Oct
05
2019

Breast Cancer Risk Persists After Hormone Replacement Therapy

New research showed that the breast cancer risk persists after hormone replacement therapy (HRT). This is described in this CNN article. It is common knowledge for some time that female patients who use synthetic hormones as hormone replacement in menopause, have a 1.6-fold to 1.8-fold risk to develop breast cancer. However, since the abrupt ending of the Women’s Health Initiative (WHI) in 2002 the truth about the risks of HRT became known and made HRT more confusing. After all, in this trial they wanted to show once and for all that HRT would be beneficial. The expectation was that HRT would prevent osteoporosis, heart attacks and breast cancer. But the results were quite different. Instead the study found a 41% increase in strokes, 29% increase in heart attacks, 26% increase in breast cancer, 22% increase in total cardiovascular disease and a doubling in the risk for blood clots.

Missing information about synthetic hormones

What the authors of the study did not explain was the fact that it was the properties of the synthetic hormones, progestagen and Premarin, that were responsible for the negative effects. Had researchers insisted to perform the study with bioidentical hormones, the results would have been quite the opposite! With bioidentical hormone replacement we see the prevention of heart attacks and clots; cancer rates are lower than controls, and the prevention of osteoporosis is another benefit. The end result is a reduction in mortality rates. These horrifying results from the use of synthetic hormones still frighten many women. This is particularly so when it comes to replacing hormones after menopause.

Breast cancer risk study with HRT in more details

The research study described in the CNN article is based on this comprehensive Lancet study. The researchers did a Meta analysis of 58 prospective studies. Unfortunately all the hormones given were synthetic hormones (not bioidentical ones) that had the same configuration as in the WHI. On average women became menopausal at age 50. This is when the physicians commenced HRT. The prospective follow-up showed that 108,647 postmenopausal women developed breast cancer around the age of 65. 55,575 women (51%) had used HRT. Postmenopausal women who used estrogen/progestagen combinations during years 1–4 had a relative risk of 1.60-fold to develop breast cancer. This risk increased during years 5–14 after exposure to estrogen/progestagen with a relative risk of 2.08-fold to develop breast cancer. 

More details about breast cancer risks

The risk of developing breast cancer was lower when women took estrogen only as a form of HRT. For years 1-4 the relative breast cancer risk for patients on estrogen alone was only 1.17-fold. Regarding years 5-14 with estrogen-alone replacement the breast cancer risk was 1.33-fold.

Women of average weight who started their HRT of estrogen/progestagen pills at age 50 with menopause one woman in 50 users developed breast cancer between the ages of 50 and 69. In women who used estrogen regularly, but progestagen only irregularly, one in 70 users developed breast cancer. For estrogen only users one in every 200 women developed breast cancer.

Discussion of the above results

Dr. Wright and Dr. John Lee have pointed out years ago that there are alternatives to taking synthetic hormones as HRT. Taking oral synthetic hormone preparations is problematical. First, the pharmaceutical company attached chemical side chains to the synthetic hormones. The women’s estrogen receptors recognize the synthetic hormones only partially. Hormone researchers developed progestagen to mimic a woman’s progesterone. But it turns out that the estrogen receptors read progestagens like an estrogen. This is the reason why there are higher breast cancer rates with the combination of estrogen/progestagen than estrogen alone. Secondly, there is a problem of estrogen dominance, which causes a higher likelihood that the patient develops breast cancer or heart attacks.

Avoiding estrogen dominance reduces breast cancer risk

If estrogen is balanced with progesterone, the cancer promoting effect of estrogen is counterbalanced, and the women on bioidentical hormone replacement are protected from the serious side effects women of the WHI had to endure.

Bioidentical estrogen applications are available through creams that women apply to the skin. This avoids the problem of the first-pass effect; if estrogens are absorbed from a pill in the gut they have to pass through the liver, which is the organ that metabolizes them.

Bioidentical hormone replacement as an alternative to HRT

In Europe there has been a strong resistance to using synthetic hormones. As a result long-term studies were able to show that there is no danger when bioidentical hormone replacements therapy uses creams that are applied to the skin or intravaginally. This avoids the first-pass effect in the liver, as is the case with synthetic estrogens and progestagens taken orally as pills.

John Lee stated that physicians should measure hormones and identify those women who are truly hormone deficient. These are the ones who need hormone replacement. However, physicians should use only bioidentical hormones in a hormone replacement therapy. And they should also replace only as much as necessary to normalize the hormone levels. This is also the level where postmenopausal symptoms disappear. Dr. Lee noted: “A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes or heart attacks”.

How is bioidentical hormone replacement done?

The best method is usually a bioidentical hormone cream application to the forearms or to the chest wall once per day. A woman on bioidentical hormone replacement applies bioidentical Bi-Est cream and progesterone cream to the skin of her forearms or chest wall. The hormones get directly absorbed into the blood stream and can do their job without interference. The treating physician can prescribe different amounts of the bioidentical hormones depending on saliva tests or blood tests. 1 or 2 months later repeat blood or saliva tests can follow to verify that the amounts of the replacement hormones and their absorption are adequate for the patient’s need.

Difficulties to measure progesterone levels

Dr. David Zava, PhD gave a talk on breast cancer risks. This was a presentation at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. Dr. Zava, who runs the ZRT laboratory, spent some time to explain how to measure progesterone in a physiological way.

Blood (serum) progesterone levels do not adequately reflect what the hormone tissue level is like in a woman’s breasts. On the other hand saliva hormone levels are giving an accurate account of what breast tissue levels are like.

Progesterone blood levels versus progesterone tissues levels

Dr. Zava gave an example of a woman who received an application of 30 mg of topical progesterone. Next, laboratory tests observed hourly progesterone levels in serum and saliva. The serum progesterone levels remained at around 2 ng/ml, while the saliva progesterone levels peaked 3 to 5 hours after the application. It reached 16 ng/ml in saliva, which also represents the breast tissue progesterone level. Dr. Zava said that the important lesson to learn from this is not to trust blood progesterone levels. Too many physicians fall into this trap and order too much progesterone cream based on a misleading low blood test. This leads to overdosing progesterone. With salivary progesterone levels it is possible to see the physiological tissue levels, which is impossible with blood tests. Dr. Zava emphasized that testing blood or urine as progesterone hormone tests will underestimate bio-potency and lead to overdosing the patient.

Breast Cancer Risk Persists After Hormone Replacement Therapy

Breast Cancer Risk Persists After Hormone Replacement Therapy

Conclusion

A new Meta analysis of 58 prospective studies with a large amount of participants showed that standard hormone replacement therapy (HRT) for postmenopausal women causes breast cancer. Postmenopausal women who used estrogen/progestagen combinations during years 1–4 after menopause had a relative risk of 1.60-fold to develop breast cancer. This risk increased during years 5–14 after exposure to estrogen/progestagen with a relative risk of 2.08-fold to develop breast cancer. Unfortunately all of the patients had received the standard Premarin estrogen and synthetic progestagen combination. The body’s estrogen receptors read both of these synthetic hormones as estrogen, which led to estrogen dominance. Estrogen dominance (with missing natural progesterone) is known to cause breast cancer.

Comments and discussion of bioidentical hormone replacement (BHRT)

I have explained in my comment that the investigators should have used bioidentical hormone replacement therapy (BHRT) instead of making a similar mistake as in the Women’s Health Initiative, where synthetic hormones caused cancer, heart attacks and blood clots.

Bioidentical hormone replacement is started with progesterone creams first in order to avoid estrogen dominance. After hormone tests estrogen is gradually introduced as Bi-Est cream applied to the skin and balanced with the progesterone. The physician orders blood estrogen levels and progesterone saliva hormone tests from time to time to monitor the hormone levels. No cancer occurs with bioidentical hormone replacement. It also protects from osteoporosis, heart attacks and strokes.

Part of this blog was published here before.

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Aug
03
2019

The Best Ways To Prevent Cancer

Cancer is the second leading cause of death, that’s why it is important to learn about the best ways to prevent cancer. Generally speaking you want to remove cancer-producing substances (carcinogens) from your diet. But diet is only part of your lifestyle that can contribute to cancer. I shall list some of the more important dietary factors below and briefly touch on important other factors.

Avoid burning your meat

When you use the BBQ, you should avoid burning your meat. Even though the marks of “charring” are considered desirable on meat from the grill, this is really burnt! As a matter of fact it is a lot better to use a slow cooker at low heat and simply cook your food longer. This way you don’t create carcinogens. Avoiding to burn your meat is particularly important for the red meats.

