Aug
10
2013

Bioidentical Hormone Replacement

In many previous blogs I have mentioned that bioidentical hormone replacement prolongs life. Here is a more detailed look at what such hormone replacement looks like for both women and men. Before I get into details I want to stress that I am talking about replacing what is missing and replacing only with natural hormones, not some artificial hormone derivative produced by a drug company. The reason this is immensely important is that hormone receptors in the body are distributed all over our vital organs including bones, blood vessels and the nervous system. If there is no lock and key fit (bio-identical hormone fitting the hormone receptor), there is trouble as the Women’s Health Initiative in 2002 has shown. Unfortunately they had used synthetic hormones for HRT that were not fitting the hormone receptors, and this caused many problems (heart attacks, strokes, osteoporosis, cancer).

Physiology of aging

As we age, we gradually produce fewer hormones in our hormone glands, but the various hormone glands deteriorate in their functions at different rates. Beyond the age of 30 we produce less melatonin and less growth hormone. As a result our sleep pattern may change, as melatonin is necessary for a deep sleep. The decreasing growth hormone production means that we are losing some of our muscle mass and accumulate more fat in the subcutaneous tissues. Our adrenal glands produce less DHEA at the age of 35 to 40, a hormone that is a precursor to our sex hormones in males and females. The gonads (testicles and ovaries) also produce fewer hormones, a process which already starts 5 years before menopause and about 5 years before andropause (the male menopause equivalent).

Typically a woman will get into menopause at the age of 45 to 55 at which time the periods stop and postmenopausal symptoms are interfering with her well-being.  Men get into andropause (the male equivalent of menopause) at the age of 55 to 65 at which time erectile dysfunction occurs and often the individual will become the “grumpy old man”.

Other hormones such as thyroid hormones are also affected by the slow down. Hypothyroidism is common in people above the age of 50.

Bioidentical Hormone Replacement

Bioidentical Hormone Replacement

Baseline laboratory tests

In order to know what is going on, the physician or naturopath needs to order a number of tests to assess whether there is inflammation, how your key hormone levels are; the cardiovascular system markers should also be checked, the liver enzymes and vitamin D3 level. Inflammatory markers are fasting insulin levels and C-reactive protein (CRP). Fasting cholesterol and subfractions (HDL, LDL, VDLP, small LDL) and fasting triglycerides are also measured. Thyroid hormones (T3 and T4, TSH) are measured to rule out over or under function. Typically hypothyroidism is found, which would have to be rectified by taking Armour (a mix of T3 and T4 thyroid hormones).

At this point I need to explain that long time ago the research by Dr. Lee has shown that progesterone hormone levels are notoriously unreliable when blood tests are done. All of the other sex hormones, and cortisol are also not that reliable with blood tests. For this reason the saliva hormone tests have been invented that conveniently report a panel of 5 hormones from one saliva sample: DHEAS (which is the storage form of DHEA), estradiol (the major estrogen in a woman), progesterone, testosterone and cortisol. The saliva hormone tests correlate very well with the actual tissue hormone levels. You can order the saliva tests through Dr. Lee’s website. Another longstanding lab in the US is Dr. David Zava’s lab. In Canada the Rocky Mountain Analytical Lab can process your saliva tests.

Women’s hormone replacement

Let us assume that a woman is getting postmenopausal symptoms and bioidentical hormone replacement is being discussed. The physician will want to first rule out that insulin resistance is not present by ordering a fasting insulin level. If this is normal and the other baseline tests are normal as well except for missing estrogen and progesterone, the physician will usually start to replace progesterone first using a bioidentical hormone cream to be applied once or twice per day. If estrogen levels were also low, the next step in 4 weeks or so is to add Bi-Est, a bioidentical estrogen replacement cream. After 8 weeks of hormone replacement the saliva hormone test is repeated to see whether the estrogen and progesterone levels have come up and also, whether the ratio of progesterone to estrogen is at least 200 or more. Dr. Lee has extensively researched this and found that women with a ratio of less than 200 to 1 (progesterone/estrogen ratio) were more prone to breast cancer. He also stated in this link that there are 3 basic rules with regard to bioidentical hormone replacement:

1. only replace hormones, when they were measured to be low.

2. use only bioidentical hormones (never synthetic hormones) and

3. only replace with low doses of bioidentical hormones to bring hormone levels to physiological levels (body levels that were experienced to be normal before).

Many women who are not replaced in menopause have estrogen dominance meaning that the progesterone/estrogen ratio is less than 200:1, which puts these women at risk of developing breast cancer. Women who are overweight or obese also are estrogen dominant (from estrogen produced in excess through aromatase in the fatty tissue, explained further below), which makes them more prone to breast cancer, uterine cancer and colon cancer. Without bioidentical hormone replacement inflammatory processes take place in the joints (causing arthritis), in the nervous system (causing Alzheimer’s and dementia) and in the blood vessels (causing heart attacks and strokes). Rebalancing your hormones to a youthful state by paying attention to the hormone levels and the hormone ratios mentioned will remove the inflammatory reactions and reduce the risk for cancer.

