Ageless: The Naked Truth About Bioidentical Hormones (30 page)

SS:
The whole supplement?

ES:
Yes, right there in the colon—and they haven’t broken down at all. The chewable calcium citrate seems to be the least irritating to the gastrointestinal tract and seems to break down better. The tablet forms compress the calcium too much, making it hard to break down.

SS:
One of my neighbors here is Dick Van Dyke, you know, the comedian. He’s around eighty, looks amazing, and is in great physical shape. He grinds all his supplements up every morning and takes them down in some awful, gaggy two to three gulps of some drink. But he told me that when coroners do autopsies on people, they find all these undissolved vitamins.

ES:
He’s right. If you get adequate vitamin D, your calcium absorption from food increases so much, you may not need very much calcium supplementation, unless you’re really eating a poor diet. There is lots of calcium in all the foods that you recommend in your Somersize program, Suzanne. So if you add it up, you get between 700 and 1,000 mg a day of calcium in a good diet.

SS:
Now let’s talk about the brain.

ES:
I did some research for a talk recently, and I spent four months researching the literature on the connections between the brain, the brain cells, the aging brain, Alzheimer’s disease, and all of the different functions in the brain that are required to keep the brain healthy during your lifetime.

Only one in every ten cells in the brain is a neuron. The neurons do the work of the brain. They store memory, make memory, move our arms and legs, and so on. So it means nine-tenths of the cells are supportive cells. These little supportive cells repair tissue, repair the neurons, supply nutrients to the neurons, and generate their own hormones. They’re called neurosteroids.

Most people don’t realize it, but the brain can make all of the hormones that are present in the body. It can make its own cortisone, estrogen, testosterone, DHEA, and progesterone. These little supportive cells have the capacity to generate hormones within the brain structure itself.

These hormones regulate every major function of the brain, from brain repair, growth of new neurons, to the structural maintenance of the long axons, which connect different areas of the brain from one brain cell to another in different areas. In fact, the long axons go from the brain out to your fingertips. And these are myelinated, meaning they’re coated with myelin. Myelin is the sheath around the neuron cells that protects it. And myelin requires progesterone.

SS:
And the brain requires a template that it recognizes as reproductive, in the right proportions of the minor and major hormones, to operate optimally.

ES:
Yes, and in the peripheral nervous system, the cells that coat and make myelin are called Schwann cells. In the brain they’re called oligodendrocytes, and these require progesterone. What’s fascinating is that synthetic progesterone does not help these cells make myelin.

SS:
But bioidentical—

ES:
But bioidentical does, and of course, regular progesterone that’s either produced by the ovary or in males (we men don’t have ovaries) is generated by the cells. Progesterone has a lot to do with maintenance of these long axons and the repair of the axons and the coating. Progesterone in both men and women can help in regenerating spinal nerves, because those are myelinated fibers that go up and down the spine. Some research is going on to show that progesterone is neuroprotective and neuroregenerative to repair myelin to make these connections.

SS:
Let me understand—for male hormonal decline, it’s not just a matter of throwing in testosterone. It’s looking at the ratio of all of them together, and that men need to look at their progesterone and estrogen levels?

ES:
Yes, those cells that make their own progesterone need to be healthy to keep
making their own progesterone
. So it’s really a balance between maintaining circulating levels of systemic hormones and replacing those that are no longer being produced.

Looking at all the hormones requires a balancing act among all of them. As we age, the synchronous production of hormones becomes dissynchronous. The rise and fall during the day gets dysregulated and upset, so part of the skill of replacing hormones is trying to bring
some synchronous side to hormones. DHEA, for example, is probably best given at bedtime.

SS:
That’s interesting, because I take mine in the morning.

ES:
That’s fine for your morning, but your brain regenerates at night. The night is not a sleeping, quiet period. The night is your regenerative period. The night is the most active regenerative time in your whole body for the entire twenty-four-hour period. Your body tears down during the day and rebuilds at night. There’s a surge of hormones at night that helps to direct the replacement. So people with sleep disorders, who are not treating their sleep apnea, are having dysregulated production of hormones during this dysregulated sleep cycle.

SS:
I understand the importance of sleep and the healing hormone work that happens during the night. We are sleep-deprived as a society.

ES:
There’s a lot of science that needs to be done by looking at the synchrony of hormones with aging in men. For example, testosterone normally rises at night, and then in the early morning hours, it peaks and then declines during the day.

SS:
That is not a surprise to me. I have a husband who is on full hormone replacement.

ES:
Yes, you’re right. Other things rise in the early morning with men, and that’s a sign of health. That early morning rise actually reflects testosterone. It’s a very good biomarker for when testosterone is inadequate in men, because they lose that early morning erectile capacity, but when you replace hormones, you see that rise return. That indicates health, and it’s not a sexual thing. Those morning rises actually aren’t very useful. They’re reflex erections that relate to the sensitivity of the vascular tissue and neural tissue in the pelvis.

When those tissues are healthy, nerve and vascularwise, they’re much more responsive. The rise and fall has been documented, and it goes on all night long. Men just don’t pay much attention to it until they wake up in the morning. But if testosterone is low, this rise disappears or is significantly reduced, and that is a good way to have some assessment of whether their testosterone levels are low and whether their treatment is adequate.

At any rate, going back to the brain and the importance of
hormone replacement for regenerating cells, you need to understand that the immune cells in the brain are little cells that actually migrate. These little cells in the brain are called microglia, and they monitor for infection and help suppress excessive inflammation after injury. These cells are very sensitive to estrogen. When levels of hormones go down, these microglia can’t do their job, and then brain inflammation goes up.

