• Immunotherapy for Cancer

    Immunotherapy for Cancer

    Dr. Joseph Maroon discussed immunotherapy for cancer at the Anti-Aging Conference in Las Vegas, which I attended. He was one of the keynote speakers Dec. 14, 2024. He was a neurosurgeon in the past and has given many lectures at these yearly Anti-Aging Conferences before. The full title of his presentation was … [Read More...]

  • Treatment of Hormone Deficiencies with Bioidentical Hormones

    Treatment of Hormone Deficiencies with Bioidentical Hormones

    Dr. Thierry Hertoghe discussed treatment of hormone deficiencies with bioidentical hormones at the Anti-Aging Conference in Las Vegas, which I attended. He was one of the keynote speakers Dec. 13, 2024. He is a well-known endocrinologist from Brussels/Belgium and has given many lectures at these yearly Anti-Aging … [Read More...]

  • Menopause Revisited

    Menopause Revisited

    At the 32nd Anti-aging Conference in Las Vegas menopause was reviewed, which I call “menopause revisited”. The presenter was Dr. Sara Gottfried who is the director of Precision Medicine. She is also affiliated with the Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, Pennsylvania, … [Read More...]

  • Anti-Inflammatory Diets Improve Inflammation

    Anti-Inflammatory Diets Improve Inflammation

    A CNN review article noted that anti-inflammatory diets improve inflammation. This is important for medical conditions that also have inflammation attached to it. For instance, rheumatoid arthritis, diabetes or chronic kidney disease all carry inflammation with them. But according to a 2019 study more than 50% of … [Read More...]

  • Ultraprocessed Food Leads to Premature Aging

    Ultraprocessed Food Leads to Premature Aging

    An article in the medical journal “Medical News Today” found that ultraprocessed food leads to premature aging. What are ultraprocessed foods? The NOVA Food Classification System explains what ultraprocessed foods (UPFs) are and what other ones are not. Examples of ultraprocessed foods are: fatty, sweet, savory … [Read More...]

  • Vital Information about Cholesterol Drugs

    Vital Information about Cholesterol Drugs

    Most people know about statins to treat high cholesterol, but they do not have vital information about cholesterol drugs. Recently an article appeared in CNN, which was very informative. In the following I will review what is new about cholesterol lowering drugs. PCSK9 inhibitors, which are monoclonal … [Read More...]

    Oct
    12
    2013

    Music More Powerful Than Anti-Anxiety Drugs

    When was the last time you saw your physicians for anxiety and you were given a prescription that said: “for anxiety listen to your favorite music!” instead of receiving a prescription for an anti-anxiety drug (anxiolytic). This is exactly what a recent study suggests that showed prior to surgery you can control your anxiety either with anti-anxiety drugs or by listening to your favorite music. Listening to your favorite music will do you no harm, while many drugs do have harmful side effects.

    How singing can change the brain chemistry

    Other studies have investigated how singing can change your brain functioning in terms of brain chemistry. The researchers found that singing will release dopamine in your brain, which is responsible for feeling pleasure; it will stimulate your immune system by elevating immunoglobulin A and decreasing cortisol (the stress hormone). This in turn will preserve your immune cells (lymphocytes). Oxytocin levels of your brain are increased, which promotes social affiliation. It also calms down the autonomic nervous system resulting in a better airway opening, calming of your heart rate and soothing the wave-like muscle contractions in your gut, medically called peristalsis. You would refer to that as “butterflies in your stomach”. Music therapy reduces pain and anxiety by 50% and is important for children and adults alike.

    Pain and anxiety reduced

    A study in Germany showed that pain and anxiety were significantly reduced with music therapy. A Taiwanese study of women in labor found that music therapy significantly reduced pain and anxiety of women during labor. Ref. 1 explains that music therapy is useful as an adjunct to treating cancer pain, and reducing anxiety associated with colposcopy procedures. It also can help when treating patients who had heart attacks in the setting of a cardiac care unit.

    Music More Powerful Than Anti-Anxiety Drugs

    Music More Powerful Than Anti-Anxiety Drugs

    Hypnosis and guided imagery

    Music has been successfully combined with clinical hypnosis and guided imagery where words are carefully chosen to help the patient experience pleasant feelings, which counteract the experience of pain, anxiety or fear of dying. A simple relaxation CD or tape with soothing background music will facilitate this type of therapy. This is useful for patients in a palliative care unit where they prepare themselves to accepting the inevitable death from an incurable disease. But chemotherapy patients undergoing these procedures for cancer treatments also have benefitted from a significant reduction in nausea, vomiting (side effects of chemotherapy) and pain.

    Autism and music therapy

    A Cochrane study showed that autistic children did better in terms of communication skills when music therapy was incorporated into the treatment protocol. One of the core deficits in autistic children is in the area of communication and social skills. This is where music therapy was most effective. Behavioral problems (stereotypic behavior) in autistic children did not respond to music therapy. A comprehensive treatment program for autistic children should therefore incorporate music therapy. Here is a blog that describes what difference music therapy can make in the lives of autistic children written by a member of the American Music Therapy Association.

    Substance abuse and music therapy

    An area where you may not expect music therapy to have a role is in the area of drug and substance abuse rehabilitation , which is discussed in more detail in this site. The beauty about music therapy is that it is not a drug, yet the natural endorphins that are released by the brain help the affected person getting through withdrawal easier. Music therapy helps building up self-esteem, participating in group activities, promoting self awareness and expressing feelings.

    Mood disorders in adolescents

    One important area where music therapy has been employed is with anxiety and depression in adolescents. Adolescents spend an average of 4 hours per day listening to music. So they are already programmed to listen to music. With the help of a music therapist they can be directed to listening to the type of music that will help them get motivated, relax more, make them feel accepted and be part of their peer groups. In this study the authors suggested to combine music therapy with dance and art therapy. In this way the whole person gets involved in the treatment and this can be integrated with conventional antidepressant treatments at reduced doses (with less side-effects) or with cognitive therapy.

    General objectives of music therapy

    Music therapy is best incorporated into a treatment protocol as an adjunct. It can help reduce the use of drugs for psychiatric patients, for people with anxiety and for patients with pain conditions. The Cleveland clinic has a useful summary about music therapy, which describes the uses of it for reducing anxiety, for helping with coping skills, mood improvement and distraction from pain. There are registered music therapists you can ask for help. The website of the American Music Therapy Association may have other useful links for you.

    Conclusion

    Music therapy is a treatment modality with no side effects, but providing effective treatment for quite an impressive range of clinical conditions as discussed. Music therapists are widely available in the US and many other countries. This treatment can be integrated with conventional or complementary treatments. It helps people to heal the body as a whole unit (mind and body).

    More information on anxiety disorders: http://nethealthbook.com/mental-illness-mental-disorders/anxiety-disorders-panic-disorders-phobias-ocd-ptsd-anxiety-others/

    References

    1. Rakel: Integrative Medicine, 3rd ed.© 2012 Saunders. Chapter on Integrative Therapy; subchapter of Mind-Body Therapy.

    Last edited Nov. 7, 2014

    Oct
    05
    2013

    Fighting Back Against The Flu

    Every year there is concern about the upcoming flu season. Mostly the discussion centers on the composition of the latest flu bugs and what type of strains would be included in the latest vaccine recommended. The first flu case of the season has just been reported in a child. Here I am going to review what you can do to minimize your probability of getting the flu, or if you get it, how to minimize the severity of the illness.

    The immune system

    We know for some time that the antibody-mediated immune system is what helps overcome flus. The body’s immune system produces antibodies against the flu via T-helper cells that recognize the glycoprotein (hemagglutinin) of the flu virus and pass a signal on to B cells (bone marrow derived lymphocytes), which in turn are turned on to produce a lot of antibodies (Ref.1). These protect you from future flus of this type. If you have pre-existing antibodies that fit the bug in circulation you are OK ,and you will usually not get the disease.

    The factors that protect you from the flu

    However, there are many other factors that support your immune system. I will discuss the most important factors in more detail here.

    1. We do know that vitamin D3 strengthens the immune system. I would recommend 1000 to 2000 IU per day in the wintertime, but up to 4000 IU or 5000 IU per day during an active epidemic would be reasonable. There is less flu when people are taking Vitamin D3 supplements.

    Influenza A was reduced in school children supplemented with 1200IU of vitamin D3. This study recommended higher doses of 2000 to 7000 IU of vitamin D3 per day; but it also stated that as a precaution serum vitamin D levels should be monitored (technically it is serum 25-hydroxy-vitamin D levels that are measured) to avoid vitamin D toxicity. Normal levels are between 40-70 nanograms per ml. Toxic levels are above 100 nanograms per ml. Your family doctor can order a serum 25-hydroxy-vitamin D level for you.

    2. Eating fruit and vegetables is important for maintaining a healthy immune system. In a randomized study from Belfast, UK elderly volunteers (82 of them, aged 65 to 85) were assigned to either eat 2 portions or 5 portions of fruit and vegetables per day over 16 weeks. At 12 weeks into the trial both groups received a Pneumovax II vaccination, and the antibody response was measured at the end of the 16th week of the study.  There was a significant increase in antibody binding capacity to pneumococcal capsular polysaccharide in the 5 portion fruit and vegetable group compared to the 2 portion group that had no such increase. The authors concluded that there is a measurable improvement of the immune system when an older population increases their fruit and vegetable intake.

