Hot flashes in Cancer: Neutraceuticals for Treatment

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Over several blogs, I look forward to reviewing the biology of hot flashes, causes, and management tools. Today, let’s take a moment to look at neutraceutical medicines. Neutraceuticals include herbal medicines such as black cohosh and homeopathic herbs. The category also includes vitamins, and phytoestrogens (including soy and flaxseed). Historically, studies have been challenged by lack of standardization for the interventions. Let’s turn to some of these potential remedies for hotflashes.

Black cohosh: This herb is derived from the North American periwinkle plant, and has been well-studied for hot flashes among women with breast cancer, but not very much for symptoms linked to prostate cancer management. It acts on serotonin receptors, but does not have estrogen-like actions. While some historic trials showed effectiveness, modern trials do not show it to work among women without cancer. Some studies show it helps women who are on tamoxifen, but check with your doctor before you considering using it.

St. Johns’ wort: My review leads me to believe that this intervention does not work well. In addition, it can interact with some specific medicines.

Homeopathic herbs: While some observational trials have shown benefit, two randomized, controlled trials have not found homeopathic herbs to be effective against hot flashes, compared to placebo. We do not have high level evidence to suggest you should use this approach.

Vitamins: Vitamin E is one of the most investigated vitamins used to reduce hot flashes. First of all, some women should take caution: Heart disease, high blood pressure, and high blood pressure can present problems. There is some concern about inducing cancer, too. My read: Vitamin E may reduce hot flash incidence by 1 or 2 per day. Folic acid may help alleviate hot flashes, but more studies are needed.

Flax Seed: This rich source of lignans (a class of phytoestrogens) has been investigated in 3 prospective, randomized trials. There appears to be no benefit for women, and no good data for men.

Red clover: A randomized trial showed no benefit among women. No good data for men.

Soy isoflavones: A systematic review of 19 randomized studies (meta-analysis) suggests that soy may reduce hot flashes more than a placebo for women. The median dose was 54 mg per day. We don’t have much data about prostate cancer-related hot flashes and soy among men, but what is available is a bit conflicting.

Well, that’s it for today. Going forward, we’ll turn to other potential interventions. For now, I suggest exercise, and looking for triggers (for example, caffeine, heat, stress, alcohol, and spicy foods). I’m Dr. Michael Hunter.