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Preface from the book

Bringing BHRT into the 21st Century

By Jonathan V. Wright, MD

Doctors often learn as much from their clients as clients learn from their doctors. One of many times this has happened to me was in the early 1980s, when a woman suffering symptoms of menopause reminded me that she wasn’t a horse (for details, see Chapter 2), and that she’d prefer to replace her disappearing ovarian hormones with the exact same molecules that menopause had mostly taken away, and not alien-to-human horse hormone molecules. That stimulated me to put together what turned out to be the very first comprehensive “bio-identical hormone replacement therapy” (BHRT) program here in North America. The bio-identical hormones included were estradiol, estriol, estrone (for technical reasons, this third estrogen not used as much any more) along with progesterone, DHEA, testosterone, and thyroid.

		The word about BHRT spread first by woman-to-woman communication, reporting to each other how much better they felt. “I feel like my self again” was a very typical comment. Then came articles and books (including the very first book on this topic by Dr. Lenard and me, published in 1997) and many other publications. Since 2004, BHRT has been given enormous publicity by Suzanne Somers’ series of books discussing BHRT, and lately by TV superstars Oprah Winfrey (who had Suzanne on one of her shows) in early 2009; “Dr. Phil,”’ and Robin McGraw (Mrs. “Dr. Phil”) and the other doctors on the TV show “The Doctors.” Since it’s beginning in the early 1980s, comprehensive BHRT has since grown from one woman, one physician, and one compounding pharmacy to hundreds of thousands of women, and (at this time) several thousand physicians and compounding pharmacies. Men have joined the comprehensive BHRT movement, too, of course using the bio-identical pattern for males (See Chapter 10).
NHR Book was first published in 1997.

But even though my comprehensive BHRT prescriptions were the first in North America, I can’t really take credit for “inventing” BHRT! The model was there all along, right there in women’s (and men’s) bodies. I copied — not invented it — as precisely as I could, following the pattern of hormones found naturally, using the exact same molecules, in the same quantities, following the same timing, and using the best ways of getting them into the body. This was all guided by a principle that has always kept my entire medical practice as safe and effective as possible: Copy Nature! But I can’t even claim to be the first to copy Nature, nor did I do the best job. The first and finest job of copying Nature with BHRT was actually accomplished in China, between the years 1025 and 1833 AD.

Lessons from Ancient China
No, I’m not kidding! The details are discussed at great length in volume 5 of Joseph Needham and GD Lu’s classic multivolume series, Science and Civilization in China.1 (For those lacking time to read all 36 densely packed pages on this topic, an excellent 4 page summary can be found in Robert Temple’s The Genius of China.2 ) Described in Needham and Lu’s book are several methods of preparing complete patterns of human hormones, much more complete than anything available today. These included not only the hormones listed above, but also human growth hormone (HGH), pituitary hormones, such as adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), follicle stimulation hormone (FSH), and luteinizing hormone (LH), the thyroid hormones T4, T3, T2, and T1, parathyroid hormone (PTH), calcitonin, cortisol, dehydroepiandrosterone (DHEA), aldosterone, erythropoetin (EPO)... I could go on and on with every hormone mentioned in today’s textbooks, but the list still wouldn't be complete, as these preparations also contained every hormone not yet discovered by now, but present in the human body all the same. How could this happen, especially in the 11th century, when none of these individual hormones were even identified by scientists until the late 19th and early 20th centuries?

It’s all due to the same principle mentioned above: Copy Nature! No, these medieval Chinese scientists and chemists had no way of knowing any of the individual hormones, but they correctly guessed that all of the substances that “power” the human body are found in human urine, which has indeed been found by “modern science” to contain every hormone known to be secreted by the human body3   (and many other things, too, such as sodium, potassium, calcium, magnesium and every other trace element found in our food — but that’s a discussion for another time.) Before you go “yuck!” and quit reading, remember that since the late 1960s and up to the present day, millions of American women — and many more overseas — have been prescribed and willingly swallowed pills containing hormones concentrated from pregnant mare’s urine — better known as Premarin®, which unfortunately are not bio-identical to humans, and because of that, caused an enormous amount of trouble for decades before “modern medicine” decided to research it thoroughly.

Quite obviously, the urine of young adults is likely to contain the highest quantities of sex steroids (as well as all the others), so for those effects, that’s the urine medieval Chinese physicians used, gender-specific for women and men.  Needham and Lu provide detailed documentation that from the 11th through the 19th centuries, Chinese physicians — very often famous Taoist physicians — would evaporate or precipitate urine in quantities from a few gallons to hundreds of gallons at a time, thus concentrating every hormone produced by young healthy bodies. These concentrates were then compressed with resins, gums, and spices into pills, and swallowed by various Emperors and Empresses and many others interested in healthy longevity. Needham and Lu report that many of those who took these preparations were observed to appear much younger than their actual ages — even then, this original version of BHRT was known to support healthy aging and help retain a more youthful appearance.

