The Best Sleep You’ll Ever Have…….is in your grasp and so simple.
Robert G Carlson, MD, Sarasota, FL
Do you have trouble falling asleep? Or perhaps you’re able to fall asleep, but then plagued by constantly waking up throughout the night, resulting in a broken, restless sleep that leaves you feeling like a zombie the next morning?
Have you been given sleeping pills to help with your sleep, pills that leave you spaced out, like you’re moving in slow motion and not fully rested? Not being able to sleep is critical, resulting in loss of memory, ineffective work habits, and increasing irritability. Starting in their early 40’s, women are in commonly plagued with sleeping problems. The answer is really quite simple. About ten years before menopause, ladies progesterone levels start to plummet. This sets them up for sleepless nights. Progesterone, natural progesterone that is soy-based, not the peanut oil pharmaceutical progesterone Prometrium, provides improvement in sleep, dramatic reduction in irritability (who wouldn’t be irritable if you can’t sleep and remain exhausted), reduction in headaches and the reduction in the signs of estrogen dominance. Besides natural progesterone, NOT synthetic progestins like Prempro or Provera, has now been shown to reduce breast and uterine cancer, reduce cholesterol and reduce heart disease. And it also makes you feel better!
Sleep medicines don’t deal with the real underlying causes of why women are having trouble sleeping as they get older. The major reason is because progesterone levels are so low. Progesterone is like nature’s valium, it is the Feng-Shui of hormones providing calmness and relaxation, factors critical in falling asleep.
With women who are either perimenopausal(which can be up to 10 years before menopause), menopausal, or suffering from surgically induced menopause (hysterectomy), the progesterone levels can drop to such low , immeasurable level that ladies simply can’t sleep. It often takes women an hour or more to get to sleep or they find themselves waking up throughout the night.
So how does bio-identical hormone replacement therapy help? When natural progesterone is taken as a pill, versus in the cream, it travels to the brain and interacts with the GABA receptors. These receptors when activated naturally promote sleep and help patients reach the restorative sleep (REM sleep) more quickly.
How does hormone replacement with progesterone differ from taking sleeping pills when it comes to the quality of sleep a woman might expect? Sleeping pills are synthetic, not natural. There is nothing natural about them, and because of that the natural restorative REM sleep is never achieved. Oh yes, sleeping pills will help you get to sleep, but they don’t get the quality of sleep achieved naturally. When I treat women struggling with sleep issues in their 40’s and 50’s, sleep undoubtedly affected by progesterone levels, one of the most common response I hear after starting progesteroneis ‘This is the best sleep I’ve ever had’.
How quickly can patients expect results? I have seen patients experience results very quickly. Sometimes within the first one or two doses. They often can’t believe how rested they are when they wake up and want to get rid of their sleeping pills as soon as possible.
One patient of mine, Erika is a perfect example of the difference a good night’s sleep can make. In her early fifties, I met Erika with major concerns of “I just can’t sleep”. She had been experiencing “on and off sleep” – waking up frequently throughout the night for years. Essentially sleep deprived. The lack of sleep was making her feel older than her years, and mentally and physically exhausted. She told me, “It was horrible and very hard to function.”
After only a few weeks of hormone replacement however Erika reported to me with excitement in her voice, “I can sleep now. I can think clearly now. It’s unbelievable.” Though still dealing with the stresses and pressures of before, she finds it easier to deal with now she has the benefit of a full and restful night’s sleep. “I really do feel like this very huge dark cloud has been lifted, thanks to you, Dr. Carlson.” She said fighting off tears of joy. “I see everything in a different view.” Her words of encouragement to ladies struggling with menopause and sleeping problems are: “I’m sleeping through the night and feeling like I’m back in my twenties or thirties. It’s amazing.”
Tuesday, August 24, 2010
Youthful Skin with Bioidentical Hormone Therapy Bio-Identical Hormones make you look younger
Youthful Skin with Bioidentical Hormone Therapy
Bio-Identical Hormones make you look younger
So how much control do you have over how quickly your face ages? You know, sagging cheeks, wrinkles and frown lines? The surprising answer is that you have more control over facial aging than you think. Factors such as divorce, smoking, and the use of anti-depressants dramatically accelerate facial aging. So what is beneficial in making women’s faces look more youthful? Hormone replacement therapy. Yes , a Case Western Plastic surgery study found that hormone replacement therapy made a big difference by reducing the aging process.
Aging, especially in the skin seems to accelerate after menopause in women. Aging faster with wrinkles spreading rapidly, skin quickly loses elasticity and smoothness are common features in postmenopausal women not receiving hormone replacement therapy. The basis for the use of topical estrogen therapy stems from the documented evidence of reducing diseases of aging, including heart disease, osteoporosis and cancer but also in the estrogen depleted chronological aging of our skin. To a large degree the features of aging skin seem to result from the decline in estrogen levels after the menopause. Of all hormones that decline with age, estrogens have the most dramatic effect on the skin. Estrogens are known to protect women from heart disease, and now it seems that they also slow down skin aging. Several studies indicate that postmenopausal women on estrogen replacement therapy develop less wrinkles and have better skin texture and elasticity than those not taking estrogens.
