Feb
18
2017

Weight Gain In Menopause

Dr. Tasneem Bhatia, also known as Dr. Taz gave a lecture about weight gain in menopause. This was part of the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The full title of the talk was “Hormone Balance and Weight Control in Menopausal Women”. Dr. Taz practices integrative medicine at CentreSpring MD, Atlanta. GA.

A few statistics about menopause

Weight gain in menopause is common. There are 50 million women who suffer from this in the US. Globally 300 million women have this problem. The average weight gain is between 5 and 50 pounds. There may be a small percentage of women where a genetic component comes in, and where all the females in the ancestry had a weight problem after menopause. But we do not know for certain what is genetic and what is due to hormone deficiency. It is only in the last few decades that doctors have determined how important hormone deficiencies are in menopause.

It has been determined that 10 million women who are over 40-years-old need treatment in long-term care facilities.

We will see below that when this knowledge is incorporated into a treatment schedule, the weight problem can normalize. In this case 2/3 of the cost of caring for postmenopausal women with obesity and diabetes can be reduced.

Pathophysiological changes in menopause

There are three intertwining aspects that drive weight gain in menopause. There is an altered metabolic rate, and less calories are burnt, which makes you gain weight when you eat the same amount of calories. Secondly there is a significant decline of three key hormones, estrogens, progesterone and thyroid hormones in menopause. Third, as the weight rises and the other mentioned hormones are missing, it is harder for the pancreas to keep up with insulin production and insulin resistance is developing. I will explain this further below.

1. Decreased energy expenditure

With the lack of the ovarian hormones there is a slowing of the resting metabolic rate. There is also decreased energy expenditure from reduced fat oxidation. Overall there is less need to consume the same amount of calories as before. But the hormonal changes trigger hunger and cravings.

2. Ovarian aging

With ovarian aging there is less estrogen production in the ovaries. This leads to less ovulation in the premenopausal period. A lack of ovulations creates a lack of progesterone production. When there are anovulatory cycles, there is no progesterone producing corpus luteum reducing progesterone production further. When estrogen and progesterone are missing, this is a stress on the thyroid gland that is trying to partially compensate for the lack of the ovarian hormones. Eventually though thyroid hormone production is reduced and hypothyroidism sets in. This is very hard on the adrenal glands that produce cortisol. For some time the adrenal glands can compensate for missing thyroid hormones with cortisol overproduction. But in time adrenal gland fatigue develops.

3. Insulin resistance

Insulin resistance can lead to diabetes, which becomes a real menace together with the metabolic changes of obesity.

Health risks of weight gain

Dr. Taz pointed out that there are very specific risks associated with the metabolic changes around menopause. There is an increased risk for heart attacks and strokes as LDL cholesterol and triglycerides are elevated and arteries get calcified from circulating calcium that was leaked out from the bones into the blood stream.

Osteoporosis is common in menopause; the brittle bones lead to an increased risk of fractures in the hips, wrists and vertebral bodies.

There is also increased risk of cancer in postmenopausal women, particularly breast cancer and colon cancer. The higher the weight, the more risky it is for these women to get one of these cancers.

Alzheimer’s disease and cognitive decline is also very common in menopause. This may be directly related to a lack of estrogen and progesterone, but may also have to do with overconsumption of sugar and starchy foods.

Hormone changes in menopause

Hormone changes in menopause can be complex. It is not only a lack of estrogens and progesterone that are the problem. All hormones work together. When there is weakness in one area (in the ovaries with menopause), those hormones that are acting in the same way or in opposition to ovarian hormones will be affected. In this way it is understandable that the thyroid gland can develop a weakness (hypothyroidism) or why the adrenal glands are over stimulated first, but will eventually suffer with adrenal fatigue in future. In a similar way the pancreas produces too much insulin, partially because weight gain stimulates this. Typically the physician finds the fasting insulin level elevated with menopausal obesity. But as insulin levels are too high, the body’s insulin receptors get lazy and do not respond fully to insulin anymore. This is called insulin resistance. In time insulin resistance can lead to diabetes.

1. Lack of estrogen

A lack of estrogen in menopause is likely the single most important reason for weight gain in menopause.  As estrogen secretion declines, visceral obesity increases. There is also impaired insulin regulation. With obesity there is an additional risk of developing diabetes.

2. Progesterone

Progesterone is the other female hormone that is reduced with menopause. Bioidentical progesterone cream can prevent osteoporosis and hot flashes in menopause. Bioidentical progesterone replacement can also help a menopausal woman to sleep better. In menopause the production of progesterone goes down by 75% while estrogen production drops down by 35%.

3. Hypothyroidism

Hypothyroidism (with elevated TSH blood tests) is commonly found in menopausal women. This is known to be associated with weight gain. As a result it is important to check for hypothyroidism in menopausal women. It is important to check for micronutrients like iodine, selenium and iron and if they are low, supplementation may be necessary. Some women develop an inflammatory thyroiditis, called Hashimoto’s disease. This can be confirmed with a thyroid nuclear scan. The reason this is important to recognize is that after several years when it burns itself out, hypothyroidism develops often, which requires thyroid hormone replacement.

4. Cortisol response

The cortisol response to stress is suboptimal due to the decreased progesterone levels in menopause. Adequate amounts of progesterone are needed to synthesize cortisol. But in a group of menopausal women following a significant stressful event cortisol production was much higher than in non-stressed women.

5. Other hormones

Other hormones like leptins and melatonin are also contributing to weight gain in menopause. In rat experiments where ovariectomies (mimicking menopause) were performed, there was a clear relationship between low estrogen levels and weight gain; higher estradiol doses inhibited leptin expression resulting in weight normalization.

Leptin and melatonin are influencing insulin regulation. This can in time lead to diabetes in connection with weight gain. It is at this point when a woman’s body shape can turn from a healthier pear shape to an unhealthy apple shape. The extra visceral (abdominal) fat is very active metabolically and causes inflammation in the body. These changes can lead to high blood pressure, heart attacks, strokes and digestive dysfunction.

Treatment of weight gain in menopause: food, hormones and lifestyle

How do you treat a complex problem like weight gain in menopause? It is no surprise that this will require a number of treatment modalities in combination.

1. Diet

It is important to start on an anti-inflammatory diet like the Mediterranean diet. Any extra sugar should be cut out as surplus carbohydrates lead to fat deposits and higher blood lipids. Dr. Taz suggested a 1200-calorie diet. Reduce salt intake. Eat more food during the day until 4 PM, nothing to eat after 8 PM. Increase plant-based foods, lower or eliminate trans fats. Increase foods rich in probiotics (bifidobacteria) like kefir, yogurt and kombucha.

2. Exercise 

Do some exercise in a gym where you combine a treadmill for 30 minutes with 25 minutes of weight machines for strength training. Aim for doing this 5 times per week. But it would be more beneficial doing it every day. Have additional activity bursts on and off during the day. Exercise has been shown to increase HDL cholesterol, which protects from heart attacks and strokes.

3. Stress management

Supplements like adaptogens help the adrenal gland to better cope with stress. These are available through your health food store. Meditation, yoga, self-hypnosis will all help to refocus and protect you from stress. B-complex vitamins and vitamin C strengthen your immune system and give you more energy. Building and maintaining community is another factor in reducing stress.

4. Establishing healthy sleep

Many postmenopausal women have poor sleep habits, partially from hot flashes (due to estrogen deficiency), partially from melatonin deficiency and also from progesterone deficiency. In the next section I will describe how to normalize these hormones. But in addition you need to educate yourself to go to bed between 10 PM and 11 PM every night and to sleep 7 to 8 hours. If you go to bed later, you will disturb your diurnal hormone rhythm and this will interfere with a normal sleep pattern. There is an age-related reduction of melatonin production in the pineal gland. This is why many postmenopausal women are deficient in melatonin. You may need 3 mg of melatonin at bedtime. If you wake up in the middle of the night you could take another 3 mg of melatonin. You may experience a few nightmares as a side effect; otherwise melatonin is very well tolerated.

5. Bioidentical hormone replacement

The complex hormone deficiencies described above are responsible for the many symptoms of menopausal women including weight gain. It is important to work with a knowledgeable health care provider who knows how to prescribe bioidentical hormones. Typically blood tests and possible saliva hormone tests are done before replacement. This establishes which hormones have to be replaced. Typically bioidentical progesterone is replaced first. Secondly, estrogen is added as Bi-Est cream, if blood levels indicate that it is low. If thyroid is required because of a high TSH level (meaning hypothyroidism) supplementation with Armour or a similar balanced T3/T4 combination is started. If fasting insulin levels are high, the doctor may want to start metformin as this is known to normalize insulin resistance. Blood tests have to be repeated from time to time to ensure adequate hormone levels.

6. Supplements

Every woman treated will likely require different supplements. But magnesium is one mineral that is often missing in the diet. 250 mg of magnesium twice a day will be enough for most women and men to balance internal metabolic reactions. Magnesium is a co-factor to many enzyme systems. Vitamin K2 (200 micrograms daily) and vitamin D3 (around 4000 to 5000 IU per day) in combination are important to prevent osteoporosis. Apart from these there are many options to take other supplements. Ask your healthcare provider what you should take.