Sugar and an overabundance of starchy foods can cause cancer

You never thought that sugar and an overabundance of starchy foods could cause cancer, but they do. The reason is that the metabolism of cancer cells is using 10- to 12-times more sugar than the metabolism of normal cells. The worst thing a cancer patient can do is to over-consume sugar. Replace sugar by stevia, which is a harmless, plant-based sweetener and does not lead to an insulin reaction. Avoid all other sugar substitutes, as there are other heath problems with most of them.

Avoid phthalates

Those who have a craving for macaroni and cheese are out of luck. This food contains phthalates that are part of the ingredients of almost every sample of cheese powder used to manufacture macaroni and cheese. Phthalates can cause infertility and breast cancer. So you must definitely avoid macaroni and cheese, at least the stuff from the box. Prepare your own!

A high fat diet

What does a high fat diet do? It increases the risk for breast cancer. But it can also increase colorectal cancer risk. Limit your fat intake to about 10% of saturated fat. That is the recommendation of the FDA. Increase your consumption of fish and seafood. Only one proviso: predator fish like shark, marlin, tilefish, swordfish and grouper are high in mercury. But wild salmon, sardines and oysters are low in mercury. You can also enjoy shrimps and prawns.

Take high dose vitamin D3 supplements

High dose vitamin D3 supplements help you to avoid cancer. There are strong statistics showing that vitamin D3 is a powerful tool to lower your risk of developing cancer. Your family doctor should take a blood test called 25-hydroxy vitamin D level to make sure that you absorb enough vitamin D3. There are slow and fast absorbers and the only thing to know how well your gut absorbs vitamin D3 is in doing this blood test.

Also, curcumin (turmeric) 500 mg once per day is good for cancer prevention.

Take enough fiber

Make sure you take enough fiber, which does not only reduce colorectal cancer, but also many other cancers. When you eat plant-based food, you automatically get fiber in it. North Americans are not consuming enough fiber in their diet.

Avoid processed meat and too much red meat consumption

Processed meat and red meat cause cancer.

Beef, lamb and pork seem to contribute to causing cancer according to the WHO. Use common sense and eat fish, chicken and turkey. Reduce your beef consumption. My grandmother served beef as a Sunday dish.The rest of the week simple, plant-based foods appeared on the table. Ask your grandmother, what she used to cook. Or ask your mother what she ate as a child.

Eat moderate amounts of fruit and vegetables

The claim that fruit and vegetables would protect you from cancer is not as solid as researchers thought of in the past. Newer research has shown that a basic intake of fruit and vegetables is needed for nutrients, but consuming more than that will NOT protect you from cancer.

This link explains that eating more vegetables or fruit beyond a certain point will not do harm, but will not protect you further from cancer.

Drink green tea or black tea

If you like tea, drink green tea or black tea. Sweeten it with stevia, but not with sugar. Tea has been shown to have cancer prevention properties.

Avoid alcohol consumption to prevent cancer.

Coffee is a healthy drink and it has mild anti-cancer effects as well. It does not matter whether you drink it caffeinated or decaffeinated.

Other lifestyle issues

Quit smoking

If you are still smoking, quit smoking! Smoking is by and large the biggest risk for developing lung cancer, throat cancer, esophageal cancer and pancreatic cancer.

Watch your calorie intake

Eat smaller meals more often. This way the production of your digestive juices will consume some calories. In addition your taste buds are satisfied, so your hunger for food is more controlled. The end result is that you will not gain weight.

Prevent obesity and type 2 diabetes

This will help prevent obesity and type 2 diabetes, both of which are established risk factors to develop cancer. Here is a review that shows you, which cancer types are caused by obesity. With regard to diabetes, there is a strong association to developing liver cancer, pancreatic cancer and endometrial cancer (=uterine cancer). There is a lesser risk (only 1.2 to 1.5-fold) to develop cancer of the colon and rectum, breast cancer and bladder cancer.

Pollution

Poor air quality with pollution can also be a factor in causing cancer. Pollution does not stay local, but travels through the stratosphere around the globe. The result is that now 10 to 15% of lung cancer in the US occurs in patients who never smoked. This translates into 16,000 to 24,000 deaths annually of never-smokers in the US. In certain cities such as Beijing lung cancer rates have doubled in 9 years between 2002 and 2011. Lung cancer in non-smokers can be caused from exposure to radon, to second-hand tobacco smoke, and other indoor air pollutants.

Bioidentical hormone replacement

When males do not replace missing testosterone in andropause they are much more prone to develop prostate cancer. Similarly, when women are menopausal and do not get progesterone supplementation, they develop a higher amount of breast cancer due to estrogen dominance. It follows from this that bioidentical hormone replacement in menopause and andropause will help to prevent prostate cancer and breast cancer.

The Best Ways To Prevent Cancer

The Best Ways To Prevent Cancer

Conclusion

There is strong evidence that certain foods can cause cancer. Other foods including supplements like curcumin and vitamin D3 can help prevent cancer. Basically, you want to avoid all that is known to cause cancer and eat more of the healthy foods that do not cause cancer. This will help to decline your cancer risk. I suggest that in addition you should quit smoking, avoid pollution as much as possible, reduce excessive alcohol intake and watch your calorie intake. By doing this you prevent obesity and type 2 diabetes, and you will move into the low-risk cancer group. We all need to work on this on an ongoing basis.

Practical hints regarding the best ways to prevent cancer

The best ways to prevent cancer is to avoid processed red meat and all other processed foods. Eat more vegetables, fruit, wild salmon and other seafood. Don’t eat red meat more often than once a week and make it red meat from grass fed animals. In addition exercise regularly, get enough sleep and practice some form of relaxation (yoga, Tai Chi, self-hypnosis etc.). This lifestyle will not only prevent heart attacks and strokes, but also the majority of cancers.

Previously published here.

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Mar
02
2019

Exercise For Different Age Groups

In a health article CNN reported about exercise for different age groups.

Exercise has profound positive effects on the body. First it strengthens the lungs and the heart. Secondly, it conditions your muscles. Thirdly, exercise can protect you from chronic diseases like heart disease, type 2 diabetes and many cancers. Each age group needs different exercises, as follows.

Growing up years

During childhood exercise helps to grow healthy bones, regulate weight and build up self-confidence. In addition the child sleeps better, when exercise is part of the course of the day. Children should try out various sports. They should learn how to swim and how to handle a ball. They should also play in playgrounds together with other kids. Several studies have shown that during the teen years exercise levels decline steadily, particularly for girls. Especially during the teen years regular exercise builds a healthy body image and helps adolescents to manage stress and anxiety. Parents should encourage teens to keep one team sport regularly. For those who are not into team sports, swimming and any kind of sport is a good substitute.

Exercise for different age groups: in your twenties

In your mid twenties you are at the highest performance level in your life. You have the fastest reaction time and your heart pump capacity is the highest. Exercise physiologists measure this by an expression, called VO2 max. This value decreases each year by 1%. Your reaction time also decreases every year. The good news is that you can slow down the decline by exercising regularly for the rest of your life. If you train your body regularly during this time, your lean body mass will be preserved and your bone density will stay dense until your later years. To make it more interesting, vary your training with various sports.

If you are a regular exerciser, talk to a trainer about interval training, which intermittently pushes your exercise limit to the maximum. This type of training releases human growth hormone from your pituitary gland. The effect of this is that you increase your stamina and endurance. It also builds up lean muscle mass, decreases body fat content and provides you with more energy.

Exercise for different age groups: in your thirties

Family life and stress at the job can be a reason that you forget about exercise. But right now there is a particular need to maintain a regular exercise program. You may want to get up early, work out at a gym and go to work from there.

Some employers encourage those who work at a desk to get up every 30 minutes and have a brief exercise break for only 2 or 3 minutes. There are computer programs that show you what to do and all you have to do is copy what you see on the screen. Keep good posture while you sit. When you need a rest room break, you may decide to use the rest room downstairs. This gets you to climb some stairs and use the muscles that were resting when sitting at the desk.

As already outlined for those in the twenties, high-intensity interval training is a tool where you can exercise for only 20 minutes intensely. You do a burst of maximum exercise that brings you up to 80% of your maximum heart rate. This can be done cycling or sprinting and is alternated with low intensity exercise.

Women should do Kegel exercises (pelvic contractions) following labor to prevent incontinence.

Change exercises around to keep them interesting.

Exercise for different age groups: in your forties

This is the time when a lot of people put on extra weight. Resistance training is a way to counteract this by burning fat and preventing the loss of 3-8% of muscle mass per decade. As this link shows, 10 weeks of resistance training increases muscle mass by 3 pounds (1.4kg), increases the resting metabolic rate by 7% and decreases fat by 4 pounds (1.8kg). Exercise machines in gyms or Pilates equipment in Pilates centers will give you this type of training.

