Medical Articles by Dr. Ray

May

2017

New Treatments For Premenstrual Syndrome

By Ray Schilling | coffee, exercise, headache, Hormones, low back pain, Pain, premenopause, Prevention, Stress management, thyroid disease, Vitamins and supplements, Women’s Diseases

Dr. Pamela W. Smith gave a talk about new treatments for premenstrual syndrome (PMS). She presented this talk on Dec. 11 at the 24^th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The original title was “New Treatment Modalities for PMS”.

Signs and symptoms of PMS

Dr. Smith discussed signs and symptoms of PMS first. She showed 9 slides where she listed all of the symptoms of PMS that commonly occur.

Symptoms are varied; they can mimic various psychological problems like anxiety, depression, panic attacks and more. But physical symptoms like abdominal bloating, acne, back aches, and asthmatic attacks are also common. There are a myriad of more symptoms of PMS: constipation, cramps, clumsiness, dizziness, drowsiness, decreased sex drive, facial swelling, forgetfulness, fatigue, headaches, a herpes-like outbreak, hot flashes, sensitivity to light and noise, insomnia, joint pains, mood swings, palpitations, restlessness, poor memory, sore throat, tearfulness, vomiting and weight gain.

What do we know about PMS?

PMS is due to a hormone dysfunction

There is no definitive test that would help in the diagnosis of PMS. But we do know that there is a hormone dysfunction that leads to a monthly recurrence of symptoms during the two weeks prior to the woman’s menstruation. When her period begins or shortly after all of these symptoms disappear.

PMS due to estrogen dominance

PMS is very common; 70to 90% of women have a certain degree of PMS. In 20 to 40% of women symptoms are severe. Many researchers have shown that there is a problem in the feedback loop between the pituitary gland and the ovaries. This leads to a decrease of progesterone production in the ovaries. The result is an overabundance of estrogen, which many hormone experts call estrogen dominance.

Several hormones need checking with PMS

But things can get complicated when other hormone changes occur. A woman may also turn hypothyroid. When she gets closer to menopause estrogen deficiency may also develop. Electrolyte disturbances can occur from high estrogen levels causing excessive aldosterone levels. This would lead to high sodium and low potassium blood levels. The end result may be an activation of the renin-angiotensin system, which could cause high blood pressure.

Neurotransmitters of the brain can be involved in PMS

Neurotransmitters are often disbalanced. When serotonin is low in the brain, depression can develop. Noradrenalin deficiency leads to a lack of focus, energy and memory.

Women with PMS often have hypoglycemia

Hypoglycemia is also common among women with PMS. This may be due to cravings for sweets and consumption of starchy foods. Women who crave sweets may also consume caffeine excessively. But caffeine increases prostaglandin production in the body. This leads to breast tenderness, abdominal cramping, arthritis and back pains.

PMS after partial hysterectomy

A partial hysterectomy can cause PMS in a woman who never before had symptoms of PMS. The current school of thought is that blood supply to the ovaries after a hysterectomy has decreased, and this could be the reason for the onset of PMS.

Birth control pill can cause PMS

The birth control pill can bring on PMS due to the progestin component in it.

Tubal ligation may cause PMS

Tubal ligations can also be a cause: 37% of women who had tubal ligations develop PMS. The reason is a change in hormone production. In these women estrogen is produced to a higher degree than progesterone is.

Lab tests for women with PMS

Although there is no single test that would be able to diagnoses PMS, a variety of abnormal tests are often abnormal in association with PMS. Frequently there is deficiency for vitamin A, B6, E, magnesium, potassium, zinc and trace minerals. Calcium can be too high or too low, but blood tests will reveal that.

Four PMS types

Dr. Smith said that PMS has been divided into 4 subcategories depending on the main symptoms.

Anxiety: PMS A
Carbohydrate craving: PMS C
Depression: PMS D
Hyperhydration: PMS H

PMS A is associated with estrogen excess and progesterone deficiency. There is a diminished stress response in the hypothalamus/pituitary/adrenals axis. Symptoms are mainly anxiety, irritability, insomnia and emotional lability.

PMS C is associated with sugar craving, hypoglycemia, headaches, heart palpitations and spontaneous sweating.

PMS D is leading to increased neurotransmitter degradation. Symptoms consist of depression, crying, despair, feeling hopeless, fatigue, low libido, apathy and insomnia.

PMS H is caused by increased aldosterone activity triggered by estrogen surplus in the late luteal phase. Symptoms are weight gain, swelling of hands and feet, a feeling of bloating, breast tenderness or engorged breasts. Women will find that their clothes simply fit tighter.

Migraine headaches in PMS

Some women with PMS are plagued by migraine headaches. It may have started in puberty or after taking birth control pills for contraception. Sometimes the onset is after a pregnancy, miscarriage or abortion. When PMS develops and a woman has migraines, they usually occur around the same time in her menstrual cycle. With pregnancy the migraines disappear in the last trimester when progesterone hormone production from the placenta is the highest.

Hormonally related headaches can occur for 4 main reasons.

Estrogen and progesterone are on the rise around the time of ovulation
When a woman has hypoglycemia (due to hyperinsulinemia)
Estrogen levels are changing
When there is estrogen dominance

Treatment for PMS

Dr. Smith explained in detail the various treatment modalities for PMS. Treatment has to be personalized according to what type of PMS the doctor thinks that the patient is suffering of.

Dietary factors

In the beginning it is important to pay attention to the diet. Studies have shown that PMS patients tend to eat too many carbs and too much refined sugar compared to patients without PMS. PMS patients also eat too many dairy products and too much sodium. In addition PMS patients are deficient in iron, manganese and zinc. A good start is a Mediterranean diet, which is at the same time anti-inflammatory.

The recommendations is to eat 6 small meals a day. Avoid caffeine and alcohol. They are antagonists to the B complex vitamins. By avoiding sugar, you also avoid fluid accumulation and magnesium deficiency. A low fat, high-complex carb diet helps reduce breast tenderness. Reducing fat and increasing fiber in the diet decreases estrogen levels in the blood. These steps help PMS symptoms.

Nutritional supplements

Magnesium, vitamin B6, A, D3, E, L-tryptophan, calcium, zinc, fish oil (EPA/DHA) and evening primrose oil are the main supplements recommended for PMS patients. Your healthcare provider can advise you what you should take and what dosage.

Exercise

Regular exercise has very beneficial effects on reducing many symptoms of PMS. Even as little as 8 weeks of exercise -as was done in this study- had a significant effect. Exercise elevates endorphin levels, improves blood sugar stability, decreases norepinephrine and epinephrine in the brain and helps to decrease estrogen levels. This will control blood sugar levels, reduce anxiety, reduce estrogen-related symptoms and increase satisfaction.

Thyroid medication

Many women with PMS have borderline hypothyroidism or are overtly hypothyroid. In these cases the patient should receive small amounts of thyroid hormones.

Progesterone

Most PMS patients persistently lack one hormone, progesterone. The best test for this is a saliva hormone test, because this reflects the tissue levels. Blood levels test too low and are useless. Bioidentical progesterone cream is applied transdermally (through the skin) from day 14 to 25 of each menstrual cycle. Micronized progesterone pills are also bioidentical and can take the place of progesterone cream.

Botanicals

There are a number of home remedies, which are heavily promoted on the Internet. They may, however, not be as effective as advertised.

Estrogen balancing Black Cohosh

Black Cohosh is said to balance estrogen and is anti-spasmodic.

Progesterone raising Chasteberry

Chasteberry decreases LH and prolactin. It raises progesterone, acts as a diuretic and binds opiate receptors. This reduces PMS related aches and pains.

Herbal supplement St. John’s Wort

St. John’s Wort helps these symptoms: anxiety, depression, mood swings, feeling out of control and pain.

Anti-inflammatory Ginkgo biloba

Ginkgo biloba is a mild blood thinner. Women who are on blood thinners should not use it! It improves depressive symptoms and mood, has anti-inflammatory effects and helps with anxiety control.

Nutrient-rich saffron

Saffron: In a clinical trial the Saffron group did significantly better in PMS symptom control than the placebo group. Saffron is rich in magnesium, vitamin B6, iron and other nutrients that are missing in PMS patients, which explains the effectiveness of this botanical.

Lavender, Motherwort, and Dandelion

Other botanicals: Other botanicals are Lavender, Motherwort, and Dandelion.

Candidiasis

Due to prolonged exposure to high sugar and refined carb intake many women with PMS suffer from candidiasis (chronic yeast infection). Anti-Candida programs help to eradicate Candida overgrowth, which often improves several PMS symptoms.

Mind/body therapy

Cognitive-behavioral therapy helps for depression and anxiety. Hypnotherapy, yoga and biofeedback therapy are also useful methods.