Weight Gain In Menopause

Weight Gain In Menopause

Conclusion

This was a fast review of what Dr. Taz explained in a talk about weight gain in menopause. There are complex hormone changes that need to be addressed. A well-balanced diet like the Mediterranean diet needs to be followed. Stress management skills need to be learnt. A regular exercise routine needs to be followed. Healthy sleep patterns have to be reestablished. And missing hormones need to be replaced not in synthetic forms, which are toxic to the body, but in the bioidentical forms. Postmenopausal women will feel better when this comprehensive treatment program is in place; and in time they will feel normal again.

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May
28
2016

Two Sides Of Medical Marijuana

The newest craze is to treat menstrual cramps with medical marihuana, but there are two sides of medical marijuana. What women with menstrual cramps may not know is that it is estrogen dominance that is the cause of their symptoms. As women get closer to menopause they ovulate less often, and there are anovulatory menstrual cycles. This leads to a relative loss of progesterone from the corpus luteum that will form less frequently in the small cavity where the cyst with the egg was. Nature designed women’s menstrual cycle with mostly estrogen production in the first half of the menstrual cycle and mostly progesterone production in the second half of her cycle.

Other causes of estrogen dominance

When a woman gains weight, estrogen can also be produced in the fatty tissue due to an enzyme called aromatase. Androgenic hormones, which are testosterone-like and produced in the adrenal glands, get metabolized into estrogen through aromatase. This upsets the balance between progesterone and estrogen. Normally that balance when measured with saliva hormone tests should be higher than 200 to 1. But when progesterone production from the ovaries is missing, or when estrogen production is in overdrive through aromatase, estrogen is dominant. The progesterone to estrogen ratio drops below 200 to 1. This is bad news as it has consequences. It can cause a number of symptoms: migraine headaches, painful menstrual periods, endometriosis, and fibrocystic disease of the breasts with breast pain; even cancer can develop in the cervix, the uterus and the ovaries. Estradiol, the main estrogen compound in women, stimulates cells to divide, when it is not balanced by progesterone. Progesterone does the opposite: it balances the effects of estrogen.

Two sides of medical marijuana: treating symptoms

Drug companies always look out for symptoms that they can treat with a patented drug. The link at the beginning of this blog pointed out that “there are some very sick patients in need” to justify treating them with marijuana. This may relieve their symptoms for as long as they take the chemical compound. But it does nothing for the hormone imbalance. With the next menstrual cycle the symptoms will recur, and the marijuana will be consumed intermittently for years to come. What is worse is that the women think that nothing bad can happen to them: they are just relieving their symptoms. But as pointed out, unbalanced estradiol can give them migraine headaches. It can cause painful menstrual periods with or without endometriosis. Breast pain can be caused from fibrocystic disease. The worst of all is that after decades of estrogen dominance cancer of the cervix, cancer of the uterus and cancer of the ovaries can be caused. This is when drug manufacturers have unwittingly victimized their customers.

Proper treatment of menstrual cramps

1) Premenopausal women: The proper treatment for estrogen dominance because of a lack of progesterone in premenstrual women is to replace the progesterone deficit by bioidentical progesterone cream. Naturopathic physicians and anti-aging physicians understand this and treat it this way. Many practicing physicians including specialists, however, use anti-inflammatories and pain medications to treat this. Replacing the missing progesterone is causal treatment. Treating pain is symptomatic treatment. Treating the cause treats the medical problem properly; symptomatic treatment treats the drug company to a profit at the expense of the patient’s health.

2) Women with obesity: As explained already, estrogen dominance can also be produced from estrogen conversion of androgenic adrenal gland hormones due to aromatase in fatty tissue. The key here is to concentrate on watching the diet and exercising regularly. Even 10 to 20 pounds of weight loss can have significant effects on lowering estrogen production. The treating naturopath or anti-aging physician should measure progesterone and estrogen levels in a saliva hormone test. The progesterone to estrogen ratio should be calculated. If progesterone is missing, this can be added by giving a bioidentical progesterone cream or by taking oral micronized progesterone capsules at bedtime. As mentioned above, this is a causal therapy, and will in time not only cure the painful periods, but will prevent all of the other negative conditions mentioned. And most of all, there are no negative side effects, because the body knows the bioidentical hormones.

Two sides of medical marijuana: side effects of marijuana

Marijuana has real side effects. j can cause high blood pressure, dry mouth, headaches, dizziness, hallucinations, depression and sexual problems. It is unsafe with pregnancy, as it has been shown to be associated with childhood leukemia. Marijuana can cause rapid heartbeats and increases the risk of having a heart attack. Regular use of marijuana is associated with lung cancer and emphysema. There is an association of marijuana use and seizures: in some patients it makes seizures worse, in others it makes them better. But marijuana is a central nervous system suppressant. So it is imperative that you stop marijuana two weeks before any surgical procedure, as the anesthetic and other medicines given during surgery will also depress the nervous system.

Why the difference between hormones and marijuana?

You may ask yourself why there would be such a difference in the side effect profile of hormones versus marijuana? Hormones are natural messenger molecules in the body. They are designed by our genes to communicate between our brain, the hormone glands, and cells in organs with certain hormone receptors. This design helps to ensure optimal balance of our metabolic processes.

In contrast, marijuana is affecting cannabinoid receptors in the brain. There are several subtypes that are defined at this point. But these were only detected because researchers were curious what marijuana was doing. This research is in flux. We do not know enough about the long term side effects of marijuana. We do know that marijuana has central nervous depressive effects, because it is binding to these receptors. This makes these receptors not available for the normal brain function. One of these effects may even be that it would block pain perception for a period of time. But nobody knows how safe this is in the long term.

Another possible effect, which makes it to the media a lot, is a possible anti-cancer effect. Before you get your hopes up, read this thorough review of all the cancer research with cannabinoids. I am afraid that at this point there is no clear evidence to support that cannabinoids help fight cancer persistently. There are occasional cures reported, but this is not a persistent pattern.

Safety of synthetic hormones versus bioidentical hormones

You may have heard of the Women’s Health Initiative (WHI) that was abruptly ended in 2002. They used synthetic estrogens (derived from horses) and synthetic progestins (bad copies of progesterone). There results were breast cancer, uterine cancer, heart attacks and strokes that developed in patients who took these synthetic hormones. Originally the investigators wanted to show that HRT (hormone replacement therapy) would prevent heart attacks and strokes. It was supposed to also show that osteoporosis would be diminished. But the opposite was true! The synthetic hormones blocked the natural receptors, so the woman’s own hormones could not reach their target cells. Had the investigators used bioidentical hormones, the natural receptors would have been stimulated, and all of the research objectives would have been reached. The WHI was a huge debacle, which showed that drug sponsored research can lead to disasters. The only problem now is that women are scared, as they do not understand what hormones do. The bioidentical hormones, when balanced properly, are harmless. Synthetic hormones from drug manufacturers are interfering with the body’s hormone receptors causing all kinds of serious side effects including cancer. Bioidentical hormones don’t do that.

Two Sides Of Medical Marijuana

Two Sides Of Medical Marijuana

Conclusion

Those who like to push the sale of marijuana will minimize the side effects of marijuana. They will also push testimonials of women who have been helped with regard to painful periods.

You will rarely hear about women who had their hormones analyzed and had been replaced with bioidentical hormones to normalize their estrogen dominance. The latter approach is a safe approach with no side effects, because you are using natural hormones that stimulate your body’s hormone receptors. Synthetic hormones or marijuana are foreign substances to the body, partially blocking cell receptors, which blocks normal cell function. But nobody knows exactly what these chemicals do other than produce a myriad of side effects. Are you really willing to put your health at risk? After reading this, the answer should be clear.

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May
23
2015

Treating Menopausal Symptoms

There has been a lot of confusion since the Women’s Health Initiative that was prematurely abandoned because the women in the group that were treated with PremPro developed heart attacks, strokes and breast cancer. The clinical trial was supposed to confirm that hormone replacement therapy (HRT) with synthetic hormone supplementation would be heart protective, but it did the opposite.

I have addressed the problem of menopause and andropause in another blog.

Here I will review what can be done for a woman who enters menopause, has symptoms of hot flashes, lack of energy, sleep disturbances etc., but wonders whether not something could be done without introducing any risks as mentioned above. The answer is yes. I will review first what bioidentical hormones do and then discuss a bioidentical hormone replacement plan.

Hormones

The normal hormone action in a woman gets regulated through a complex interactive cycle between the stimulatory releasing factors of the hypothalamus that release pituitary hormones, which in turn stimulate the ovaries to produce estradiol and progesterone in a cyclical fashion. When salivary hormone levels are measured, there is a hormone ratio of 200:1 of progesterone to estrogen. According to Dr. Lee who researched this in detail in his books estradiol is potentially cancer producing in the breast and in the lining of the uterus. However, when the ratio of 200:1 (progesterone to estradiol) or more is found in a woman’s saliva the carcinogenic estrogen effect is neutralized by progesterone (Ref. 1 and 2). When a woman approaches menopause, less progesterone is being produced by the ovaries, as there can be anovulatory cycles. This means that a corpus luteum is not developing and progesterone is missing (Ref. 3 and 4). The change of cyclical hormone changes causes the pre- and postmenopausal symptoms.

