Mar
02
2024

Living with the Aging Process

By | Alzheimer’s disease, andropause, Arthritis, Cancer, Cardiovascular disease, cholesterol, Diabetes, diet, erectile dysfunction, exercise, heart attack, Hormones, lifestyle, Menopause, osteoarthritis, telomeres

The following article describes living with the aging process. Older adults undergo the process of aging between the ages of 50 and 80. This is a complex process affecting various systems parallel. There are hormone factors that are particularly prominent in women during menopause. Joints are affected by degenerative changes, which can lead to total knee and hip replacements. The aging process was described in an article by Monica Jimenez at Tufts University.

What is aging?

Aging is the loss of function over time. The body is much more complex than a car, so there are more possible points of failure.  Christopher Wiley is a scientist on the Basic Biology of Aging Team who studies the role of nutrition and metabolism in aging at a cellular level at Tufts University. He said:” The fact that life works is amazing”. He went on to say: “The body tries to maintain itself and restore homeostasis(self-healing) even in the face of all this stress and all this damage. We have these really sophisticated programs for dealing with these points of failure.”

Aging goes on relentlessly

He explains the aging process this way: “It can start with something as simple as a broken molecule, one little thing that goes wrong in one cell, and then it’s like the butterfly effect,” Wiley said. “The tissue starts struggling, and then the organ, and then your entire body.”

Dr. Wiley warns about those who say physicians could make people “immortal”. “There’s definitely a misconception out there that we’re trying to make people immortal. But there is never going to be an immortality vaccine,” Wiley said. “There’s never going to be one thing that defeats all of aging. There’s always going to be another point of failure.”

Slowing down biological aging

The emphasis of research about aging is not to add chronological years. It is on biological aging and on how well our cells and tissues are functioning. Dr. Sarah Booth is the director of the Human Nutrition Research Center on Aging (HNRCA) at Tufts. She said: “Lengthening the time in which we can continue to move around, care for ourselves, and participate in social life and activities, is a worthier goal than extending years of suffering.” Many people become disabled in their last years of life, then they die. “Healthspan” is a new term for our years of freedom from disability, Booth noted.

Factors that prolong healthy aging

  1. Telomere length: One of the factors of longevity is our telomere length. Telomeres are the protective caps at the end of each chromosome. When they wear down, it leads to mistakes in the DNA copies of genetic information. There are supplements and herbs that can elongate telomeres. Exercise and the fasting mimicking diet also make telomeres longer. Older adults in good shape have longer telomeres, which stabilizes the DNA in their cells.
  2. Healthy diet: Researchers have determined that several diets are healthier than others. The Mediterranean diet is anti-inflammatory, so is the DASH diet, which was developed for people with high blood pressure. The HNRCA of Tufts is one of six organizations that got research grants recently to investigate life-prolonging diets. The amount was for $8.5 million.

Exercise and lifestyle factors

  1. Regular exercise: Over the years a lot of research accumulated data that shows regular exercise makes people biologically younger. Heart vessels have less atheromatous deposits and the brain stays younger as well. One study reported that 30 minutes of exercise daily prevents dementia.
  2. Other lifestyle factors: other factors are whether or not you are smoking (it goes without saying that you must quit). In addition, genetics (longevity gene), the environment (polluted or not), stress levels and socioeconomic class all play a factor in how fast we age. These latter points are difficult to tease apart, but they influence us globally. Target organs for aging are: the brain, heart, eyes, and bones, along with cancer, obesity, and more.

Hormone replacement 

  1. Bioidentical hormone replacement: One factor about delaying aging significantly was not mentioned in the review article by Monica Jimenez. But I am including it, because bioidentical hormone replacement is important for women who undergo menopause in their 50’s. I also mention it because men enter andropause in their 60’s. BiEst estrogen and progesterone cream make a big difference for the symptoms of menopausal women. Similarly, men experience a lot of relief with testosterone injections twice a week, when blood testosterone levels are low. If they have a lack of erections (erectile dysfunction) they may in addition need to take the “happy pill”. Sildenafil or tadalafil can treat erectile dysfunction by giving a good erection to a menopausal male. Hormone replacement can add as much as 10 healthy years to your life.

Discussion

Dr. Booth said: “We’re looking at the same question through different lenses with different tools, technologies, and perspectives. Progress in aging research is only going to be achieved by bringing together different disciplines addressing the same problem.”

Christopher Wiley added: “The biggest change I’ve seen in the past ten years is that we really are finding new, different ways of actually intervening somewhere that could potentially extend the healthy years of life, and prevent people from getting age-related diseases.” He mentioned that scientists are gradually reducing the suffering associated with aging: “What aging research is really trying to do is compress the morbidity and make it as small as possible – to alleviate suffering,” Wiley said. “I think that’s a much more humanitarian goal, and I think we’re having a lot of success with those efforts.”