New Treatments For Premenstrual Syndrome

Conclusion

At the present time there is a better understanding of PMS than in the past. Progesterone deficiency and other hormone weaknesses seem to be at the center of this condition. But vitamin and mineral deficiencies also play a role. The healthcare provider should order some baseline blood tests and hormone tests for the patient, including a saliva progesterone level.

Treatment consists of a combination of steps taken simultaneously. The dietary approach comes first: a Mediterranean diet will be beneficial. Next add nutritional supplements. Regular exercise is essential. Finally bio-identical hormone replacement of the missing hormones is necessary.

If there is an underlying chronic candidiasis infection, it needs treatment. The choice of drug would be nystatin. Some botanicals may be helpful, as discussed. When anxiety and depression are important parts of the PMS symptoms, mind/body therapy (such as cognitive therapy etc.) may also be helpful.

The key with PMS treatment is to not give up, but to re-evaluate the condition, if the initial attempt does not bring full relief. By not giving up and using all modalities of treatment the patient will be able to get rid of the condition, eliminate the symptoms of PMS and achieve well being.

Apr

2017

Only Moderate Alcohol Consumption Benefits Your Heart

By Ray Schilling | alcohol, Cancer, Cardiovascular disease, heart attack, Heart Disease, Stroke

A new study from England finds that only moderate alcohol consumption benefits your heart. The study appeared on March 22, 2017 in Great Britain. 1.937 million people (51% women, 49% men) had participated in this investigation over 6 years. The lead author, Dr. Steven Bell is a genetic epidemiologist. He said that the purpose of this study was to clear up some of the confusion from previous studies. He wondered why the control group without alcohol exposure had more cardiac problems than the moderate group. It did make sense though, that the high alcohol group had worse cardiac problems.

But he and researchers from Cambridge University and University College London did this study to get more detail. They were curious why the current non-drinking group serving as a control did not undergo more scrutiny. It consisted of a mix of lifelong abstainers; people who drank formerly, but then gave it up. And the other group was those who drink on an occasional basis.

With this in mind the researchers designed their study. They also used larger numbers to increase the reliability of the study.

Details of English study

The data comes from the Clinical Practice Research Datalink providing anonymous patient records from general practices in England. The patients upon entry into the study had to be older than 30 years, but have no evidence of cardiovascular disease. A total of 1,937,360 patients qualified to be part of the study.

Based on patients’ records and patients recollections people, researchers looked at 5 classes of drinkers:

Non-drinkers (14.3%)
Former or ex-drinkers (stopped drinking at one point, 3.7%)
Occasional drinkers (drinking rarely, 11.9%)
Moderate drinkers (drinking within sensible limits, 61.7%)
Heavy drinkers (hazardous alcohol use, 8.4%)

Various cardiovascular diseases apart from heart attacks

The end point of the study researchers concentrated on the frequency of cardiovascular diseases like angina, heart attack, sudden cardiac death, stroke, peripheral arterial disease, abdominal aortic aneurysm and others. I only listed 6 of the 12 cardiovascular diagnoses as otherwise it would get too technical.

More information: Most study participants were non-smokers, their BMI was within normal limits, and they also did not have diabetes.

Findings of the study

There were significant differences among subclasses of alcohol consumption and the development of cardiovascular diseases over 6 years.

U-type dose response curve

The findings were in line with a number of previous similar studies that showed a U-type dose response curve between developing cardiovascular diseases and alcohol consumption. The group of non-drinkers (without former and occasional drinkers ) often had a 20% to 56% higher risk of developing cardiovascular disease, while moderate drinkers had no added risk.

Sudden cardiac deaths

On the other hand the heavy drinkers were at risk of developing cardiac arrest (50% increased risk) or heart failure (22% increased risk). A death from a sudden heart attack occurred in heavy drinkers with a 21% increased risk. A former drinker had a 40% increased risk for this, but a non-drinker a risk of 56% increased risk!

Smaller amounts of alcohol help to clean out arteries

A non-drinker had a 32% increased risk of getting a regular heart attack, a former drinker had a 31% increased risk, an occasional drinker 14%, a moderate drinker no added risk, and a heavy drinker had a 12% reduced risk! This seemed to show that drinking alcohol keeps the coronary arteries open and clean. I have had pathology demonstrations with Professor Dr. Adalbert Bohle at Tübingen University during my medical training in 1969. At that time he pointed out how clear and wide open the coronary arteries were in chronic alcoholics. It was not heart disease that killed those patients; they had died from end stage liver cirrhosis, and we saw pathological slides of that.

Strokes in heavy drinkers

Heavy drinkers get more ischemic strokes (33% risk increase) and more intracerebral hemorrhages (37% risk increase).

Lower leg arterial obstruction

Obstruction of blood vessels in the lower legs (peripheral arterial disease) is common with heavy drinkers (35% risk increase) and even former drinkers (32% risk increase). Non-drinkers have a 22% increased risk while moderate drinkers have a 0% risk (no increased risk).

Aortic aneurysms

There was no association between heavy drinking and aortic aneurysm. On the other hand, non-drinkers (32% increased risk) and former drinkers (23% increased risk) showed an increased risk of aortic aneurysm formation.

Other effects of alcohol consumption

The study above did not take into consideration that alcohol consumption has many other consequences beside cardiovascular effects. One for instance is the effect on the brain and the increase of serious car accidents. Another effect is the causation of cancer.

The American Cancer Society clearly states that alcohol consumption has been causatively associated with cancers in the following locations:

Mouth
Pharynx (throat)
Larynx (voice box)
Esophagus
Liver
Breast
Colon
Pancreas

The conundrum of alcohol benefit for heart attacks versus alcohol cause of cancer

Many studies have shown a dose-response curve between alcohol consumed and the development of these cancers. In other words there is never a safe low dose, below which no cancer risk would occur over time.

These authors conducted a metaanalysis of 16 prospective cohort studies including 6,300 patients. It showed that alcohol caused cancer of the colon and rectum. High intake of alcohol showed a 50% increased risk of causing colon cancer. With regard to rectal cancer the risk was 63% higher. In both cases the highest alcohol intake was compared to the lowest category of alcohol intake.

More on cancer risk from alcohol consumption

These authors concluded their discussion by pointing out that 6% of the worldwide cancer deaths are attributed to alcohol intake. They also stated that colorectal cancer risk increased by 50% in the heaviest alcohol users. Among the group of heavy drinkers the cancer death rate would likely be 9%. There would a reduction of mortality from cardiovascular disease by one third in middle and old age. The end result would be 6% mortality again; essentially there is no change.

No matter how you try to solve this equation, there is a risk of cancer deaths from exposure to alcohol. There is also a risk that heavy drinking can cause significant cardiovascular diseases mentioned.

Only moderate alcohol consumption benefits your heart

Conclusion

Everything we do in life has consequences. With regard to drinking you know that accidents are more common in drinkers; with prolonged exposure to higher alcohol consumption you can get dementia. Moderate amounts appear to have significant protection from heart disease, but the risk for several cancers is not negligible. This point was not mentioned in the study I discussed in the beginning of my blog. In the latter part I included some data about cancer risks from alcohol consumption.

Heart attack prevention with small amounts of alcohol

The paradox remains that non-consumption of alcohol is associated with a significant cardiovascular risk because of a U-shape dose response curve. Moderate alcohol use is associated with the lowest cardiovascular risk. The question is whether we can balance moderate drinking with staying in the low cancer risk area. The recommendation of 1 glass of wine for women and 2 glasses of wine for men has been confirmed by the above study. This is considered a healthy preventative dose with respect to cardiovascular risk. It is the official recommendation for cardiovascular disease prevention. The cancer literature clearly states that there is a small cancer risk from moderate alcohol intake. This is particularly true for the 8 cancers discussed. The last word may not have been spoken yet about reduction of cardiovascular risk.

You can prevent heart attacks without the use of alcohol

Dr James Nicholls, the director of research and policy development at Alcohol Research UK had this to say. He pointed to the fact that there are other ways to prevent cardiovascular disease. For those who do not drink at present it would not make sense to take up drinking. You can strengthen your heart by starting a Mediterranean diet and starting to exercise regularly. The beneficial substance for your heart in red wine is resveratrol. Taken it as a supplement. Resveratrol has no side effects and does not have the cancer risk like an alcoholic drink does. Dr. Nicholls added, “If you drink within the existing guidelines it is unlikely that alcohol will either lengthen or shorten your life.” It is really up to every individual to balance the wine glass with personal health!

Apr

2017

What Foods Lower Insulin Resistance?

