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 Interview with Dr. Uzzi Reiss, Beverly Hills gynecologist, obstetrician and specialist in Anti-Aging Medicine
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CBS CARES: What are "biest" and "triest," and what are the advantages and disadvantages of taking those instead of just estradiol?
DR. REISS: In triest, you have all three estrogens: estrone, estradiol, and estriol. In biest, you have only estradiol and estrone. And this is completely unscientific, but people that prescribe bio-identical hormones claim that estrone is bad. Well, estrone is not bad. We can't have anything in our body that's bad, okay? Even if something has some bad aspect, it's good in another aspect. When you take estradiol orally, it turns into estrone. After our body uses the estrone, the estrone goes in three directions.
In one direction is two-hydroxyestrone, which decreases breast cancer. In another direction, we have 16-hydroxyestrone, which builds bone and increases breast cancer. This is why the stronger a woman's bone is, the more likely she'll have breast cancer.
And in the third direction is four-hydroxyestrone, which increases breast cancer. But in order for it to do that, you must have a specific gene defect in a specific site in the liver. About 40 percent of women have this. So, by identifying all three, we can modify it. If you have more of the one you don't need, biologically we can decrease it. And I think that should be done to every woman.
You know, estrone, estradiol-there's no bad, there's no good. Usually, there's a balance between estrone and estradiol of about 50/50. Whenever you take estrogen by mouth, because it gets converted to estrone by the liver, you'll have a huge level of estrone compared to estradiol. So there's really no reason to give estradiol by mouth. I think taking estradiol in a cream is superior because it bypasses the liver, and you'll have slightly more estradiol than estrone. The cream I use really is based on these physiological changes.
CBS CARES: So in your opinion, it doesn't make sense for a doctor to give a menopausal woman one estrogen hormone like estradiol instead of the combination in triest?
DR. REISS: In our bodies, estradiol doesn't exist alone. We have a whole rainbow of hormones that work together and can counteract each other in the body. I think we should use the whole combination. And when you give the whole rainbow of hormones, you can give much less. But you know what? There's no science about it, unfortunately. The science about estriol is from 20, 30 years ago, showing that the higher the level of estriol in your body, the less breast cancer there is.
By cream, I use triest. In my triest, there's some estrone and three times more estradiol. The dominant hormone is estriol. So I kind of create the balance in one to one, then people take it. With a drug, there's absolutely no science about how it should be.
CBS CARES: Who manufactures the creams that you use?
DR. REISS: This raises another problem. There are 2,000 pharmacies. But it's a totally different product in different places. Every one of my patients has to use a particular, individualized product that I give them. It took me 20 years to develop, but I know that it works, and I know exactly what we should get as an outcome.
CBS CARES: Is it your view that women should start bio-identical hormone therapy as early as possible after menopause?
DR. REISS: I think we need to replace things in our bodies the minute we lose something. Do you think that the minute you don't see well you should start to wear glasses, or wait to go blind before doing something about it? I think hormones are part of a system that gives us life, brains, mood, motivation, sensuality, sexuality, physical and mental energy, and the wish to grow, learn and excel. Hormones are not in our body by mistake. And they're not in our bodies for just 20 or 30 years. They're there to allow us to function well and enjoy the universe given to us.
CBS CARES: Do all your patients tell you that their symptoms improve when they go on natural hormones?
DR. REISS: Yes, except if it's started too late and their bodies will not accept it. You take an 80-year-old, get her on estrogen, and she'll have the most minimal breast tenderness and freak out and won't take it. The point is, you can't wait.
CBS CARES: Would you say that even women who don't experience troublesome, or any, menopausal symptoms should also take bio-identical hormones?
DR. REISS: You know what? That's a great question. And I don't know the absolute answer. I always ask myself when patients come to me, "Does this person need bio-identical hormone therapy?"
What I can tell you is that there is a small percentage of women who have totally different mechanisms and might have more estrogen in their cells.
And, at least 50 to 75 percent of women who come to me and say, "Great, what can you offer me?" need HGH, or human growth hormone. It's their thyroid.
CBS CARES: Is there a connection between menopause and thyroid function?
DR. REISS: No. It's not that they're connected, but that those women have had a thyroid deficiency for a long time. When they finally go to the doctor complaining of fatigue and weight gain, they look at their thyroid and find something that was there for many years.
CBS CARES: Do you recommend any particular foods to your patients?
DR. REISS: If you don't want to take hormones, you can eat a lot of soy. Soy in foods like pomegranates has an estrogenic type of activity. Unless you have Hashimoto's disease, a type of autoimmune thyroid disease, women should eat a lot of cruciferous vegetables like broccoli, brussel sprouts and cabbage. The best cabbage is savoy cabbage, because it has a fraction of what's called "indole -3-carbinol," which improves the activity of the protective portion of estrogen in the body.
CBS CARES: How did you get interested in natural hormones?
DR. REISS: It was luck. I was trained in Israel, where it was like a big government HMO. When I came to Albert Einstein in New York, I had to do the same training again from the very beginning. It was totally the opposite of anything they taught me in Israel. What was great about the department in Einstein was that there were four full time professors who hated each other. Each of them wanted to promote his own idea. So this helped me grow my own philosophy about health care.
I was always interested in mind and body. And because some people learn to do something in one way and no other way, like a monkey, I wanted to think differently and try to do different things. And I listen, you know? When somebody tells me that five days before her period she gets depressed, she doesn't sleep, she feels foggy and angry, but that when she finishes her period, she feels great, I ask: "What happened? Hey, here your estrogen went up, and here, your estrogen went down."
You know, we are the best medical textbooks on the planet. When somebody tells you, "I have pain," they have pain. So you don't go and say, "You don't have anything." You don't say, "Well, you're depressed. Take this anti-depressant." You try to understand why it's happening. And when you do that, you slowly come to the conclusion that something is deficient. Our bodies don't have a deficiency of Prozac, of antibiotics, of sleeping pills, of anti-anxiety medication. Our bodies have failures in a few or some of the systems that we have had from the very beginning. Until we spend more time finding the failure that causes the problem, we are not going to correct the problem.
CBS CARES: Is there anything we haven't asked you which you think is really important for us to communicate to CBS viewers and readers of this website?
DR. REISS: I think we're in the beginning of what I call Westernized Talibanism of women. There is an invasion of women's sacred property--their estrogen. Our society wants to take estrogen away from women and make them foggy, depressed, and unproductive. The moment they should collect the fruits of 25 or 30 years of hard work, they're collapsing because their own hormones are taken away from them because of fear.
That's the point I wanted to make. All these women think that their own hormones are going to kill them. It's a tragedy.
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