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.

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.

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.

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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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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

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Dec
07
2013

Slow Down Aging And Prevent Disabilities

You have seen it many times before: a man or a woman retires at age 65; for a while you see them around at social functions; then they are not seen any more and they return in a wheel chair only to die prematurely. You ask yourself: what can I do better to avoid this death trap?

There are several aspects to this equation: first, we would like to slow down the aging process. Part of this is to retain our physical functioning. In the following I am discussing the ingredients that are necessary to achieve the goal of aging in dignity, but avoiding disability.

It starts with a healthy mind set

You need to be optimistic and have a mindset of believing in yourself that you can do it. With a negative attitude, you will manage to find something to complain about, no matter how perfect the day has been. Negative thinking is rampant, and depression tends to be higher in the older population. If you suffer from depression or you had negative events such as accidents or abuse in the past, it is important to do some house cleaning. Do not be hesitant seeking professional help and counseling from a health professional to help you build up your self-esteem.

Regular exercise is important

A regular exercise program helps you to get your day organized. If you think that you are too busy to find the time to exercise, you are sacrificing your wellness and in fact you sabotage your health. It’s time to rethink your lifestyle! The reason you need exercise is to set the automatic pilot on staying healthy and active. If you are accustomed to sitting down in front of the computer or television set for hours, your muscles do not get the exercise they need. Fast-forward several decades and you will be one of those who rely on walkers, wheel chairs and assisted living establishments. Without training your muscles you are more prone to falls and injuries. Your balance organ is not getting the impulses it needs on an ongoing basis to prevent you from falls later in life. People in their 80’s are often stable up to the point where they trip and fall. I have seen many patients like this arrive in an ambulance where I was doing my shift as the emergency physician in a community hospital. When I summarize the fate of all of the people in their 80’s who had falls and broke their hips over the years, 50% of them made it through the surgery and went back home (often with a walker or in a wheel chair) or ended up in a nursing home; the other 50% died from complications of the surgery, often from heart attacks during the surgery or from clots in their pelvic veins or in the leg veins that dislodged and turned into pulmonary emboli. A fracture and in particular a hip fracture in your 80’s is a serious, potentially deadly accident. So, you need strong muscles and joints and you need strong bones. All of this comes free to you from years of regular exercise in your 60’s and 70’s.

Slow Down Aging And Prevent Disabilities

Slow Down Aging And Prevent Disabilities

You guessed right: good nutrition is important!

Eat right and your body will function right. This is where a lot of people are sent on the wrong path due to clever advertising from the Agro Industry, Big Pharma, the American Dietetic Association and the United States Department Of Agriculture. So they preach that wheat and wheat products are good for you, but the lab tests show that it induces hyperinsulinemia and leads to diabetes. The genetic changes of wheat (“accomplished” through forced chemical hybridization in the 1970’s) are responsible for the metabolically very active wheat belly (accumulation of visceral fat) that Ref. 1 has described in detail. But others have researched this topic as well. Ref. 2 for instance confirms that gliadin, the glue in wheat, which allows dough to stick and makes it easy to create bread, bagels and pasta, is responsible for neurological issues like numbness of fingers and feet (peripheral neuropathy), balance problems and cognitive decline all the way to Alzheimer’s disease. If you continue to eat wheat and wheat products (all contained in conveniently packaged “processed” foods), you may very well find that your balance and muscle control will deteriorate by the time you are in your eighties. This condition is not new: one of the lecturers I listened to at McMaster University in Hamilton, Ontario in 1977 referred to those unfortunate individuals who were severely disabled as the “tea and toasters”. The tea in this case was probably the lesser evil, but the wheat induced malabsorption and malnutrition was a reality already in the mid and late 1970’s.