Men’s hormone replacement

Males enter andropause 10 to 15 years later than women are entering menopause. Typically testosterone production slows down leading to hair loss, erectile dysfunction, loss of muscle mass, osteoporosis and Alzheimer’s/dementia. Blood tests (bioavailable testosterone) or saliva tests are both reliable in determining a deficiency. Replacement with bioidentical hormone creams once per day is the preferred method of treatment. Overweight and obese men produce significant amounts of estrogen through an enzyme localized in fatty tissue, called aromatase.

Aromatase converts testosterone and other male type hormones, called androgens, into estrogen. Estrogen causes breast growth, weakens muscles, and leads to abdominal fat accumulation, heart disease and strokes.

Similar to women, where the progesterone/estrogen ratio is important, there is another ratio for men, called testosterone/estrogen ratio. This should be in the 20 to 40 range for a man to feel good and energetic. Unfortunately many men above the age of 55 have testosterone/estrogen ratios much smaller than 20. This makes them more prone to heart disease and prostate cancer (Ref.1).

However, a male also does need a small amount of estrogen and normal thyroid hormones as well as all of the other hormones for his “hormonal symphony” (mentioned in Ref. 2) to function at his best.

Safety of hormone replacement

There are still otherwise reputable websites that state that bioidentical hormones are not safer than standard synthetic hormones. This confuses the consumer and does not serve the public well. I much prefer the text of the Wikipedia, which is a more thorough review regarding safety of hormone replacement and explains what the issues are.

In the US there is a collective experience of about 25 years on thousands of patients, but there have not been any randomized studies, as Big Pharma that would have the money to finance such studies is not interested in proving that bioidentical drugs would be safer than their distorted synthetic hormone copies that will not fit the body’s hormone receptors. There are some noble exceptions as Big Pharma is producing bioidentical insulin and human growth hormone that had toxicity studies done and showed safety. In Europe bioidentical hormones have been used since the 1960’s, on a larger scale since the 1970’s. So the European experience of safety of bioidentical hormones is presently about 40 to 50 years.

The FDA is contributing to the confusion of the public as can be seen from this publication. One example where the FDA is confusing the consumer, is the progesterone product Prometrium, a bioidentical micronized progesterone capsule that can be taken by mouth. By law the manufacturer had to put a warning label on the package identical to progestin, which is the synthetic, non-bioidentical hormone having been shown to have severe side effects. As is explained in this last publication Prometrium should not have been required to have a warning label in it ; the paper explains what I have already stated above, namely that bioidentical hormones are the safest form of hormone replacement and administered in the right ratios will actually prevent cancer and prevent premature cardiovascular and joint deterioration. In other words, bioidentical hormone replacement can add many years of useful life when started early enough before permanent organ damage sets in from the aging process (which would be due to missing hormones).

Why bother about hormone replacement?

Nature has a plan of “knocking us off” to make room for the next generation. The only way that you can change nature’s plan of killing us prematurely through cardiovascular disease, arthritis, dementia and loss of your sexual life is by bioidentical hormone replacement. Of course you also need the other ingredients of known life prolongers such as healthy (preferably organic) foods, exercise and detoxification. Many women are scared to treat the hormone deficiencies that cause their menopausal symptoms because of the Women’s health Initiative results with synthetic hormones. Men who would benefit from testosterone are often anxious that they may get prostate cancer, when in reality it is the exact opposite: testosterone prevents prostate cancer (Ref.3).

Conclusion

I wrote this blog about bioidentical hormone replacement in order to clarify this often-misunderstood topic. Don’t get confused by the FDA, by highbrow medical websites (such as the likes I mentioned). Big Pharma has a powerful lobby that attempts to keep the medical profession in the belief that their products are better than those that nature has provided (I call it “defend your patent rights”). We are still in a flux state where anybody who tells the truth about hormones gets much criticism. In another few decades it will be an accepted fact and people will wonder why the Women’s Health Initiative was done without a control with bioidentical hormones. With bioidentical hormone replacement you can add about 20 years of youthful life without disabilities to the normal life expectancy. Exercise, detoxification and organic food with avoidance of wheat, starch and sugar can add another 5 to 10 years to your life. The baby boomers are lucky that they have this new tool to prolong life. I wonder whether they will put it to good use.

More information about bioidentical hormone replacement: http://nethealthbook.com/hormones/anti-aging-medicine-women-men/

References:

1. John R. Lee: “Hormone Balance for Men – What your Doctor May Not Tell You About Prostate Health and Natural Hormone Supplementation”, © 2003 by Hormones Etc.

2. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008

3. Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008

Last edited Nov. 7, 2014

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Jun
29
2013

Aging And Lack Of Hormones Matter, Not Evolution

Aging and lack of hormones matter, not evolution. Recently a story went through the media regarding the findings of a research group from McMaster University, Hamilton/Ont. that described that as men were dating younger women evolution took fertility away from aging women. It sounds to me that this research, which included computer modelling  was mainly driven by sociological observations. Some older males may seek out female partners that have the same age as their daughters, which seems to be considered “socially acceptable”. Contrary to that successful relationships of older females with younger partners are often met with less tolerance!

Hormones are important for behaviors

It seems that medical facts like hormonal changes that are behind behaviors have not been taken into account. The following blog provides you with a background of hormonal changes for both sexes as we age. I also describes how to reset the clock for males and females alike to an age between 30 and 35, which creates a “level playing field”. It is a 101 on bio-identical hormone replacement.