Living with the Aging Process

Living with the Aging Process

Conclusion

Aging is a slow process that starts the moment we are born. But between the age of 50 and 80 we age faster. I mentioned 5 specific areas that can slow down the aging process. If somebody smokes, he/she must stop smoking. Cigarette and tobacco smoking  the biggest aging factor. The protective caps at the end of each chromosome go by the name of telomeres. When they shorten prematurely, mistakes occur in the DNA copies of genetic information. This leads to premature aging.

What keeps you younger for longer

The good news is that exercise, the fasting mimicking diet and several supplements can elongate telomeres. A healthy diet like the Mediterranean diet and regular exercise keeps the arteries open preventing heart attacks and strokes. Bioidentical hormone replacement helps to rebalance your hormones, which is important for normal cell function. In anti-aging circles they talk about life prolongation of about 10 years for hormone replacement alone. It comes down to not simply extend your lifespan, but to extend your years of healthy living without disability.

Jul
01
2023

What to Do about Hot Flashes in Menopause

By | Hormones, Insomnia, Menopause

This article is regarding what to do about hot flashes in menopause. It is important to realize that 80% of women who transition to menopause develop hot flashes and night sweats. Notably, this happens between 45 years and 55 years for most women. Another key point, two methods to fight menopause are non-hormonal methods including a new FDA approved drug and estrogen/progesterone therapy to replace missing hormones. Below I am reviewing both methods.

Non-hormonal methods to fight hot flashes

June 7, 2023 CNN published a review article about non-hormonal methods to fight hot flashes. In the article health professionals pointed out that there are a number of steps that the menopausal woman can take to lower the number and intensity of hot flashes. Indeed, menopausal symptoms include not only hot flashes, but also chills, night sweats, sleep problems, mood changes, vaginal dryness and pain during sex. It is important to realize that some women are not good candidates for hormone therapy, because they have a family history of estrogen-dependent cancers, cardiovascular disease, stroke, blood clotting disorders, deep vein thrombosis and chronic liver disease. The North American Menopausal Society just published the 2023 update to their recommendations for non-hormone therapy of menopause.

A new drug blocking hot flashes and night sweats

In this recommendation a new FDA approved drug is included. The pharmacological name is fezolinetant, the brand name is Veozah. To point out, this drug targets the neural activity in the brain that causes hot flashes and night sweats. It binds to the NK3 receptor, which regulates body temperature. The end result is a block of the KNDy (pronounced “candy”) neurons in the brain. To emphasize, these consist of kisspeptin, neurokinin B and dynorphin. The initials led to the abbreviation of the KNDy neurons (pronounced “candy”). To explain, the most common side effects are nausea and headaches. The only other medications that the FDA recognizes as effective for hot flushes and night sweats are low dose SSRI antidepressants.

Other recommendations of the 2023 non-hormone therapy of menopause update

By all means, triggers like caffeine and alcohol overconsumption and smoking should be avoided. Weight loss and cognitive therapy are reducing hot flashes. Clinical hypnosis is also effective as a treatment, as is Gabapentin. Specifically, a low-fat, plant-based diet and a half-cup of cooked soybeans per day led to a 88% reduction in moderate to severe vasomotor symptoms (hot flashes). Researchers compare this to a group with no dietary changes over 12 weeks.

Despite all of these measure menopausal women on hormone replacement did feel a lot more improvement.

Hormone replacement with estrogen and progesterone

Before we discuss this further a quick review of the Women’s Health Initiative in 2002 is necessary. This was a large study that 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 conjugated equine estrogen and medroxyprogesterone acetate. The reason these women had to suffer these side effects was because their physicians insisted in using hormones from drug companies rather than compounded bioidentical hormones. But these synthetic hormones were not pure hormones; they were adulterated with side chains. 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.

European trials regarding bioidentical hormone treatment

However, studies in Europe showed over many years that hormone replacement with bioidentical estrogen and progesterone creams from compounding pharmacies have no deleterious side effects, but replace the action of the missing hormones in menopause. Women lose their hot flashes and night sweats, regain their previous energy and sleep again through the night. Here is a link what the Mayo Clinic recommends to treat menopause.

Present day recommendation from regenerative physicians

The key about hormone replacement after menopause is to balance estrogen replacement with bioidentical progesterone. The ratio of the two hormones needs to be about 200:1 (or higher) for progesterone versus estrogen. Estradiol, which is the main estrogen in women is a mild carcinogen when not properly balanced with progesterone. By having higher progesterone dosages for hormone replacement, the body is protected from cancer and other side effects. Dr. John Lee years ago coined the term “estrogen dominance”. He also recommended the ratio of 200:1 of progesterone versus estrogen to balance the two hormones. A postmenopausal woman can apply a bioidentical BiEst cream (estrogen) to her skin and combine this with a bioidentical progesterone cream. Alternatively, she may prefer to take oral progesterone (Prometrium) 100 or 200 mg at bedtime. These tablets consist of crystallized bioidentical progesterone. None of this will cause cancer or other detrimental conditions.