    3. Avoid stress, because stress has been shown to weaken the immune system. This review shows that the immune system is weakened by the stress response via the elevated corticosteroid hormones (the stress hormone ACTH stimulates cortisol release from the adrenal glands). The stress of social isolation is also contributing to the weakening of the immune system in older people.

    Fighting Back Against The Flu

    Fighting Back Against The Flu

    4. Exercise moderately and your immune system will get strengthened. Over exercising should be avoided as too much cortisol is released from your adrenal glands, which is toxic to lymphocytes thus weakening your immune system.

    5.  Socializing is good for you as studies have shown that you live 2 ½ years longer. This study here is from Connecticut, but other studies confirmed this as well.

    6. Make love. The endorphins that are released in the process stimulate the immune system.

    7. Take probiotics, because they help your gut flora to stay normal. A normal gut flora promotes a stronger immune system as the Peyer’s patches (clumps of immune cells) in the gut wall are intimately linked to the immune system. In this way probiotics indirectly support your immune system.

    8. Avoid smoking.  Smokers have more upper and lower respiratory tract infections than non-smokers. Here is information that explains this as well.

    9. Get enough sleep. The circadian rhythm of your hormones ensures that your hormones function at their optimal level. Melatonin from the pineal gland is important in triggering the circadian rhythm, but melatonin itself supports the immune system as well. Your adrenal glands need resetting overnight so that cortisol is secreted according to your stress level, not too much and not too little. Overstimulation from performance sports, grief reactions, car accidents, injuries etc. lead to a surplus of cortisol and weakening of the immune system.

    10. Take your flu shot (but without thimerosal) every year, but take it as a single shot (without thimerosal as a preservative). This CDC link explains that single shot flu vaccines are available without thimerosal. I recommend this type of flu vaccine. The central nervous system is extremely sensitive to nanograms of mercury, and it is for this reason that I would not buy into the argument of the CDC that one should not be concerned about safety of thimerosal. The newest for this flu season is the quadrivalent (or four-strain) flu vaccine, which is now available in pharmacies throughout the US.

    11. Vitamins and supplements support your immune system, particularly vitamin D3. DHEA, which is available over the counter in the US stimulates antibody production when the flu vaccine is given, particularly in the elderly, in other words DHEA strengthens the immune system Vitamin C is known to support the immune system and is rapidly depleted in those who suffer from any viral infection. There are other nutrients that are useful to stimulate your immune system.

    12. Consider herbs: Echinacea, Siberian ginseng, Asian and American ginseng, astragalus, garlic, and shiitake, reishi (also called “lingzhi mushroom”) and maitake mushrooms have all been shown to stimulate the immune system with negligible side effects.

    13. Wash your hands, particularly when there is a flu going around. Door knobs for instance are known to keep live viruses for 2 to 8 hours, so washing your hands will reduce the amount of virus you are exposed to.

    Conclusion

    There is no single solution to prevent the flu, but we can all minimize our exposure to the virus and strengthen our immune system. Although it is wise to get a yearly flu shot to boost your immune system (without thimerosal as a preservative) just before the epidemics come around, this alone is not as good as combining the non-specific factors mentioned here with it. Particularly vitamin D3 (2000 IU to 4000 IU per day) and the old stand-by vitamin C (1000 mg to 2000 mg daily) will stimulate your immune system. Spice up your dinners with mushrooms that stimulate your immune system (maitake, shiitake, reishi mushrooms). Go to bed early enough to allow your circadian hormone rhythms to be reset overnight as you sleep. This will stimulate your immune system (from melatonin and DHEA of your adrenal glands).

    More info on the Flu: http://nethealthbook.com/infectious-disease/respiratory-infections/flu/

    References:

    1. Long: Principles and Practice of Pediatric Infectious Diseases, 4th ed. Prevention. Vaccine. © 2012 Saunders

    Last edited Nov. 7, 2014

    Sep
    28
    2013

    Sleepless Nights

    Sleeping problems (insomnia) are very common. About 10% of the population suffers from chronic insomnia; 30% of the population suffers from occasional sleep problems. In a large outpatient population of a clinic consisting of 3500 patients who had at least one major clinical condition, 50% complained of insomnia, 16% had severe symptoms, 34% had mild symptoms (Ref.1). Insomnia is more common among women, and older people as well as in people with medical or psychiatric illnesses. Long-term studies have shown that the same insomnia problems persist throughout many years. It is not possible to offer a simple remedy for insomnia, because insomnia is a complex problem. Here I will discuss some of the causes of insomnia and also discuss some of the treatment options.

    Symptoms of insomnia

    The person who suffers from insomnia will usually state that they have problems falling asleep. Worries of the day suddenly circulate through their thoughts and they toss and turn nervously looking at the clock from time to time and getting more and more anxious that they cannot sleep. Others fall asleep OK, but in the middle of the night they wake up perhaps to visit the restroom, but then they cannot go back to sleep. Others wake up 2 hours before their normal alarm clock time and they feel their stomach rumbling making it impossible to fall back to sleep. Older people with chronic diseases and general poor health suffer more from insomnia. In this setting insomnia may be more related to the underlying disease rather than old age. Psychiatric disorders also are associated with more insomnia. Treat the underlying psychiatric illness, and the insomnia disappears.

    Although insomnia is a sleep disturbance during the nighttime, people who are affected with this complain of daytime fatigue, of overstimulation, yet they catch themselves making frequent mistakes, and their inability to pay attention gets them involved in accidents and falls. Longitudinal studies have shown (Ref. 1) that people with chronic insomnia are more likely to develop psychiatric disease, such as major depression,  anxiety disorder and alcohol and substance abuse. Unfortunately these disorders can by themselves again cause insomnia, which reinforces chronic insomnia. Insomnia leads to poorer social and physical functioning, affects emotions, leads to a lack of vitality and physical endurance, contributes to worsening of pain and can affect general and mental health.

    Research about insomnia

    Much has been learnt from sleep studies using polysomnography monitoring during a full night’s sleep. These studies have been used mainly as a research tool. In such studies eye movements, brain wave activity, muscle activity, chest movements, airflow, heart beats, oxygen saturation and snoring (with a microphone) are all simultaneously recorded. This way restless leg syndrome, sleep apnea, snoring, seizure disorders, deep depression etc. that can all lead to insomnia can be diagnosed and separated from insomnia. The stages of sleep (wakefulness, stage 1 to 3 sleep and the REM sleep stage) can also be readily measured using polysomnography (Ref.2). According to this reference the majority of insomnia cases do not need this complex procedure done.

    Sleepless Nights

    Sleepless Nights

    Causes of insomnia

    Traditionally insomnia cases are classified into primary insomnia and secondary insomnia. Secondary insomnia is caused by all of the factors discussed below. When they are dealt with, we are left with cases of primary insomnia.

    The following medical conditions can cause insomnia: heart disease, pulmonary diseases like asthma and chronic obstructive pulmonary disease (COPD); gastrointestinal disease like liver cirrhosis, pancreatitis, irritable bowel syndrome, ulcers, colitis, Crohn’s disease; chronic kidney disease; musculoskeletal disease like arthritis, fractures, osteoporosis; neurodegenerative disease like MS, Parkinson’s disease, Alzheimer’s disease; endocrine disease like diabetes, hyper- or hypothyroidism, adrenal gland fatigue and insufficiency; and chronic pain conditions. Also, psychiatric conditions like major depression, schizophrenia and anxiety disorders can cause insomnia.

    This list in not complete, but it gives you an idea of how complex the topic of insomnia is.
    The physician who is seeing a patient with insomnia needs to rule out any of these other causes of insomnia to be certain that the only condition that is left to treat in the patient is insomnia itself. The other diagnoses have to be dealt with separately or else treatment of insomnia will fail.

    Ref. 1 points to a useful model of how to think about causation of insomnia: there are three points to consider, namely predisposing, precipitating, and perpetuating factors. Let’s briefly discuss some of these.

    Predisposing factors

    We are all different in our personal make-up. If you are well grounded, chances are you are not susceptible to insomnia. Anxious persons or persons who have been through a lot of negative experiences in life will have personality traits that make them more prone to insomnia. Lifestyle choices such as late nights out, drinking with the buddies in a bar (extreme circadian phase tendencies) will have an impact on whether or not you develop insomnia.

    Precipitating factors

    A situational crisis like a job change or the death of a loved one can initiate insomnia.  However, there could be a medical illness such as a heart attack, a stroke or the new diagnosis of a psychiatric illness that has become a precipitating factor. Sleep apnea and restless leg syndrome belong into this group as well as would the stimulating effect of coffee and caffeine containing drinks. Jet lag and nighttime shift work can also be precipitating factors.

    Perpetuating factors

    Daytime napping to make up for lost sleep the night before can undermine sleep initiation the following night, which can lead to a vicious cycle. Similarly, the use of bedtime alcoholic drinks leads to sleep disruption later that night and can become a perpetuating factor, if this habit is maintained. Even the psychological conditioning of being anxious about whether or not you will fall asleep easily or not the next night can become a perpetuating factor.

    I will return to this classification and the factor model of causation of insomnia when we address treatment options.

