Feb
06
2016

Effects Of Hormones On The Heart

Since February is heart month, this is a good time to discuss the effects of hormones on the heart. I believe that this is a timely topic to understand how we can protect ourselves from heart disease. During the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 11-13, 2015 in Las Vegas Dr. Ron Rothenberg gave a talk entitled ”Hormones And The Heart”. He stated that he wanted to give an overview of the effects on the endocrine system and on the cardiovascular system, in particular the effect of testosterone and estrogen. Also discussed were the effects of thyroid hormones, growth hormone, vitamin D and melatonin. In the following I will summarize what he explained in detail.

Testosterone treatment in men

He stated that there has been some confusion about the protective effect of testosterone on the heart in men. But Dr. Sharma and colleagues who investigated 83,010 male veterans with documented low testosterone levels clarified this confusion with this large study.

One group received testosterone replacement therapy, another did not receive replacement therapy and one group received replacement with testosterone, but the testosterone levels did not normalize.

Mortality reduction with testosterone replacement

The observation time for the various groups was between 4.6 years and 6.2 years. The results were impressive. A comparison between the results of men on testosterone replacement and the results of men without testosterone replacement, showed that there was a 56% reduction in overall mortality. Furthermore, there was a reduction of heart attacks by 24% and a reduction of strokes by 36%. There was no difference between the control group without testosterone replacement and the partial testosterone replacement group where the testosterone levels did not come up. It is clear from this that with proper testosterone replacement where the physician monitors testosterone levels and corrects the levels, significant reductions in strokes and heart attacks can be achieved. The explanation for these findings is simple: both, brain cells and heart cells in males, have testosterone hormone receptors that need to be stimulated for full function.

Hormone replacement in women

This topic was confusing for many years because of the insistence of the medical profession to use horse estrogen extracts from pregnant mares (Premarin) and synthetic Provera (instead of bioidentical progesterone). These artificial hormone-like substances were used in the much-discussed Women’s Health Initiative (WHI).

Dr. Rothenberg said about this study that investigators used the wrong estrogen, the wrong progesterone, the wrong route of administration of estrogen (oral estrogen causes inflammation), and the wrong women at age 63 who already had cardiovascular disease and breast cancer.

Revisiting the Women’s Health Initiative

One important aspect that was learnt by re-interpreting the WHI was that when estrogen replacement was initiated right away when menopause started, the heart attack risk went down by 34%. Estrogen and Provera together reduced the risk only by 28% (Provera being the wrong hormone). Again, the explanation for this findings is simple: women have both estrogen and progesterone receptors in heart and brain cells, which want to be stimulated with the natural hormones. When estrogen is missing, women need bioidentical replacement of what is missing with estradiol transdermal creams. When a woman is progesterone-deficient, she needs replacement with bioidentical progesterone transdermal cream or with micronized progesterone orally.

Estrogen

KEEPS study

With regard to estrogen replacement the KEEPS study has shed a new light on what is going on with hormone replacement in women.

700 women in early menopause participated in this study. Treatment consisted of 0.45 mg of Premarin (still the wrong hormone) or 50 micrograms of transdermal estradiol (the right active human estrogen). Women also received 200 mg of micronized progesterone (Prometrium, the real human progesterone) for 12 days each month. After 4 years of observation there was no case of breast cancer, uterine cancer, heart attack, transient ischemic attack, stroke, or blood clots in veins between the three groups. Both Premarin and transdermal estrogen had slightly reduced coronary artery calcifications on CT scans compared to the placebo group without hormones. The Premarin group increased the triglyceride and the CRP (a measure of inflammation) levels while the transdermal human estrogen did not do that.

It is a disadvantage to the woman, if she does not receive bioidentical hormone replacement after menopause 

Another study showed that due to the WHI study with the wrong synthetic hormones many women were fearful of starting estrogen replacement. The lack of hormone replacement with nature-identical hormones is responsible for the death of many women, who did not have the beneficial effects. They died of cancer and heart disease.

Dr. Rothenberg explained that this study and others have shown the following
  1. Bioidentical hormone replacement must be started immediately at or before menopause to have the best results in terms of cardiovascular and neuroprotective (Alzheimer’s) prevention.
  2. Oral estrogen induces inflammation, which causes heart attacks, strokes and venous thromboembolism (blood clots). To prevent this, estradiol must be given as a transdermal cream. This will avoid the first pass effect through the liver, which is the cause for inflammation. Transdermal estradiol does not have the first pass effect. Inflammatory cytokines are implicated in autoimmune processes, initiation of cardiovascular disease, osteoporosis and Alzheimer’s disease.
  3. If estrogen replacement is not done right away with the start of menopause, the estrogen receptor may get damaged, which means that when estrogen replacement is started at a later date, it is no longer effective.

Progesterone

Progesterone is the other female hormone that physicians often overlook. It balances the effects of estrogens, but the body can also metabolize it into estrogen or testosterone. Tiny amounts of testosterone are necessary for normal libido. In premenopause the ovaries already reduced progesterone production. She should receive progesterone replacement by transdermal bioidentical progesterone cream in premenopause.

Estrogen dominance needs to be treated with transdermal progesterone (or micronized oral progesterone). Both estrogen and progesterone can be accurately determined using a saliva hormone test. Blood tests are accurate for estrogen levels, but not for progesterone levels.

Thyroid replacement

Not infrequently thyroid tests are low (hypothyroidism) and cholesterol levels rise. This can lead to heart attacks and strokes. For instance, a slightly elevated TSH of 5.5 is associated with a total cholesterol level of 209 mg/dL, and a TSH level of 7.0 is associated with a cholesterol level of 270 mg/dL (normal less than 180 mg/dL). It is very important to detect hypothyroidism early and to treat it effectively to prevent cardiovascular disease. The active thyroid hormone is T3. Thyroid replacement has a stabilizing effect on the heart rhythm. It works together with testosterone in men and estrogen in women to stabilize metabolism of all cells, but in particular the heart muscle cells and brain cells. Hypothyroid patients are often depressed, but thyroid replacement lifts the depression. Cognitive deficits in patients with hypothyroidism are also remedied with thyroid treatment.

Growth hormone replacement

Growth hormone (GH) is important in childhood for bone growth and growth of all the organs. But GH still has an important function later in life. GH improves cardiac performance; it does so by thickening the wall of the left heart chamber, the main pump of the heart muscle. GH improves the contractility of the heart muscle, reduces the stress on the heart muscle wall and decreases vascular resistance. In animal experiments GH plays an important role in remodeling the heart after a heart attack.

GH deficiency occurs with aging; it leads to high LDL (bad) cholesterol and high triglycerides in the blood and increased fibrinogen, which causes blood clots. All of this increases the risk for heart attacks and strokes.

Age-related GH production declining

When people age, they lose GH production, which puts them at a considerable risk to get heart attacks and strokes, but they are also at a higher risk of serious falls due to muscle weakness and balance problems. When the doctor detects low IGF-1 levels in the blood and confirms low GH metabolites in a 24-hour urine sample, the time has come to do daily GH injections with human GH. You achieve this using a similar pen that is in use for insulin injections. The dosage is only between 0.1 mg and 0.3 mg per day before bedtime. This is remarkably effective not only for heart attack and stroke prevention, but also to treat muscle weakness, lack of mental clarity and general well being. Patients report that their joint and muscle aches disappear and they can engage in physical activities again.

Melatonin replacement

Most people think of melatonin as the “sleeping hormone”. The pineal gland releases melatonin. It rules overnight giving you a refreshing sleep. In the morning and during the day the light that enters your eyes inactivates it.

Melatonin is a powerful antioxidant, stabilizes the heart’s rhythm (anti-arrhythmic activity), is anti-inflammatory, anti-hypertensive and protects against heart attacks and strokes. People who have heart disease often have very low blood melatonin levels. Physicians can use melatonin intravenously in patients who have heart attacks. This will reduce the amount of damage to the tissue and stabilize the heart rhythm.

Age-related decline of melatonin production

Like with GH, the production of melatonin deteriorates significantly beyond the age of 40. Blood levels of melatonin can be easily ordered, and replacement is easy to do. 3 mg of melatonin taken at bedtime will be a sufficient dose for most people. You can take another 3 mg, if you wake up in the middle of the night. It will wear off within 3 to 4 hours.

Vitamin D replacement

The history of vitamin D3 is interesting. Vitamin D3, the active form of vitamin D has many actions: it stimulates the immune system and reduces the risk of infection, it reduces blood pressure, it reduces inflammation by reducing circulating cytokines, and it increases insulin sensitivity making insulin receptors more responsive.

Vitamin D3 binds to the vitamin D receptor, which is contained on all cells.

Many middle-aged and older people are deficient for vitamin D.  A lack of it leads to higher mortality. Vitamin D helps to restore circulation in patients with ischemic heart disease. Vitamin D insufficiency causes high blood pressure, diabetes and metabolic syndrome. In addition, vitamin D deficiency also causes enlargement and thickening of the wall of your heart’s main pumping chamber, heart failure and chronic vascular inflammation.

More on the effect of vitamin D3 preventing mortality

A prospective 7.3-year study looked at the hazard ratios of the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality files with lower 25-hydroxyvitamin D levels. There were 33,994 persons part of the survey, of whom 1,493 died.

Below 10 ng/ml of 25-hydroxyvitamin D level the mortality was 2.5 fold for all causes and 3.08-fold for cardiovascular causes compared to those with levels of 100 ng/ml or higher.

The recommendation presently is to maintain serum levels at 60-80 ng/ml of 25-hydroxyvitamin D to prevent cardiovascular disease.

Effects Of Hormones On The Heart

Effects Of Hormones On The Heart

Conclusion

The following is important to remember regarding prevention of heart disease.

  1. Never smoke or if you do, quit smoking.
  2. Have your thyroid hormones checked. Thyroid hormones are important as an energy source for your heart muscle, and they lower LDL cholesterol levels.
  3. Your sex hormones matter: in men it is testosterone, in women estrogen and progesterone that support your heart.

Other effects on the heart

  1. Vitamin D is not only important when we grow bones as youngsters, but it continues to be important when we are older. It supports our heart and other body functions. It is an essential team player, as it prevents premature deaths. Blood levels of vitamin D are easy to measure.
  2. Two hormones leave us rapidly as we age: melatonin and human growth hormone. However, the physician can measure the levels of both hormones and if low he can replace what is missing.
  3. There are only two more things you need to do: eat a Mediterranean type diet and exercise on a regular basis. This will ensure your heart is still healthy in years to come.

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Jan
23
2016

Life Extended By Several Decades

Have you ever thought about the possibility to prolong your “Freshness Date”? At the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas the endocrinologist, Dr. Thierry Hertoghe from Belgium gave a talk about “How to extend the human lifespan by 40 years”. Dr. Hertoghe explained that it is possible to extend life by paying attention to the factors that prolong life and combining them as an anti-aging type lifestyle. He made a distinction between

  1. normal aging: up to age 82
  2. healthy aging: up to age 100
  3. anti-aging medicine: up to age 122
  4. reversing aging medicine: much more than 122, perhaps to age 150 or more.

Normal aging (up to age 82)

Life expectancy is on average about 82 years. From the age of 50 to 60 onwards you may encounter problems with increased cholesterol, high blood pressure leading to heart attacks and strokes. Coronary artery by-pass surgery may extend an individual’s life by 10 to 15 years. But hardening of the arteries in the general circulation will eventually cut down the blood supply to vital organs leading to premature death that could have been avoided.