What to Do about Hot Flashes in Menopause

What to Do about Hot Flashes in Menopause

Conclusion

Recently a publication describes a new drug that helps with hot flashes. The pharmacological name is fezolinetant, the brand name is Veozah. It blocks special neurons in the brain that are responsible for hot flashes. But possible side effects of this drug are nausea and headaches. Contrary to this there is no side effect with bioidentical hormone replacement when the physician balances the concentration of estrogen and progesterone. In this case the hormone balance prior to menopause simply returns. In this case her hot flashes and other menopausal symptoms simply stop. Anti-aging physicians in Europe have shown decades ago that the described combination of BiEst and Prometrium is safe, contrary to the synthetic drugs that were used in the Women’s Health Initiative where women died from heart attacks, breast cancer and blood clots.

Oct
05
2019

Breast Cancer Risk Persists After Hormone Replacement Therapy

By | blood test, breast cancer, Cancer, Hormones, Menopause, Osteoporosis

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 a more 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.

Feb
24
2018

What Causes Premature Aging?

By | alcohol, Anti-aging medicine, Dementia, Diabetes, diet, Drugs, exercise, heart attack, Prevention, Smoking, Stroke, testosterone, thyroid disease

Some people look 10 years older than their stated age, and we often wonder: what causes premature aging? Accelerated or premature aging can have a multitude of underlying causes. I will list a few here:

1. Weakening hormones

Men go through andropause at around the age of 60 to 65 and women go through menopause around the age of 55 to 65. In both males and females it is the sex hormones that are missing around that age. If hormones replacement follows fairly quickly with bioidentical hormones, this will not affect the visual appearance that much. In contrast, if bioidentical hormones are not the therapeutic choice for  hormone replacement, but synthetic ones, the hormones are not in balance, as synthetic hormones do not restore the hormonal balance. Nothing is gained, as the person will still age prematurely.

Synthetic versus bioidentical hormone replacement

In addition the synthetic hormones will cause heart attacks, strokes, clots, and cancer. Prescriptions for synthetic hormones are often the cause that the aging patient population gets these serious complications. Frequently physicians insist on using synthetic hormones from a “reputable” drug company to replace missing hormones. The reason this does not work is that a male has testosterone receptors. They need to be stimulated by bioidentical testosterone to restore all of his missing functions. Also, the same is true in menopausal females who need stimulation of their estrogen receptors and progesterone receptors. Consequently, only bioidentical hormones will return a postmenopausal woman back to normal. There is a perfect fit between the bioidentical replacement hormones and her hormone receptors. Using synthetic hormones is like trying to unlock a door with a key that does not have a perfect fit: you damage the lock!

2. Missing human growth hormone (HGH) and thyroid hormones

These hormones have a special place in aging.

Human growth hormone deficiency

First, HGH production is running out in many people at age 60. A person with HGH deficiency will have lower muscle mass and strength. Other symptoms are dry and thin skin, particularly at the back of the hands. Men are balding, and they loose interest in sex. There are difficulties concentrating and they may have “senior moments”, which are memory lapses. Often they are prone to depression and anxiety. A blood test will frequently show elevated triglycerides. A blood test (IGF-1) and a urine test exist which make it possible to look for HGH metabolites to assess whether a 40, 50 or 60 year-old person is producing enough HGH. Many may need replacement of HGH. This is administered by injection through a tiny needle into the skin, similar to a diabetic injecting insulin. This will bring back what was missing due to HGH deficiency.

Thyroid hormone deficiency

Thyroid hormones (T3 and T4) are other important factors that could make you look older prematurely. Your hair is getting thinner; your skin turns dry and pale. The nails may be getting brittle. When the outside half of the eyebrows is very thin or missing, this can be a sign of hypothyroidism. In a similar vein the skin in the face may be puffed up due to swelling of the layers under the skin (myxedema). It is important to diagnose hypothyroidism, which is common in the aging population. The physician needs to order a blood tests (TSH, T3 and T4). If TSH is above the upper limit, your physician needs to replace both T3 and T4 by tablets (I prefer Armour as the T3 and T4 is balanced).

