Apr
08
2017

Breast Cancer Risks

Dr. David Zava, PhD gave a talk on breast cancer risks. This was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The detailed title was: “The Role of Hormones, Essential Nutrients, Environmental Toxins, and Lifestyle Choices on Breast Cancer Risk”.

He pointed out that both estrogens and progesterone are safe hormones, as long as they are not overdosed and they are balanced. Unfortunately many women in menopause have too much estrogen on board as the ovaries are still producing them, but there is a lack of progesterone, the moderating hormone that makes estrogen safe.

In the following I am summarizing Dr. Zava’s talk with regard to the essential messages, but leaving away much of the highly technical detail that was presented as this would dilute the message of this blog. I will include a few links for those who are inclined to read more details about the topic.

Balance between estrogen and progesterone

Most of her life a woman is used to cyclical hormone changes between estrogen and progesterone. When a woman no longer ovulates in premenopause and menopause there is a surplus of estrogen and a lack of progesterone. Having no ovulation means that there is no corpus luteum developing, where in the past progesterone was made. This creates a disbalance where estrogen is dominating; it is called “estrogen dominance”.

This is a dangerous hormone disbalance, because the breast ducts are stimulated to grow and the modifying, calming effect of progesterone is missing. Mixed into this is that the stress hormone, cortisol also can make the effect of estrogen worse. On the other hand Dr. Zava showed slides from studies where progesterone was replaced through a skin progesterone cream (percutaneous bioidentical progesterone cream). Plasma and breast tissue concentration of progesterone were measured in 40 premenstrual women. They had been diagnosed with breast lumps and were scheduled for surgery. One group was treated with progesterone cream for 10 to 13 days; the other group was the placebo group. At the time of surgery the plasma (blood) values were unchanged, but progesterone levels in breast tissue were elevated more than 100-fold over the values from the placebo group who had been treated with a neutral skin cream. The same experiment also showed that progesterone reduced the number of proliferating epithelial cells (experimental progesterone group). Estrogen on the other hand was shown to increase the number of proliferating epithelial cells (placebo group).

Another example that Dr. Zava gave was a study where 25 mg of bioidentical progesterone cream applied directly to breasts of premenopausal women increased breast tissue progesterone 100-fold, while blood concentrations of progesterone remained the same. Again breast stimulation by estrogen of normal epithelium cells was decreased by progesterone.

How to measure progesterone levels

Dr. Zava who runs the ZRT laboratory spent some time to explain how to measure progesterone in a physiological way. He said that these experiments and others that he also projected tell a clear story. Blood (serum) progesterone levels do not adequately reflect what tissue levels in a woman’s breasts are. On the other hand saliva hormone levels do give an accurate account of what breast tissue levels are like. A woman received 30 mg of topical progesterone application. She then had hourly progesterone levels in the serum and in the saliva done. The serum progesterone levels remained at around 2 ng/ml, while the saliva progesterone levels peaked 3 to 5 hours after the application. It reached 16 ng/ml in saliva, which also represents the breast tissue progesterone level. Dr. Zava said that the important lesson to learn from this is not to trust blood progesterone levels. Too many physicians fall into this trap and order too much progesterone cream, which leads to overdosing progesterone. With salivary progesterone levels you see the physiological tissue levels, with blood tests you don’t. Dr. Zava said: avoid using venipuncture blood or urine in an attempt to interpret hormone test levels, as you will underestimate bio-potency and overdose the patient.

Historical failure of estrogen replacement therapy (ERT)

A review of breast cancer would not be complete without mentioning the Women’s Health Initiative (WHI). The U.S. National Institutes of Health (NIH) initiated this trial in 1991.