However, if you start eating organic foods to avoid the chemicals and estrogen-like xenoestrogens from pesticides, and you cut out sugar, high-density carbs and wheat products, you will no longer have problems with weight control and you will maintain your muscle, brain and nerve function. This is not what you learn from the regular agencies mentioned at the beginning of this paragraph, but Ref. 1 and 2 will fill you in on the details. Essentially, I follow a Mediterranean diet without sugar, starchy foods and wheat or wheat products. Ref. 2 stressed the importance of enough saturated and healthy fat (omega-3 fatty acid rich oils) in a balanced diet consisting of 20% protein and low carbs. No specific numbers were given regarding the %-age of fat. I would say that a limit of about 25 to 35% for fat would be reasonable except for the Inuit who are used to a fat content in their diet of 80%. The new thinking is that healthy fats are good for your brain and heart. Healthy fats are omega-3 fatty acids (EPA and DHA) derived from fish oil as they are very protective (anti-inflammatory) oils, so is olive oil and coconut oil. These latter two are anti-inflammatory monounsaturated fatty acids. Keep in mind that you want to change the ratio of omega-3 to omega-6 fatty acids (the ratio in this link is cited as omega-6 to omega-3) more in the direction of omega-3 fatty acids, so that the ratio will be between 1:1 and 1:3. Most Americans are exposed to ratios of 1:8 to 1:16 (too many omega-6 fatty acids in fast food and processed foods), which leads to inflammation of the arteries as well. Omega-6 fatty acids, found in safflower oil, sun flower oil, grape seed oil and canola oil are bad for you when not balanced by enough omega-3’s (flax seed oil and fish oil) as they lead to inflammation through the arachidonic acid system in the body. It may be a surprise to you that saturated fats are OK: animal fat like butter, lard, cream, ghee (clarified butter), and other animal fats provided they come from clean (not antibiotic or bovine growth hormone treated) animals. Buy organic and buy organic meats as well such as grass fed beef and bison, chicken and turkey.

Here is an example of what a day would look like nutritionally in terms of a breakfast, lunch and dinner (recipes by Christina Schilling):

Breakfast:  Great Greens Omelet

(2 servings)

1 tablespoon olive oil or coconut oil

3 chopped green onions

3 cups spinach leaves or a mix of greens: kale, spinach, Swiss chard

1 red pepper cut into strips

3 eggs and 3 egg whites

2 tablespoons grated Parmigiano

In non-stick pan sauté green onion, greens and pepper strips in oil, stir eggs and egg whites and pour over the vegetables, sprinkle with Parmigiano. Cook on medium heat, till the egg mixture has started to set. Turn over and briefly let cook. Remove from pan, divide into two portions and sprinkle with a bit of salt (optional). Serve with salsa and guacamole.

Lunch: Oriental Salad

(2 portions)

1 small Sui choy cabbage (Napa cabbage)

2 cups mung bean sprouts

1 small daikon radish, shredded to yield 1 cup

1 red pepper, cut into thin slices

3 green onions, chopped

1 medium sized carrot, cut into matchstick size pieces

1 can sliced water chestnuts, rinsed.

Dressing: 2 tablespoons sesame oil,

2 tablespoons rice vinegar,(light balsamic vinegar works too)

1-tablespoon tamari soy sauce

1 tablespoon Thai sweet chilli sauce

1-teaspoon fresh grated ginger

3 tablespoons chopped fresh cilantro

Prepare all vegetables and put into salad bowl. Stir all dressing ingredients together and pour over vegetable mix. Stir gently, cover and refrigerate. This salad can be consumed immediately or kept refrigerted for a day. To complete the salad with a protein portion add your choice of 6 oz. cooked shrimp or the same quantity of cubed or sliced grilled chicken.

Dinner:  Florentine Chicken

(2 servings)

1 large boneless chicken breast

1 tablespoon of chopped fresh basil-alternatively use 1 teaspoon dried basil.