Around the mid 60’s to mid 70’s 12.4% of African Americans or 2.9% Caucasians get Alzheimer’s disease. These figures worsen rapidly with further aging: in their mid 70’s to mid 80’s 32.5 % of African Americans and 9.8% of Caucasians suffer from Alzheimer’s disease. At the age of 85+ years 54% of African Americans and 27% of Caucasians have Alzheimer’s disease. With normal aging Alzheimer’s has already increased, and this trend likely is continuing.

Loss of memory, depression and musculoskeletal pain

Memory loss also leads to a shortened survival curve; people with memory loss live two years less on average than compared to a group with no memory loss.

Add to this loss of life because of depression, common in older age. Compared to a non-depressed group over 2 years of older people the depressed group lived 30% shorter.

Musculoskeletal pain in younger age (18-44) was 38%; the next demographic group aged 45-64 reported 61% of musculoskeletal pains; seniors between 65 and 74 had 68% of musculoskeletal pain, and in the demographic group of 75 and up 71% of persons suffered of musculoskeletal pain. As we will learn later there may be hormone deficiencies behind these neck and back pains. If the patient does not seek treatment, this can lead to falls, fractured hips and premature loss of life. Those who survive accidents often become wheel chair bound and end up in nursing homes.

Patients with rheumatoid arthritis and patients with other disabilities have a lower life expectancy

One specific subgroup of patients with musculoskeletal pain are rheumatoid arthritis sufferers. After 10 years of having rheumatoid arthritis patients will have a survival of only about 50%. With involvement of more than 30 joints  (more severe form of the disease) only about 40% will survive. In other words, rheumatoid arthritis is an important factor for lowering people’s life expectancy.

At an age of 65 to 74 men have 23% of disabilities, while woman have 27.5% disabilities. This increases between the ages of 75 or older to 40% for men and 44.5% for women. At the age of 65 disabled men have a 3.5% higher death rate than the average population; disabled women’s death rate is 2.5% higher than the normal population. In other words, disability kills.

Obesity, and heart disease

Urinary urgency and incontinence leads to a 3.13-fold higher mortality rate than a control group of men who do not have these symptoms.

65% of men and 85% of women above the age of 50 have abdominal obesity. This is not just a harmless condition. There is an association between increased triglyceride levels and increased mortality due to cardiovascular disease and diabetes.

By the age of 65-74 heart disease has a frequency of 32% in men and 23% in women. At the age of 75 years and older this jumps to 44% in men and 32% in women. Once the doctor diagnoses heart disease, it causes a lot of premature deaths: an average person with heart disease lives 10 years shorter than those who do not have heart disease!

Healthy aging (up to age 100)

Improving lifestyle factors increases life expectancy

If we look at normal aging, we realize that all these diseases and disabilities we discussed are eventually killing us. In order to live longer we have to take steps that are known to interfere with some of these factors. For instance, quitting smoking will prevent heart disease, several cancers and chronic obstructive lung disease (emphysema). Positive thinking, social support and transcendental meditation will increase survival by preventing mental illness and depression, which in turn will prevent suicides. A healthy diet such as the Mediterranean diet or the Pegan diet will avoid cardiovascular disease and cut down cancer rates.

Live longer with better diet

One dietary change is called the “polymeal”. It consists of fish, fruit, vegetables, garlic, almonds, a moderate amount of wine and dark chocolate. Compared to the Standard American diet this type of diet would add 9 years for men and 8.1 years for women regarding their life expectancy. For instance, prostate cancer showed a 7-fold increase in a group of men who ate a lot of pickled vegetables, fermented soy products, salted fish and preserved meats, when compared to a control group who did not include these foods. In a group of women who had their meat well done and ate three servings of beef per week, breast cancer risk was 4.62-fold higher compared to women who ate meat done rare or medium rare. Overall cancer and cardiovascular mortality dropped by 35% in a study where 5 or more servings of fruit and vegetables were eaten per day.

Regular exercise and supplements of vitamin C and omega-3

A regular exercise program will strengthen the heart and lungs, keep your weight stable, reduce heart attacks and strokes and reduce the probability to develop cancer. A group of men between 61 and 81 were observed over 12 years and divided into those who did not exercise versus those who walked more than 2 miles per day. The exercising men had 19% less mortality compared to the sessile men. Vitamin C from fruit and vegetables or from taking supplements reduces global mortality from all causes by 46% compared to controls that did not. Similarly taking omega-3 fatty acid supplements (fish oil) daily reduced all cause mortality by 20%.

Dr. Hertoghe calls this “healthy aging” and this would allow you to be able to reach an age of about 100 years.

Anti-aging medicine (up to age 122)

Low thyroid hormones

Dr. Hertoghe told the audience that further attention to anti-aging factors could reduce mortality even further. He found over the years that paying attention to correcting hormonal weaknesses would have profound effects on how old a person becomes. Thyroid hormone replacement has been one of the steps that has helped people to feel more energetic, have less muscle pain, less falls, less fractures and complications. It also translates into longer lives.

One slide showed that a low free T3 level (low thyroid) was associated with a 3.6-fold higher death rate. A low free T3 level is an accurate predictor of cumulative death rate in cardiac patients.

T3 is also important for the maintenance of the immune system, which shows in patients with tuberculosis: the one-year mortality rate from TB in thyroid deficient patients was 75%, while patients with a normal thyroid had a mortality from TB of only 7%.

Replacement of missing sex hormones

Secondly, replacing missing sex hormones can add more life because cardiovascular disease is postponed (less heart attacks, less strokes), there is less cancer and better cancer survival, if a person comes down with cancer. Many statistics were quoted.

One interesting slide showed the longitudinal survival follow-up of congenital dwarfs in comparison with their normal brothers or sisters. Untreated male dwarfs turned only 56 years on average, while their unaffected normal brothers turned 75 years on average (19 years longer). With female dwarfs the difference is even more striking: untreated females dwarfs turned 46 years on average, while their normal sisters turned 80 years on average (a difference of 34 years).

Bioidentical hormone treatment prolongs life, lowers heart attack rates and lowers cancer rates

Another publication showed that the heart attack risk was 3.8-fold higher in a group of patients with hypopituitarism (under function of the pituitary gland), but the treatment group (treated with GH) had a normal rate of heart attacks.

11606 men aged 40 to 79 years were followed for between 6 and 10 years. The group who had the top 25% range of testosterone had a 19% lower mortality rates from heart attacks or cancer.

Older women, particularly aged 100 in Okinawa had 2.3-fold higher testosterone levels than women in the US at age 70. On the other hand 70-year old Okinawan women had 2.7-fold higher estrogen levels than US women.

Bioidentical hormone replacement therapy (BHRT) prior to developing breast cancer showed a 27% longer survival among 984 breast cancer patients in Sweden compared to those without prior hormone treatment.

Lower mortality rates for bioidentical hormone replacement therapy of breast cancer patients

In another group of breast cancer patients (2755 patients) aged 35 to 74 who were treated with bioidentical hormone replacement therapy (BHRT) after their breast cancer diagnosis, 50% had a lower recurrence rate (compared to no-BHRT treatment) and there was a reduction of 66% of mortality from breast cancer compared to controls without BHRT treatment. Another study showed that breast cancer patients would have a mortality rate of 33.3% without hormone treatment. After non-estrogen hormone treatment the mortality rate dropped to 12.5% and to 6% after estrogen/progesterone use. This shows the healing results of the various natural hormones.

Treating the cause rather than the symptoms

A group of 280 men and women around the age of 50 were treated with anti-aging hormone replacement for 2 or more years. In the beginning there were 34% of women and 15% of men with coronary artery disease. There were also 36.4% of women and 34.1% of men with high blood pressure. After replacing all of the missing hormones with bioidentical hormones for more than 2 years, coronary artery disease had dropped to 1.6% of the women and 1.08% of the men; high blood pressure had dropped to 2% of the women and 3% of the men. No drugs, just hormones! Of course, initially the doctors prescribed drugs to stabilize their condition, but they could gradually drop them safely. The reason was that the doctors treated the underlying hormone deficiency. The doctors were treating the cause of the cardiovascular disease rather than only the symptoms.

Low mortality of women on bioidentical hormone replacement

Dr. Hertoghe presented data of 6.38-year follow-up of 286 consecutive patients using anti-aging medicine (replacement of missing hormones with bioidentical hormones). These patients had an overall cancer rate of 2.1%, which compared very favorably to the 3.2% cancer rate among US women. The overall cancer rate was  3.1% in French women and 3.1% in Belgium women on no hormones. This is the type of information that is needed following the Women’s Health Initiative (WHI) that scared women into the false belief that hormones would be “poisonous”.

Synthetic hormone do not fit the hormone receptor

In the WHI synthetic hormones caused cancer and heart attacks; the reason for this was that synthetic hormones are not the identical shape as the natural hormones. But hormones and hormone receptors have to fit like a key into a lock; otherwise they are not effective or even block the natural life prolonging action of the natural hormone. This is why in the WHI study the outcomes were poor. Using bioidentical hormones the doctor can prevent heart attacks and strokes and they are also cancer-protective.

Reversing aging medicine (much more than 122, perhaps to age 150 or more)

General medicine has the goal to make patients as healthy as possible. With reversing aging medicine the goal is to make patients as young as possible. They are at their healthiest and feel younger again.

With anti-aging medicine using a healthy diet, exercise and bioidentical hormone replacement therapy the patients can add 15 years of good life. Add to these organ transplants, if necessary, telomerase activators and stem cell therapy. This can add another 25 years of life expectancy to a total of 40 years.

Growth hormone deficiency

Growth hormone deficiency is the one factor that has been underestimated. The discussion of dwarfs in comparison to their healthy brothers and sisters showed us the following. Growth hormone production can add between 19 and 34 years (average 26.5 years) of life. Dr. Hertoghe has done blood tests (IGF-1) and lately also 24-hour urine metabolite tests of growth hormone on aging patients and found that many are deficient with regard to GH production. These were patients where Dr. Hertoghe already replaced their thyroid hormones, if abnormal and replaced their sex hormones when they were low. But they lost hair, developed old looking faces with wrinkles. In addition, a loss of subcutaneous fatty tissue is giving the face a hollow appearance. They also had muscle and joint pains and thin skin, particularly over the back of their hands.

Replacement of growth hormone

He replaced their missing GH using daily GH self-injection with a tiny needle (similar to diabetes injections). Within 1.5 to 3 years the wrinkles disappeared, the faces started to look younger and patients did feel younger. Their muscle and joint pains had disappeared and their hair grew back. The dosage range is between 0.1mg and 0.3mg, a tiny amount of GH daily. This is not inexpensive, but some health care plans pay for this, as a lack of GH is a true hormone deficiency.

About organ transplants

Often it is a single limiting organ that determines when we die, typically the heart, lungs, brain, liver, kidneys, small bowel, pancreas or bone marrow. Organ transplants can add years of life, but it can be cumbersome to find a suitable donor. One study showed that only 40% to 60% of organ transplants are surviving 8 years after the surgery.

Stem cell therapies are other ways to prolong life. More research will perfect this, but essentially stem cells can provide 220 different cell types for in-vitro organ culture. This can probably be of use in the future to replace malfunctioning organs.