    Drugs that can cause insomnia

    One major possible cause for insomnia  can be side effects from medications that patients are on (would belong to the ‘perpetuating factors’ among causes). Physicians call this “iatrogenic insomnia”. The antidepressants, called selective serotonin reuptake inhibitors (SSRI’s) like Prozac are particularly troublesome with regard to causing insomnia as a side effect. Other antidepressants like trazodone (Desyrel) are used in small doses to help patients with insomnia to fall asleep. Some asthmatics and people with autoimmune diseases may be on prednisone, a corticosteroid drug. This can cause insomnia, particularly in higher doses; so can decongestants you may use for allergies; beta-blockers used for heart disease and hypertension treatment; theophylline, an asthma medication and diuretics. Central nervous stimulants like caffeine or illicit drugs can also cause insomnia. Hormone disbalance in general and hyperthyroidism specifically as well as Cushing’s disease, where cortisol levels are high will cause insomnia.

    Treatment of insomnia

    So, how should the physician approach a patient with insomnia? First it has to be established whether there is secondary insomnia present due to one of the predisposing, precipitating or perpetuating factors. In other words, is there secondary insomnia due to other underlying illnesses? If so, these are being addressed first. Lifestyle choices (staying up late every night) would have to be changed; alcohol and drug abuse and overindulging in coffee or caffeine containing drinks needs to be dealt with. Cognitive therapy may be beneficial when mild depression or anxiety is a contributing factor to insomnia.

    The remaining insomnia (also medically termed “primary insomnia”) is now being treated.

    The following general points are useful to get into the sleeping mode (modified from Ref. 3):

    1. Ensure your bedroom is dark, soundproof, and comfortable with the room temperature being not too warm, and you develop a “sleep hygiene”. This means you get to sleep around the same time each night, have some down time 1 hour or so before going to bed and get up after your average fill of sleep (for most people between 7 to 9 hours). Do not sleep in, but use an alarm clock to help you get into your sleep routine.
    2. Avoid caffeine drinks, alcohol, nicotine and recreational drugs. If you must smoke, don’t smoke later than 7PM.
    3. Get into a regular exercise program, either at home or at a gym.
    4. Avoid a heavy meal late at night. A light snack including some warm milk would be OK.
    5. Do not use your bedroom as an office, reading place or media center. This would condition you to be awake.  Reserve your bedroom use only for intimacy and sleeping.
    6. If you wake up at night and you are wide awake, leave the bedroom and sit in the living room doing something until you feel tired and then return to bed.
    7. A self-hypnosis recording is a useful adjunct to a sleep routine. Listen to it when you go to bed to give you something to focus on (low volume) and you will find it easier to stop thinking.

    Drugs and supplements for insomnia

    1. In the past benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), fluorazepam (Dalmane), temazepam (Restoril), triazolam (Halcion) and others were and still are used as sleeping pills. However, it was noted that there are significant side effects with this group of drugs. Notably, there is amnesia (memory loss), which can be quite distressing to people such as not remembering that someone phoned while under the influence of the drug, you promised certain things, but you cannot remember the following morning what it was. Another problem is the development of addiction to the drugs with worse insomnia when the drugs are discontinued. Many physicians have stopped prescribing benzodiazepines.

    2. There are non-benzodiazepines drugs that are used as sleeping pills (hypnotics), such as Zaleplon (Sonata), Zolpidem (Ambien) and Eszopiclone (Lunesta).  They seem to be better tolerated.

    3. Ramelteon, a melatonin agonist, is available by prescription in the US. It probably is the best-tolerated mild sleeping pill and works similar to melatonin, but is more expensive. Chances are that your physician likely would prescribe one of the non-benzodiazepines drugs or Ramelteon for you as they do not seem to be addicting.

    4. However, there is an alternative: Many patients with insomnia tolerate a low dose of trazodone (Desyrel), which is an antidepressant with sleep restoring properties. A low dose of 25 to 50 mg at bedtime is usually enough for insomnia. This allows the patient to fall asleep within about 30 minutes of taking it, and sleep lasts through most of the night without a hangover in the morning. Many specialists who run sleep laboratories recommend trazodone when primary insomnia is diagnosed. However, this is still a drug with potential side effects as mentioned in the trazodone link, but 50 mg is only ¼ of the full dose, so the side effects will also be less or negligible.

    5. I prefer the use of melatonin, which is the natural brain hormone designed to put us to sleep. Between 1 mg and 6 mg are sufficient for most people. We know from other literature that up to 20 mg of melatonin has been used in humans as an immune stimulant in patients with metastatic melanoma with no untoward side effects other than nightmares and some tiredness in the morning. A review from the Vanderbilt University, Holland found melatonin to be very safe as a sleeping aid. There are several melatonin receptors in the body of vertebrates (including humans), which are stimulated by melatonin.

    6. Other natural methods are the use of L-Tryptophan at a dose of 500 mg at bedtime, which can be combined with melatonin. It is the amino acid contained in turkey meat, which makes you tired after a Thanksgiving meal. GABA is another supplement, which is the relaxing hormone of your brain, but with this supplement tolerance develops after about 4 to 5 days, so it is only suitable for very short term use. Herbal sleep aids are hops, valerian extract and passionflower extract. They are available in health food stores.

    Conclusion

    A lack of sleep (insomnia) is almost a given in our fast paced lives.

    When it comes to treatment, all of the other causes of secondary insomnia need to be treated or else treatment attempts would fail. What is left is primary insomnia. This is treated as follows:

    We need to review our sleeping habits, lifestyles and substance abuse. Remove what is detrimental to your sleep. Start with the least invasive treatment modalities such as self-hypnosis tapes, melatonin, L-Tryptophan or herbal extracts. Should this not quite do the trick, asks your doctor for advice. The non-benzodiazepines drugs or Ramelteon would be the next level up. It may be that an alternative such as low dose trazodone would be of help. Only, if all this fails would I recommend to go to the more potent sleeping pills (keep in mind the potential for addiction to them).

    References

    1. David N. Neubauer, MD (John Hopkins University, Baltimore, MD): Insomnia. Primary Care: Clinics in Office Practice – Volume 32, Issue 2 (June 2005)  © 2005, W. B. Saunders Company

    2: Behrouz Jafari, MD and Vahid Mohsenin, MD (Yale Center for Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA): Polysomnography. Clinics in Chest Medicine – Volume 31, Issue 2 (June 2010), © 2010 W. B. Saunders Company

    3. Jean Gray, editor: “Therapeutic choices”, 5th edition, Chapter 8 by Jonathan A.E. Fleming, MB, FRCPC: Insomnia, © 2008, Canadian Pharmacists Association.

    Last edited Sept. 28, 2014

    Sep
    21
    2013

    In Vitro Fertilization As A Last Resort To Get Pregnant

    Since its invention in 1978 there have been 5 million babies born through in vitro fertilization (IVF). According to the World Health Organization there are about 120 to 160 million couples worldwide struggling with infertility problems.

    Assisted reproduction technology (a fancy name for artificial insemination) has been helped a lot by the breakthrough discovery in the US with regard to ultrasound identification of mature follicles in the ovaries. The second technical breakthrough, another ultrasound method done trans-vaginally to recover eggs from the identified mature follicles, has also helped the IVF technology (Ref.1).

    When all of the cases of infertility in the United States are broken down into what causes them, the following was found (Ref. 2):

    20% of cases of infertility were caused by anovulation, about 35% were due to abnormal semen production in the male, 30% by pelvic disease (fibroids, tubal blockage, polycystic ovaries), and 15% of cases were unexplained.

    Process of artificial insemination

    There are a number of steps that have to be followed to be successful with IVF.

    a) Hormonal stimulation of the ovaries: The first step in getting eggs from a woman who desires IFV is to stimulate her ovaries to produce several mature follicles. This is achieved with gonadotropins, which are hormones that lead to ovarian overstimulation. Over the years this has been fine tuned with gonadotropin-releasing hormone (GnRH) analogues given first (stimulating release of LH and FSH from the pituitary gland). Subsequently follicle-stimulating hormone (FSH) is given, which causes the ovaries to produce follicles that can be identified on a TV screen using ultrasound technology. When follicle maturity is established with the ultrasound method, human chorionic gonadotropin can be given to trigger ovulation. However, when this is done and combined with artificial insemination through depositing sperm via a catheter into the uterus, the pregnancy rates judged by today’s standards to be too low (in the order of 15 to 20% per cycle).

    b) Harvesting of eggs:

    Nowadays the 2 or 3 follicles that have been identified as mature by ultrasound are used for follicular aspiration. With transvaginal sonography and a long needle that comes out from the ultrasound probe, the specialist will be able to harvest the mature eggs from the follicular cysts.

    c) In vitro fertilization methods:

    There are basically two methods for fertilization. First the standard IVF method is simply to add sperm to the eggs in a Petri dish with growth medium. After spontaneous fertilization the eggs undergo cell division. Compared to this standard IVF the success rates have been found to be higher with a newer method, called intracytoplasmic sperm injection (ICSI). In this case a single sperm is injected through a fine needle into the egg. On the 2nd or 3rd day of in vitro culture with either of these methods of fertilization the embryos consist of 6 to 8 cells. The embryos (typically one or two) are now introduced into the uterus of the mother by the specialist.