1 tablespoon grated Parmigiano

4 thin slices prosciutto

1 tablespoon olive oil

2 tomatoes- cut into halves

3 chopped green onions

2 cups baby spinach leaves

pinch of salt

Spread chicken breast flat and top it with the basil, Parmigiano and prosciutto slices. Fold into half an hold the stuffed chicken breast together at the edges with a toothpick or two. Heat olive oil in frying pan, add onion and tomato slices and put the chicken breast on top. Put lid on the pan, and cook at medium heat till the chicken is cooked through. If you test with a fork, the juices will be clear. Remove vegetables and chicken from pan, put on serving plate and keep warm. Remove toothpicks from meat, and cut chicken breast into two portions. Put spinach into pan and let the leaves wilt at medium heat (cover with lid). Put spinach on the side of the chicken and tomatoes, and sprinkle with a bit of salt.

Dessert after dinner: Berry Sorbet

(2 servings)

2 cups of deep frozen berries (strawberries, blueberries or a berry mix, no sugar added)

¾ cup of organic yogourt or goat’s milk yogurt

a few drops of liquid stevia or small amount of powdered stevia-to taste.

Put into blender and process till smooth. You will have to open the blender jar to stir the contents in between. Serve with a dollop of whipped cream,  if desired.

What about the “slow down” of menopause and andropause?

It is a fact that as we age, our hormone glands do not produce as much hormones as when we were in our 20’s and 30’s. But if you find a health care provider who is interested in anti-aging medicine (there are about 26,000 physicians, chiropractors and naturopaths who are members in the A4M), your hormones can be measured accurately from saliva and blood tests. This will tell whether you are hypothyroid, deficient in sex hormones and whether you should be supplemented with the missing hormones in adequate doses through bio-identical hormones. For instance, women are often deficient in progesterone in menopause and men deficient in testosterone. Treatment needs persistence and patience, as it often takes months for the patient to feel better and up to 2 years, to find the exact balance for you where the hormones are re-balanced and your symptoms of tiredness, insomnia, hot flushes etc. disappear. All our body cells have hormone receptors that require stimulation for the cells to function normally. Your health professional needs to pay attention to this and not just treat your symptoms symptomatically. When your hormones are in balance and you take a few supplements, your bones will be strong (no osteoporosis), your brain will be clear, your hearing perfect, and your balance great. You will be much less likely in your eighties to fall and break a bone and your mind will be clear and sharp.

Stress management

As the baby boomers age, they need to be aware of the stress in their lives. You may have been accustomed to having lots of energy when you were in your child rearing years or in your active professional career. Often we do not even notice that there may be stress in our lives. But your adrenal glands know. This is really a subpart of what I said of hormones: they need to be in balance. But cortisol, which is produced in your adrenal glands, is different from the menopause/andropause hormones. Corticotrophin-releasing hormone (CRH) from the hypothalamus and adrenocorticotrophin hormone (ACTH) from the pituitary gland are the rulers of the adrenal glands. And it is how you handle stress when you are in your 40’s, 50’s and 60’s which will determine whether you come down with adrenal fatigue, various degrees of adrenal insufficiency or not. Ref. 3 is a whole book that deals with this topic. Here I like to mention only that the best test to diagnose adrenal problems is a four-point saliva hormone test for cortisol. You connect the four points and get a curve where the cortisol level is expressed as a function of time. If this curve is below the lower normal range, which the laboratory provides for you, you need to be managed by a knowledgeable health care professional in order to build up the reserves of your adrenal glands. Yoga, meditation, deep prayer, self-hypnosis and enough regular sleep are all proven methods to overcome any stress related issues. Sometimes more effort is needed to rebuild the adrenals by specific herbs or porcine adrenal gland cortex extracts. Your health care provider can tell you more regarding this.