There are a lot of effects that estrogens are having: estradiol is involved in neutralizing free radicals that age your cells; it maintains libido, supports bone health, prevents Alzheimer’s, prevents cataracts and skin wrinkling, prevents hot flashes and much more. Progesterone on the other hand keeps your hair from falling out, protects from blood clots, has an antidepressant effect, protects myelin sheaths (prevents multiple sclerosis), reduces cholesterol, prevents diabetes and much more. A table with all of the properties of these two hormones can be found here (scroll down).

Testosterone is also necessary in women for normal libido. However, the dose is much smaller than in the male. These traces of testosterone are produced in the adrenal glands and in the ovaries. These can be tested in either blood or saliva.

Safety of hormone replacement

Immediately when hormone replacement is discussed, the question of safety comes up. I have discussed this in detail here. Briefly, there is a 25 year collective experience in the US with bioidentical hormone replacement with no case of breast cancer, uterine cancer or other complications. In Europe bioidentical hormones have been used since the 1960’s, on a larger scale since the 1970’s. So the European experience of safety of bioidentical hormones is presently about 40 to 50 years. Again no breast cancer, uterine cancer, blood clots, heart attacks or strokes have occurred.

In contrast the synthetic hormones promoted by Big Pharma and approved by the FDA have caused the problems of the Women’s Health Initiative.

There has been a review of the Women’s Health Initiative in Postgraduate Medicine 2009 that clearly described that only bioidentical hormones are safe.

Bioidentical hormone replacement

Basically, what is missing should be replaced with the same hormones that were in your body all along. The reason for this is that each cell of your body has specific hormone receptors. There is a key/lock fit with regard to the hormone and the fitting hormone receptor in the cell that will stimulate necessary biochemical reactions to sustain cell function in every corner of your body. Why would you use a false key (synthetic hormone) that does not fit? Just because a regulatory body, Big Pharma and a physician who was influenced by Big Pharma say so? This does not make sense. Your body requires the bio-identical hormone that your body used to make when you were younger. With the gentle replacement of bioidentical hormones that youthfulness will come back. Based on hormone tests, the first hormone that usually needs to be replaced is progesterone, which can be applied as a skin cream or can be taken as Prometrium, a tablet that can be taken by mouth. After two to three months the hormone levels can be repeated and the ratio of progesterone to estradiol can be calculated (as stated above should be greater than 200:1). If testosterone levels are missing and this is clinically verified by symptoms, a small amount of testosterone cream can be applied as well. DHEA levels, cortisol and thyroid levels are also determined and what is missing is replaced. Fasting insulin is often also measured, particularly in a person who may be overweight or obese. A naturopathic physician or an anti-aging physician (A4M) can help you with the management of bioidentical hormone replacement.

New consensus rules

In 2012 a new HRT consensus statement was published allowing postmenopausal symptoms to be treated for 5 years. It was endorsed by 15 agencies. But when you read this with an open mind, it has NOT changed the synthetic hormones, but argues that up to 5 years of treatment would be relatively safe. There is no clear distinction made between natural progesterone and the synthetic progestins, which produce clots, heart attacks and strokes. Bioidentical hormones have been with women all their lives; when menopause sets in, there is a lack of progesterone, and estrogen dominance causes cancer problems. In Europe postmenopausal women can use bioidentical hormones as long as they feel they need it, in North America there is a consensus statement that postmenopausal women should not use  HRT with synthetic hormones from Big Pharma for longer than 5 years. This does not make sense! Why still synthetic hormones? I smell influence peddling worn out on the shoulders of postmenopausal women.

Treating Menopausal Symptoms

Treating Menopausal Symptoms

Conclusion

A lot of women have been unnecessarily scared by hormone replacement because of the Women’s Health Initiative, which was just a confirmation that synthetic hormones are noxious substances for the body. The recommendations from the consensus statement did nothing to clarify the situation.  All their lives women have been under the influence of their own bioidentical hormones produced by their hormone glands. So replacement with bioidentical hormones (structurally identical to the natural hormones in women) is safe and will bring back the vitality of the past, remove all postmenopausal symptoms and help women live a longer life without Alzheimer’s, heart disease or cancer (Ref.5). I agree with the European studies, the studies presented at many of the A4M conferences I have attended and the Postgraduate Medicine article mentioned above that stated that bioidentical hormone replacement is safe.

 

References:

Ref.1: Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. On page 256 and 257 Dr. Lee describes how progesterone can be used as a cream to treat PMS.

Ref. 2: Dr. John R. Lee: “Natural Progesterone- The remarkable roles of a remarkable hormone”, Jon Carpenter Publishing, 2nd edition, 1999, Bristol, England.

Ref. 3: Dr. John R. Lee and Virginia Hopkins: “Hormone Balance Made Simple – The Essential How-to Guide to Symptoms, Dosage, Timing, and More”. Wellness Central, NY, 2006

Ref.4: Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. Page 29 – 38 (Chapter 2): Risk factors for breast cancer. Page 360 to 374 explains about xenohormones and how they cause estrogen dominance. Pages 221 to 234 (chapter 12) explains why Tamoxifen is not recommended and bio-identical progesterone is more powerful in preventing breast and uterine cancer

Ref.5: Dr. John R. Lee: “What your doctor may not tell you about menopause: the breakthrough book on natural hormone balance”. Sept. 2004.

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Dec
16
2014

Straight Talk About Menopause

In men andropause, the equivalent of menopause is easy to spot and treat. With them it is about a lack of testosterone, which is confirmed with a blood test and treated with testosterone until the blood level comes back to normal and the symptoms disappear (lack of drive, loss of erections).

In women symptoms of menopause are more subtle, but more profound when they have fully developed. Unfortunately there is a lot of misinformation out there including in the media, so often women do not get treatment that would turn their lives around and make the next phase of life more livable. To my way of thinking this is simply not acceptable in a time when help is readily available. Read what I am writing here first and discuss this with your gynecologist or primary care provider. If you notice that there is a prejudice towards using synthetic hormones, go for a second opinion from a naturopathic physician. I will explain why later.

Confusion from the Women’s’ Health initiative in 2002

A discussion about menopause and hormone replacement therapy (HRT) would be incomplete without mentioning the Women’s Health Initiative. I have discussed this study in a previous blog.

Briefly, the use of Premarin and Provera as HRT caused heart attacks, strokes, breast cancer, uterine cancer and osteoporosis, not exactly what women wanted to see as side-effects from a hormone replacement therapy! This happened because the hormone receptors in the hormone-derivative, Premarin (an estrogen-like substance) and Provera (a progesterone-like substance) did not fit like a key and lock. The study was intended to show how useful Premarin and Provera would have been as hormone replacement therapy; the authors hoped to show that the treatment group would live longer, have less cancer of the breast and of the uterus, have less strokes and heart attacks and would suffer less osteoporosis. But because in this study the wrong ingredients were used to do the study, this should not be a discouragement to continue to look for the original goals of helping women to live longer, have less postmenopausal symptoms, less cancers (uterine and breast) and no osteoporosis. The solution is simple: in Europe many women have been treated for decades with bioidentical hormones and were shown to have no postmenopausal symptoms, no premature cardiovascular disease or cancers. Here is a 2010 review that mentions some of today’s confusion, but also points out several large European studies that did not use Premarin or Provera, but showed no increased risk of heart disease, no increased risk of cancer or osteoporosis.

Diagnosis of menopause

Symptoms of hot flashes, night sweats and vaginal dryness have all been found to be strong predictors of menopause as I reviewed here. FSH and LH hormones are above the normal range when a woman is in menopause and this is a very reliable test for menopause that your doctor can order. Usually in menopause it is the progesterone that is no longer produced by the body because the woman stopped ovulating and her ovaries do no longer produce progesterone in the missing corpus luteum that would have followed ovulation.

Progesterone depletion is best measured with a saliva hormone test rather than a blood test as progesterone in tissues accumulates to many times the value of blood tests. Only saliva tests correlate with the tissue levels of progesterone as Dr. John Lee has shown in the past.

On the other hand, estrogen levels are usually still in very good supply (in 65 to 80% of women in menopause) as the ovaries, the adrenal glands and the fatty tissue continue to produce estrogen in sufficient quantities for years to come.

Straight Talk About Menopause

Straight Talk About Menopause

Bioidentical hormone replacement (BHT)

The main principle of replacement with bioidentical hormones has been stated by Dr. John Lee and is still valid. Only replace the hormones that are missing and replace them in the lowest possible concentration, but in the natural form (called ”bioidentical”). Most women in menopause will only need progesterone. This comes in many FDA approved versions, as Prometrium (100 mg capsules) taken orally, or as bioidentical progesterone cream which is applied to the skin. The end point of treating is the lack of hot flashes, night sweats and vaginal dryness and the normalization of the FSH/LH blood levels. Saliva tests are expensive, but if they are taken when the other symptoms have subsided, they will also be in the normal range.

