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

What you should know about cardio care
LADIES, WHEN IT COMES DOWN to the facts—they are heartrending. Heart attack, stroke and cardiovascular diseases are devastating to women, destroying the lives of more women per year than all other cancers combined. Among the common risk factors are: increasing age, heredity, smoking, high blood pressure and obesity. Other factors like stress can cause hypertension, ultimately causing the onset of heart disease.

Regardless of the fact that one in four women perish from heart disease, until now, cardiovascular disease was mostly overlooked in women due to its misleading label as a “men’s disease.” Luckily, due to scientific advances and owledgeable doctors, the rate of heartrelated deaths in the U.S. are nearing a record low, according to the American Heart Association. Frankly, we’re glad to see the medical field is now giving more attention to this deadly disease, and are intrigued by the new advances that are developing. Be kind to your heart; know the facts. >> —D.D.

Women and Heart Disease
MOST WOMEN, young and old, live with the misconception that breast cancer is a worse risk to their lives than heart disease. But heart attacks kill more men and women than any cancer. In fact, according to Dr.Jacob Litwinczuk, an interventional cardiologist on staff at Jupiter Medical Center, women are more likely to die from Cardiovascular disease than all forms of cancer combined.

Dr. Litwinczuk says that because women are more likely to have different symptoms of heart disease than men, both they—and even some doctors—may overlook Cardiovascular disease in the feminine gender.

“Women, on average, present with disease 10 years later than men and when they develop angina (chest pains) it is sometimes attributed to anxiety and panic attacks,” he says.

It is vitally important for women to be aware of the risk factors for heart disease, its symptoms and, most importantly, to take control through lifestyle choices to modify those risks.

Dr. Litwinczuk points to three most important risk factors: hypertension (high blood pressure), smoking and cholesterol levels. Controlling these factors are essential to good heart health.

A good way to fight off a heart attack is to watch your diet. Dr. Litwinczuk is a staunch proponent of the so-called Mediterranean diet, which features fish, monosaturated fats such as canola oil, vegetables and fresh fruit. Second, be sure to exercise, but discuss it with your doctor before undertaking any program. Third, give up smoking if you are a smoker, and don’t start if you haven’t taken up the habit.

By making some small changes to their habits, women can begin to take a proactive stance against heart disease. Live knowledgably and you are sure to live a healthier life. For inquiries about heart health, contact Jupiter Medical Center at 561.747.2234.

Making MRI and Heart Devices Play Nice
UNTIL A FEW YEARS AGO, patients with implanted heart devices were out of luck if they needed to have a magnetic resonance imaging (MRI) test. It was feared that the MRI machine’s powerful electromagnetic fields could heat up or dislodge the metal components of a pacemaker or defibrillator, causing tissue damage, device malfunction or even death.

But Johns Hopkins heart experts Henry Halperin, Saman Nazarian and colleagues have painstakingly determined how to safely perform MRI scans on patients with modern pacemakers and defibrillators, which are made of titanium and better protected from radiofrequency energy.

To prevent misfires, they reprogram each device so its electronics won’t mistake the MR radiofrequency for an arrhythmia. They also turn off a defibrillator’s shocking function for the 30 to 60 minutes needed to perform the imaging test. In addition, they halve the amount of energy used at peak scanning, reducing the strength of the electromagnetic field from as much as four watts per kilogram to two watts per kilogram per patient. And during the scan, they closely monitor every patient using electrocardiography and pulse oximetry.

The Hopkins team has been able to make definitive diagnoses in some 180 patients who have been scanned so far, helping plan artery-opening procedures, measuring tumor growth, detecting strokes and a brain mass, and diagnosing a blood clot in the spine that had been missed by CT scanning. They also pinpointed the cause of one woman’s seizures.

For more information about cardiovascular treatments at Johns Hopkins, visit hopkinsmedicine.org/heart.

Innovative Thermogard™ System for Cardiac and Vascular Surgery
THE RESULTS OF A STUDY conducted by Gary Allen, M.D., F.A.C.S., Chief of Adult Cardiac Surgery at Memorial Regional Hospital, were recently published in the medical journal, “Annals of Thoracic Surgery.”

Dr. Allen’s study, “Intra-Operative Temperature Control Using the Thermogard™ System During Off-Pump Coronary Artery Bypass Surgery,” originally presented at The World Society of Cardio Thoracic Surgeons Congress in Greece in May, 2008, demonstrates the safety and effectiveness of endovascular temperature control. In addition, endovascular warming is simple to employ and eliminates the need for uncomfortably warm operating room temperatures. In fact, based on 38 cases where open-heart patients were randomly given either conventional warming or the Thermogard system, clinical outcomes actually improved.