Exercise for different age groups: in your fifties

Many people develop joint aches when they are fifty and older. Also, chronic diseases like heart disease, type 2 diabetes and others are starting to get more frequent. In postmenopausal women, where estrogen is on the decline, heart disease is getting more common. Bioidentical hormone replacement can reverse these problems. Strength training twice a week will counter muscle loss that you would get otherwise without any regular exercises. Do weight-bearing exercises like a fast walk where you breathe a bit faster and where you break out into a sweat. This will make your bones and muscles stronger and prevent osteoporosis. Tai Chi, yoga and Pilates are all exercises suitable for this age group.

Exercise for different age groups: in your sixties

This age group is characterized by the fact that multimorbidity is getting more prevalent. People often have mental and physical illnesses. Or they have diabetes and heart disease. They often are on multiple drugs for various conditions. Aging is also a strong risk factor for developing many cancers. But regular exercise can prevent many cancers. For instance post-menopausal breast cancer, colon cancer and cancer of the womb are cancers that can be prevented to a certain extent with regular exercise. Heart disease and type 2 diabetes will also largely improve with regular exercise.

Physical exercise tends to decline in this age group for various reasons. Some reasons are obesity, various diseases that make individuals more sessile and general disability. It is important to resist this trend as much as possible. Take ballroom dance lessons and join the dancing community. Any other dance type (Latin, Bachata, Salsa, Kizomba, Argentine dancing etc.) is good exercise and enjoyable as well. It is a fun way to socialize and exercise at the same time. Aqua-aerobics is a great way to keep your joints and muscles in good shape. People with arthritis will tolerate this. Use brisk walking to maintain your cardiovascular fitness. Do strength and flexibility exercises twice per week to maintain your muscle mass and your balance.

Exercise for different age groups: in your seventies and beyond

Frailty and falls are common in the 70’s and 80’s. Many fractures are happening needlessly. Keep exercising regularly and your muscles will be strong enough to prevent falls. Walk and talk with friends instead of sitting around a table. It is good for your friends to walk as well. If you have several chronic conditions, talk to a physiotherapist or exercise professional what type of exercises you should do. You need some strength, balance and cardiovascular exercises. Enlist the help of a trainer. Sustained exercise is what benefits you most. Think of brisk walks, swimming and aqua-exercises.

Exercise For Different Age Groups

Exercise For Different Age Groups

Conclusion

We are born to stay active. Movement is life. As long as we live, we need to do regular exercise. This way a lot of chronic diseases will be prevented and even many cancers as well. I have summarized that for different age groups there are different activities that are appropriate. But the key in all age groups is to move and keep your lean muscle mass from shrinking. As explained, this will automatically make you also lose a few pounds. Strength exercises (also called resistance exercises) are the key to achieving this. When you get older, you are not exempt from exercising. Now even more than before your well being depends on exercising regularly. You want to prevent osteoporosis, falls and fractures. You want to avoid chronic diseases, heart disease and diabetes, and exercise is one valuable key to achieve this.

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Feb
02
2019

Hormones Helping In Menopause

Dr. Filomena Trindade presented a talk about hormones helping in menopause. This talk was part the 26th Anti-Aging Conference of the American Academy of Anti-Aging Medicine in Las Vegas from December 13 to 15, 2018. The exact title of her talk was “Women and cognition: insulin, menopause and Alzheimer’s”. Above the age of 80 Alzheimer’s disease in women becomes much more common compared to men. PET scans of the brain of postmenopausal women in comparison to PET scans of premenopausal women, often show more than 30% slow down of metabolism after menopause. Literature regarding that finding showed that it was mostly the decline in ovarian estrogen production that was responsible for the slow down in brain metabolism. Other factors that lead to Alzheimer’s disease are central adiposity (abdominal) and inflammation in the body.

Brain insulin resistance and Alzheimer’s

Older women with Alzheimer’s have more IGF-1 resistance and IGF-1 dysfunction. Other studies showed that minimal cognitive impairment (MCI) progressing into Alzheimer’s disease (AD) might be due to type-2 diabetes. One of the studies stated the following:

“We conclude that the term type 3 diabetes accurately reflects the fact that AD represents a form of diabetes that selectively involves the brain and has molecular and biochemical features that overlap with both type 1 DM and type 2 DM.“

Another publication said that type 3 DM is a neuroendocrine disorder that represents the progression of type 2 DM to Alzheimer’s disease.

Dr. Trindade presented several hormone studies in postmenopausal women who started to develop Alzheimer’s disease. Older women with existing Alzheimer’s did not respond to estrogen hormone replacement. They did not recover with regard to their memory loss. However, younger women who just entered menopause responded well to estrogen hormone replacement and many recovered from their memory loss.

Hormone changes in menopause

There are a number of hormones that experience changes with the onset of menopause. Estrogen production ceases in the ovaries. The production of progesterone in the ovaries also ends. In addition thyroid and adrenal gland hormone production decreases. Often insulin production is increased, but insulin resistance is present at the same time.

Stress can interfere with progesterone and aldosterone production as pregnenolone is the same precursor molecule for both hormones.

How stress interferes with Selye’s general adaptation syndrome

Stage 1 of Selye’s adaptation syndrome, called arousal, involves elevation of cortisol and DHEA. When stress is over, the patient recovers on his/her own.

Stage 2 is the adaptation stage, where cortisol is chronically elevated, but DHEA is declining. The patient feels stressed, has anxiety attacks and may experience mood swings and depressions.

Stage 3 is the exhaustion stage. The underlying cause of this stage is adrenal insufficiency. Both cortisol and DHEA blood levels are low. Patients often suffer from depression and chronic fatigue.

Other hormones and menopause

DHEA and cortisol (stress) have the same precursor (pregnenolone). This means that when a patient is stressed, DHEA production tends to suffer as most of the pregnenolone is used for the production of cortisol.

Dr. Trindade spent some time explaining the complicated details of thyroid hormones during menopause. In essence stress can interfere with the normal metabolism of thyroid hormones with respect to T3, T4 and reverse T3. The end result is that not enough functioning thyroid hormones are present and hypothyroidism may develop.

Both estrogen and progesterone are lower in menopause. In a longitudinal French study with over 80,000 postmenopausal patients the women that received replacement with bioidentical progesterone and estrogen did the best in terms of low Alzheimer’s rates and lower heart attack rates. You achieve optimal Alzheimer’s prevention best starting hormone replacement at the time when menopause starts. You need both estrogen to control hot flashes and to give you strong bones, and progesterone for preservation of your brain, your hair growth and a good complexion.

Hormones Helping In Menopause

Hormones Helping In Menopause

Conclusion

Hormones are missing in menopause and this becomes the starting point for many postmenopausal complaints of patients. The sooner the physician does blood tests to diagnose hormone deficiencies, the better. Various studies showed that the best result in terms of Alzheimer’s prevention is possible, when estrogen and bioidentical progesterone are replaced right at the beginning of menopause. This approach prevents neuroinflammation. There are no extracellular beta amyloid protein deposits and no intracellular tau protein deposits that typically are present with Alzheimer’s disease. In addition the cardiovascular system stays healthier for longer. It contributes to preventing heart attacks and strokes. A longitudinal French study with over 80,000 women who have received treatment with a combination of estrogen and bioidentical progesterone have excellent survival data. The women also enjoy excellent mental health, no cardiovascular complications and less cancer than controls without hormone treatment.

 

Nov
03
2018

When you are sleepless

You are not alone when you are sleepless. Insomnia is a widespread problem in society.

Previous review of the topic of insomnia

I have reviewed the topic of insomnia before in a blog.

Briefly I pointed out that in some people there is a mutation of the gene that controls the circadian sleep rhythm. It is called the CRY1mutation. Some people have sleep disturbances from working night shifts. I mentioned the blue light of electronics that is produced by the TV screens or computer screens. The more you are exposed to it, the more it stimulates the brain to produce serotonin. This undermines the melatonin production, and as a result the person finds it extremely difficult to fall asleep. Children playing with i-phones, tablets or watching children’s programs on television can have sleep disturbances from the blue light. Blue has the frequency that over stimulates the brain and interferes with melatonin production. Drug and alcohol abuse can also interfere with the normal circadian sleep rhythm and cause insomnia.