If you have problems getting these tests done and getting a prescription of the appropriate bioidentical hormone replacement, seek the advice of a naturopathic physician who is usually familiar with this type of treatment. Quite a few of the primary care physicians and gynecologists are starting to take an interest in bioidentical hormone replacement, but many of them are 20 to 30 years behind when it comes to treatment of menopause.

Conclusion

Bone mass density can be increased by 15% over 3 years with progesterone replacementHeart attacks can be prevented by replacing missing hormones with bioidentical ones. Apart from progesterone or testosterone levels, melatonin often is also depleted and has been found useful in attaining a better quality of sleep and in cancer prevention. The key is to not be one-sided, but to check for all your key hormones. Replace what is low with bioidentical hormones using moderation. You will have less symptoms, live healthier and live longer.

Last edited Dec. 16, 2014

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Aug
02
2014

Keep Your Muscles In Older Age

Intuitively you may have noted that older folks who have very little “meat” on them are not as healthy as people of the same age with well-developed muscles.

A research team under the supervision of Dr. Preethi Srikanthan and Dr. Arun S. Karlamangla from the David Geffen School of Medicine at UCLA, Los Angeles, CA decided to measure the muscle mass index instead of the body mass index. They did this using bioelectrical impedance (simple electronic body composition bathroom scales) and they wanted to see whether there would be any correlation with regard to mortality statistics in an older population.

The study group consisted of 3659 participants from the National Health and Nutrition Examination Survey III (average age for males 55 and older, females 65 and older). The survey took place between 1988-1994. Mortality rates were computed by the end of 2004. The median length of follow-up per person was 13.2 years.

The authors of the study compared mortality curves for four subgroups of muscle mass from low to high: 0-25%, 25-50%, 50 to 75% and 75 to 100%. When the lowest muscle mass group was compared to the highest muscle mass group, there was a 20% increased mortality rate for the lowest muscle mass group.

This study had careful controls built in and could demonstrate that the difference was not due to better or worse LDL cholesterol values or triglycerides; it was not due to differences in diabetic rates or other factors. This is the first study that shows in a US based population that a lower than average muscle mass is an independent risk factor for premature death in an older population.

The authors were aware of Danish study that had previously shown that a lower muscle mass was associated with a higher mortality rate in 50 to 64 year-olds.

I like to comment regarding this study by putting it into the context of other medical findings.

Keep Your Muscles In Older Age

Keep Your Muscles In Older Age

1. Older people tend to have more falls

Several studies have shown over the years that older people fall more often because of a combination of balance problems with slower reaction time, and also because of poorer muscle development when compared to a younger age group. The medical costs are staggering when older people reach the age of 85 where about 20% of that subpopulation experience serious falls resulting in hip fractures and hospitalizations. There is a mortality of about 25% associated with hip fractures in that age group. And about 50% of those who survive will not be living independently at 1 year following a hip fracture. Fortunately fractures from falls can largely be prevented by making physical changes to the home to prevent tripping and having extra guard rails where needed. But another important factor is to exercise regularly within the capabilities of the older person to maintain muscle mass, which will balance the body and control upper and lower extremity strength as the person moves around.

2. Fit people live longer

A Stanford University study followed 6000 middle-aged men for 10 years and found that the fittest who exercised regularly were 12% more likely to stay alive for every metabolic equivalent; this is the energy that a sitting person uses in terms of oxygen consumption. They also found that the least fit had a 4.5-fold higher death rate within 6 years from the beginning of the study compared to the fittest.

To put this into perspective: a regular walk at less than two miles an hour would be equivalent to 2 metabolic equivalents, a brisk walk at 4 miles per hour is worth 5 metabolic equivalents and running 6 miles an hour is worth 8 metabolic equivalents. This is how the math works: a regular walk every day translates into 2×12% = 24% more likelihood of staying alive in the next 6 years compared to a sedentary person. A person exercising with a brisk walk with a speed of 4 miles per hour every day would be 5×12% = 60% more likely to be alive in 6 years compared to a sedentary person who does not exercise. Not smoking and having a normal weight would add to your probability of living longer. Pushing yourself to the extreme (running 6 miles per hour) may be problematic for the majority of us as there are issues of getting into adrenal gland insufficiency that can develop, if you over-stress yourself. (This is my comment, not part of the study).

Now you may have wondered about the woman’s side (as the previous study was an all-male study). The answer comes from a recent paper that studied 10 clinical trials throughout the world (US, Denmark, Germany, Sweden, Taiwan and Japan) involving only postmenopausal women. Yes, there is the same surprising finding that regular brisk exercise makes the women live longer with less disabilities and less mortality!

The bottom line: exercise regularly and live.

3. Exercise develops your muscles and maintains them

We were born to use our muscles daily (designed as hunter/gatherers), but in the meantime this is what we do: sitting in front of the computer or TV, in cars, in class (school, university, work) or in the movie theatre. So we need to discipline ourselves to get into a routine that balances all of the other activities. Muscle strength exercises or activities as indicated in this link are the answer.

The earlier we adopt this type of a routine, the better off we are when we reach the golden years of retirement. I am one of the examples of former non-exercisers. Apart from liking to go for long walks 3 to 4 times per week I did no formal exercises until 8 years ago when my wife and I got into ballroom and Latin dancing inspired by “Dancing with the stars”. But it is only about 2 years now that we took up regular gym workouts for 45 to 60 minutes every day. It is now easier for me to walk up on a steep hill in our neighborhood that has an 18% incline than 2 years ago.  Muscles need regular exercise. You put a limb in a cast and within 3 weeks most of the muscle strength has melted away. You remove the cast and it will take 3 to 6 weeks of regular exercise to regain the muscle strength. So why not maintain your muscle strength in the first place?

4. Exercise develops cardiovascular fitness

The aerobic part of my daily exercise program (treadmill) develops cardiovascular fitness as the lungs have to work harder and the heart is being activated. Doing this regularly is mimicking going through the landscape looking for food and hunting.  Of course most of us drive in our cars to the grocery store and get our food that way. So my balance is to go to the gym and at least once a day get that work-out. What can we expect from fitness training? An NIH study showed that with a moderate work-out of only 2.5 hours per week you will gain 4.5 years of life due to cardiovascular fitness. This is better than money in the account. It is free healthy additional life!

5. Sensible nutrition will help preserve muscle mass

No, I am not taking your food away. I am suggesting that we watch the quality of the food we are consuming. If you are like the average consumer, you may be eating too many carbs in form of pasta, bread, rice and potatoes. Some of you have read in past blogs that my wife and I cut out sugar and starchy foods as well as wheat since 2001. We both lost 50 pounds and kept it down. I know that if I would restart sugar and starchy foods, my fat content would go up, my muscle content down and the BMI up. How do I know? I weigh myself every day on body composition scales (which works by the principal of bioelectrical impedance analysis), which show all of these indicators. Recently I got into some organic Bing cherries. They were delicious, but it also is a fruit with significant sugar content! Within a day I knew that I’d better watch the quantities I consume (fat composition was up, muscles mass down). It took 3 days for my values to be back to normal.

When it comes to muscle mass, overconsumption of refined carbs is one problem; however, our bodies do need quality lean meat and some fish (salmon, mackerel; low mercury fish) as a source of protein. I buy organic meats to get away from the problem of pesticide pollution as much as possible. Some people like vegan food, they may need to supplement with protein supplements.

Conclusion:

It may sound like common sense that a body with well-developed muscles will live longer. You may want to compare this to a well-maintained car (less rust, good maintenance) and the car will still drive well once it has a high mileage.

We have bodies that need maintenance (exercise) and good nutrition (no junk food, sensible diet). If we make this our regular lifestyle, we will develop and maintain muscles. It will keep us in the group with a lower mortality rate compared to sessile persons and junk food consumers.

Nothing happens without any effort. We need to earn muscle fitness for ourselves! Think about it, improve where you need to improve and then maintain it. More than anything else this will pay dividends well into your future.

More information on:

1. Exercise (fitness): http://nethealthbook.com/health-nutrition-and-fitness/fitness/

2. Arteriosclerosis (hardening of the arteries and how to avoid it): http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/

 

Last edited Nov. 8, 2014

 

Jun
21
2014

Older Grumpy People Have Higher Risk Of Dementia

Although in this recent study from Finland researchers found that grumpiness in older age seems to lead to dementia at a faster rate, I like to emphasize here that there may be an under lying problem of hormone deficiency.

Other studies have shown that in males low testosterone levels are associated with grumpiness and dementia is setting in sooner in those males who are deficient for testosterone. For older grumpy females it is the lack of progesterone that has been found to be deficient and when you replace it, memory comes back, symptoms of menopause reverse themselves and the grumpiness is gone. Testosterone replacement may be required by as many as 1 in 4 men in the their 40’s as is summarized in the article from Great Britain.

How can we tell whether there is a change in an older man? There are quite a few symptoms that can be seen by loved ones around this man: an increase in abdominal girth, shrinking muscles, lack of energy, irritability. The key is to get him to the doctor and ask the doctor to order a bioavailable testosterone blood test.

