Nurse Barb Dehn: Vaccine hesitancy, S-equol, and women’s health in rural Africa

Michael Krychman, MD, is a sexual health specialist and expert in survivorship medicine at the Southern California Center for Sexual Health and Survivorship Medicine.

Barb Dehn, NP, is a women’s health nurse practitioner at El Camino Women’s Group and a nationally recognized health expert who specializes in pregnancy, breastfeeding, fertility, menopause, and sexual health.

MK: Hi, I'm Dr. Michael Krychman here with Contemporary OB/GYN®. We’re at the North American Menopause Society Annual Meeting in Washington [D.C.], and I'm so excited that I have Nurse Barb Dehn here. She is a regular medical reporter, she's with NBC California Live, she wears a million different hats. We're going to try and pick your brain a little bit for the next little while.

Tell us, what's been going on? What have you been doing on your show?

Addressing vaccine hesitancy

BD: We have been talking a lot about COVID. We've been talking about how to get people from vaccine hesitancy to vaccine willingness. And guess what? trusted ob-gyn are some of the people who are making the biggest difference in people's lives because women love ob-gyn. They delivered their babies, they're always there for them. So ob-gyn have a lot more influence than they may think about helping people decide to be vaccinated.

MK: It's a very touchy subject. I know in where I am in Orange County, it's a very touchy subject, where people are getting their information or their misinformation. We really need good resources and how to communicate with our patients. Because I agree with you, we have impact and now we're asking everybody, 'Have you gotten the vaccine?' And if not, what's your hesitancy? Where are you getting information? How can we educate you to make informed decisions based on fact, not fiction, right?

BD: Exactly. And we don't want to shame or blame. What I always say is we have two ears and one mouth so we can listen twice as much as we talk. When you listen, then you really can dive deeper into the real reasons, and sometimes, it's really surprising. And then you can do myth busting, if possible, but not to shame or blame because people already kind of feel entrenched in their positions.

MK: I have to tell you the truth. I have kids. Their teams and I use that line all the time, 'two ears, one mouth, let me listen more than I speak.' And I think that's a really good clinical pearl for almost everything that we do, right?

BD: Especially for sex. And you’re a sexual medicine expert. No matter who I'm talking to when it comes to sex, especially teens, I always say, 'It's not about the birds and the bees. Really, it's about listening and asking open-ended questions. Sometimes just what-if questions, right, when you're talking to a teen? Or, 'When do you think people might want to have sex, and you know what has to happen in a relationship before you make that decision?' So I like to ask a lot of questions.

Myths and misconceptions about soy

MK: I know you've been super busy here and I was lucky enough to attend just a session earlier today that you presented on1. Tell me, what are the highlights and the take-home messages because I think it's really, super exciting and new.

Even for someone seasoned like me, I've walked away with a lot of like clinical pearls and really excited about new things coming down in innovation, so I know you're on the cutting edge. So tell us what's going on.

S-Equol and estrogen receptors

BD: Well, I have been always interested in soy because it's a phytoestrogen. There's so much conflicting data about it, and we talk about myths and misconceptions when it comes to soy. So many people are afraid of it because of rodent studies that showed hyperplasia in the breast, but it turns out, when it comes to soy, some people are able to metabolize soy into its natural metabolite S-Equol. But S-Equal—get this—it only works on estrogen receptor beta.

What happens is, it has a 13-fold greater affinity for estrogen receptor beta than alpha, which means that it sometimes acts like an estrogen, and other times it acts like a sirmaur an antagonistic or it's antagonistic.

MK: Getting back to basics, many clinicians don't even know. They just think 'estrogen receptors,' right? And they're [thinking], 'All estrogen receptors are the same and they do the same thing.' We now know, and the [inaudible] really taught us, that sometimes cells get turned on sometimes, they get turned off, and this adds another layer.

The receptor alpha and beta, I think it's really exciting, and I think it's important to remember that not all soy is created equal. There are different qualities. It's really exciting because you gave us some statistics about women and what they want, and it really was an eye opener for me.

