How Diet And Nutritional Supplements Compliment Bio-Identical Natural Hormone Therapy

Dr. Enrique Jacome

To attain the greatest benefits from natural bio-identical hormones and bio-identical hormone replacement therapy (BHRT), proper food and natural nutritional supplements are crucial. If you consistently remain on a balanced nutritional supplement regimen and a healthy diet, you will help your body to utilize and metabolize bioidentical hormones through the most natural pathways and decrease your risk for developing cancer.

Nutrients found in food that enhance hormonal health:
Cruciferous vegetables such as broccoli, brussel sprouts, cauliflower, kale and cabbage are of significant importance in ensuring that the body's estrogen is metabolized through the correct pathways. This decreases the risk for developing breast and prostate cancer. The particular component found in cruciferous vegetables that provides these hormonal health benefits is indole-3-carbinol (I3C). This powerful natural substance helps the liver to detoxify many carcinogens including xenoestrogens.

Isoflavones from soy products such as: soy beans, soy milk and tofu can also beneficially influence hormones metabolism and decrease breast and prostate cancer risk. When consuming soy products it is wise to make sure that they are organic and do not contain any genetically engineered organisms (GMOs). Unfortunately almost all non organic soy is genetically engineered.

Flax seed powder is a very rich source of lignans that can protect against breast, prostate and uterine cancer.

Fish oil (and omega 3 essential fatty acids) besides providing cardiovascular and mental health benefits, positively influences breast and prostate health.

Antioxidant rich fruits and vegetables are known for significantly decreasing one's risk for breast and prostate cancer. Drinking several cups of green tea a day will protect you from free radicals and improve your hormonal health. When consuming fruits and vegetables, remember that organic are the best, eating non organic fruits and vegetables can overload your body with toxic pesticides.

Nutritional supplements that complement BHRT:
Eating the correct diet and taking natural nutritional supplements on a daily basis can significantly (up to 90%) reduce your risk for many types of cancers. Since receiving all the nutrients that your body needs from food alone is nearly impossible, to obtain anti-cancer benefits from nutrition we have to supplement with high quality, natural nutritional supplements.


The supplements most beneficial for hormonal health are:

• Indole-3-carbinol and DIM such as Estrodim improve estrogen metabolism pathways and help liver in detoxification process.
• Calcium D-glucarate protects against genetic mutations.
• Soy isoflavones (genistein and daidzein) are selective estrogen receptor modulators, having protective effects on breast cells and prostate cells.
• High quality pure fish oil (tested to be free from chemicals and heavy metals) such as Orthomega fish oil, helps to significantly reduce risk for breast and prostate cancer.
• Vitamin C and vitamin E supplements by reducing oxidative stress were shown to have protective effects on breast tissue and reduce breast cancer risk. Vitamin C and vitamin E also reduce one's risk for endometrial cancer.
• Vitamin D plays an important role in assisting the body to absorb calcium into bone tissue. It also is essential in breast and prostate cancer prevention.
• Iodine, a microelement known for its role in thyroid hormone production, is also necessary for proper function of breast tissue. Low iodine levels may cause fibrocystic breast disease and increase risk of breast cancer.   
  
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Study Shows That Hormone Replacement Therapy May Improve Visual Memory Of Postmenopausal Women

Dr. Enrique Jacome

Research from the University of Michigan Health System suggests that hormone therapy might help women retain certain memory functions. In a study in the new issue of The Journal of Clinical Endocrinology & Metabolism, they report that a group of postmenopausal women showed more brain activity during a visual memory test than did women who were not taking the hormone therapy.

The 10 postmenopausal women in the study, ages 50-60, were given hormone therapy or a placebo for four weeks, followed by a month with no medications, and then four weeks of the other treatment. Their brain activation was measured as they were shown a complex grid of 81 squares, with 40 of them darkened to form a pattern.

Participants were asked to find the matching image from a choice of two, with the new set of images presented after varying time periods (one to four seconds). During the time that the two images were shown, participants were asked to choose the one that matched the initial grid by pressing one of two buttons on an MRI (magnetic resonance imaging)-compatible response pad.

Those who were taking combined estrogen-progestin hormone therapy showed significantly increased activity in the prefrontal cortex, a region of the brain that is critical in memory tasks, compared with those on placebo (a pill with no medicinal value). The researchers used images from functional MRI, or fMRI, to compare the participants' brain activity.