Hormone factors of insomnia

For natural sleep to occur, we need melatonin which the pineal gland releases in the evening. It initiates and maintains sleep during the night. The natural opponent of melatonin is cortisol, the stress hormone, from the adrenal glands. Both hormones need to be in balance to allow you to sleep normally. Shortly before we wake up in the morning melatonin production goes down and cortisol production is up. Cortisol levels are low at night and high during the day. So it is cortisol that keeps us going throughout the day. But an excess of cortisol from chronic stress can also interfere with falling asleep and sleeping through the night.

Stress and insomnia

When we feel stressed, cortisol production goes way up. This has consequences regarding our sleep pattern. It can interfere with falling asleep, causes us to wake up from a deep sleep in the middle of the night and can give us problems falling asleep again. Chronic stress exposure leads to high cortisol production by the adrenal glands, which in turn will lower melatonin and cause sleep disturbances. Older people (above the age of 50) have very little melatonin production left, as there is an age-related decline of melatonin production. The melatonin production is highest in younger years and lowest in older age.

What to do when you are sleepless

There are several over-the-counter remedies, which in combination can be quite effective.

Melatonin for when you are sleepless

Melatonin (3 mg at bedtime) is a good start to see what it does for your sleeplessness. Taking a small amount of melatonin at bedtime we can re-establish the balance between cortisol and melatonin, which helps the circadian hormone rhythm and sleep pattern to come back. Some people wake up in the middle of the night and find it difficult to fall asleep again. If this happens at 3 AM, a good remedy at this time is to take another 3 mg of melatonin. Melatonin stays in the system for about 4 hours. Light during the day de-activates the effect, when light hits the retinas upon opening your eyes. You should not exceed 6 mg of total melatonin overnight. Otherwise it will interfere with the balance of cortisol and melatonin, lowering cortisol levels, which would rob you of energy during the day.

Phosphorylated serine (Seriphos)

A supplement that is freely available in the US (but not in Canada) consists of a simple amino acid. As this link shows (second item in the link) phosphorylated serine Seriphos) helps to down-regulate cortisol levels (lowering them). This means that melatonin gets the upper hand and you can sleep again.

The dosage for phosphorylated serine (Seriphos) varies from person to person, but will be in the range of 1000 mg to 3000 mg in the evening. After about 30 days the circadian rhythm may have recovered and you can stop the Seriphos. A one-day pause is required once a month for resetting the hormone receptors. Should you still have problems sleeping, you can continue with it for another month and pause again for a day. Seriphos has very few side effects.

Valerian root capsules

Another useful sleep aid is valerian root (as capsules). 500 mg to 1000 mg will help you to relax. It does not have the side effect of feeling groggy the next morning.

Other considerations when you are sleepless

Hormone problems like thyroid abnormalities (too much or too little thyroid hormones) are issues that your doctor has to investigate. Women in menopause often have sleep disturbances due to a lack of estrogen and progesterone. A knowledgeable healthcare professional is able to take care of that by prescribing bioidentical hormone creams.

When men approach andropause (the equivalent of menopause in women), they lose testosterone production. This can cause insomnia. The doctor can verify the hormone loss by a blood test. Replacement with either bioidentical testosterone cream or injections will rebalance testosterone levels. Insomnia may disappear. It is essential not to overdose testosterone, as this can also cause insomnia.

Sleep lab for when you are sleepless

When home remedies do not help, it may be time to check into one of the sleep labs to diagnose the kind of sleep disorder you are suffering from. Here is an overview what is happening there.

Essentially you get hooked up to monitors and are encouraged to just sleep as you would normally do. The physician in charge of the lab will later explain to you what the monitors showed, and tell you what type of sleep. According to the findings your doctor will recommend what measures are appropriate to remedy the situation.

Treatment for insomnia when over-the-counter remedies fail

Short acting benzodiazepams

When anxiety is not a problem, but only insomnia is (falling asleep or staying asleep) lorazepam 1 mg (Ativan) or temazepam 10 mg (Restoril) are shorter acting benzodiazepams that will help. It is not a permanent but a short “emergency break” for intermittent use, so that the GABA benzodiazepine receptors have time to recover. Otherwise, with continuous use tolerance would set in. This means higher and higher doses of the sleep medication would be necessary to achieve the same effect. Another non-benzodiazepine is Zolpidem 5 mg (Ambien). Even though this medication is not a benzodiazepine, it works on stimulating the same GABA benzodiazepine receptors.

Longer acting benzodiazepams combined with antidepressant Trazodone

For several years the combination of a small amount of the longer acting benzodiazepams, clonazepam (Rivotril) at 0.5 mg combined with a small amount of the anti-depressant trazodone (Oleptro or Desyrel) at 50 mg at bedtime has been has been in use quite successfully.

But there is a concern of drowsiness caused by Rivotril as this link shows.

Trazodone, which is an antidepressant has a sleep cycle restoring effect at low doses and has less side effects, because it is used at ¼ the dose for a full-blown depression. Males are often complaining that it reduces their sex drive, and it may cause erectile dysfunction.

Clonazepam side effects

Rivotril was originally in use to control epileptic seizures and anxiety. The combination therapy for sleep disorders uses Rivotril at ¼ of the regular dose. Although it is good as a sleep aid, it has a long half-life and stays in the system well into the next day. This may present as sleepiness and cause falls in elderly patients because of clouded attention. Replacement by one of the medium long acting benzodiazepams could be the solution. A drug pause for 1 day will help to reset the GABA benzodiazepine receptors and prevent tolerance from happening. Knowing all those effects and side effects it is wiser to reserve the use of these medication strictly when everything else has failed!

When you are sleepless

When you are sleepless

Conclusion

As I mentioned before, you are not alone when you are sleepless. Insomnia can present as having problems to fall asleep, but it may present in others as a problem in the middle of the night waking up and having problems going back to sleep again.

I described non-conventional methods to help you to sleep using melatonin, Seriphos and valerian root capsules. If this fails, a sleep lab investigation may be necessary to get to the bottom of your insomnia problem. Physicians often prescribe short acting benzodiazepams like lorazepam (Ativan) and temazepam 10 mg (Restoril).

Other possibilities to treat insomnia

There are other possibilities to treat insomnia, with a combination of a low-dose antidepressant (trazodone, brand name Oleptro in the US) and low-dose anti-seizure and anti-anxiety drug clonazepam (Klonopin or Rivotril). Anxiety can often be a big component in insomnia and this treats both. On the other hand, anxiety is a separate problem, which needs professional treatment. There can be side effects of sleepiness from clonazepam and men complain of a lack of sex drive and erectile dysfunction from trazodone. Help is available when you are sleepless. But you need professional help to work on the problem and find the solution.

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Dec
23
2017

Birth Control Pill Increases The Risk Of Breast Cancer

A recent study showed that the birth control pill increases the risk of breast cancer. This publication did research on 1.8 million of women of Denmark who took various forms of contemporary birth control pills (BCP). They were under the age of 50 and the observation of the participants continued for about 11 years.

Risks for breast cancer

When a woman took the BCP for less than one year, the risk of developing breast cancer was 9% higher compared to controls. But this rate increased even more to 38% after the use of the BCP for over 10 years. Women who had used progestin only intrauterine devices had a risk of 21% to develop breast cancer. It did not make a difference whether the BCP was a mix of estrogen and progestin or progestin. Researchers expressed the risk in the following fashion:

  • Less than one-year exposure to BCP: a 1.09-fold risk to develop breast cancer
  • Over 10-years use of BCP: a 1.38% risk to develop breast cancer
  • IUD with progestin in uterus: a 1.21% risk to develop breast cancer

Strokes and Heart attacks from the BCP

At the 86th Annual Meeting of the Endocrine Society in New Orleans/Louisiana a Canadian delegation presented this data. They had done a meta-analysis of 14 trials regarding side effects of the birth control pill (BCP). These women had taken the BCP on a prolonged basis (Ref. 1). The researchers monitored the risk of heart attacks and strokes. They found an association with the prolonged use of the low dose estrogen BCP. Researchers examined all of the studies between 1980 and October of 2002. 14 independent studies qualified for the meta-analysis.

Metaanalysis of BCP caused heart attacks and strokes

The strength of such a meta-analysis lies in the pooling of data and the fact that the data comes from a much larger patient population, which generally makes the results more reliable. Dr. J. Baillargeon from the Centre Hospitalier Universitaire in Sherbrooke, Quebec/Canada, stated that they found a

  • 85-fold risk for developing heart attacks with long-term use of the BCP and at the same time there was a risk of
  • 54-fold of hemorrhagic strokes with long-term use of the low-dose BCP.

It is important that women who contemplate going on the BCP know not only about the dangers of developing breast cancer, but also about the dangers of heart attacks and hemorrhagic strokes.