By Ray Schilling | Cardiovascular disease, heart attack, Heart Disease, Mortality, Nutrition, Stroke, sugar

When people get diabetes or prediabetes, what foods lower insulin resistance? You may have heard that eating too many carbs and gaining weight can cause high insulin values. This causes the body’s insulin receptors to become sluggish, a condition called insulin resistance. Continuing to eat too many refined carbs leads to a critical point. You can suddenly run out of enough insulin and would develop type 2 diabetes at this time.

So, what foods lower insulin resistance?

Low glycemic food

Insulin resistance and type 2 diabetes occur because people do not pay attention to the glycemic load of the food they choose. Many people eat bread, pasta and starchy vegetables like potatoes. They also eat excessive sugary sweets, such as cupcakes, ice cream, or chocolate bars. All the pancreas can do is keeping blood sugar stable by overproducing insulin. But you can assist your pancreas to not overwork itself.

Leave the high glycemic index foods alone. Instead eat low glycemic foods like non-starchy vegetables (peppers, broccoli), lean meats, fish and nuts. Add high-fiber foods like beans and some whole grains. Eat foods rich in omega-3 fatty acids like salmon. Have a dessert with berries that are rich in antioxidants. Blueberries, strawberries, raspberries and black berries are all low glycemic foods, rich in vitamin C and antioxidants. They are “nature’s candy”.

Research on insulin resistance

In a study from Singapore differences of insulin sensitivity were found between lean Asian Indians and Chinese and Malays, living in Singapore. The Asian Indians had less insulin sensitivity, which means they had higher insulin resistance. This occurs because of a genetic variant of insulin sensitivity.

Another lengthy publication investigated the connection between metabolic syndrome and insulin resistance. In addition it examined the connection of heart attacks and strokes to wrong diets. The researchers pointed out that the percentage of diabetes and cardiovascular disease will reduce significantly on a sensible diet. How is this achievable? By adopting a healthy diet that also leads to weight loss.

Diets in the US and in the Western world have major shortfalls, due to the fact that people consume not enough vegetables, fruit and whole grains. Instead we see a higher intake of red and processed meat. In addition there was higher intake of sugar-sweetened foods and beverages. Refined grains and flour products are another unhealthy food source. In the US and other westernized countries we see an overconsumption of sodium and saturated fat.The key to a healthy diet was adopting a Mediterranean diet. A study exists where a group of patients with metabolic syndrome consumed mostly whole grains, vegetables, fruits, nuts, and olive oil. The control group simply followed a “prudent” diet.

What foods lower insulin resistance? The Mediterranean diet does!

Two years later the group on the Mediterranean diet showed the following results: they had a higher intake of monounsaturated fat (olive oil) and polyunsaturated fat (fish oil) and fiber. Their omega-6 to omega-3 ratio had decreased. The high-sensitivity C-reactive protein, a general measure for inflammation, had decreased. Other inflammatory kinins like interleukins had also decreased. The insulin sensitivity endothelial function score showed improvement. The important part overall was that the Mediterranean diet prevented the metabolic syndrome compared to the “prudent” control diet.

In 2018 a study from Spain was looking for positive effects when supplementing with olive oil or nuts. A Mediterranean diet with extra olive oil or extra nuts reduced the risk of heart attacks in a high-risk group compared to controls. The study included 7447 persons and these were the results after 4.8 years: the Mediterranean diet group that used more olive oil had 28% fewer cardiovascular events compared to the control group. The Mediterranean diet group with nuts had 31% less events. Heart attacks, strokes or death from cardiovascular disease were these “events”!

What foods are unhealthy?

In order to be able to avoid unhealthy foods it is important to identify what harms us. Foods to avoid are listed in this link. Sweetened beverages, fountain drinks, sodas and fruit juices contain loads of sugar. They will cause an insulin response and on the long-term insulin resistance. Avoid starchy vegetables, such as potatoes, pumpkin, corn, and yams. Also avoid processed snacks and boxed foods. Starchy foods break down into sugar, which also stimulates insulin release. Your no-food list continues with excessive sugary sweets, such as cupcakes, ice cream and chocolate bars. White bread, rice, pasta, and flour are also starchy, and the body breaks down starch into sugar and stimulates insulin production.

Some saturated fats are acceptable, but hydrogenated fat must be avoided altogether.

Epigenetic factors regarding insulin resistance

A recent publication on March 14, 2017 investigated the effect of exercise on insulin sensitivity in a mouse model where the mother mouse was obese.

Pregnant, obese mice were insulin resistant and the offspring came down with diabetes. But when the pregnant mice exercised, the insulin sensitivity came back to normal. In addition the offspring were not diabetic. This effect was not due to genetic factors. Instead the authors believe it was due to epigenetic factors, in this case treating insulin resistance with exercise. When the pregnant mother turns insulin sensitive, the offspring is programmed to regulate their blood sugar metabolism normally.

An April 2017 study from Korea investigated the effects of healthy nutrition on patients with metabolic syndrome and insulin resistance. They noted that avoiding unhealthy foods could normalize markers of disease.

The authors discuss how nutritional factors can contribute to inheritance of epigenetic markers in the next generation. They also showed how dietary bioactive compounds could modify epigenetic factors. Taking dietary components that regulate epigenetic factors contribute significantly to health. The authors concluded that a healthy diet could prevent pathological processes that otherwise would cause metabolic disease.

What Foods Lower Insulin Resistance?

Conclusion

It is interesting to note that insulin resistance can be reversed into insulin sensitivity by eating healthy foods. Research papers are now describing how a healthy diet of the mother can affect her offspring positively. These effects are due to epigenetic factors, as genetic factors have not changed.

We are already hearing that diseases like heart attacks, high blood pressure, strokes, diabetes and others can largely be prevented by a proper diet. The key is to avoid high glycemic foods and eat low glycemic foods instead. It is not complicated. Eat non-starchy vegetables (leafy greens, peppers, broccoli), lean meats, fish and nuts. Add high-fiber foods like beans and some whole grains. Eat foods rich in omega-3 fatty acids like salmon. The end result is that insulin resistance disappears and metabolic processes return to normal. This was what Hippocrates had in mind when he stated “Let food be thy medicine and medicine be thy food.”

Apr

2017

Breast Cancer Risks

By Ray Schilling | 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 24^th 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.

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.

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.

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

Conclusion

Dr. David Zava, PhD gave an interesting talk at the 24^th 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.

Apr

2017

When Food Causes Inflammation

By Ray Schilling | Abdominal Pain, Arthritis, autoimmune disease, Cancer, Cardiovascular disease, chronic pain, depression, Diabetes, diet, heart attack, Heart Disease, immune system, Inflammation, lifestyle, Nutrition, Obesity, Pain, Prevention, Processed food

Dr. Hal Blatman gave a talk about when food causes inflammation. He gave his talk on Dec. 9 at the 24^th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The original title was “Food, Pain and Dietary Effects of Inflammation”.

Dr. Blatman is the medical director of Blatman Health and Wellness Center, Cincinnati and Batman Medical Services, Manhattan.

General remarks about nutrition

Dr. Blatman pointed out that mistakes of nutrition are often behind chronic diseases and illnesses. The physician’s task is to explain to patients how they can change their food intake to improve inflammation in the body and to allow the body to heal itself.

Hippocrates said 400 BC “Let food be thy medicine and medicine be thy food”.

In this context Dr. Blatman stated that nutrition could exacerbate symptoms or relieve symptoms and there must be rules for good nutrition. If we do not take care of our nutrition, the gut flora composition changes and causes leaky gut syndrome. But if we consume healthy foods all of this improves.

Mathematical formula for when food causes inflammation

To make it easier to understand the impact of food on our health the speaker offered this formula:

G-B+R=P

G = stands for good, beneficial things you can put into your body.

B = bad, toxic things that affect your body negatively.

R = reserves that your body has since birth (minus the amounts you have used up)

P = pain and problems you are going to experience

It is P (pain and other medical problems) what brings the patient to see the doctor. G and B is what the patient can change. When done right, the P value in the formula reduces and the pain or medical problems go away.

Nutritional rules

Dr. Blatman said there are three rules about nutrition.

Rule #1 is to not eat fake or toxic foods

He listed NutraSweet, Splenda, Saccharin, margarine and olestra.

Aspartame

Aspartame experiments on rats showed that it can cause cancer: Dr. Blatman said that aspartame causes multiple myeloma and Hodgkin’s lymphoma in man. Aspartame worsens depression, 10% is metabolized in the liver into methanol, a nerve poison.

Splenda

Splenda (sucralose) originates from sugar. However, several chlorine atoms were inserted into the sugar molecule. It reduces beneficial microflora in the gut. It also interacts with liver enzymes, which interfere with the bioavailability of oral drugs.

Saccharin

Saccharin alters gut bacteria and increases glucose tolerance.