"Our findings suggest that even relatively short periods of hormone therapy have effects on the memory systems that may be of benefit to some women during the perimenopausal transition or early postmenopause," says lead author Yolanda R. Smith, M.D., associate professor in the Department of Obstetrics and Gynecology at the U-M Medical School.

"Other studies have indicated that long-term hormone therapy is not beneficial for the prevention of chronic illnesses," Smith says. "But our study indicates that the effects of short-term hormone therapy on brain circuitry and function warrant further study."

The role of estrogen in maintaining brain function is of great significance as the population ages and the incidence of dementia increases, says senior author Jon-Kar Zubieta, M.D., Ph.D., associate professor of psychiatry and radiology at the U-M Medical School and associate research scientist at U-M's Molecular & Behavioral Neuroscience Institute (MBNI).

Zubieta notes that working memory - that is, a limited-capacity storage system that allows the brain to actively maintain and manipulate information that is critical for conducting many daily activities over short time periods - has been demonstrated to be less efficient in older adults. This decline has been linked with changes in the prefrontal cortex.

"Our finding of increased activation in the prefrontal cortex in older women using hormone therapy is important and suggestive of potential therapies that need to be explored further," he says. "Eventually, this could lead to new options for women as they enter a time when memory problems typically develop."

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Is That Age Your Feeling Or Is It Hormone Deficiency?

Dr. Enrique Jacome

We see many people in their 50s, 60s, 70s and 80s who attribute their symptoms to aging. This idea may come from their physicians, who, in glib response to their questions about the origin of symptoms, respond “What do you expect? You’re 70 years old.”

It is an error to attribute physical decline to aging alone. Because chronological age is not reversible, blaming a condition wholly on age is tantamount to saying nothing can be done about it. Despite their age, we have helped many patients improve by implementing life enhancement programs, no matter how old. There is an enormous variability of function in people of all ages, and many important influences on function are not fixed, but modifiable.

Aging effects are mimicked by:
Hormone deficiency
Overweight
Unrelenting stress
Poor diet
Nutritional deficiencies
Drug toxicity
Undiagnosed medical conditions
Lack of exercise
Non-productivity
Musculoskeletal problems

Each of these factors can be addressed and improved. We look at all of them, and offer ways of correcting deficiencies and imbalances. Most people of middle or older age are prescribed three or four or more medications, all of which generate side effects, and in combination further aggravate symptoms. Fatigue, forgetfulness, and lack of energy are common consequences of drug therapy. When drugs are reduced or eliminated these symptoms improve. Drugs can be discontinued when lifestyle factors requiring their use are corrected.

Hormone replacement is one way to avoid the need for certain drugs, such as bisphosphonates for osteoporosis, sedatives for anxiety, and antidepressants for depression.

We evaluate levels of sex hormones, which decline in both men and women, and include estrogen, progesterone, and testosterone. Other hormones we assess are thyroid, adrenal, and growth hormone. Optimal therapy includes various combinations of hormones, depending on the patient’s response to initial measures.

Both men’s and women’s response to hormone replacement can be rapid and dramatic. Improvements in energy, libido and cognitive function can occur within days, leading the individual to wonder why she/he didn’t look into hormone therapy earlier.

Cardiovascular benefits of hormone replacement are documented. Estrogen maintains arterial elasticity, preventing arteries from becoming stiff. Stiffness is the first measurable defect in arterial function. It precedes the onset of vascular events- heart attacks and strokes- by several years. Further, a recent study reveals a lower rate of rupture of brain aneurysms, a major cause of brain hemorrhage and paralysis, in women taking estrogen replacement therapy. In men, higher levels of testosterone, estrogen, and growth hormone are all protective against cardiac disease.

The gains from hormone replacement are so marked, so effective in deterring and even reversing the process of aging, that it is inappropriate to manage any patient with age-related conditions without exploring the benefits, along with the risks, of hormone repletion.

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Understanding Our Hormones

Dr Enrique Jacome

As we age we lose our hormones. All of our good building up hormones start declining after age 30.   Cortisol and insulin tend to increase, which can harm our health. These changes are detrimental to our vitality and our health.