Lessons learnt from the Women’s Health Initiative

The Women’s Health Initiative in 2002 showed that women who were on Premarin and progestin for hormone replacement in menopause came down with breast cancer, heart attacks, stroke, and thromboembolic events. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127562/

They were using the synthetic hormones, namely conjugated equine estrogen and medroxyprogesterone acetate. The reason these women had to suffer these side effects was because their physicians insisted on using “pure hormones that a drug company had manufactured”. But these synthetic hormones were not pure hormones; they were hormones adulterated with side chains so that pharmaceutical companies could patent them.

Misfit of synthetic hormones with hormone receptors

These side chains made the synthetic hormones not fit the body’s hormone receptors. And this is the reason why the synthetic hormones created chaos in the body with breast cancer, strokes and heart attacks. In essence the mix of conjugated equine estrogen and the medroxyprogesterone were functioning like estrogens. So, there was an overdose of estrogenic hormones when taking these hormones and this use resulted in the development of breast cancer, heart attacks and strokes. The BCP is very similar to these hormones that are in the medication for hormone replacement therapy in menopause, but the hormone dosage in the BCP is much lower.

Other high-risk settings for women taking the BCP

There are other higher risk subpopulations of women who should avoid the BCP:

  • Had 1st degree relative with breast cancer on one breast :5-fold relative risk ; there is a genetic reason for breast cancer here
  • 1st degree relative with breast cancer on both breasts : 9.5-fold relative risk ; genetic risk more obvious.
  • No relative, but patient had history of breast cancer : 4-fold relative risk ;
  • First child born later than 30 years of age : 1.9-fold relative risk ; in comparison with a woman who has her first child prior to age 20
  • If woman consumes 3 oz. of alcohol per day : 2-fold risk; in comparison with woman not using alcohol or BCP
  • Prior radiation for Hodgkin’s disease (age 10 to 19) : 10- to 75-fold risk; radiation exposure during time of breast development leads to an enormous risk ratio about 15 years later

Mechanism of the BCP

The BCP or OC (oral contraception) utilizes the fact that ovulation (=release of a fertile egg) requires a complex interaction between hormones to occur. The gonadotropin hormones LH and FSH from the pituitary gland must stimulate the ovaries. The right mixture of estrogen and progesterone from the ovaries achieves this. Without that proper hormonal interaction ovulation will not take place leading to an infertile cycle. With contraception scientists were able to suppress ovulation for as long as patients are taking the birth control pill regularly. By giving a small amount of estrogen and progesterone like substance (called “progestin”) in the oral contraceptive form (the birth control pill) ovulation stops, the lining of the uterine cavity becomes stable through estrogen, and the mucous plug in the cervical canal thickens, making it much more difficult for sperm to enter.

Estrogen dominance from the BCP

The Women’s Health Initiative has taught physicians a tough lesson: you cannot mess with nature’s hormones or else you create a risk of strokes (41%), heart attacks (29% more), blood clots (twice as many), breast cancer (26% more), colorectal cancer (37% more) and the patient will have a higher risk for Alzheimer’s disease (76% more often). This was a trial involving over 16,000 postmenopausal women.

Although the hormones used in these women were slightly different in concentration, structurally they were very similar to the ones used for birth control purposes. What nature seems to tell us is that you cannot mess with hormone receptors, or you set up the body for one of the diseases mentioned.

Hormonal disruption

The truth is that the combination of  synthetic estrogen-like and progesterone-like substances  in the BCP are not bio-identical hormones. They suppress ovulation, which means they are creating progesterone deficiency in the woman who takes these synthetic hormones. The end result is that physicians create estrogen dominance in these women, which according to Dr. Lee is the reason for the above listed complications (Ref.2).

It makes more sense to use less invasive alternatives for birth control methods instead of the BCP. A well-fitted IUD (inserted by a gynecologist) is a good alternative. This will not create havoc with the woman’s hormones and will not create infertility after contraception is no longer needed. Bio-identical progesterone replacement using creams is being used to rebalance the original hormones when the BCP is discontinued.

Birth Control Pill Increases The Risk Of Breast Cancer

Birth Control Pill Increases The Risk Of Breast Cancer

Conclusion

The birth control pill (BCP) is a popular form of contraception. But there are significant risks of breast cancer, heart attacks and strokes associated with its use. According to the previous literature the risk of complications associated with the BCP was between 1.3- and 1.6-fold. The present study with smaller concentrations of hormones in the more modern BCP still showed a risk of 1.38-fold regarding breast cancer. It did not mention heart attacks and strokes as additional risk factors. The Danish study was supported by a grant from the Novo Nordisk Foundation. Novo Nordisk is a major producer of BCP’s in Europe and in the world. It would be in their interest to minimize the risks associated with the BCP. Any woman using the BCP should use it only as long as she really needs it. Ultimately she would be better advised to use alternatives like IUD’s and condoms.

References

  1. https://www.askdrray.com/birth-control-pill-increases-strokes-and-heart-attacks/
  2. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. Page 360 to 374 explains xenohormones.

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Oct
21
2017

Bioidentical Hormone Replacement

Recently Medical News Today published an article on bioidentical hormone replacement in the Sept. 19, 2017 edition.

Although it was partially informative, I felt that there was an underlying bias against the use of bioidentical hormone replacement. The article made it sound as if hormone replacement therapy would not be safe. But the opposite is true with bioidentical hormone replacement.

Why are many women afraid of bioidentical hormone replacement?

At the time when there was a lot of confusion about hormone replacement therapy (HRT) the results of the Women’s Health Initiative (WHI) made it even more confusing. After all there was one trial to show once and for all that HRT would be beneficial. The expectation was that HRT prevents osteoporosis, heart attacks and breast cancer. But the results were quite different. Instead the study found a 41% increase in strokes, 29% increase in heart attacks, 26% increase in breast cancer, 22% increase in total cardiovascular disease and a doubling in the risk for blood clots.

Missing information about synthetic hormones

What the authors of the study did not explain was the fact that it was the properties of the synthetic hormones, progestin and Premarin were responsible for the negative effects. Had research insisted to perform the study with bioidentical hormones, the results would have been quite the opposite! With bioidentical hormone replacement we see the prevention of heart attacks and clots; cancer rates are lower than controls, and the prevention of osteoporosis is another benefit. The end result is a reduction in mortality rates. But the horrifying results that are due to the use of synthetic hormones and that the WHI warned about linger on in the minds of many women.

The use of bioidentical hormone replacement

Dr. John Lee pointed out in several of his books that the physician should only replace hormone loss with bioidentical hormones. He also pointed out that physicians should only replace those hormones that are at low levels or missing. This means that the woman should have confirmatory blood tests like FSH, LH, blood estrogen and salivary progesterone. If estrogen and progesterone are missing, the physician usually starts the woman on progesterone cream first. After two months, when laboratory tests show a saturation with progesterone , the addition of estrogen can follow, typically as the Bi-Est cream. This is a mix of estriol and estradiol.

Caution to balance against estrogen dominance

Progesterone is started first to balance against the potential cancer-inducing effect of estradiol. With the addition of progesterone a balance is the result, and estrogen will not cause breast cancer. This is also why Bi-Est is used: it is a mix of estriol and estradiol. Estriol is neutral with regard to causing breast cancer. Estradiol is the main natural estrogen in a woman, so some of it is necessary to make the woman feel normal. This is how the body receptors are functioning. But estradiol alone, when not in balance with progesterone, can cause breast cancer and uterine cancer.

The key is that only women who need bioidentical hormones should receive it. There are some women whose blood tests do not show a lack of estrogen, but only a lack of progesterone. These women should receive replacement with bioidentical progesterone to re-establish the hormone balance between estradiol and progesterone.

Safety of bioidentical hormone replacement products

As I have mentioned before, the Women’s Health Initiative in 2002 showed that on Premarin and progestin, two synthetic hormone products women came down with breast cancer, heart attacks, stroke, and thromboembolic events. They were using the synthetic drugs, namely conjugated equine estrogen and medroxyprogesterone acetate. The reason these women had to suffer these side effects was because their physicians insisted in using “pure hormones that a drug company had manufactured”. But these synthetic hormones were not pure hormones; they were adulterated with side chains so that pharmaceutical companies could patent them. These side chains made the synthetic hormones not fit the body’s hormone receptors. And this is the reason why the synthetic hormones created chaos in form of breast cancer, strokes and heart attacks.

