Testosterone replacement therapy can be a necessary medical intervention in some men for conditions such as sexual dysfunction, depression, and chronic fatigue. However, there are known risks. Popularity of testosterone prescriptions are skyrocketing, but who is it safest for and who is at the greatest risk of early cardiovascular death and heart attack? How do consumers make decisions in combination with their doctor without knowing the consequences? Ultimately you have to rely on the experience and knowledge of your provider, but having the right information in front of you can only help the decision process.
In a recent publication from Endocrine Today, evidence suggests that a new subset of men should not use testosterone replacement therapy. Men with obstructive coronary artery disease have higher risk of death and heart attack when using testosterone replacement therapy.
But that leaves some questions, doesn't it? What if you've had a coronary angiograph which confirmed obstruction or perhaps had an angioplasty or stent to correct obstruction and also have confirmed or suspected low testosterone levels? Are you just out of luck with no therapy for the hormone imbalance?
Symptoms of hormone imbalance in aging men are not limited to sexual dysfunction. Rather, depression, poor sleep, poor recovery from activity, poor stamina, libido (sex drive), lack of energy, and decreased strength and performance may all be symptoms of hormone imbalance. We also note that stress and poor blood sugar control can deteriorate men's hormones at an accelerated rate as well. Does this sound familiar? If so, read on.
We often suggest lifestyle modification such as weight loss, stopping smoking, and increasing exercise, especially activities such as weight training and sprinting to improve hormone balance in aging men, but the reality is that besides stopping smoking, these are quite tall orders for those who have obstructive coronary artery disease. Thirty minutes of weight lifting or daily sprinting probably isn't going to be approved by the cardiologist or cardiac rehab therapist. Not to mention that poor hormone balance often makes losing weight difficult.
Getting back to the basics of health, the pillars of good living, may be the answer along with specific products to support hormone balance.
From a diet perspective, adequate protein is an absolute must to stop the breakdown of muscle in aging men. Supplemental protein shakes are often a good way to go if appetite isn't great or cooking isn't your strong suit. If you can tolerate whey protein, it seems to be one of the best sources. It raises glutathione levels which is important from an antioxidant perspective and also contains branch chain amino acids which support muscle health. Vegan protein powders are a bit easier on the body. These contain hemp, pea, and/ or rice but often times are much lower in protein content. Shoot for 20 grams per shake. Nuts and seeds provide excellent protein from plant sources as well. Vegetable and plant nutrients cannot be understated for general heart health and all doctors and practitioners should be encouraging this behavior.
From a dietary supplement side, Revolution Macalibrium is a tested formula of specific phenotypes of maca (Lepidium peruvianum). Maca has a rich history of supporting men's hormone health; however, research has shown that there are specific phenotypes ideal for men’s hormonal health. Revolution Macalibrium not only has these exact phenotypes but has concentrated levels of the full spectrum of active constituents ten to twenty times higher than the levels found in raw maca which is why doctors and patients are getting such strong results quickly. This is a foundational product that works through the hypothalamus-pituitary-adrenal axis to help a man make his own hormones versus relying on hormones from outside of the body. A man's own hormones made by him is much safer since nothing is more natural than your own hormones.
Omega-3 fatty acids, especially those rich in EPA and DHA are recommended. If a man has high triglycerides, the American Heart Association suggest 2.4 grams of EPA + DHA per day. This seems like a prudent suggestion for all men facing either hormone imbalance, obstructive coronary artery disease, or life in the modern world. Reducing inflammation and supporting cell membrane health are just two well known mechanisms of omega-3 fatty acids and since the human body doesn't make its own omega-3's it has to rely on us to ingest them every day. I prefer high EPA products. Some products contains as much as 1060 mg of EPA and 274 mg of DHA per 2 capsules. Two capsules twice per day is ideal to hit this goal dose of 2.4 grams. Be wary of lower doses or you'll end up taking 8 capsules per day. Many products will contain 180 mg of EPA and 120 mg of DHA. This is perhaps suitable for the percentage of the population that gets nearly adequate dietary omega-3 fatty acids and is already healthy.
Other interventions and supplements may be indicated given your history and complicating factors, and in that case we recommend working with a doctor who understands your condition and also natural approaches. Click here to find a practitioner close to you.