  1. The WHI ended suddenly in July 2002. The authors stated: “The overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2 year follow-up among healthy postmenopausal US women.” The study found a 41% increase in strokes, 29% increase in heart attacks, 26% increase in breast cancer, 22% increase in total cardiovascular disease, a doubling of blood clots. The recommendation made by this study was to discontinue PremPro.
  2. Another study that was mentioned was “Breast cancer and hormone-replacement therapy in the Million Women Study”.  In this study postmenopausal women were given HRT with synthetic hormones, either estrogen alone or estrogen mixed with a progestin (in British English “progestagen”. After 5 years estrogen alone was associated with a 30% increased risk of developing breast cancer. HRT with an estrogen-progestagen mix was associated with a 100% increased risk of developing breast cancer.
  3. Unfortunately in both of these human experiments the wrong hormone substances were used, namely synthetic estrogens and synthetic progestins. They are NOT identical with natural estrogens and progesterone that a woman’s body makes. As long as the hormones used for hormone replacement therapy are chemically identical to the natural hormones, the body will accept them as they fit the natural hormone receptors in the body. It is the misfit of synthetic hormones that blocks the estrogen receptors or the progesterone receptors. You can readily see from the illustrations of this link that there is a fine balance between the workings of these receptors and there is absolutely no room for patented side chains that Big Pharma introduced into synthetic HRT hormones. The other problem of both these studies was that every woman was getting the same dose of hormones and that nobody measured their estrogen blood or estrogen saliva hormone levels. In retrospect the regulatory agencies should never have allowed these “hormones” to hit the market.

Breast cancer develops in three stages

Dr. Zava explained that it has been known for some time that there are 3 stages involved in the development of breast cancer.

  1. Initiation

Damage to the DNA of one of the cells types in the breast is what starts the process in the development of breast cancer. This can be done by catechol estrogen-3,4-quinones as was shown by these researchers.

Aromatase inhibitors can be used to reduce estrogen in overweight or obese women where aromatase is present in fatty tissue. The reason obese women have more breast cancer is likely from the extra estrogen production from androgens, male hormones produced in the adrenal glands that get converted by aromatase into estrogen.

Iodine/iodide has been shown to alter gene expression, which reduces breast cancer development, but also slows down cell division in existing breast cancer. The authors suggested to use iodine/iodide supplements as adjuvant therapy in breast cancer treatment.

  1. Promotion

The next step is that something has to promote the DNA mutation into becoming part of a cancer cell. Estrogen quinones are dangerous estrogen metabolites. They can form from catechol estrogens (other metabolites of estrogen) by reactive oxygen species. But selenium, a trace mineral can interrupt the formation of estrogen quinones, which stops the breasts cancer promotion process. A study from the Klang Valley, Malaysia showed that selenium showed a dose-response effect with respect to prevention of breast cancer; the more selenium in the food, the less breast cancer occurred.

  1. Progression (includes invasion and metastases)

Several factors can help the breast cancer cells to progress, grow bigger locally and eventually move into other areas of the body as metastases. Dr. Zava showed several slides where details of metabolic processes were shown and how changes in some of these would lead to progression of breast cancer. Estrogen excess is a common pathway to breast cancer. The key is to balance it with progesterone, supplements, remove anything that causes estrogen overproduction like obesity (via the aromatase pathway).

The fallacy of overdosing or underdosing

When estrogen is overdosed, it becomes aggressive as indicated before; it can initiate DNA mutations that can cause breast cancer. If it is under dosed, the lack of estrogen can cause heart attacks, strokes and osteoporosis. When estrogen is balanced with progesterone a postmenopausal woman feels best and she is protected from the negative effects of estrogen.

Measures that help prevent breast cancer

  1. When supplementing with bioidentical hormones, keep estrogen within physiological limits and don’t overdose. This can be measured through blood tests or saliva hormone tests. Your most important natural opponent of estrogen is progesterone, which is usually missing in menopause. Measure hormones using tests (progesterone only with saliva tests, estrogen either by blood tests or saliva tests). Don’t rely going by symptoms.
  2. Keep the progesterone to estrogen ratio (Pg/E2) at an optimal range, which is in the 100- to 500-fold range. Measure the saliva hormone level of both progesterone and estrogen and calculate. Remember that progesterone serum levels are meaningless. The much higher progesterone level protects the postmenopausal woman from estrogen side effects. Here is a statement worth noting: “Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT.” This was the conclusion of a study using bioidentical hormones, where the protection from breast cancer and heart attacks and strokes was also noted.
  3. Increase fiber intake and reduce red meat consumption. This will eliminate conjugated steroid hormones in the stool. It also increases the sex hormone binding globulin in the blood, which limits the bioavailability of estrogens. Fiber absorbs bile toxins and removes them from the body.
  4. Calcium-D-glucarate is a supplement that will decrease beta-glucuronidase. The estrogens were conjugated with the purpose to be eliminated, but beta-glucuronidase causes the conjugated estrogens to be reabsorbed.
  5. Probiotics likely stimulate the immune system and help reduce the risk of breast cancer.
  6. Avoid toxins like petrochemical pollutants and toxic chemicals. Avoid trans fats. If toxic, heavy metals are present (arsenic, cadmium, lead, mercury) remove these. Some naturopaths use EDTA chelation to do this.
  7. Supplements: sulforaphane (broccoli), EGCG (green tea), alpha-lipoic acid (antioxidant), cruciferous vegetables, resveratrol, selenium and iodide/iodine, N-acetyl cysteine-glutathione. All these supplements/nutrients will prevent estrogen to go to the “dark side”. The dark side is the formation of toxic 4-OH estrogen that could further be converted into catechol estrogen-3,4-quinones that can damage DNA and cause mutations.
  8. Increase methylation of catechol estrogens: vitamin B1, B6, B12 and folic acid. Methyl donors also are useful for this purpose: MSM (methylsulfonylmethane), SAMe, and Betaine.
  9. Improve your diet (Mediterranean type), exercise moderately, reduce stress, and replace hormones in physiological doses as discussed under point 1 and 2.
Breast Cancer Risks