These hormone changes are part of the cycle of life, a building up and then shutting down. Hormones are the highest in our most vital and healthy time of our life, our teens and twenties when we have our highest energy and best health, our “child-bearing years”. After this time, about age 30, our genetics dictate that our good hormones decline: testosterone, estrogen, progesterone, thyroid hormone, and growth hormone.  Hormones that can harm us, cortisol and insulin, start to rise.  At about age 40, hormone decline accelerates in women as the ovaries begin shutting down hormone production in the peri-menopause. Men’s hormones continue to decline. This is nature’s way of shutting us down and eliminating us. It is not a coincidence that the healthiest time of our lives is when we have our full complement of hormones, nor that we begin developing the diseases of aging, heart, bone, brain, and eye problem, as our hormones decline. We age because we lose our hormones!

This was not as issue prior to 1900, when the average age of death was 50. Most men and women did not experience the full force of hormone loss. Now with the average age of death at 80, we can live 30 years or more without our hormones and the consequences.

Certainly, lifestyle, exercise, body weight and exercise, nutrient supplements all contribute to being healthy and may help make the process of hormone loss easier or make certain hormone loss slower. But none of these things will put your hormones back. Acupuncture, chiropractic, yoga, and Aruvedic medicine may also help alleviate hormone symptoms, but none will not put your hormones back. The only way to keep your youthful compliment of hormones is by replacing them, and only with hormones that have the same exact molecular structure that is native to the human body.

When women enter their 40’s they start feeling these changes as ovaries start to shut down production of sex hormones in peri-menopause and menopause. Nature is most cruel to women because symptoms of perimenopause can be swift and profound. Menopause has been often likened to falling off a cliff where men’s andropause is likened to rolling down a hill. Men begin noticing the more gradual decline in testosterone called andropause. Meanwhile thyroid hormone and growth hormone also declines.

In women testosterone is the first to start declining, then progesterone. In their 40’s, women start noticing insomnia, irritability, mood swings, depression, low libido, hair loss, and migraines directly associated with low progesterone. Estrogen also starts declining, but is the last to go with hot flashes, weepiness, night sweats, and lack of energy. The symptoms of hormone change can continue for 15-20 prior to loss of menstruation.

With loss of testosterone, men experience fatigue, memory loss, loss of libido, loss of muscle mass, weight gain, decreased athletic ability, muscle aches, and decreased interest in activities.

Thyroid hormone and growth hormone play vital roles in hour health and energy as well, and need to be replaced and even optimized (but not abused) when deficient with bioidentical equivalents.

Bioidentical hormone replacement will alleviate the symptoms of menopause and andropause.   I am often asked, “Do I have to take them forever?”.  The answer is yes. If you stop taking hormones all your symptoms will come back. Once you stop making your hormones, they are gone. They do not come back unless you put them back with bioidentical hormone replacement.

The long term consequences of lack of hormones are weight gain, loss of muscle mass, heart disease, high cholesterol, diabetes, colon cancer, macular degeneration, cataract formation, high blood pressure, and osteoporosis. A lower chance of having these problems keeps me happily taking my hormones and vitamins each day.  I also feel the same way I did in my 30’s!

We all will die some day. The fact is that our cells can only divide so many times. Each time they divide they lose some DNA, and when a critical limit is met, they die. Current maximum age is believed to be 120 years due to this effect.

Of course we have to fuel our cells with nutrients and vitamins, limit our exposure to toxins and chemicals, and detoxify. 

We are living longer because we have great living conditions and can prevent mortality from many diseases and accidents. But most of us will feel lousy for the last 30 years struggling with symptoms and disease until we come to accept our age and poor state of wellness. 50% of those who live to be 85 will have Alzheimer’s (estrogen can prevent Alzheimer’s disease).

It doesn’t have to be that way. With bioidentical hormone and nutrient replacement you can enjoy feeling good for the rest of your life. 

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The Thyroid, Hormones And Anti-Aging

Hormones interact with each other. Changes in one hormone invariably affect the activity of other hormones. For instance, testosterone is converted in fatty tissue to estrogen, and the administration of testosterone increases estrogen levels as well. In addition, the symptoms of different hormone deficiencies overlap. Fatigue, for instance, may be a manifestation of deficiency of estrogen, testosterone, thyroid hormone, or cortisol, or of several of them at the same time.