Women’s Health Initiative authors whitewashed study results

Instead of admitting their mistakes, the full truth never became public. Instead the authors of the WHI study stated that it would be necessary to limit hormone replacement in menopause to the minimum amount of synthetic hormones to control symptoms, and their use should not exceed more than 5 years. These authors never distinguished between bioidentical hormones that fit the body’s hormone receptors and the synthetic hormones that irritated or blocked the body’s hormone receptors. There are thousands of women in Europe who have been on bioidentical hormones for decades, and they are doing just fine!

Bioidentical hormones in balance have no side effects

The truth is that bioidentical hormones –as long as they are kept in balance-do not have any side effects. Bioidentical hormones are the same that a woman produces in her ovaries before menopause sets in. The production of her bioidentical hormones kept her healthy. But the treating physician needs to carefully watch the balance of the hormones in the woman who is replaced with bioidentical estrogen and progesterone. This means that she needs to get enough progesterone to counterbalance estrogen stimulation. Hormones are constantly changing and if you don’t measure them, you don’t know what you are dealing with.

Dr. Lee said to measure hormone levels

John Lee showed a long time ago that you should measure hormones and identify those women who are truly hormone deficient. These are the ones who need hormone replacement. However, physicians should use only bioidentical hormones to replace what is missing. And they should also replace only as much as necessary to normalize the levels. This is also the level where postmenopausal symptoms disappear. Dr. Lee noted: “A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes or heart attacks”.

How is bioidentical hormone replacement done?

The best method is usually a bioidentical hormone cream application to the forearms or to the chest wall once per day. This avoids the first-pass metabolism where the hormones, if absorbed from a pill in the gut have to pass through the liver. Part of the hormones can get metabolized and some of the hormone effect may disappear. By applying bioidentical Bi-Est cream and progesterone cream to the skin, the hormones get directly absorbed into the blood stream and can do their job without interference. The treating physician can prescribe different amounts of the bioidentical hormones depending on saliva tests or blood tests. 1 or 2 months later repeat blood or saliva tests can follow to verify that the amounts of the replacement hormones and their absorption are adequate for the patient’s need.

What are the side effects of bioidentical hormone replacement?

Normally, when estrogen and progesterone are in balance, there should be no side effect. However, in the beginning of replacement therapy sometimes one of the hormones gets too high. If this happens with estrogen replacement, the woman becomes estrogen-dominant. She would experience symptoms of bloating, fatigue, weight gain, depression, headaches, loss of sex drive. She can also develop uterine fibroids, endometriosis and hypothyroidism. It was Dr. John Lee who first described this (Ref.1). There can also be mood swings, craving for sweets, irritability, and sluggishness in the morning. The key is to cut back on the estrogen dosage; alternatively, if progesterone is low in saliva tests, this hormone may need an increase, which would rebalance estrogen. At the end of fine-tuning of bioidentical hormone replacement the woman will feel normal and have no negative side effects, but the process of fine-tuning may take several months.

Difficulties to measure progesterone levels

Dr. David Zava, PhD gave a talk on breast cancer risks. This was a presentation at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. Dr. Zava, who runs the ZRT laboratory spent some time to explain how to measure progesterone in a physiological way.

Blood (serum) progesterone levels do not adequately reflect what the hormone tissue level is like in a woman’s breasts. On the other hand saliva hormone levels are giving an accurate account of what breast tissue levels are like.

Progesterone blood levels versus progesterone tissues levels

Dr. Zava gave an example of a woman who received an application of 30 mg of topical progesterone. Next, laboratory tests observed hourly progesterone levels in the serum and in the saliva. The serum progesterone levels remained at around 2 ng/ml, while the saliva progesterone levels peaked 3 to 5 hours after the application. It reached 16 ng/ml in saliva, which also represents the breast tissue progesterone level. Dr. Zava said that the important lesson to learn from this is not to trust blood progesterone levels. Too many physicians fall into this trap and order too much progesterone cream based on a misleading blood test. This leads to overdosing progesterone. With salivary progesterone levels you see the physiological tissue levels, with blood tests you don’t. Dr. Zava emphasized that testing blood or urine as progesterone hormone tests will underestimate bio-potency and lead to overdosing the patient.

Bioidentical Hormone Replacement

Bioidentical Hormone Replacement

Conclusion

Bioidentical hormone replacement, properly done, does not cause cancer, does not cause blood clots and prevents heart attacks and strokes. It also prevents osteoporosis and the associated fractures in older women. The key is that the natural hormones fit the body’s own hormone receptors. The reason why menopausal symptoms appear is that natural hormones (estrogen and progesterone) are missing. Physicians treated patients with synthetic hormones during the Women’s Health Initiative. In contrast, hormone replacement for missing hormones in a menopausal woman with bioidentical hormones  has no side effect. Contrary to the Women’s Health Initiative in 2002 there are no breast cancers, no heart attacks and no strokes with bioidentical hormone replacement. What is even better is that these women will live without all the postmenopausal problems, and their life expectancy will be about 10 years longer than without bioidentical hormone replacement.

References

Ref. 1. Dr. John R. Lee: “What your doctor may not tell you about menopause: the breakthrough book on natural hormone balance”. Sept. 2004.

Apr
08
2017

Breast Cancer Risks

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

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

In the following I am summarizing Dr. Zava’s talk with regard to the essential messages, but leave away much of the highly technical detail of the presentation. This would dilute the message of this blog. I will include a few links for those who wish to read more details about the topic.

Balance between estrogen and progesterone

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

This is a dangerous hormone disbalance, because the breast ducts experience a growth stimulus, but the modifying, calming effect of progesterone is missing. Mixed into this is that the stress hormone, cortisol also can make the effect of estrogen worse. On the other hand Dr. Zava showed slides from studies documenting replacement of missing progesterone with a skin progesterone cream (percutaneous bioidentical progesterone cream).

Progesterone concentration in breast lumps after progesterone cream applications

Plasma and breast tissue concentration of progesterone were measured in 40 premenstrual women. The diagnoses were breast lumps and the physicians arranged surgery for them. One group received progesterone cream treatment for 10 to 13 days; the other group was the placebo group. At the time of surgery the plasma (blood) values of progesterone were the same, but progesterone levels in breast tissue were more than 100-fold higher than the values from the placebo group who had received a neutral skin cream. The same experiment also showed that progesterone reduced the number of proliferating epithelial cells (experimental progesterone group). Estrogen on the other hand led to an increase of the number of proliferating epithelial cells (placebo group).

Progesterone cream applied to breasts of premenopausal women

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

How to measure progesterone levels

Dr. Zava who runs the ZRT laboratory spent some time to explain how to measure progesterone in a physiological way. He said that these experiments and others that he also projected tell a clear story. Blood (serum) progesterone levels do not adequately reflect what tissue levels in a woman’s breasts are. On the other hand saliva hormone levels do give an accurate account of what breast tissue levels are like. A woman received 30 mg of topical progesterone application. She then had hourly progesterone levels in the serum and in the saliva done. The serum progesterone levels remained at around 2 ng/ml, while the saliva progesterone levels peaked 3 to 5 hours after the application. It reached 16 ng/ml in saliva, which also represents the breast tissue progesterone level.

Blood progesterone levels are unreliable

As a result, Dr. Zava said that the important lesson to learn from this is not to trust blood progesterone levels. Too many physicians fall into this trap and order too much progesterone cream, which leads to overdosing progesterone. In contrast, with salivary progesterone levels you see the physiological tissue levels, with blood tests you don’t. Dr. Zava said: avoid using venipuncture blood or urine in an attempt to interpret hormone test levels, as you will underestimate bio-potency and overdose the patient.

Historical failure of estrogen replacement therapy (ERT)

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

Researchers prematurely terminated Women’s Health initiative

The WHI ended suddenly in July 2002. The authors stated: “The overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2 year follow-up among healthy postmenopausal US women.” The study found a 41% increase in strokes, 29% increase in heart attacks, 26% increase in breast cancer, 22% increase in total cardiovascular disease, a doubling of blood clots. The recommendation made by this study was to discontinue PremPro.

Breast cancer in the Million Women Study from synthetic hormones

Another study that was mentioned was “Breast cancer and hormone-replacement therapy in the Million Women Study”.  In this study postmenopausal women received HRT with synthetic hormones, either estrogen alone or estrogen mixed with a progestin (in British English “progestagen”). After 5 years estrogen alone had a 30% increased risk of developing breast cancer. HRT with an estrogen-progestagen mix had a 100% increased risk of developing breast cancer.