Breast Cancer Risks

Conclusion

Dr. David Zava, PhD gave an interesting talk at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. It became clear that estrogens, when unopposed by enough progesterone, could cause mutations in breast tissue of women and cause breast cancer. He also reviewed two major clinical trials where hormone replacement therapy (HRT) was used. The problems with these were the synthetic estrogen hormones that caused breast cancer and the synthetic progestins that also behaved like estrogens (not like progesterone) and caused even more breast cancer. The lesson to be learnt from this is that only bioidentical estrogens and progesterone can be used in hormone replacement for menopause. Also, the hormones must be balanced as discussed under point 2 of measures that help to prevent breast cancer. In addition there was a list of other useful supplements given that can be taken to reduce the danger of breast cancer.

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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
14
2016

Hormone Replacement Therapy In Menopause

Back in the 1980’s many physicians were hopeful that hormone replacement therapy in menopause (HRT) could extend the lives of postmenopausal women by approximately 10 years, if HRT would be started early enough. But the HERS study (Heart and Estrogen/progestin Replacement Study) in 1998 and the WHI study (Women’s Health Initiative) of 2002 changed things dramatically.

The HERS study did not show any benefit with regard to prevention of heart disease. Instead it showed more gallbladder disease (1.38-fold) and blood clots (2.89-fold) develop in the experimental group versus the placebo.

The WHI study was complex and had several arms. There also were some methodological errors in the study as pointed out here.

Instead of a decrease in heart attacks, there was an increase, when estrogen and progestin was combined. There were more cases of colon cancer, more blood clots and heart attacks in the placebo groups compared to the experimental groups. It seems that something went wrong with these trials.