Depleting hormones due to aging

Both men and women experience a slow decrease in hormone production beyond the age of 30, but the depletion occurs somewhat faster in women than in men. As a result women get menopause at the age of 45 to 55 (cessation of periods and postmenopausal symptoms) and men get into andropause (the male equivalent of menopause) at the age of 55 to 65. The main symptom of andropause is erectile dysfunction. These are acceptable simple physiological facts that endocrinologists knew since the 1950’s to 1960’s. Common sense would suggest that replacing missing hormones with bioidentical hormones should bring the body chemistry back to normal. However, this is not what conventional medicine has done.

Synthetic hormones are not bioidentical hormones

Instead, Big Pharma got wind of how powerful hormones were, and they developed hormone-like substances that could be patented and produced on a large scale. What they did not disclose initially was the fact that non-bioidentical hormones with side-chains and chlorine or fluoride atoms in the molecules would cause heart attacks, strokes and blood clots. An example of this is Premarin, an estrogen concoction that is derived from pregnant mares and Provera, a “progesterone-unlike” synthetic product, both of which were used for HRT (“hormone replacement therapy”).

Aging And Lack Of Hormones Matter, Not Evolution

Aging And Lack Of Hormones Matter, Not Evolution

Results of the Women’s Health Initiative (using synthetic hormones)

As there were conflicting reports about the benefit of hormone replacement after menopause in the medical literature, the National Institutes of Health funded a large study (the Women’s Health Initiative) to clarify what was going on with regard to side effects and effects of HRT. Unfortunately, the researchers used synthetic non-bioidentical hormone products in these studies (Premarin and Provera) instead of bioidentical estrogen and progesterone. The results of the Women’s Health Initiative were devastating. In 2002 doctors  were warned that Premarin and Provera used as HRT would cause increased heart attack rates and breasts cancer, which led to premature death.

Results of the Women’s Health Initiative confused hormone therapy

Overall, the placebo group did better than the experimental group and this is why the trial was prematurely stopped. Due the wide publicity regarding the negative results of the Women’s Health Initiative postmenopausal women feel confusion about what to do. Either they do not see their physician for hormone replacement. Or conventional doctors advise them that they should use only small amounts of Premarin. Their physician also tells them not to take HRT for more than 5 years for fear that it may cause breast cancer. Medico-legal considerations are at play and the whole issue of HRT after menopause has been politicized.

Facts about bioidentical hormone replacement therapy (BHRT)

The key with menopause or andropause is to accurately determine what the hormone levels are, which requires saliva hormone tests, not blood tests. The results are compared to what is normal for a 30- to 35-year-old person and missing hormones are replaced with bio-identical hormones as originally suggested by Dr. John Lee some time ago. Briefly, he mentioned 3 fundamental rules in bioidentical hormone replacement: first, only replace those hormones that are missing; secondly, use bioidentical hormones instead of synthetic hormones and thirdly, use the smaller doses that are enough to replace the normal hormone levels that the body had around your mid-thirties, don’t over treat. He also stated that there is a need to address lifestyle issues like poor diets, excessive alcohol intake, stress and insulin resistance (from obesity). His recommendations are still valid today, as hormone facts have not changed.

Replace hormones that are missing with bioidentical hormones

So, the physician or naturopath needs to use common sense and replace what is missing with bio-identical hormones (not with synthetic hormone-like drugs that make the patient sick). If people do this properly, a normal sex life persists in both males and females and both age at a much slower pace without the development of heart attacks, strokes or osteoporosis. When people rebalance hormones, adopt a proper diet and do regular exercises, diseases like diabetes, cancer, osteoporosis, heart attacks, strokes, arthritis or high blood pressure do not develop. In other words, this is a way to prevent disabilities and you are able to enjoy an active life in vibrant health.

More info on bioidentical hormone replacement

Eventually all of us, male or female succumb to the hormone deficiencies that come with aging. As long as males still produce testosterone, males will have a normal sex drive. But 10 or 20 years beyond the point where their partners entered menopause erectile dysfunction will eventually set in. Just taking Viagra is no substitute for the missing testosterone and other hormones. If we do not pay attention to hormone restoration, the biological clock is ticking and the diseases I mentioned above will start to occur and lead to premature death. On the other hand with male hormone restoration (bioidentical testosterone) the body chemistry and physiological functions return to how they were in his 30’s. The same is true for female hormone restoration (using estriol/estradiol and progesterone).

Bioidentical hormone replacement in Europe

The irony is that a small number of physicians back in the 1960’s and 1970’s in Europe used bioidentical hormone replacement. It was amazingly successful. One of these doctors is Dr. Hertoghe, an endocrinologist in Belgium. They were able to show then that women could regain their sexual desire and their vitality with bioidentical hormone replacement (BHRT). For some reason (could it be greed?) Big Pharma and various government agencies were able to get the upper hand and suppress this knowledge. They spread the word that hormones that come factories would be of “higher quality” than bioidentical hormone creams from compounding pharmacies. Fortunately, these lies have been exposed in numerous publications and the information is now more easily accessible through the use of the Internet.