So, if you know a man considering testosterone replacement and also has obstructive coronary artery disease, arm them with this important information so he can make an empowered decision.
Friday, November 9, 2012
Thursday, September 6, 2012
On Your Feet, Thyroid?
If you have a thyroid condition, you probably wish you could whip it into shape in a few weeks of hard work, like a Boot Camp. But drill sergeants and obstacles courses are not what your thyroid needs. Think of your thyroid gland as your friend who cries at movies and hems and haws over rather small life changes. It is, like your friend, sensitive to feedback.
When the thyroid is screaming for trouble, don't forget about its compadres (other organs) that offer direction and guidance to the thyroid gland.
- Gall bladder function impacts the thyroid gland because poor gall bladder function keeps the all important fat soluble vitamins from working. (Lots of thyroid sufferers have had gall bladder surgery). The gall bladder secretes bile, a necessary substance to take in vitamins A, D, E, and K. If your gallbladder is bile deficient or you have had it removed, you may not be absorbing enough fats resulting in a lack of fat soluble vitamins like Vitamins A, D, E, and K. Your thyroid and adrenals needs vitamin A to work correctly and efficiently. Not just beta carotene but good old-fashioned, preformed vitamin A! Check your multivitamin as to the source of its Vitamin A. Post-surgically, I recommend micellized forms of vitamin A, D, E, and K.
- Digestive function modulates thyroid function as well as it is intimately involved with the immune system (lots of gluten sensitivity in thyroid sufferers). If you have any type of digestive dysfunction from heartburn to gas, diarrhea or constipation, addressing the root cause of it is important. Oftentimes, a pH balanced diet, probiotics, and stress reduction are the first steps to fixing a busted digestive system.
- Hormone balance is also key in both men and women with thyroid dysfunction. Low progesterone can actually hide the fact that a sluggish thyroid is actually a more sinister form called Hashimoto's Thyroiditis. As estrogen declines so too does thyroid function. So much so that a reported 30% of postmenopausal women suffer from hypothyroidism.
- Belly fat. That's right, fat is an organ too. Extra weight around the middle negatively impacts thyroid function. The more fat you have on your frame, the more inflammatory signals you release to the rest of your body.
So where do you start? Well, you can't send your friend to Boot
Camp and yell at them to be tough....you have to strengthen them. Revolution Macalibrium for men and Femmenessence for women are ideal foundational products
to strengthen the stress response system in addition to meditation, proper
sleep, and a diet rich in plant nutrients. Femmenessence has specific formulations for perimenopausal women and reproductive-aged women as well. These products help your thyroid gland but supporting a myriad of hormones in the body. Every hormone imbalance including stress hormone imbalance directly impacts thyroid function.
Realize that this is a place to start with thyroid conditions. Reducing fat through a primarily plant-based diet, resistance training, and supporting all organs through stress reduction and proper supplementation are all pieces to a potentially complex puzzle. For more information about these products or concepts, contact corey.schuler@naturalhi.com
Tuesday, June 5, 2012
Updated evidence on menopause hormone therapy
A recent panel has re-evaluated the scientific literature
since the 2001 publication of the Women’s Health Initiative in order to
determine if hormone replacement therapy is safe long term and for chronic
conditions such as bone loss, cardiovascular risk, and / or mood health. The
results of this panel are from critical review of 51 published articles and
will guide the standard of care for postmenopausal women. Frankly, we’ve
learned a lot in the last 11 years and I think this panel did an excellent job
of culling the data albeit falling short of offering reasonable and safe
solutions to the challenge of increased risk of chronic disease beginning at
menopause. But that's okay. It wasn't their goal.
In full disclosure, I’m an
advocate of natural products so my first inclination is the cheer the panel’s
recommendation. It has been my read of the last decade of literature as well.