Unknown facts about hormone replacement therapy in menopause

  1. Both clinical trials used the wrong hormones to do the trials. If you use the wrong hormones in a trial, you would expect to get the wrong test results. Horse derived estrogen (equine estrogen) is hardly a match for bioidentical, human estrogen in women. But decades ago the drug manufacturer had decided that estrogen was easiest to manufacture on a large scale when urine from pregnant mares was used. The product contains conjugated horse estrogen and is known by the name Premarin. Premarin is not bioidentical to human estrogens.
  2. The other hormone, medroxy progesterone (MPA) is a progestin, a bad copy of the bioidentical progesterone that a woman’s corpus luteum of one of her ovaries produces. This is in the second half of her menstrual cycle. During pregnancy the placenta produces lots of progesterone to protect the pregnancy. As Dr. Masley, a cardiologist stated synthetic progestins cause heart attacks, while progesterone does not. Masley said: “Medroxy progesterone (MPA) increases the risk for heart disease and for breast cancer. I can’t understand why any physician would recommend medroxy progesterone during menopause, but it is still in use.”
  3. Next there is the question whether the liver changes the composition of an oral hormone tablet metabolically or not. The answer is: yes! Dr. Masley stated in the link above that oral estradiol, when compared to estrogen rubbed onto the skin, increases levels of inflammation by 192%. The C-reactive protein (CRP),can be measure with a blood test.The risk for a blood clot increases by 400%. A woman using estrogen should always use the estrogen patch or an estrogen cream with bioidentical estrogen to avoid these complications.
  4. Measure hormones – don’t estimate: Hormones are constantly changing and if you don’t measure, you don’t know what you are dealing with. Dr. John Lee showed a long time ago that you should measure hormones and identify those women who are truly hormone deficient. These are the ones who need hormone replacement. However, you use only bioidentical hormones to replace and you replace only as much as is needed to normalize the levels. This is also the level where postmenopausal symptoms disappear. Lee noted: “A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes or heart attacks.”
  5. The elusive progesterone: when progesterone is measured as a blood test it may come back as high while it can be low in a saliva hormone test in the same woman. Dr. Lee has pointed out that studies have shown that progesterone levels in tissue are usually higher by several factors when compared to blood levels and that blood levels are not reliable predictors of tissue levels (Ref.1). On the other hand he found that saliva levels have a good correlation with tissue levels in organs like the ovaries or the uterus. Dr. Lee preferred saliva hormone tests for this reason. When it comes to progesterone levels you can trust saliva test, but you cannot trust blood tests. Many physicians ignore that fact and strictly order blood progesterone levels coming to false conclusions.
  6. We know that estrogen and progesterone must be balanced to avoid troubles of developing heart attacks or cancer. In the link under point 4 above Dr. Lee stated that women without breast cancer have saliva progesterone hormone levels that are more than 200-fold higher than the saliva estradiol levels. On the other hand women with breast cancer have a ratio of less than 200 to 1 with respect to progesterone to estradiol saliva levels. There is a similar ratio in men where the ratio of testosterone to estradiol must be larger than 20 to 1 or he is at a higher risk of developing prostate cancer. Unfortunately many older men, when overweight or obese, have high estrogen levels and the ratio is less than 20 to 1.
  7. Masley has mentioned that in the first 6 years after menopause using a topical form of estrogen and micronized progesterone as tablets can minimize the risk of future heart attacks and strokes. But after 10 years it is less obvious what is the best solution. The question is what type of estrogen application is used. Is it estradiol or is it Bi-Est or Tri-Est, which are other topical estrogen applications. Tri-Est is 80% estriol, 10% estrone, and 10% estradiol while Bi-Est is 80% estriol and 20% estradiol. Tri-Est in particular would be very close to the natural composition of estrogens in a woman’s body.

What to do after 10 years of hormone replacement therapy in menopause

Given the insecurity what to do after 10 years of menopause, my suspicion is that there are other factors that play a role with respect to hormone replacement. A lot of women have extra pounds accumulated. Fatty tissue contains an enzyme called aromatase.

This makes estrogen from androgenic hormones including testosterone. The adrenal glands situated above the kidneys produce these hormones in menopause. The more overweight or obese a postmenopausal woman is, the higher the estrogen levels in her blood because of the action of the aromatase. Most physicians have not measured hormones in the past, but just replaced hormones monitoring only postmenopausal symptoms. This is changing. What I said under point 4 above is happening more. Naturopaths tend to be more comfortable with bioidentical hormone replacement the way I have described it. If you did hormone tests (preferably saliva hormone tests) you would pick up higher estrogen levels and low progesterone levels with unfavorable progesterone to estrogen ratios as mentioned. These women do not need estrogen (they have it already in their systems). They need progesterone replacement only. Progesterone can be taken as micronized bioidentical progesterone capsules at night or as progesterone bioidentical cream to be applied to the skin. Here is another take on the use of bioidentical hormones.

Hormone Replacement Therapy In Menopause

Hormone Replacement Therapy In Menopause

Conclusion

Bioidentical hormone replacement is complex. It requires some basic knowledge of the facts mentioned above. I find it surprising that two separate research groups could not free themselves of the Big Pharma grip. In not doing so they unwillingly produced studies showing all of the undesirable side effects of using artificial hormones. When manufacturers modify natural hormones with unnatural side-chains, the end products are synthetic hormones. These do not fit the appropriate natural hormone receptors. The anti-aging community as represented by the A4M group (American Academy Of Anti-Aging Medicine) with more than 25,000 physicians worldwide has been saying this all along. Now we know that it is really true. Use hormone replacement knowledgeably and use bioidentical hormones!

References

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

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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.