    In Vitro Fertilization As A Last Resort To Get Pregnant

    In Vitro Fertilization As A Last Resort To Get Pregnant

    Success rates of in vitro fertilization (IVF)

    Approximately 10% of all U.S. couples with women of the reproductive age are infertile, approximately more than 7 million women; the incidence of infertility steadily increases in women after the age of 30. Among fertile couples who have sex during the week before ovulation, about 20% achieve a pregnancy.  If regular unprotected sex does not lead to a pregnancy within one year, the couple is considered infertile (that is the medical definition of infertility). With infertile couples using intrauterine insemination there is a pregnancy success rate of about 8 to 9% per cycle. However, IVF has a success rate of 30% per cycle. The chance of a pregnancy after six cycles of IVF is 72% provided the woman is in close contact with the IVF specialist and follows all of the instructions carefully. If the woman does not adhere to the program (this includes some dropouts), the pregnancy rate for IVF is only 51% in 6 months (Ref.2).

    In 2010 the Nobel Prize for Physiology and Medicine went to Bob Edwards for his outstanding work on IVF. His work has improved the success rate for pregnancy of infertile couples significantly.

    Costs of in vitro fertilization (IVF)

    The conventional IVF cost is about 60,000$ to achieve a successful pregnancy; a newer, simplified IVF version costs only 265$, a method which has been developed for development countries. In the simplified version fertility drugs are given as generic tablets. The pregnancy rate for IVF is about 34% in this study from Belgium involving 100 infertile couples so far with the women being under the age of 36.

    Gender selection and genetic abnormalities

    Gender selection is highly controversial and is not being practiced. However, there are gender specific genetic abnormalities that can be identified in the 2 to 3 day old embryo after a few in vitro cell divisions. If DNA analysis shows an X-linked abnormality, this genetic abnormality would not be implanted into the womb. An embryo with a normal DNA test would be implanted instead (male or female). There are obvious ethical guidelines that have to be followed and these have been in place for a number of years.

    The following overview of IVF contains a mini video showing a single sperm injection into an egg (the intracytoplasmic sperm injection method or ICSI). This is the latest in IVF technology, but also the most expensive option.

    Complications with in vitro fertilization (IVF)

    A review article in the Journal of Obstetrics and Gynecology in March of 2004 (Ref. 3) compared the complications and outcomes of single baby pregnancies (=singletons) that were either conceived normally (control group of 1.9 million spontaneous singletons) or conceived by IVF (12,283 IVF singletons pooled from 15 studies). Compared to normally conceived babies the group of IVF conceived babies had a perinatal mortality rate, which was 2.2-fold higher, the rate of preterm deliveries was 2.0-fold higher, low birth weight was 1.8-fold higher, a very low birth weight was 2.7-fold more common and the classification of “small for gestational age” based on birth weight was 1.6-fold higher. The medical researchers found a number of reasons for this: compared to normally conceived babies, the rate of IVF conceived babies had a higher rate of placenta previa, early preterm delivery, spontaneous preterm delivery, gestational diabetes, preeclampsia, and neonatal intensive care admissions were also significantly more common.

    Other observations

    If anovulatory cycles are the reason for infertility, clomiphene treatment can often restore regular menstrual cycles, but according to Ref. 2 there is an 8% risk for multiple gestations (twins, triplets) with a higher infant mortality rate.

    For women with tubal obstruction IVF is better than attempting to do tubal reconstruction.

    Women with unexplained infertility (no cause found despite thorough investigations) are treated by controlled ovarian stimulation as mentioned above and by inserting semen from the husband into the uterine cavity through a small plastic catheter (intrauterine insemination). With this combination pregnancy success rates of 10% per cycle can be achieved and this should be the first approach to cases of unexplained infertility (Ref.2)

    Fibroids in the uterus are from estrogen dominance, so are polycystic ovaries. Replacement of missing progesterone with bioidentical progesterone cream will often shrink or melt the fibroids away, cure the ovaries of polycystic disease and restore fertility (this is not taught in medical schools and will not be told to most women attending fertility clinics). There are countless numbers of women attending fertility clinics needlessly; had they only checked their hormone status with saliva hormone tests and corrected the hormone imbalances with bioidentical hormones.

    In vitro fertilization with or without ICSI has a pregnancy success rate of 50% per cycle for women less than 30 years of age. Above the age of 30 these numbers are lower and genetic abnormalities are higher necessitating the more expensive ICSI fertilization method. The pregnancy rate is also directly related to how many embryos are transferred into the womb. Usually 1 or 2 embryos are inserted. Twins are not uncommon with IVF.

    Conclusion

    In 35 years in vitro fertilization has developed into a sophisticated tool that helps women who previously were considered to be permanently infertile to conceive a normal pregnancy. Despite these technical advances we should not lose sight why infertility is such a problem today. Two main factors come to mind: sexually transmitted diseases can scar up the Fallopian tubes making it impossible for the sperm to reach their goal, the fertile egg. Men can also get scarring of their collecting ducts for the sperm (from epididymitis) from Chlamydia and other VD. Secondly, couples are settling into marriage much later in life, often well beyond their 30th birthday. Ideally a woman should have her first pregnancy between 20 and 25, when she is most fertile. If these things don’t fall into place, there is a cost to IVF and there are the associated risks discussed.

    More information on infertility: http://nethealthbook.com/womens-health-gynecology-and-obstetrics/infertility-php/

    References

    1. Adam: Grainger & Allison’s Diagnostic Radiology, 5th ed. © 2008 Churchill Livingstone, CHAPTER 53 – Imaging in Obstetrics and Infertility.

    2. Lentz: Comprehensive Gynecology, 6th ed. © 2012 Mosby: Treatment of the causes of infertility.

    3. Review article in the Journal of Obstetrics and Gynecology in March of 2004 (March 2004, Volume 103, Issue 3: pages 551-563) examined the complication rates of IVF.

    Last edited Nov. 7, 2014

    Sep
    14
    2013

    Food Processing Can Be A Danger To Your Health

    This article is entitled: food processing can be a danger to your health. Food processing is found everywhere: in pizzas, hamburgers, ready to eat deep frozen dinners, and in the myriad of packages that you see in the center of the grocery store. There are aisles and aisles of ready-made food packages including potato and corn chips, power bars, low fat yoghurt, and on and on it goes. So, what are the problems with these foods? Here are the major players that you will find (sometimes not) on the food ingredient lists.

    Hidden sugar

    With the recommendation for the past few decades that we should use low fat yoghurt a whole industry has sprung up surrounding low fat products. If you study the labels you will see that this has been done at the expenses of adding hidden sugar content. Don’t go for the berry or other fruit yoghurt, because it is over processed, sweetened with sugar or high fructose corn syrup. This is a fast track to becoming a diabetic. Stick to plain yoghurt with 2 to 3 % fat, which has only the original milk sugar in it, but no additives. Also, in the US you ought to avoid any milk and milk products containing bovine growth hormone, which is solely there for increasing the milk farmer’s profit, but will seriously undermine your health (it blocks your growth hormone receptors).

    Added sugar changes your metabolism

    Ref. 1 and 3 explain in detail how the metabolism is being changed through added sugar and an overdose of starchy foods, which is the reason for the pancreas over producing insulin. This in turn causes such varied diseases like heart attacks, diabetes, inflammatory conditions like arthritis, MS, Alzheimer’s disease and cancer.

    Cut out cookies, excessively starchy foods like potatoes, bread, pasta and rice. Within half an hour of ingesting these your system will be overrun with sugar, the breakdown product of starchy food.

    Added salt

    The chef adds salt often to preserve foods, to lengthen their shelf life and to stimulate your appetite. Restaurants add salt to stimulate your appetite for more liquids. As a result more beverages (alcoholic and nonalcoholic) will be ordered, which is where the profit margin is highest. High amounts of salt will not be beneficial to you, as it will raise your blood pressure and on the long-term will cause high blood pressure, heart attacks and strokes. When you buy organic food, there is no additional salt in it, although you get sodium chloride, which is naturally present in the vegetables and fruit. Add very little salt, if any; instead add  herbs and spices, which contain valuable trace minerals.

    Food Processing Can Be A Danger To Your Health

    Food Processing Can Be A Danger To Your Health

    Hidden fat

    Whenever you have a food that was deep fried such as potato chips, corn chips or French fries, there is the danger of exposing yourself to trans fats from polyunsaturated fatty acids. This is also true for deep fried chicken or any other ready to eat foods that have been prepared in the deep fryer. This type of oil is often reused after it is filtered and advanced glycosylation end products (AGE’s) are accumulated in it. This ages your cells including your skin much faster. AGE’s also worsen diabetes by causing more complications like heart attacks and kidney failure. For the same reason you should avoid burning meats on the BBQ or food that you cook on a stove.

    Beware of hidden fat in hamburgers

    Hamburgers also have a lot of hidden fat, sometimes as much as 50%. This fat enters your bloodstream and finds its way as fat deposits in your arteries. After decades of eating too many hamburgers and sausages your coronary arteries clog and you require a stent or a bypass surgery. If you do not want to become a statistic prematurely, cut out sausages, hamburgers and other processed meats replacing them with lean turkey breast, organic chicken and lean pork, venison or grass-fed lean cuts of beef or bison.

    MSG and other food additives

    Many foods have artificial sweeteners in them, which includes excitotoxins like MSG and aspartame. Food manufacturers add MSG to stimulate your appetite, but it has devastating effects on your brain cells on the long term. Food manufacturers disguise the name by using synonyms like yeast extract, sodium caseinate, broth stock, malt extract, natural flavors and others. Soda drinks either have added sugar, in which case your insulin response makes you want to eat more calories in a day leading to obesity and to dementia. Diet conscious people use aspartame in low-calorie drinks, but it causes insulin resistance making you gain weight. It also damages your brain.

