The naked truth behind hormone science and how to safely rejuvenate mind, body and spirit

BY GLORIA HAKKARAINEN MD, FACOG, FASBP, FABAAM

The newest data on hormone research shows that hormone replacement therapy (HRT) actually benefits patients when dosing route and medication are properly chosen, and when doctors monitor patients closely. The big scare which had women going off hormone therapy started in 2001, with the preliminary results of the Women’s Health Initiative (WHI). The WHI study looked into the use of Premarin and Prempro in women who on average were already 17 years into menopause. It showed that Prempro (a mixture of pregnant purified horse mare’s urine and synthetic progestin, medroxyprogesterone acetate) after approximately five years of use, led to an extra eight cases of breast cancer per 10,000 users. The news media rushed in early to bring it to headlines and soon medical societies were advising physicians to minimize or discontinue use altogether.

Another study which showed similar discouraging results was the HERS trial (the Heart and Estrogen Progestin Replacement Study), which evaluated 2,763 postmenopausal women with known cardiovascular disease. Prempro was used again and did not demonstrate any significant improvement in future heart disease protection for this group of women. Based on these two trials, many women stopped taking their hormones and have suffered from unrelenting symptoms of menopause. Of course, many forms of HRT exist and the risk analysis was blindly extrapolated to all forms of hormone use, both bio-identical and synthetic, to make everything more confusing than ever. As more rational and in-depth analyses came to light, however, we were able to see that by 2005 the hormone story was beginning to change.

When renowned hormone experts analyzed the data more carefully, it was shown that many of the women in the WHI study were already at high risk of developing cardiovascular disease. These women were largely overweight to obese, many already had been placed on cholesterol controlling drugs, were using aspirin, and quite a few had high blood pressure. They were essentially past the ability of hormone therapy to make much of a direct impact on improving their heart attack risk. The studies did show however that the synthetic progestin use (MPA) acts very differently compared with natural progesterone, and that not all progestins are alike.

More scientists have re-analyzed over 25 years worth of good HRT studies, now giving a more comprehensive understanding of what judicious hormone use can do for patients. Clearly HRT has many beneficial effects on the body, including improving skin quality and integrity, eliminating wrinkles, boosting immune system function, relieving symptoms of muscle aches, improving the elasticity and collagen content of the pelvic tissues, keeping the brain sharp, preventing osteoporosis, fighting depression and much more! Modern day hormone analysis provides not only a look at estrogen stores in the body, but also at a host of other hormones including testosterone, progesterone, DHEA (dehydroepiandersterone), melatonin, cortisol and thyroid— to name a few.

The latest data from the North American Menopause Society (NAMS) shows that when women start to replace declining hormones earlier than what was done in the WHI study (late 40s and 50s), the aging effect of hormone depletion can actually be forestayed or reversed. Also the route of administration: oral, sub-lingual, sub-buccal, transdermal, transvaginal, gel, patch, cream or injection can be customized for patient convenience and efficacy. One may, for example, attempt to avoid oral routes of estrogen if possible, as these can elevate triglycerides (the amount of fat in the blood) and lead to an increased risk for a blood clot, or affect the gallbladder.

Let’s take a closer look at these hormones and how they work together in a magnificent balance that makes up the human body. I will also mention a word about estrogen metabolism and breast cancer risk, and how specialized testing can be used to help a patient assess their overall risk of the development of breast disease.

Hormones are very special chemical molecules that direct many fundamental and critically important processes in the body. They can act both on tissues a long distance away from their secretion site (endocrine), on neighboring tissues (paracrine) and on the individual cell itself that released it (autocrine). Each endocrine organ system makes a distinct hormone whose release is controlled by two areas in the brain: the anterior pituitary gland and the hypothalamus. There is a complex interplay between various hormones as the brain receives and senses the needs of the body. There is also a negative feedback loop that works to ensure that just enough of each hormone is made. Replacing just one hormone doesn’t make sense as we see declining levels of many hormones during menopause. Evaluating and studying the hormone profile across systems ensures that all critical areas are treated.