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

Jul
02
2014

Focus On Health Rather Than Disease

Not too long ago I came across a blog that summarized the “18 Biggest Problems with Modern Medicine”. Although this is a useful list, it occurred to me that these problems could be compressed into about 9 underlying themes. Below I am describing the same type of problems regarding modern medicine in a somewhat abbreviated fashion.

Points 1 to 4 below cover points 1 to 9 of the “18 Biggest Problems with Modern Medicine”:

1. The patient is seen as a complicated machine with parts that could break down. When there is a breakdown of the machinery, symptoms develop, which are quickly fixed with a patented medicine, but without really addressing the underlying problem. 

This type of approach soothes pain, but changes nothing for a chronic illness like MS. Nobody has all the answers to this complicated illness, but we know that it is an autoimmune disease. So it makes sense to avoid foods that could make the patient worse. This is exactly what Dr. Terry Wahls is describing in her YouTube video.

Also, vitamins and supplements for multiple sclerosis that support the immune system would be useful. Vitamin D3 in high doses, but monitoring blood levels by doing 25-hydroxy vitamin D blood tests from time to time would also be useful.

2. A holistic approach to building up health rather than fixing a clinical problem, which belongs to a disease, is not part of modern medicine.

In the past a stomach acid problem was treated with H-2 receptor antagonists like cimetidine or ranitidine. The newer proton pump inhibitors, like omeprazole were added and were supposed to be better in suppressing the acid formation. But they did nothing to cure the ulcer or gastritis problem. The problem often was that chronic stress allowed a bacterium, H.pylori to multiply in the stomach wall causing stomach acid and a burning sensation. This did respond to the antacid medications for a period of time, but came back when the medication was stopped. A simple over the counter licorice compound, called DGL or a simple mastic gum from the health food store can cure the helicobacter infection and cure your peptic ulcer disease without the need for the expensive patented H-2 receptor antagonists or proton pump inhibitors.

Focus On Health Rather Than Disease

Focus On Health Rather Than Disease

3. Everybody with the same disease is treated with the same medical treatment schedule, often agreed on by consensus expert panels. The body’s self-healing capacity or the placebo effect, which is an expression of the same natural healing response, is ignored.

Here is a study that was done on patients with irritable bowel syndrome (IBS) on placebo pills. Placebo pills were 24% more effective than the control group who took no pills in controlling symptoms of IBS. Why not utilize this in conventional medicine?

4. The disease is treated, not the patient; numbers from lab tests count, not clinical signs of the physical examination. What used to be called the “art of medicine” has been abandoned.

The art of medicine is important to establish a rapport with the patient, but also to pick up silent features during the examination that may otherwise be overlooked.

Points 10 to 18 of the“18 Biggest Problems with Modern Medicine” are covered by points 5 to 9 below:

5. Diet, lifestyle, hormone changes (due to chronic stress and older age) are all ignored. If there are the hormone changes of menopause or andropause, only synthetic hormones are given and only for a limited time not exceeding 5 years. Bioidentical hormone replacement invokes butterfly feelings in the physician’s stomach and must therefore be rejected. It’s almost a knee-jerk response. The reason for that is the fear that bioidentical hormones would have the same devastating side effects as the synthetic hormones. However, this is a fallacy, as a young person with fully functioning natural hormones will not come down with nefarious side effects of strokes, heart attacks or cancer.

This link to Dr. Lee’s website explains why bioidentical hormones fit the hormone receptors better than the synthetic concoctions.

6. The thought that the body may have been exposed to toxins (like heavy metals, xenoestrogens etc.) from the environment that are taken up and stored in the body like a sponge and should be detoxified from time to time is foreign thinking to modern medicine except for a small group of dedicated physicians and naturopaths who offer various forms of chelation therapy.

The TART trial has shown that there was a 18% reduction of heart attack rate in the group that received 40 chelation therapy treatments. Chelation therapy can easily be combined with traditional treatment methods, but mostly his option is ignored.

7. Similarly the idea that supplements and vitamins would be essential to support the body in the fight against free radicals that form inside the body every day is not something every doctor will feel comfortable in recommending.

In Ref. 1 (chapter 8) I have cited evidence from a clinical trial that multivitamins elongate telomeres by 5.1% and add 9.8 years of productive life in those who take multivitamins over a long period of time versus those who do not.