For the foreseeable future, “modern” 21st century BHRT will remain far behind medieval Chinese BHRT because of the former’s woefully incomplete hormone pattern. The only part of “modern” BHRT that’s actually superior are its delivery (into the body) systems, transdermal — or even better, as you'll subsequently read — transmucosal crèmes, which help us “Copy Nature” (there’s that phrase again) better than pills. Transmucosal crèmes introduce the hormones they carry directly into the bloodstream, just as our own hormone-secreting glands do. By contrast, pills carry the hormones into the intestines and then to the liver, which is definitely not meant to be the first stop on Nature’s route for hormone travel in the body. For many hormones, the liver is actually the most important part of the body’s hormone disposal (not use) system. Sending overly large quantities of hormones to be disposed of before they’re even used by other body cells leads to potential “side effects,” including extra risks of blood clots, heart disease, and cancer.

Catching up with Medieval Chinese Science by 21st Century Recycling
“Modern” BHRT could actually “catch up” — in a decade or less — with comprehensive medieval Chinese BHRT, which included every hormone, major and minor, found in the human body. Ironically, that “catching up” could be done by following a pattern pioneered by a 20th century patent medicine company, by processing urine, not horse urine, but human urine. And as “bonus points,” if this is done, it could well permanently solve — or greatly lessen — the chronically recurring financial problems of school districts, colleges, and universities across these United States.

“Wait a minute!” you might be thinking. What’s he suggesting here? Mixing BHRT with school districts, colleges, and universities? How could public school districts actually hold the key to upgrading 20th century and earlier BHRT to the 21st century, allowing us to equal and surpass Chinese BHRT of the 10th through 19th centuries? I’m sure you've guessed how by now, but just in case not, here it is:

Where are the most healthy and robust adult hormones to be found? In young adults, of course. And where are young adults concentrated regularly in large groups? In high schools, colleges, and universities. By making appropriate use of this presently neglected (literally flushed away) but reliably produced natural resource, which obviously, the young adults don’t wish to keep, high schools, colleges, and universities could go a long way toward preventing and even eliminating the financial crises in which they so frequently find themselves.

Yes, that's right. By re-plumbing high school, college, and university restrooms, urine flow could be re-routed to two (one for women, one for men) very high-tech filtration and purification installations, which would totally clean it up and extract only the myriad hormones in ultra-pure concentrated form, discarding or putting to other use all the rest. Working with high-tech processing techniques, this ultra-pure, strongest and best-possible-hormonally-balanced concentrate (as it originated from healthy young women and men) could be divided by compounding pharmacists into individualized daily doses as prescribed by each woman’s and man’s physician. The compounding pharmacist could also “tweak” the concentrate exactly as prescribed, for example, adding a bit of extra bio-identical progesterone for part of a woman’s BHRT cycle, and then put the final individualized result into the most effective and safest delivery form, likely a transmucosal crème or gel. By supplying this system with this most hormonally rich “raw material,” participating public school districts, colleges, and universities could achieve total sales of billions of dollars annually, and thereby help solve their financial problems.

Think I'm kidding? You think Americans simply won’t “go for” a program in which urine — yuck, urine — is recycled into a “healthy aging” treatment? Think again: Remember Premarin®, concentrated and purified from horse urine? What could be yuckier than that? (Well, yes, but please don’t answer that out loud.) (Recall that NASA has overcome the “yuck factor” and developed a way for astronauts on long space voyages or visits to the space station to recycle their own urine for drinking water.) Yet, buoyed by the promise of reversing the symptoms of menopause and slowing many of the normal changes of aging, by 2001 Premarin® sales were over $2 billion annually. A little bit of this would go a long way at your local school district, and at many colleges and universities.

I’ve discussed this idea at many seminars and public meetings for several years, and many of the physicians and other attendees seem to think it’s meant as a joke. It’s really not, as it follows many sound principles in health care, including “First, Do No Harm” and “Copy Nature.” It follows sound business principles, too, including “Sustainable Industry,” “Recycle ‘waste,’” and on the profit-making side “Do Well by Doing Good.” The first school districts, colleges, and universities to implement this idea will (if their programs are run well) make the most money. Why not have your educational institution or institutions be among the first?

Enough of that. For now, we have the BHRT we have, synthesized from starting material in the Mexican yam and/or soy plants − bio-identical for sure, but incomplete at best. Yet, incomplete as it is, today’s BHRT for women is far safer and more effective than horse estrogens and patent-medicine medroxyprogesterone (“Premarin® + Provera® sold for decades as menopausal hormone replacement therapy, or “HRT”). In this book, you’ll find more than ample evidence to prove that point, and for your doctor, who may not yet be persuaded that BHRT can safely and significantly reduce your risk of Alzheimer’s disease and other cognitive malfunctions; heart attack, stroke, and other cardiovascular and cerebrovascular diseases; osteoporosis; and (for non-tobacco-smoking women) emphysema and COPD; this updated version of our earlier pioneering book includes all the scientific journal support he or she might want.

		Just as importantly for many, today’s BHRT can noticeably slow the physical appearance of aging for any woman who uses it properly and regularly. Nearly any woman who’s used BHRT for 5 to 10 years notices herself and hears from others that she “doesn't look her age.” After 10 years or more, the difference in appearance between BHRT-using and non-BHRT using women of the same age is obvious to everyone. An example: My wife Holly has been a BHRT user, and lets me show her picture at seminars and print it here along with this question: “How old was she when this picture was taken?”
ANSWER: 66 years old!