3. Smoking

The lining of the airways absorb cigarette smoke. The chemicals circulate around in the blood and lead to aging of the skin. Chronic cigarette smoke exposure also melts away the subcutaneous tissue. The end result is a haggard look. The natural glow disappears from the skin and because of carbon monoxide binding to hemoglobin the skin color looks more greyish. In addition the blood vessels are narrowing or clogging. This means that the body cannot absorb nutrients as well, and cells are starving. There is only one remedy for this: quit smoking!

4. Overexposure to ultraviolet light

The radiation of UV light can penetrate deep into and under the skin. This makes the subcutaneous fat melt away. The largest UV exposure is in the facial area. As a result we see aging there. The end result is a sagging appearance of the face. This link has an image of a woman before and after a non-surgical facelift with stem cells and fatty tissue: Stem Cell Treatments That Are Currently Available – Medical Articles by Dr. Ray

In a surgical procedure the physician harvests mesenchymal stem cells from fatty tissue by liposuction. A cell separator separates the mesenchymal stem cells, the connective tissue and the fat cells. The connective tissue is discarded. Mesenchymal stem cells and fat cells are mixed and injected into the thinned subcutaneous fatty tissue until the person’s younger facial contour is back to normal. Typically this will last for 10 years or more.

5. Drugs and alcohol abuse

Both can lead to malnutrition with weight loss and loss of subcutaneous fatty tissue, which causes sagging breasts in women. In men “beer tits” are common. The reason for this is estrogen accumulation, as alcohol interferes with the elimination of estrogen in the liver. Alcohol is a general cell poison. It causes all of the cells to age prematurely. The more alcohol you drink, the faster you age. The skin develops wrinkles, loss of elasticity and collagen, redness and puffiness. In other words chronic alcohol abuse ages you prematurely. The only remedy for this is to quit drinking. Some of your skin vitality may come back. Our body has an amazing capability to heal itself!

6. Medical illnesses

Many medical illnesses like diabetes, mental illness (depression and schizophrenia), multiple sclerosis, inflammatory bowel disease; cancer and others make you look a lot older very fast.

I will briefly explain the reasons for this.

  • Diabetes

With diabetes type 2 the pancreas releases too much insulin after a meal with starches and sugar; think about a sweet muffin or a toast with jam. The extra insulin causes inflammation. This stimulates enzymes that break down elastin and collagen, leading to wrinkles and sagging skin.

  • Mental illness like depression and schizophrenia

We know from studies that depression leads to shortening of telomeres. This in turn causes cell death in the most rapidly dividing cells like in the skin and hair follicles. The end result is prematurely aged hair and skin. Schizophrenia also leads to premature shortening of the telomeres, which causes premature aging, mitochondrial dysfunction, inflammation and oxidative stress. The end result is that the person looks older than what their chronological age is.

  • Multiple sclerosis

It is sometimes difficult to discern in patients with MS what is normal aging and what is aging from the disease. This link gives some background on this. Many MS patients are anxious, and anxiety and stress by itself also leads to premature aging.

  • Inflammatory bowel disease

The chronic inflammation of either ulcerative colitis or Crohn’s disease can lead to premature aging. High doses of vitamin D3 and molecularly distilled fish oil can be useful to help treat the inflammation. Probiotics are also important to restore the bowel flora.

  • Cancer

Cancer leads to cachexia (excessive weight loss). There is also excessive inflammation, which leads to accelerated aging. The inflammation causes increased oxidative stress. This leads to tissue damage and DNA damage, which makes all cells more vulnerable to develop other cancers. Oxidative stress can substantially accelerate telomere shortening. As a result skin can become saggy, wrinkles develop and the person looks prematurely aged.

7. A chronic lack of physical activity

People who never exercise tend to get overweight and eventually obese. This leads to premature aging. Exercise would elongate telomeres, but inactivity shortens them. Obesity leads to increased oxidative stress and to DNA damage. Obesity also shortens telomeres. All of this leads to premature aging.

What Causes Premature Aging?

What Causes Premature Aging?

Conclusion

These are only a few examples of causes of accelerated aging. The key is to stick to a healthy, balanced diet (like the Mediterranean diet) and exercise regularly. Stop smoking (if you do), don’t take street drugs, and make sure you get enough sleep. Getting enough sleep helps your hormones regenerate overnight. The sympathetic overdrive from your daily activities is counterbalanced by the parasympathetic activities during sleep that causes relaxation. For hormone replacement you may have to see an anti-aging physician, a naturopath or integrative medicine physician. This may be your only chance to address any hormonal deficiencies. Conventional medicine does a very poor job of HRT (hormone replacement therapy) with synthetic hormones. Conventional practitioners want to treat you with synthetic hormones that will make you sick. Hormones for replacement have to be bioidentical! This way you will live 10 to 15 years longer, look younger and stay healthy.