Safety of bioidentical hormones

But Big Pharma still tries to intimidate and twist the truth! Here is a recently published prospective study over 3 years involving 300 women from Texas (Women’s Wellness Center, Tyler, Texas, USA) that showed anti-inflammatory effects and anti-anxiety effects with bioidentical hormone replacement. It also showed that no biochemical changes took place that would have caused changes in fibrinogen levels. Bioidentical hormones do not affect clotting, do not cause inflammation, heart attacks cancer. This confirms what Moskowitz had stated in 2006 about the safety of bioidentical hormones.

Testosterone is mostly bioidentical

Male testosterone products from Big Pharma are by and large hormone preparations  that are actually bioidentical testosterone. It is with women’s hormones that Big Pharma made substantial chemical modifications so that the final products did not fit the estrogen and progesterone receptors, causing heart attacks, blood clots and breast cancer.

Bioidentical hormone replacement and saliva hormone tests

Both women and men should get a saliva hormone panel test measuring DHEA-S (storage form of DHEA), estradiol, testosterone, progesterone and cortisol from one sample test tube when they become hormone deficient. Typically, the physician should test women first around the age of 35 to 40. Similarly, a man needs testing around the age of 45 to 55. This provides a baseline hormone level. The treating physician or naturopath can then decide, whether bioidentical hormone replacement is necessary. If so, only what is missing is replaced with bioidentical hormone creams from a compounding pharmacy. The hormone levels are titrated to the level around the age of 30 to 35. Thi is according to the principles by Dr. Lee. For A4M physicians this is a routine that is familiar. Your regular physician will likely feel uncomfortable, but many naturopaths will feel very comfortable doing this.

Discussion of the evolutionary study of McMaster University

It may sound intriguing to rationalize that older men like to date and marry younger women. In my medical opinion these researchers got it wrong. Hormone weaknesses manifest themselves perhaps 10 years later in men than in women. In some men testosterone production may even diminish only 20 years later. Older men may not find a sex partner the same age, if women do not use bioidentical hormone replacement. The McMaster team should have done their research including a control group.

Older women on bioidentical hormone replacement preserve their sex drive

This group should consist of men and women who used bioidentical hormone replacement. Researchers likely would notice that older women preserve their sex drive with bioidentical hormones. The sex drive of these older women would be comparable to women in their 30’s. Also, the “aging clock” would have slowed down in these women on bioidentical hormone replacement. This in turn would probably have resulted in a different behavior pattern among the older males.

References

1. Why choose bioidentical hormones: http://www.empowher.com/menopause/content/bioidentical-hormones-vs-synthetic-hormones-what-s-difference

2. Anti-Aging Medicine for Women and Men: http://www.nethealthbook.com/articles/antiagingforwomenandmen.php

3. Menopause: http://www.nethealthbook.com/articles/menopause.php

4. Andropause: http://www.nethealthbook.com/articles/malemenopauseandropause.php

5. 2009 Postgraduate Medicine article on the bioidentical hormone debate: http://www.ncbi.nlm.nih.gov/pubmed/19179815

Last edited June 29, 2013

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Mar
17
2013

Calcium, Vitamin D3 and Vitamin K2 Are Needed For Bone Health

Introduction

I am reviewing in this blog why calcium, vitamin D3 and vitamin K2 are needed for bone health. Recently there has been a lot of coverage in the press regarding postmenopausal treatment of women to prevent osteoporosis. It is all based on this original publication February 26, 2013.

Essentially, there are a number of studies where researchers did a meta-analysis of several trials. They studied osteoporotic bone fracture frequency in female subjects taking 400 IU vitamin D and 1000 mg calcium daily. The researchers measured the frequency of osteoporotic fractures as the indicator  for osteoporosis in these postmenopausal women. The conclusion was that there was no value in taking these supplements to prevent osteoporosis. Many other media publications carried this story.

No kidney stones in study with calcium and vitamin D3

Just two days earlier (Feb. 24, 2013) another study was released with a much larger patient base of 36,282 postmenopausal women of the Women’s Health initiative in the US who were followed up for 7 years. Initially there confusion how compliant the patients were taking their supplements. The required supplementation consisted of 1000 mg of calcium carbonate and 400 IU of vitamin D3. 7 years into the trial the researchers compared the supplement compliant group with the control group taking placebos.

Calcium and vitamin D3 supplementation significantly reduces risk of hip fractures

The study group had 35% to 38% less fractures of the hip than the placebo group. This supplementation did not cause kidney stones in the study group. This was in contrast to what previous smaller studies showed. Some physicians insisted citing the older studies that vitamin D3 and calcium supplementation would cause kidney stones. But the above study refutes the causation of kidney stones by supplementing with vitamin D3 and calcium. In other words, all of these kidney stone concern you have so often read in the media are not true.

Outline of this review

In order to make sense of supplementation as osteoporosis prevention I will first review what a normal bone metabolism requires.  I will then comment on what is missing in some of the studies and why it still makes sense to supplement to prevent osteoporosis. In addition, at the end of this blog I will also recommend a sensible supplementation regimen.  All this is based on a balanced review of the medical literature.