Life Extended By Several Decades

Life Extended By Several Decades

Conclusion

The dream of staying younger for longer can be a reality today. You just need to be willing to discipline yourself and watch what you are eating (Mediterranean type diet). Also, exercise regularly and have a positive psychological attitude. If the outdoor air is poor where you live, you may want to consider moving. Move to a place with good air quality. Sleep well for 7 ½ hours every night and retire not later than 10 to 11PM. You need to be asleep between midnight and 3AM as the growth hormone peak occurs at that time.

Take supplements

Take supplements that contain longevity micronutrients (magnesium, vitamins A, C, D, E, B6, B12, Co-Q-10, selenium, zinc, iron in premenopausal women etc.). Replace all missing hormones with bioidentical ones, like thyroid hormones (T3 and T4), sex hormones, DHEA and GH. Stem cell therapy and telomerase activators for cell rejuvenation will also have more of a place in the future.

Even, if you do only part of this reversing aging program you will slow down aging.

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Jan
16
2016

Low Thyroid (Hypothyroidism)

Dr. Pamela Smith gave a detailed talk regarding low thyroid (hypothyroidism) at the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas. As a lack of thyroid hormones is one of the causes of premature aging, it is important to pay attention to your thyroid hormones. Here I am summarizing the highlights of this talk.

Thyroid disease, particularly low thyroid hormone levels (hypothyroidism) is very common in the population. Part of the problem is that in 72% of the world population dietary iodine is insufficient to provide adequate amounts of iodine to the body that is required for thyroid hormone production in the thyroid gland. The US Institute of Medicine has recommended 150 micrograms of iodine intake every day. Japan with its emphasis on seaweed intake is one of the few countries where thyroid deficiency is extremely low (Ref.1).

But apart from dietary factors there are many other factors that can lead to insufficient amounts of circulating thyroid hormones (see below).

The production of thyroid hormones

The thyroid gland produces the thyroid hormones by adding iodine atoms into the amino acid L-tyrosine to make thyroxin (T4) and triiodothyronine (T3). T3 is the main active hormone, which is about 5-times more powerful than T4. There is a feedback cycle between thyroid hormones, the hypothalamus and the pituitary gland. Both the hypothalamus and the pituitary gland have thyroid hormone receptors that sense the level of T3 and T4 and can modify the production of these hormones. The majority of T3, which is the main active thyroid hormone, comes from conversion of T4 into T3 by a selenium-dependent enzyme.

Most of the thyroid hormones are bound in the blood by thyroid binding globulin. Only the free T3 and free T4 are metabolically active and will affect the metabolism of our body cells. The delicate balance can be easily disrupted. Oral contraceptives and sex hormone replacement therapy can increase the amount of circulating thyroid binding globulin, thus creating a thyroid hormone deficiency state, as the free T3 and free T4 are diminished.

Other factors influencing circulating thyroid hormones

Low adrenal gland hormone activity

Low adrenal gland hormone activity can occur simultaneously with hypothyroidism. On the other hand, when thyroid hormones are low by themselves, the adrenal glands often compensate by producing more cortisol to offset some of the symptoms of hypothyroidism.

Conversion of T4 to T3

An enzyme located in the liver, kidneys, pituitary gland, hypothalamus and brown fat is necessary for conversion of T4 to T3, the more active thyroid hormone. Anything that interferes with this conversion leads to hypothyroidism. Over the years medical research has identified many factors that interfere with this process. For instance, there are trace elements necessary for this enzymatic reaction, like selenium and zinc; if they are low in the diet, low T3 will be the result. But other nutrients, if missing, will also interfere with T4 to T3 conversion: iodine, iron as well as vitamins A, B2, B6 and B12.

Medication can interfere with conversion of T4 to T3

Several medications can also interfere with the conversion of T4 to T3: we already mentioned birth control pills; others are estrogen, lithium (patients with bipolar disorder are often on this), phenytoin, theophylline, beta blockers (such as propranolol), chemotherapy and clomipramine.

Too much fiber in diet can interfere with conversion of T4 to T3

But dietary factors can also lower T3 due to a lack of conversion from T4: too many cruciferous vegetables, a low carbohydrate diet, low fat diet, low protein diet, excessive alcohol use, walnuts and soy. In a study that examined the effects of soy involving 37 adults on a high soy diet over three months 50% developed hypothyroidism. When the soy diet was stopped it took one month to normalize the thyroid function (Ref. 2).

Chronic inflammation, diabetes, aging and more can lower T3

There is no end of factors that cause low T3 because of the inability to convert from T4: chronic inflammation due to cytokines, diabetes, aging, poisoning with heavy metals like mercury, lead and cadmium (cigarette smoking), fluoride, pesticides, exposure to radiation and stress. Other toxic substances that enter the body can interfere with the same T4 to T3 conversion process: dioxins, phthalates (chemicals added to plastics) and PCB. But excess calcium and copper (copper salts could come from spraying of organic fruit) can also lead to low T3.

Too much cortisol from stress can lower T3

Other hormones can disbalance the equilibrium and cause low T3 because of a lack of conversion from T4. One reason can be too much stress, which causes cortisol from the adrenal glands to rise. Surgeries cause the same stress response (high cortisol levels) also will lower T3.

Reverse T3, an inactive form of T3

There is another conversion process that has been shown to lead to lowered T3: it is called “reverse T3 (rT3)”. rT3 is an inactive form of T3, which blocks thyroid receptors and renders T3 less active. rT3 is particularly important in stressful situations and in athletes who engage in extreme exercise. In these individuals T3 and T4 blood tests are normal, TSH is suppressed and rT3 is elevated. That’s how the doctor can diagnose this condition. Other conditions that lead to high reverse T3 are: aging, diabetes, exposure to free radicals (chemotherapy or radiation in cancer treatment), fasting, prolonged illness, toxic metal exposure, inflammatory cytokines, depression and anxiety, bipolar disorder, Alzheimer’s and Parkinson’s disease, chronic fatigue syndrome and fibromyalgia.

Certain supplements and dietary habits can help to increase the conversion from T4 to T3

After all this negative news it is almost a wonder that the thyroid is still doing its work! Since we know the risk factors, it is important to be aware that certain supplements and dietary habits can help to increase the conversion from T4 to T3. Here is a list of those that help: iodine, iron, zinc, selenium, potassium, Ashwaganda, and a high protein diet. Other positive factors are vitamins A, B2 and E; growth hormone, testosterone, insulin, glucagon, melatonin and estrogen (high dose).

Symptoms of hypothyroidism

There was an overwhelming amount of information about signs and symptoms of hypothyroidism that was reviewed. I can only highlight some of the more common symptoms here. It is important to know that some of these signs and symptoms occur several years before the lab values become abnormal. This is particularly true of the “eye brow sign” and the thinning of eyebrows is a pointer to hypothyroidism!

More signs and symptoms of hypothyroidism

Depression, weight gain, constipation and migraine type headaches can be early non-specific signs of hypothyroidism. Women often present with irregular periods. Other symptoms are: decreased memory and inability to concentrate, anxiety/panic attacks, muscle and joint pains, a puffy face, swollen eyelids, decreased sexual interest, and sleep disturbance. Sparse, coarse, dry hair; missing hair confined to the outside 1/3 of both eye brows (eye brow sign) and carpal tunnel syndrome are also associated with a lack of thyroid function. Often there is also a loss of eyelashes or eyelashes that are not as thick. Blood tests can show high cholesterol, iron deficiency anemia or vitamin B12 deficiency. This should prompt the physician to order thyroid tests.

Blood tests for hypothyroidism

The doctor needs to order TSH, free T3, free T4, reverse T3 and thyroid antibodies to have a complete documentation of what is going on. In addition the doctor will order these three thyroid antibodies: antithyroglobulin antibody, antimicrosomal antibody and antithyroperoxidase (anti-TPO) antibody. There are a number of more studies that an endocrinologist would order in difficult to diagnose cases. Thyroid antibodies are an important cause of hypothyroidism in the US. They can also be due to Hashimoto’s thyroiditis, an inflammatory condition of the thyroid gland. Some people have autoimmune antibodies against adrenal gland tissue. There are also patients who have gluten sensitivity. They may produce these autoantibodies to both the adrenal glands as well as the thyroid gland.

Treatment of hypothyroidism

Treatment for hypothyroidism consists of detoxification, proper nutrition and thyroid hormone replacement.

Detoxification can include intravenous chelation therapy, if heavy metals are part of the development of hypothyroidism. In some cases detoxification is all that is necessary.

Proper nutrition with a Mediterranean diet and some iodine supplements or seaweed is important. By the time the physician diagnoses hypothyroidism, there is  damage  in the thyroid gland and the missing thyroid gland hormones have to be replaced.

Replacement of thyroid hormones

Replacement of thyroid hormones is best done by desiccated thyroid or compounded thyroid (both T3 and T4). The physician takes the normalization of the TSH level as the end point. It should be below 2.0 (not the lab normal value of below 5). Free T3 should be optimally between 3.5 and 4.3 and reverse T3 should be 50 to 150 pg/ml to be optimal.

If reverse T3 is high, the patient will have hypothyroid symptoms, even if T3 and T4 blood tests are normal. Because reverse T3 derives from T4, the physician will have to lower T4 or take the patient off T4. Replacement with T3 will lead to lower TSH production by the pituitary gland. At the same time production of T4 and inappropriate conversion to reverse T3 will decrease.

Treating concomitant factors

Depending on what other conditions the patient presents with, it likely will help to eliminate stress, treat selenium and iodine deficiency, treat infections and treat growth hormone deficiency, if present.

There were many more pearls of wisdom in this very comprehensive talk on hypothyroidism, but there is not enough room in this blog to mention all of this. For more info read Dr. Pamela Smith’s book (Ref.3).

Low Thyroid (Hypothyroidism)

Low Thyroid (Hypothyroidism)

Conclusion

The maintenance of our health and well being involves the thyroid as one of the main players. Hypothyroidism can develop for multiple reasons: inadequate iodine intake, toxins including heavy metals, autoantibodies from gluten. In addition there may be another sensitivity and side effects from certain medication usage. It is a fallacy to think that supplements, vitamins and lifestyle choices can “cure” thyroid deficiency. Once the levels are low, thyroid replacement is the only way to reestablish a hormonal balance! The treating physician must consider many factors when replacing thyroid hormones optimally. Desiccated thyroid hormone replacement (containing T3 and T4) is the best type of replacement of missing thyroid hormones. The needs can differ a great deal, as no patient is the same! For best results the treating physician needs to individualize treatment.

References

Ref. 1: Brownstein, D., “Iodine: Why You Need It, Why You Can’t Live Without It”. Medical Alternatives Press, 2004.

Ref. 2: Kelly, G., “Peripheral metabolism of thyroid hormones: A review,” Alt Med Rev 2000; 5(4):306-33.

Ref. 3: Smith, P. “What You Must Know About Thyroid Disorders”. Garden City Park, NY: Square One Publishers, 2016.

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Dec
19
2015

Beer Belly Bad News

You heard the expression “beer belly”, but now we learn “beer belly bad news”. It is an unflattering term for increased abdominal girth, especially in males. It is quite often that this picture is found in middle-aged men who consume more beer than what is good for them, but they may also mill around the hot dog stands at the ball game instead of being physically active. Any leftover calories are stored as belly fat, which protrudes their stomach as if they were pregnant.

There is a big difference between belly fat and body fat. Belly fat is metabolically much more active. Body fat is more sessile. So, it is the belly fat we need to do something about as this has been shown to be associated with heart attacks, strokes and diabetes.