    I recommend stevia extract

    I recommend the plant extract stevia, which is a sweetener that does not have the deleterious effects of aspartame. Sucralose (Splenda) was developed through research on insecticides when a student found out that it tasted sweet. Although Big Pharma has succeeded to introduce sucralose into the diet of diabetics, it is a sweetener that in my opinion is not safe. First it kills ants: a few years ago, I did an experiment where I took a package of Splenda from Starbucks and sprinkled it on Hawaiian ants.

    Experiment with Splenda powder and ants in Hawaii

    In the beginning they were reluctant to eat it, but after a few hours they came and took it in. One day later there were only dead ants left in the area where I sprinkled Splenda before. I refuse to eat insecticide-laced soda! Second, when you read the link about the “sweet deception about Splenda” above you find that it has reduced the growth rate of rats, caused anemia in mice, enlarged the liver and the brain of rats, shrunk ovaries of rats and caused kidney damage with calcifications in rats. We have no official human data, although millions of Splenda doses have been consumed.  Nobody has done clinical safety studies in man.

    Gluten and gliadin

    One of the food additives you may not think much about is gliadin, which bakers user to bind the ingredients together. Its origin is wheat, which is usually the Clearfield variety of wheat (a dwarf variety). Dr. William Davis (Ref.1) has examined the effects of wheat and wheat products on humans in detail. Suffice it to say that it is safest to avoid wheat and wheat products entirely; otherwise, you could develop bowel disease like celiac disease, ulcerative colitis, Crohn’s disease; heart disease, obesity, autoimmune diseases, but also CNS disease like Parkinson’s disease, ataxia, and dementia (including Alzheimer’s disease).

    Other health problems associated with marketing and so-called “best practices” of agroindustry

    Milk and milk products are not as innocent as in the past when no marketing boards were around. Animals are no longer freely roaming on green pastures. The farmer keeps them in high-density facilities and they put them on antibiotics to prevent infectious illnesses. So the rumor goes. In reality farmers have found out that antibiotics and bovine growth hormone will both increase milk production. The profit principle has been applied and as a result the consumers of milk and milk products have a change of their bowel flora from the antibiotics, which can cause heart attacks. The bovine growth hormone from milk and milk products causes breast cancer and prostate cancer.

    Superbugs

    Superbugs have emerged as a danger from treating beef animals with antibiotics in feeding lots leading to resistant bacterial strains that can cause human disease like flesh eating disease etc. These superbugs imported from the grocery store and meat market are what can make us sick! Eating only organic meat and organic foods are one way that we can use to protect ourselves. Organic milk or goat milk are alternatives to regular (unhealthy) milk.

    Toxins in our foods

    Roundup is rampantly present in agroindustry to protect crops from weeds. Traces of it are present in most regular crops. Despite claims that Roundup would be safe for the consumer, newer research has shown that it is not. Genetically modified crops are routinely sprayed with Roundup, as they are resistant to this herbicide, so I recommend to stay away from these crops as well.

    Your best protection is to buy organic foods, as inspectors test these crops for Roundup contamination.

    Heavy metals

    Heavy metals can be another source of food toxicity. Red wine was found to contain heavy metals, which could undermine that heart healthy effect of a glass of red wine per day.

    Mercury is toxic to the central nervous system. It comes from the effluent of gold mines, the smog from coal burning and volcanic activity, which finds its way into the ocean. Fish is the main source of exposure to humans as explained in this link.

    Conclusion

    We need to be vigilant about the food we eat. The more food processors create new items, the more ingredients they mix in. We need to ask questions about food preparation. Did the food processors mix in food additives? Are they harmless or bad for our health? Beware of sugar as this causes insulin levels to raise causing obesity, diabetes, heart attacks, strokes and cancer. Watch the addition of salt, which causes high blood pressure, heart attacks and strokes. Avoid polyunsaturated fats, cook with olive oil instead. It’s the Mediterranean way of preventing heart attacks. No butter, no margarine, because this fat ends up in your arteries. Avoid wheat and wheat products that food manufacturers often mix into foods. Cook your own food whenever possible. Eat lots of vegetables and salads.

    Keep the glycemic index of your food low

    Watch the glycemic index and avoid high glycemic index foods. Sweeten with stevia, but avoid all other sweeteners. This way you avoid the insulin response discussed above.

    The dietitians of the US have summarized the problems the American public faces in Ref. 2. Essentially, we need to take back the responsibility for our own food preparation and become less dependent on manufactured foods. Ref. 3 lists a good collection of wheat-free recipes.

    References

    1. William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

    2. The Profession of Dietetics at a Critical Juncture: A Report on the 2006 Environmental Scan for the American Dietetic Association; Journal of the American Dietetic Association – Volume 107, Issue 7 (July 2007)

    3.  William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

    Sep
    07
    2013

    Preserve Your Muscles And Joints

    Our ancestors were hunters and gatherers, constantly on the go. They did not have to think too much about their muscle and joint health, they simply moved them. In our society this has changed a lot. At work we spend hours sitting at a desk, and then we use computers and watch television at home. Instead of walking to the neighborhood store, we use our car.

    Here I will review what we can do to keep our joints and muscles in top shape until a ripe old age.

    Brief intro regarding the anatomy of joints and muscles

    Our joints are designed to give us full mobility. But the joints cannot do it alone. The muscles are designed to allow the joints to move in a full range. Without exercise the muscles will shrivel up (medical term “atrophy”) within only 2 to 3 weeks. So without regular exercise your joints won’t do you any good. Besides the joint capsules need regular stretching in full range exercises to produce the lubricating fluid (synovial fluid) that nourishes the joint surfaces and the menisci of the knees. Think of muscles and joints as being a functional unit designed to move you about.

    Our joints have aerodynamic designs to do the most optimal job for our body. For instance the knees have more of a hinge design that includes menisci for shock absorption while the shoulders and hips have more of a ball and socket type construction.

    Wear and tear with aging

    It is usually thought that injuries and aging wear down the joints. But there are other factors such as the wide spread use of statins that can contribute to muscles weakness. Ironically statins are taken to protect the heart, but side effects can interfere with the ability to exercise your heart because of aching muscles and joints.

    With optimal nutrition and avoidance of wheat and wheat products to prevent autoimmune arthritis (lupus, rheumatoid arthritis, dermatomyositis) your joints can stay young for much longer (explained further below). But your joints and muscles need to move through a full range of motion regularly to keep the blood circulation and nutrition of their tissues in top shape.

    What causes joint deterioration?

    Aging, weight gain, diabetes, smoking and lack of exercise all are known to cause a worsening of arthritis, particularly osteoarthritis, but also rheumatoid arthritis. The wrong diet with lots of sugar and starch and trans fats (hamburgers, pasta, sugar soda drinks) causes hyperinsulinemia (insulin overproduction, like in type 2 diabetes) and is almost guaranteed to make you sick with arthritis, obesity and diabetes.

    There is also evidence that wheat causes inflammation and arthritis by stimulating your pancreas to produce too much insulin. This has been proven for dogs and for humans. A good diet book to follow is Dr. William Davis “Wheat Belly Cookbook” (Ref. 1) with 150 recipes. If you are overweight, these recipes will also help you to lose some weight effortlessly.

    A caution to marathon runners: the constant pounding of prolonged jogging can cause osteoarthritis of hips and knees decades down the road. You may want to switch to different exercises before this happens.

    Preserve Your Muscles And Joints

    Preserve Your Muscles And Joints

    What helps joints?

    Molecularly distilled omega-3 fatty acid helps to prevent inflammation of your joints. Vitamin D3 will help your bones to be strong to support the tendons and ligaments. Chicken cartilage can build up joint cartilage within a few weeks! So, if you feel pain in your joints use 3 capsules of omega-3 (the strong, molecularly distilled ones) twice per day. This will help your joint inflammation within 3 to 4 weeks. If this alone is not enough add chicken cartilage from the health food store, which will help to build up the hyaline cartilage within your joints. For those who are questioning the effect of chicken cartilage, here is a 1993 chicken cartilage Harvard study proving it.

    Below are more general steps that will help your joints, ligaments and muscles.

    Maintaining health of joints and muscles

    a)    It starts with good nutrition.

    Hamburgers and deep fried French fries will not do the trick. Muscles require protein from meat, fish, poultry and dairy products. If you are a vegetarian you need to become knowledgeable on what essential amino acids are and what combination of vegetables will give you the amino acid composition to build up a full protein.

    Joints need ingredients from cartilage, which you find in chicken cartilage (available in health food stores as fikzol (type II cartilage). I you prefer, chicken soup would also give you the ingredients to build up cartilage, but it would require a lot of regular chicken soup consumption to achieve this.