Studies in postmenopausal women have demonstrated significant decrease skin thickness with marked thinning of the epidermis (outer skin layer), loss of critical collagen resulting in deterioration of skin structures, deepening of wrinkles and widening of skin pores. The more rapid the collagen loss, which occurs in the first two years after menopause, the more dramatic the appearance of aging in these women. Studies have shown up to a 30 % loss of skin collagen immediately after menopause and the loss continues if there is no estrogen replacement received. This British Medical Journal study amazingly showed that women who then received topical estrogen therapy experienced an increase in skin collagen content 48 % higher than those who did not received hormone replacement therapy. Proper bioidentical hormone replacement with estrogen, progesterone and testosterone replacement is a complex decision requiring the analysis of one's medical history and a physician who has the knowledge to expertly balance a women’s hormones.
Women after menopause have been shown to have improved skin benefits using estrogen topical preparations. A University of Vienna study in postmenopausal women demonstrated a marked improvement in skin elasticity and firmness after only six months of therapy; wrinkle depth and pore size decreased by over sixty percent in both estradiol and estriol groups. Skin moisture and collagen synthesis increased significantly.
I believe that estrogen creams could also improve the signs of aging in premenopausal women as well although further studies are needed to confirm that. The Plastic and Reconstructive Surgery article showed that hormone replacement therapy dramatically reduced the appearance of facial aging in women. So not only does hormone replacement reduce your risk of heart disease, cancer , and osteoporosis, but it also makes you look younger. So now you have European and American studies that support the benefits of Hormone Replacement therapy on the skin. The benefits of Hormone replacement therapy on the heart, bones, memory and cancer are being clearly documented in the medical literature. So, it’s about time we took the fear out of HRT and provide women with a safe and healthy approach to wellness. Now that sounds like a great idea to me.
Robert Carlson, MD, FACS
Bio-Identical Hormones make you look younger
So how much control do you have over how quickly your face ages? You know, sagging cheeks, wrinkles and frown lines? The surprising answer is that you have more control over facial aging than you think. Factors such as divorce, smoking, and the use of anti-depressants dramatically accelerate facial aging. So what is beneficial in making women’s faces look more youthful? Hormone replacement therapy. Yes , a Case Western Plastic surgery study found that hormone replacement therapy made a big difference by reducing the aging process.
Aging, especially in the skin seems to accelerate after menopause in women. Aging faster with wrinkles spreading rapidly, skin quickly loses elasticity and smoothness are common features in postmenopausal women not receiving hormone replacement therapy. The basis for the use of topical estrogen therapy stems from the documented evidence of reducing diseases of aging, including heart disease, osteoporosis and cancer but also in the estrogen depleted chronological aging of our skin. To a large degree the features of aging skin seem to result from the decline in estrogen levels after the menopause. Of all hormones that decline with age, estrogens have the most dramatic effect on the skin. Estrogens are known to protect women from heart disease, and now it seems that they also slow down skin aging. Several studies indicate that postmenopausal women on estrogen replacement therapy develop less wrinkles and have better skin texture and elasticity than those not taking estrogens.
Studies in postmenopausal women have demonstrated significant decrease skin thickness with marked thinning of the epidermis (outer skin layer), loss of critical collagen resulting in deterioration of skin structures, deepening of wrinkles and widening of skin pores. The more rapid the collagen loss, which occurs in the first two years after menopause, the more dramatic the appearance of aging in these women. Studies have shown up to a 30 % loss of skin collagen immediately after menopause and the loss continues if there is no estrogen replacement received. This British Medical Journal study amazingly showed that women who then received topical estrogen therapy experienced an increase in skin collagen content 48 % higher than those who did not received hormone replacement therapy. Proper bioidentical hormone replacement with estrogen, progesterone and testosterone replacement is a complex decision requiring the analysis of one's medical history and a physician who has the knowledge to expertly balance a women’s hormones.
Women after menopause have been shown to have improved skin benefits using estrogen topical preparations. A University of Vienna study in postmenopausal women demonstrated a marked improvement in skin elasticity and firmness after only six months of therapy; wrinkle depth and pore size decreased by over sixty percent in both estradiol and estriol groups. Skin moisture and collagen synthesis increased significantly.
I believe that estrogen creams could also improve the signs of aging in premenopausal women as well although further studies are needed to confirm that. The Plastic and Reconstructive Surgery article showed that hormone replacement therapy dramatically reduced the appearance of facial aging in women. So not only does hormone replacement reduce your risk of heart disease, cancer , and osteoporosis, but it also makes you look younger. So now you have European and American studies that support the benefits of Hormone Replacement therapy on the skin. The benefits of Hormone replacement therapy on the heart, bones, memory and cancer are being clearly documented in the medical literature. So, it’s about time we took the fear out of HRT and provide women with a safe and healthy approach to wellness. Now that sounds like a great idea to me.
Robert Carlson, MD, FACS
Monday, June 21, 2010
Vitamin D myths and management-Robert Carlson,MD
THE MANY VITAMIN D MYTHS
Patient EB is a 50-year-old female with a family history of colon cancer and breast cancer as well as a history of arthritis with probable autoimmune etiology. She takes a daily multivitamin which includes 10,000 units of Vitamin A as well as a separate 1000 IU of Vitamin D3 and her 25-(OH) Vitamin D3 level is 36 ng/mL (reference range 33-100 ng/mL). Should EB increase her dose of Vitamin D3? Should she continue her multi-vitamin?