Apr
08
2017

Breast Cancer Risks

By | breast cancer, Cardiovascular disease, fiber, Fitness, heart attack, Hormones, immune system, Menopause, premenopause, Stress management, toxins, Vitamins and supplements

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.

Feb
18
2017

Weight Gain In Menopause

By | Diabetes, Hormones, Menopause, Nutrition, Obesity, Osteoporosis, premenopause, Prevention, Women’s Diseases

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.

May
14
2016

Hormone Replacement Therapy In Menopause

By | Cancer, Cardiovascular disease, heart attack, Hormones, Menopause, Mortality, Osteoporosis, Stroke

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

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

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

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

Unknown facts about hormone replacement therapy in menopause

Premarin is not bioidentical to human estrogens

Both clinical trials used the wrong hormones to do the trials. If you use the wrong hormones in a trial, you would expect to get the wrong test results. Horse derived estrogen (equine estrogen) is hardly a match for bioidentical, human estrogen in women. But decades ago the drug manufacturer had decided that estrogen was easiest to manufacture on a large scale when urine from pregnant mares was used. The product contains conjugated horse estrogen and is known by the name Premarin. Premarin is not bioidentical to human estrogens.

Synthetic progesterone causes heart attacks

The other hormone, medroxy progesterone (MPA) is a progestin, a bad copy of the bioidentical progesterone that a woman’s corpus luteum of one of her ovaries produces. This is in the second half of her menstrual cycle. During pregnancy the placenta produces lots of progesterone to protect the pregnancy. As Dr. Masley, a cardiologist stated synthetic progestins cause heart attacks, while progesterone does not. Masley said: “Medroxy progesterone (MPA) increases the risk for heart disease and for breast cancer. I can’t understand why any physician would recommend medroxy progesterone during menopause, but it is still in use.”

Don’t use estrogen orally, but only by estrogen patch or estrogen cream

Next there is the question whether the liver changes the composition of an oral hormone tablet metabolically or not. The answer is: yes! Dr. Masley stated in the link above that oral estradiol, when compared to estrogen rubbed onto the skin, increases levels of inflammation by 192%. The C-reactive protein (CRP) can be measured with a blood test. The risk for a blood clot increases by 400%. A woman using estrogen should always use the estrogen patch or an estrogen cream with bioidentical estrogen to avoid these complications.

Measure hormones, don’t estimate

Measure hormones – don’t estimate: Hormones are constantly changing and if you don’t measure, you don’t know what you are dealing with. Dr. John Lee showed a long time ago that you should measure hormones and identify those women who are truly hormone deficient. These are the ones who need hormone replacement. However, you use only bioidentical hormones to replace and you replace only as much as is needed to normalize the levels. This is also the level where postmenopausal symptoms disappear. Lee noted: “A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes or heart attacks.”

Measure progesterone hormone levels only in saliva

The elusive progesterone: when the physician measures progesterone as a blood test, it may come back as high while it can be low in a saliva hormone test in the same woman. Dr. Lee has pointed out that studies have shown that progesterone levels in tissue are usually higher by several factors when compared to blood levels and that blood levels are not reliable predictors of tissue levels (Ref.1). On the other hand he found that saliva levels have a good correlation with tissue levels in organs like the ovaries or the uterus. Dr. Lee preferred saliva hormone tests for this reason. When it comes to progesterone levels you can trust saliva test, but you cannot trust blood tests. Many physicians ignore that fact and strictly order blood progesterone levels coming to false conclusions.

Progesterone to estradiol ratio

We know that estrogen and progesterone must be balanced to avoid troubles of developing heart attacks or cancer. The link of Dr. Lee above stated that women without breast cancer have saliva progesterone hormone levels that are more than 200-fold higher than the saliva estradiol levels. On the other hand women with breast cancer have a ratio of less than 200 to 1 with respect to progesterone to estradiol saliva levels. There is a similar ratio in men. Here the ratio of testosterone to estradiol must be larger than 20 to 1. If this is not the case, he is at a higher risk of developing prostate cancer. Unfortunately many older men, when overweight or obese, have high estrogen levels and the ratio is less than 20 to 1.

Bioidentical hormones can prevent heart attacks and strokes

Masley has mentioned that in the first 6 years after menopause using a topical form of estrogen and micronized progesterone as tablets can minimize the risk of future heart attacks and strokes. But after 10 years it is less obvious what is the best solution. The question is what type of estrogen application is used. Is it estradiol or is it Bi-Est or Tri-Est, which are other topical estrogen applications. Tri-Est is 80% estriol, 10% estrone, and 10% estradiol while Bi-Est is 80% estriol and 20% estradiol. Tri-Est in particular would be very close to the natural composition of estrogens in a woman’s body.