Calcium, Vitamin D3 and Vitamin K2 Needed For Bone Health

Calcium, Vitamin D3 and Vitamin K2 Needed For Bone Health

Bone metabolism

But vitamin D3, vitamin K2 and strontium together have also been shown to build up bone density within one year.

So, how does vitamin K2 deposit calcium into the bone? Vitamin K2 stimulates a hormone, called calcitonin, which is produced by specialized C cells (parafollicular cells) inside the thyroid gland and released into the bloodstream. Calcitonin arrives in the bone where it binds firmly with receptors of osteoclasts (bone remodeling cells), which stops breakdown of bone. Calcitonin is helped by another hormone, called osteocalcin, which is produced by the bone producing cells with the name osteoblasts.

Vitamin K2 controls osteocalcin, which is a calcium-regulating hormone

The physician can measure osteocalcin levels in the blood and use this as a research tool to see whether a medication is effective in building up bone mass density (BMD). Vitamin K2 control osteocalcin as a calcium-regulating hormone. If vitamin K2 is present, carboxylation of osteocalcin will lead to mineralization of the bone (new bone formation); if vitamin K2 is absent, osteoporosis sets in.

The skeleton of an average adult contains 1–1.3 kg of calcium and 99% of this is mostly in the form of hydroxyapatite.

The key vitamins for bone metabolism are vitamin D and vitamin K2

Calcium absorption from the small intestine requires vitamin D3 (Ref.1). To transport calcium from the blood into the bone we require both vitamin D3 and vitamin K2 (=menaquinone). This blog explains that several studies have shown that vitamin K2 (or MK-7) plays a double role of preventing calcification of the arteries and bringing the calcium into the bones of osteoporotic women.

Apart from Vitamin K2 that is necessary for osteoporosis prevention other factors have shown to be of importance. For instance, testosterone is an anabolic hormone (meaning a hormone that builds up) and it has clearly been shown that it is bone building: It does so by stimulating osteoblasts, which are bone producing cells that reside inside the bone.

Vitamin D3, vitamin K2, Calcitonin and osteocalcin

But vitamin D3, vitamin K2 and strontium together have also been shown to build up bone density within one year.

So, how does vitamin K2 deposit calcium into the bone? It does so by stimulating a hormone, called calcitonin, which is produced by specialized C cells (parafollicular cells) inside the thyroid gland and released into the blood stream. Calcitonin arrives in the bone where it binds firmly with receptors of osteoclasts (bone remodeling cells), which stops breakdown of bone. Calcitonin is helped by another hormone, called osteocalcin, which is produced by the bone producing cells with the name osteoblasts.

Vitamin K2 controls osteocalcin, which is a calcium-regulating hormone

Osteocalcin levels in the blood can be measured and used as a research tool to see whether a medication is effective in building up bone mass density (BMD). Vitamin K2 controls osteocalcin as a calcium-regulating hormone. If vitamin K2 is present, carboxylation of osteocalcin will lead to mineralization of the bone (new bone formation); if vitamin K2 is absent, osteoporosis sets in.

Vitamin K2 also prevents heart attacks and strokes

Vitamin K2 has a second function: it removes calcium from the arterial walls and tissues. How does it do this?

Matrix GLA protein is found in tissues of the heart, lungs, kidneys and blood vessels. When vitamin K2 stimulates carboxylation of this protein, it will function like a broom and clean out calcium deposits (calcification) from blood vessels and organ tissues. As vitamin K2 is needed for this carboxylation process, it appears that nature had in mind to remove calcium from soft tissue organs and blood vessels and form hydroxyapatite in the bone for bone strength.

Vitamin K2 is the key to deposit calcium into the bone

It seems that vitamin K2 is the key vitamin necessary to do this job. Another player is magnesium, which is part of of the normal function of more than 300 cellular enzyme systems. In terms of hormones the three hormones parathyroid hormone (PTH), vitamin D3 and calcitonin need to interact normally, all requiring magnesium as cofactor. In addition, zinc, copper, boron, and manganese are also essential as trace minerals. They act as cofactors with regard to specific enzymes of the bone metabolism (Ref. 1).

Bioidentical hormone replacement essential after menopause and andropause

In the aging person hormonal deficiencies are also factors for causing osteoporosis to develop. As this link shows, Dr. John Lee found bioidentical progesterone topical cream very helpful in women with respect to increasing bone mass density by 15% over 3 years.

When bloods tests show testosterone depletion men need to replace what is missing with bioidentical testosterone. So, bioidentical hormone replacement in both men and women is part of a bone health management program to prevent osteoporosis.

Some trials that demonstrate how you can build up bone

  • In this paper parathyroid hormone  was used in combination with 1000 mg of calcium and 400 IU of vitamin D3 in a group of postmenopausal women with osteoporosis. Within 3 month of treatment there was an increase of bone mass density in the lower back (lumbar spine) of 4.7%, which translates into a yearly increase of bone mass density of 18.8%. In the past when physicians tested other agents for bone regeneration, this type of result never occurred. There is a  variation of this hormone,  a parathyroid hormone look-alike with the name Teriparatide (PTH 1-34). The patient administers this once daily as an injection of 20 mcg up to 2 years. Physicians found this useful in treating fractures of the vertebrae and other fractures in osteoporotic postmenopausal women (Ref.2).

