Botanical Bliss: Wear Organic, Eat Organic

Today I sit with the question: If we are all so clear about eating organic, why are we not wearing organic clothing? Our conventional clothes contain toxic fertilizers/pesticides/herbicides/insecticides, heavy metals, endocrine disruptors, teratogens (causes birth defects) and carcinogens. The question lingers from a blissful day yesterday spent at a "Native Dye" workshop with my friends and colleague, eco-artist Rebecca Burgess, at the California School of Herbal Studies (CSHS) in Forestville, CA (County of Sonoma). 

Rebecca was very kind to let me crash the workshop, which she has taught twice before at CSHS, and to speak to the students on the topic of "Toxic Endpoints of Conventional Clothing: Endocrine Disruption, Heavy Metal Exposure & Cancer." My unofficial title: "These Jeans Are Killing Me."

A friend texted me, after hearing the title of my talk, "Look at you going all NRDC on us."

Good point.

After driving at high speed the 72 miles from Oakland to Forestville and dragging my 5-year-old daughter behind me (she was off school for Sukkot) at 7am, I turned onto the long liminal driveway to CSHS.

"Donkeys!" shrieked Maya, my youngest kid, her impatience with the drive a distant memory.

"Yes, Donkeys!" I affirmed. "Or Burros?" I'm not so good at distinguishing the two. Too rounded to be horses. Not llamas. Woah, I'm noticing animals again. We entered sacred space. Hassles of leaving the house so early and traffic on the 101 receded as we both took in the landscape: luscious herbs and flowers, silence, farm animals, brilliants smells and sights of Indian summer in Sonoma.

We parked and walked into the red building ("The Barn") that you see above. I'm a conventionally-trained doctor and never take my kids with me to work. When I did in the past, I get people who look at my young kid, then me, then the kid, then quickly away with a withering sigh.

I walk into CSHS and a group of twenty-something women, all beaming warm and inviting energy at us with shining eyes, greet and welcome us. Estrogen and oxytocin (the hormone of love and bonding) boils over the pot in this place. My daughter grins ear-to-ear and settles right in, ready to make new friends.

I set up our Powerpoint and look for tea - my stainless steel commuter mug needs a refill. There's a big hot water urn in the corner that I spy, but... uh, where's the tea? There's a conspicuous lack of tea bag options next to the hot water. Oh, I get it. All these women were nursing Mason jars filled with steeping flowers and plant bits. Hello, they are Herbalism Students! These peeps are way beyond tea bags.

Rebecca and I finished setting up her steaming vats of natural dye: indigo (naturally fermented) black walnut, coffeeberry, California sage, Madrone, Eucalyptus. Powerpoint begins. Rebecca flashes her slide that is the segue to my brief presentation - how conventional dye causes all kinds of health problems (short list that I've augmented: lymphoma, bladder cancer, asthma, contact dermatitis, hypothyroidism, estrogen dominance), and naturally-dyed clothing actually has healing properties (again, Rebecca's work to which I've added my own thoughts), such as: 

• Pokeberry (see photo below) acts as a lymphatic cleanser
• Woad - contains 20 times as much glucobrassica as brocolli and I hypothesize may improve estrogen dominance similar to DIM (di-indole methane)
• Horsetail - decreases bone loss in women

Radical idea of clothes that heal, not hurt.

Here's Rebecca preparing a pokeberry dye vat for us:

Those pretty berries above got smooshed and made into this gorgeous dye vat - remember this cleanses your lymphatics to work with these berries and wear them.

And here is an organic cotton food/snack bag I dyed with the pokeberry. Take it to the farmer's market next time you're gathering apples or persimmons.

This feels like prayer. My kind of prayer.

Now why bother, you might ask. Great question. Part of my presentation was to take a common toxic clothing item - your beloved jeans and tell the back story of how they were made. In the US, women on average own 8 pair of jeans. I'm no exception and happen to love my Sevens for All Mankind, my Dolces and my Luckies. 