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

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

This makes estrogen from androgenic hormones including testosterone. The adrenal glands situated above the kidneys produce these hormones in menopause. The more overweight or obese a postmenopausal woman is, the higher the estrogen levels in her blood because of the action of the aromatase. Most physicians have not measured hormones in the past, but just replaced hormones monitoring only postmenopausal symptoms. This is changing. What I said under point 4 above is happening more.

Bioidentical hormone replacement practiced by naturopaths

Naturopaths tend to be more comfortable with bioidentical hormone replacement the way I have described it. If you did hormone tests (preferably saliva hormone tests) you would pick up higher estrogen levels and low progesterone levels with unfavorable progesterone to estrogen ratios as mentioned. These women do not need estrogen (they have it already in their systems). They need progesterone replacement only. A woman can take progesterone by mouth as micronized bioidentical progesterone capsules at night. It also  comes as bioidentical progesterone cream for application to the skin. Here is another take on the use of bioidentical hormones.

Hormone Replacement Therapy In Menopause

Hormone Replacement Therapy In Menopause

Conclusion

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

References

  1. Dr. John R. Lee: “Natural Progesterone – The remarkable roles of a remarkable hormone”, Jon Carpenter Publishing, 2nd edition, 1999, Bristol, England.
May
23
2015

Treating Menopausal Symptoms

By | Anti-aging medicine, Hormones, Menopause, Osteoporosis, Prevention, Women’s Diseases

There has been a lot of confusion since the Women’s Health Initiative that was prematurely abandoned because the women in the group that were treated with PremPro developed heart attacks, strokes and breast cancer. The clinical trial was supposed to confirm that hormone replacement therapy (HRT) with synthetic hormone supplementation would be heart protective, but it did the opposite.

I have addressed the problem of menopause and andropause in another blog.

Here I will review what can be done for a woman who enters menopause, has symptoms of hot flashes, lack of energy, sleep disturbances etc., but wonders whether not something could be done without introducing any risks as mentioned above. The answer is yes. I will review first what bioidentical hormones do and then discuss a bioidentical hormone replacement plan.

Hormones

The normal hormone action in a woman gets regulated through a complex interactive cycle between the stimulatory releasing factors of the hypothalamus that release pituitary hormones, which in turn stimulate the ovaries to produce estradiol and progesterone in a cyclical fashion. When salivary hormone levels are measured, there is a hormone ratio of 200:1 of progesterone to estrogen. According to Dr. Lee who researched this in detail in his books estradiol is potentially cancer producing in the breast and in the lining of the uterus. However, when the ratio of 200:1 (progesterone to estradiol) or more is found in a woman’s saliva the carcinogenic estrogen effect is neutralized by progesterone (Ref. 1 and 2). When a woman approaches menopause, less progesterone is being produced by the ovaries, as there can be anovulatory cycles. This means that a corpus luteum is not developing and progesterone is missing (Ref. 3 and 4). The change of cyclical hormone changes causes the pre- and postmenopausal symptoms.

There are a lot of effects that estrogens are having: estradiol is involved in neutralizing free radicals that age your cells; it maintains libido, supports bone health, prevents Alzheimer’s, prevents cataracts and skin wrinkling, prevents hot flashes and much more. Progesterone on the other hand keeps your hair from falling out, protects from blood clots, has an antidepressant effect, protects myelin sheaths (prevents multiple sclerosis), reduces cholesterol, prevents diabetes and much more. A table with all of the properties of these two hormones can be found here (scroll down).

Testosterone is also necessary in women for normal libido. However, the dose is much smaller than in the male. These traces of testosterone are produced in the adrenal glands and in the ovaries. These can be tested in either blood or saliva.

Safety of hormone replacement

Immediately when hormone replacement is discussed, the question of safety comes up. I have discussed this in detail here. Briefly, there is a 25 year collective experience in the US with bioidentical hormone replacement with no case of breast cancer, uterine cancer or other complications. In Europe bioidentical hormones have been used since the 1960’s, on a larger scale since the 1970’s. So the European experience of safety of bioidentical hormones is presently about 40 to 50 years. Again no breast cancer, uterine cancer, blood clots, heart attacks or strokes have occurred.

In contrast the synthetic hormones promoted by Big Pharma and approved by the FDA have caused the problems of the Women’s Health Initiative.

There has been a review of the Women’s Health Initiative in Postgraduate Medicine 2009 that clearly described that only bioidentical hormones are safe.

