Hormones after Menopause - But Not the Ones You Might Think

Many aspects of our modern lives put us under a lot of stress -- and that can tax the capacity of our adrenal glands.  These walnut-sized glands sit on top of our kidneys, and produce hormones such as cortisol and DHEA to help us deal with stressors.  As stress becomes prolonged, our adrenals can become fatigued, leading to lower levels of these hormones.  That's why I often recommend testing of these hormones when it's necessary for the individual patient.  Along with healthy lifestyle changes, supplementation with adaptogenic herbs and nutrients can help support normal adrenal function.  If DHEA (dehydroepiadrosterone) is low, supplementing with low-dose DHEA can help to support that pathway in the body.

A recent preliminary study found that low-dose DHEA is also helpful in relieving the physical symptoms of menopause.  With concerns about some of the dangers of synthetic hormone replacement therapy (HRT), this could be a good alternative for many women, along with other supportive therapies.  It's important to keep in mind that monitoring DHEA levels is a good idea during supplementation, since this is a hormone.  

Also, using low doses (in the range of 5-15 mg per day) is the approach I recommend.  Many supplements available at stores or online contain much higher doses, ranging from 25-100 mg per capsule.  While there are specific health conditions that may benefit from the short-term use of such high doses of DHEA, it disturbs me that this is available over the counter.  When we start taking large amounts of hormones willy-nilly, whether synthetic or "natural," we're really messing with our endocrine system -- possibly with unintended consequences.

Hormone Might Ease Menopause, Boost Women's Sex Life: Study

Slash Your Risk of Breast Cancer

Last week, I wrote about weighing the risk vs. benefit for any type of preventative therapy.  A new study on breast cancer risk factors sheds some light on the best places to focus efforts for prevention.  This is important, since:

1. Women face a 1 in 8 lifetime risk of developing breast cancer, and
2. Most risk factors are controllable.

It's also important not to lose sight of the forest for the trees.  We all have limited time and energy, so focus attention on the risk factors that have the strongest evidence:

• Overweight/obesity
• Prolonged hormone replacement therapy
• Alcohol use > 1 drink per day
• Excessive radiation from medical tests (e.g., CT scans) early in life (before age 30)
• Smoking or second-hand smoke
• Night shift work
• Exposure to bisphenol A (BPA) and other plastics that act as estrogen-like compounds

Have any of these situations?  Worry about those before inconclusive risks such as cell phones or hair dye chemicals.  Also:  even though there has been a barrage of conflicting evidence in recent years, the bulk of the data comes down in favor of yearly mammograms for preventing breast cancer deaths.

The SHOCKING TRUTH about your health risks...

...is that most what you hear about them is exaggerated.  I mean, what are your risks, really?

There are a lot of claims for preventative therapies out there, both conventional and alternative.  The first step to deciding what is best for your health is to really understand the risk vs. benefit, or cost vs. benefit.

Let's say there's new nutritional supplement (or drug) that has been found to decrease your risk of a certain type of cancer by 50%.  That is a huge number, and seems like everyone should be taking it.  Why not?  Well, let's take a closer look.  That 50% is a decrease in relative risk -- meaning that the odds of getting that cancer are half of what they ordinarily would be.  So if your risk would normally be 0.2% (2 chances in a thousand), this new supplement cuts your risk to 0.1% (1 chance in a thousand).  The absolute risk reduction is only 0.1% (0.2% - 0.1%).  If this supplement costs $100 per month, it might seem worth it if you look at the 50% number.  But when you realize that you're really only decreasing your absolute risk by 0.1%, suddenly the cost seems to outweigh the benefit.

Many health conditions contain quite an element of fear.  It's important to try to look beyond this.  For example, a lot of people have a fear of flying -- no surprise, given the thought of hurtling through the air in a heavy metal cylinder 30,000 feet above the earth.  However, when you look at the risks, you are much more likely to get injured or killed in your own car than in a commercial airplane.  Similarly, some scary diseases carry a risk so close to zero, that it's just not worthwhile to invest much in prevention.

So anytime you hear SHOCKING claims about decreased health risks, ask these questions before jumping at a new preventative therapy:

• What are my odds of getting that condition in the first place?
• Are the claims based on valid research?  (I.e., good scientific method, performed by a third party rather than the manufacturer)
• Are the statistics quoted for relative risk (most of the time), or absolute risk?
• Was the research done on people who match your demographics?  (Risks are often different for men and women, different ethnic groups, etc.)
• Most importantly:  are there any simple things I can do to reduce my risk instead?
• If you're still smoking, don't bother with any supplements for cancer prevention.
• Brushing and flossing your teeth are probably more effective for heart disease prevention than antioxidant supplements.
• Reach for the fruits and veggies before the next miracle pill.
• Many of you already know what my favorite supplement is.