Useful supplements

1. On March 17, 2013 I wrote in a blog about prevention of osteoporosis the following summary:

“The best combination is 1000 mg (or 1200 mg as per National Osteoporosis Foundation recommendation) of calcium per day together with 400 to 800 IU of vitamin D3 (for cancer prevention you may want to take 4000 IU to 5000 IU of vitamin D3 per day instead monitored by a 25-hydroxyvitamin D blood level test through your physician) and 100 micrograms of vitamin K2 (also called MK-7). In the age group above 50 missing hormones such as bioidentical testosterone in men and bioidentical progesterone/estrogen combinations in women should be given as well. This works best, if you also watch your weight, cut down your alcohol consumption to a minimum (or better cut alcohol out altogether), exercise regularly (this builds up bone and muscle strength) and stick to a balanced diet resembling a Mediterranean or zone type diet (low-glycemic,  low fat, wheat free and no sugar).” I would add in view of Ref. 1 and 2 that “low fat” should now be replaced by “balanced fat diet”. With this I mean that nuts, almonds, olive oil, unsalted butter are allowed within reason. Lately there have been new insights that some cholesterol is needed for normal hormone production. What needs to be cut out are omega-6 fats and trans fats.

2. Omega-3-fatty acid supplements from molecularly distilled fish oil at a good dosage (3 to 6 capsules a day) will prevent chronic inflammation that often causes arthritis. Chicken cartilage (UC-II) from the health food store will desensitize your system in case you have rheumatoid arthritis or osteoarthritis. This will prevent crippling arthritic disease down the road.

3. Mitochondrial aging (the mitochondria are the energy packages in each body cell) is slowed down by the two supplements ubiquinol (=Co-Q-10, take 400 mg per day) and 20 mg of PQQ (=Pyrroloquinoline quinone). Co-Q-10 repairs DNA damage to your mitochondria and PQQ stimulates your healthy mitochondria to multiply. Between the two supplements you will have more energy.

4. Vitamin C 1000 to 2000 mg per day and a multivitamin supplement help to support the rest of your metabolism. Some may want to add PS (Phosphatylserine) 100 to 200 mg per day, which works together with vitamin D3 for Alzheimer’s prevention.

Conclusion

By now you noticed that nothing comes from ignoring the fact that we are aging. We need to pay attention to our body functions and think about what we can do to make us stronger. In the end we are our own caregivers. When we are in our eighties, we should still be active and our brains should function with a lot more experience than in our past. Our bones will be strong and our balance should prevent us from falling. I do not want to use assisted living and I do not like the confinement of a wheel chair. In the meantime I am going to carry on dancing.

More information on:

1. Fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

2. Nutrition: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/

3. Vitamins, minerals and supplements: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/vitamins-minerals-supplements/

References

1. William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

2. David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

3. James L. Wilson, ND, DC, PhD: “Adrenal Fatigue, the 21sty Century Stress Syndrome – what is it and how you can recover”; Second printing 2002 by Smart Publications, Petaluma, Ca, USA

Last edited Nov. 7, 2014

Oct
19
2013

Healthy Choices Start In Your Brain

You may have seen the CNN heading “Where is self-control in the brain?”  If we want to make any healthy choices in life including sound financial choices, we need a balanced brain that makes the right decisions for us.

Researchers at the Caltech in Pasadena, CA have examined this question in detail using functional MRI scans and found out that there are two loci on the frontal lobe of the brain that control your impulses: the “ventral medial prefrontal cortex” (red in this link) that processes your initial image (like seeing a delicious ice cream cone”) and the “dorsolateral prefrontal cortex”(green in this link), where you decide that this is not healthy for you because it has too much sugar in it. The Caltech researchers found a group of volunteers who were impulsive and made the wrong choice simply based on their taste buds without consideration for their health in general. An equally large group of volunteers was also found who had functional activity in the ventral medial prefrontal cortex and the dorsolateral prefrontal cortex, the latter of which modified the final decision into the healthy choice. The impulsive group made their decision to buy simply with the activation of only the ventral medial prefrontal cortex.

The researchers think that it is this kind of lack of balanced thinking that decides whether we are going to make the right or wrong health choices for ourselves. The sad part is that ultimately, the summation of bad health decisions during life can become the cause of developing dementia, such as Alzheimer’s disease. The good news is that many of the causes of dementia can be avoided, which means that the average person could prevent dementia. I will discuss this in detail here.