Huge difference between bioidentical hormones and synthetic hormones

Unfortunately in both of these human experiments the researchers used the wrong hormone substances, namely synthetic estrogens and synthetic progestins. They are NOT identical with natural estrogens and progesterone that a woman’s body makes. As long as the hormones used for hormone replacement therapy are chemically identical to the natural hormones, the body will accept them as they fit the natural hormone receptors in the body. It is the misfit of synthetic hormones that blocks the estrogen receptors or the progesterone receptors. You can readily see from the illustrations of this link that there is a fine balance between the workings of these receptors and there is absolutely no room for patented side chains that Big Pharma introduced into synthetic HRT hormones.

Individualizing bioidentical hormone prescriptions based on blood tests

The other problem of both these studies was that every woman was getting the same dose of hormones and that nobody measured their estrogen blood or estrogen saliva hormone levels. In retrospect the regulatory agencies should never have allowed these “hormones” to hit the market.

Breast cancer develops in three stages

Dr. Zava explained that it common knowledge for some time that breast cancer develops by going through 3 stages.

  1. Initiation

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

Aromatase inhibitors is useful to reduce estrogen in overweight or obese women where aromatase is present in fatty tissue. The reason obese women have more breast cancer is likely from the extra estrogen production from androgens. Aromatase converts these male hormones from the adrenal glands into estrogen.

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

  1. Promotion

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

  1. Progression (includes invasion and metastases)

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

The fallacy of overdosing or underdosing

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

Measures that help prevent breast cancer

Supplement only with bioidentical hormones

When supplementing with bioidentical hormones, keep estrogen within physiological limits and don’t overdose. This can be measured through blood tests or saliva hormone tests. Your most important natural opponent of estrogen is progesterone, which is usually missing in menopause. Measure hormones using tests (progesterone only with saliva tests, estrogen either by blood tests or saliva tests). Don’t rely going by symptoms.

Progesterone to estrogen ratio

Keep the progesterone to estrogen ratio (Pg/E2) at an optimal range, which is in the 100- to 500-fold range. Measure the saliva hormone level of both progesterone and estrogen and calculate. Remember that progesterone serum levels are meaningless. The much higher progesterone level protects the postmenopausal woman from estrogen side effects. Here is a statement worth noting: “Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT.” This was the conclusion of a study using bioidentical hormones, where the protection from breast cancer and heart attacks and strokes was also noted.

Eat more fiber containing foods and less beef

Increase fiber intake and reduce red meat consumption. This will eliminate conjugated steroid hormones in the stool. It also increases the sex hormone binding globulin in the blood, which limits the bioavailability of estrogens. Fiber absorbs bile toxins and removes them from the body.

Calcium supplement

Calcium-D-glucarate is a supplement that will decrease beta-glucuronidase. The estrogens were conjugated with the purpose to be eliminated, but beta-glucuronidase causes the conjugated estrogens to be reabsorbed.

Reduce breast cancer risk with probiotics

Probiotics likely stimulate the immune system and help reduce the risk of breast cancer.

No pollutants and toxic chemicals

Avoid toxins like petrochemical pollutants and toxic chemicals. Avoid trans fats. If toxic, heavy metals are present (arsenic, cadmium, lead, mercury) remove these. Some naturopaths use EDTA chelation to do this.

Other useful supplements

Supplements: sulforaphane (broccoli), EGCG (green tea), alpha-lipoic acid (antioxidant), cruciferous vegetables, resveratrol, selenium and iodide/iodine, N-acetyl cysteine-glutathione. All these supplements/nutrients will prevent estrogen to go to the “dark side”. The dark side is the formation of toxic 4-OH estrogen that could further be converted into catechol estrogen-3,4-quinones that can damage DNA and cause mutations.

Methylation of catechol estrogens

Increase methylation of catechol estrogens: vitamin B1, B6, B12 and folic acid. Methyl donors also are useful for this purpose: MSM (methylsulfonylmethane), SAMe, and Betaine.

Healthy lifestyle (diet , exercise) helps your immune system

Improve your diet (Mediterranean type), exercise moderately, reduce stress, and replace hormones in physiological doses as discussed under point 1 and 2.

Breast Cancer Risks

Breast Cancer Risks

Conclusion

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

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Feb
25
2017

Heart Health Improves With Hormone Replacement

Dr. Pamela Smith gave a lecture in December 2016 showing that heart health improves with hormone replacement. Her talk was part of the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9 to Dec. 11, 2016) in Las Vegas, which I attended. The title of the talk was: “Heart health: The Importance of Hormonal Balance for Men and Women”. Her keynote lecture contained 255 slides. I am only presenting a factual summary of the pertinent points here.

1. Estrogen

First of all, estrogens are the main female hormones in women that protects them from heart attacks.

Observations regarding risk of heart attacks

  1. Women have a lower risk of heart attacks before menopause compared to men of the same age.
  2. Heart attack rates go up significantly after menopause.
  3. Estrogen replacement therapy may reduce the risk of heart attacks by 50% for postmenopausal women.

Lipid profile after menopause

There is an elevation of LDL cholesterol, total cholesterol and triglycerides as well as lower HDL cholesterol levels. All of this causes a higher risk of heart attacks for postmenopausal women. Estrogen replacement therapy increases the large VLDL particles, decreases LDL levels and raises HDL-2. Postmenopausal women who do estrogen replacement therapy (ERT) are helping to reduce their heart attack rates.

Difference between oral and transdermal estrogen replacement

The liver metabolizes estrogen taken by mouth. This reduces the protective effect on the cardiovascular system. In contrast, transdermal estrogen (from commercial estrogen patches or from bioidentical estrogen creams) has a higher cardioprotective effect. The liver does not metabolize transdermal estrogen. Dr. Smith explained using many slides how estrogen prevents heart attacks. Apart from lipid lowering effects there are protective effects to the lining of the arteries. In addition there are metabolic processes in heart cells and mitochondria that benefit from estrogens. The end result is that postmenopausal women who replace estrogen will outlive men by about 10 years. The production of Premarin involved pregnant mares. In other words, it is not human estrogen and it does not fit the human estrogen receptors. Also the liver metabolizes estrogen taken as tablet form, which loses a lot of the beneficial effects that you get from transdermal estrogen. 

How can you document the beneficial effects of estrogen replacement?

  1. Carotid intima measurements in postmenopausal women on ERT show a consistent reduction in thickness compared to controls.
  2. Postmenopausal women on ERT reduce their physical and emotional stress response compared to postmenopausal women without ERT.
  3. Hormone replacement therapy in postmenopausal women reduces blood pressure. Measurements showed this effect to be due to a reduction of angiotensin converting enzyme (ACE) by 20%. This is the equivalent of treating a woman with an ACE inhibitor without the side effects of these pills.
  4. Coronary calcification scores were lower in postmenopausal women on ERT than a control group without ERT. These calcification scores correlate with the risk for heart attacks.
  5. Oral estrogen replacement leads to proinflammatory metabolites from the liver metabolism of estrogen. No proinflammatory metabolites occur in the blood of women using transdermal estrogen. The anti-inflammatory effect of transdermal estrogen is another mechanism that prevents heart attacks.
  6. Postmenopausal women on ERT had no increased risk of heart attacks or venous thromboembolism (clots in veins). Menopausal women without ERT have a risk of 40% of dying from a heart attack. Their risk of developing breast cancer is 5.5%, the risk of dying from breast cancer is about 1%. There was an increase of venous thromboembolism in women who took oral estrogen.
  7. Estrogen has antiarrhythmic effects stabilizing the heart rhythm. Dr. Smith said that in the future intravenous estrogen might be used to prevent serious arrhythmias following heart attacks.

Estrogen levels in males

Males require a small amount of estrogens to maintain their memory, for bone maturation and regulation of bone resorption. But they also need small amounts of estrogen for their normal lipid metabolism.

However, if the estrogen levels are too high as is the case in an obese, elderly man, there is an increased risk of heart disease. Factors that lead to increased estrogen levels in an older man are: increased aromatase activity in fatty tissue, overuse of alcohol and a change in liver metabolism, zinc deficiency, ingestion of estrogen-containing foods and environmental estrogens (also called xenoestrogens).

2. Progesterone

Furthermore, progesterone is the second most important female hormone, the importance of which has been neglected in the past. Progesterone is significantly different from the progestin medroxyprogesterone (MPA). MPA was the oral progestin that was responsible for heart attacks and blood clots in the Women’s Health Initiative. MPA increases smooth muscle cell proliferation. This in turn causes hardening of the coronary arteries. In contrast, progesterone inhibits smooth muscle cell proliferation, which prevents heart attacks. Progesterone also lowers blood pressure and elevates HDL cholesterol, but MPA does not.

Progesterone in males

In a small study Depo-Provera was given to males for 17 days. Blood tests showed a lowering of triglycerides, LDL cholesterol and Apo A-1.