There are so many myths surrounding Vitamin D. First and foremost, is the myth that Vitamin D is
a Vitamin. Vitamin D is not a Vitamin, it is actually a steroid hormone. Vitamin D is produced in one part of the body (the skin), and then travels to a remote site, where it exerts an endocrine effect. Thus, it fulfills the definition of a hormone. Another Vitamin D myth is that its only function is calcium regulation. That idea has been well and truly debunked in recent years. Then there is the idea that 1000 IUs a day is more than enough, which is simply not true. Also many believe that taking over 2000 units a day might cause toxicities. I hear this from numerous health professionals and even from pharmacists who should know better. The literature is very clear…..evidence from clinical trials shows that a prolonged intake of 10,000 units of Vitamin D per day poses no risk of adverse effects for adults 1 ……therefore one can take 10,000 units a day and have no risk for toxicity.
Other myths of interest include:
1) Most people living in the US get adequate amounts of Vitamin D – not true (see below).
2) Extreme care must be taken to avoid toxicity – not true! There have been numerous
studies on Vitamin D toxicity and no toxicity has been seen in doses lower than 30,000
IU/day (200 ng/mL). An excess of Vitamin D causes hypercalcemia, however all known
cases of Vitamin D toxicity with hypercalcemia have involved intakes of 40,000 IU or more
per day.2
3) Spending 15 minutes in the sun each day enables the body to produce ample amounts of
Vitamin D – that may be true if you are sitting on a beach in Hawaii at noon wearing
nothing but a bikini, but for the vast majority of us that is a myth. Unfortunately, once sunscreen is applied the Vitamin D production drops to nothing. If you live above 35 degrees latitude, the body is unable to produce adequate amounts of Vitamin D from the winter sun. In fact the only adequate amount of sunshine in Boston occurs, between May and Sept, otherwise there is inadequate sunlight for Vitamin D metabolism.
4) Eating a balanced diet will provide adequate amounts of Vitamin D – not true! Vitamin D is present, in small amounts, in only a handful of foods – oily fish, eggs, and fortified
foods. Vitamin D fortified Milk and Orange Juice only contain 50 Units of Vitamin D2, not Vitamin D3. Thus it is very unlikely that adequate amounts could be obtained from the diet.
• Vitamin D does not prevent cancer – it does , in fact one study showed the reduction in all cancers by 77 % over a four year period in a well designed study.(see below).
• Vitamin D does not prevent autoimmune disease – it does , reducing Systemic Lupus ,Rheumatoid Arthritis and Childhood onset diabetes(see below).
• Vitamin D does not prevent acute MI and heart disease – it does (see below).
As mentioned above, the notion that most people living in the US get adequate amounts of
Vitamin D is far from true. Research has shown that Vitamin D deficiency is present among all age groups of US citizens from children to the elderly, and especially in African-Americans.3 Studies have shown that the prevalence of low 25-(OH) D levels (<20 ng/mL) is approximately 36% in young adults aged 18-294 ,42% of African-American women aged 15-495 ,41% of outpatients aged 49-83,6 and 57% of inpatients.7
In Europe, it is believed that between 28 and 100% of healthy adults and 70-100% of hospitalized adults have low 25-(OH) D levels (<20 ng/mL).8,9,10
A study we completed examining women age 35-65 in Tampa, Florida in December, demonstrated that 92 % of the women had 25-(OH) D levels less than the low normal range of 32. Can you imagine what the Vitamin D levels are in the same group of women in Minneapolis, Minnesota in December?
Research has shown that the incidence of many diseases could be dramatically reduced by
increasing serum 25-(OH) D levels, and by looking at the list below, it is easy to see why Vitamin D has become a very hot topic in recent years:
1) Increasing serum 25-(OH) D levels to 35 ng/mL could prevent 30% of MI in men11 and
reduce the risk of fracture in elderly people by 50%.12
2) Increasing serum 25-(OH) D levels to approximately 40 ng/mL could reduce the risk of
cancer in postmenopausal women by 35%13 and reduce the risk of falls in elderly people
by 50%. 14
3) Increasing serum 25-(OH) D levels to 50 ng/mL could reduce the incidence of breast
cancer by as much as 80%,15 multiple sclerosis by as much as 60%,16 and type I
diabetes by up to 50%.17
Why is Vitamin D so beneficial? There is no clear answer at present. However, anything that has
such wide-ranging benefits has to possess the ability to modulate inflammation. Indeed, studies have shown that Vitamin D inhibits nuclear factor-κβ (NF-κβ) 18 – a protein that plays a key role in the inflammatory response and in the proliferation of cancer cells. It has also been shown to lower levels of the inflammatory marker CRP.19 Thus, it is vital that we ensure our patients are getting plenty of Vitamin D.
What about Patient EB, does she need to increase her daily dose of Vitamin D3? Yes. The
reference range for 25-(OH) D is 32-100 ng/mL Given the evidence published in the medical literature over the last few years, it is advisable to try and keep patients at the top end of the reference range – so, we should be aiming for 75-100 ng/mL The optimal dose for an average person is 5000-15,000 IU/day; however this should be lowered for people who get a lot of sun exposure. Ideally check Vitamin D leveIs and regularly check serum calcium in patients who take supplementary Vitamin D, just to ensure there is no risk of hypercalcemia.
So what about her multi-Vitamin choice? Some multi-Vitamins may be doing more harm than good. I recommend avoiding excessive amount of pre-formed Vitamin A in the retinol form, as opposed to the beta-carotene form that converts to Vitamin A in your body. The presence of excessive pre-formed actually will neutralize all the amazing benefits of Vitamin D3.20 Unfortunately, multi-vitamins often continue a lot of Vitamin A(average 4400 units) as retinol and very low levels of D3( average 400). Vitamin A and Vitamin D receptors are very close to each other and excess Vitamin A will block the beneficial effects of Vitamin D. Women who took the highest intake of pre-formed Vitamin A actually had twice as many hip fractures. 21 So keep the non- beta carotene Vitamin A supplements to less than 1000 units, and this will allow all the amazing benefits of Vitamin D3.