According to medical research 84% of men and 62% of women in the age group of 57 to 64 have been sexually active in the previous 12 months. Take an older age group of 65 to 74 and still 67% of men and 40% of women are sexually active. Fast-forward to age 75 to 85 and the rate has dropped to 39% of men and 17% of women (Ref.1). A person’s sexual activity is a barometer how well the hormones are balanced. These figures show that bioidentical hormone replacement has not been well accepted. Women have a reason as they were misled by Big Pharma as was shown in the

Older Grumpy People Have Higher Risk Of Dementia

Older Grumpy People Have Higher Risk Of Dementia

Women’s Health Initiative:

The National Institutes of Health had funded a large study (the Women’s Health Initiative) to clarify what was going on with regard to side effects and effects of HRT.

Unfortunately, synthetic non-bioidentical hormone products were used in these studies (Premarin and Provera) instead of bioidentical estrogen and progesterone. The results of the Women’s Health Initiative were devastating. In 2002 doctors were warned that Premarin and Provera used as HRT would cause increased heart attack rates and breasts cancer, which led to premature death. Overall the placebo group did better than the experimental group and this is why the trial was prematurely stopped.  As a result of the wide publicity regarding the negative results of the Women’s Health Initiative postmenopausal women either do not see their physician for hormone replacement or are advised by conventional doctors that only small amounts of Premarin could be used for not more than 5 years for fear of causing breast cancer. Medico-legal considerations are at play and the whole issue of HRT after menopause has been politicized.

Problems now for HRT:

It is like a negative shadow has been cast forward with regard to hormone replacement because of the Women’s Health Initiative. People are still confused and don’t understand that the synthetic hormone-like drugs from Big Pharma are like an ill-fitting key for the hormone receptors in the body whereas bioidentical hormones are the perfect fit.

Otherwise there would not be a 45% drop-off (from 62% to 17%) in sexual activities in women from age 60 to 80. Men have it somewhat easier: their drop rate between age 60 an 80 is also 45% (from 84% to 39%), but as they entered into male menopause 10 to 15 years later than women did with menopause, their sexual activity is still double that of women at the age of 80.

However, if people could overcome their unrealistic fear of bioidentical hormones, hormones that fit the body’s hormone receptors a lot more people would be encouraged to use bioidentical hormone replacements.

What, if the grumpy, old man is willing to see his doctor?

The doctor should look at all of the hormones including a fasting insulin level as hyperinsulinism often complicates hormone replacement. Thyroid, which often is also lowered at an older age should be also tested (T3, T4 and TSH). A saliva hormone test can show a panel of 5 hormones: cortisol, DHEAS, testosterone, progesterone and estradiol. As hormones are in a balance with each other this allows to compute the testosterone to estrogen ratio, which ought to be 20 or higher. But hormones alone are not the answer. There needs to be a combination of proper nutrition (cut out sugar, starchy foods, preferably switch to organic foods to escape the xenoestrogens that foul up your hormone balance), also exercise and use vitamins and supplements. I have summarized all of this in my recent book “A survivor’s Guide to Successful Aging” (Ref.2).

When the hormone tests come back the doctor will likely order the missing hormones (hopefully as bioidentical hormones).

It can take 2 to 3 months before the full effect of bioidentical hormone replacement is seen. But most men will be astounded how well they can feel. He will notice that he does not tire with exercising. His muscle mass builds up; his posture improves. His stamina comes back. He will find that the previously foggy thinking is gone and his thought processes have become clear again. And yes, his sex live comes back. So now he has to talk to his sex partner about her bioidentical hormone replacement so they both can enjoy the benefits!

Hidden benefits of bioidentical hormone replacement:

The bones become stronger, the heart beats harder and better, the brain thinks clearer, because the key organs like the brain, the heart and the bones have the appropriate hormone receptors (in both sexes).  No, this is no exaggeration. This can be measured by an exercise tolerance test (for the heart). Bone density can be measured and has been done (2% to 4% increase per year). Brain function is indirectly visible to the people around the person: apart from new vitality, improvements in mood and more energy, the grumpiness is gone and the person is perceived as a pleasant person once again.

Conclusion:

The observation of an “old, grumpy man” when he entered the male menopause is accurate, but should not distract from the fact that he has a responsibility to look after himself. It is important to recognize that it is not only women who enter the menopause, but that men 10 to 15 years later will do the same. Both sexes enter a state of hormone disbalance that is treatable. The answer is to replace the hormone deficiency with the missing bioidentical hormones.

More information on male menopause (=andropause): http://nethealthbook.com/hormones/hypogonadism/secondary-hypogonadism/male-menopause/

References:

1.Rakel: Textbook of Family Medicine, 8th ed., copyright 2011 Saunders

2.Dr.Ray Schilling: “A Survivor’s Guide to Successful Aging“, Amazon.com, 2014

Last edited Nov. 8, 2014

Mar
01
2014

Smoking Remains A Health Hazard

Recently new statistics came out that show that 48.8 million people in the US (19% of the population) still smoke. 22 % of the population are male, 17% female. Smoking is responsible for 20% of all deaths in the US (1 in 5 deaths). It is interesting to note that in the older age group (above the age of 65) only 8% are smoking, but 22 % of the 25 to 44 year old group is smoking. Among the American population Native Americans have the highest percentage of smokers (32% are smokers). 10% of Americans of Asian descend smoke. Blacks, Whites and Hispanics are placed in between them and the American Indians. Finally, people who can least afford it (who are below the poverty level) have the highest percentage of smokers (29% smoke) while 18% of people above the poverty level smoke. Education seems to have a protective effects when it comes to smoking: of the least educated group of people 45% are smokers while only 5% with postgraduate education smoke.

Effects of cigarette smoke on the body

As this link shows the concoction of various ingredients in the smoke of cigarettes causes various parts of the body to react differently to these chemicals. Here is a rundown of diseases caused by smoking cigarettes.

1. Lung cancer: This is the most common cause of death in women who smoke, more common now than breast cancer. 90% of lung cancers in women are due to smoking. The same was true in males, but as a group they now smoke less than in the past.

2. Other cancers:  cervical cancer, kidney cancer, pancreatic cancer, bladder, esophageal, stomach, laryngeal, oral, and throat cancers are all caused by smoking. Recently acute myeloid leukemia, a cancer of the bone marrow has been added to the list of smoking related cancers.

3. Abdominal aortic aneurysm: As cigarette smoke destroys elastic tissue, it is no wonder that the loss of support of the wall of the aortic artery leads to the development of large pouches, which eventually rupture with a high mortality rate due to massive blood loss.

4. Infections of lungs and gums: Smokers are prone to infections of the lungs (pneumonia) and of the gums (periodontitis).

5. Chronic lung diseases: emphysema, chronic bronchitis, asthma.

6. Cataracts: lack of perfusion of the lens leads to premature cataract formation.

7. Coronary heart disease: hardening of the coronary arteries, which leads to heart attacks, is very common in smokers.

8. Reproduction: reduced fertility in mothers, premature rupture of membranes with prematurely born babies; low birth weight; all this leads to higher infant mortality. Sudden infant death syndrome is found more frequently in children of smoking moms (Ref. 1).

9. Intermittent claudication: after decades of smoking the larger arteries in the legs are hardening and not enough oxygen reaches the muscles to walk causing intermittent pausing to recover from the muscle aches. If it is feasible a cardiovascular surgeon may be able to do a bypass surgery to rescue the legs, often though this is not feasible and the patients lower legs or an entire lower limb may have to be amputated.

10. Others: osteoporosis is more common in smokers; poor eye sight develops due to age-related macular degeneration that sets in earlier and due to tobacco amblyopia, a toxic effect from tobacco on the optic nerve; hypothyroidism is aggravated by smoking and menopause occurs earlier.

Smoking Remains A Health Hazard

Smoking Remains A Health Hazard

What happens in the lung tissue in smokers?

Ref. 1 gives a detailed rundown of the changes in the lung tissue as a result of exposure to cigarette smoke. The various components of cigarette smoke lead to an activation of special white blood cells, called monocytes that after stimulation turn into tissue macrophages. In addition neutrophils (regular white blood cells) also get stimulated. Between them they produce cytokines and chemokines and the neutrophils secrete elastase that digests elastic tissue in the lungs. Breakdown products of the elastic tissue serve as a powerful stimulus to the immune system to mount an autoimmune response. After some time of being exposed to cigarette smoke the immune system considers part of the lining of the lungs as foreign and cytotoxic lymphocytes attack the lining of the air sacs (alveoli). Lung specialists consider chronic obstructive pulmonary disease (COPD or emphysema) to be an autoimmune disease (Ref.1).

The sad part is that when this condition has progressed far enough, even quitting smoking may be too late to stop the autoimmune disease by itself as the body has been sensitized and the immune system is convinced that the altered lung tissue should be attacked. Add to this that carcinogenic substances and toxins in cigarette smoke damage the DNA of all cells and the energy producing mitochondria, and the stage is set for the combination of chronic inflammation and the release of free radicals to cause all of the diseases mentioned above.