Bioidentical hormone replacement

Basically, what is missing should be replaced with the same hormones that were in your body all along. The reason for this is that each cell of your body has specific hormone receptors. There is a key/lock fit with regard to the hormone and the fitting hormone receptor in the cell that will stimulate necessary biochemical reactions to sustain cell function in every corner of your body. Why would you use a false key (synthetic hormone) that does not fit? Just because a regulatory body, Big Pharma and a physician who was influenced by Big Pharma say so? This does not make sense. Your body requires the bio-identical hormone that your body used to make when you were younger. With the gentle replacement of bioidentical hormones that youthfulness will come back. Based on hormone tests, the first hormone that usually needs to be replaced is progesterone, which can be applied as a skin cream or can be taken as Prometrium, a tablet that can be taken by mouth. After two to three months the hormone levels can be repeated and the ratio of progesterone to estradiol can be calculated (as stated above should be greater than 200:1). If testosterone levels are missing and this is clinically verified by symptoms, a small amount of testosterone cream can be applied as well. DHEA levels, cortisol and thyroid levels are also determined and what is missing is replaced. Fasting insulin is often also measured, particularly in a person who may be overweight or obese. A naturopathic physician or an anti-aging physician (A4M) can help you with the management of bioidentical hormone replacement.

New consensus rules

In 2012 a new HRT consensus statement was published allowing postmenopausal symptoms to be treated for 5 years. It was endorsed by 15 agencies. But when you read this with an open mind, it has NOT changed the synthetic hormones, but argues that up to 5 years of treatment would be relatively safe. There is no clear distinction made between natural progesterone and the synthetic progestins, which produce clots, heart attacks and strokes. Bioidentical hormones have been with women all their lives; when menopause sets in, there is a lack of progesterone, and estrogen dominance causes cancer problems. In Europe postmenopausal women can use bioidentical hormones as long as they feel they need it, in North America there is a consensus statement that postmenopausal women should not use  HRT with synthetic hormones from Big Pharma for longer than 5 years. This does not make sense! Why still synthetic hormones? I smell influence peddling worn out on the shoulders of postmenopausal women.

Treating Menopausal Symptoms

Treating Menopausal Symptoms

Conclusion

A lot of women have been unnecessarily scared by hormone replacement because of the Women’s Health Initiative, which was just a confirmation that synthetic hormones are noxious substances for the body. The recommendations from the consensus statement did nothing to clarify the situation.  All their lives women have been under the influence of their own bioidentical hormones produced by their hormone glands. So replacement with bioidentical hormones (structurally identical to the natural hormones in women) is safe and will bring back the vitality of the past, remove all postmenopausal symptoms and help women live a longer life without Alzheimer’s, heart disease or cancer (Ref.5). I agree with the European studies, the studies presented at many of the A4M conferences I have attended and the Postgraduate Medicine article mentioned above that stated that bioidentical hormone replacement is safe.

 

References:

Ref.1: Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. On page 256 and 257 Dr. Lee describes how progesterone can be used as a cream to treat PMS.

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

Ref. 3: Dr. John R. Lee and Virginia Hopkins: “Hormone Balance Made Simple – The Essential How-to Guide to Symptoms, Dosage, Timing, and More”. Wellness Central, NY, 2006

Ref.4: Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. Page 29 – 38 (Chapter 2): Risk factors for breast cancer. Page 360 to 374 explains about xenohormones and how they cause estrogen dominance. Pages 221 to 234 (chapter 12) explains why Tamoxifen is not recommended and bio-identical progesterone is more powerful in preventing breast and uterine cancer

Ref.5: Dr. John R. Lee: “What your doctor may not tell you about menopause: the breakthrough book on natural hormone balance”. Sept. 2004.

Jun
21
2014

Older Grumpy People Have Higher Risk Of Dementia

By | Alzheimer’s disease, Anti-aging medicine, Health, Hormones, Men's Health, Women’s Diseases

Although in this recent study from Finland researchers found that grumpiness in older age seems to lead to dementia at a faster rate, I like to emphasize here that there may be an under lying problem of hormone deficiency.

Other studies have shown that in males low testosterone levels are associated with grumpiness and dementia is setting in sooner in those males who are deficient for testosterone. For older grumpy females it is the lack of progesterone that has been found to be deficient and when you replace it, memory comes back, symptoms of menopause reverse themselves and the grumpiness is gone. Testosterone replacement may be required by as many as 1 in 4 men in the their 40’s as is summarized in the article from Great Britain.

How can we tell whether there is a change in an older man? There are quite a few symptoms that can be seen by loved ones around this man: an increase in abdominal girth, shrinking muscles, lack of energy, irritability. The key is to get him to the doctor and ask the doctor to order a bioavailable testosterone blood test.