Hydrogenated fat and margarine

Insects don’t eat margarine, mold will not grow on it, and it will not support life. Merchants like it because food does not turn stale on shelves. Hydrogenated fats like margarine are like poisons. They raise the bad LDL cholesterol levels and reduce beneficial HDL cholesterol levels. The prostaglandin balance changes so that inflammation occurs. There is increased evidence of diabetes and the cell membrane composition changes. Proinflammatory cytokines can cause pain in the dorsal root ganglions. It follows from all of this that it is best to cut out all hydrogenated fat and margarines.

Partially hydrogenated vegetable oil

The cell membrane consists of two lipid layers at a specific ratio of omega-6 essential fatty acids and omega-3 essential fatty acids. It also contains triglycerides, phospholipids and protein. Cell membrane absorb nutrients to move into the cell and eliminate waste out of it. The cell membrane needs to remain flexible and within neurons needs to transmit electrical information. The membrane composition is critical for the cell membranes to perform optimally. It is here that the physician has to explain this to the patient. All the fats we eat are the raw material, which will make up our cell membranes. So what fat we eat that day travels into the cell wall that becomes part of it that day. The same process occurs with cell wall repair. If we eat hydrogenated fat that day, it travels into the cell wall. A membrane with hydrogenated fat will:

Not transmit nutrients inside the cell
Will not transmit waste out
Causes the membrane to lose flexibility
In a nerve cell there will be abnormal neuron transmission

If we eat hydrogenated fat, we become like a “genuine GM truck fixed with inferior parts”, so Dr. Blatman. The interesting observation is that it takes 4 months after eliminating hydrogenated oil from the diet to get it out from red blood cells. Be aware that French fries increase pain for 4 months, so why eat them?

Olestra

Olestra, an artificial fat: This fat, Olestra has been developed as an artificial fat and is used in chips. It can cause diarrhea, abdominal cramps and weight gain with long-term use. Olestra belongs into the group of fake/toxic foods. Don’t eat Pringles or chips that are made with this.

Healthy oils

There are two types of essential fatty acids, omega-6 fatty acids and omega-3 fatty acids. Many processed foods contain only omega-6 fatty acids, because this is the cheapest way to produce them (they are based on vegetable oils). Instead you want to eat healthy fats like omega-3 fatty acids contained in nuts and fish. You can also add molecularly distilled, high potency omega-3 fatty acids (purified fish oil) as a supplement to help restore the balance between omega-6 and omega-3 in your food intake. Avoid omega-6 fatty acids from corn oil, safflower oil, grape seed oil, soybean oil, cottonseed oil, canola oil and peanut oil.

Metabolism of omega-6 fatty acids versus omega-3 fatty acids

Compare the metabolism of omega-6 fatty acids with that of omega-3 fatty acids.

The linoleic acid of omega-6 fatty acids gets metabolized into arachidonic acid, which causes pro-inflammatory mediators, PGE2 and LTB4. On the other hand with omega-3 fatty acids alpha-linolenic acid (ALA) is metabolized into EPA, DHA and the anti-inflammatory mediators PGE3 and LTB5.

It is easily understandable why a surplus of omega-6 fatty acids from processed foods will disbalance the omega-6 to omega-3 ratio. This ratio should be 1:1 to 3:1, but many Americans’ omega-6 to omega-3 ratio is 6:1 to 18:1. Omega-6-fatty acids cause arthritis, heart disease and strokes. Be particularly careful in avoiding soybean oil, which is the most popular oil in the last few decades to foul up the omega-6 to omega-3 ratio through processed foods.

Balance of omega-3 and omega-6 fatty acids

When it comes to balancing omega-3 and omega-6 fatty acids in your diet, be aware that nutritional balancing can help you restore the ideal omega-6 to omega-3 ratio of 1:1 to 3:1. An easy way is to cut out processed foods as much as possible. Supplement with molecularly distilled fish oil capsules to add more omega-3 fatty acids into your food intake. Dr. Blatman gave the example of rheumatoid arthritis patients that were put on omega-3 supplements. After 24 weeks their joint swelling and tenderness went down.

Rebalancing the omega-6 to omega-3 ratio was able to treat depression as this research showed. This makes you wonder how much depression may be caused by overconsumption of processed food.

Suggested doses of omega-3 fatty acid supplementation

Dr. Blatman suggested the following doses of omega-3 supplementation for various purposes:

1 gram/day as supplementation for healthy adults with a good diet
1-3 grams/day for people with cardiovascular disease
5-10 grams/day for patients with an autoimmune disease, with chronic pain or with neuropsychiatric conditions

He mentioned that these doses are empirical, but in his opinion definitely help. Due to quality differences he suggested that you buy fish oil capsules in a health food store where the quality is best. Stay away from discount stores (the quality is the worst) and drug stores.

Other healthy oils are olive oil and coconut oil. They are also useful for cooking.

Rule #2 is not to eat inflammatory foods

Our body functions like a luxury car; it needs pure food to function. Anything less leads to inflammation, particularly when you eat sugar and processed foods.

Inflammatory foods are sugar, white flour, fruit juice and white/red potatoes. A medium potato=1/2 cup of sugar! Other problematic foods are wheat grain contained in breads, pasta, cereal and thickeners in soups and sauces.

What is the problem with these foods? They break down the zonulin proteins that are a bridge between the lining cells of the gut.

This leads to an increase of intestinal permeability, and leaky gut syndrome can develop. Inflammatory cytokines from visceral fat add to the gut inflammation, and cardiovascular disease and high blood pressure can develop.

Fried potatoes, in particular the consumption of French fries, have been identified as the cause of inflammatory bowel disorder (IBD). Countries with the highest consumption of French fries have the highest incidence of IBD.

A Mediterranean diet and the DASH diet are anti-inflammatory diets.

Rule #3 is to not disturb the bowel flora

A healthy bowel flora is symbiotic with the body. You achieve this by eating green leafy vegetables. A toxic flora from dysbiotic microbes comes from eating white flour, white sugar and red meat. Red meat leaves residues on which dysbiotic bacteria thrive.

Symbiotic gut bacteria produce vitamin K, cobalamin, pyridoxine, biotin, riboflavin, pantothenic acid and short fatty acids. They also degrade metabolic toxins, prevent pathogens from colonization and they stimulate the immune system to mature.

Dysbiosis occurs when the wrong diet consisting of sodas, white flour, sugar and red meat is over consumed. There are toxins that are produced by the dysbiotic microbes. These injure the bowel wall and make the immune system work harder. Immune system dysfunction, fatigue and fibromyalgia can follow.

Dr. Blatman stated that gut dysbiosis that causes leaky gut syndrome could also cause ulcer disease, diabetes, heart disease, fibromyalgia, chronic fatigue syndrome, chronic pain and even cancer.

When Food Causes Inflammation

Conclusion

This was a whirlwind tour through a talk given by Dr. Blatman during the 24^th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas. What food we eat determines what gut bacteria we harbor, symbiotic ones or toxic ones. This in turn determines which way our health develops. But the content of what we eat is also important. If we consume processed foods we end up consuming way too many omega-6 fatty acids, which cause inflammation, arthritis and heart disease. This is happening in front of our eyes, if we start seeing things the way they are. I was aware of this since the mid 1990’s. In a lecture I attended at a continuing education conference a cardiologist pointed out that inflammation was the determining factor of whether or not our patients would get a heart attack.

Cholesterol concept being replaced by inflammation concept

The lecturer mentioned then that the older cholesterol concept would be replaced by the newer inflammation concept. He was right, but it goes even further! There is the important omega-6 to omega-3 ratio, and fish oil supplementation helps. At the same time it is necessary cutting out processed foods. But there is the newer insight that our bowel flora and red meat consumption can culture toxic bacteria in our own gut. It is in our power to start eating more vegetables and cut out sugar and starchy food. It is time to see chips and French fries not as a “convenience” but a hazard to your health. Food does not have to cause inflammation; right food choices will help us to stay well and live longer.

Mar

2017

How Stress Affects Our Hormone System

By Ray Schilling | Alzheimer’s disease, Anti-aging medicine, autoimmune disease, Cancer, Cardiovascular disease, Diabetes, fractures, Heart Disease, Hormones, immune system, Inflammation, Nutrition, Obesity, stress, thyroid disease

Dr. Andrew Heyman gave a detailed talk recently about how stress affects our hormone system. He presented his talk at the 24^th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. It was entitled “Understanding the Stress, Thyroid, Hormone Connections & Prioritizing Systems”.

Dr. Heyman stressed in particular that there is a triad of hormonal connections that is important to remember: the thyroid hormones, the stress hormones (adrenal glands) and the pancreas (insulin production). It seems like we need a balance of these hormones for optimal energy production and circulation. Under stress our sugar metabolism can markedly derail, we develop obesity and fatigue. But when balanced we experience vitality and wellbeing.