 

Abdominal girth to hip ratio instead of BMI

Originally it was thought that excessive weight would best be measured with the body mass index (BMI). But subsequently it was shown that athletes with well-developed muscles could have BMI’s that were in the overweight (between 25.0 and 30.0) or even obese category (more than 30.0). Also, some people with heavy bones can have excessive BMI values despite them being normal based on other measurements. The new measurement is the old fashioned abdominal girth to hip ratio.

Weight gain leads to metabolic syndrome

You measure the abdominal girth, the hip girth and divide the abdominal girth by the hip girth. Normally this should be 80% (=0.8) or less for women and 90% (=0.9) or less for men. But a person with a beer belly will have ratios of 1.2 or 1.5.

If you take blood tests of that person you would also find elevated triglycerides, lowered HDL cholesterol (the protective cholesterol) and elevated LDL cholesterol (the bad cholesterol). In addition, we know from studies that often the insulin level is elevated in the sense of hyperinsulinism. In fact that person has often the metabolic syndrome, which is a characteristic change of the metabolism in an obese person. The blood is thicker with clotting factors floating around, there are inflammatory kinins that circulate and these factors work together on causing hardening of the arteries.

Why is a beer belly dangerous?

There are not only cardiovascular risk on the long-term causing heart attacks and strokes down the road. There is a danger of fat deposits in the liver, called fatty liver disease.

In time this can turn into liver cirrhosis and in some cases develop into liver cancer. Because belly fat causes inflammation in the system including in the lining of the blood vessels, this can in time also affect the immune system, weakening it and eventually allowing cancer to develop. Common cancers that are associated with obesity are breast cancer, ovarian cancer and uterine cancer in women, prostate cancer in men and pancreas and colon cancer in both sexes.

Estrogen from aromatase in beer bellies

In men beer bellies produce a lot of estrogen, the female hormone. This is so because fat tissue contains the enzyme aromatase that metabolizes male hormones into estrogen. Estrogen in men is only good in traces, but when the body produces it massively, it will counter testosterone production and will cause heart attacks and strokes.

What can you do about a beer belly?

We need to understand how beer bellies develop. One of the sources of fat from beer bellies is the consumption of foods that contain a lot of fructose. Food manufacturers have been diligent in mixing high fructose corn syrup into sugary drinks and into a myriad of processed foods.

Sugar itself can only be processed and stored until the glycogen stores in the liver and the muscles are filled. The liver metabolizes a surplus of sugar into triglycerides and LDL cholesterol. This is also the case for any fructose that comes from metabolized sucrose (table sugar) and from the high fructose corn syrup popular with the food processing industry. One problem is that fructose can only be processed by the liver, while glucose gets directly taken up by cells with the help of insulin.

German obesity wave after WWII in the 1960’s

The surplus of fructose metabolizes into triglycerides and LDL cholesterol before the body stores it as fat in fat cells. Unfortunately a lot of the fat will end up between your guts, in the liver as fatty liver and in the beer belly, a metabolically more active form of fat.

The sad part is that in the 1960’s I have seen the German economic wonder (“Wirtschaftswunder”) where many mid fifty to mid sixty business men died as a result of obesity and subsequent heart attacks and strokes. At that time Germans who were starving during World War II lived it up. This was in the late fifties and 1960’s. They ate whatever they could: cakes, fatty cheeses, whipped cream, fatty foods like pork roasts and beef.

Unhealthy hydrogenated fats, starchy food and sugar caused beer bellies

They also consumed loads of bread, buns, pasta and sugar. Margarine also became popular with its hydrogenated fatty acids that also contained free radicals. The end result was that they gained weight, did not exercise and developed their beer bellies.

In the 1980’s the school of thought was that saturated fatty acids  were responsible for heart attacks, strokes and obesity.  A low fat/high carb diet became popular and continued to steadily increase. Sure, the hydrogenated fatty acids did not help and should be cut out. But the bigger problem was the consumption of high fructose corn syrup and over-consumption of high glycemic-index carbohydrates.

Steps of how to get rid of the beer belly

Here is the solution of what to do get rid of the beer belly.

Eliminate sugar and high fructose from diet

Remove sugar and high fructose corn syrup from your diet.

Remove empty starches from your diet

The second effective step is to cut out as many empty starches that you can cut out like white rice, bread, sweets, cookies, cakes, ice cream and pasta. Starchy foods metabolize in the gut into sugar, which causes an insulin response. The extra insulin is responsible for developing inflammation in the arteries, which eventually leads to heart attacks and strokes.

Regular exercise

Exercise on a regular basis. This will produce HDL cholesterol, the protective cholesterol, which balances LDL cholesterol.

Rebalance your food intake

Perhaps the most important step is to rebalance your food intake. With this I mean that you replace high glycemic-index carbs with low glycemic-index carbs. This means you will eat a lot of salads, steamed vegetables, and fruit. This gives you a lot of extra fiber, which your system needs to slow down the rate of sugar absorption. It also  helps you to lower LDL cholesterol and detoxify your body in the gut where fiber binds toxins.

Moderate your alcohol intake

If you are heavily into alcoholic drinks, this is another source of refined carbohydrates. They metabolize into LDL cholesterol, triglycerides and can cause fatty liver disease and liver cirrhosis. A moderate consumption of alcohol (one drink for women per day and two drinks for men per day) lowers the risk of heart attacks and strokes, while excessive alcohol intake increases the risk.

Bioidentical hormone replacement

Bioidentical hormone replacement may be something you have not heard about. But if you are a woman above the age of 40 or a man above the age of 50 chances are that you need some hormone tests. As a male, your natural hormone production from your testicles or adrenal glands is likely not keeping up.  As a woman, your ovaries or adrenal glands are no longer keeping up with the demand of regular life. Part of the aging process is that the production of our sex hormones slows down. It does so shortly before menopause in women and shortly before andropause in men.

Lack of function of key organs in menopause and andropause

This will not only manifest itself in hot flashes and sleep disturbance in women. Men experience erectile dysfunction and grumpiness. Eventually this leads to a lack of energy production in the heart, the brain and other organ systems. When these organs have sex hormone receptors, but circulating sex hormones are missing, they cannot function optimally.

Lack of hormones causes heart attacks, strokes and cancer

A lack of hormones translates into yet another cause of heart attacks, strokes and certain cancers. This is an area where conventional medicine disagrees with anti-aging medicine. Years in general practice have taught me that heart attacks, strokes, colorectal cancer and pancreatic cancer happen more often when hormones are missing in both sexes. Cancer of the breasts, uterus and ovaries and prostate cancer are more common when sex hormones are missing. These cancers occur when natural sex hormone production declined.

On the other hand, with bioidentical hormone replacement the metabolism of all cells will return to normal. With this the likelihood of not developing all these illnesses at an earlier time is diminishing as well. It is not a panacea for eternal life, but it will add significant longevity. And with this comes the knowledge that you will not get premature disabilities, which is what we all need.

Beer Belly Bad News

Beer Belly Bad News

Conclusion

We need to assess our food intake habits and cut out the items that contribute to the beer belly. Next we need to ask ourselves what other change in lifestyle we require.  Think about anything to improve our body shape and our energy metabolism. Life is too precious to just throw away years of fruitful living in our golden retirement years. Work on these factors in midlife or even in younger years and you will enjoy disease-free aging.

Dec
12
2015

Thyroid Cancer In Children

First of all, thyroid cancer in children is normally not happening. Likewise it is usually older people who get thyroid cancer. If children in one area are getting a lot of thyroid cancer, epidemiologists probably ask whether there was radioactive iodine poisoning in the area. Certainly, the Fukushima disaster in March 2011 was in effect such radioactive iodine poisoning in this region of Japan.

The disaster of Fukushima

An area extending about 20 kilometers from the nuclear plant has been declared an exclusion zone. It is not surprising that now there are reports of thyroid cancers in the area of Fukushima. The most recent statistics released in August 2015 showed that 137 of those children monitored in the Fukushima area came down with thyroid cancer while the year before there were only 112 such cases (25 cases less). Elsewhere, the disease occurs in only about one or two of every million children per year. Overall the amount of thyroid cancers in the Fukushima area is 20 to 50 times of what would normally be expected in a population.

Experience from Chernobyl nuclear accident

We learnt from the Chernobyl nuclear accident in April 1986 that the latency period (time elapsed between exposure to radiation and the first cancer observations) was about 4 years. The most dominant type of thyroid cancer was papillary carcinoma, which is a more benign type of cancer. Certainly, genetic examination of the tumors showed chromosomal rearrangements.

It is truly interesting to note that in Belarus, which is quite a distance from Chernobyl (Ukraine) there was a wave of thyroid cancers that stemmed from the Chernobyl disaster.

In the period of 1987-2000 there were about 4,400 radiation-induced thyroid cancers that appeared in Belarus; of these 692 cancers were among children and 3,709 cancers were among adolescents and adults.

How is thyroid cancer in children diagnosed?

Thyroid nodules can easily be detected by ultrasound examination. Normally in children there are no nodules in the thyroid gland, but it is out of nodules in the thyroid that thyroid cancer develops. If a thyroid nodule is detected in a child, the child needs to be referred to a specialist for further examinations and tests.

Treatment of thyroid cancer

If there is a local nodule within the thyroid gland, usually the pediatric surgeon will remove this surgically. Depending on the stage of the disease radiotherapy may or may not be included.

What can physicians do to minimize the impact of thyroid cancer in children?

When the Fukushima disaster occurred, physicians offered potassium iodide pills for adults and children alike to take. The iodide saturates the body’s iodine receptors with non-radioactive iodine. Specifically, this prevents radioactive iodine from inhaled air to enter the thyroid and lead to mutations of the thyroid tissue. We know from the atom bomb in Nagasaki that this type of action has helped to prevent the development of some thyroid cancers. Unfortunately not everyone after the Fukushima disaster took these iodide pills or they stopped taking them after a while, which allowed radioactive iodine to enter the thyroid glands of those exposed to the substance.

Screening program

An unprecedented ongoing screening program of almost the entire children population in the Fukushima area is diagnosing thyroid follicles early. This has helped the medical teams to diagnose the thyroid cancers early and continue to follow these children. Notably, physicians treated thyroid cancer early before cancer metastases occurred. When hypothyroidism occurred, they treated this right away with thyroid medication.

Long-term follow up after Hiroshima and Nagasaki

Previous experience with patients affected by the atom bombs in Hiroshima and Nagasaki, Japan in 1945 has shown interesting findings 55 to 58 years later. The researcher followed a total of 4091 (1352 men and 2739 women) people. 14.6% of them had solid thyroid nodules; 2.2% of them had malignant thyroid tumors; 4.9% of them had benign thyroid nodules, and 7.7% had thyroid cysts.

Thyroid antibody analysis showed that 28.2% had positive thyroid antibodies, 3.2% had antithyroid antibody-positive hypothyroidism and 1.2% had Graves disease (=hyperthyroidism with enlarged thyroid). There was a significant linear dose-response curve between exposure to radiation and the amount of solid nodules, malignant tumors, benign nodules and cysts that had developed over the years in the 4091 men and women.

These types of long-term follow-ups show how important it is to follow all of the exposed individuals from the Fukushima disaster.