CONCLUDING REMARKS
There are many myths surrounding hormone replacement therapies, however from the evidence
presented above, we can see that not one of them is true. Hormone optimization provides us with an extremely powerful anti-aging tool to maximize quality of life.
REFERENCES
1. Vieth R. Vitamin D and Cancer Mini-Symposium: the risk of additional Vitamin D. Ann Epidemiol. 2009; 19(7):441-5.
2. Vieth R. Vitamin D supplementation, 25-hydroxyVitamin D concentration, and safety. Am J Clin Nutr. 1999;69:842-56.
3. Holick MF. High prevalence of Vitamin D inadequacy and implications for health. Mayo Clin Proc.
2006;81:353-373.
4. Tangpricha V, Pearce EN, Chen TC, Holick MF. Vitamin D insufficiency among free-living healthy young
adults. Am J Med. 2002;112:659-662.
5. Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C,
Gunter EW, Bowman BA. HypoVitaminosis D prevalence and determinants among African American and
336 white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. Am
J Clin Nutr. 2002;76:187-192.
6. Malabanan A, Veronikis IE, Holick MF. Redefining Vitamin D insufficiency [letter]. Lancet. 1998;351:805-
806.
7. Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM,
Prince RL, Finkelstein JS. HypoVitaminosis D in medical inpatients. N Engl J Med. 1998;338:777-783.
8 . McKenna MJ. Differences in Vitamin D status between countries in young adults and the elderly. Am J
Med. 1992;93:69-77.
9. Isaia G, Giorgino R, Rini GB, Bevilacqua M, Maugeri D, Adami S. Prevalence of hypoVitaminosis D in
elderly women in Italy: clinical consequences and risk factors. Osteoporos Int. 2003;14:577-582.
10. Passeri G, Pini G, Troiano L, Vescovini R, Sansoni P, Passeri M, Gueresi P, Delsignore R, Pedrazzoni M,
Franceschi C. Low Vitamin D status, high bone turnover, and bone fractures in centenarians. J Clin
Endocrinol Metab. 2003;88:5109-5115.
11. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-hydroxyVitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168:1174-80.
12. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture
prevention with Vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA.
2005;293:2257-2264.
13. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium
supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85:1586-1591.
14. Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP. A higher dose of Vitamin d
reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc.
2007;55:234-239.
15. Garland CF, Gorham ED, Mohr SB, Grant WB, Garland FC. Breast cancer risk according to serum s5-
hydroxyVitamin D: Meta-analysis of dose-response. Presented at: American Association for Cancer
Research Annual Meeting; April 12-16, 2008; San Diego, California.
16. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyVitamin D levels and risk of
multiple sclerosis. JAMA. 2006;296:2832-2838.
17. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of Vitamin D and risk of type 1
diabetes: a birth-cohort study. Lancet. 2001;358:1500-1503.
18. Szeto FL, Sun J, Kong J, Duan Y, Liao A, Madara JL, Li YC. Involvement of the Vitamin D receptor in the
regulation of NF-kappaB activity in fibroblasts. J Steroid Biochem Mol Biol. 2007;103:563-566.
19. Boxer RS, Dauser DA, Walsh SJ, Hager WD, Kenny AM. The association between Vitamin D and
inflammation with the 6-minute walk and frailty in patients with heart failure. J Am Geriatr Soc.
2008;56:454-461.
20. Melhus H, Michaëlsson K, Kindmark A, Bergström R,. Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture. Annals of Internal Medicine, 1998;129(10):770-8.
21. Johansson S, Melhus H. Vitamin A antagonizes calcium response to vitamin D in man. J Bone Mineral Res. 2001;16(10):1899-905.
Robert G Carlson, MD, FACS
Patient EB is a 50-year-old female with a family history of colon cancer and breast cancer as well as a history of arthritis with probable autoimmune etiology. She takes a daily multivitamin which includes 10,000 units of Vitamin A as well as a separate 1000 IU of Vitamin D3 and her 25-(OH) Vitamin D3 level is 36 ng/mL (reference range 33-100 ng/mL). Should EB increase her dose of Vitamin D3? Should she continue her multi-vitamin?
There are so many myths surrounding Vitamin D. First and foremost, is the myth that Vitamin D is
a Vitamin. Vitamin D is not a Vitamin, it is actually a steroid hormone. Vitamin D is produced in one part of the body (the skin), and then travels to a remote site, where it exerts an endocrine effect. Thus, it fulfills the definition of a hormone. Another Vitamin D myth is that its only function is calcium regulation. That idea has been well and truly debunked in recent years. Then there is the idea that 1000 IUs a day is more than enough, which is simply not true. Also many believe that taking over 2000 units a day might cause toxicities. I hear this from numerous health professionals and even from pharmacists who should know better. The literature is very clear…..evidence from clinical trials shows that a prolonged intake of 10,000 units of Vitamin D per day poses no risk of adverse effects for adults 1 ……therefore one can take 10,000 units a day and have no risk for toxicity.
Other myths of interest include:
1) Most people living in the US get adequate amounts of Vitamin D – not true (see below).