Dr. Allen has been Chief of the Adult Cardiac Surgery program for Memorial Regional Hospital since January, 2008. He provides extensive expertise and programmatic leadership to the healthcare system’s Cardiac and Vascular team. In 2007, Dr. Allen was the 33rd surgeon in the world inducted into the “Beating Heart Hall of Fame,” an honor given by Guidant Corporation to the top cardiac surgeons who demonstrate exemplary off-pump procedure technique.

Aside from being an accomplished, published author, Dr. Allen is also a highly sought-after speaker and course director. Clinical research, graduate medical education and patient education are important facets of his practice outside the operating room.

Memorial Cardiac & Vascular Institute is a leader in cardiovascular care in South Florida, offering a full array of services dedicated to the prevention, detection and treatment of cardiovascular disease. The cardiovascular specialists at the Institute pride themselves on working together as a cohesive team, making sure that you receive both undivided attention and unparalleled care. To find out more about cardiovascular care at Memorial Regional Hospital, call 954.987.2000.

Groundbreaking alternatives to open-heart surgery
AS THE POPULATION AGES, the average age of patients undergoing openheart surgery has increased rapidly. The increased age of the patients adds an element of risk to this kind of surgery. Cardiovascular surgeons are working to develop new techniques for less patient risk. With the rapid advances made in technology, alternatives to open surgical procedures increase. For example, the number of coronary artery bypass surgical procedures is continuing to decrease with an increase in less invasive percutaneous coronary stenting.

There will be an increase in minimally invasive-hybrid procedures. There have been tremendous advances made in transcather endovascular peripheral vascular procedures expanding to the treatment of thoracic aortic and abdominal aortic aneurysms. For instance, intricate repairs to the heart can now be performed through flexible catheters threaded into blood vessels in the groin or arm. Using this method, physicians can repair or replace heart valves, open blockages in the blood vessels, gently ablate the surface of the heart to stop arterial fibrillation and perform a host of diagnostic and therapeutic procedures. In comparison to open-heart surgery, catheter techniques can mean less pain and faster recovery for patients.

At Palm Beach Cardiovascular Associates, Dr. Richard Faro works with cardiology and radiology colleagues to provide combined or hybrid procedures–ateam approach. As noted with the increasing number of patients, the number of procedures will increase as well. Emerging techniques will even encompass taking advantage of the growth of molecular biology and robotics. The future will be a cardiac surgeon leading a team, designating a surgical interventionalist who will offer both open and percutaneous treatment modalities. The new techniques and procedures will be of great benefit to patients. Call Palm Beach Cardiovascular Associates at 561.626.9801

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Have you ever watched a Hollywood movie where people (or their organs) are biologically cloned? It sounds rather futuristic and scary at first but the reality of accomplishments in regenerative and anti-aging medicine might surprise and impress you. Remember the boy who lived in the plastic bubble? He could have possibly been saved by stem cell therapy.

According to the National Academies of Science, doctors have been using adult stem cells—the active agents in bone marrow transplant—for over 40 years to treat a variety of diseases including leukemia, rare anemias, blood cancers and immune system diseases.

What is a stem cell?
A stem cell is a cell that has potential to transform itself into different needed cell lines in the body, helping the body recuperate from injury and disease. There are various types of stem cells that can be saved and used, including fetal cord blood stem cells, adult peripheral blood stem cells and progenitor cells.

Amazingly, the body keeps its own stem cell bank. It senses the current regenerative needs on a constant basis and then via a complex signaling system—which scientists are still trying to understand—those cells travel to the area where they are needed and turn into the special cell line that is required.

Being mammals comes at a high price because we lose our regenerative capacity as we move up the food chain. Simple bio-logical organisms can virtually replace lost limbs, such as a salamander does. Hydra can even form two entire organisms if it is halved. Humans are able to regenerate their circulating blood cells from a source in the bone marrow—“HSC” (Hematopoietic stem cells).

How many times can the human cell divide?
Leonard Hayflick, a prominent scientist in the field of anti-aging studied cell division and proved that human fibroblast cells can only divide 50 times in cell culture before their demise. Even when he froze these cells and then reconstituted them in culture, they took off at the same place they had left off—up to 50 times only. This implies that human cells have an intrinsic limit. Further research showed that stem cells from various sources can accomplish different things. Embryonic cells from five to seven day old embryos have the ability to turn into just about anything, while adult stem cells are much more limited in their usage.

Stem Cells and Anti-Aging
There seems to be an intricate connection between premature aging and stem cell regenerative capacity. Some famous scientists believe that preprogrammed cell death begins at birth following a present path that can not be altered. The number and quality of stem cells a person has affects their ability to withstand the “insults of life” that can come from toxic exposure in the environment or intrinsic stressors such as the synthesis of ATP (Adenosine Triphosphate), the energy unit of the body. Cells need to remain in balance. To do this, they use a variety of signals from an immediate complex array around them, deciding whether of not to send a signal to the body that they need remodeling.

