I've now spent a couple of months with this book, having read all of it at least twice and chasing down many of the references. I'm a physiologist working in the area of human metabolism, and spend my working life reading and writing scientific papers, and I felt this book had the potential to be as important as "Good Calories, Bad Calories" by Gary Taubes.
I did not, like others posting here, feel confused by the writing or feel the book was in any practical way disorganized. This book is written for the lay reader and not intended to be delivered like a technical review of the literature. I wasn't at all bothered by the song titles and largely ignored them, and felt they really didn't create a problem in finding a topic I wanted to review. If I wanted to go back to something, the index was usually helpful. There was an important case in which the index was not helpful, though, and that was in returning me to the discussion on the necessity of peaking estrogen levels on progesterone receptors. I had to go into the medical literature online to track back to that because it was easier for me to find it that way. I think the main problem with the writing is that it attempts to cover a LOT, and it's therefore quite dense. It gives one a lot to track down to determine how much is really supported by the evidence and how much is stretched to fit a bias. I personally have no problem that Wiley is not medically credentialed. To me, that criticism is just a dogmatic harumph. There are journalists and statisticians writing about medicine who's work I completely respect, and Wiley does have two credentialed co-writers. I'm sure they were all able to handle the material expertly.
And yeah, it is biology not politics. Just because what she's saying is definitely not what many of us want to hear, from a strictly biological and evolutionary point of view, a lot of it is just plain accurate. Accurate also is her description of our ancestral diet and how that impacted hormonal regulation. I try not to, but I upset people every day in my practice when describing the damage they're doing to themselves with their [ADA recommended] high carbohydrate diets, and just because they don't want to hear it because they've placed their confidence in our medical research establishments and because they're addicted to these sugars, doesn't make what I'm saying wrong. This book upsets many of us who are feminists, but she's a feminist too, trying to open our minds to certain evolutionary realities and how we might mitigate the fallout; she's just not saying what we want to hear. We shouldn't shoot the messenger.
There are complaints here in the reviews that her citations are not relevant or supportive of her statements of facts. I found some instances where she cited support for a statement and some of those citations had nothing to do with her statement, although others cited in the same group did. What I found was not so much a lack of support for her cited statements, but that sometimes the studies themselves were bad and so you can't really use them to support a conclusion. In vitro studies, observational studies and studies in species that don't have any common metabolism with humans [such as cholesterol studies in rabbits] are really weak. But they're all she can quote as the only human hormone studies are with synthetic hormones, not natural ones. This, however, does not diminish the weakness of the evidence and the leap that must occur to turn an animal model into a human application. It does certainly suggest a mechanism but it does not prove her many statements that "YOUR HORMONES" do this or that. She got a lot right, tho, including the problem of breast cancer survival statistics with or without treatment, the well-known problems with mammography and breast cancer treatments, how medical treatments largely arose from the military-industrial complex. She also got right all the stuff about saturated fat, cholesterol and statins in her discussion of menopausal heart disease. And there's plenty of evidence to show cardioprotective benefits of estrogen, and John Lee and his clinic's work has accummulated important information with bioidentical progesterone.
She does, very much, rant on the drug companies and the NIH, and the barbarism of medical practice both now and in the past. It's hard not to when you work in medicine. National health policy [the one that recommends what you eat and what kinds of procedures/medications you can have] is deeply corrupted by institutional career making and drug money. An important example is the development of the food pyramid, which recommended a reduction in saturated fat based on rigged science that linked it to heart disease. That national health initiative has been largely credited with causing the current diabetes epidemic while doing nothing at all to lower heart disease. It can make you downright shrill when the damage of health policy meets you everyday in your work, and I don't begrudge her shrillness.
There is also an inherent logic to a central thesis that if estrogen caused cancer, why are cancer rates basically non-existent in females with the highest estrogen levels [young females]? In my experience, human biology always boils down to common sense, and this is an important piece of common sense that should not be ignored.
So here's my two problems with the book. She assumes that all the diseases we actualize as aging women are strictly related to sex hormones, and she makes many conclusive statements that are without citations. On the latter point, I found myself continuously writing in the margins "Ref?", and sometimes "REF?!" if the statement was particularly leaping.
On the former point, she does a bang up job describing insulin resistance and chronically high cortisol levels from our changing diets and lifestyles, and then states that the diseases related to insulin resistance and cortisol are all due to deranged sex hormones on these other hormonal regulators. I went, "Say what?" way more than once. Could it be that these diseases are also just directly related to insulin resistance and chronically high cortisol levels? And of course, there's sufficient evidence in the medical literature that they are. And that's the big issue in menopause research overall; when we're talking about what causes these diseases, how much of the variance is related to estrogen/progesterone and other sex hormones, and how much is related directly to insulin/cortisol and the other messengers that control obesity?
One way to try to get at how much of the variance is just sex hormones is to go back to the inherent logic presented in the book that if estrogen caused cancer, then why aren't cancer rates soaring in women with maximal estrogen? A similar logical question could be that if low estrogen and absent progesterone are *the* thing responsible for our diseases of aging [cancer, insulin resistance, heart disease], then why have the incidence of some of these diseases skyrocketed in females with maximal levels of sex hormones? A population study published in the journal Diabetes Care [Bloomgarden 2004] indicates that as rates of obesity [defined as greater than 95th percentile of BMI] have increased from 4.6% in 1970 to 15.5% in 2000 among teens up to 19 years of age, rates of impaired glucose tolerance, systolic blood pressure, triglycerides and reduced HDL have also significantly risen vs. normally weighted teens of both sexes. All of these parameters are known precursors to heart disease, diabetes and cancer. Recent investigations have also linked the rise in c-sections to metabolic syndrome in pregnant women. Both of these groups, teens up to 19 and pregnant woman, have maximal sex hormones and yet suffer - in increasingly disturbing numbers - the diseases that Wiley claims are disease of old women. This seems to indicate that very much of the variance is related to insulin/cortisol etc, and this is something that menopausal women can do A LOT about via lifestyle changes, whether or not they choose supportive hormonal therapy.
And therein lies the problems I have with her leaps.
For the record, I am a perimenopausal female and I take natural hormones because I definitely feel better on them and I'm also convinced that they afford a level of protection against cancer and heart disease. I am not, however, taking the Wiley Protocol. I know many women on BHRT who are still significantly insulin resistant because of their diets, still have high chronic stress chemistry, and are not addressing either of these with exercise or refreshing sleep. They are still very much not well, even though they are on BHRT.