2) Extreme care must be taken to avoid toxicity – not true! There have been numerous
studies on Vitamin D toxicity and no toxicity has been seen in doses lower than 30,000
IU/day (200 ng/mL). An excess of Vitamin D causes hypercalcemia, however all known
cases of Vitamin D toxicity with hypercalcemia have involved intakes of 40,000 IU or more
per day.2
3) Spending 15 minutes in the sun each day enables the body to produce ample amounts of
Vitamin D – that may be true if you are sitting on a beach in Hawaii at noon wearing
nothing but a bikini, but for the vast majority of us that is a myth. Unfortunately, once sunscreen is applied the Vitamin D production drops to nothing. If you live above 35 degrees latitude, the body is unable to produce adequate amounts of Vitamin D from the winter sun. In fact the only adequate amount of sunshine in Boston occurs, between May and Sept, otherwise there is inadequate sunlight for Vitamin D metabolism.
4) Eating a balanced diet will provide adequate amounts of Vitamin D – not true! Vitamin D is present, in small amounts, in only a handful of foods – oily fish, eggs, and fortified
foods. Vitamin D fortified Milk and Orange Juice only contain 50 Units of Vitamin D2, not Vitamin D3. Thus it is very unlikely that adequate amounts could be obtained from the diet.
• Vitamin D does not prevent cancer – it does , in fact one study showed the reduction in all cancers by 77 % over a four year period in a well designed study.(see below).
• Vitamin D does not prevent autoimmune disease – it does , reducing Systemic Lupus ,Rheumatoid Arthritis and Childhood onset diabetes(see below).
• Vitamin D does not prevent acute MI and heart disease – it does (see below).
As mentioned above, the notion that most people living in the US get adequate amounts of
Vitamin D is far from true. Research has shown that Vitamin D deficiency is present among all age groups of US citizens from children to the elderly, and especially in African-Americans.3 Studies have shown that the prevalence of low 25-(OH) D levels (<20 ng/mL) is approximately 36% in young adults aged 18-294 ,42% of African-American women aged 15-495 ,41% of outpatients aged 49-83,6 and 57% of inpatients.7
In Europe, it is believed that between 28 and 100% of healthy adults and 70-100% of hospitalized adults have low 25-(OH) D levels (<20 ng/mL).8,9,10
A study we completed examining women age 35-65 in Tampa, Florida in December, demonstrated that 92 % of the women had 25-(OH) D levels less than the low normal range of 32. Can you imagine what the Vitamin D levels are in the same group of women in Minneapolis, Minnesota in December?
Research has shown that the incidence of many diseases could be dramatically reduced by
increasing serum 25-(OH) D levels, and by looking at the list below, it is easy to see why Vitamin D has become a very hot topic in recent years:
1) Increasing serum 25-(OH) D levels to 35 ng/mL could prevent 30% of MI in men11 and
reduce the risk of fracture in elderly people by 50%.12
2) Increasing serum 25-(OH) D levels to approximately 40 ng/mL could reduce the risk of
cancer in postmenopausal women by 35%13 and reduce the risk of falls in elderly people
by 50%. 14
3) Increasing serum 25-(OH) D levels to 50 ng/mL could reduce the incidence of breast
cancer by as much as 80%,15 multiple sclerosis by as much as 60%,16 and type I
diabetes by up to 50%.17
Why is Vitamin D so beneficial? There is no clear answer at present. However, anything that has
such wide-ranging benefits has to possess the ability to modulate inflammation. Indeed, studies have shown that Vitamin D inhibits nuclear factor-κβ (NF-κβ) 18 – a protein that plays a key role in the inflammatory response and in the proliferation of cancer cells. It has also been shown to lower levels of the inflammatory marker CRP.19 Thus, it is vital that we ensure our patients are getting plenty of Vitamin D.
What about Patient EB, does she need to increase her daily dose of Vitamin D3? Yes. The
reference range for 25-(OH) D is 32-100 ng/mL Given the evidence published in the medical literature over the last few years, it is advisable to try and keep patients at the top end of the reference range – so, we should be aiming for 75-100 ng/mL The optimal dose for an average person is 5000-15,000 IU/day; however this should be lowered for people who get a lot of sun exposure. Ideally check Vitamin D leveIs and regularly check serum calcium in patients who take supplementary Vitamin D, just to ensure there is no risk of hypercalcemia.
So what about her multi-Vitamin choice? Some multi-Vitamins may be doing more harm than good. I recommend avoiding excessive amount of pre-formed Vitamin A in the retinol form, as opposed to the beta-carotene form that converts to Vitamin A in your body. The presence of excessive pre-formed actually will neutralize all the amazing benefits of Vitamin D3.20 Unfortunately, multi-vitamins often continue a lot of Vitamin A(average 4400 units) as retinol and very low levels of D3( average 400). Vitamin A and Vitamin D receptors are very close to each other and excess Vitamin A will block the beneficial effects of Vitamin D. Women who took the highest intake of pre-formed Vitamin A actually had twice as many hip fractures. 21 So keep the non- beta carotene Vitamin A supplements to less than 1000 units, and this will allow all the amazing benefits of Vitamin D3.
CONCLUDING REMARKS
There are many myths surrounding hormone replacement therapies, however from the evidence
presented above, we can see that not one of them is true. Hormone optimization provides us with an extremely powerful anti-aging tool to maximize quality of life.
REFERENCES
1. Vieth R. Vitamin D and Cancer Mini-Symposium: the risk of additional Vitamin D. Ann Epidemiol. 2009; 19(7):441-5.
2. Vieth R. Vitamin D supplementation, 25-hydroxyVitamin D concentration, and safety. Am J Clin Nutr. 1999;69:842-56.
3. Holick MF. High prevalence of Vitamin D inadequacy and implications for health. Mayo Clin Proc.
2006;81:353-373.