I know there are heavy metals used in getting that pretty denim color, and pesticides and fertilizer used in growing the cotton. Do conventional pesticides and fertilizer act as endocrine disruptors and slow my thyroid and stimulate my estrogen receptors in my boobs? Um, yes. I never really put it together as I did while preparing yesterday's presentation - and to state very directly: my beloved jeans are hurting my health. Here's a few soundbites:

• 2/3 pounds of toxic pesticides and fertilizer are used to make one pair of jeans
• water from conventional denim textile companies is full of heavy metals such as mercury, lead, cadmium, chrome, copper, zinc, antimony
• 7 million pounds of toxic chemicals are used annually for cotton in California alone

If this sounds outrageous, that's because it is. If you need a visual of what you're putting on your skin every time you dress in conventional jeans, try this one. This is from a CNN story published in April, 2010, on the "Blue Jean Capital of the World" -- Xintang, Guangzhou. This textile village produces 200+ million jeans per year. Check out the black nasty water coming out of this village and emptying into China's Pearl River (how sad and ironic that this black stuff is entering a river named for pearls?). I'm not a water pollution person, but as an integrative doctor, I can say that the black muck of heavy metals, carcinogens and endocrine disruptors on your jeans cannot be good for your body.

As the local Chief Medical Officer in Guarngzhou, Dr. Tony Lu, states, this black muck is full of chemicals that may be: "neurotoxic, carcinogenic, they disrupt the endocrine system. They cause cancer of different organs."

People, we have alternatives. We are on board with organic food, but let's take the next step and get mindful about what we put against our skin, and especially the skin of the most vulnerable among us, fetuses in utero, babies, children. 

Here are a few more pics of the brilliant Rebecca Burgess, spreading the good word. 

Let's find some foxy organic cotton jeans, colored with natural dyes. My Seven jeans now hold less appeal, Now, I'm eye-ing my Lululemon brightly-colored yogawear in a whole new way. 

If you're worried the alternative is not pretty, check out some of the samples from our workshop yesterday.

While it's true that I'm a relative beginner at changing out my wardrobe, Rebecca is much farther along of the path. She writes a gorgeous blog, and walks the talk - she now wears for the next year clothing that is sourced and dyed with local resources within a 150-mile radius. The experiment is called "fibershed" and I can't wait to check her heavy metals before and after. So much fun for this integrative gynecologist!

Treatment for Vaginal Dryness

We know that one quarter of women at or past menopause note vaginal thinning, irritation, decreased sexual response or dryness, and seek medical attention for it. I find the numbers are actually much higher if you ask women routinely. I'm a big fan of natural lubricants first, and if that doesn't work, try a tiny dose of natural estriol vaginal cream. I like estriol because you usually need less of it than the other forms of estradiol. It is by prescription, and needs to be formulated by a reliable compounding pharmacy. The good news is that it takes about 2 weeks to re-estrogenize the tissues, and it also prevents bladder infections. Remember that pre-menopausal women can have thiss too -- especially thin women who don't have much estrogen on board. Below are some guidelines, published by the North American Menopause Society.
SG

New Guidelines Issued for Treatment of Vaginal Atrophy
News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD

May 15, 2007 — The North American Menopause Society (NAMS) has issued a 2007 position statement about the treatment of vaginal atrophy with local vaginal estrogen. The guidelines, which are published in the May-June issue of Menopause, state that therapy should be guided by clinician and patient preference.

Using the general principles established for evidence-based guidelines, NAMS convened a panel of clinicians and researchers with expertise in genitourinary disease to review, synthesize, and interpret the current evidence on vaginal estrogen therapy for vaginal atrophy, develop conclusions, and make recommendations. The advice of this expert panel was used to assist the NAMS Board of Trustees in publishing this position statement.

"Although hot flashes typically accompany the loss of ovarian estrogen production at menopause, they usually abate over time regardless of whether estrogen therapy is used," Editorial Board Chair Gloria A. Bachmann, MD, said in a news release. "In contrast, vaginal symptoms (eg, vaginal dryness, vulvovaginal irritation and itching, and painful intercourse) are usually progressive and unlikely to resolve spontaneously. Left untreated, vaginal atrophy can result in years of discomfort, with a significant impact on quality of life."