Metabolic activation pathways

Dr. Heyman projected a slide that showed the metabolic activation pathways. Likewise, he stated that a number of different factors could influence the hormone system:

Diet: trans fats, sugar, too many carbs, food allergies.
Drugs: drug-induced nutrient depletion (over-the-counter drugs, prescription drugs).
Physical exercise: frequency and type matters.
Environmental exposure: chemicals, pesticides, herbicides, heavy metals, plastics, molds, and pollens.
Stress: physical stress, psychogenic stress.
Genetics: methylene-tetra-hydro-folate reductase enzyme deficiency (MTHFR mutation), APOE genes, lack of vitamin D
Disease: past or present conditions, active disease or syndromes.

Target areas within your system

The target areas in your system are the

Pancreas, where blood sugar can rise because of insulin resistance. In particular, too much insulin production causes inflammation, hormone disbalances, kidney damage, and hardening of the arteries through plaque formation.
Thyroid gland, which depends on TSH (thyroid stimulating hormone) for activation. Autoantibodies can also affect it negatively.
Brain: decrease in serotonin resulting in anxiety, depression and food cravings; decreased melatonin causing sleep disturbances; increased ghrelin and decreased leptin secretion leading to overeating and obesity.
Liver/kidneys: both of these organs are important for detoxification; the liver produces thyroid binding globulin, which when increased can lower the free thyroid hormones.
Immune system (gut, lymph glands): the Peyer’s patches in the gut mucosa produce a large portion of the immune cells; lymph glands, the bone marrow and the spleen supply the rest. A leaky gut syndrome can affect the whole body, in addition causing inflammation and autoimmune reactions.
Hypothalamus/pituitary/adrenal glands: this is the main axis of the stress reaction. A brain under stress activates the hypothalamus. It sends a cascade of activating hormones via the pituitary gland and likewise activates the adrenal glands. Finally this leads to cortisol overproduction, and release of epinephrine and norepinephrine from the center of the adrenal glands. High blood pressure, anxiety, heart palpitations, arrhythmias and more can finally develop from this.

Hypothalamus/pituitary/adrenal glands activation and clinical effects

The main hormone axis of the stress reaction goes first from the hypothalamus, secondly via the pituitary gland and thirdly to the outside surface of the adrenal glands, which produces cortisol. The term for this is the HPA axis. Stressed people, therefore, make too much cortisol, which weakens immune functions, reduces human growth hormone production, increases belly fat, increases blood pressure and reduces insulin action. In addition, stress also reduces estrogen production in women and testosterone production in men.

Accordingly, the final clinical presentation is osteopenia, then osteoporosis with spontaneous fractures of bones. In addition there is also cardiovascular disease leading to heart attacks and strokes, and cognitive decline with memory loss. There are complications with infections. Also the metabolic syndrome can lead to obesity and type 2-diabetes.

Stress and the hippocampus

In the center of our brain there is a memory-processing unit, the hippocampus that converts short-term memory into long-term memory. Repeated stress interferes with normal hippocampus function. Indeed, high cortisol levels interfere with the proper functioning of the hippocampus causing memory problems.

Hippocampus atrophy can come from chronically high cortisol levels due to chronic stress. In addition this can lead to Alzheimer’s disease.

Effects of chronic stress

Chronic stress leads to cardiovascular disease, to diabetes, chronic inflammation, Alzheimer’s disease, thyroid disorders, cancer, neurological disorders and autoimmune diseases. Researchers showed that inflammation releases tumor necrosis factor-alpha (TNF-alpha), which is a key player of chronic inflammation. This, however leads to the release of other inflammatory kinins like IL6 and others. The resulting chronic inflammation can cause Crohn’s disease, rheumatoid arthritis, insulin resistance, dementia, metabolic syndrome, obesity and atherosclerosis with associated markers (decreased HDL, increased LDL, CRP and triglycerides).

Hormone imbalance causes disease

Excess cortisol production from stress leads to Th2 type inflammatory kinins; usually associated with this is a reduction of DHEA (a male hormone in the adrenal glands), which leads to reduced Th1 type kinins. Overall, the end result is chronic inflammation. When chronic stress has tired out the adrenal glands, a four-point salivary cortisol level test shows a flat curve. This indicates adrenal gland fatigue or, if worse, even adrenal gland insufficiency. Most noteworthy, patients with leukemia, breast cancer, uterine cancer, prostate cancer, pituitary gland cancer and lung cancer show such a pattern.
The disregulation of the HPA axis is particularly evident in patients with metabolic syndrome. People who have this syndrome have a high morning serum cortisol level. As a matter of fact, high cortisol increases the risk to develop metabolic syndrome.
Metabolic connections: high cortisol leads to a partial blockage of thyroid hormones, which in turn leads to hypothyroidism. Hypothyroidism will affect glucose tolerance, and if not treated leads to type 2 diabetes.

In a large study involving 46,578 members of Kaiser Permanente Northwest it was determined that for every 1 point above a fasting glucose level of 84 mg/dL there was an additional 6% risk to develop type 2 diabetes over the next 10 years.

Pathological hormone disturbances

Dr. Heyman mentioned the following hormone patterns that he discussed in detail, increased cortisol levels, increased insulin levels and decreased thyroid levels.

Elevated cortisol

Prolonged elevation of cortisol leads to atrophy of the hippocampus with brain atrophy and Alzheimer’s or dementia. The immune system gets altered, there is lower DHEA hormone leading to weaker muscles and weakened immunity. There is insulin resistance (decreased insulin sensitivity), decreased serotonin and increased depression. Carbohydrate cravings lead to weight gain (central obesity). Changes in the thyroid metabolism leads to hypothyroidism.

Increased insulin level

People who develop high insulin levels are usually sugar or carbohydrate addicts. As they gain weight they change their metabolism into the metabolic syndrome. The extra insulin that is floating around triggers the insulin receptors to become less sensitive (also called “resistant”). The people love to eat. They snack frequently on protein bars and candy bars. As they gain weight, consequently their energy goes down and as a result they often develop painful joints. This prevents them from being physically active. They notice episodes of foggy thinking. Women complain of frequent yeast infections.

The body tries to compensate by slightly decreasing thyroid hormones and slightly increasing cortisol levels.

Decreased thyroid levels

There is increased lactic acid production and decreased insulin sensitivity. Oxidative stress is increased. The patient is depressed and cognition and memory are reduced. Also, the gut has slower motility. The mitochondria, the energy packages in each cell are reduced and functioning less productively. Cardiac function is reduced.

The body tries to compensate for the primary thyroid weakness by slightly elevating insulin and cortisol.

Treatment of stressed hormone system

Before the doctor can treat a disbalanced hormone system, blood tests have to be done that show what kind of hormone constellation is present. Dr. Heyman suggested the following support with supplements.

Treatment of thyroid disorders

Thyroid supplementation may involve any of these: Selenomethionine, iodine, chromium, thyroid glandular, tyrosine, ferritin, Ashwagandha, coleus forskohlii, 7-keto DHEA, ferritin and iron. Other possible supplements that were mentioned by Dr. Heyman were Rhodiola, schisandra, ginseng, Rg3, eurycoma longifolia, neuromedulla glandular, DHEA, tryptophan/5 HTP, licorice, Cordyceps.

This, however, is not all. Missing thyroid hormones need replacement with a balanced T3/T4 medication like Armour thyroid.

Adrenal support

The following supplements are used to support adrenals: Adrenal glandular, vitamin C, adrenal cortex extract, Holy Basil, Pharma GABA, Magnolia/Phellodendron, L-theanine, sterols & sterolins.

Pancreatic support

These supplements support the insulin production in the pancreas:

Chromium, vitamin D, magnesium, alpha-lipoic acid, fish oil, micro PQQ, bitter melon, cinnamon, arginine, vanadium, benfotiamine (synthetic derivative of B1 vitamin) and Bergamot.

Dr. Heyman completed his talk by giving a few patient examples, explaining what blood tests showed, what the hormone disbalance was, and which treatment options were helpful.

How Stress Affects Our Hormone System

Conclusion

Dr. Andrew Heyman gave a talk at the 24^th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. He talked about how stress in due time affects our hormone system. Symptoms from stress can stem from different causes including hormone disbalances. Given these points, conventional medicine would simply treat the symptoms. However, this will not be successful with stress-induced hormone disbalances, namely, because it does not treat the causes. Obviously only causal treatment of the hormone disbalance will restore the person’s wellbeing and the symptoms will disappear at the same time. In short, anti-aging medicine and integrative medicine are attempting to follow this approach.

Mar

2017

What’s new about testosterone?