Children suffering with Progeria are an extreme example of rapidly programmed cell death. Usually these patients are as young as 10 years of age and have already suffered many diseases we normally see in older people including heart attacks, cancer, diabetes and stroke. Genetic Researchers have discovered an important factor in aging of their DNA (genetic code)—the Telomeres.

Simply put, a Telomere can be described like the plastic wraps on the end of a shoelace. Without this small but necessary component, the entire DNA strand of genetic material could potentially unwind, creating a critical loss of genetic material. Each time the DNA replicates the telomere length shortens just a little bit. Telomeres are divided in seven base pairs and once they are shortened down to a predestined cut off point, the cells ability to divide simply stops.

Certain cell lines are “immortal” in humans. These are primarily eggs and sperm, explaining why a family trait—like that prominent nose of an uncle, for example—continues on in certain family lines. These traits are passed on from “immortal” cells to the developing embryo and are virtually copied in the new baby.

Human cancer cells are immortal as well. In fact, cells like eggs, sperm and cancer cells share one trick that regular body cells or somatic cells don’t have; they express an enzyme called telomerase that can replenish the missing telomeres and thus avoid cell death.

This has been an exciting new field of anti-aging research. If only we could discover how to turn on the telomerase gene for the longevity of aging cells, and at the same time turn them off in cancer cell lines. Wouldn’t that be a perfect world? It seems that over expression can lead to cancer and under expression leads to premature aging. So, the body needs balance between these two powerful opposing forces to say the least.

Storing Your Stem Cells
Stem cell and treatment centers have sprung up all over the world. More diseases are making it on the treatment list than ever before. There were 1,095 different clinical trials using adult peripheral stem cells as of May 2008 in the U.S. alone. There are both private and public stem cell banks available and the cost of banking one’s cells has become more affordable. Why bank one’s cells, you may ask? The newest data shows that private banking can obtain greater than 95 percent viable cells even after years of storage.

Of course, the main question on the minds of many patients is whether or not they should store some of their stem cells. I believe it is a solid investment in tomorrow’s health. Banking cells has become very simple. Special collection bags are used in a similar manner to a blood donation. The amount of blood required is the usual pint, approximately 250cc. Patients should be in a good state of overall health, provide all relevant health information and obtain clearance by their banking physician. The process is very straightforward and the cells can be placed in a family will for the future. Most lay people, especially those in the U.S., are unaware of how simple and effective this procedure could be and that it is powerful medical insurance, indeed.

Most reputable banks use a rigorously monitored system of identification and cells can be sent all over the world to leading researchers in a particular field, allowing the cells to aid in overturning progressive diseases. Imagine your child’s cells saving grandma from a deadly chronic disease such as diabetes, Parkinson’s or Alzheimer’s disease.

Miracles have happened all over the world using stem cell therapy. Unfortunately the U.S. has been a little behind due to recent government constraints of the sources used for stem cell research lines. Congresswoman Diana Degette writes in her book “Sex, Science and Stem Cells,” that the previous administration had vetoed several of her bills promoting ethical stem cell research.” Her drive for the therapy may come from the needs of a diabetic daughter.

It is notable that stem cells today are being increasingly used to restore and sustain regenerative capacity. They have been used to treat cancer and the effects of Chemotherapy and radiation, in re-growing heart and pancreatic tissues, to restore bloodflow after a stroke (angiogenesis) and to regenerate cartilage, bone and skin in non-healing wounds. Many patients and their families suffering with chronic ailments such as ALS (Lou Gehrig’s Disease), Parkinson’s and Alzheimer’s dementia are watching the development of stem cell treatment carefully and hopefully soon we will be able to offer them more effective alternatives than ever before.

As of April 2008, there were 721 phase III FDA approved adult stem cell trials. Most of these are in cancer treatment with a significant number for cardiac by-pass surgery, diabetes, wound healing and breast cancer to name a few. Do you know of anyone suffering with some of these common afflictions? Here in South Florida, we have access to excellent stem cell banks for both fetal umbilical cord blood and adult peripheral blood. Many of these banks also have a “mother bank” usually located near the National Institutes of Health in Bethesda, Maryland.

In choosing to bank my daughter’s cells, I was pleased to see that many more options have become available; in fact family banking has been a new trend among those families that can afford storage. There is nothing more important than keeping yourself and your loved ones healthy, so make 2009 the year of the body in both fitness and in health.

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 Center in West Palm Beach.

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