Effect of Vitamin K2, estrogen and calcium citrate supplementation

Calcitonin and calcium strontium

  • Calcitonin is very effective in reducing bone pain when the patient has compression fractures from osteoporosis; the physician can prescribe it as an intranasal spray of 200 units daily (Ref. 2). However, on March 5, 2013 the FDA announced that salmon calcitonin would not be safe for humans as there is a slight risk that cancer can develop as a “side-effect”.
  • According to Ref. 2 physicians sometimes use strontium ranelate in Europe for the treatment of postmenopausal osteoporosis. Researcher showed that strontium ranelate builds up bone and decreases the amount of bone resorption. Side effects include nausea and diarrhea.

The team players of bone metabolism to build strong bone

We are now in a position to analyze why the researchers of the first paper (citation above) concluded that calcium and vitamin D3 supplementation were not enough to make a statistical difference in the treatment of postmenopausal women in comparison to placebos. As explained bone metabolism is a complex process involving several team players, where the key player is vitamin K2, which the researchers of that study ignored completely. The examples I mentioned above in point form show that exercise and calcium are also important. Vitamin K2 by itself worked quite well as it is so powerful. Hormones like PTH and calcitonin are effective, but more difficult to take for the average consumer and the FDA now has banned calcitonin.

Importance of vitamin D3 as a supplement

Vitamin D3 is important for absorption of calcium from the intestine, but also for depositing calcium into the bone in addition to vitamin K2. The WHI study mentioned above is highly significant because of a 1/3 reduction of hip fractures after 7 years of vitamin D3 and 1000 mg of calcium per day supplementation. If you add vitamin K2, exercise and bioidentical hormone replacement in postmenopausal women who need it, the prevention of hip fractures, wrist fractures and vertebral compression fractures likely will be as high as 50% in those who are taking their supplements regularly (compliance issues like forgetting the supplements or deliberately not taking them were mentioned in several of the studies).

Vitamin K2 helps to reduce heart attacks, strokes and osteoporosis

With the right supplementation, which includes vitamin K2 as mentioned above, you achieve that you lower your heart attack and stroke risk as the vitamin K2 removes the calcium from the blood vessels and deposits it into the bones, while at the same time strengthening your bones. Attention to proper nutrition, exercise and your hormone balance (using only bio-identical hormones to replace what’s missing) will also reinforce osteoporosis prevention. The bonus of using bioidentical hormone replacement therapy is that you prevent heart attacks and strokes in addition to preventing osteoporosis. I think that this is a good deal!

An easy-to-follow osteoporosis prevention program

The best combination is 1000 mg (or 1200 mg as per National Osteoporosis Foundation recommendation) of calcium per day together with 400 to 800 IU of vitamin D3 (for cancer prevention you may want to take 4000 IU to 5000 IU of vitamin D3 per day instead monitored by a 25-hydroxyvitamin D blood level test through your physician) and 100 to 200 micrograms of vitamin K2 (also called MK-7). In the age group above 50 several hormones can be missing.

Hormone depletion in menopause and andropause

That’s why the doctor recommends bioidentical testosterone in men and bioidentical progesterone/estrogen combinations in women with hormone depletion. This works best, if you also watch your weight and cut down your alcohol consumption to a minimum. Cutting alcohol out completely would be even better. In addition, exercise regularly as this builds up bone and muscle strength.  It also helps, if you stick to a balanced diet (Mediterranean or Zone type diet). These diets are low-glycemic, low fat, wheat free and without sugar).

If you want to age gracefully, you need not only a healthy heart and a healthy brain. You also need healthy bones as this prevents disabilities.

References

  1. McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22nd ed. Copyright © 2011 Saunders, An Imprint of Elsevier
  2. Rakel: Integrative Medicine, 3rd ed. Copyright © 2012 Saunders, An Imprint of Elsevier

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I received the following feedback (Originally on Nov. 10, 2013)

 Dr. Ray, I read your March 17 Blog entry which suggested 100 ug of Vitamin K2 with 5000 IU of D3.   I have atherosclerosis and have radically changed my diet (plant only), but also now take an average of about 3000 IU of Vitamin D3. Dr. Kate Rhéaume-Bleue (book on K2) recommended taking about 200 ug per day of K2, but increasing K2 to about 1,000 ug if taking around 5,000 IU of D3 to ensure proper activation of MGP. What is your opinion with regard to a D3/K2 ration?  Thank you

 Answer from Dr. Ray (Originally on Nov. 12, 2013, modified April 29, 2021)

I appreciate your question about what doses of vitamin K2 to take. There are varied recommendations, but I like to go by human trials and what they have actually shown. In this review in 2010 from the Life Extension Magazine a study is cited that showed that only 45 micrograms of vitamin K2 was enough to get the calcium out of the arterial walls and into the bones.

200 micrograms of Vitamin K2 daily

Dr. Mercola reviewed the literature and found that most investigators were now using 180 to 200 micrograms. In the past I took 100 micrograms of vitamin K2 per day. However, a few years ago I increased it to 200 micrograms per day. With regard to vitamin D3 absorption my anti-aging doctor found that I have an absorption problem regarding vitamin D3. This is why I need 10,000 IU of vitamin D3 daily. This brings my vitamin D blood level up into the high normal range (between 50 and 80 ng/mL). Toxic vitamin D blood levels start only above 150 ng/mL.