Thyroid Cancer In Children

Thyroid Cancer In Children

Conclusion

A massive screening program covers children who had exposure to radioactive iodine in the Fukushima region. Most noteworthy, researchers are investigating nodules in the thyroid glands of children that are precursors to thyroid cancer. Specifically, physicians biopsied and resected suspicious thyroid gland areas before they developed into thyroid cancer or metastases. As a result, physicians now build on the experience of prior nuclear disasters. In essence, these would be the atom bombs in Hiroshima, Nagasaki and the nuclear accident in Chernobyl. Finally, apart from radioactive iodine researchers noted the release of other nuclear isotopes in these nuclear incidences. Maybe they have been responsible for other malignancies that have developed in children, men and women in these areas.

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Oct
03
2015

What Stress Does

I like to discuss what stress does. We all are stressed out at times. Some people are stressed all the time and this is called chronic stress.

Acute stress

Let’s say you were in a minor rear-ender accident. It is annoying, but at least you had no injury. But you have to deal with the insurance company, get the repair done and maybe get a car rental during the time of repair. Yes, you may have a few days where you feel that your hands are shaky and your heart pounds, or your sleep may not be restful. But when everything is done things are back to normal. This is an example of acute stress with a shorter running time. It has a limited severity, is an inconvenience, but it does not really affect your body on the long-term.

Chronic stress

Let’s assume the car accident was more severe and you received a personal injury with a broken leg. You end up in hospital and the orthopedic surgeon fixes the fracture with a surgical plate. The leg has to be in a cast for several weeks, and you have to use crutches. Every day you feel reminded of the car accident, because it is awkward to walk with crutches. After weeks you notice that you have gained weight. Your doctor is also worried about you because your blood pressure showed higher readings. You do not sleep as well, waking up frequently and having nightmares about another fictitious accident. On top of that you came down with the flu. What happened here? The stress reaction released cortisol, which weakened your immune system and may be responsible for catching the flu.

High blood pressure and increased alcohol consumption

On the long-term cortisol can also contribute to high blood pressure, but so can alcohol consumption. You may have increased your alcohol intake in the evening to relax more, but with the chronic stress and the cortisol increase this can cause high blood pressure. The weight gain that you noticed has to do with the fact that you cannot work out any more because of your healing leg fracture and you having to use crutches. Inadvertently you may also eat a bit more rich food; a lot of people do that as food can be used as comfort food.

Disbalance of melatonin and cortisol with stress

And why do you sleep less well? Chronic cortisol elevation leads to lower melatonin levels, as these two hormones are natural opponents. A high melatonin level leads to a low cortisol level and vice versa. With relaxation methods you can lower cortisol and the melatonin level increases normalizing your sleep. Chronically elevated cortisol can also lead to weight gain as sugar is converted into fatty acids that are stored as subcutaneous fat. Muscles can melt down when cortisol is high giving the appearance of spindly arms and legs.

Causes of chronic stress

Holmes and Rahe tested a stress scale in 1970, which has become the standard ever since. You get a certain amount of points for a stressful event, e.g. 100 for the death of a spouse; 45 point for retirement; 23 for trouble with the boss etc. Add up all of the points that are affect you right now; if the total score is less than 150 points there is only a minor risk of getting medical problems from the chronic stress; for 150 to 299 points the risk of illness is moderate and for 300 and more points you are at a significant risk for illness.

Physical illness and mental illness from stress

There is physical illness and mental illness that chronic stress can cause. Physical illness can be high blood pressure, hardening of the arteries. The long-term risks from this are possible heart attacks and strokes. But chronic adrenalin and noradrenalin elevation associated with chronic stress can burn part of your brain cells in the hippocampus and medial prefrontal cortex. This can lead to memory loss, spatial memory loss and aggression. Mental illness caused by chronic stress can be anxiety, depression, social isolation, panic attacks and panic disorder. Psychosomatic symptoms can include headaches, back pain, abdominal pain and difficulties concentrating.

Job stress and cancer

Perhaps one of the best examples of job stress and cancer is a study where the amount of breast cancer was correlated to the amount of stress. I discussed this in another blog. Briefly, women with a less responsibility had the lowest rate of breast cancer, but they too had some stress as there was a higher breast cancer risk after 15 years on the job versus only 5 years on the job. The same study showed that women with high responsibility had the highest breast cancer rates.

How stress leads to higher breast cancer rates

A hormone disbalance can explain this based on high cortisol levels associated with chronic stress. If cortisol is high, the cortisol binding globulin (CBG) increases; this in turn also binds more circulating progesterone, as progesterone attaches to CBG. CBG is a transport protein for both cortisol and progesterone. The end result is that estrogenic compounds get the upper hand, a condition called estrogen dominance. I have explained under the above link that this was the real reason for the increase in breast cancer in the stressed women. Similar mechanisms are causing other cancers to occur more frequently with chronic stress.

Chronic stress and cardiovascular disease

High stress jobs were found to cause a 2.2 to 2.4-fold increase of strokes and heart attacks due to cardiovascular disease when compared to low stress jobs. This was based on a British Medical Journal study in October 2002. As I discussed above under a brief description of chronic stress cardiovascular disease is often what develops as part of chronic stress. People who are under chronic stress feel that they do not have enough time to prepare good, healthy food at home. They tend to eat out more often. Even well educated people just swallow a quick hamburger and other processed foods.

Bad fats lead to heart attacks and stroke

This increases the bad fats like trans fats and omega-6 fatty acids in their system causing inflammation of the blood vessels as explained in this blog. The LDL cholesterol and triglycerides get elevated, sugar from sugary snacks oxidizes the LDL cholesterol and your coronary arteries and brain arteries get clogged up. This sets anybody on the downward pathway, and it is now only a matter of time when the chronically stressed person will develop a heart attack or stroke.

Chronic stress extremes: PTSD and burnout in soldiers

Dr. Thierry Hertoghe gave a lecture during the 22nd Annual World Congress on Anti-Aging Medicine in Las Vegas (Dec.10 to 14, 2014). The title was: “Burnout: A multiple hormone deficiency syndrome”. Burnout is the extreme of chronic stress. He said that burnout is a common condition where several hormones are affected, with the cortisol axis being the main one, but other hormone glands being stressed as well. As a result endocrine glands age prematurely. Symptoms are fatigue, exhaustion, gastrointestinal problems, anxiety, depression and aggressiveness. The underlying hormone abnormalities are a lack of cortisol, thyroid deficiency, growth hormone deficiency, testosterone and estrogen deficiency and oxytocin deficiency. Burnout is common in teachers and there is a questionnaire that has been developed for teachers (teacher’s burnout scale) to monitor them whether they are heading this way.

Burnout or PTSD

Soldiers who return from combative situations often suffer from burnout or from PTSD. The teacher’s burnout scale already mentioned can monitor their burnout severity. In suspected cases laboratory tests that measure hormone levels give concrete answers about hormone deficiencies. Treatment protocols were discussed in detail. Multiple bioidentical hormone replacements are necessary, possibly for prolonged periods, if not life long. In addition supportive counseling sessions from a counselor or psychiatrist will help to tone down increased brain activity and help regain the internal balance. Why is this important? It is important, because hormones are necessary on a cellular level and regulate the energy metabolism of every cell in the body. Also, by recognizing what is going on and helping the affected individuals, a lot of pain and suffering can be prevented.

Accelerated aging from telomere shortening

Chronic stress has been shown to cause telomere shortening. So does a lack of sleep (insomnia), smoking and alcohol overconsumption, all conditions that can be associated with chronic stress. What can we do about this? Learn what shortens telomeres and ultimately your life. Cut out what you can and take supplements that lengthen your telomeres.

Positive thinking combats stress

Negative thoughts are draining you of energy. You want to stay optimistic within what’s reasonable. Be thankful for all the good things in your life. Minimize what’s negative, but think about positive solutions to get rid of energy draining parts in your days. Do this persistently until it becomes part of your life and you will have extra energy that you didn’t waste in negative thinking or needless, anxious anxiety. Worrying does not get us anywhere, but it depletes our energy.

Relaxation methods counter stress

Self-hypnosis is a simple way to allow your whole body to relax. However, the various forms of yoga will do the same thing for you. Meditation is another way of finding peace and tranquility. Prayer is know to help people in sickness and in health. All of these methods will re-energize you. They calm your brain, help you to cope with stress and rebalance your hormones at the same time.

Building social ties and mutually supportive relationships will also build you up. It makes you feel that you belong, you have your place in society, you help others, and they support you.

Constant overdrive has physical consequences

We need some stress to get us going, but we do not need “distress”. Dr. Hans Selye, the father of the general adaptation syndrome due to stress, gave a lecture about this topic in Hamilton, Ont. in 1977, which I attended. I vividly remember how he projected a picture of his skeleton showing bilateral hip replacements. He said that chronic stress could lead to arthritis. In his case, he said, he had developed end stage arthritis in his hips requiring total hip replacements on both sides. To illustrate further that stress leads to physical consequences, he explained that one person may develop a heart attack, another a stroke, a third could get arthritis. Constant overdrive has physical consequences.

What Stress Does

What Stress Does

Conclusion

Stress can be deadly, particularly if it lingers on and becomes chronic. But we can reorganize our lives to minimize stress. Some people may decide to seek a less stressful occupation. Others may elect to stay at that job, but develop hobbies, learn how to relax and take relaxation classes to combat job stress. The key is to start thinking about what stress you may be under and then develop a plan to counter it so you can allow yourself to rebalance your life.

Sep
25
2015

Testosterone

One of the driving hormones in a man is testosterone. It also is known that with age testosterone levels fall. The lesser known fact is the importance of monitoring testosterone levels in aging males, so they have the choice of intervening with the aging process. Here are the facts about testosterone, about replacement of testosterone and about the anxieties of the medical profession to deal with this.

Androgen receptors contained in key tissues

Androgen receptors are situated in the key organs like the brain, heart, muscles, bones, kidneys, fat cells, genitals, hair follicles and skin. They respond to all male hormones, called androgens, like testosterone, dihydrotestosterone (DHT) and DHEA. DHT is produced by metabolizing testosterone with the help of an enzyme, called 5α-reductase in the adrenal glands. This is responsible for hair loss in males and some females. There is a genetic factor for this. It is important that the man continues to have all tissues stimulated by testosterone when he ages or the key organs mentioned are going to suffer.

A lack of testosterone as the man ages (around 55 to 65) leads to a slowdown in thinking, osteoporosis in the bones, muscle atrophy (melting in of muscle tissue), and a lack of sex drive. Mood swings can turn the male into the “grumpy old man”. The skin gets thinned and is more brittle.

Animal experiments have shown that the development of fatty streaks in blood vessels happens at a higher rate in castrated animals. The more encouraging finding in these animals is the fact that this condition is reversible by replacement of testosterone. In healthy males of a younger age all organs are working well. The problems starts when males age and the hormone regulation in the brain slows down, which ultimately leads to andropause in males, the equivalent of menopause in women. When testosterone is replaced in an aging man with low testosterone levels, the androgen receptors in key organs mentioned above are stimulated and normal organ function returns.

Reluctance of physicians to prescribe testosterone

It used to be taught to medical students that testosterone would be the cause for prostate cancer. This was based on old observations by Dr. Huggins, a Canadian born surgeon who practiced in Chicago, that orchiectomy improved the survival of advanced prostate cancer patients by a small percentage. Dr. Lee pointed out that Dr. Huggins neglected to realize that testicles make both testosterone and small amounts of estrogen.