Causes of dementia

It is interesting to study patients with various forms of dementia as it is often in the frontal and temporal portions of the brain where brain cells are dying off resulting in impulsive buying, impulsive behavior and lack of recent memory. It is also important to recognize that a number of conditions or factors can cause dementia:

1. Genetic causes

Here is the

There are two types of frontotemporal lobe dementias, a tau-protein positive FTD and a ubiquitin-positive FTD, which has been shown to be due to a deficiency in progranulin. Both of these genetic defects are located on chromosome 17. In Alzheimer’s dementia, which occurs later in life there can be genetic defects at chromosomes 21, 14 or 19. Epigenetic factors like exercise, avoidance of alcohol, and taking omega-3 supplements can even partially prevent or postpone the onset of dementia from genetic causes.

Healthy Choices Start In Your Brain

Healthy Choices Start In Your Brain

2. Toxins like alcohol

Another example of how people can get dementia is through the effect that regular alcohol consumption has on our brains and bodies. This image of an MRI scan shows a normal brain for comparison on the left and  the MRI scan of the brain of a chronic alcoholic on the right.  When a chronic alcoholic has severe atrophy of the brain a psychiatric condition, called Korsakoff’s syndrome can occur. This psychotic condition as a result of the brain having been poisoned by regular alcohol intoxication. Essentially the toxic effect of high daily doses of alcohol have shrunk not only the surface of the brain, but also the deeper substance of the brain. The patient is psychotic, has loss of memory and is unable to care for him/herself.

3. Vascular damage to the brain

Strokes can cause vascular dementia that leads to Alzheimer’s disease-like memory loss. This link points out that diseases like hypertension, obesity, diabetes, atrial fibrillation, ischemic heart disease and dyslipidemia all predispose you to possibly get a stroke with subsequent dementia.

4. Traumatic head injuries

In boxers, football players and combat soldiers brain cells can get lost from repetitive head trauma leading to dementia (in this case it is called “dementia pugilistica”).

5. Infectious dementia

HIV in AIDS patients can affect the brain and cause an HIV-associated dementia. Bacterial meningitis and viral meningitis can kill brain cells and cause a form of dementia as well.

6. Immune disorders

We know that MS can go on to develop dementia as a late complication. In MS there are autoantibodies against myelin, the insulation material that surrounds nerve fibers. An important category of immune disorders is autoimmune disease that can cause dementia. The cardiologist, Dr. William Davis, has presented compelling evidence that wheat allergies can cause dementia, but if detected early and treated by a gluten free diet, this clears up the mind and stops further development of dementia (Ref.1 describes wheat allergies causing dementia; a wheat free diet is described in Ref.2).

7. Hormone deficiencies

A classical example is hypothyroidism, which in the past before thyroid medicine was available, often led to dementia. A simple blood test, TSH (thyroid stimulating hormone) can detect whether or not you are hypothyroid. The A4M recommendation for a normal level is below 2 (not below 5 as often reported by official lab value reports).

8. Lack of vitamins

Thiamine (=vitamin B-1) is often missing in alcoholics. If you are missing vitamin B-6 and vitamin B-12 in your diet, this can predispose you to develop dementia as well. Aging people lose a factor from the gastric mucosa (the intrinsic factor) that is essential to absorb vitamin B-12 in the mall bowel, which predisposes them to develop pernicious anemia and dementia. A simple vitamin B-12 injection can prevent this from happening.

9. Too much sugar consumption

Sugar consumption has skyrocketed in the 1900’s and keeps on going up in the new millennium as well. Here is a review that discusses the possibility that Alzheimer’s can be triggered by overconsumption of sugar. The higher the blood sugar levels in diabetics, the higher the risk for developing Alzheimer’s disease. A study in Seattle has confirmed this. High insulin levels are found in type 2 diabetes; they are responsible for making brain cells stimulate the production of the gooey substance amyloid that causes Alzheimer’s disease. The authors of this study showed this to be true both in humans and in animal models.