The more you educate yourself on risk vs. benefit, the savvier healthcare consumer you'll be.

Exercise = Longer Life

OK, so I know I go on and on about the importance of exercise.  But it's worth reinforcing, especially since our entire modern American culture is geared toward inactivity:  at work (desk jobs) or leisure (TV, computer, or other "screen" of your choice).

The latest scientific research, from the journal Circulation, found that maintaining physical fitness in mid-life decreased the chances of dying from any cause.  No surprise there -- we already know exercise is good for our health.  The difference here is that this is one of the largest studies to date to show that this protective effect of exercise held true regardless of body weight.  That's right -- if you don't lose weight, or even if you gain weight, exercise still prolongs your life.

Keep in mind that the converse is true:  if you have a normal body weight, but don't exercise, you lose that protective effect.  So if you're one of those naturally skinny people, don't think you're off the hook.

Just remember that we are biological creatures, and our bodies are designed to move!  Once again, we have evidence that movement is life, and stasis is death.

Want to live longer? Focus on fitness, not fat; Even thin people need to work out to stay healthy

It's the Hap, Happiest Season of All... Right?

This time of year brings all sorts of emotions for folks -- most warm and fuzzy, but there can also be quite a bit of sadness as well.  I heard a recent radio interview with integrative medicine expert Andrew Weil, MD, that perfectly summed up my own thoughts about depression and how to approach it.

Some highlights:

• This is a dark, cold time of year -- it's really a more natural time for introspection and "hibernation," rather than celebration.
• Sadness is OK... wow!  What a concept!  The idea that all people have to be happy at all times is peculiar to our modern American culture.  And with almost 10% of American adults on a prescription antidepressant, Big Pharma has a big interest in promoting and maintaining that idea.
• There are many natural ways to support yourself through mild to moderate depression:  
• fish oil supplements (be sure to get pharmaceutical grade)
• maintaining adequate vitamin D levels (get a blood test to check your current level)
• using mind-body techniques such as abdominal breathing, the Sedona Method, or meditation
• addressing pain through treatments such as Neurostructural Integration Technique

Be gentle with yourself, and take an accepting attitude toward all your emotions.  That's the first step toward contentment.

More Reasons to Exercise

I've often mentioned that exercise is my favorite supplement, since it has so many health benefits.  One of the most obvious benefits of exercise is weight loss, since we burn calories with exercise.  In the balance between reducing food intake and increasing exercise for weight loss, watching food portions generally gives more bang for the buck.  Why?  A half hour of moderate  exercise might burn about 200 calories or so -- an amount that could easily be cancelled out with a bag of M&Ms.

Let's not write off exercise altogether, though.  We've known that beyond just the calories burned in a single workout, exercise helps to build muscle -- which then raises our basal metabolic rate (BMR).  A higher BMR means that our body will burn more calories all day, every day -- even while sleeping!  A recent study found that regular exercise actually changes the brain, making it easier to pay attention to our body's hunger and fullness signals.  So that portion control I mentioned earlier becomes a lot easier to manage.

Want another reason to exercise?  How about improved sleep:  side effects include more energy, greater memory and concentration, and... oh, yeah!  Easier weight loss.

Too Much of a Good Thing

You've probably heard a lot (either from me or other sources) about the benefits of vitamin D:  decreased heart disease risk, better blood sugar control, decreased risk of autoimmune disease, less chronic pain and depression.... just for starters.

However, anything can have its downside, and researchers at the American Heart Association found that excess vitamin D levels can lead to greater risk of an abnormal heart rhythm called atrial fibrillation.  This is a serious condition that might precipitate heart muscle damage or clots inside the arteries and veins.

The probable cause for this is that with more vitamin D, the body can absorb more calcium.  While calcium is good for bones, too much calcium can affect nerves and muscles -- including the heart.

How much is too much according to this study?  Greater than 100 ng/ml of serum 25-hydroxyvitamin D.

This is why I recommend that nearly every patient get blood levels tested for 25-hydroxyvitamin D -- not only to check for deficiency, but also to monitor for excess.  I recommend an optimal range of 40-100 ng/ml, but based on this research, it seems prudent to bring the top end of that range down a bit to be on the safe side.

At this time of year, at any latitude north of Virginia, the sun's rays are not strong enough to produce any vitamin D in human skin.  This a good time to get your levels checked, to be sure you're set for the winter.  And if you're taking a supplement greater than 2000 IU per day, get your levels checked every 3-4 months to monitor for excess.

By the way, this article claims that 25-hydroxyvitamin D levels of 41-80 ng/ml are "far above what most doctors suggest."  This is an inaccurate statement, since every standard reference laboratory in the country puts the top end of the range between 80 and 100 ng/ml.

A caution on excess vitamin D