Thyroid hormone status should be assessed in all patients undergoing sex hormone evaluation. Thyroid hormone activity impacts both the production and the activity of sex hormones. Hypothyroidism may suppress menstruation, and cause many of the symptoms of menopause: fatigue, weight gain, depression, memory loss, hair loss, dry skin. A woman may appear to be entering menopause when in fact she has a thyroid disorder, and correction would restore her menses and eliminate the other symptoms.

Hypothyroidism is very common in women, affecting over 10%. It is generally an autoimmune disorder, meaning an attack by the body’s immune system against itself, and anti-thyroid antibodies can be measured. It occurs less frequently in men. Thyroid insufficiency raises blood pressure and cholesterol, increasing the risk of cardiac disease.

Treatment generally involves administration of thyroid hormone in doses to normalize the TSH (thyroid stimulating hormone) level. Symptoms start to improve in less than a week. We prefer to use an animal-derived formulation containing both T3 and T4, called Armour thyroid or Naturthroid (available in our office). Most commercial preparations contain only T4, which some individuals do not easily convert to T3, which is the more active form in the brain. Thyroid-related depression should be addressed with T3 augmentation.

Some authorities assert that hypothyroidism results from allergy to gluten, a grain-based protein found in wheat, rye and barley. Elimination of these foods may improve a thyroid condition.

DHEA is an adrenal hormone with activity similar to testosterone, the level of which falls progressively with age. It is considered an antiaging hormone, with beneficial effects on bone density, immune function, sense of well-being, and libido. People in the poorest health will have the lowest levels. Adrenal gland suppression, which occurs with administration of steroids for asthma and autoimmune disorders, will reduce DHEA to near zero.

We measure DHEA in all older patients and those with immune disorders. DHEA is provided in a dose to increase the blood level to that of a young adult. Although DHEA is a hormone, access is not regulated, and it can be purchased without prescription. It should not be taken, however, without first measuring the blood level. Subsequent DHEA determinations will inform the need for dose adjustment. Excessive doses may cause acne or hair loss.

Cortisol is produced by the adrenal glands. It is considered a stress hormone, in that levels rise with physical or emotional stress. Running a marathon, encountering a tidal wave, or getting a threatening letter from the IRS will all raise cortisol levels. Prolonged stress, which is common in our current overburdened lives, is thought to cause adrenal compromise. The adrenals are no longer able to properly release cortisol, and the normal day to night variation, where cortisol is high in the morning and declines throughout the day, no longer holds.

Salivary cortisol measurements, taken four times during the day, reveal aberrations in production, with low levels in the morning, high levels at night, or elevated or depressed levels throughout the day. This can be corrected by reducing stress, addressing other hormone imbalances, and providing nutrients to re-establish normal adrenal activity. Nutrients to support cortisol production include pantothenic acid, pyridoxine, vitamin A, vitamin C, and niacin. Supplements to suppress overactive adrenals include phosphatidylserine, ashwagandha, L-theanine, rhodiola and Siberian ginseng.

Growth hormone levels decline with age, and depletion contributes to fatigue, depression, reduced physical performance, osteoporosis, heart failure, muscle wasting and deposits of abdominal fat. Since growth hormone blood levels are normally very low, adequacy is assessed by measuring IgF1, a hormone produced in the liver under the influence of growth hormone. Low levels of IgF1 correlate with increasing incidence of congestive heart failure, the major cause of hospitalization in older adults.

Growth hormone supplementation increases muscle mass, reduces abdominal fat, improves the sense of well-being, helps to heal muscle and tendon injuries, and improves survival in congestive heart failure.

Apparently because of abuse by professional athletes, the FDA limits growth hormone prescription to short children, and patients with inflammatory bowel disease, AIDS, pituitary insufficiency, and proven adult growth hormone deficiency.

Human growth hormone levels can be measured at thirty minute intervals after giving an oral dose of L-dopa and carbidopa, which stimulate growth hormone release by the pituitary. Failure of blood levels to rise indicates growth hormone deficiency. Human growth hormone (hGH) can then be administered by injection into abdominal tissues, usually in a dose of one unit daily.

Human growth hormone releasing hormone (GHRH) is related to growth hormone. It is given by injection, and raises growth hormone levels by stimulating the pituitary gland to release growth hormone. Its use is not restricted by the FDA. IgF1 levels should be measured before and three months after growth hormone therapy, to assess response.

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