BD: So, 2 million women every year become menopausal--and yet--only one in four are using any kind of treatment, whether it's over the counter, or it's a prescription remedy. But 50%--and I actually think that's a little low--50% of women want to use some type of supplement or natural product.

Now they're coming to us with a lot of crazy ideas that they're hearing from an online influencer. It's really up to us to look at the data and say, 'Look, is this evidence-based?' And, 'Does it hold up against placebo?' And as it turns out, S-equol has great data, and it has great safety, a great safety profile.

MK: I think that's really important. Because there are a lot of snake-oil remedies. We see it all the time. Every day they're putting some kind of strange thing in their vagina, or they're taking this weird product that comes in a brown paper bag, and we don't know what it is. Then they have complications.

It's really exciting that some of these companies are taking the extra step to do that research. That's very reassuring for us as clinicians to implement it. Where do you see the future of this?

Increasing knowledge of receptors to provide tailored care

BD: I'm really excited. I was just doing a literature review looking at ovarian cancer cells being inhibited by estrogen receptor beta activation, and it was recent research coming from the University of Texas.

I think as clinicians, we're going to start paying more attention not just to whether, like breast cancers are estrogen-receptor positive or negative, but if they are estrogen-receptor positive, is it an alpha-receptor? Is it a beta-receptor? And how do we use that knowledge about receptors to more tailor or individualize the treatment options we have for women? You and I both know, one size never fits all. So we're always looking for a tool in our menopause toolbox so that we can offer different things to patients because every woman wants different things.

MK: Or sometimes even layer. Very often I'll do behavioral things, and I'll incorporate a nutraceutical or a supplement. Even with estrogen, people want to stay on a lower dose, but they still want an extra oomph. So, sometimes you've got to layer it. And I think your concept is right, precision medicine. Are you doing any other events here? Any posters, any other exciting things?

Foundation for African Medicine Education (FAME)

I know you're really passionate about health care and health care disparities. I can't have you interviewed without talking about your commitment to FAME. I really think it's amazing, so I think people want to know about it. So, tell us about fame and and how you got started, where we are and where we need to be.

BD: This is very kind of you because I've been going to Karatu, Tanzania, which is Sub-Saharan Africa--very close to the Serengeti, very close to the wildebeest migration--for about six years. I became a board member, but here's what I'm challenged [and] charged with.

I have been building out our Global Fellowship Program specifically for ob-gyn.

FAME is a non-denominational hospital. There's no religion involved. It is sustainable. Truly sustainable. It's all Tanzanian doctors, all Tanzanian nurses, and experts like yourself. We get the neuro team from Penn that comes, and we've had a global fellow. I'm actually recruiting post-residency fellows to come to FAME for at least three months. Our last fellow loved it so much, he stayed for nine months.

We're looking for people who want to finish their training or do a fellowship with us at FAME. It's an amazing, amazing, process and you get to see a whole 'nother part of the world. So that's what I've been charged with.

We have anesthesia fellows from Stanford, we have the neuro team from Penn, we had a surgical fellow from Creighton [University], University of Arizona for our ob fellow, and I'd like to welcome anybody else. You can find me at NurseBarb.com if you're interested. I think I'm trying to get you to come over right?

MK: I think I have to make that trip. What about clinicians? How can they help?

BD: If a clinician wants to come, we'd like you to come for three weeks at least. You would come in, you would mentor your Tanzanian colleagues, you'd act like an attending. You would learn a lot about infectious disease. We learn from each other.

There's a volunteer house, and it's a safe area. We're learning from each other, we're working together, and there's a huge need for women's health. Because--obviousl-- everything there is emergent, right? You'll see this kind of crazy stuff that you would never see in the United States. It's an amazing experience, but we do expect people to give back. You have to pay your own way, but afterwards, you can go on safari!

MK: Barb, I really want to thank you for your time today. It's been wonderful to see you in person. I know we've been challenged by Zoom meetings and everything. The future I'm sure will be on the Zoom and in person again. I know you're super busy here at the conference, but I really want to thank you for your time and your insight, especially your dedication to women's health.

BD: Oh, thank you. What a pleasure. Thank you so much.