There are ways for physicians to avoid the side effects of high level dosing of any one hormone. Just as a cook uses various key ingredients of a recipe, where all elements are needed are to make the dish come together, so too the body regulates each hormone and they all support one another’s function. For example, thyroid function helps estrogen maintenance and vice versa. Some hormones, like cortisol (the hormone that is released in response to stress), actually increase with age. Abnormally high levels of cortisol can accumulate leading to elevated blood sugar levels and metabolic syndrome (pre-diabetes). The following list touches on some of the more critical hormones that exist in the body:

THE THREE SISTERS OF ESTROGEN

(E1) Estrone: mainly made by the adrenal glands; also made in fat, muscle and skin and can be converted from estradiol; normally considered an estrogen reservoir; the primary estrogen seen in menopause, normally represents between 10 to 20 percent of circulating estrogens prior to menopause; after menopause the major source can be from fat cells so obese women can have an elevated estrone to estradiol ratio; high levels can increase risk of endometrial and breast cancers; clearance routes and metabolites can affect breast disease risk

(E2) Estradiol: made by the ovaries; primary estrogen seen in young women; the strongest acting of all the estrogens (12 times stronger than estrone and 80 times that of estriol); most active biologically and the one reproduced by “Big Pharma” in most Rx formulations

(E3) Estriol: made by the ovaries; the weakest estrogen strength of all three kinds (approximately 1/80 that of estradiol); rises with pregnancy; thought to be protective/neutral to the breast; the majority component of BHRT (Bio-identical) therapy

THE A-B-Cs OF HORMONES

Adiponectin: exciting newcomer to hormone research and therapy; made by fat stores and acts as a satiety signal to the brain; also vital to clearing local inflammation to coronary blood vessels to reduce plaque formation thereby reducing heart disease risk; huge future target for obesity and new cardio protective meds of the future; low levels indicate disease risk.

Cortisol: made by the adrenal glands; principal hormone produced in response to acute or chronic stress; induces sugar stores to be broken down and can lead to pre-diabetes; increases with age and can lead to unwanted abdominal/truncal fat; most patients respond well to behavior modification and supplements that help support the adrenal glands; over demand to the system can lead to adrenal fatigue and insufficiency and “burn out” states can lead to apathy, extreme depression and inability to fight disease

Insulin: very important in regulation of blood sugar in the body; increased resistance to insulin in the body with aging leads to diabetes and metabolic syndrome (elevated blood pressure, triglycerides or fat in the blood stream and noted borderline high levels of blood sugar); controlled by many body regulating signals that ultimately determine overall health; fasting levels can be used to detect early onset disease

(IGF-1) Insulin Growth Factor -1: hormone made by the brain at night that travels to the liver and is converted to growth hormone; essential in many processes in the body; used for retaining of lean body muscle to burn off unwanted excess fat; immune system enhancer; generates new growth of bone muscle and tissues used to maintain the body; levels start declining at around 30 years of age and viewed by many anti-aging experts as a vital part of a comprehensive hormone assessment

Melatonin: hormone made by the pineal glands (mostly at night with sleep in a darkened room); responsible for the sleep and wake cycle; newest data shows that proper melatonin levels can lead to improved antioxidant levels and ability to ward off cancer (especially breast)

Progesterone: made by the ovaries and adrenal glands; has mood enhancing and anti-depressant effects; protects the uterine lining from overgrowth and cancer; usually made mid-cycle and is the first hormone that starts to decline with aging; can be used to treat PMS (pre-menstrual syndrome) and endometriosis; helps to normalize irregular cycles; used in fertility treatments to support early pregnancy

Testosterone: important hormone for women that exists at lower levels than in men; called the “hormone of desire” because of a known powerful effect to enhance libido or sex drive; assists with self-confidence and is an anti-depressant; also needed to maintain lean body mass to burn off fat which helps women retain their youthful figure; important also for energy and motivation; builds bones, muscles and ligaments to ward off osteoporosis

