin, the Non-Bisphosphonate Anti-Osteoporosis Agent

Third, you might consider a bisphosphonate + calcitonin (Miacalcin).  Calcitonin is a non-bisphosphonate anti-osteoporotic  agent, an inhibitor of osteoclast activity that binds to specific receptors on the osteoclasts and reduces their relative hyperactivity, thereby effectively inhibiting bone resorption by decreasing osteoclast formation and activity, as demonstrated by dozens of clinical studies as well as the PROOF and QUEST  trials, and at 200 IU daily, delivered by nasal inhaler, it can reduce vertebral fractures by 33% (as noted in Jean-Jacques Body's (Institut Jules Bordet) review).   In addition to this antiresorptive action, patients with painful new vertebral compression fractures who were treated with calcitonin had by two weeks reduced pain (via  inducing increase in plasma ß-endorphins similar to the endogenous opiate system) required fewer analgesic medications, and they regained mobility sooner, thought to itself reduce bone loss secondary to prolonged bed rest, as noted by Laura Gehrig and colleagues with AAOS, confirmed by Carlo Gennari at the Institute for Internal Medicine in Siena, among numerous other confirmative studies and reviews.  The analgesic effect can be evident as soon as the second week of treatment. 

 

And a bonus: as Nordic researchers Morten Karsdal and colleagues have concluded, calcitonin appears to mainly target the most active osteoclasts, and this suggests that calcitonin treatment will lead to a continuously positive bone balance in contrast to bisphosphonates and so thereby result in improved bone quality, not just density, in a physiologic manner via unique and specific modification of bone microstructure, confirmed by MRI.   I don't typically, for extra bone benefit, advise two bisphosphonates, unsupported by the evidence, but a bisphosphonate + calcitonin is not subject to such objection and may add additional, and rapid, extra positive anti-osteoclast activity as well as provide appreciable analgesia against bone pain.

 


So don't dust off the walking cane just yet.

 


Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com

Calico

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Goddess Forever
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Reply with quote  #6 
Thank you so much Constantine,
I feel so much better!!!....no cane yet....holy moly....

Just told hubby we have to get a house with a pool in Florida, so I can float then we all can have a Nosurrender Pool Party

My D assay was 67 in 2008, very good!

I guess I would lean toward Calcitonin, that is a really good percentage of fracture reduction!

bad little L 4
I just don't get why it goes down when all goes up.

I feel old....heck...I am old!!

Consider yourself hugged!!!!
Some day, when we all have a Nosurrender meeting, you probably get squished by all of us!!!! Invest in some body armor

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