10. Lifestyle issues like lack of exercise, excessive weight (obesity, being overweight) and poor diet (fast foods) play an enormous role in terms of causation of dementia in addition to the other factors mentioned. On the other hand organic foods Lack of toxins) and a Mediterranean type diet will preserve your brain cells.

Treatment of dementia

At present treatment of dementia is very limited, as we do not have a complete understanding of dementia at this point. The traditional treatment of dementia outlined here will only marginally delay further deterioration of dementia, but ultimately fail. In my opinion this is because the medical profession has been concentrating on fighting the symptoms of dementia rather than the cause.

Given the list of known causes above, I like to give you 6 recommendations that will help you to prevent Alzheimer’s disease and dementia in general.

  1. I would suggest that you cut sugar out of your diet and replace it with stevia. This also includes dates, grapes, bananas; also wheat and wheat products and starchy foods like pasta, potatoes, rice and bread (see Ref. 1 and 2 for details). The manufacturers of soda drinks, pies and cakes will not be happy about this recommendation, but it will please your brain cells. You will also be surprised how easy it is now to lose weight, which will please you (this also lowers your risk for heart attacks and strokes).
  2. Severely limit your alcohol consumption to less than 1 drink for women and 2 drinks for men per day (better still would be to stay sober) unless you want to become part of the hospital population mentioned in one of the links at the beginning of this blog.
  3. Have your hormones checked, particularly your thyroid hormones, but also estrogen and progesterone levels in women and testosterone in men. Our brain cells have hormone receptors for a reason. They need to be stimulated by our hormones, even in menopause or andropause. Replace the missing sex hormones with bioidentical hormone creams and missing thyroid hormones with thyroid tablets (Armour is the best mix of T3 and T4 thyroid hormones, not Synthroid).
  4. Prevent repetitive brain injuries before it is too late. Rethink whether you really need to box, street fight, play football, rugby or hockey.
  5. Use vitamins for prevention of dementia: The B complex vitamins like B-2, B-6, B-12 (by injection); vitamin D3 has recently been shown to be effective in slowing down Alzheimer’s disease. Vitamin D3 is low in Alzheimer’s patients and vitamin D3 supplements will slow down this disease. Although vitamin C showed equivocal results, it does have some neuroprotective qualities and decreases β-amyloid production and acetyl cholinesterase activity. A Mediterranean-type diet (Ref.2) is also helpful in preventing dementia.
  6. Exercise daily. It will discipline you to stick to the other points mentioned above. It gives you some extra endorphins and will make you feel good about yourself.

Conclusion

Although we do not yet have a complete picture regarding Alzheimer’s disease and dementias, we do know enough to reduce our risk of getting them. When you cut out wheat and wheat products, autoimmune antibodies against your brain cells will not be produced, your opiate receptors in the brain will not be seduced to eat more and more sugar, starchy foods or high fructose corn syrup, so you will have no problem in cutting out high glycemic index foods (Ref.1). This will reduce insulin and reduce IGF-1 growth factors that would have made you vulnerable to produce the gooey amyloid substance that makes you lose your memory. The orbitofrontal part of your brain (particularly the dorsolateral prefrontal cortex) will be reminding you what you read here: healthy lifestyle choices start in your brain.

References

1. William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

2. 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 Oct. 19, 2013

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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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Aug
17
2013

Postpartum Depression

Recently there has been a lot of publicity around the topic of postpartum depression (PPD). Typically the reports originate from a case where depression led to catastrophic consequences. It is sad that it often takes a tragedy before a problem like this is publicly more acknowledged. But sadly reports are often one-sided and are missing vital information about preexisting risk factors that are frequently not picked up by the family doctor. There is often denial on behalf of the mother and family, the mother is getting no support from support groups, even though there are such groups. And swift treatment that would be available is often not given. The results are finally making headlines. Once a mother is desperate and deeply depressed (“psychotic depression”) she is capable of killing the baby, herself and others who are close. PPD affects 15% of mothers (Ref.1); a small percentage of them may have postpartum psychosis, which is the most severe form of PPD.