By Ray Schilling | andropause, blood test, Heart Disease, Men's Health, testosterone

Dr. Gary Huber recently gave a lecture on what’s new about testosterone. He presented his talk at the 24^th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. It was entitled “Evolution of Testosterone – Dispelling Myths & Charting a Future”.

History of testosterone

There are some notable historic landmarks with respect to the discovery of testosterone.

1869: Dr. Charles Brown-Sequard suggested that the “feebleness of older men” was due to a lack of testosterone. He injected himself with testicular extracts from dogs and guinea pigs.

1912: The Danish physician Dr. Thorkild Rovsing transplanted the testicles of a young soldier killed in battle into an old man with gangrene. The gangrenous wound healed completely.

1918: Dr. Leo Stanley sampled fresh testicles from executed prisoners at the San Quentin Prison and transplanted them to prison inmates. Some regained their sexual potency.

1930’s: Professor Adolf Butenandt collected 25,000 liters of urine from willing policemen. He was able to isolate a breakdown product of testosterone, androsterone. Eventually he isolated both progesterone and testosterone. He received the Nobel prize for his work with sex hormones in 1939.

Historical detours and misguided opinions about testosterone

1935: Because natural hormones cannot be patented, Big Pharma came up with the idea of modifying testosterone by adding a methyl group at the 17-alpha position of testosterone. This new substance, 17 alpha-methyltestosterone, was a new compound. The FDA could patent it. Men liked it, because they could swallow this testosterone derivative as a pill. However, the liver changed 17 alpha-methyl-testosterone into 17 alpha-methyl-estradiol, a strong estrogenic compound. The body could not metabolize this testosterone compound too well. Shortly after introduction into patients it became evident that 17 alpha-methyl-testosterone caused liver cancers. This “testosterone equivalent” was on the market for 50 years before the FDA outlawed it because it caused liver cancer. It also caused suspicion among physicians about any testosterone replacement, even the bioidentical hormones that are safe.

Prostate cancer myths

Prostate cancer myth

Conventional medicine teaches (and I have believed this for many years) that testosterone would be the cause for prostate cancer. This was based on old observations by Dr. Huggins, a Canadian born surgeon who practiced in Chicago, that orchiectomy improved the survival of advanced prostate cancer patients a bit. Dr. Lee pointed out that Dr. Huggins neglected to realize that testicles make both testosterone and small amounts of estrogen. The belief that testosterone production was the culprit of prostate cancer led to the practice of physicians to do orchiectomies. This inadvertently removed the real cause of prostate cancer, an estrogen surplus. This improved the survival of these patients somewhat. Nowadays we have more sophisticated testing methods.

Estrogen causes prostate cancer, testosterone does not

Dr. Abraham Morgentaler (Ref. 1) has compiled a lot of evidence about the importance of testosterone in men. He proved, based on a lot of more modern references, that it is not testosterone that is the cause of prostate cancer. We know now that estrogen dominance is responsible for prostate cancer and that this develops as stated above because of the low testosterone and low progesterone during the male menopause (also called “andropause”).

It is important, when testosterone deficiency is present in an aging man, to replace the missing testosterone with bioidentical testosterone.

Some physicians still practice the old method of hormone depletion therapy in advanced prostate cancer cases. But Dr. Morgentaler and other researchers have shown that it is wrong to do hormone depletion therapy or orchiectomies.

10% absorption rule myth

For years there has been a persistent myth that the skin would only absorb 10% of testosterone. There was never any proof of this and newer studies showed that indeed the skin absorbs about 90% of testosterone.

Misleading science created myths

Unfortunately three key medical journals, JAMA, NEJM and PLOS ONE have published misleading studies. The content did not discuss physiology, mechanism of actions, appropriate dosing or true science. But they concluded that testosterone therapy was causing heart attacks and strokes. There was an outcry about this particular study in the medical community. Unfortunately there were more similar false “studies”. The problem with these was that the controls were wrong or they compared unequal groups that were not comparable. It is reminiscent of previous effort of the tobacco industry wanting to cover up that cigarette smoke causes lung cancer.

Testosterone replacement treats the cause of the deficiency

Here we have the problem that testosterone cures so many conditions for which the Pharma industry has many patented medicines that control the symptoms. But testosterone can actually treat the cause of the illness, testosterone deficiency, which leads to a cure of many other symptoms.

For a long time confusion plagued the older physician generation. But younger physicians are replacing the older generation and they treat testosterone deficiency with bioidentical testosterone in the proper dose.

Clinical observations about a lack of testosterone

There is evidence that men have lower testosterone as they age and this has worsened when we compare data from early 2000 to the 1980’s and 1990’s. As this paper shows, men investigated in the 1980’s were still having higher testosterone levels in older age. But in the 1990’s and more so in 2004 these values have declined even more. This fact coincides also with other studies, showing decreased sperm health and increased infertility. The reason for this is also a lack of testosterone!

Causation of low testosterone

Dr. Huber pointed out that many studies have pointed to a variety of causes for low testosterone levels in men.

BPA, toxins and pesticides

BPA, toxins and pesticides that occupy testosterone receptors and interfere with the hypothalamus/pituitary hormone function that stimulates the Leydig cells to produce testosterone.

The more stress, the less testosterone

The more stress men are under, the less testosterone production there is. Sleep deprivation below 5 hours per night leads to a significant lower testosterone production. Most testosterone production occurs during the sleep in the early morning hours.

Less testosterone from weight gain and sugar overconsumption

Weight gain and sugar overconsumption poison the testosterone producing Leydig cells.

Poly-pharmacy can lower testosterone

Poly-pharmacy. Many drugs lower testosterone production: statins, diuretics, metformin, spironolactone, opiates, antidepressants, verapamil, alcohol, chemotherapy for cancer, antihistamines, ketoconazole, beta blockers, H2 blockers, finasteride, estrogens and alpha methyldopa.

Many references were provided that support these data. One paper reported that the risk of a heart attack climbs to 4 times the risk of normal, when the man sleeps less than 6 hours per night. As sleep hours lower, the risk for metabolic syndrome increases by 42% and this leads to heart attacks. Testosterone replacement can reverse this risk as it is a lack of testosterone production that caused the risk.

Link of low testosterone to cardiovascular disease

The literature is overwhelming that low testosterone has adverse effects on the cardiovascular system. To be more specific, the metabolic syndrome, heart disease (and strokes), diabetes and high blood pressure have their root in low testosterone.

Metabolic syndrome

Inflammation is mediated by cytokines such as IL-6. Dr. Huber mentioned one study where healthy men received IL-6. This promptly suppressed testosterone levels. He said that there are many cytokines that work in concert to suppress testosterone. One useful clinical test for inflammation is the C-reactive protein, which indicates whether or not inflammation is present in a person. Metabolic syndrome is common in obese patients. In a study CRP was found to be significantly associated with obesity. When CRP is high, testosterone levels are low. When the CRP level is high, there is a risk of getting the first heart attack.

Testosterone treatment and inflammation

On the other hand, when men with high inflammatory markers from low testosterone levels were replaced with testosterone, the tumor necrosis factor was reduced by 50%, IL1b by 37%, triglycerides by 11% and total cholesterol by 6%.

In the Moscow study a group of obese men with low testosterone levels were treated with testosterone injections. There was an impressive reduction of insulin (17%), CRP (35%) weight reduction of 4% and TNF-a reduction of 31% within 16 weeks.

Heart disease (and strokes)

Hardening of the arteries (medically called atherosclerosis) is due to chronic inflammation. Researchers developed a new heart attack/stroke specific biomarker. It is a ratio of oxidized LDL, divided by HDL. This has an odds ratio of 13.92 compared to a control without a risk for a heart attack or stroke.

Administration of testosterone hormone led to dilatation of coronary arteries. The Rotterdam study showed that low testosterone levels were associated with high risk for heart attacks and strokes, but that treatment with testosterone removed this risk. Testosterone increases AMP kinase for energy production in heart muscle cells, but also dilates coronary arteries for more blood supply to the heart.

Diabetes

Among men with diabetes 20-64% have low testosterone levels. In another study men with higher testosterone levels had a 42% lower diabetes risk. Testosterone levels are inversely related to body mass index and insulin resistance. Men with diabetes have lower testosterone levels than men who were not diabetic and were weight-matched. Most diabetics have high CRP values.

High blood pressure

Experience with androgen deprivation therapy for prostate cancer has shown that blood pressure gets elevated due to testosterone deficiency. Testosterone increases LDH, the protective subunit of cholesterol, and decreases LDL cholesterol and triglycerides. Testosterone also lowers inflammatory markers and reverses clotting factors making blood thinner. All of this leads to a widening of the arteries and lowering of blood pressure.