    Sugar and starchy foods, which are broken down within half an hour after a meal into sugar in your blood, cause an insulin response from your pancreas. This in turn can cause inflammation in your joints and tendons. It is interesting to note that type 2 diabetes and arthritis are associated. A ketogenic, low sugar/starch diet will prevent arthritis and diabetes as it reduces the insulin level in the blood, which in turn turns off inflammation in the joints.

    b)   Supplements:

    Omega-3 fatty acids will help control any inflammation including the inflammation from arthritis (you need 3 capsules of the concentrated, molecularly distilled fish oil twice per day to achieve this).  DMSO gel, available in health food stores in the US, can also be used to rub onto inflamed joints. It will penetrate tissues rapidly, is nontoxic and helps control inflammation along with the omega-3 fatty acids. Regular anti-inflammatory pain relievers (NSAIDs) are harsh on your kidneys and can irritate the gastric lining causing bleeding gastric erosions, so definitely not recommendable.

    Glucosamine, chondroitin sulfate, or a combination of both is available in the health food store and has been shown to help with osteoarthritis. I contributes to building up hyaline cartilage.

    c)   Watch your weight:

    It has been shown that the rate of degenerative arthritis (=osteoarthritis) in obese people is much higher when compared to slim people.

    d)   Exercise:

    You need to move your joints, ligaments and muscles every day to maintain their strength and range of motion. A daily workout at home or in a gym is best. I recommend 30 minutes of a treadmill or equivalent (jogging, Stairmaster etc.) as aerobic exercises. Then you need 30 minutes of isometric exercises like a circuit on exercise machines in the gym or dumbbells and expanders (resistance bands) at home. I consider this as the basic fitness routine every day.

    Ballroom dancing and Latin dancing or Zumba is also a good combination exercise, which I would recommend on top of the basic exercise. Dancing helps to maintain your balance as well, which is something the older population tends to lose. In addition dancing stimulates your brain cells and makes you less vulnerable to develop dementia in old age.

    Other aerobic exercises that can be recommended are walking (brisk walk) and/or intermittent jogging. Swimming has the advantage particularly for arthritis sufferers that you are floating. It allows you to exercise your leg and arm muscles, even if you have some arthritis pains.

    e)  Pain relief: What could you do for pain relief? I do not like NSAIDs as this will damage your kidneys on the long-term and cause gastric erosions that can bleed massively. Electro acupuncture is very useful for muscle and joint pains and has no side effects. Physiotherapy treatments are useful to recondition your muscles and build up the range of motion of your joints. Chiropractic treatments for back and neck pain will also help. Instead of narcotics, why not try low dose Naltrexone (LDN). It has been shown to help with the pain of fibromyalgia.

    Conclusion

    In this brief review I have attempted to show you that your body is not on a one-way street in the direction of disability and death. There is a lot we can actively do to prevent this from happening prematurely. Just eat right, supplement (if you have symptoms), exercise and be active. Soon you will no longer be aware of your previously achy joints or muscles, as the pain tends to melt away when you are reconditioned.

    More information on fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

    References:

    1. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

    Last edited Nov. 7, 2014

    Aug
    31
    2013

    Peanut Allergies Are Deadly

    Introduction

    This article is about “peanut allergies are deadly”. In the US 1.5 million suffer from peanut allergies (Ref.1). People who have peanut allergies have to avoid peanuts and foods that contain even traces of peanuts lifelong. Here is a recent example of a 13-year old girl who died at a camp when she tried food contaminated with peanuts. Before we discuss peanut allergies in detail, we need to review first how the immune system is functioning.

    How the immune system is primed to develop an allergy

    Our immune system knows the difference between our own body components and substances that come from the outside. Scientists call this tolerance to our own surface proteins; and scientists call it an immune reaction that is mounting as a reaction to anything different from the surface antigens. There are different cells that make up the immune system. One of the main working cells of the immune system are the lymphocytes. A subtype are B cells that originate from the bone marrow producing antibodies when an immune reaction occurs. Antibodies fit like a lock and key to the surface of an antigen, in this case the peanut protein. T helper cells are T lymphocytes (thymus derived lymphocytes). They help the B cells to recognize the difference between the own protein components and the outside components.

    IgE antibodies directed against peanut protein

    There are also T killer cells, which when parasites or viruses enter the body activate them. With regard to peanut allergies, it is the B cells and T helper cells that interact. The B cells produce a powerful, very specific IgE antibody directed against peanut protein. There are memory B cells, which continue to produce these specific anti-peanut protein antibodies. They can cause severe allergic reactions when future exposure to peanuts (even traces) occurs. The more often a person allergic to peanuts encounters traces of peanuts, the more  the immune system gets boosted. This produces even more antibodies of the IgE type through reactivated B memory cells (Ref. 2). 98% of the population does not react to peanut exposure with allergies. But the other 2% who may have genetic susceptibility factors that predispose them to this often develop life-threatening reactions. These have the name “anaphylactic reaction”.

    What is an anaphylactic reaction to peanuts?

    The most extreme form of allergies involving IgE antibodies can cause anaphylaxis. In the beginning stages of a peanut allergy there may only mild symptoms such as hives on the skin, itching and tingling around the mouth, a runny nose, a scratchy throat, wheezing, stomach cramps, vomiting or diarrhea. However, with a more severe allergy an asthma attack can develop. In this case the blood pressure drops leading to fainting or shock. In addition, severe airway obstruction in the throat or lungs can cause suffocation.

    I vividly remember an 11-year-old boy who arrived by ambulance in the emergency room of the hospital where I was working as the on-call physician. He had a hard time talking as his throat was swelling up as part of his anaphylactic reaction, within minutes he passed out completely (shock). Fortunately, an anesthetist was in the department and could intubate him very quickly.

    Period of unconsciousness

    However, despite adrenaline treatment, oxygen by artificial ventilation and high doses of corticosteroid drugs he did not wake up until 10 hours later. In retrospect it turned out that he had eaten some crackers of a familiar brand that he knew as being free of peanut flour. However, he saw an ad that the same brand of crackers was available as cheese crackers and he tried one of these. This prompted his admission to the hospital. The parents read the ingredients later: the label on the cheese crackers noted in small print that the flour of the cheese crackers contained peanut flour! Always read labels, even if it is a familiar brand! Fortunately for this boy he did not have brain damage from the time of his unconsciousness. He has been extremely careful since and is reading labels and avoiding unknown food items.

    Peanut Allergies Are Deadly

    Peanut Allergies Are Deadly

    Cross-reactions between peanuts and other allergens

    Allergies can be made worse when a person has inhalant allergies from pollens of trees or grasses that can share protein components from protein found in foods. The latest findings are that there are cross allergies between Fenugreek and lupine, which are both legumes, as are peanuts, so there are common antigens present in their proteins. A mouse-testing model has shed more light on this. Fenugreek has been shown to control mild diabetes by improving insulin resistance, but it cannot be consumed by persons who are highly allergic to peanuts because of the cross allergy mentioned.

    There are other possible cross allergies to legumes like lentils, soy and chickpeas.

    Other factors that can cause allergies to get worse

    In the past the RAST test was often used.  This is a blood test for common food allergies that can cause severe allergic reactions like egg, milk, peanut, tree nuts, wheat, crustacean shellfish and soy. However, since about 2010 this has been replaced by the more sensitive ImmunoCAP Specific IgE test. Children who have food allergies to egg, milk, wheat, nuts, peanuts and soy often outgrow these allergies when they age, in other words their immune system can develop tolerance to many of these foods. Not so with peanut allergies! They tend to be very persistent.

    Immune responses to food allergies are complicated

    There are complications with immune responses to food allergies. They contained immediate type immune reactions and delayed type immune reactions. Allergists investigate the immediate immune responses with the above mentioned ImmunoCAP Specific IgE test. They can measure the delayed immune responses using the ELISA test. Positive IgE antibody tests for peanut protein are a marker that the person likely has more other allergies. An allergist should investigate them in that regard (Ref. 2).

    New wheat varieties complicate the lives of people with allergies

    What complicates the allergy sufferers’ lives even more is the fact that new wheat varieties were introduced. This happened in the 1970’s. The new wheat has the name Clearfield wheat. It has a much higher gliadin (gluten) and lectin content than the old wheat varieties. As a result of exposure to this new type of wheat gluten intolerance and leaky gut syndrome have increased substantially in the world population (Ref.3). In addition, genetically modified foods like soy, corn, sugar beets, canola and others have challenged the immune system of sensitive humans even more.

    Autoimmune diseases from GMO food and modern wheat

    We do know that some people can develop autoimmune diseases from GMO foods and modern wheat, and this may be the reason that a host of diseases that belong into this disease category (MS, rheumatoid arthritis, Hashimoto’s thyroiditis, ankylosing spondylitis etc.) are much more common now than in the past. The geneticists developing GMO foods were unaware how sensitive the immune system is.  The immune system detects a few different amino acid sequences in a protein mounting a strong immune response to it.

    Treatment for peanut allergies

    The key for sufferers from peanut allergies is to avoid exposure to it. Read labels and use common sense. If a food item has no label, do not attempt to eat it. Food manufacturers often mix peanut flour into the dough of crackers. But not every product has a label that identifies whether peanut flour is in it. Alternatively it says so only in fine print. With peanuts the antibodies usually circulate in the blood life long. The reason is that the B memory cells do not diminish and experience reactivation very quickly on repeat exposure. At this time they produce antibodies again. As exposure to peanuts can cause severe asthma or anaphylactic shock, it is important to carry an EpiPen with you and to know how to use it.