Risk factors for postpartum depression

In Ref. 1 several risk factors are reviewed that can lead to postpartum depression. For instance, a history of a major depressive episode or anxiety attacks during the pregnancy has been found among mothers who developed PPD. However, there may also have been a history of dysphoria (intense feeling of discontent) before her periods in the past; stressful events during the pregnancy or right after birth. Often there is poor social support or a marital conflict. Other factors are low income, young maternal age or immigrant status with deprivation. A lack of support from the partner can also be a major factor.

Up to 85% of women experience postpartum blues within the first 10 days after the delivery of the baby. Symptoms such as mood swings, fatigue, confusion, tearfulness, mild elation and irritability are common during these initial days following her delivery. Progesterone levels following delivery are decreased for at least one month, sometimes up to 3 months. This leads to sleep problems (insomnia), which coupled with the baby crying in the middle of the night causes more sleep disruption. Abnormal brain wave pattern have been documented on women following the birth of a child.

Only 1 in 500 mothers after birth develop what physicians call “postpartum psychosis”, which is a recognized psychiatric emergency.  The symptoms here are extreme mood swings with confusion, poor judgment, disordered thoughts (“delusions”), paranoia (where they think that someone is after them or it is the baby’s fault that they feel that way). Erratic behavior and impaired functioning are also part of this symptom complex. It is this state that needs to be monitored in a psychiatric unit as it is associated with a high suicide and homicide rate. A psychiatrist with experience in treating PPD needs to treat the patient.

Urbanization leads to a lack of support, which is particularly devastating to new mothers who need all the support they can get. This is reflected in a higher percentage of PPD in urban areas versus the percentage of PPD in more rural areas where there is more family support.

 

Postpartum Depression

Postpartum Depression

Hormone changes with postpartum depression

Some people would say that they couldn’t understand why a woman who just had a baby would not be happy and content. Most women are, but if the stress from the pregnancy and from childbearing were too much for the system, there is a point where the hormones are no longer balanced and the coping mechanisms are undermined.

Serotonin concentrations in the brain of women during pregnancy are kept at a higher level due to higher estrogen levels that slow down the degradation of serotonin. Serotonin is the brain hormone that makes you feel good. Estrogens and progesterone are very high during the pregnancy, but this changes right after the baby’s delivery and during the time of recovery in the first few days and weeks. Studies have shown that there was a 15% higher thyroid autoantibody rate in postpartum depression patients when compared to non-depressed postpartum mothers. This was weakly associated with postpartum depression and was responding favorably to thyroid replacement therapy. Progesterone levels were much lower in depressed and nondepressed patients following delivery because with the delivery the placental source of natural progesterone was removed. In a group of patients where progesterone was replaced, no significant improvement of PPD was observed, but they did not explain whether the progesterone replacement was done with bioidentical hormones or synthetic hormones.

Dr. Michael Platt described a case of a postpartum woman who was hypothyroid as well (Ref.2). She responded to hormone replacement with thyroid hormones and progesterone by shedding 60 pounds (she always had a weight problem) over 10 months changing from a size 20 to a size 4. She was able to wean herself off the anti-depressants. In breast feeding women this could be a significant difference as women on bioidentical progesterone can breast feed and will positively influence their breast fed child’s brain development (brain cells have a lot of progesterone receptors, which are stimulated by progesterone).

A recent Canadian study involving pregnant women and women after delivery of their babies showed that there was a significant drop of progesterone levels in saliva samples for several weeks, particularly with breast feeding. The authors explained that the lack of ovulation with a lack of progesterone synthesis in the ovaries was responsible for this. It takes several weeks for most women to regain regular menstrual cycles. It would follow from this that there is room for bioidentical progesterone replacement in the first few months of the postpartum period until the ovaries have resumed their normal cyclical hormone activity.