Of course, none of this means that BHRT is perfectly safe! Although BHRT uses exact copies of human hormones and is demonstrably safer than conventional HRT, it still uses hormones. To use BHRT safely, a woman can’t expect to get her hormone prescriptions and not see her physician again. Careful follow-up monitoring for both quantities of each hormone used (“not too much, not too little, but just right for you”) and for the metabolism of each hormone (does it turn into — ie, metabolize — too many procarcinogens and not enough anticarcinogens?) is very important and can be easily fixed if it is not producing the ideal mix.

Physicians skilled and knowledgeable in BHRT know not only how to order these tests in adjusting quantities of hormones, but also which minerals, vitamins, and botanicals to recommend to restore a safer pattern of metabolism. You’ll discover information about how to find such a physician — if you don’t know one already — in the book’s “Resources” section (See Chapter 11).

“Routine” testing is still very important for women using BHRT. Breast check-ups, Pap smears, infrared thermography (as accurate as mammography, but much less uncomfortable and considerably less hazardous) to screen for breast lumps; ultrasound examinations; and even mammograms in some cases. Your own BHRT-knowledgeable physician can, of course, give you the best individual guidance.

But BHRT is only one tool — even though a very important one — for promoting healthy aging. Diet and exercise are, as always, at the top of the list, closely followed by general and individually-specific dietary supplementation. While those are beyond the scope of this book, why not check (sorry about the shameless plug) the book Natural Medicine, Optimal Wellness (2006) by Alan R. Gaby, MD, and me, for both general guidelines and individual health-problem-specific advice and recommendations?

Dr. Lane Lenard and I hope you enjoy this book, and perhaps learn something about BHRT you might not have known before. More importantly, we hope you can use this information to help you live a long and healthy life!

Jonathan V. Wright, MD                                                                 
Tahoma Clinic, Renton, Washington                                                                  
www.tahomaclinic.com
September 2009         

1. Needham J, Lu G-D. Proto-endocrinology: The enchymoma in the test-tube: Medieval preparations of urinary steroid and protein hormones in science and civilization in China, vol. 5: Chemistry and chemical technology, part 5: Spagyrical Discovery and Invention: Physiological Alchemy. 1983; Cambridge, UK; Cambridge University Press: 301 337.
   
   
2. Temple, Robert. The genius of China: 3,000 years of science, discovery, and invention. Part 5, Section 52. The science of endocrinology. 1986; New York: Simon and Schuster: 127-130.
   
   
3. It’s very unlikely that modern science has to this day identified all the hormones present in human urine. For example, the hormone hepcidin,an important iron-regulating hormone was unknown it until was discovered in human urine in 2001. (Rossi E. Hepcidin - the iron regulatory hormone. Clin Biochem Rev. 2005; 26: 47–49). 
   Abstract 
   
   

Dr. Jonathan Wright is the Medical Director of Tahoma Clinic in Renton, Washington where he also practices medicine. A Harvard University (A.B. 1965) and University of Michigan graduate (M.D. 1969), Dr. Wright has taught natural biochemical medical treatments since 1983 to thousands of physicians in the USA, Europe, and Japan. In 1982, Dr. Wright personally developed the use of bio-identical estrogens in daily medical practice, and was the first to use DHEA in private practice. He originated successful natural treatment for elimination of childhood asthma and D-mannose treatment for E. coli urinary tract infection, and discovered cobalt’s effect on estrogen detoxification.

		In 1973, Dr. Wright founded Tahoma Clinic, which focuses on disease prevention and treatment by natural biochemical means. Tahoma Clinic is staffed with medical doctors, naturopathic physicians, nutritionists, allergists, nurses and administrative personnel committed to the vision of providing patients with the best holistic medical care. The infamous 1992 FDA Tahoma Clinic “raid” (“The Great B-Vitamin Bust”) was a major impetus for Congressional reform of vitamin/mineral regulation. Dr. Wright continues to be an advocate for patient freedom of choice in healthcare. Dr. Wright is internationally known for his books and medical articles. He has authored/co-authored 11 books, selling over 1.1 million copies, with two texts achieving best selling status: “Book of Nutritional Therapy” and “Guide to Healing with Nutrition”.
Dr. Jonathan V. Wright

Dr. Wright authors Nutrition and Healing, a monthly newsletter emphasizing nutritional medicine in medical practice that reaches over 90,000 in the USA, and another 20,000 or more worldwide.

Along with Alan Gaby, M.D., Dr. Wright routinely presents the comprehensive and scientifically documented “Nutritional Therapy in Medical Practice” seminar which has helped numerous health professionals gain insight into nutritional approaches for disease. Dr. Wright speaks nationwide at various medical association conferences on varied topics including nutritional medicine, natural hormone replacement therapies for men and women, the natural treatment of cardiovascular diseases, asthma, diabetes, D-mannose for bladder infection, Vitamin D usage and laboratory testing, clinical uses of nutrient elements, and many other subjects.