(TSH) Thyroid Stimulating Hormone: hormone secreted from the anterior pituitary of the brain that signals the thyroid gland to release thyroid hormone from the colloid gland in the neck; the thyroid hormone that is put forth is usually not that active and then is converted to T3 (Tri-iodo thyronine); responsible for the rate of most metabolic reactions in the body; women are much more prone to thyroid disease than men and sluggish thyroid function can lead to weight gain, fatigue and dry, flaky skin and constipation problems, poor self esteem and depression; some patients can make antibodies attacking their own thyroid gland with age, thyroid function testing can determine a patient’s current status, thyroid supports natural estrogen maintenance in the body. These hormones can be measured reliably in many ways, including the use of blood serum, saliva, bloodspot and urine testing. Each test the use of blood serum, saliva, bloodspot and urine testing. Each test has been designed to check a particular hormone system and you should speak with your doctor to see if you need further testing. Some tests, like thyroid hormone are done as a routine screening check, while others can be done at a specialist’s office such as estradiol at an infertility clinic or with your gynecologist. Most patients will need follow up testing of their levels once they start replenishment to ensure that levels are still safely in normal ranges and to avoid unwanted side effects of high level dosing. For example, too much estrogen can lead to breast tenderness, too much progesterone to abdominal bloating, and too much testosterone can cause acne or hair growth.

Estrogen metabolites, such as the hydroxy estrones, can also be assessed if one is worried about breast cancer risk on hormone use. The 2-OH estrone is considered to be the main safe estrogen clearance route in the body while the 4-OH and 16 alpha OH estrones, if not cleared appropriately, can lead to inappropriate tumor promotion of certain lines of breast cancer seen in laboratory studies. The 2/16 ratio of hydroxy estrones has been a widely used method to assess how a person clears their estrogen naturally from the body. Patients who don’t clear their estrogen as optimally as others may benefit from an estrogen clearance promotion diet/eating plan that includes key supplements such as indolyl methanes, sulforaphanes and antioxidants to ensure a good 2/16 ratio. This can easily be rechecked on repeat testing of estrogen metabolites after patients start on an estrogen detoxification and estrogen dominance clearance plan after about six months of care.

So don’t let fear lead you to discount the importance of checking your hormones. When done safely with a hormone specialist, you can enjoy the well known benefits of hormone therapy to rejuvenate your total mind, body and spirit. Many physicians are now savvy to checking these levels for their patients. Ask to make sure that the physician you visit is boarded with a concentration towards hormone analysis and treatment. Certain physician societies exist such as the American College of Obstetrics and Gynecology, American Academy of Anti-Aging Medicine (A4M), the International Hormone Society, the World Society of Anti- Aging Medicine, the American Academy of Clinical Endocrinologists, the Institute of Functional Medicine and more, that have rigorous standards that physicians follow to help to ensure proper testing and treatment protocols are followed. Remember the human body is a marvelous creation indeed, listen to it and take care of it and you will have a “harmonious” future together. v

Dr. Gloria Hakkarainen MD, FACOG, FASBP, FABAAM is an OB/GYN and also board certified in multiple disciplines. She specializes in wellness, weight loss and anti-aging, all with a focus on prevention. She practices at Palm Beach Weight & Wellness in West Palm Beach.

Reading References for those interested in finding out more; Dr Pam Smith,MD HRT: The Answers; Dr Winnifred Cutler, PhD , Hormones and Your Health; Suzanne Somers, Breakthrough, Eight Steps to Wellness

For Nicole Dyk of Jupiter, less is more when it comes to household cleaning products. Not that her house is dirtier than any other in town—far from it. Dyk just prefers to use fewer of the dyes, harsh chemicals and pungent fragrances she describes as “awful” that are the staple ingredients of most cleaners.

So when she shops, she seeks the products that are eco-conscious. “I don’t have a particular list of favorites…” she notes. “The fewer synthetic chemicals the better, especially when it comes to fragrances.” Dyk’s uncomplicated approach to cleaning comes from a concern for her health as well as the environment. She’s a cancer survivor, and says that 25 years ago, after her diagnosis, she departed from mainstream medicine. She has since widened her view about natural products to include those she uses in everyday life.
“I clean as much as possible with water alone, and use a water softener for my whole house,” she says, “which means the products I do use go farther. I like clean, but I’m not hung up on antibacterial products for every little thing. The microbes are always around, and I strongly believe the best defense is a strong immune system.”

According to Emily Main, senior editor of National Geographic Society’s Green Guide, the best defense for the environment and for health is to use the natural cleaners that are already in your home—products like baking soda, white distilled vinegar, lemon juice and olive oil.