Avoid sugar and too much starch consumption

Remember that other risks for cardiovascular disease are sugar and starch consumption. The liver turns this into triglycerides and too much LDL cholesterol, which plugs up your arteries. Avoid wheat because of the gliadin content. This causes an addiction to wheat and sugary foods. Here is a summary how leaky gut syndrome and autoimmune illnesses may develop from this. If you want to consume beef, reduce your consumption to once or twice per week. It id best to stick to only eat grass fed, antibiotic free beef). But I rather prefer to eat organic chicken, turkey and lean pork. I understand that you have a plant only based diet, but I would recommend to you to reconsider that. Ask your doctor to check your ferritin from time to time. This way you do not miss an iron deficiency that may develop. For other readers: Don’t forget your vegetables (organic, please).

More information about osteoporosis: http://nethealthbook.com/arthritis/osteoporosis/

Last updated Nov. 6, 2014

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Dec
01
2008

Fifty Percent of US Population Do Not Take Enough Calcium

Even though supermarket shelves are stocked to the hilt with a wide assortment of groceries, not all is well in the USA. At the annual meeting of the American College of Nutrition Theresa A. Nicklas, D.P.H. summed up the current situation in the following statement: “The American population is overweight but undernourished.” Results from a study of more than 25,000 people showed, that half the population does not get enough calcium, magnesium and potassium.

Many people consume more calories than they need, but nutrients like the ones mentioned before and which are essential for functions such as immunity, bone health and blood pressure are falling short of the recommended amounts. The only age group in which the recommendations for calcium intake were met was the age group up to 8 years. In adults the needs were not met, and more females than males were deficient in all of the three nutrients.

Fifty Percent of US Population Do Not Take Enough Calcium

Calcium intake prevents osteoporosis

 

 

The situation could be corrected by consuming 3 to 4 equivalents in the dairy group. It should be added that not only dairy foods are rich in calcium. For individuals who do not consume dairy foods, soy products are rich in calcium, as are almonds, almond butter and nuts. Legumes (beans) as well as green vegetables (bok choi, collard greens, turnip greens) are calcium sources that should be incorporated in a nutrient rich diet.

More information about osteoporosis: http://nethealthbook.com/arthritis/osteoporosis/

Annual Meeting of the American College of Nutrition

Last updated Nov. 6, 2014

Aug
01
2008

Osteoporosis Drug Prevents Breast Cancer Recurrence

Standards in breast cancer treatment have been surgery, radiation therapy and chemotherapy. In hormone receptor positive cancer types Tamoxifen has been the drug of choice for many years to achieve suppression of the ovaries in premenopausal women. A new medication under the name of Anastrozole has also been introduced. In the meantime researchers have examined the success of the various approaches. No difference has been found between Anastrozole and Tamoxifen, but a new drug which has been used for osteoporosis patients shows that it can boost disease free survival for breast cancer patients. The medication called zoledronic acid taken in combination with either Tamoxifen or Anastrozole can increase disease free breast cancer survival by 36%. Zoledronic acid can inhibit tumor cell growth and stimulate the immune response, and the lead author of the study, Dr. Michael Gnant concludes that the combination treatment creates a tumor-hostile environment. The benefits are not only a reduction of bone metastases but others as well.

Osteoporosis Drug Prevents Breast Cancer Recurrence

The most concerning side effect is osteonecrosis of the jaw, but the researcher reported that in the trial not a single case has materialized. Other researchers, such as Dr. Martine Piccart-Gebhart , professor at the department of oncology at the University of Brussels caution that this is an important trial, but it should not be seen as a practice-changing trial. More work is needed to establish the best dosage and treatment schedule. More results from other trials investigating the combination treatment with zoledronic acid are expected this summer.

More information about breast cancer: http://nethealthbook.com/cancer-overview/breast-cancer/

National Review of Medicine, June 2008, page 18 and 19

Comment on Nov. 17, 2012: There is criticism regarding Zoledronic Acid because of osteonecrosis of the jaw and the fact that biophosphonates also have the metatasis suppressing effect. See this link.