However, it is oversimplified to come to the conclusion that HRT is good or HRT
is bad. That binary way of thinking is ruinous. I strongly believe there is a
definite place for Hormone Replacement Therapy. I also believe it cannot be
used as the panacea it once was thought to be. In the case of bone health, we
must be ever mindful of the complete physiology. Sure, estrogen inhibits
osteoclastic activity and helps to maintain bone mineral density, but other
hormones have a role in osteoblastic activity such as progesterone and
testosterone. Growth hormone and cortisol have their own effects partially
independent of sex hormones and partially dependent on their levels. Furthermore,
we now have evidence that bone morphogenetic proteins, progenitor cells for
bone, have cross talk with estrogen and there may be other unknown interactions
to other hormones and signals. Some authorities now place osteopenia and
osteoporosis, especially precocious bone loss in the inflammatory disease
marker, causing us to work through the contribution of cytokines and
prostaglandins whose pathways are influenced by estrogen levels. And this is
just bone health, not to mention cardiovascular health and other quality of
life issues that are also influenced by hormone status. Why is this important
to say? Because, we haven’t heard the last of HRT. We will likely come to
understand a further undeclared subpopulation that has little to no risk of
cancer and cardiovascular incident. However, we aren’t there yet and we have
patients in front of us that need our help. This panel’s recommendation brings
us one step closer to the truth. What is missing from the conversation and
really outside the scope of this article is the reason for hormone imbalance
and potential less risky recommendations that clinicians can make today to
support not only the symptoms of menopause but also the long term consequences
of hormone loss. Personally, I’ve been involved in understanding this exact
mode of action. That is, improving the function of what has become known as the
HPA or hypothalamus-pituitary-adrenal axis. In fact, there are several axes
that we should be aware of that are influenced by an aging hypothalamus. These
axes, but particularly the HPA, when supported can stimulate the body’s own
production and balance of hormones. In essence, improving this system allows
the feedback and control of hormone production to be self-regulating without
the burden to liver biotransformation that exogenous hormones appear to have.
When a post-menopausal woman can improve her ability to produce her own
hormones with changes in menopausal symptoms, bone mineral density scores, and
cardiovascular support, then we have something to write about. This approach
can be used in conjunction with hormone therapy in order to be in line with the
recommendation of smallest dose, shortest duration of time. This is the
question that should be asked. “What can we do, today, for women to be on the
smallest dose of hormone replacement for the shortest amount of time and still
retain quality of life?” The question should not be “is HRT good?”. More
research into patient selection criteria is warranted. However, what I’m afraid
will happen, at the expense of quality patient care, is disregard for these
recommendation with some clinicians refusing to prescribe and others continuing
to over-prescribe. We want something with a broad therapeutic window with no
history of safety concerns. Something that supports endogenous hormone
production so that lowest dose, shortest duration can be honored. We want
something that has clinical trials that support efficacy in a broad spectrum of
conditions the way HRT does. What we want exists and is available on the market
as a natural product. Femmenessence (Maca-GO®) is that commercially available natural product. The following is a technical/ White Paper on the evidence of Femmenessence
Friday, April 27, 2012
They make you fat…and they aren’t food!
What do new car smell, your favorite fragrance, and a plastic
bottle have in common? Well, while it sounds like a bad joke, it is quite
serious. Each of these and many other common products contain substances called
obesogens. That’s right, chemicals that initiate or propagate obesity. Of
course, diet and exercise are still real contributors to weight, but the body
composition equation runs a coefficient of hormone balance and obesogens
disrupt hormone balance….sometimes in a big way! And don’t think that just because you maintain
healthy body weight that this doesn’t apply to you. Obesogens are endocrine disruptors
and are the same chemicals that contribute to hormone issues such polycystic
ovarian syndrome, amenorrhea, low testosterone, infertility, increased perimenopausal
and menopausal symptoms, and certain cancers regardless of what the scale says.
Plasticizers leach from carpets and newly installed car
interiors, thus providing that ever so pungent new car smell. In fact, when
working with a hormone imbalance patient, I ask questions about exposure to new
carpets and cars and after the weird looks, I get the story and excitement of a
new “thing”, and then another weird look. Although, more often than not
symptoms started or got worse after the new purchase.
If you’re thinking this is just another made up term to
scare us or another excuse to rationalize dietary indiscretion, you would be
misinformed. Obesogen is a term first coined in 2002 and since then has been
cited in 19 peer-reviewed articles, with 6 of those published in 2011 and 4
already in 2012. It is gaining understanding and isn’t going away.