Quit smoking still important

It is extremely important to quit as soon as possible to avoid the full-fledged sensitization of the immune system against ones own lung tissue. Studies have shown that 36% of survivors of heart attacks will successfully quit, 21% of healthy men with a known risk of cardiovascular disease will quit when asked to do so and 8% of pregnant women will quit. When a physician examines a patient in the office and asks a smoker to quit smoking 2% of these smokers will respond and still not smoke 1 year after this doctor’s visit. This may not sound like much, but it is an encouraging effect. Perhaps the most important fact is what I mentioned in the beginning of this blog: the least educated group of people smoked the most (45%) while the most educated people smoked the least (5% of people with a postgraduate education). My hope is that the Internet and other educational media will contribute to education to convince people how important prevention is.

Pharmacological assistance to quit smoking

Nicotine replacement therapy can involve any of 2- and 4-mg nicotine polacrilex gum, transdermal nicotine patches, nicotine nasal spray, the nicotine inhaler or nicotine lozenges. Discuss with your doctor what may be best in your case. Typically one of these products is used for 3 to 6 months.

Bupropion is an antidepressant with a nicotinic acetylcholine receptor affinity. Bupropion is useful to help with the withdrawal from nicotine addiction, which occurs in depressed or non-depressed people. It strictly has to do with the stimulation of the nicotinic acetylcholine receptor.  Typically the dose is 150 mg of a sustained released bupropion tablet per day for 7 days prior to stopping smoking, then at 300 mg (two 150-mg sustained-release doses) per day for the next 6 to 12 weeks. 44% quit at 7 weeks versus 19% of controls. A newer nicotine partial receptor stimulator, varenicline, has been compared to bupropion. It was slightly more effective in helping people to get off cigarettes. Varenicline is started at a dose of 0.5 mg per day for 3 days, then 0.5 mg twice daily for 4 days, followed by a maintenance dose of 1 mg twice daily. If nausea is a problem, lower doses can be used. Varenicline has been approved for a 3-month period with an option of a second 3-month period, if relapse occurs. Discuss with your doctor what is best for you.

According to Ref. 1 a combination therapy of bupropion and nicotine patch was more effective than either one alone.

Will power, hypnotherapy

Hypnotherapy to quit smoking has been popular, but is not as effective as it is often claimed. Will power, measured by the “placebo” response is quite effective given the fact that nicotine is very addictive and yet 19% in the placebo group were able to quit on their own. According to Ref. 1 varenicline treatment for 12 weeks produced abstinence for 9 to 52 weeks and was compared to bupropion and placebo. The abstinence rates were 23%, 15%, and 10% for varenicline, bupropion, and placebo. This means that will power was still 2/3 as effective as bupropion and 43% as effective as varenicline. Don’t underestimate will power!

Conclusion

The best scenario is to never start smoking. The second best is to quit as soon as possible. Unfortunately, the third scenario of continuing to smoke is still very prevalent worldwide. I have seen the damage done first hand in practicing medicine, which motivated me to never smoke. But I am aware of the difficulties of quitting because of the highly addictive nature of cigarette smoking. Where is the support from governments on this? The problem is that the government benefits from taxation of cigarettes. Nevertheless it is laudable that there are government sites through the CDC to help you quit smoking.

At the end we are all responsible for our own health. If you are presently smoking, psych yourself up for the day that you will quit. Quitting means that you are deciding actively to live longer. Studies have shown that it takes often several attempts before you eventually quit successfully.More information on some of the topics mentioned:

1. Lung cancer and other cancers: http://nethealthbook.com/cancer-overview/overview/epidemiology-cancer-origin-reason-cancer/

2. Heart attack: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

3. Chronic obstructive pulmonary disease: http://nethealthbook.com/lung-disease/chronic-obstructive-pulmonary-disease-copd/

Reference

1. Mason: Murray and Nadel’s Textbook of Respiratory Medicine, 5th ed.© 2010 Saunders

Last edited Nov. 7, 2014

Feb
19
2014

Every Patient Is Unique

Modern Western Medicine tends to see the disease of a patient as a unique entity. Conventional medicine behaves as if a disease is associated with characteristic symptoms, findings and lab test results, which are then treated in a standard fashion by treating the symptoms of the disease.

The reality though is different: The same disease can present in various patients with different symptoms.

Naturopathic physicians, integrative physicians and anti-aging physicians see patients as unique individuals with characteristic personality traits and slightly varied presentations, which may be shared in a disease entity, but differ substantially from person to person.

It is important to be aware of this uniqueness, if the caregiver wants to achieve the optimal treatment result.

Big Pharma does not like this approach as they would like you to think that the conventional medicine system is superior. A certain disease is treated a certain way, preferably with the most expensive drugs.

I thought that in this blog it would be good to shed some light on this important topic.

Menopausal women with symptoms

Let us consider an example of a 55-year old woman who has hot flashes, dry skin, a loss of hair from the outer aspect of her eyebrows, does not sleep well and has lost her sex drive. She also has put on 20 pounds in the last year despite no change in her diet.

This is how conventional medicine would handle this patient

The doctor examines the woman and does a Pap test as well. A conventional doctor would likely order standard blood tests consisting of a complete blood count, thyroid tests (T4, TSH) and FSH and LH levels. The conventional physician would find that the thyroid hormones are low with a high TSH (thyroid stimulating hormone) and would treat the woman with Synthroid (a synthetic thyroid hormone drug). The LH and FSH were found to be high indicating to the conventional physician that the woman is in menopause. He would offer the standard PREMPRO (a synthetic hormone preparation containing a mare estrogen combination with a progestin) with the warning that he will give her the lowest estrogen combination and only up to 5 years because of the negative findings of the Women’s Health Initiative.

Every Patient Is Unique

Every Patient Is Unique

Here is an example how a naturopathic or anti-aging physician’s would investigate and treat the patient

A naturopathic physician or an anti-aging physician would likely add a female saliva hormone panel to the other blood tests mentioned above and also do a T3 hormone level as part of the thyroid blood tests. The doctor will explain to the patient that she was found to be menopausal and also hypothyroid. With respect to the hypothyroidism the physician will explain that apart from thyroxin (T4) there is a second hormone, triiodothyronine (T3) that is also necessary in order to replace all of the thyroid hormones that humans have. Drug companies assume that T4 (Synthroid) will reverse automatically into whatever amount of T3 the body needs, so they have convinced most conventional doctors to prescribe T4 drugs only (like Synthroid). The problem is that as the body ages, the enzymes necessary to convert T4 into T3 do not work as well as in a younger age.This can be verified by testing T3 and T4 levels simultaneously.

The end result is that the patient who only gets T4 replaced may still have some of the symptoms like lack of energy and depression even when T4 has been replaced. Not so with the patient treated by the naturopath or the anti-aging physician who put our patient on Armour (porcine-derived thyroid hormone replacement containing both T4 and T3).

With regard to the blood tests and the saliva hormone tests the second patient was told that the blood tests confirmed menopause (high LH and FSH) and that the saliva female hormone panel showed what was going on. In this particular patient the female saliva hormone tests showed that the progesterone level was low, the testosterone level was low and estrogen was normal. Another hormone, DHEA-S (which is DHEA sulfate, the storage form of DHEA) was also on the low side. Cortisol that had also been tested was normal. The physician explained that the woman’s adrenal glands showed a slight weakness not producing enough DHEA, which is a precursor to testosterone. The low testosterone level was responsible for her lack of sex drive. Progesterone, which needs to be high enough to counterbalance estrogen, was missing, which was likely the cause of her hot flashes and the lack of energy together with the missing thyroid hormones. The physician explained that the woman needed a small amount of DHEA tablets by mouth, a full replacement of progesterone (through the use of a bioidentical hormone cream) and also a small amount of bioidentical testosterone cream to normalize her hormones.

A reassessment of the patients 2 months later showed that the first woman still had some depression and lack of energy, while the second woman felt her normal self again. Both women had regrown their eyebrows from replacing the missing thyroid hormones and have lost several pounds since the beginning of their treatments, but obviously there were quite different clinical results. The first woman was treated in a “standard conventional medicine” fashion, which will lead to breast cancer as unnecessary estrogen was given. She also will be at risk of getting cardiovascular disease as she was replaced with Progestin, a synthetic drug thought by conventional physicians to represent “progesterone”. The Women’s Health Initiative has proven that this was the outcome with PREMPRO and yet this drug is still on the market!

The second woman received an individualized and personalized holistic treatment protocol. The low progesterone from missing her ovulations after menopause was being replaced and her body very quickly responded favorably by making her feel normal again. The missing adrenal gland hormones and testosterone were replaced and this normalized her sex drive. Both, progesterone and thyroid hormones (T3 and T4) are anabolic hormones and they gave her back her energy and restored her sleep pattern. With normal hormone levels she also lost her depression symptoms.

Two men with depression

If you thought that the difference of these two clinical approaches were just coincidental, think again. The next examples are two men in their early 50’s who see their physicians because they felt depressed and had a lack of energy. Both were normal weight.