“White vinegar is a miracle,” she says. “Using products like these is the greenest alternative, and also the cheapest. Baking soda is nonabrasive; lemon juice is a spot remover and disinfectant.” In her own home, Main uses a combination of items she purchases, and those she makes. She keeps vinegar in a spray bottle, and adds a little tea tree oil (available at vitamin and natural foods stores) to curb the pungent smell and also as a natural germ killer. She swears by Bon Ami for cleaning the shower and tub, and a little white vinegar diluted in a bucket of water for the floors. In the kitchen, Main says she uses white vinegar to clean the counters. “I have a small kitchen, and I use the counter for a lot of things,” she says. “I like to know that if I’m laying lettuce directly on the counter, it’s not picking up the residue of harmful cleaning agents.”

Dale Kemery, spokesperson for the Environmental Protection Agency, says that while some homemade cleaning recipes work, they might not perform as well as those that are commercially sold. That’s because the mix of ingredients is what makes them effective. “If baking soda’s cleaning power alone were acceptable, then we’d probably see more commercial cleaning products formulated with simple, one-ingredient recipes,” he says. Kemery also cautions that if items like baking soda and vinegar are mixed in improper proportions, they could be ineffective. So for those who are not inclined to make a batch of their own cleaners, how do shoppers navigate store shelves full of products claiming to be green? Not all of those claims are true, Main says, and consumers have to be diligent about reading the list of ingredients. At the Green Guide, she says, “We have set the standard that if a company doesn’t tell us what is in the product, we won’t consider it green. Those who are willing to tell you aren’t afraid to say what’s in their product.”

Kemery says the EPA recognizes safer products by allowing them to carry the Design for the environment (DfE) label. The label means the EPA has scientifically screened the ingredients and determined they are safe for human health and for the environment, based on currently available information. The DfE label is on more than 800 products, Kemery says, with retailers like Wal-Mart and Home Depot adopting the standard for products. “In 2008, the use of ‘chemicals of concern’ was reduced by 237 million pounds, up from 188 million pounds in 2007,“ he adds. Harmful cleaning agents for the environment and for your health include chlorine, bleach and ammonia. Used in combination, items like bleach mixed with ammonia will form toxic gases. Main also cautions against products containing surfactants, which are wetting agents that help other ingredients in the product penetrate dirt and grime.

Petroleum-derived products—many fragrances are composed of elements from petroleum, for example—are contained in a variety of items we use every day, not just those we use to clean. Main says ingredients made from petroleum disrupt aquatic reproductive cycles when they leak into our water. But it’s not always simple to determine which cleaners in themselves are unsafe, because they each contain a different mix of ingredients, making it difficult to track the ones that do specific harm to the water supply. And to complicate the matter, many products don’t have to disclose all of their ingredients under the protection of trade secrets. Aside from reading labels and researching which companies are truly making products that can claim to be environmentally friendly, consumers can use their collective purchasing power to force companies to go green. Clorox, with its Green Works line, and Colgate-Palmolive have marketed green products that Main says are “pretty good.” When consumers push for laws regulating environmental and health protection, and pressure companies to manufacture better products, it usually results in action, according to Main. “We’ve found that the health side is usually what drives the change, for parents especially,” says Main. “Ammonia is a very serious asthma trigger and chlorine bleach can be extremely hard on the airways.” The future looks green for household products, Main says, if consumers remain diligent and aware. Many are skeptical of the plethora of products claiming to be green that are usually more expensive, she says, but some manufacturers have responded with better solutions to their old standbys.

Make Your Own Cleaners

Here are a few recipes for natural, inexpensive household cleaners from the Green Guide.

IN THE LAUNDRY ROOM: 1/2 cup of hydrogen peroxide per load instead of bleach

TILE FLOORS AND LINOLEUM: 1 cup white vinegar in two gallons of hot water. No need to rinse.

FURNITURE POLISH: 1/2 cup of white vinegar mixed with 1 teaspoon olive oil

TUB AND TILE: Juice from 1/2 lemon and Borax TOILET BOWL: Baking soda and white vinegar. Let sit and then scrub.