Treatment options for low testosterone

It is important to support the hypothalamic /pituitary/adrenal gland axis and remove other causes, such as stress and lack of sleep. Younger men can be stimulated in the pituitary gland through Clomiphene. Men older than 60 likely have true secondary hypogonadism and need testosterone replacement. Topical testosterone creams are available commercially or from compounding pharmacies. Injectable testosterone preparations that can be metabolized by the body are available. One such preparation is Delatestryl. A small dose (like 50 mg) is self-injected subcutaneously twice per week, which keeps the testosterone level stable. The last resort, if the creams or injections don’t work, is the use of testosterone pellets that a physician can implant under the skin.

What’s new about testosterone?

Conclusion

At a recent Anti-Aging conference in Las Vegas that I attended, Dr. Huber gave an overview of testosterone. There has been an objective reduction of testosterone levels in men since the 1980’s due to pollutants in our environment. Testosterone plays a key role for heart and brain function. It affects sex drive, fertility and potency. But it also prevents diabetes, high blood pressure and weight gain. On top of that it prevents prostate cancer and likely many other cancers. The key with low testosterone is to replace it to high normal levels. Blood levels should be measured every two months, when replacement has been instituted, in order to ensure adequate levels.

References Ref.1 Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008

Mar

2017

Obesity And Diabetes Can Cause Cancer

By Ray Schilling | breast cancer, Cancer, Diabetes, Fitness, Inflammation, Nutrition, Obesity, prostate cancer, Vitamins and supplements

Dr. Nalini Chilkov gave a talk about how obesity and diabetes can cause cancer. The original title was “Integrative Cancer Care, Increased Rates of Cancer and Cancer Mortality Associated with Obesity and Insulin Resistance, Nutraceutical and Botanical Interventions”. She presented her talk at the 24^th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended.

In the following I will present a brief summary of her lecture.

Obesity is a major risk factor for cancer

Obesity causes 14% of all cancer deaths in men and 20% of cancer deaths in women. This link explains this in more detail. The following 15 cancers related to obesity in terms of causation. They are: colon cancer, gastric cancer, gallbladder cancer, ovarian cancer, breast cancer, liver cancer, uterine cancer, endometrial cancer, rectal cancer, pancreatic cancer, cervical cancer, non-Hodgkin’s lymphoma, renal cancer, multiple myeloma and esophageal cancer.

The American Society of Clinical Oncology reported about a meta-analysis involving 82 studies. This involved more than 200,000 women with breast cancer. The researchers compared premenopausal and postmenopausal women who were obese or normal weight. Premenopausal, obese breast cancer women had a 75% increase in mortality compared to the normal weight breast cancer group. In comparison with the normal weight group the postmenopausal group of obese breast cancer women showed a 34% increase of mortality.

With obese prostate cancer patients there is a similar observation. Obese patients have a more aggressive prostate cancer on the Gleason score and the cancer is in a more advanced stage at the time of diagnosis.

Diabetes increases mortality from cancer

Obesity is a common risk factor for both cancer and diabetes. But diabetes by itself is also increasing mortality of several cancers. In a consensus report details of the relationship between cancer and diabetes have been discussed in detail. The following cancers have been identified to have an increased risk of diabetes: pancreatic, gastric, esophageal, colorectal, liver, gallbladder, breast, ovarian, endometrial, cervical, urinary bladder, renal, multiple myeloma and non-Hodgkin’s lymphoma.

A meta-analysis suggests that cancer patients who are diabetic have a 1.41-fold increased risk of dying compared to those cancer patients who have normal blood sugars. Dr. Chilkov explained in detail what the various mechanism are that account for the faster cancer growth in obese and diabetic patients. High insulin levels is one of the risk factors, so is IGF-1, an insulin-like growth factor. The aromatase enzyme in fatty tissue turns male type hormones into estrogen, which also can stimulate cancer growth.

Carbohydrate restriction diet to prevent obesity

Low carb diets like the Mediterranean diet, the ketogenic diet and the Atkins diet will drop blood insulin and lactate levels. Cancer size and cancer growth are related to insulin and lactate levels. A low carb diet can reduce insulin-mediated uptake of sugar into cancer cells.

Research has shown that cancer metabolism slows down when a 10%-20% carb/high protein diet is consumed by the patient. This reduces the amount of sugar that is taken up by cancer cells. It also reduces insulin, so there is less cancer growth. A ketogenic diet is a more strict way to restrict carbohydrates. Intermittent fasting is also a useful method to reduce carbohydrate intake.

Here is an interesting study that illustrates the power of intermittent fasting. The study involved 2413 patients with early breast cancer who were followed for 7 years. Those breast cancer patients, who consistently did not eat anything between dinner and breakfast for 13 hours or more, had a 36% lower risk of having a cancer recurrence. There was also a 21% lower risk of dying from breast cancer when fasting was done for 13 hours or more overnight.

Supplements to prevent obesity, diabetes and cancer

A low carb diet and in some cases even a ketogenic diet is beneficial as a baseline. A regular exercise program is also useful for general fitness building and cardiovascular strengthening. In addition Dr. Chilkov recommended the following supplements.

To reduce inflammation in the body, Dr. Chilkov recommended taking 2000 to 6000 mg of omega-3 fatty acids per day (molecularly distilled fish oil).
Berberine 500 to 1000 mg three times daily. Dr. Chilkov said that Berberine has anti-cancer properties, improves insulin sensitivity and reduces absorption of sugars in the intestinal tract.
Curcumin inhibits cancer cell division, invasion and metastatic spread through interaction with multiple cell signalling proteins. Several researchers showed that curcumin could lower blood sugar levels by stimulating insulin production from beta cells in the pancreas. Triglycerides, leptins and inflammation in fat cells are also lowered by curcumin. Insulin sensitivity increases through the action of curcumin. Dr. Chilkov recommended 300 mg/day of curcumin for 3 months.
Resveratrol, the bioflavonoid from red wine is a powerful anti-inflammatory. This antioxidant has several other effects, which make it challenging to measure each effect by itself. This group of investigators managed to simultaneously measure these effects. They found that resveratrol lowered the C-reactive protein by 26% and tumor necrosis factor-alpha by 19.8%. Resveratrol also decreased fasting blood sugar and insulin; in addition it reduced hemoglobin A1C and insulin resistance. The recommended daily dose of resveratrol is 1000 to 5000 mg.
Green tea catechins (EGCG) help to normalize the glucose and insulin metabolism. The dosage recommended was 1-3 grams per day.
Reishi mushroom (Ganoderma lucidum) contain polysaccharides with antidiabetic and antiobesity effects. They make gut bacteria produce three types of short-chain fatty acids that control body weight and insulin sensitivity.

Obesity And Diabetes Can Cause Cancer

Conclusion

Obesity is a risk factor not only for diabetes, but also for cancer. Chronically elevated blood sugars, increased fasting insulin levels and increased IGF1 levels can cause cancer. In addition they can stimulate tumor growth and increase cancer mortality. It is for this reason that the health care provider should screen all diabetics for cancer. In her talk Dr. Nalini Chilkov gave clear guidelines what supplements will be beneficial to reduce the risk of obesity and diabetes as well as cancer. Start with a healthy, balanced diet. Add an exercise program. Then consider some of the above-mentioned supplements to reduce your risk for cancer, diabetes and obesity.

Mar

2017

Weight Loss Surgery Is Unnecessary

By Ray Schilling | Cosmetic surgery, depression, Diabetes, Mortality, Nutrition, Obesity

Dr. Flavio A. Cadegiani gave a talk saying that weight loss surgery is unnecessary. Dr. Cadegiani is the director of a weight loss clinic with the name Corpometria Institute in Brasilia, Brazil. He is board certified in endocrinology and metabolism and in internal medicine. He presented his talk at the 24^th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended.

Here are the main topics that he presented.

Weight measurements are wrong when based on the BMI

Dr. Cadegiani stated that we do not understand obesity, because we look at it from the wrong angle. Current dietary approaches have failed. But obesity research is still proceeding in the wrong way. If all else fails, weight loss surgery is finally the last resort. But this is wrong.

The problem with body mass index (BMI) is that people would consider an athletic body type “obese”, because the BMI exceeds 30.0. However in a very muscular person the reason for the elevated BMI is an increased muscles mass, not fat. Body composition scales reveal that, but a simple weight measurement does not.

Dr. Cadegiani recommended measuring waist circumference with <94 cm (37 inches) for men and <88 cm (34.65 inches) for women being normal.