After a stroke, if adequate estrogen is present, it suppresses excessive damage—and the area of the stroke is much smaller and heals much greater. When estrogen is not present after a stroke, there’s a greater widespread inflammation that causes cellular destruction.

So if women and men are on hormone replacement, including estrogen, and have a stroke, they will have much smaller areas of stroke and much greater healing of the area of tissue around the stroke.

SS:
That’s fantastic information.

ES:
The studies are very clear. The damaging effects of stroke are controlled by hormones.

SS:
This is a great argument for those women who are toughing it out and going natural. I don’t really believe they are doing themselves a service.

ES:
Everything I say about estrogen is true for men, but we men get our estrogen from our testosterone and from our DHEA.

SS:
But at some point, in testosterone decline, estrogen production exceeds testosterone, right?

ES:
Yes, because if you look at the estrogen levels in aging men, the estrogen levels go down very slowly, but the testosterone levels go down much faster. Some men are very estrogen-deficient, and some men, because they became obese, have estrogen production that is still quite high, but no testosterone.

SS:
And this has got to be at epidemic proportions because of the obesity problem in this country.

ES:
Yes, it is. There are two kinds of testosterone deficiency. One is overt deficiency, in which the testicles aren’t working and you don’t have enough estrogen or testosterone. This can occur at any age from
the forties on. If it’s below age forty, it’s probably related to other endocrine problems. But if you become completely deficient in testosterone, you don’t generate enough testosterone to make estrogen. Add to that, if you get syndrome X and become centrally obese and/or obese late in life, then you generate these estrogens in the fat cells. And estrogen suppresses testosterone.

SS:
So what’s the prognosis for these men?

ES:
We find that the men with higher estrogen have an increase in problems with heart attacks.

SS:
Well, as I look around America, there are many men who fall into that category.

ES:
This is why estrogen and testosterone have to be measured in men. I measure estradiol as a primary powerful estrogen in men. Some of the men are high in estrogen and low in testosterone, and some are low in both. So it really needs to be done on an individual basis. And those men who have middle-age spread are the high-estrogen guys. They have more risk factors for stroke and heart attack.

SS:
When a patient walks into your office, in that first thirty seconds, do you pretty much know what’s going on with them?

ES:
You have to look at their life history to get a clear picture. Were they thin when they were young and now they are obese? Or were they obese all their life? Now, strangely, I’ve seen men who were obese all their life who have low testosterone, and some with high estrogen, and they are healthy as a horse. They have no sexual dysfunction, either. Their bodies have adapted to that balance.

SS:
I didn’t realize that the body can adapt to this condition.

ES:
Yes, this condition is normal for this man. If a man goes from having a low estrogen/high testosterone ratio—in other words, muscular and athletically built—to becoming dumpy, fat, and centrally obese in his forties and fifties, he will have real trouble. His estrogen goes up and becomes a serious problem. A lot of men are being given aromatase inhibitors, which block the fat cell conversion of testosterone into estrogen to help control the problem. The problem with this is, yes, it may downregulate the estrogen, but what does it do to the brain?

SS:
What
does
it do to the brain?

ES:
We men get our estrogen in our brain from aromatase conversion of testosterone and DHEA. So when you give an aromatase inhibitor, you are downregulating one of the key hormones that causes the brain to be self-repairing and self-protecting.

Another factor is the use of Proscar to block DHT [dihydrotestosterone] conversion from testosterone to shrink the prostate. But there’s DHT in the brain. And this medicine that blocks DHT formation is also affecting the conversion of progesterone into something called allopregnenolone, which is different from pregnenolone. Pregnenolone is a potent neurosteroid that’s important in brain repair. So these men are being given DHT to shrink the prostate, and the prostate shrinks because you make it deficient in DHT, but
you’re shrinking the brain at the same time
. I think more studies need to be done to see if this really makes sense. The drug companies that give us systemic-acting hormone blockers should be aware that these medications are going to have pervasive effects in other tissues that might show up in two, three years, five years, ten years.

SS:
What do you think about statins?

ES:
Statins inhibit the ability of your body to generate its own cholesterol. So if we lower cholesterol, there’s a clear reduction in events with the studies on statins. There are reductions of stroke, and there is a reduction of heart attack of 20, 25, 30 percent, depending upon the study.

SS:
Significant.

ES:
However, long-term studies have failed to show any improvement in overall mortality rate. It’s interesting that if you lower the major cause of death by 25 or 30 percent, you don’t see an upside on longevity of an equivalent amount. So what’s happening? We’re becoming unhealthy in other ways. But they don’t seem to report on what is causing these other people to die.

The brain itself makes its own little neurosteroids by manufacturing its own cholesterol in the brain. So if we inhibit the body’s ability to make its own cholesterol, are we also inhibiting the ability of the body to make its own neurosteroids?

SS:
So are you saying that ultimately statins could actually be working against us?

ES:
Exactly. And those studies are yet to be done. Statins have some important positive effects on inflammation. So now drug companies are talking about maybe using them to treat Alzheimer’s. Remember I said when hormones decline, the inflammation of the brain goes up? Well, they’re touting the anti-inflammatory effects of statins to cut down the brain inflammation of Alzheimer’s. That’s the theory. Drug companies would love to have a drug that would go in and stop Alzheimer’s.

The problem is, if you inhibit the brain from making its own cholesterol, you’re inhibiting the brain from making its own neuroprotective hormones that control the Alzheimer’s process. But if your cholesterol is very low, you have an increased risk of Alzheimer’s disease.

There’s a study called the Cache Study that showed that if you had lower cholesterol, you had a lower incidence of vascular dementia. Those are the strokes and heart attacks that come from ministrokes, or brain degeneration that comes from ministrokes.