8. In the health care industry we are still working in a hierarchical system where the doctor is on top and the patient is on a lower level and dependent. In the future medical system the doctor and the patient are equal partners who try to solve a health problem as a team.

The doctor may have more experience in diagnosing, prescribing and monitoring health problems, but the patient is the one who owns the problem and is encouraged to comply with the prescribed treatment and to report back to the doctor, if there are new symptoms that may lead the doctor to new insights resulting in improving the treatment plan.

9. Big Pharma influences doctors to prescribe their patented medicinesNew drugs and old drugs are sold like the latest invention against the dreaded disease XYZ (you can fill in whatever the diagnosis is). But none of these drugs is effective against a hormone disbalance, stress, a lack of sleep, lack of exercise or malnutrition. The patient’s co-operation is needed to work on these issues.

I have explained in Ref.1 that the metabolic syndrome, which is responsible for much of our modern diseases (diabetes, heart attacks, arthritis, strokes, cancers, Alzheimer’s disease) can be overcome by a combination of steps: paying attention to our food intake, cutting out sugar and high glycemic starchy foods and excessive fats. Regular exercise will help you to build up and maintain muscle mass and at the same time to melt in excessive fat. Yoga, self-hypnosis, meditation and prayer can remedy stress. Bioidentical hormones can replace any hormone deficiencies. Detoxification, vitamins and supplements complete this program, which allows you to successfully age without disabilities. All these steps taken together allow your body to recover and find a new balance where drugs are rarely needed.

Conclusion:

The reason Medicare is so expensive is that life style issues are not often addressed. By only treating symptoms the underlying causes of an illness are not removed. This means that the illness will not be cured. Take for instance heart attacks. If you want to go down the road from angina to heart attack to bypass surgery or stents, you will soon run out of options. The next level of curative medicine approach is a heart transplant after heart attack number 4 or 5. Comprehensive medicine would approach this differently by paying attention to what you eat and motivate you to cut out starchy foods, wheat, and sugar. This would address obesity, which is a problem in many Western countries. You would engage in regular physical exercise. Stress would be overcome in yoga classes or self-hypnosis sessions. Bioidentical hormones would replace your missing hormones based on saliva hormone tests or blood test samples. The heart muscle that has a lot of testosterone receptors would respond to this. As mentioned above a series of chelation treatments to remove heavy metals could also be offered in this combined, comprehensive heart attack prevention program with a reduction of 18% of heart attacks. This all is available now, but regrettably few people make use of it.

References:

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

Last edited July 3, 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

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May
10
2014

The Full Story About Testosterone

Much has been written about what happens when women get into menopause. This begs the question: do men experience a change of life? As a matter of fact, they do. It is called “andropause”, and they can experience problems as a result. Here is a study from the Massachusetts General Hospital in Boston, MA, which was published in the New England Journal of Medicine (Sept. 2013) describing in detail what happens when men get into andropause (the male equivalent of the menopause).

We know from other studies that in obese men testosterone is converted into estrogen because of the enzyme aromatase that converts testosterone into estrogen resulting in erectile dysfunction and loss of sex drive. In lean men above the age of 55 there is a true testosterone reduction because the testicles produce less testosterone. This results in less sex drive, moodiness and lack of energy. But these men will do well with bioidentical testosterone replacement.

Main findings of the Massachusetts General Hospital study:

  1. Testosterone was responsible for thigh muscle development and leg press strength, for erectile function and sexual desire.
  2. Surprisingly, estradiol (the main estrogen component in both sexes) plays a significant part in sexual desire in the male. This became particularly apparent in the post-andropause male who desired hormone replacement. When bioidentical testosterone is used to replace what’s missing there was no problem with sexual desire or erectile function as a small amount of the testosterone was aromatized into estradiol. The researchers were able to measure both testosterone and estradiol levels.
  3. Here is a surprising fact: a lack of estrogen leads to abdominal obesity. This could also be verified by hormone measurements.
  4. In the past doctors used synthetic testosterone products like methyltestosterone, danazol, oxandrolone, testosterone propionate, testosterone cypionate or testosterone enanthate. The problem with these synthetic testosterone products is that the body cannot metabolize a portion of them into estrogen that is desirable for a normal sex drive, so the testosterone compounds alone are not doing their job as well as the bioidentical testosterone that the body can aromatize.