When an orchiectomy was done (because of the belief that testosterone production was the culprit) inadvertently the real cause of prostate cancer (an estrogen surplus) was also removed thus improving the survival of these patients somewhat. Nowadays we have more sophisticated testing methods. Dr. Abraham Morgentaler (Ref. 1) has compiled a lot of evidence about the importance of testosterone in men. He proved, based on a lot more modern references that it is not testosterone that is the cause of prostate cancer. We know now that estrogen dominance is responsible for prostate cancer and that this develops as stated above because of the low testosterone and low progesterone during the male menopause (also called “andropause”). Dr. Morgentaler, a urologist from Harvard University has taken prostate cancer patients and put them on testosterone. To his and everyone else’s surprise testosterone treated prostate cancer patients improved, their prostate cancer either disappeared or become much less aggressive, which can be measured with the Gleason score based on its microscopic appearance. The result was that they did better, not worse on testosterone.

Unfortunately the history of testosterone, orchiectomy and prostate cancer as explained led to confusion among the medical profession. We now know that testosterone is innocent with respect to prostate cancer, testicular cancer or any other cancer. But some of the old-timers among the physicians doggedly hold on to their false belief from the past because they were taught this way. If a man asks one of these physicians for testosterone replacement he may not only be told that he/she could not do that, but will also receive a tirade of false statements about testosterone.

We dealt with the myth of prostate cancer that is not related to testosterone treatment. There is another myth that older physicians often cite: that testosterone would supposedly be causing blood clots. At the University of Texas Medical Branch at Galveston (Texas, USA) a large study was done involving 30,572 men, ages 40 years and older. They all had venous thromboembolism and received an anticoagulant drug or an intravascular vena cava filter following their diagnosis. They also had a low testosterone level and were given testosterone replacement therapy. They were followed and monitored for further venous thromboembolism. None were found in any of the men. The conclusion of the investigators was that filling a testosterone prescription was not associated with any clotting condition.

Aging and testosterone

The Massachusetts Male Aging Study showed that testosterone has been declining in the male population over a period of 20 years. Partially this was related to aging, but otherwise there may also be environmental factors, called estrogen-like substances or xenoestrogens, that have contributed to it as well. Although age is a factor, there is so much variation from man to man, that it is best to just measure testosterone and determine whether the total testosterone level is above or below 500 ng/dL. This seems to be the most reliable indicator in determining whether a man needs hormone replacement, apart from symptoms due to testosterone loss. These are: increased risks for prostate problems and/or cancer, cardiovascular disease, loss of bone density, a rise in cholesterol and urinary dysfunction. Dr. Randolph describes this in detail and also discusses who needs bioidentical testosterone replacement.

A New England Journal of Medicine study from September 2013 explained that apart from testosterone the male body needs a small amount of estradiol, the female hormone for normal functioning. This is achieved through the enzyme aromatase contained in fatty tissue. But testosterone replacement must be given as the bioidentical testosterone, so that a small amount of it can be converted by aromatase into estradiol. I have reviewed this in a blog entitled “The Full Story About Testosterone”.

Risk of prostate cancer

Having reviewed the hard facts about prostate cancer risk, it is now clear that older men get prostate cancer because of lowered testosterone in their blood and increased body weight, where fat converts androgens by the aromatase into estradiol; this leads to estrogen dominance. Estrogen dominance causes breast cancer and uterine cancer in women and prostate cancer in men. When the total testosterone level in a man is lower than 500 ng/dL it is a sign that he needs testosterone replacement therapy to protect his prostate from prostate cancer.

Cardiovascular disease

As the cardiovascular system has a lot of androgen receptors on its cell surfaces, it is important that the man continues to have the proper stimulus from androgenic hormones (testosterone, dihydrotestosterone and DHEA) for proper contractility of heart cells and relaxation of smooth muscle cells in the arteries to control blood pressure. With a lack of testosterone there is hardening of the arteries, loss of muscle cells in the heart muscle and increase of blood pressure. So far there is only an indication that low testosterone is associated with diabetes, high blood pressure and heart attacks. It has not been proven that it is the cause (so webmd.com says). But careful replacement with bioidentical testosterone helps patients to get rid of their symptoms, have the energy to exercise and feel better. Long-term studies have already shown that hormone replacement saves lives, but the medical profession is slow to accept this (Ref.1). Here is a link that explains this a bit further.

If a man who is low in testosterone wonders whether it would be worthwhile to go on testosterone therapy, here is the clear answer: would you like to have a 47% lowered risk of dying, a reduction of 18% in heart attacks and 30% reduction in the risk for a stroke? This is what a 14-year follow-up study published in the European Heart Journal in August, 2015 found.

The same is true for cardiovascular disease as stated above: if the total testosterone level in a man is lower than 500 ng/dL it is a sign that he needs testosterone replacement therapy to protect his cardiovascular system to prevent heart attacks and strokes.

Loss of bone density

Older men can get osteoporosis, which can lead to compression fractures in the spine and to fractures in the hip, the ankle or wrist. It is thought that with the lack of testosterone there is also a lack of estradiol via the aromatase pathway in fatty tissue. This small amount of estradiol is thought to prevent osteoporosis all his life until the testosterone drops with older age. Once again it is important to monitor his total testosterone level and replace with bioidentical testosterone when it is lower than 500 ng/dL.

Rise in cholesterol

With obesity the metabolic syndrome sets in where the LDL cholesterol is increased. This is a direct risk for hardening of the arteries. In an obese older man with low testosterone there is a double risk from the low testosterone and the metabolic syndrome. As a result the heart attack and stroke rates in obese men with low testosterone are much higher than in obese men with normal testosterone levels. Men with obesity need to lose weight by changing their diet to healthier eating habits and starting a regular exercise program with swimming and walking. At the same time those with a testosterone level of lower than 500 ng/dL should have testosterone replacement with bioidentical testosterone.

Urinary dysfunction

A hyperactive bladder, dribbling, hesitancy and leaking bladder can all be part of testosterone deficiency. But this is not that easy to diagnose. A full consultation by an urologist may be necessary to assess various other causes that could hide behind these symptoms. Part of the work-up though is to measure the total testosterone level and replace with bioidentical testosterone when it is lower than 500 ng/dL

Alzheimer’s disease

Alzheimer’s disease can be due to a lack of testosterone. It is therefore important to measure the total testosterone level in a man. If it is lower than 500 ng/dL, as mentioned before , it is a sign that he needs testosterone replacement therapy to prevent Alzheimer’s disease.

Burnout

According to Dr. Thierry Hertoghe, an endocrinologist from Belgium, there are several hormones that can be missing in a person with burnout: a lack of cortisol, thyroid, growth hormone, testosterone/estrogen, progesterone and oxytocin. The middle-aged manager with burnout would have other hormones missing apart from testosterone. This needs to be measured with blood tests. Whatever is low would have to be replaced with bioidentical hormones.

Some details regarding testosterone measurements and delivery

The deeper you delve into testosterone replacement, the more details there are to consider.

First, there is a sex hormone-binding globulin that is mostly produced by the liver and circulating in the blood.

It is like a storage form of testosterone and only 1 to 2% of the total testosterone is unbound. This is called the free or bioavailable testosterone. Some physicians measure just that portion of testosterone.

Second, when it comes to replacement of testosterone in a man who is deficient for testosterone, there are several delivery systems, which some people find a little confusing. There are testosterone gels, which are least absorbed; another application are creams which are often prepared by compounding pharmacies. These creams are usually well absorbed. But some men do not absorb either creams or gels. They need testosterone injections or testosterone pellets. The goal is to replace testosterone in a manner that there is a fairly equal amount of testosterone available at all times. Some men achieve that only with testosterone pellets, others with testosterone cypionate injections. For this reason blood test that determine the levels of free testosterone are necessary.

Testosterone

Testosterone

Conclusion

Testosterone is a key hormone in the male and needs to be monitored, particularly when he is aging. A careful history of his symptoms needs to be taken by a knowledgeable physician or naturopath. If blood tests show that the total testosterone is less than 500 ng/dL replacement with bioidentical testosterone is needed.

 

References:

Ref.1: Dr. Abraham Morgentaler: “Testosterone for Life – recharge your vitality, sex drive, and overall health” McGraw-Hill, 2009

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Sep
12
2015

Ageless Aging

We have been exposed to a lot of clichés about aging, which makes it more difficult to dispel rumors and to clearly focus on what can and what cannot postpone aging and the associated disabilities. Here I will attempt to summarize what is known about this topic.

The American Academy of Anti-Aging Medicine (also known as A4M) has published a book where all of this is discussed in detail (Ref.1). But there are yearly conferences as well in Las Vegas and other places where further details regarding anti-aging are discussed. Since 2009 I have been attending the conferences in Las Vegas regularly every year.

Based on this knowledge let me start by reviewing the tools of anti-aging that can be used to slow down the process of aging significantly.

  1. Mitochondria

At the center of anti-aging is the preservation and metabolic optimization of the mitochondria. Each of our cells contains little particles called mitochondria, which is where our energy metabolism takes place. Mitochondria function like mini-batteries.

The citric acid cycle builds up ATP, which is subsequently hydrolyzed into ADP and orthophosphate releasing energy for cell metabolism.

Old people who shuffle when they walk and have difficulties climbing stairs have lost significant amounts of mitochondria and simply run out of energy. The key to prevent this from happening is to preserve our mitochondria. We inherited them from our mother, because only the head of the sperm, which does not contain mitochondria entered the ovum when the egg cell that was destined to become you was fertilized. Subsequently the mitochondria from mother’s egg have provided all of the mitochondria in the cells of our body.

  1. Preserving mitochondria

There are supplements that specifically preserve mitochondria: PQQ (=Pyrroloquinoline quinone) helps mitochondria to multiply. A typical dose to take every day is 20 mg. Mitochondrial aging is slowed down by ubiquinol (=Co-Q-10, 400 mg per day is a dose that I recommend). Co-Q-10 repairs DNA damage to your mitochondria.

There are simple lifestyle changes that you can make: eat less calories as this will stimulate SIRT1 genes, which in turn stimulate your cell metabolism including the mitochondria.

Resveratrol, the supplement from red grape skin can also stimulate your mitochondria metabolism. 300 to 500 mg of trans-Resveratrol once daily is a good dose.

Build in regular exercise into your day – and I mean every day– as this will also stimulate your mitochondria to multiply similar to the effects of PQQ. Lipoic acid is an anti-oxidant that counters the slow-down of mitochondrial metabolism. I recommend 300 mg per day.

L-arginine is an amino acid that is a precursor of nitric oxide (NO). Red beet is a rich source of nitric oxide, which is directly released into your system. There are also commercial products for NO. This keeps the arteries open, prevents high blood pressure and also hardening of the arteries and has a direct effect on preserving mitochondria.

Researchers from the McKusick-Nathans Institute of Genetic Medicine of the Johns Hopkins University School of Medicine in Baltimore, MD found that mitochondrial DNA content varies according to age (less mitochondrial DNA in older age), sex (yes, women have more than men) and mitochondrial DNA; it even has an inverse relationship to frailty and a direct relationship to life expectancy. This paper was published in February of 2015.

Each mitochondrion has its own mitochondrial DNA contained in 2 to 10 small circular chromosomes that regulate the 37 genes necessary for normal mitochondrial function.

In multi ethnic groups it was apparent that mitochondrial DNA content was dictated by the age of a person.