Much like we are learning that certain phytonutrients speak
directly to our own genetic material, the hypothalamus, our master gland, and may
either potentiate or interfere with enzymes, so too do these environmental
chemicals.
The following are four truths as found in the Journal of Andrology:
- “Obesogens are chemicals that directly or indirectly lead to increased fat accumulation and obesity.
- Obesogens have the potential to disrupt multiple metabolic signaling pathways in the developing organism that can result in permanent changes in adult physiology.
- Prenatal or perinatal exposure to obesogenic endocrine disrupting chemicals has been shown to predispose an organism to store more fat from the beginning of its life.
- This suggests that humans, who have been exposed to obesogenic chemicals during sensitive windows of development, might be pre-programmed to store increased amounts of fat, resulting in a lifelong struggle to maintain a healthy weight and exacerbating the deleterious effects of poor diet and inadequate exercise.”[1]
So it really may be true that some people are literally
programmed to be fatter. However, that doesn’t mean that it is inevitable or
uncontrollable. We are all dealt a different deck. Not all of us have the
genetic material to be Olympic athletes and some that do, do not participate in
the required training to compete, thus illustrating the contributions of both
how we were made and what we’re exposed to. Where this becomes vitally
important is during the reproductive years. Preconception programs often
address helping moms-to-be and dads-to-be engage in healthy behaviors,
optimizing hormone levels, improving detoxification, and reducing exposures to toxins.
This is one such sensitive windows where obesogens can wreak havoc on
metabolism…prior to conception!
The list of obesogens include phthalates also known as
plasticizers are also found in personal care products such as shaving creams,
colognes, and lotions, Bisphenol A (BPA) is found in plastic bottles and
polyvinylchlorides found in shower curtains.
Recent changes at Whole Foods Market address possible
concerns with obesogens. Dr. J. Renae Norton describes these changes in a two
part series (Part I and Part II).
However, you can drive yourself crazy thinking about
avoiding these chemicals. Most of them are released for absorption through your
skin or ingested when plastics are heated. Avoiding hot plastics is a good step
in the right direction but total avoidance is likely not possible with these nearly ubiquitous chemicals. Additionally, though, you can support the excretion of
these chemicals through supporting liver, kidney, and bowel function on a daily
basis. Glutathione levels are perhaps
most important if we zoom in single markers of the body. Glutathione acts as a free
radical scavenger and also supports liver function. Without the bowel and
kidneys functioning at their best, these chemicals cannot be eliminated.
Supporting kidney function can be done with Sole therapy using Original
Himalayan Crystal Salt and pH Quintessence on a
daily basis. The pH Quintessence product also supports liver function,
glutathione levels and bowel motility, making it a versatile and easy to use
product. While obesogens may have programmed you to gain weight faster than
normal and caused hormone imbalance, supporting the hypothalamus, the master
gland, can help send the right signals to the right glands that need help the
most while your body restores homeostasis. The hypothalamus talks to the
pituitary gland and these two partners then communicate to the thyroid gland, pancreas,
adrenal glands, ovaries, and testes. Natural Health International has
introduced products for men
well as different stages of life for women (Premenopausal, Perimenopausal, and Postmenopausal) to
support comprehensive endocrine balance without introducing hormones from
outside the body but rather supporting hypothalamus and pituitary function and
all their downstream metabolic effects.
Obesogens are a serious chemical insult, but with some
awareness of their effects, can be minimized and our bodies fully supported.
[1] Janesick
A, Blumberg B.
Obesogens, stem
cells and the developmental programming of obesity. Int J Androl. 2012 Feb 28. doi: 10.1111/j.1365-2605.2012.01247.x.
Tuesday, April 17, 2012
Tuning Metabolism: Melatonin’s Role in a Rapid Weight Loss Program
Most individuals following a medically guided weight loss program will
lose weight. However, the operative word here is following. The number one reason why programs fail is poor
compliance. The old adage frequently attributed to Benjamin Franklin applies
“Failure to plan is planning to fail.”
Practitioners hear the excuses, “I’m too tired…”, “I’m too stressed….”,
or “I’m too busy….” to plan and coordinate the right foods and exercises into
my lifestyle to stick with the program. Even the simplest plans can end in
failure due to a poor night’s sleep or perceived decreased energy during the
day.