    Oral immunotherapy

    In Europe attempts have been made to develop an oral desensitization method for food allergies including peanut allergies, but it has not produced concrete results yet. Recently, however, research from Texas, USA showed that it is possible to desensitize patients with peanut allergy by oral desensitization. In Australia where food allergies are more prevalent than in the US, tolerance to peanut, nut and shellfish allergies is being pursued by oral immunotherapy. Another group in Australia has developed a vaccination method using peptides, which are a sequence of amino acids, but shorter than the full peanut protein. It appears that this is the future direction of treatment for peanut and other IgE allergies: a kind of vaccination treatment to induce competing antibodies, which will neutralize the allergic IgE antibodies.

    Conclusion

    Peanut allergies have become more troublesome as the food industry has mixed peanut flour into Thai sauces, drinks, cookies, crackers and such. The person allergic to peanuts must read food labels and eat as much single-ingredient natural food as possible. This goes against the tendency of food processors who produce foods with a long rat tale of ingredients. If you see a label “may contain nuts or peanuts”, stay away from this product, as it is safer. Always carry an EpiPen or Twinject with you, just in case you develop an anaphylactic reaction (you only have a few minutes to stop the allergic reaction with adrenaline). In the future vaccination with a peanut protein specific peptide vaccine as mentioned regarding the Australian research, will probably become the treatment of choice.

    More information on status asthmaticus (an acute asthma attack).

    References

    1. Adkinson: Middleton’s Allergy: Principles and Practice, 7th ed. Chapter: Food Allergy. © 2008 Mosby.

    2. Mandell: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed.© 2009 Churchill Livingstone.

    3. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

    Aug
    24
    2013

    Pimples And Acne Can Be Caused By Food

    This article is about “pimples and acne can be caused by food”.For a long time nobody knew why teenagers get acne. But many assumed that it would come from hormonal changes as teenagers grow up. But why then are there some ethnic regions in the world where teenagers do not get acne? In this blog I will present the background that shows that wheat, sugar and dairy products are the culprits. People in regions of our planet where acne does not exist do not eat these foods.

    Regions where acne does not exist

    1. The Kitivan Islanders of Papua New Guinea have no cases of acne in teenagers. They adhere to the old hunter/gatherer diet of no sugar, no alcohol, no wheat and no grains. Instead they eat root vegetables such as sweet potato, yam, taro, tapioca; fruit like papaya, pineapple, banana, mango, watermelon, guava and pumpkin; and also vegetables, coconuts and fish.

    2. African Bantus and Zulus: These original African warriors eat a low glycemic diet with no wheat, no milk and no refined sugar or starches. Their teenagers and young adult do not have acne, if they stick to the original tribal diet.

    Further regions without acne

    3. Aché hunter/gatherers of Paraguay: a study by researchers from the Colorado State University in 2002 showed that sugar, wheat and other high-glycemic foods were missing in the diet of these native tribes. As a result they have no acne when they consume this type of diet, which is very similar to the Kitivan Islanders of Papua New Guinea.

    4. Japan’s Okinawans when sticking to their original diet before 1970 had clear complexion and no pimples (acne). But as this link shows the McDonald’s and other fast foods with too much salt, too much sugar, wheat, deep fried and convenience foods entered the scene after 1970 and the acne rate went up to the American level.

    More regions without acne

    5. The natives of the Purus Valley in Brazil: A dermatological examination of 9955 school children age 6 to 16 showed an acne incidence of only 2.7%. In contrast in Westernized countries the rate of acne is 60 to 80%. The diet in this region is again similar to the other groups already mentioned above.

    6. Canadian Inuit before 1950 did not consume dairy products and were acne free. Since then, there has been a steady increase of dairy products, soda, beef, and processed foods.

    How acne develops

    The medical term for pimples or acne is “acne vulgaris”. For years it has been postulated that hormones and medication can cause acne. According to Ref.1 there are several steps that work together in causing acne. The hair follicle and sebaceous gland work as one unit. Male hormones, called androgens play an important role in the development of acne, both in males and females. Males produce testosterone not only in testicles, but also in the skin itself. An enzyme, 5-alpha-reductase, converts it into the much more active metabolite dihydrotestosterone. In individuals with hypersensitive receptors in the sebaceous gland this causes blockage in the sebaceous gland ducts. At the same time, it stimulates the sebaceous gland oil production leading to the formation of a keratotic plug. White heads and black heads are formed this way.

    Factors leading to inflammatory substances

    Factors that contribute to inflammatory substances are sugar, wheat and starch intake causing insulin release. This stimulates IGF-1 receptors in the skin, which causes growth of the subcutaneous skin layers, which is pushing up from the layer below the skin, kinking the sebaceous gland duct and causing acne pustules (pimples) to form. A skin bacterium, called Propionibacterium acnes (P. acnes), is getting trapped in the pimple causing a local skin infection, which in turn can cause acne cysts and furuncles, particularly in males where there is a family history of acne. High cortisol levels from stress can also be a contributing factor in causing acne. Today’s teenagers are exposed to a lot of stresses from exams, competitive sports and peer pressures.

    Polycystic ovary syndrome

    Females with PCOS (polycystic ovary syndrome) have higher androgen production from ovarian cysts, which results in acne as well.

    Both male and female teenagers experience an androgen surge when puberty sets in. If the teenager avoids the additional insulin response, which comes from eating sugar, starch, grain and particularly from consuming wheat and wheat products, the plugging up of skin pores will not occur, meaning these teenagers will be acne free.

    Milk sensitivity

    Some teenagers are also sensitive to milk protein from milk and milk products. In sensitive people whey protein allergy causes the same insulin/skin IGF-1 response described above. This leads to blocking of skin pores. If there is no blockage in the hair follicle, the P. acnes bacteria will stay on the surface of the skin (these bacteria are part of the normal skin flora) and the sebaceous gland secretions flow unimpededly to the surface of the skin keeping it naturally lubricated. These observations are further confirmed by a study from Malaysia in 2012 showing that a high glycemic load diet with milk and ice cream caused worsening of acne in teenagers of both sexes.

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    Treating acne correctly

    A)   Conventional acne treatment

    Big Pharma has a firm hand in the treatment of acne;  they are supporting symptomatic treatment of acne rather than treating the cause. There are surface treatment modalities that open the skin pores: peeling agents such as benzoyl peroxide. General practitioners often treat the infection with antibiotic pills (tetracycline or erythromycin), but this is not treating the cause, only the super infection that comes from the plugged-up skin pores (stasis of sebaceous gland secretions). Another approach is topical application of antibiotic and peeling agent in combination (1% clindamycin and 5% benzoyl peroxide gel), which the patient applies twice daily (Ref.2). Resistant cases, usually the ones who have a family history of severe acne, have been treated by a skin specialist who has a special license to treat with isotretinoin (Accutane), a vitamin A derivative. It works in many cases, but it often has serious side effects.

    Side effects of Accutane

    These include skin dryness, eye dryness, muscle and bone pains, headaches and liver enzyme abnormalities. There can also be an instability of mood including depression and causing birth defects in the fetus of a pregnant woman (Ref. 3). In 2009 the manufacturer stopped distributing the drug in the US, because of too many lawsuits regarding damages from the drug.

    I am not saying you should ever take this toxic medication. What I am saying is that treating symptoms, but not the cause has led to peculiar drug manufacturing. Physicians use this drug now to treat brain cancer and pancreatic cancer.

    B)   Dietary approach to treat acne

    There has been a renewed interest in the last 40 years to sort out the connection between dietary factors and acne. The most straightforward treatment in my opinion is to modify what you eat.

    A clinical trial from the University of Melbourne in 2007 showed that a low-glycemic diet reduced the acne lesions by 22% compared to a control group.

    Two factors are clear: a low-glycemic diet produces fewer pimples, the stricter the patient applies a low-glycemic diet, the more effective the treatment is. Up to 50% reduction in acne lesions were observed among patients with acne who adhered to a strict low-glycemic index diet in just 12 weeks. There is also evidence that milk and other dairy products can contribute to acne, which works through the same mechanism of IGF-1 stimulation mentioned above.

    Milk and skim milk can cause acne

    A US study from Boston showed a 22% increase in acne lesions with total milk consumption and increase of 44% after skim milk consumption.

    Omega-3-fatty acid supplementation is useful for inflammatory acne in about 2/3 of the cases as this study showed. Here is an image of a patient from this study who benefitted from omega-3 supplementation. The baseline image is seen with inflammatory acne lesions on his cheek. Only 12 weeks after taking 3 Grams of omega-3 supplementation daily his face looked much improved.

    Conclusion

    There is a lesson we learn from the analysis of the regions in the world where acne does not exist. Cutting out wheat, wheat products, grains, sugar, milk and milk products leads to amazing results regarding acne prevention. This leads to improvements of patients who suffer from acne. We have been lulled into believing that medical science will give us a magic pill to solve our complexion problems. I mentioned that one of the “magic pills” (isotretinoin) is so toxic that physicians now use it for cancer treatments. All along we allowed the food industry to destroy our complexion. They did so by inducing an insulin and IGF-1 response that plugged up our skin pores. We can open them up by eliminating certain foods. They are wheat and wheat products, sugar, high-glycemic foods as well as dairy products.