3. Testosterone

Finally, testosterone is the third sex hormone that is present in women. In men it is the main hormone, but women benefit from just a small amounts of it for libido, clarity of thought and muscle endurance.

Testosterone replacement in women

Testosterone in women does not only increase their sex drive, but also relaxes the coronary arteries in women who were testosterone deficient. This allows more blood flow to the heart. In postmenopausal women testosterone replacement lowered lipoprotein (a) levels up to 65%. The physician replaces first with bioidentical estrogen; only then does he consider replacing missing testosterone in women. Otherwise testosterone alone can cause heart attacks in women.

Elevated testosterone in women with PCOS

Women with polycystic ovary syndrome (PCOS) can have increased testosterone levels when they go through premenopause or menopause.

Women with PCOS are at a higher risk to develop diabetes, heart disease and high blood pressure. 50% of women with PCOS have insulin resistance. 70% of women with PCOS in the US have lipid abnormalities in their blood.

Elevated testosterone levels in the blood can lower the protective HDL cholesterol and increase homocysteine levels. Both can cause heart attacks.

Women with PCOS have a 4-fold risk of developing high blood pressure.

Testosterone replacement in males

A 2010 study showed that low testosterone levels in males were predictive of higher mortality due to heart attacks and cancer. Low testosterone ca cause high blood pressure, heart failure and increased risk of cardiovascular deaths. There was a higher incidence of deaths from heart attacks when testosterone levels were low compared to men with normal testosterone levels.

Low testosterone can cause diabetes and metabolic syndrome, which in turn can cause heart attacks.

It is important that men with low testosterone get testosterone replacement therapy.

DHT (Dihydrotestosterone)

DHT is much more potent than testosterone. Conversion of testosterone leads to DHT via the enzyme 5-alpha-reductase. While testosterone can be aromatized into estrogen, DHT cannot. Some men have elevated levels of DHT. This leads to a risk of heart attacks, prostate enlargement and hair loss of the scalp.

Andropause treatment

Only about 5% of men in andropause with low testosterone levels receive testosterone replacement in the US. This may be due to rumors that testosterone may cause prostate cancer or liver cancer. The patient or the physician may be reluctant to treat with testosterone. Researchers sh0wed that bioidentical testosterone does not cause any harm. It is safe to use testosterone cream transdermally. It does not cause prostate cancer or benign prostatic hypertrophy.

An increase of 6-nmol/L-serum testosterone was associated with a 19% drop in all-cause mortality.

Testosterone helps build up new blood vessels after a heart attack. Testosterone replacement increases coronary blood flow in patients with coronary artery disease. Another effect of testosterone is the decrease of inflammation. Inflammation is an important component of cardiovascular disease.

Testosterone replacement improves exercise capacity, insulin resistance and muscle performance (including the heart muscle).

Apart from the beneficial effect of testosterone on the heart it is also beneficial for the brain. Testosterone treatment prevents Alzheimer’s disease in older men by preventing beta amyloid precursor protein production.

4. DHEA

The adrenal glands produce the hormone dehydroepiandrosterone (DHEA). It is a precursor for male and female sex hormones, but has actions on its own. It supports muscle strength. Postmenopausal women had a higher mortality from heart disease when their DHEA blood levels were low.

Similar studies in men showed the same results. Congestive heart failure patients of both sexes had more severe disease the lower the DHEA levels were. Other studies have used DHEA supplementation in heart patients, congestive heart failure patients and patients with diabetes to show that clinical symptoms improved.

5. Melatonin

Low levels of melatonin have been demonstrated in patients with heart disease. Melatonin inhibits platelet aggregation and suppresses nighttime sympathetic activity (epinephrine and norepinephrine). Sympathetic activity damages the lining of coronary arteries. Melatonin reduces hypoxia in patients with ischemic stroke or ischemic heart disease. Lower nocturnal melatonin levels are associated with higher adverse effects following a heart attack. Among these are recurrent heart attacks, congestive heart failure or death. Melatonin widens blood vessels, is a free radical scavenger and inhibits oxidation of LDL cholesterol. Melatonin reduces inflammation following a heart attack. This can be measured using the C-reactive protein.

In patients who had angioplasties done for blocked coronary arteries intravenous melatonin decreased CRP, reduced tissue damage, decreased various irregular heart beat patterns and allowed damaged heart tissue to recover.

6. Thyroid hormones

It has been known for more than 100 years that dysfunction of the thyroid leads to heart disease. Hypothyroidism can cause heart attacks, hardening of the coronary arteries and congestive heart failure. Lesser-known connections to hypothyroidism are congestive heart failure, depression, fibromyalgia, ankylosing spondylitis and insulin resistance. Some cases of attention deficit hyperactivity disorder (ADHD) with low thyroid levels may successfully respond to thyroid replacement.

Thyroid hormones improve lipids in the blood, improve arterial stiffness and improve cardiac remodeling following a heart attack. Thyroid hormones help with the repair of the injured heart muscle. They also work directly on the heart muscle helping it to contract more efficiently. Lower thyroid stimulating hormone (TSH) values and higher T3 and T4 thyroid hormone levels lead to improved insulin sensitivity, higher HDL values (= protective cholesterol) and overall better functioning of the lining of the arteries.

Dr. Smith said that thyroid replacement should achieve that

  • TSH is below 2.0, but above the lower limit of normal
  • Free T3 should be dead center of normal or slightly above
  • Free T4 should be dead center of normal or slightly above

Most patients with hypothyroidism require replacement of both T3 and T4 (like with the use of Armour thyroid pills).

7. Cortisol

Cortisol is the only human hormone that increases with age. All other hormones drop off to lower values with age. The adrenal glands manufacture cortisol. With stress cortisol is rising, but when stress is over, it is supposed to come down to normal levels. Many people today are constantly overstressed, so their adrenal glands are often chronically over stimulated. This can lead to a lack of progesterone. It also causes a lack of functional thyroid hormones as they get bound and are less active. When women have decreased estradiol in menopause there is a decline in norepinephrine production, production of serotonin, dopamine and acetylcholine. Women with this experience depression, lack of drive and slower thought processes.

Heart Health Improves With Hormone Replacement

Heart Health Improves With Hormone Replacement

Conclusion

Seven major hormones have been reviewed here that all have a bearing on the risk of developing a heart attack. It is important that these hormones are balanced, so they can work with each other. Hormones can be compared to a team that works together and is responsible for our health. If one or several of the team players are ineffective, our health will suffer. For this reason hormone replacement is crucial.

Hormone effects on heart muscle

Hormones have effects on mitochondria of the heart muscles cells. They stabilize the heart rhythm as in the case of estradiol. But they can also strengthen the heart muscle directly through DHEA and estrogens in women and DHEA and testosterone in men. Thyroid hormones are another supportive force for the heart. Physicians can  use them therapeutically in chronic heart failure patients. When people age, their hormone glands will produce less hormones, but blood tests will show this. Replacing hormones that are missing can add years of active life. Taking care of the symphony of hormones means you are taking care of your most important organ, the heart!

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Feb
18
2017

Weight Gain In Menopause

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

A few statistics about menopause

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

About 10 million women who are over 40-years-old need treatment in long-term care facilities.

We will see below that when physicians incorporate this knowledge into a treatment schedule, the weight problem can normalize. It is possible to reduce the costs of taking care for postmenopausal women with obesity and diabetes by 2/3 of these cases.

Pathophysiological changes in menopause

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

1. Decreased energy expenditure

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

2. Ovarian aging

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

3. Insulin resistance

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

Health risks of weight gain

Dr. Taz pointed out that around the time of menopause there are very specific risks that have to do with the metabolic changes. There is a definite risk for heart attacks and strokes as LDL cholesterol and triglycerides show an increase and arteries calcify from circulating calcium leaking out from the bones into the blood stream.

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

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

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

Hormone changes in menopause

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

1. Lack of estrogen

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

2. Progesterone

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

3. Hypothyroidism

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

4. Cortisol response

The cortisol response to stress is suboptimal due to the decreased progesterone levels in menopause. Progesterone is a precursor of cortisol, so in menopause not enough of it is around to synthesize cortisol. But in a group of menopausal women following a significant stressful event cortisol production was much higher than in non-stressed women.

5. Other hormones

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

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

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

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

1. Diet

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

2. Exercise 

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

3. Stress management

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

4. Establishing healthy sleep

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

5. Bioidentical hormone replacement

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

6. Supplements

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

Weight Gain In Menopause

Weight Gain In Menopause

Conclusion

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

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