Here is the conventional medicine approach

The physician took a history, during which a lack of sex drive was also noted. He examined the patient and came to the conclusion that physically nothing was wrong with the man, but a diagnosis of depression was made. This would account for the tearfulness, sleep problems and loss of sex drive. The doctor prescribed one of the standard antidepressants (in this case sertraline, brand name Zoloft). Three weeks later the patient returned and as he was better, a repeat prescription for the antidepressant was given. After a further two months the patient was reassessed. When the symptoms were reviewed, it became apparent that a lack of sex drive was still present, if anything the patient felt the antidepressant had made this worse. Some of the depressive symptoms have improved on the conventional antidepressant. The doctor discussed that the antidepressant could be increased by one tablet per day. The doctor also discussed the option of using Viagra for the decreased sex drive and difficulty having an orgasm.

This would be the  naturopathic or anti-aging physician’s approach. Again similar to before a history was taken and a physical examination was done. The physician noted that the patient was in the age where a lack of sex drive could indicate an early andropause (the male equivalent of menopause, often difficult to spot with the first presentation). A depression questionnaire indicated that the man was moderately depressed. The patient was sent for blood tests and for saliva hormone tests (a male hormone panel). The physician stated that he would like to arrange for cognitive therapy treatment to sort out the various factors of his depression, but also help his mood by trying to start him on St. John’s wort, an herb that has been proven to be effective for mild to moderate depression. The blood work came back as normal. However, the hormone tests showed that testosterone was in the lower third of the normal range. DHEA-S, cortisol and estrogen were normal. So a few weeks later when the tests had come back the patient was called in.  The doctor explained to him that the low testosterone level would explain why his sex drive had deteriorated along with his symptoms of depression. Bioidentical testosterone cream was added to the antidepressant herbal treatment. The result was that within one month this patient’s sex drive was back to normal. Together with the cognitive therapy treatments and the herbal antidepressant the depression was also resolved. After a further three months of counseling he was able to stop the St. John’s wort. Due to the counseling sessions he felt stronger than ever before and his mood remained stable even when the counseling sessions were terminated. He continued to use the bioidentical testosterone cream regularly.

These are examples of two different approaches in two identical men in their early 50’s. It appears to me that the conventional approach did a disservice to the sick person, only treated symptoms, but did nothing to solve this patient’s real problems. The second case’s depression was treated properly and the physician luckily also did not miss the underlying early andropause with low testosterone levels. Repeat testosterone levels showed a high normal testosterone level, which was now in the upper 1/3 of the normal range.

The conventional approach missed the early testosterone deficiency, which  would cause heart disease, should the testosterone levels become even lower. Viagra certainly would not be the answer as this has a number of potentially serious side effects. The antidepressants at even higher doses would cause more erectile dysfunction, which was what he hoped to have treated.

Conclusion

People often have several conditions at the same time. It takes intuition, readiness to do testing, repeat close observation and repeat examination on the part of the physician. This needs to be coupled with good listening skills to sort out a patient. On behalf of the patient it is important to tell the physician all of your symptoms and observations. Be patient and never give up. A good patient/physician relationship will go a long way in sorting out complex medical problems. Every patient is unique. Not every symptom means the same thing in two different patients.

More information on:

1. Menopause: http://nethealthbook.com/hormones/hypogonadism/secondary-hypogonadism/menopause/

2. Depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

Last edited Nov. 7, 2014

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Sep
21
2013

In Vitro Fertilization As A Last Resort To Get Pregnant

Since its invention in 1978 there have been 5 million babies born through in vitro fertilization (IVF). According to the World Health Organization there are about 120 to 160 million couples worldwide struggling with infertility problems.

Assisted reproduction technology (a fancy name for artificial insemination) has been helped a lot by the breakthrough discovery in the US with regard to ultrasound identification of mature follicles in the ovaries. The second technical breakthrough, another ultrasound method done trans-vaginally to recover eggs from the identified mature follicles, has also helped the IVF technology (Ref.1).

When all of the cases of infertility in the United States are broken down into what causes them, the following was found (Ref. 2):

20% of cases of infertility were caused by anovulation, about 35% were due to abnormal semen production in the male, 30% by pelvic disease (fibroids, tubal blockage, polycystic ovaries), and 15% of cases were unexplained.

Process of artificial insemination

There are a number of steps that have to be followed to be successful with IVF.

a) Hormonal stimulation of the ovaries: The first step in getting eggs from a woman who desires IFV is to stimulate her ovaries to produce several mature follicles. This is achieved with gonadotropins, which are hormones that lead to ovarian overstimulation. Over the years this has been fine tuned with gonadotropin-releasing hormone (GnRH) analogues given first (stimulating release of LH and FSH from the pituitary gland). Subsequently follicle-stimulating hormone (FSH) is given, which causes the ovaries to produce follicles that can be identified on a TV screen using ultrasound technology. When follicle maturity is established with the ultrasound method, human chorionic gonadotropin can be given to trigger ovulation. However, when this is done and combined with artificial insemination through depositing sperm via a catheter into the uterus, the pregnancy rates judged by today’s standards to be too low (in the order of 15 to 20% per cycle).

b) Harvesting of eggs:

Nowadays the 2 or 3 follicles that have been identified as mature by ultrasound are used for follicular aspiration. With transvaginal sonography and a long needle that comes out from the ultrasound probe, the specialist will be able to harvest the mature eggs from the follicular cysts.

c) In vitro fertilization methods:

There are basically two methods for fertilization. First the standard IVF method is simply to add sperm to the eggs in a Petri dish with growth medium. After spontaneous fertilization the eggs undergo cell division. Compared to this standard IVF the success rates have been found to be higher with a newer method, called intracytoplasmic sperm injection (ICSI). In this case a single sperm is injected through a fine needle into the egg. On the 2nd or 3rd day of in vitro culture with either of these methods of fertilization the embryos consist of 6 to 8 cells. The embryos (typically one or two) are now introduced into the uterus of the mother by the specialist.

In Vitro Fertilization As A Last Resort To Get Pregnant

In Vitro Fertilization As A Last Resort To Get Pregnant

Success rates of in vitro fertilization (IVF)

Approximately 10% of all U.S. couples with women of the reproductive age are infertile, approximately more than 7 million women; the incidence of infertility steadily increases in women after the age of 30. Among fertile couples who have sex during the week before ovulation, about 20% achieve a pregnancy.  If regular unprotected sex does not lead to a pregnancy within one year, the couple is considered infertile (that is the medical definition of infertility). With infertile couples using intrauterine insemination there is a pregnancy success rate of about 8 to 9% per cycle. However, IVF has a success rate of 30% per cycle. The chance of a pregnancy after six cycles of IVF is 72% provided the woman is in close contact with the IVF specialist and follows all of the instructions carefully. If the woman does not adhere to the program (this includes some dropouts), the pregnancy rate for IVF is only 51% in 6 months (Ref.2).

In 2010 the Nobel Prize for Physiology and Medicine went to Bob Edwards for his outstanding work on IVF. His work has improved the success rate for pregnancy of infertile couples significantly.

Costs of in vitro fertilization (IVF)

The conventional IVF cost is about 60,000$ to achieve a successful pregnancy; a newer, simplified IVF version costs only 265$, a method which has been developed for development countries. In the simplified version fertility drugs are given as generic tablets. The pregnancy rate for IVF is about 34% in this study from Belgium involving 100 infertile couples so far with the women being under the age of 36.

Gender selection and genetic abnormalities

Gender selection is highly controversial and is not being practiced. However, there are gender specific genetic abnormalities that can be identified in the 2 to 3 day old embryo after a few in vitro cell divisions. If DNA analysis shows an X-linked abnormality, this genetic abnormality would not be implanted into the womb. An embryo with a normal DNA test would be implanted instead (male or female). There are obvious ethical guidelines that have to be followed and these have been in place for a number of years.

The following overview of IVF contains a mini video showing a single sperm injection into an egg (the intracytoplasmic sperm injection method or ICSI). This is the latest in IVF technology, but also the most expensive option.

Complications with in vitro fertilization (IVF)

A review article in the Journal of Obstetrics and Gynecology in March of 2004 (Ref. 3) compared the complications and outcomes of single baby pregnancies (=singletons) that were either conceived normally (control group of 1.9 million spontaneous singletons) or conceived by IVF (12,283 IVF singletons pooled from 15 studies). Compared to normally conceived babies the group of IVF conceived babies had a perinatal mortality rate, which was 2.2-fold higher, the rate of preterm deliveries was 2.0-fold higher, low birth weight was 1.8-fold higher, a very low birth weight was 2.7-fold more common and the classification of “small for gestational age” based on birth weight was 1.6-fold higher. The medical researchers found a number of reasons for this: compared to normally conceived babies, the rate of IVF conceived babies had a higher rate of placenta previa, early preterm delivery, spontaneous preterm delivery, gestational diabetes, preeclampsia, and neonatal intensive care admissions were also significantly more common.

Other observations

If anovulatory cycles are the reason for infertility, clomiphene treatment can often restore regular menstrual cycles, but according to Ref. 2 there is an 8% risk for multiple gestations (twins, triplets) with a higher infant mortality rate.

For women with tubal obstruction IVF is better than attempting to do tubal reconstruction.