Last edited November 4, 2014

Feb
01
2007

Lycopene Benefits Backed By Science

Lately a lot of attention has been directed to the health benefits of vegetables and fruit. Vitamin C has long been an accepted household term, and nobody questions the benefits. Newer buzz words are the terms “bioflavonoids” and “antioxidants”. Some products are aggressively marketed extolling the above named beneficial substances, but often the consumer is left mildly bewildered by exaggerated claims. Often the sale prices of these miracle foods are as lofty as the bold statements that go along with them.
For any shopper it is important to know that some of the most beneficial foods are not high priced items, but very common staples. Take tomatoes, for instance. They are a significant source for the substance lycopene, which lately has received a lot of attention. Lycopene and its dietary sources as well as its benefits have been researched world wide, and the results are now in. It is responsible for the red color in fruit or vegetables, such as tomatoes, and its isomeric form 5-cis-lycopene is the most stable form having the highest antioxidant properties. Common dietary sources are tomatoes, watermelons, pink guava, pink grapefruit, papaya, apricot and other fruit. In the Western diet tomato-based foods account for about 85% of dietary sources of Lycopene. Studies have shown that lycopene is more efficiently absorbed from processed tomato products compared to raw tomatoes. Once it is absorbed it is distributed throughout the body. The highest levels showed up in the testes, the adrenal glands, prostate, breast and liver.
Research going back to 1995 showed an inverse relationship between the consumption of tomatoes and the risk of prostate cancer. A follow up publication in 1999 showed that the same inverse relation of lycopene intake and cancer also included breast, cervical, ovarian, liver and other organ sites. Further studies have followed these initial publications, and the great majority of them suggest that an increased intake of lycopene showed an association with a significant reduction in the risk of many cancers.
Coronary heart disease and lycopene benefits were also examined. The strongest population based evidence comes from a multi center case control study in Europe (EURAMIC). 662 Cases and 717 controls were recruited from 10 different European countries, and there was a significant relationship between levels of lycopene in fatty tissue and the risk of myocardial infarction. Lower lycopene levels were associated with a higher risk of heart attacks.Lycopene was also shown to decrease levels of oxidized LDL (LDL or low density lipoprotein is known as the “bad” cholesterol). Another small study showed that lycopene was reducing total cholesterol levels and as a result was lowering the risk of coronary heart disease (CHD).
The list of benefits does not end here: the dietary oxidant reduces oxidative stress and levels of bone turnover markers, meaning that it may contribute to the bone health, especially reducing the risk of osteoporosis in postmenopausal women.

Lycopene Benefits Backed By Science

Lycopene Benefits Backed By Science

For people with mild hypertension (high blood pressure), consumption of lycopene resulted in significant reductions of systolic and diastolic blood pressures.
Infertility in males was significantly helped by lycopene intake. In a study infertile man received 8 mg lycopene per day in capsule form. Laboratory tests confirmed an increased sperm density along with functional sperm concentration and mobility. This treatment protocol with lycopene supplementation resulted in a success rate of 36% pregnancies in their partners.
Pregnant women with pre-eclampsia who were treated with lycopene supplement significantly improved, which was shown by decreased diastolic blood pressure, the reduction of pre-eclampsia and a decrease of intrauterine growth retardation, resulting in a healthier mother and baby.
Future research is pending surrounding lycopene in metabolic and inflammatory diseases and in its role of possibly preventing neurodegenerative diseases such as Alzheimer’s disease. Other inflammatory conditions such as arthritis and emphysema will likely also be shown to benefit from lycopene. Preliminary data has already indicated this.
The Food and Drug Administration (FDA) of USA has recently approved lycopene as a safe “natural coloring agent” and a Generally Recognized as a Safe (GRAS) component. The Department of Nutritional Sciences , Faculty of Medicine, University of Toronto, c/o Dr. A.V. Rao et al. who completed this meta analysis of the recent literature have recommended that we all consume a regular daily lycopene dose in our food and supplements as part of our diet for good health.

More info about lycopene and prostate cancer: http://nethealthbook.com/news/lycopene-reduces-prostate-cancer-risk/

Reference: The Whitehall-Robins Report, December 2006, Volume 15, No.4

Last edited November 2, 2014

Dec
01
2005

Lycopene For Bone Health

The tomato pigment Lycopene in the diet has been demonstrated to be a beneficial agent in reducing age-related diseases, cardio-vascular disease and even prostate cancer. A new aspect has now been investigated.
Consuming more lycopene in the diet is of significant benefit to post-menopausal women, as it reduces oxidative stress and bone turnover. The findings come from head researcher Erin Collins from the University of Toronto. The study results also suggest, that dietary lycopene is readily absorbed, particularly in combination with vitamin C. These results are encouraging, as lycopene may be one of the main agents important for the prevention of osteoporosis.” We found that women who consumed more tomato products on a daily basis had a lower bone turnover and lower oxidative stress than women of the same age group who did not consume as much”, reports Ms. Collins. The participants of the research project were between 50 and 60 years. Lycopene levels in the blood were analyzed, and a seven-day food record was completed. The lowest quartile of estimated lycopene intake was 1.8 mg per day, and the highest was 8 mg per day. Lab tests also showed that higher levels of lycopene were associated with a lower level of protein oxidation and cross-linked N-telopeptides of type I collagen, for short NTx. The latter one is a marker of bone turnover. The intake of vitamin C appeared to work together with lycopene, but it only showed to have a correlation, if 500 mg per day or more of vitamin C was consumed. The effect was not observed among the volunteers who consumed less than 500 mg per day of vitamin C.
An intervention study will begin shortly, which will be the first of its kind. It will assess the bone parameters in women treated with different doses of lycopene pills.

Lycopene For Bone Health

Lycopene For Bone Health

It is likely that follow-up studies will confirm initial findings, and dietary lycopene could become a simple, inexpensive way of helping to prevent osteoporosis.

More information about osteoporosis: http://nethealthbook.com/arthritis/osteoporosis/

Reference: The Medical Post, October 11, 2005, page 8

Last edited October 29, 2014