10 reasons why we are misled by the BMI

The inventor of the BMI was a mathematician. He explicitly stated that the BMI would not predict the level of fatness of an individual. The other factors are bone mass and muscle mass.
Because the BMI ignores the waist size, it is scientifically invalid.
There are physiological reasons why it is wrong: studies did not factor in the relative proportion of the bone, muscle and fat content.
The BMI gets the logic wrong: the CDC site claims that the BMI “is a reliable indicator of body fatness for people”. This is simply not true!
The BMI is based on bad mathematics: the formula assumes low muscle mass and high fat content.
The BMI is lying by scientific authority: Dr. Cadegiani said it has an “air of scientific authority, but it is mathematical snake oil.”
The BMI suggests that there are distinct categories of underweight, ideal, overweight and obese. It assumes sharp boundaries that hinge on a decimal place. All of this is nonsense.
Cynical people could suspect that medical insurance companies lobby for the continued use of the BMI as it keeps their profits high. Sometimes insurance companies charge higher fees for people with an elevated BMI.
Doctors can contribute to the continued use of the BMI, if they don’t feel the need to use another way of assessing their obese patients.
It is embarrassing that we still base the assessment of obesity on a 200-year-old mathematical formula when we know of more reliable measures.

Bariatric surgery done too easily

Dr. Cadegiani noted that publications on bariatric surgery (=weight loss surgery)

underreport surgical complications and deaths. The bariatric industry is rich, and 90% of the booths during obesity conferences belong to bariatric-related companies. Long-term follow-up studies are lacking. Those who do follow-ups report an increase of pancreatic tumors after 10 years following bariatric surgery.

Long-term follow-ups also describe a 70% increase of psychiatric disorders including depression and alcoholism. Those who had bariatric surgery experience a 200% increase in suicides.

Overcoming weight centered approach

Here is how to avoid the weight-centered approach that would lead the clinician to wrong conclusions.

There are four factors that need consideration:

The assessment includes metabolic blood markers
The assessment incorporates body composition scales
The patient participates by measuring waist circumference and body weight
The clinician incorporates clinical signs and symptoms

Classic metabolic markers are liver enzymes and hormone levels like testosterone, Thyroid (T3) LH and IGF-1. Apo B and triglyceride levels have to come into consideration for a lipid metabolism assessment. The physician monitors inflammation through a combination of uric acid levels, ferritin and C-reactive protein (CRP). An oral glucose tolerance test and fasting insulin level can predict diabetes 5 to 10 years before it will occur clinically. Other metabolic markers are homocysteine and metalloproteinases. There are newer tests to measure insulin resistance.

Oxidized LDLc is the only marker that is linked to diabetic retinopathy. Another marker, resistin is an independent marker for obesity-related cancer, cardiovascular disease and overall mortality. A triglyceride glucose-waist circumference index has been found to be the best predictor for future development of diabetes.

Body composition analysis

The patient measures his/her own waist circumference and body weight on body composition scales. This gives additional information about fat and muscle composition. Dr. Cadegiani’s team likes to understand what is really going on in terms of what triggers fat excess.

Questions are: what is the level of emotional overeating? How much anxiety is there in the patient’s life that leads to overeating? What is the social and cultural environment? What were previous weight loss attempts? And what is the family history in term of excessive weight?

Other important factors are to check for binge eating disorders or night eating syndrome. In addition any patient planning to go for weight loss therapy should be checked for depression, mood disorders and suicide potential.

Otherwise body composition scales by electrical bioimpedance were found to be very useful in assessing fat and muscle percentage as well as visceral fat percentage.

Aggressive clinical approach improves metabolism

Dr. Cadegiani and his group have published their own research paper in February 2017 showing that an aggressive clinical approach can prevent the need for bariatric surgery. This publication describes that in a group of 43 subjects who were thought to be bariatric surgery candidates only 3 patients (7%) went on to have the procedure done. 93% of the subjects were able to shed pounds with the method offered and avoided bariatric surgery.

They documented that clinical parameters and blood tests all improved on their program. The researchers focused on triggers that caused obesity in their patients. The measured markers were oxidized LDL cholesterol, triglycerides, the liver enzymes ALT and μGT, fasting glucose, Hemoglobin A1C, uric acid and CRP. All of these parameters improved with the modification in food intake. 81.2% of the weight loss was from the reduction of fat mass. 46.5% of patients had a normal waist circumference measurement at the end of the trial. They also achieved normal body fat and visceral fat percentages. As already stated 93% of all the patients in this trial avoided weight loss surgery, called bariatric surgery.

Dr. Cadegiani suggested that obesity should be approached with a scientifically based and responsible method. This will change the way we manage obesity.

Weight Loss Surgery Is Unnecessary

Conclusion

Attention to detail of the patient with weight problems will allow the patient to reduce fat percentage. Waist measurements should be regularly performed as well as body composition scales measurements. This way the physician can follow the fat and muscle percentages. Key to success is to reduce the refined carb contents of food intake (sugar and starchy foods) and have a calorie deficit diet. Exercise is also an important component. An aggressive clinical approach to obesity can improve the clinical outcome and can prevent bariatric surgery.

Feb

2017

Heart Health Improves With Hormone Replacement

By Ray Schilling | Alzheimer’s disease, andropause, Anti-aging medicine, Cardiovascular disease, Diabetes, Health, heart attack, Heart Disease, High Blood Pressure, Hormones, Inflammation, Menopause, mitochondria, Mortality, Obesity, Prevention, prostate cancer, stress, Stress management, Stroke

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

1. Estrogen

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

Observations regarding risk of heart attacks

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

Lipid profile after menopause

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

Difference between oral and transdermal estrogen replacement

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

How can you document the beneficial effects of estrogen replacement?

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

Estrogen levels in males

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

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

2. Progesterone

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

Progesterone in males

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

3. Testosterone

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

Testosterone replacement in women

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

Elevated testosterone in women with PCOS

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

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

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

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

Testosterone replacement in males

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

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

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

DHT (Dihydrotestosterone)

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

Andropause treatment

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

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

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

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

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

4. DHEA

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

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

5. Melatonin

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

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

6. Thyroid hormones

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

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

Dr. Smith said that thyroid replacement should achieve that

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

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

7. Cortisol

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

Heart Health Improves With Hormone Replacement

Conclusion

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

Hormone effects on heart muscle

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

Signs and symptoms of PMS

What do we know about PMS?

PMS is due to a hormone dysfunction

PMS due to estrogen dominance

Several hormones need checking with PMS

Neurotransmitters of the brain can be involved in PMS

Women with PMS often have hypoglycemia

PMS after partial hysterectomy

Birth control pill can cause PMS

Tubal ligation may cause PMS

Lab tests for women with PMS

Four PMS types

Migraine headaches in PMS

Treatment for PMS

Dietary factors

Nutritional supplements

Exercise

Thyroid medication

Progesterone

Botanicals

Estrogen balancing Black Cohosh

Progesterone raising Chasteberry

Herbal supplement St. John’s Wort

Anti-inflammatory Ginkgo biloba

Nutrient-rich saffron

Lavender, Motherwort, and Dandelion

Candidiasis

Mind/body therapy

Conclusion

Details of English study

Various cardiovascular diseases apart from heart attacks

Findings of the study

U-type dose response curve

Sudden cardiac deaths

Smaller amounts of alcohol help to clean out arteries

Strokes in heavy drinkers

Lower leg arterial obstruction

Aortic aneurysms

Other effects of alcohol consumption

The conundrum of alcohol benefit for heart attacks versus alcohol cause of cancer

More on cancer risk from alcohol consumption

Conclusion

Heart attack prevention with small amounts of alcohol

You can prevent heart attacks without the use of alcohol

Low glycemic food

Research on insulin resistance

What foods lower insulin resistance? The Mediterranean diet does!

What foods are unhealthy?

Epigenetic factors regarding insulin resistance

Conclusion

Balance between estrogen and progesterone

Progesterone concentration in breast lumps after progesterone cream applications

Progesterone cream applied to breasts of premenopausal women

How to measure progesterone levels

Blood progesterone levels are unreliable

Historical failure of estrogen replacement therapy (ERT)

Researchers prematurely terminated Women’s Health initiative

Breast cancer in the Million Women Study from synthetic hormones

Huge difference between bioidentical hormones and synthetic hormones

Individualizing bioidentical hormone prescriptions based on blood tests

Breast cancer develops in three stages

Initiation

Promotion

Progression (includes invasion and metastases)

The fallacy of overdosing or underdosing

Measures that help prevent breast cancer

Supplement only with bioidentical hormones

Progesterone to estrogen ratio

Eat more fiber containing foods and less beef

Calcium supplement

Reduce breast cancer risk with probiotics

No pollutants and toxic chemicals

Other useful supplements

Methylation of catechol estrogens

Healthy lifestyle (diet , exercise) helps your immune system

Conclusion

General remarks about nutrition

Mathematical formula for when food causes inflammation

Nutritional rules

Rule #1 is to not eat fake or toxic foods