In obese men the problem is that there is too much estrogen in the system, which leads to a disbalance of the hormones in the male with a relative lack of testosterone. Overweight and obese men produce significant amounts of estrogen through aromatase located in the fatty tissue. Aromatase converts testosterone and other male type hormones, called androgens, into estrogen. Excessive levels of estrogen cause breast growth, muscle weakness, lead to abdominal fat accumulation, heart disease and strokes. Dr. Lee described what happens in men who enter andropause years ago as indicated under this link.

The Full Story About Testosterone

The Full Story About Testosterone

Testosterone to estrogen ratio:

Dr. Lee indicated that in his opinion saliva hormone testing is more reliable than blood tests (Ref. 1). One of the advantages of doing saliva hormone tests of estrogen and testosterone is that you can calculate directly the ratios of these two hormones. In hormonally normal younger males the testosterone to estrogen ratio is larger than 20 – 40 (Ref.2). The testosterone to estrogen ratio in obese men is typically less than 20 meaning it is too low. But lean men in andropause produce too little testosterone and their testosterone to estrogen ratio is also less than 20, because they may still have enough estrogen in their system from aromatase in the fatty tissue, but they are lacking testosterone due to a lack of its production in the testicles (Ref. 1 and 2).

When a man in andropause is given bioidentical hormone replacement with a testosterone gel or bioidentical testosterone cream this is absorbed into the blood and body tissues and then partially metabolized into a small amount of estrogen. This can be seen when saliva hormone tests are done; a higher level of testosterone is detected and much lower estrogen level so that the testosterone to estrogen ratio is now 20 to 40 or higher and the affected person will no longer be the “grumpy old man” that had been a source of distress to his partner before.

This New England Journal of Medicine study is important because it confirmed what anti-aging physicians had been saying for years: a small amount of estrogen is necessary for the male for bone health as estrogen receptors will regulate the bone density, it also helps for a normal sex drive. The same is true for women: a small amount of the opposite hormone (testosterone) will help a woman’s sex drive, but she needs the right mix of progesterone to estrogen (a progesterone to estrogen ratio of 200:1 using saliva tests) to feel perfectly normal as a women.

Health and well-being of a man depend on normal testosterone levels:

It is important to realize that testosterone is not only supporting a man’s sex drive and libido, key organs like the heart, the brain and blood vessels contain testosterone receptors as well. The body of a man was designed to respond to testosterone all along. It is when testosterone production is no longer keeping up that premature aging becomes apparent, as the target organs do no longer receive the proper signals.

A healthy heart in a man depends on regular exercise and testosterone stimulation whether he is young, middle aged or old. The same is true for the lining of the arteries where testosterone receptors are present to help with the normal adjustment to exercise and relaxation. The brain cells have receptors for all of the sex hormones and in a man they are used to higher levels of testosterone and lower levels of progesterone and estrogen. If you take the balance away, the aging man will feel miserable and grumpy. Depression will set in. Here is a brief review how one man’s life has been changed by testosterone replacement.

So, bioidentical hormone replacement is not just a matter of replacing one hormone, you need to pay attention to all of the hormones. Lifestyle issues enter the equation as well. I have reviewed the issue of bioidentical hormone replacement for women and men in this blog.

Conclusion:

When a man reaches the age of 55 or older there comes a point where a lack of testosterone and estrogen sets in. It is wise to start doing intermittent blood or saliva hormone tests before this point is reached in order to gage when bioidentical hormone replacement treatment should be given. Along with an assessment regarding the hormone status it would be wise to also assess lifestyle issues as often other factors play a role in premature aging. I have reviewed these factors systematically in a recent publication (Ref. 3). It is best to combine bioidentical hormone replacement with life style interventions to achieve optimal preservation of a man’s health.

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

References:

  1. John R. Lee, MD: “Hormone Balance for men- what your doctor may not tell you about prostate health and natural hormone supplementation”. 2003 by Hormones Etc.
  2. George Gillson, MD, PhD, Tracy Marsden, BSc Pharm: “You’ve Hit Menopause. Now What?” 2004 Rocky Mountain Analytical Corp. Chapter 9: Male Hormone Balance (p.118-148).
  3. Dr.Schilling’s book, March 2014, Amazon.com:“A Survivor’s Guide To Successful Aging: With recipes for 1 week provided by Christina Schilling”.

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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