According to medical research 84% of men and 62% of women in the age group of 57 to 64 have been sexually active in the previous 12 months. Take an older age group of 65 to 74 and still 67% of men and 40% of women are sexually active. Fast-forward to age 75 to 85 and the rate has dropped to 39% of men and 17% of women (Ref.1). A person’s sexual activity is a barometer how well the hormones are balanced. These figures show that bioidentical hormone replacement has not been well accepted. Women have a reason as they were misled by Big Pharma as was shown in the

Older Grumpy People Have Higher Risk Of Dementia

Older Grumpy People Have Higher Risk Of Dementia

Women’s Health Initiative:

The National Institutes of Health had funded a large study (the Women’s Health Initiative) to clarify what was going on with regard to side effects and effects of HRT.

Unfortunately, synthetic non-bioidentical hormone products were used in these studies (Premarin and Provera) instead of bioidentical estrogen and progesterone. The results of the Women’s Health Initiative were devastating. In 2002 doctors were warned that Premarin and Provera used as HRT would cause increased heart attack rates and breasts cancer, which led to premature death. Overall the placebo group did better than the experimental group and this is why the trial was prematurely stopped.  As a result of the wide publicity regarding the negative results of the Women’s Health Initiative postmenopausal women either do not see their physician for hormone replacement or are advised by conventional doctors that only small amounts of Premarin could be used for not more than 5 years for fear of causing breast cancer. Medico-legal considerations are at play and the whole issue of HRT after menopause has been politicized.

Problems now for HRT:

It is like a negative shadow has been cast forward with regard to hormone replacement because of the Women’s Health Initiative. People are still confused and don’t understand that the synthetic hormone-like drugs from Big Pharma are like an ill-fitting key for the hormone receptors in the body whereas bioidentical hormones are the perfect fit.

Otherwise there would not be a 45% drop-off (from 62% to 17%) in sexual activities in women from age 60 to 80. Men have it somewhat easier: their drop rate between age 60 an 80 is also 45% (from 84% to 39%), but as they entered into male menopause 10 to 15 years later than women did with menopause, their sexual activity is still double that of women at the age of 80.

However, if people could overcome their unrealistic fear of bioidentical hormones, hormones that fit the body’s hormone receptors a lot more people would be encouraged to use bioidentical hormone replacements.

What, if the grumpy, old man is willing to see his doctor?

The doctor should look at all of the hormones including a fasting insulin level as hyperinsulinism often complicates hormone replacement. Thyroid, which often is also lowered at an older age should be also tested (T3, T4 and TSH). A saliva hormone test can show a panel of 5 hormones: cortisol, DHEAS, testosterone, progesterone and estradiol. As hormones are in a balance with each other this allows to compute the testosterone to estrogen ratio, which ought to be 20 or higher. But hormones alone are not the answer. There needs to be a combination of proper nutrition (cut out sugar, starchy foods, preferably switch to organic foods to escape the xenoestrogens that foul up your hormone balance), also exercise and use vitamins and supplements. I have summarized all of this in my recent book “A survivor’s Guide to Successful Aging” (Ref.2).

When the hormone tests come back the doctor will likely order the missing hormones (hopefully as bioidentical hormones).

It can take 2 to 3 months before the full effect of bioidentical hormone replacement is seen. But most men will be astounded how well they can feel. He will notice that he does not tire with exercising. His muscle mass builds up; his posture improves. His stamina comes back. He will find that the previously foggy thinking is gone and his thought processes have become clear again. And yes, his sex live comes back. So now he has to talk to his sex partner about her bioidentical hormone replacement so they both can enjoy the benefits!

Hidden benefits of bioidentical hormone replacement:

The bones become stronger, the heart beats harder and better, the brain thinks clearer, because the key organs like the brain, the heart and the bones have the appropriate hormone receptors (in both sexes).  No, this is no exaggeration. This can be measured by an exercise tolerance test (for the heart). Bone density can be measured and has been done (2% to 4% increase per year). Brain function is indirectly visible to the people around the person: apart from new vitality, improvements in mood and more energy, the grumpiness is gone and the person is perceived as a pleasant person once again.

Conclusion:

The observation of an “old, grumpy man” when he entered the male menopause is accurate, but should not distract from the fact that he has a responsibility to look after himself. It is important to recognize that it is not only women who enter the menopause, but that men 10 to 15 years later will do the same. Both sexes enter a state of hormone disbalance that is treatable. The answer is to replace the hormone deficiency with the missing bioidentical hormones.

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

References:

1.Rakel: Textbook of Family Medicine, 8th ed., copyright 2011 Saunders

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

Last edited Nov. 8, 2014

May
10
2014

The Full Story About Testosterone

By | Heart Disease, Hormones, Men's Health, Obesity, Osteoporosis, Prevention, Stroke

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

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

Main findings of the Massachusetts General Hospital study:

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

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

The Full Story About Testosterone

The Full Story About Testosterone

Testosterone to estrogen ratio:

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

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

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

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

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

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

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

Conclusion:

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

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

References:

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

Last edited Nov. 8, 2014

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