Programs can focus on reduced calories, increased activity,
detoxification, or hormone balance. The best ones have a contribution from all
of these and will also pay particular attention to the stresses that are placed
on a body that is decreasing in total mass!
Most weight loss patients expect to feel better when starting a “get
healthy plan,” but more times than not one or more predictable yet overlooked
stresses derails a well-meaning patient and frustrates a well-intentioned
doctor. Most people feel a bit worse
before they feel better.
Stresses on the weight-loss body include
Waking up early, going to bed earlier, or staying up later to
accommodate a new lifestyle can be disastrous to the normal diurnal cycles that
the body clings to for natural adaptation and survival. Any change (even
healthy ones) to the status quo causes additional stress to the body in an
attempt to restore homeostasis. Melatonin is the most commonly suggested
therapeutic for entrainment of circadian rhythm. Most often studied in shift
work disorders, jet lag, changes in season, and among the blind, little doubt
exists between the connection between this powerful hormone and daily cycles. A
3 milligram dose is often used over the short term to correct for changes and
ease the body into adapting to the new healthy patterns. If not addressed up
front during a weight loss programs, many patients will seek conventional medical
intervention for sleep such as prescription hypnotics. However, this can have
potential ill results as reported in the British Medical Journal which
associated these medicines with increased mortality. [1]- Changes in circadian rhythms
- Oxidative stress
- Toxic release from adipose (fat) tissue
With melatonin’s reputation as a sleep product, many practitioners
forget that melatonin is a powerful antioxidant that crosses the blood-brain
barrier. Most patients have never even been introduced to this concept. Rapid
weight loss patients may experience increased oxidative stress due to exercise,
increased protein intake, and even reduced calorie intake can be seen by the
body as an oxidative stress event. In fact, even healthy fats including fish
oils which support the reduction of systemic inflammation can increase an
individual’s need for antioxidants. Oral melatonin has the potential to reduce
this oxidative stress load.[2]
Melatonin at 0.3 milligrams can effectively be used for long-term support in
the event that a rapid weight loss program is expected to take a longer time
frame. For example, individuals needing to lose more than 30 pounds may require
three or more months and low, physiological-dosed melatonin (0.3 mg) is
appropriate for supporting this process.
Toxins, whether environmental or excess intermediate metabolites from
normal metabolism, are often sequestered in adipose tissue to protect vital tissues
and organs from free radical damage. During rapid weight loss, adipose tissue
decreases in size (the desired outcome of the program), yet this eliminates
valuable storage for these toxins. Weight loss releases these toxins into the
blood stream and must be handled effectively. Fecal elimination must be
supported as well urinary excretion. Liver support, antioxidant support, and bowel
and kidney support are all necessary to safely and effectively master a rapid
weight loss plan. When dietary antioxidants and alkalization are not enough,
simple supplementation of pH-supporting greens and melatonin can be useful. In
fact, melatonin has been used to support bowel motility among those with those
further into the dis-ease state of irritable bowel syndrome[3]
and pain in those with inflammatory bowel disease.[4]
In the context of weight-loss, it is rare to find a patient seeking
this type of support without other comorbid conditions. Addressing these
personalized needs are key to success. Sleep challenges are pervasive affecting
up to 30% of the population. Gastrointestinal disturbances and hormone and/ or
stage-of-life related conditions also affect a majority of weight loss
patients. Thus, using a combination of interventions to support hormone balance, gastrointestinal health, and healing sleep is simply good lifestyle
medicine and prudent to support compliance in a medically supervised weight
loss program.
[1] Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open 2012;2: e000850.
[2] Reiter RJ, Tan DX, Osuna C, Gitto E. Actions of melatonin in the reduction of oxidative stress. A review. J Biomed Sci. 2000 Nov-Dec;7(6):444-58.
[3] Lu WZ, Gwee, KA, Moochhalla, S, Ho, KY. Melatonin improves bowel symptoms in female patients with irritable bowel syndrome: a double-blind placebo-controlled study. Aliment Pharmacol Ther 2005; 22: 927–934.
[4] G H Song, P H Leng,K A Gwee,S M Moochhala, K Y Ho. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised, double blind, placebo controlled study. Gut 2005;54:1402-1407 doi:10.1136/gut.2004.062034
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