Women with unexplained infertility (no cause found despite thorough investigations) are treated by controlled ovarian stimulation as mentioned above and by inserting semen from the husband into the uterine cavity through a small plastic catheter (intrauterine insemination). With this combination pregnancy success rates of 10% per cycle can be achieved and this should be the first approach to cases of unexplained infertility (Ref.2)

Fibroids in the uterus are from estrogen dominance, so are polycystic ovaries. Replacement of missing progesterone with bioidentical progesterone cream will often shrink or melt the fibroids away, cure the ovaries of polycystic disease and restore fertility (this is not taught in medical schools and will not be told to most women attending fertility clinics). There are countless numbers of women attending fertility clinics needlessly; had they only checked their hormone status with saliva hormone tests and corrected the hormone imbalances with bioidentical hormones.

In vitro fertilization with or without ICSI has a pregnancy success rate of 50% per cycle for women less than 30 years of age. Above the age of 30 these numbers are lower and genetic abnormalities are higher necessitating the more expensive ICSI fertilization method. The pregnancy rate is also directly related to how many embryos are transferred into the womb. Usually 1 or 2 embryos are inserted. Twins are not uncommon with IVF.

Conclusion

In 35 years in vitro fertilization has developed into a sophisticated tool that helps women who previously were considered to be permanently infertile to conceive a normal pregnancy. Despite these technical advances we should not lose sight why infertility is such a problem today. Two main factors come to mind: sexually transmitted diseases can scar up the Fallopian tubes making it impossible for the sperm to reach their goal, the fertile egg. Men can also get scarring of their collecting ducts for the sperm (from epididymitis) from Chlamydia and other VD. Secondly, couples are settling into marriage much later in life, often well beyond their 30th birthday. Ideally a woman should have her first pregnancy between 20 and 25, when she is most fertile. If these things don’t fall into place, there is a cost to IVF and there are the associated risks discussed.

More information on infertility: http://nethealthbook.com/womens-health-gynecology-and-obstetrics/infertility-php/

References

1. Adam: Grainger & Allison’s Diagnostic Radiology, 5th ed. © 2008 Churchill Livingstone, CHAPTER 53 – Imaging in Obstetrics and Infertility.

2. Lentz: Comprehensive Gynecology, 6th ed. © 2012 Mosby: Treatment of the causes of infertility.

3. Review article in the Journal of Obstetrics and Gynecology in March of 2004 (March 2004, Volume 103, Issue 3: pages 551-563) examined the complication rates of IVF.

Last edited Nov. 7, 2014

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Preserve Your Muscles And Joints

Our ancestors were hunters and gatherers, constantly on the go. They did not have to think too much about their muscle and joint health, they simply moved them. In our society this has changed a lot. At work we spend hours sitting at a desk, and then we use computers and watch television at home. Instead of walking to the neighborhood store, we use our car.

Here I will review what we can do to keep our joints and muscles in top shape until a ripe old age.

Brief intro regarding the anatomy of joints and muscles

Our joints are designed to give us full mobility. But the joints cannot do it alone. The muscles are designed to allow the joints to move in a full range. Without exercise the muscles will shrivel up (medical term “atrophy”) within only 2 to 3 weeks. So without regular exercise your joints won’t do you any good. Besides the joint capsules need regular stretching in full range exercises to produce the lubricating fluid (synovial fluid) that nourishes the joint surfaces and the menisci of the knees. Think of muscles and joints as being a functional unit designed to move you about.

Our joints have aerodynamic designs to do the most optimal job for our body. For instance the knees have more of a hinge design that includes menisci for shock absorption while the shoulders and hips have more of a ball and socket type construction.

Wear and tear with aging

It is usually thought that injuries and aging wear down the joints. But there are other factors such as the wide spread use of statins that can contribute to muscles weakness. Ironically statins are taken to protect the heart, but side effects can interfere with the ability to exercise your heart because of aching muscles and joints.

With optimal nutrition and avoidance of wheat and wheat products to prevent autoimmune arthritis (lupus, rheumatoid arthritis, dermatomyositis) your joints can stay young for much longer (explained further below). But your joints and muscles need to move through a full range of motion regularly to keep the blood circulation and nutrition of their tissues in top shape.

What causes joint deterioration?

Aging, weight gain, diabetes, smoking and lack of exercise all are known to cause a worsening of arthritis, particularly osteoarthritis, but also rheumatoid arthritis. The wrong diet with lots of sugar and starch and trans fats (hamburgers, pasta, sugar soda drinks) causes hyperinsulinemia (insulin overproduction, like in type 2 diabetes) and is almost guaranteed to make you sick with arthritis, obesity and diabetes.

There is also evidence that wheat causes inflammation and arthritis by stimulating your pancreas to produce too much insulin. This has been proven for dogs and for humans. A good diet book to follow is Dr. William Davis “Wheat Belly Cookbook” (Ref. 1) with 150 recipes. If you are overweight, these recipes will also help you to lose some weight effortlessly.

A caution to marathon runners: the constant pounding of prolonged jogging can cause osteoarthritis of hips and knees decades down the road. You may want to switch to different exercises before this happens.

Preserve Your Muscles And Joints

Preserve Your Muscles And Joints

What helps joints?

Molecularly distilled omega-3 fatty acid helps to prevent inflammation of your joints. Vitamin D3 will help your bones to be strong to support the tendons and ligaments. Chicken cartilage can build up joint cartilage within a few weeks! So, if you feel pain in your joints use 3 capsules of omega-3 (the strong, molecularly distilled ones) twice per day. This will help your joint inflammation within 3 to 4 weeks. If this alone is not enough add chicken cartilage from the health food store, which will help to build up the hyaline cartilage within your joints. For those who are questioning the effect of chicken cartilage, here is a 1993 chicken cartilage Harvard study proving it.

Below are more general steps that will help your joints, ligaments and muscles.

Maintaining health of joints and muscles

a)    It starts with good nutrition.

Hamburgers and deep fried French fries will not do the trick. Muscles require protein from meat, fish, poultry and dairy products. If you are a vegetarian you need to become knowledgeable on what essential amino acids are and what combination of vegetables will give you the amino acid composition to build up a full protein.

Joints need ingredients from cartilage, which you find in chicken cartilage (available in health food stores as fikzol (type II cartilage). I you prefer, chicken soup would also give you the ingredients to build up cartilage, but it would require a lot of regular chicken soup consumption to achieve this.

Sugar and starchy foods, which are broken down within half an hour after a meal into sugar in your blood, cause an insulin response from your pancreas. This in turn can cause inflammation in your joints and tendons. It is interesting to note that type 2 diabetes and arthritis are associated. A ketogenic, low sugar/starch diet will prevent arthritis and diabetes as it reduces the insulin level in the blood, which in turn turns off inflammation in the joints.

b)   Supplements:

Omega-3 fatty acids will help control any inflammation including the inflammation from arthritis (you need 3 capsules of the concentrated, molecularly distilled fish oil twice per day to achieve this).  DMSO gel, available in health food stores in the US, can also be used to rub onto inflamed joints. It will penetrate tissues rapidly, is nontoxic and helps control inflammation along with the omega-3 fatty acids. Regular anti-inflammatory pain relievers (NSAIDs) are harsh on your kidneys and can irritate the gastric lining causing bleeding gastric erosions, so definitely not recommendable.

Glucosamine, chondroitin sulfate, or a combination of both is available in the health food store and has been shown to help with osteoarthritis. I contributes to building up hyaline cartilage.

c)   Watch your weight:

It has been shown that the rate of degenerative arthritis (=osteoarthritis) in obese people is much higher when compared to slim people.

d)   Exercise:

You need to move your joints, ligaments and muscles every day to maintain their strength and range of motion. A daily workout at home or in a gym is best. I recommend 30 minutes of a treadmill or equivalent (jogging, Stairmaster etc.) as aerobic exercises. Then you need 30 minutes of isometric exercises like a circuit on exercise machines in the gym or dumbbells and expanders (resistance bands) at home. I consider this as the basic fitness routine every day.

Ballroom dancing and Latin dancing or Zumba is also a good combination exercise, which I would recommend on top of the basic exercise. Dancing helps to maintain your balance as well, which is something the older population tends to lose. In addition dancing stimulates your brain cells and makes you less vulnerable to develop dementia in old age.

Other aerobic exercises that can be recommended are walking (brisk walk) and/or intermittent jogging. Swimming has the advantage particularly for arthritis sufferers that you are floating. It allows you to exercise your leg and arm muscles, even if you have some arthritis pains.

e)  Pain relief: What could you do for pain relief? I do not like NSAIDs as this will damage your kidneys on the long-term and cause gastric erosions that can bleed massively. Electro acupuncture is very useful for muscle and joint pains and has no side effects. Physiotherapy treatments are useful to recondition your muscles and build up the range of motion of your joints. Chiropractic treatments for back and neck pain will also help. Instead of narcotics, why not try low dose Naltrexone (LDN). It has been shown to help with the pain of fibromyalgia.

Conclusion

In this brief review I have attempted to show you that your body is not on a one-way street in the direction of disability and death. There is a lot we can actively do to prevent this from happening prematurely. Just eat right, supplement (if you have symptoms), exercise and be active. Soon you will no longer be aware of your previously achy joints or muscles, as the pain tends to melt away when you are reconditioned.

More information on fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

References:

1. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Nov. 7, 2014

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