4. Tangpricha V, Pearce EN, Chen TC, Holick MF. Vitamin D insufficiency among free-living healthy young
adults. Am J Med. 2002;112:659-662.
5. Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C,
Gunter EW, Bowman BA. HypoVitaminosis D prevalence and determinants among African American and
336 white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. Am
J Clin Nutr. 2002;76:187-192.
6. Malabanan A, Veronikis IE, Holick MF. Redefining Vitamin D insufficiency [letter]. Lancet. 1998;351:805-
806.
7. Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM,
Prince RL, Finkelstein JS. HypoVitaminosis D in medical inpatients. N Engl J Med. 1998;338:777-783.
8 . McKenna MJ. Differences in Vitamin D status between countries in young adults and the elderly. Am J
Med. 1992;93:69-77.
9. Isaia G, Giorgino R, Rini GB, Bevilacqua M, Maugeri D, Adami S. Prevalence of hypoVitaminosis D in
elderly women in Italy: clinical consequences and risk factors. Osteoporos Int. 2003;14:577-582.
10. Passeri G, Pini G, Troiano L, Vescovini R, Sansoni P, Passeri M, Gueresi P, Delsignore R, Pedrazzoni M,
Franceschi C. Low Vitamin D status, high bone turnover, and bone fractures in centenarians. J Clin
Endocrinol Metab. 2003;88:5109-5115.
11. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-hydroxyVitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168:1174-80.
12. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture
prevention with Vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA.
2005;293:2257-2264.
13. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium
supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85:1586-1591.
14. Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP. A higher dose of Vitamin d
reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc.
2007;55:234-239.
15. Garland CF, Gorham ED, Mohr SB, Grant WB, Garland FC. Breast cancer risk according to serum s5-
hydroxyVitamin D: Meta-analysis of dose-response. Presented at: American Association for Cancer
Research Annual Meeting; April 12-16, 2008; San Diego, California.
16. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyVitamin D levels and risk of
multiple sclerosis. JAMA. 2006;296:2832-2838.
17. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of Vitamin D and risk of type 1
diabetes: a birth-cohort study. Lancet. 2001;358:1500-1503.
18. Szeto FL, Sun J, Kong J, Duan Y, Liao A, Madara JL, Li YC. Involvement of the Vitamin D receptor in the
regulation of NF-kappaB activity in fibroblasts. J Steroid Biochem Mol Biol. 2007;103:563-566.
19. Boxer RS, Dauser DA, Walsh SJ, Hager WD, Kenny AM. The association between Vitamin D and
inflammation with the 6-minute walk and frailty in patients with heart failure. J Am Geriatr Soc.
2008;56:454-461.
20. Melhus H, Michaëlsson K, Kindmark A, Bergström R,. Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture. Annals of Internal Medicine, 1998;129(10):770-8.
21. Johansson S, Melhus H. Vitamin A antagonizes calcium response to vitamin D in man. J Bone Mineral Res. 2001;16(10):1899-905.
Robert G Carlson, MD, FACS
Prostate Cancer and Men Robert G Carlson, MD
Prostate Cancer Myth:
Testosterone therapy causes prostate cancer
Absolutely not, in fact lower testosterone levels are associated with an increased incidence of Prostate cancer.
For over 60 years there has been an overwhelming fear that testosterone therapy for low testosterone levels will cause new cancers or hidden ones to grow. There is very little scientific data to support that philosophy but even in the face of numerous recent studies saying there is NO association, doctors are still telling their patients that testosterone therapy causes prostate cancer. Instead the opposite is true. Low blood levels of testosterone don’t protect against prostate cancer, but in fact lower testosterone levels are associated with increased incidence of prostate cancer.
A Journal of National Cancer Institute article in 2008, pooled 18 separate studies looking at the effect of testosterone therapy and prostate cancer. In over 9000 men studied, there was no relationship between testosterone therapy and Prostate cancer. NONE. The authors pleaded with the medical community to move past the long-believed, but unsupported view that testosterone therapy causes prostate cancer. IT DOES NOT CAUSE PROSTATE CANCER.
To summarize:
1) Low testosterone levels do not protect against prostate cancer, and in fact are associated with a higher incidence of prostate cancer.
2) High testosterone levels in men are not associated with an increased incidence of prostate cancer.
3) Treatment with testosterone therapy does not increase the incidence of prostate cancer, even in the men who are presumably at a higher risk.
4) If a man has metastatic prostate cancer (spread all over) and has been aggressively treated to lower testosterone levels, then careful management with testosterone therapy is recommended.
5) By restoring Testosterone levels to healthy levels, aging men should expect higher energy levels, memory improvement, improvement of depression, reduction of osteoporosis, and improvement in erectile dysfunction.
Robert G Carlson, MD, FACS
Testosterone therapy causes prostate cancer
Absolutely not, in fact lower testosterone levels are associated with an increased incidence of Prostate cancer.
For over 60 years there has been an overwhelming fear that testosterone therapy for low testosterone levels will cause new cancers or hidden ones to grow. There is very little scientific data to support that philosophy but even in the face of numerous recent studies saying there is NO association, doctors are still telling their patients that testosterone therapy causes prostate cancer. Instead the opposite is true. Low blood levels of testosterone don’t protect against prostate cancer, but in fact lower testosterone levels are associated with increased incidence of prostate cancer.