About 10% to 40% of postmenopausal women have symptoms related to vaginal atrophy, most of whom require treatment. However, only about 25% of symptomatic women seek medical attention.

The therapeutic standard for moderate to severe vaginal atrophy is estrogen therapy, administered either vaginally at a low dose or systemically. There has been a relative lack of randomized controlled trials performed to date, but they have shown that low-dose, local vaginal estrogen delivery is effective and well tolerated for treating vaginal atrophy.

In North America, US Food and Drug Administration–approved treatments of vaginal atrophy symptoms that offer localized vaginal delivery of estrogen include cream, tablet, and ring formulations. These products are associated with fewer adverse effects than systemic estrogen. At the doses recommended in labeling, all of the low-dose vaginal estrogen products approved in the United States for treatment of vaginal atrophy are equally effective. The choice of treatment should therefore be individualized based on clinical experience and patient preference.

In general, creams may be associated with more adverse effects than ring or tablet formulations, perhaps because there is more potential for women to apply higher-than-recommended dosing with cream. However, a Cochrane review reported no significant differences among the delivery methods in terms of hyperplasia, endometrial thickness, or the proportion of women with adverse events. The most commonly reported adverse effects associated with vaginal estrogen therapy are vaginal bleeding and breast pain, with nausea and perineal pain reported less frequently.

When low-dose estrogen is administered locally for vaginal atrophy, progestogen is generally not indicated. Data are insufficient to recommend annual endometrial surveillance in asymptomatic women using vaginal estrogen therapy.

Vaginal estrogen therapy should be continued as long as women continue to have distressing symptoms. Management of vaginal atrophy is similar for the group of women without a cancer history and for women treated for non–hormone-dependent cancer. However, for women with a history of hormone-dependent cancer, management recommendations are individualized and vary based on each woman's preference in consultation with her oncologist.

Specific recommendations are as follows:

The primary goals of vaginal atrophy management are symptom relief and reversal of atrophic anatomic changes.

For women with vaginal atrophy, first-line treatments include nonhormonal vaginal lubricants and moisturizers.

Symptomatic vaginal atrophy that does not respond to nonhormonal vaginal lubricants and moisturizers may require prescription therapy.

Randomized controlled trials in postmenopausal women are limited. However, they have demonstrated that low-dose, local, prescription vaginal estrogen delivery is effective and well tolerated for treating vaginal atrophy while limiting systemic absorption.

Low-dose vaginal estrogen products approved in the United States for treating vaginal atrophy include estradiol vaginal cream, conjugated estrogens vaginal cream, the estradiol vaginal ring, and the estradiol hemihydrate vaginal tablet. These are equally effective at the doses recommended in labeling, so specific choice depends on clinical experience and patient preference.

When low-dose estrogen is administered locally for vaginal atrophy, progestogen is generally not indicated.

Closer surveillance may be required for women at high risk for endometrial cancer, those using a higher dose of vaginal estrogen therapy, or those with symptoms such as spotting or breakthrough bleeding. Evidence is insufficient to recommend annual endometrial surveillance in asymptomatic women using vaginal estrogen therapy.

Vaginal estrogen therapy should be continued for as long as women have distressing symptoms.

For women treated for non–hormone-dependent cancer, management of vaginal atrophy is similar to that for women without a cancer history, but for those with a history of hormone-dependent cancer, management recommendations should be based on each woman's preference and the advice of her oncologist.
"Overall, subjective improvement occurs in 80% to 90% of women treated with local vaginal estrogen," the authors conclude. "Vaginal atrophy unresponsive to estrogen may be due to undiagnosed dermatitis/dermatosis or vulvodynia, so treatment failure warrants future evaluation and careful examination."

Novo Nordisk supported the development of this position statement through an unrestricted educational grant. Members of the Editorial Board have disclosed various financial relationships with Berlex, Duramed, Johnson & Johnson, Pfizer, Roche, Wyeth, Paladin Labs Canada, Wyeth Canada, Procter & Gamble, and/or Merck.

Menopause. 2007;14:357-369.