Conventional treatment for postpartum depression

With baby blues the symptoms are much less severe (compared to PPD) and are starting 2 to 3 days after childbirth, resolving spontaneously within 10 days after delivery. PPD occurs within 3 months following delivery and responds to treatment with antidepressants and psychotherapy such as cognitive behavioral therapy.  Breast feeding needs to be stopped, as it is known that metabolites of the antidepressants end up in breast milk. Typically, a less toxic antidepressant is used like paroxetine (Paxil), otherwise citalopram (Celexa), and fluoxetine (Prozac). In the rare cases where PPD is so severe that psychotic symptoms are present (postpartum psychosis) hospitalization is mandatory (Ref.3). Some of these cases may require electroconvulsive therapy (ECT) and/or lithium treatment for mood stabilization. Thyroid hormone therapy has also shown a beneficial effect in treating antidepressant-resistant cases of PPD (Ref.4).

Alternative treatment of postpartum depression

Although review texts of the treatment of PPD mention that estrogen replacement in postnatal women with PPD was beneficial, there is a warning that this could cause blood clots and anticoagulant measures would have to be combined with this to prevent deep vein thrombosis; suggestions for progesterone replacement were mentioned, which is a treatment modality where blood clots are no danger, but formal trials have not been done, so it is being ignored by most medical professionals. Here is forum of women who have taken postpartum progesterone with positive effects.

Dr. Katherina Dalton published a trial involving 30 PPD patients with a positive response rate of 95% when treated with natural progesterone.

Before treatment patients were suffering from an average of 7.57 symptoms, after the treatment only 2.1 symptoms remained. (Figures with details regarding this study can be found under the above link).

There are many uncontrolled observations like this where natural progesterone creams are incorporated into a holistic approach to treating PPD. Dr. Mercola describes here how useful natural progesterone therapy can be. He also cautions that it should be taken cyclically to mimic nature’s biorhythm to allow progesterone receptors to recover in between treatments.

There are many websites that have useful information about natural progesterone cream treatment for PPD, such as this.

Conclusion

It is common sense that a woman may need natural progesterone following a delivery, because she just got rid of her placenta, which was a virtual progesterone factory protecting her body and the baby’s brain all throughout the pregnancy. Even if a woman decides to only use natural progesterone in a cyclical fashion for 3 to 6 months, the majority of women would not experience the baby blues or PPD. When regular menstrual cycles have been re established, the patient’s own ovarian progesterone production has resumed and progesterone cream is no longer needed until after the birth of  the next child or at the arrival of menopause. Medicine is full of examples where common sense was applied for effective treatment options despite missing randomized studies.

Natural progesterone treatment of PPD is one such example, where intuitively it was tried and it worked in many patients. Whether or not a randomized trial has been done does not concern the progesterone receptors (they just do not like the synthetic versions of progesterone, as they block the receptors leading to progesterone deficiency!).  Natural progesterone treatment can also be combined with traditional treatments of PPD.

More information on postpartum depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/postpartum-depression/

References

1.Teri Pearlstein, MD, Margaret Howard, PhD, Amy Salisbury, PhD and Caron Zlotnick, PhD: “Postpartum depression” : American Journal of Obstetrics and Gynecology – Volume 200, Issue 4 (April 2009)

2. Dr. Michael E. Platt: The Miracle of Bio-Identical Hormones; 2nd edition, © 2007 Clancy Lane Publishing, Rancho Mirage, Ca/USA (p.53-55).

3. Bope & Kellerman: Conn’s Current Therapy 2013, 1st ed.© 2012 Saunders

4. Jacobson: Psychiatric Secrets, 2nd ed. © 2001 Hanley and Belfus

Last edited Nov. 7, 2014

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