Frailty was defined as a person who had aging symptoms including weakness, a lack of energy compared to the past, activity levels that were much lower than before and loss of weight. When persons with frailty as defined by these criteria were identified, they were found to have 9% less mitochondrial DNA than nonfrail study participants.

Another subgroup were white participants; when their bottom mitochondrial DNA content was compared to the top mitochondrial DNA content, the researchers found that frailty was 31% more common in the bottom DNA content group. This means that white people are more prone to frailty and they should take steps early on to prevent this from happening.

  1. Slowing down hardening of our arteries

It makes sense that young people who do not have signs of hardening of their arteries have better blood supply to their cells and thus supply their mitochondria with more oxygen and nutrients than frail, older people. The same is true for people who exercise regularly.

Vitamin D and vitamin K2 have been shown to lower calcium in the blood vessels and to retain calcium in the bone preventing osteoporosis. This is particularly useful in postmenopausal women. This October 2014 publication mentions that apart from vitamin D and vitamin K2 resveratrol and inositol are additional factors helping to prevent heart disease and osteoporosis.

This September 2013 publication confirms that a deficiency for vitamin K2 is common in the general population. This deficiency leads to osteoporosis and calcification of the arterial wall and causes heart attacks, strokes and bone fractures. Supplementation with vitamin K2 at 200 micrograms per day every day is recommended to prevent this from occurring.

  1. Sugar and starchy foods

You need to understand that starchy foods equal sugar, once digested. As a result a refined cereal breakfast=sugar, pasta=sugar, bread=sugar, donuts=sugar, potatoes=sugar and so on. It has to do with the glycemic load. When you cut out sugar and starchy foods (meaning that the glycemic index of the foods you eat is below 50) you will shed 30 to 50 pounds of weight within 3 to 5 months, if you are overweight or obese. You will feel a lot more energy. Your blood vessels will be cleaned out as the oxidized LDL cholesterol will disappear and the HDL cholesterol will mop up what cholesterol deposits were there before.

It is certainly good for you, if you are not into the sugar and candy stuff, but the seemingly harmless pizza and all the other starchy foods mentioned above are of concern as well. All of the high -glycemic carbs stimulate the pancreas to produce insulin. This in turn produces inflammation in tissues including the brain. Alzheimer’s disease is one of the complications of this.

Where does this leave us? For decades we have been told that saturated fats and cholesterol in our diet were the culprits and we replaced them with sugar that is part of a low-fat diet. We need to pay attention to the glycemic index and cut out high glycemic foods. However, it is OK to eat some carbs from the medium glycemic food list and most of our carbs from the low glycemic food list. With regard to fat it is important to consume only the healthy fats like olive oil, coconut oil and omega-3 fatty acids. As you make these adjustments to your life style you will also prevent many cancers, as you normalize the body’s metabolism and help prevent chronic inflammation, which can cause arthritis and cancer. Finally, pay attention to stress management. The body and the mind work together. Uncontrolled stress leads to heart attacks and strokes.

  1. Cut down on processed foods

Processed foods contain the wrong type of vegetable oils that are composed of omega-6 fatty acids. This disbalances the ratio of omega-6 fatty acid versus omega-3 fatty acids. This is typical for all the processed foods, but also fast food places in the industrialized world. The consequence of this disbalance is the formation of arachidonic acid and inflammation of tissues. This causes high blood pressure from inflammation of the arteries, arthritis from inflammation in the joints and can irritate the immune system to the point of causing autoimmune diseases. The end result after decades of exposure to a surplus of omega-6 fatty acids are disabilities from end stage arthritis, as well as heart attacks and strokes from inflammation of the arteries due to the hardening of the arteries.

The remedy for this is to cut out all processed food and stick to the basics of preparing your own food from healthy ingredients with no food preservatives.

Use olive oil for salads and coconut oil for cooking. Take omega-3 supplements to restore the omega-6/omega-3 fatty acid balance.

  1. Replace hormones with bioidentical ones

When I watch postmenopausal women, many look prematurely aged with sagging skin in their faces. Had they replaced their missing hormones when they entered menopause, the bioidentical hormones used for replacement therapy would have helped their skin to remain younger looking, hardening of the arteries would have been postponed and osteoporosis in the bones would also have been prevented.

With men it is now known that testosterone is vital for prevention of prostate cancer, but it is also important to prevent heart attacks, strokes and dementia as they age.

I would recommend that you see a naturopath or an anti-aging physician to have your hormones checked and if necessary start replacement with bioidentical hormones.

Ageless Aging

Ageless Aging

Conclusion

Slowing down aging and avoiding disabilities from aging are now a possibility, if we manage our lives in a way that the biochemistry of our bodies remains the same and our mitochondria continue to function, even when we get older. I discussed the details of how to do that above. I have also written a book on the subject of anti-aging, which deals with these topics in more detail.

I hope that you incorporate at least some of these steps in your life to prevent suffering from disabilities as you age and to avoid premature aging.

References:

Ref.1: Ronald Klatz, MD, DO and Robert Goldman, MD, PhD, DO, FAASP, Executive Editors: “Encyclopedia of Clinical Anti-Aging Medicine & Regenerative Biomedical Technologies”. American Academy of Anti-Aging Medicine, Chicago, IL, USA, 2012.

Aug
14
2015

Intramuscular Stimulation For Muscle Pain

Dr. Gunn was working for the Workers’ Compensation Board of BC, Vancouver/BC in the 1970’s when he encountered a number of patients with chronic muscle spasm from work injuries. Being confronted with these difficult to solve pain issues he developed a hybrid of Chinese acupuncture and trigger point injections, called intramuscular stimulation or dry needling in 1973. Instead of hitting acupuncture points as is done with traditional Chinese acupuncture he concentrated on finding out where the trigger points were, and he needled them. This often elongated the chronically shortened muscles, alleviating or eliminating chronic pain. A trigger point is a focus point located within the muscle that has created the chronic pain. According to Dr. Gunn chronic muscle pain is a form of neuropathic pain. It means that there is an irritation in the junction of the nerve that controls the contraction of a muscle and the muscle itself. The physician or trained therapist feels the trigger point as a tender point and slightly lumpy sensation within the affected muscle and places an acupuncture needle right into it. Gentle manipulation of the fine acupuncture needle helps the irritation to gradually settle down. Typically it takes 4 to 6 visits, 1 week apart for one area with chronic pain to settle down.

Here is another site that explains intramuscular stimulation.

In the US IMS may be more known under the term “dry needling”, but the method is the same.

Trigger point injection

In Germany the Huneke bothers, two general physicians who took an interest in pain medicine developed what is now known as trigger point injections or neural therapy in 1928. Dr. Peter Dosch wrote a Manuel of Neural Therapy according to Huneke (Ref.1). It is interesting that the 11th edition of Dr. Dosch’s book is the first English edition. Essentially in this treatment modality for pain relief trigger points are identified and a local anesthetic (either Procaine or Xylocaine) is injected using a thin needle. I have used this method clinically in thousands of patients in my practice for over 16 years for back pain, neck pain, migraines and various localized pain issues involving muscle spasm. Sometimes scars from abdominal or other surgery can become a focus of irritation of nearby muscles, and freezing the trigger points in the irritated scars can suddenly relieve these painful muscle spasms. This happens so fast, literally within seconds, so the Huneke bothers called this “Sekunden-Phänomen”, which translates into “phenomenon of seconds”. Neural therapy or trigger point injections are quite commonplace now in pain centers. In the mid eighties it was not that well known among physicians. But since then anesthetists have incorporated trigger point injections into treatments at pain clinics. Unfortunately they often use Marcaine now, but Marcaine has been found to shorten telomeres, so Procaine or Xylocaine, which do not have a negative effect on telomeres, should replace Marcaine.

Here is a video how trigger point injections are done in the clinic.

Criticism of IMS and trigger point injections

There have been several critical reviews comparing dry needling (IMS) versus trigger point injection with local anesthetics. Some reviews find that IMS is giving more relief at a faster pace, but others say that trigger point injections with local anesthetics are less painful. All seem to agree that there is a place for both methods in myofascial pain. The initial criticism of a few conventional doctors that these methods would be “bogus” have been dispelled by the identification of trigger points on high-resolution ultrasound images (see next subheading) and also by clinical results, which stand for themselves.

A new look at trigger points

From the beginning conventional medicine has been fighting the existence of trigger points as an entity, so it was important to show that trigger points actually exist. To that end ultrasound investigations were done on patients, which confirmed trigger points as a small focus within the muscle.

Here is an article that states that with a high-resolution ultrasound it has been possible to locate trigger points within muscles and you can click on the image on the right side to see where the arrow points to.

Here is another view of a trigger point on a high-resolution ultrasound.

The theory is that these trigger points fire pain signals that are going up the dorsal spine and are perceived as pain in the thalamus and the cerebral pain centers. This is automatically switched to the motor neurons that will contract the muscles around where the trigger points are located in an attempt to “protect the muscle from getting injured”. This pathological reflex is what the pain specialist is attempting to interrupt by either dry needling (IMS) or using trigger point injections with local anesthetics.

Migraine headaches

One of the rewarding treatments for the therapist who does trigger point injections with local anesthetics is treating migraine patients. There are 6 nerve points that are injected with a local anesthetic: two supraorbital nerve exits; two infraorbital nerve exits and two greater occipital nerve exits.

I was amazed how quickly the patients with migraines responded to this; in several hundred patients about 60 to 70% had a complete response of relief from their migraines and another 10 to 15% had a partial response. Apart from directly helping patients with trigger point injections for migraines the doctor should do hormone tests. This is particularly important in women where estrogen levels need to be balanced with progesterone levels. In pre- and postmenopausal women missing progesterone hormone levels can cause estrogen dominance, which are frequently the cause for migraines.

Stretches to prevent trigger point development

It is well known that in order to prevent muscle injuries one should do frequent stretches. This is particularly important for any desk worker or for people doing a lot of work on computers. We tend to hold our head bent forward, which is hard on the muscles in the back of the head, the neck muscles and the shoulder muscles. The counter remedy is to engage these muscles by stretching them as shown in this link.

Why IMS (dry needling) and trigger point injections are helping patients with pain

According to the gate control theory of chronic pain it is possible to block a pain sensation that is generated through transmission in one nerve by creating a competing nerve impulse, in this case dry needling of injection with a local anesthetic (trigger point injection).

Once the pain sensation has been modified, the pain is diminished and stays diminished; in many cases, when switches are reset, the pain is gone. This is the principle behind the success of these procedures.

Prolotherapy and IMS

Prolotherapy is also a method that can be helpful for control of chronic pain. In cases that respond to prolotherapy often an area of the body that has lax ligaments or lax joint capsules is affected with chronic pain. By injecting sterile hyperosmolar dextrose solution with or without local anesthetic the ligaments or joint capsules are tightened up the way they used to be in the past. This allows the surrounding muscles that were in spasm and had trigger points in them to relax more and the pain is diminished or cured. Two to four such injections may be required for a successful treatment. The method can also be combined with stem cells and platelet rich plasma treatments to get higher healing results. The remaining milder pain can be treated with IMS (dry needling) to resolve any residual pain.