A Journal of National Cancer Institute article in 2008, pooled 18 separate studies looking at the effect of testosterone therapy and prostate cancer. In over 9000 men studied, there was no relationship between testosterone therapy and Prostate cancer. NONE. The authors pleaded with the medical community to move past the long-believed, but unsupported view that testosterone therapy causes prostate cancer. IT DOES NOT CAUSE PROSTATE CANCER.
To summarize:
1) Low testosterone levels do not protect against prostate cancer, and in fact are associated with a higher incidence of prostate cancer.
2) High testosterone levels in men are not associated with an increased incidence of prostate cancer.
3) Treatment with testosterone therapy does not increase the incidence of prostate cancer, even in the men who are presumably at a higher risk.
4) If a man has metastatic prostate cancer (spread all over) and has been aggressively treated to lower testosterone levels, then careful management with testosterone therapy is recommended.
5) By restoring Testosterone levels to healthy levels, aging men should expect higher energy levels, memory improvement, improvement of depression, reduction of osteoporosis, and improvement in erectile dysfunction.
Robert G Carlson, MD, FACS
Monday, March 8, 2010
DHA - The Importance of Omega 3
A video on Omega 3 fatty acids.
DHA is a major structural and functional component of our central nervous system, accounting for over 30 % of the total fatty acid content of the human brain. It is essential for the growth and development of brain tissues in infants and children. In adults, it helps assist in supporting normal brain function, including memory and, learning. Horrocks in 1999 described the associated increase risk of Alzheimer’s disease in patients with low DHA levels. In concert with phosphatidylserine, researchers at the NIH revealed that DHA supports energy production in brain cells, and is critical in healthy brain function.
A large number of studies have shown that omega-3 oils can improve brain function, decrease inflammation, reduce the incidence of lethal heart attacks and ischemic strokes,, improve the outcome of autoimmune diseases, and improve vision, reducing the development of macular degeneration.
Monday, February 1, 2010
The Best Sleep You’ll Ever Have
The Best Sleep You’ll Ever Have… is in your grasp and so simple.
Robert G Carlson, MD
Do you have trouble falling asleep? Or perhaps you’re able to fall asleep, but then plagued by constantly waking up throughout the night, resulting in a broken, restless sleep that leaves you feeling like a zombie the next morning?
Have you been given sleeping pills to help with your sleep, pills that leave you spaced out, like you’re moving in slow motion and not fully rested? Not being able to sleep is critical, resulting in loss of memory, ineffective work habits, and increasing irritability. Starting in their early 40’s, women are in commonly plagued with sleeping problems. The answer is really quite simple. About ten years before menopause, ladies progesterone levels start to plummet. This sets them up for sleepless nights. Progesterone, natural progesterone that is soy-based, not the peanut oil pharmaceutical progesterone Prometrium, provides improvement in sleep, dramatic reduction in irritability (who wouldn’t be irritable if you can’t sleep and remain exhausted), reduction in headaches and the reduction in the signs of estrogen dominance. Besides natural progesterone, NOT synthetic progestins like Prempro or Provera, has now been shown to reduce breast and uterine cancer, reduce cholesterol and reduce heart disease. And it also makes you feel better!
Sleep medicines don’t deal with the real underlying causes of why women are having trouble sleeping as they get older. The major reason is because progesterone levels are so low. Progesterone is like nature’s valium, it is the Feng-Shui of hormones providing calmness and relaxation, factors critical in falling asleep.
With women who are either perimenopausal(which can be up to 10 years before menopause), menopausal, or suffering from surgically induced menopause (hysterectomy), the progesterone levels can drop to such low , immeasurable level that ladies simply can’t sleep. It often takes women an hour or more to get to sleep or they find themselves waking up throughout the night.
So how does bio-identical hormone replacement therapy help?
When natural progesterone is taken as a pill, versus in the cream, it travels to the brain and interacts with the GABA receptors. These receptors when activated naturally promote sleep and help patients reach the restorative sleep (REM sleep) more quickly.
How does hormone replacement with progesterone differ from taking sleeping pills when it comes to the quality of sleep a woman might expect?
Sleeping pills are synthetic, not natural. There is nothing natural about them, and because of that the natural restorative REM sleep is never achieved. Oh yes, sleeping pills will help you get to sleep, but they don’t get the quality of sleep achieved naturally. When I treat women struggling with sleep issues in their 40’s and 50’s, sleep undoubtedly affected by progesterone levels, one of the most common response I hear after starting progesteroneis ‘This is the best sleep I’ve ever had’.
How quickly can patients expect results?
I have seen patients experience results very quickly. Sometimes within the first one or two doses. They often can’t believe how rested they are when they wake up and want to get rid of their sleeping pills as soon as possible.
One patient of mine, Erika is a perfect example of the difference a good night’s sleep can make. In her early fifties, I met Erika with major concerns of “I just can’t sleep”. She had been experiencing “on and off sleep” – waking up frequently throughout the night for years. Essentially sleep deprived. The lack of sleep was making her feel older than her years, and mentally and physically exhausted. She told me, “It was horrible and very hard to function.”
After only a few weeks of hormone replacement however Erika reported to me with excitement in her voice, “I can sleep now. I can think clearly now. It’s unbelievable.” Though still dealing with the stresses and pressures of before, she finds it easier to deal with now she has the benefit of a full and restful night’s sleep. “I really do feel like this very huge dark cloud has been lifted, thanks to you, Dr. Carlson.” She said fighting off tears of joy. “I see everything in a different view.” Her words of encouragement to ladies struggling with menopause and sleeping problems are: “I’m sleeping through the night and feeling like I’m back in my twenties or thirties. It’s amazing.”