    More information on acne: http://nethealthbook.com/dermatology-skin-disease/acne-vulgaris/

    References

    1. Rakel: Integrative Medicine, 3rd ed., Saunders 2012. Chapter 73 : Acne Vulgaris and Acne Rosacea, by Sean H. Zager, MD
    2. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed., © 2009 Churchill Livingstone.
    3. Cleveland Clinic: Current Clinical Medicine, 2nd ed., © 2010 Saunders.
    Aug
    17
    2013

    Postpartum Depression

    Recently there has been a lot of publicity around the topic of postpartum depression (PPD). Typically the reports originate from a case where depression led to catastrophic consequences. It is sad that it often takes a tragedy before a problem like this is publicly more acknowledged. But sadly reports are often one-sided and are missing vital information about pre-existing risk factors. The family doctor often misses the diagnosis of postpartum depression. There is often denial on behalf of the mother and family. The mother is getting no support from support groups, even though there are such groups.

    Swift treatment often not given

    And swift treatment that would be available is often not given. The results are finally making headlines. Once a mother is desperate and deeply depressed (“psychotic depression”) she is capable of killing the baby, herself and others who are close. PPD affects 15% of mothers (Ref.1); a small percentage of them may have postpartum psychosis, which is the most severe form of PPD.

    Risk factors for postpartum depression

    Ref. 1 reviews  several risk factors that can lead to postpartum depression. For instance, a history of a major depressive episode or anxiety attack during the pregnancy predisposes a young mother to develop PPD. However, there may also have been a history of dysphoria (intense feeling of discontent) before her periods in the past; stressful events during the pregnancy or right after birth. Often there is poor social support or a marital conflict. Other factors are low income, young maternal age or immigrant status with deprivation. A lack of support from the partner can also be a major factor.

    Up to 85% of women experience postpartum blues within the first 10 days after the delivery of the baby. Symptoms such as mood swings, fatigue, confusion, tearfulness, mild elation and irritability are common during these initial days following her delivery.

    Progesterone levels decreased up to 3 months

    Researchers found a decrease in progesterone levels following delivery for at least one month, sometimes up to 3 months. This leads to sleep problems (insomnia), which coupled with the baby crying in the middle of the night causes more sleep disruption. Electroencephalography studies documented abnormal brain wave patterns in women following the birth of a child.

    Only 1 in 500 mothers after birth develop what physicians call “postpartum psychosis”, which is a recognized psychiatric emergency.  The symptoms here are extreme mood swings with confusion, poor judgment, disordered thoughts (“delusions”), paranoia (where they think that someone is after them or it is the baby’s fault that they feel that way).

    Erratic behavior and impaired functioning

    Erratic behavior and impaired functioning are also part of this symptom complex. It is this state that needs to be monitored in a psychiatric unit as it is associated with a high suicide and homicide rate. A psychiatrist with experience in treating PPD needs to treat the patient.

    Urbanization leads to a lack of support, which is particularly devastating to new mothers who need all the support they can get. This is reflected in a higher percentage of PPD in urban areas versus the percentage of PPD in more rural areas where there is more family support.

     

    Postpartum Depression

    Postpartum Depression

    Hormone changes with postpartum depression

    Some people do not understand why a woman who just had a baby would not be happy and content. Most women are. However, the stress from the pregnancy and from childbearing can be too much on her system. There can be a point where the hormones no longer are in balance and the young mother loses her coping mechanisms.

    Serotonin concentrations in the brain of women during pregnancy are at a higher level due to higher estrogen levels that slow down the degradation of serotonin. Serotonin is the brain hormone that makes you feel good. Estrogens and progesterone are very high during the pregnancy, but this changes right after the baby’s delivery and during the time of recovery in the first few days and weeks. Studies showed that there was a 15% higher thyroid autoantibody rate in postpartum depression patients in comparison to controls without depression.

    Patients with higher thyroid autoantibody rates respond to thyroid

    Patients with thyroid autoantibodies associated weakly with postpartum depression and responded favorably to thyroid replacement therapy. Progesterone levels were much lower in patients with depression and in patients without depression following delivery. The reason for this likely is the fact that with the delivery the placental source of natural progesterone disappeared. Researchers replaced progesterone in a group of patients, but they die not observe any significant improvement of PPD. However, they did not explain whether the progesterone replacement involved bioidentical hormones or synthetic hormones.

    Dr. Michael Platt described a case of a postpartum woman who was hypothyroid as well (Ref.2). She responded to hormone replacement with thyroid hormones and progesterone by shedding 60 pounds (she always had a weight problem) over 10 months changing from a size 20 to a size 4. She was able to wean herself off the anti-depressants.

    Breast feeding women on bioidentical progesterone

    In breast feeding women this could be a significant difference as women on bioidentical progesterone can breast feed and will positively influence their breast-fed child’s brain development (brain cells have a lot of progesterone receptors, which are stimulated by progesterone).

    A recent Canadian study involving pregnant women and women after delivery of their babies showed that there was a significant drop of progesterone levels in saliva samples for several weeks, particularly with breast feeding. The authors explained that the lack of ovulation with a lack of progesterone synthesis in the ovaries was responsible for this. It takes several weeks for most women to regain regular menstrual cycles. It would follow from this that there is room for bioidentical progesterone replacement in the first few months of the postpartum period until the ovaries have resumed their normal cyclical hormone activity.

    Conventional treatment for postpartum depression

    With baby blues the symptoms are much less severe (in comparison to PPD) and are starting 2 to 3 days after childbirth, resolving spontaneously within 10 days after delivery. PPD occurs within 3 months following delivery and responds to treatment with antidepressants and psychotherapy such as cognitive behavioral therapy.  Breast feeding needs to be stopped, as it is known that metabolites of the antidepressants end up in breast milk. Typically, a less toxic antidepressant is used like paroxetine (Paxil), otherwise citalopram (Celexa), and fluoxetine (Prozac). In the rare cases where PPD is so severe that psychotic symptoms are present (postpartum psychosis) hospitalization is mandatory (Ref.3). Some of these cases may require electroconvulsive therapy (ECT) and/or lithium treatment for mood stabilization. Thyroid hormone therapy has also shown a beneficial effect in treating antidepressant-resistant cases of PPD (Ref.4).

    Alternative treatment of postpartum depression

    Although review texts of the treatment of PPD mention that estrogen replacement in postnatal women with PPD was beneficial, there is a warning that this could cause blood clots and anticoagulant measures would have to be combined with this to prevent deep vein thrombosis. Researchers suggested progesterone replacement, which is a treatment modality where blood clots are no danger. However, there are no formal trials yet, so most medical professionals ignore this suggestion. Here is forum of women who have taken postpartum progesterone with positive effects.

    Dr. Katherina Dalton published a trial involving 30 PPD patients with a positive response rate of 95% when treated with natural progesterone.

    Bioidentical progesterone treatment reduces symptoms of postpartum depression

    Before treatment patients were suffering from an average of 7.57 symptoms, after the treatment only 2.1 symptoms remained. (Figures with details regarding this study under the above link).

    There are many descriptive observations without controls like this where natural progesterone creams are part of a holistic approach to treating PPD. Dr. Mercola describes here how useful natural progesterone therapy can be. He also cautions that the woman should take bioidentical progesterone cyclically to mimic nature’s biorhythm to allow progesterone receptors to recover in between treatments.

    There are many websites that have useful information about natural progesterone cream treatment for PPD, such as this.

    Conclusion

    It is common sense that a woman may need natural progesterone following a delivery. She just gave birth to her placenta, which was a virtual progesterone factory. It  protected her body and the baby’s brain all throughout the pregnancy. If women decided to use natural progesterone for 3 to 6 months, this would make a big difference.  The majority of women would not experience the baby blues or PPD. Eventually regular menstrual cycles return, the patient’s own ovarian progesterone production resumes and there no longer is a need for progesterone cream until after the birth of the next child or at the arrival of menopause. Medicine is full of examples where common sense was applied for effective treatment options despite missing randomized studies.

    Natural progesterone treatment of PPD

    Natural progesterone treatment of PPD is one such example. Physicians used bioidentical progesterone intuitively, but it worked in many patients. The progesterone receptors do not distinguish whether or not researchers did a clinical trial. But they do not like the synthetic versions of progesterone, as they block the receptors leading to progesterone deficiency.  The physician can combine natural progesterone treatment with traditional treatments of PPD.

    More information on postpartum depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/postpartum-depression/

    References

    1.Teri Pearlstein, MD, Margaret Howard, PhD, Amy Salisbury, PhD and Caron Zlotnick, PhD: “Postpartum depression” : American Journal of Obstetrics and Gynecology – Volume 200, Issue 4 (April 2009)

    2. Dr. Michael E. Platt: The Miracle of Bio-Identical Hormones; 2nd edition, © 2007 Clancy Lane Publishing, Rancho Mirage, Ca/USA (p.53-55).

    3. Bope & Kellerman: Conn’s Current Therapy 2013, 1st ed.© 2012 Saunders

    4. Jacobson: Psychiatric Secrets, 2nd ed. © 2001 Hanley and Belfus

    Aug
    10
    2013

    Bioidentical Hormone Replacement

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

    Physiology of aging

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

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

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

    Bioidentical Hormone Replacement

    Bioidentical Hormone Replacement

    Baseline laboratory tests

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

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

    Women’s hormone replacement

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

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

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

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

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

    Men’s hormone replacement

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

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

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

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

    Safety of hormone replacement

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

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

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

    Why bother about hormone replacement?

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

    Conclusion

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

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

    References:

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

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

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

    Last edited Nov. 7, 2014