Conventional medicine approach

Conventional medicine does not have much to offer for pain control. When something is identified where surgery might be successful, this is often pursued, but the chronic pain may just get worse. In these cases of chronic pain often conventional treatment methods have nothing to offer. The patient is then told that the pain would be treated symptomatically with morphine tablets or injections or other similar prescription narcotic drugs such as codeine (e.g. Tylenol #3), hydrocodone (e.g. Vicodin) or oxycodone. However, this creates a new set of problems. Side effects such as drowsiness and impaired judgment can occur, and the patient is cautioned not operate a motor vehicle or other machinery. Even a seemingly harmless glass of wine in addition to the medication can cause severe impairment to the patient. Constipation is a well known side effect of pain medications, which can lead to impaction, where old, hardened stool forms a huge plug. Often these cases find themselves on the way to the emergency room to get relief. In addition there is nausea or vomiting, which can lead to dehydration and electrolyte imbalance. When you finally decide to get off narcotics you can have withdrawal symptoms.

Intramuscular Stimulation For Muscle Pain

Intramuscular Stimulation For Muscle Pain

Conclusion

Chronic pain associated with the musculoskeletal system can be caused by a variety of conditions. But the end result is often that trigger points develop, which set up pathological pain feedback arcs that perpetuate the effects of trigger points and the associated muscle spasm in the affected area. Fortunately in the last few decades alternative methods for pain control have been developed like IMS (dry needling), trigger point injections and prolotherapy. Many patients have experienced relief or even cures from their chronic pain. Chronic back pains, shoulder pains and migraines seem to all respond to these methods. Even scar-associated pains can be relieved. If you have chronic pain, search for alternatives: see a naturopath or an anesthetist who specializes in pain issues. Often physiotherapists have taken special training in IMS and can offer this service to the public. Any of these methods are better than depending on chronic narcotic drug administration.

 

References:

  1. Peter Dosch, MD: “Manual of Neural Therapy according to Huneke”,  Haug Publishers, Heidelberg, 1984 (eleventh revised edition, first English edition).

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Jun
20
2015

Seventeen Causes Of Blood Vessel Disease

We tend to ask the question: “What is the cause of blood vessel disease”? Would you have expected that at this point there are not just one cause, but seventeen causes of blood vessel disease identified that can all be treated? In the May 2015 issue of the Life Extension Magazine one of the causes, high homocysteine has been stressed as being an important risk factor that not every health professional has yet appreciated.

In the following overview I will briefly address all of the risk factors for cardiovascular disease and then summarize what can be done to prevent heart attacks and strokes.

1. Excess cholesterol: Too much cholesterol can lead to clogged arteries. When we eat too much red meat too often, this extra dietary cholesterol can elevate your total blood cholesterol.

2. High LDL cholesterol: The LDL cholesterol is often labeled the “bad cholesterol”. In reality it is the cholesterol that is being transported from the liver to all of the body cells, which utilize it to replace the aging membranes that envelop the cells. What is important to know is that sugar and starchy foods (pasta, cakes, cookies, noodles, white rice, potatoes, pizza, muffins etc.) lead to a surge of blood sugar, which stimulates the liver to produce more LDL cholesterol. Any excess sugar in the blood will oxidize the LDL cholesterol, which leads to accelerated hardening of the arteries.

3. Low HDL cholesterol: HDL is the type of cholesterol that is transported from the cells back to the liver. Any oxidized LDL cholesterol is also mopped up by HDL cholesterol. HDL cholesterol has been dubbed the “good cholesterol”. It is important that LDL and HDL cholesterol are balanced. It is noteworthy that HDL cholesterol is much higher in athletes and those who exercise on a regular basis (like 5 to 7 times per week). This means that there is a surplus of the protective HDL cholesterol, which prevents hardening of the arteries.

4. Oxidized LDL: As explained above sugar and starchy foods oxidize cholesterol, so does radiation. A Mediterranean diet including olive oil will stabilize your metabolism and protect LDL from being oxidized.

5. High blood sugar: In pre-diabetes and diabetes, the blood sugars are high, but they are normal in people with a normal metabolism. As explained before it is this scenario, which leads to oxidation of LDL cholesterol and accelerated hardening of arteries. This is the reason why diabetics have severe blood vessel disease with closure of major arteries like the one going to the legs. If arterial by-pass surgery is not feasible because of the severity, often a physician has no other choice but to amputate a lower leg.

6. Excess triglycerides: People with excessive weight have a change in metabolism called metabolic syndrome, where triglycerides are high. But diabetics also often have high triglyceride levels in their blood. This is an independent risk factor to develop hardening of the arteries.

7. Elevated C-reactive protein: Dr. Paul Ridker published a landmark study in 2002 where he concluded that the blood test C-reactive protein was a reliable indicator to identify people who were at risk of developing heart attack. It measures inflammation in the body. What is inflamed here is the lining of the arteries from oxidized LDL cholesterol. I hope you see a pattern. Some of these points are actually connected.

8. Low blood EPA/DHA: Essential fatty acids are not contained in processed foods. Instead the food industry puts omega-6-fatty acids into processed foods, as this is much cheaper and leads to a longer shelf life of the processed food products. Omega-6 fatty acids are the precursor for arachidonic acid, which causes inflammation, hardening of the arteries and arthritis. By introducing fish oil or wild salmon two or three times per week you can achieve a counter balance to omega-6-fatty acids. Our bodies want us to balance omega-6 fatty acids with omega-3.

9. Excess insulin: with type 2 diabetes there is a high fasting insulin level. This leads to inflammation of the blood vessel wall and triggers accelerated hardening of the arteries. It also causes the brain arteries to get narrowed, and as a result the brain develops Alzheimer’s and dementia. Alzheimer’s is now called “type 3 diabetes”. An overweight or obese person who cuts out sugar in the diet and exercises can often control excessive weight, lower insulin and normalize cognitive deficits.

10. Excess fibrinogen: Blood clotting factors are manufactured in your liver and this is balanced by fibrinolytic factors that circulate in the blood. In certain conditions like diabetes, or the metabolic syndrome too much fibrinogen is produced. This can lead to blood clots.

11. Excess homocysteine: Some people are born with gene defects that program our cells to run abnormal biochemical reactions in our cells. Correct methylation pathways are important for normal cell function. However, if there is a methylation defect, abnormalities set in and homocysteine accumulates. As we age, there is also a weakening of certain enzymes that are involved in the methylation pathway. With any of these enzyme defects you need to use appropriate supplements to normalize this metabolic defect. Vitamin B2, B6 and B12 supplementation will often stabilize methylation defects and homocysteine levels return to normal. Methyl folate 1 mg per day is also very useful. Some people in older age cannot metabolize folate very well. This is important as severe, familial cardiovascular disease, where people often suffer heart attacks during the best years in their lives, can be postponed this way by several years or decades.

12. High blood pressure: Many people are not aware that high blood pressure is a disease where the linings of the arteries are inflamed and there is too little production of nitric oxide. Nitric oxide is a signaling substance contained in many vegetables, particularly in red beets. Nitric oxide is the body’s tool to keep blood pressure normal by widening the diameter of arteries. High blood pressure leads to accelerated hardening of the arteries, because the oxidized LDL cholesterol gets deposited right under the diseased lining of the arteries. Just lowering the blood pressure with medications will not remove the other risk factors; they have to be addressed separately. The DASH diet has been developed to assist in lowering elevated blood pressure.

13. Low nitric oxide: Too much sugar and starch in one’s diet cause oxidation of LDL cholesterol as explained and this causes a dysfunction of the lining of the arteries resulting in less production of NO (nitric oxide). The lack of nitric oxide causes constriction in the arteries throughout the body, which will in turn elevate the blood pressure. Exercise will also lead to more nitric oxide production, but the right diet is the other factor. There is a supplement you can buy, called NEO-40 (one or two per day can be taken as a supplement, available on Amazon in the US, in health food stores in Canada). But make no mistake: it’s not about supplements; it is about the proper diet and lifestyle!

14. Vitamin D3 deficiency: I have blogged about the importance of vitamin D3 before. Vitamin D3 is now considered to be a hormone, as all cells have receptors for this molecule. It has anti-inflammatory qualities. It helps in the prevention of heart attacks and strokes.

15. Low vitamin K2: In this blog I have explained that vitamin K2 and vitamin D3 co-operate in removing calcium from the blood and transporting it into the bone. This way they both help in the prevention of osteoporosis. A co-factor in the prevention of osteoporosis is estrogen in women and testosterone in men.

16. Low free testosterone: Low free testosterone has been established as an independent risk factor for heart attacks and strokes. In the man there are a lot of testosterone receptors located in the heart and in the brain; this explains why with a lack of testosterone there is not only erectile dysfunction, but also the risk of developing a heart attack or a stroke.

17. Excess estrogen: When a women approaches menopause, her menstrual cycles can become irregular due to the fact that there are anovulatory cycles, and the progesterone production is starting to slow down. This hormonal state is called estrogen dominance, because estrogen dominates over progesterone. In other words, the ratio of progesterone over estrogen is less than 200 to 1 (progesterone/estrogen ratio) when saliva hormone levels are measured. This is a risk factor for hardening of the arteries. In males with a “beer belly” there is too much estrogen floating around due to an enzyme in fatty tissue, called aromatase. This enzyme manufactures estrogen out of testosterone and contributes along with other factors to causing heart attacks in that scenario.

How can we protect ourselves from these factors?

As already indicated above, there are lifestyle issues that need to be addressed as follows.

  1. First adopt a healthy diet, such as the Mediterranean diet, which includes olive oil. No sugar, no bread, pasta, potatoes, and go extremely easy on certain fruit that is high in sugar, such as dried fruit, mango, bananas and grapes, because we do not want to oxidize our LDL cholesterol for reasons explained already.
  2. Exercise regularly. If you like, go to a gym (my wife and I do this regularly). If you are insecure, ask a trainer initially to guide you through the exercise equipment. It really is not that difficult to do. You develop a routine that is good for you. Alternatively, you may want to go for a brisk walk, run or participate in dancing. If you get easily bored, rotate the activities, but do not skip days, let alone weeks! Remember that your heart works 24/7!
  3. Take some vitamins and supplements: Vitamin B2, B6, B12 and methyl folate were mentioned before. Take vitamin D3 in a good dose like 5000 IU per day or more and vitamin K2 200 micrograms per day. Omega-3 supplements (EPA/DHA) are very useful to keep inflammation under control. For more on vitamins and supplements follow this link.
  1. Have your hormones checked. Some doctors do not feel comfortable about this; maybe you want to see a naturopath about it instead. Your body needs the hormone receptors satisfied by adequate bioidentical hormone levels; otherwise you age prematurely and give up body functions that you would rather keep. Normal hormone levels prevent osteoporosis, premature hardening of the arteries, Alzheimer’s, erectile dysfunction and premature wrinkles.
Seventeen Causes Of Blood Vessel Disease

Seventeen Causes Of Blood Vessel Disease

Conclusion

All of these 17 factors explained above are independent risk factors for developing hardening of the arteries, which affect mainly the heart, brain and kidneys. All you need is one of these factors, and you could develop a heart attack, stroke or kidney failure. You have no problem accepting a preventative maintenance program for your car. Think of having appropriate tests at least once a year done through your doctor. There are blood tests available to monitor hormone and vitamin levels, as well as C-reactive protein and homocysteine levels. Here are also three tests that will assess your heart function.

Your doctor may not order the tests spontaneously. Ask for it!

More info about heart attack prevention: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/prevention-heart-attack/

More info about stroke prevention: http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/stroke-prevention/

More on arteriosclerosis (blood vessel disease):http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/

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