Thursday, January 21, 2010
Why T4 is prescribed when T3 is what patients need?
Most endocrinologists doggedly follow practice guidelines from the American Association of Clinical Endocrinologists. As many patients have told us, their endocrinologist switched them to T4 only replacement and they became ill and dysfunctional again. These reports are consistent with studies that show the ineffectiveness and potential harm of T4 alone replacement. The studies show that T4 only replacement leaves many patients suffering chronically from hypothyroid symptoms [1][2][3][4][5][6][7] and gaining weight they can't lose through dieting and exercise.[8] The patients are also likely to be prescribed additional medications to take care of side-effects and mistreated symptoms, which can lead to the development of one or more potentially-fatal diseases.[9]
Potential harm from T4 only replacement has been documented in studies and reports to some of the most reputable scientific and medical journals. In view of the risks, you must consider for yourself whether to allow your therapy to be changed from a T3+T4 combination treatment to a T4 alone treatment. If you decide not to permit it, there are doctors who know the risks and will not let you continue to suffer this mistreatment. A doctor who understands how ineffective and harmful T4 alone replacement is for patients. Some doctors provide individualized care, and are willing to listen to their patients and take the time to find how to treat them, rather than blindly treat them as if a medical guideline is some kind of perfect law written by an all knowing entity.
One needs only look at the history of the practice guidelines to find they are refined when there is an overwhelming amount of evidence that there is a better solution. Bleeding people, lobotomies, electroshock therapy were all widely prescribed practice guidelines at one point. More recently, we have an ever expanding list of medications withdrawn from the market each year, a trend that increased dramatically in the last two decades. Brand names like Fen-Phen, Propagest, Vioxx, Levaquin, Chantix, Prempro, and many others have made the news after overwhelming evidence finally caused them to fall from widely prescribed guideline standards to the focus of public outcry and lawsuits. From this standpoint, it is hard to understand how doctors not prescribing medications with mounting evidence against them are dismissed as “alternative”. Many of these “alternative” medications have long-term evidence of their efficacy and low risk of side effects. In fact, they all have the stamp of approval from the FDA to treat what they are symptoms/disease/disorder for which they have been prescribed. Armour Thyroid, for instance, was the first thyroid medication. The original patent predates the FDA. Until recently, the FDA listed it as GRAS (Generally Recognized As Safe), a designation with more stringent requirements than a new medication goes through. It was only when it was discovered that taking an extremely high dose could worsen heart problems that it was downgraded to a medication like everything else on the market.
What “alternative” medications have one in common is they are available in generic brands. What is revolutionary about them is not that they are some brand new medication. Rather, they is a well refined, heavily researched, better understanding of how best to treat the disorders/diseases/symptoms. The medical community simply knows more about medicine than we did even a year ago. There are many instances when something as simple as knowing when to or how to take a medication is more revolutionary than a new medication to treat the same problem.
Armed with not only the research available, but the knowledge of the issue at hand, you should be able to determine who will help you ferret out and correct the cause of your symptoms.
References
1. Walsh, J.P., Shiels, L., Mun Lim, E.E., et al.: Combined thyroxine/liothyronine treatment does not improve well-being, quality of life, or cognitive function compared to thyroxine alone: a randomized controlled trial in patients with primary hypothyroidism. J. Clin. Endocrinol. Metab., 88(10):4543-4550, 2003.
2. Sawka, A.M., Gerstein, H.C., Marriott, M.J., et al.: Does a combination regimen of thyroxine (T4) and 3,5,3'-triiodothyronine improve depressive symptoms better than T4 alone in patients with hypothyroidism? Results of a double-blind, randomized, controlled trial. J. Clin. Endocrinol. Metab., 88(10):4551-4555, 2003.
3.
4. Cassio, A., Cacciari, E., Cicgnani, A., et al.: Treatment of congenital hypothyroidism: thyroxine alone or thyroxine plus triiodothyronine? Pediatrics, 111(5):1055-1060, 2003.
5. Bunevicius, R., Kazanavicius, G., Zalinkevicius, R., and Prange, A.J. Jr.: Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N. Engl. J. Med., 11:340(6):424-429, 1999.
6. Bunevicius, R. and Prange, A.J.: Mental improvement after replacement therapy with thyroxine plus triiodothyronine: relationship to cause of hypothyroidism. Int. J. Neuropsychopharmacol., 3(2):167-174, 2000 (June).
7. Bunevicius, R., Jakubonien, N., Jurkevicius, R., Cernicat, J., Lasas, L., and Prange, A.J. Jr.: Thyroxine vs thyroxine plus triiodothyronine in treatment of hypothyroidism after thyroidectomy for Graves' disease. Endocrine, 18(2):129-133, 2002.
8. Tigas, S., Idiculla, J., Beckett, G., and Toft, A.: Is excessive weight gain after ablative treatment of hyperthyroidism due to inadequate thyroid hormone therapy? Thyroid, 10(12):1107-1111, 2000.
9. Saravanan, P., Chau, W.F., Roberts, N., et al.: Psychological well-being in patients on ‘adequate' doses of L-thyroxine: results of a large, controlled community-based questionnaire study. Clin. Endocrinol. (Oxf.), 57(5):577-585, 2002.
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