September 10, 2001 Research Update

James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com

Transdermal Dihydrotestosterone in Older Men w/ Androgen Deficiency

We get into a topic that always gets me a little concerned. I am usually against adding hormones to a patient's body, especially when alternatives are available. This study uses DHT to affect these patient's "youthful" status. A few things to consider here... DHT has been implicated in prostate cancer risk and this study only checks values at 3 months--hardly an adequate time frame in my opinion. Balancing the body is the key here; especially making sure that the adrenal glands are functioning optimally so they can provide adequate levels of testosterone. Next, how do we know, in our laughingly poor overall understanding of biochemistry, that lowered hormone levels in old age is bad?? There is much evidence that suggests that this is indeed a protective mechanism done deliberately by the body to protect from diseases such as cancer. Personally, in a bet of nature vs science being right, I'd put my money on nature... JCEM -- Abstracts: Ly et al. 86 (9): 4078 http://jcem.endojournals.org/cgi/content/abstract/86/9/4078

Resistance to Glucocorticoid Feedback in Obesity

Once again we see how important the adrenal glands are to our health. This study basically status that the adrenal cortex is shutting down in obese patients. The pituitary is trying to prod the adrenals to work but cannot get the adrenals to produce enough cortisol (and by inference I'm sure DHEA levels would also be low). Checking adrenal status is looking more and more to be an essential part of any workup on a patient with a multitude of chronic diseases. JCEM -- Abstracts: Jessop et al. 86 (9): 4109 http://jcem.endojournals.org/cgi/content/abstract/86/9/4109

Dehydroepiandrosterone Sulfate, Mortality in Elderly Men and Women

Well..doesn't adrenal cortical function seem to be a hot topic lately?? As a quick review, the adrenal cortex produces aldosterone (regulates BP), cortisol (the stress hormone) and DHEA (precursor to estrogen and testosterone). Low levels of DHEA indicate adrenal stress and improper function. Whether this is a result of the adrenals shunting towards cortisol production or whether the adrenal cortex is failing can be determined with adrenocortical testing using salivary levels. JCEM -- Abstracts: Trivedi and Khaw 86 (9): 4171 http://jcem.endojournals.org/cgi/content/abstract/86/9/4171

Phytoestrogen Consumption and Breast Cancer Risk

Scanning quickly would give you the idea that soy intake has no effect on breast cancer risk in non-asian women. Reading further, however, you will find that this study evaluated their "usual" intake of tofu at one serving per week, which is less than the 3+ servings shown to be protective in other studies. Am. J. Epidemiol. -- Abstracts: Horn-Ross et al. 154 (5): 434 http://www.aje.oupjournals.org/cgi/content/abstract/154/5/434

Oral Contraceptive Use and HRT Associated w/ Microalbuminuria

Many studies have linked impaired insulin sensitivity with microalbuminuria. Other studies have linked oral contraceptive use with worsening insulin sensitivity. This study sort of brings the two concepts together. Oral Contraceptive Use and Hormone Replacement Therapy Are Associated With Microalbuminuria http://archinte.ama-assn.org/issues/v161n16/abs/ioi00763.html

Ultra-Low-Dose Oral Contraceptive Effectively Treats Acne

Many times, acne can be caused by excess testosterone. In today's lifestyle patterns, high insulin levels can effect the conversion of estrogen into testosterone effectively increasing testosterone levels. One of the best ways to approach acne actually comes from within...balancing insulin levels, restoring health of the GI tract (probiotics, glutamine...), Vit A, essential fatty acids... Giving estrogens in this study may work by blunting the difference between estrogen and testosterone levels in the body, but does not actually work by lowering the excess testosterone.

Fertil Steril. 2001;76(3):461-468 An ultra-low-dose oral contraceptive has been shown to be just as effective in treating acne as pills with higher doses of estrogen, according to a study published in the September issue of Fertility and Sterility. "Our study confirms that an oral contraceptive containing only 20 micrograms of estrogen — the lowest dose on the market today — is effective in suppressing androgen production and reducing acne lesions," said Diane Thiboutot, MD, lead study investigator and associate professor of medicine at Penn State College of Medicine in Hershey, Pennsylvania. "This clinical trial is good news for women because it shows that we now have more birth control choices that are not only 99% effective in preventing pregnancy, and offer numerous other health benefits, but can also treat acne lesions without causing a change in weight — a common estrogen-related side effect," said Dr. Thiboutot."In addition, the choice of a low-dose contraceptive resulted in a low occurrence of estrogen-related side effects like nausea, headaches, and breast tenderness, in addition to weight gain," she added. "If women experience fewer side effects and can treat their acne, they may be less likely to discontinue pill use, to switch to a less effective method of birth control, or to use no birth control at all."

DHEA Deemed 'Effective Hormonal Replacement Treatment' for Women

Getting the idea? As mentioned numerous times, I am against using hormones in the body as a first resort to replace hormones that are low. In peri and postmenopausal women, balancing adrenal steroidogenisis should be the first plan of attack. This along can increase DHEA levels without exogenous administration. This lets the body find its own level instead of modulating it from outside. If this is unsuccessful, than a trial of DHEA is warranted (can also be used if adrenocortical testing indicates adrenal exhaustion with no DHEA or cortisol being produced). The author comes to a dangerous conclusion at the end of the article, suggesting that DHEA should be moved from the supplement category to hormone replacement; this would take DHEA off the health food shelves.

Fertil Steril 2001;76:241-248 Treatment with dehydroepiandrosterone (DHEA) is similar to that with estrogen-progestin replacement therapy in its effects on several endocrine parameters in postmenopausal women, Italian physicians report. Dr. Alessandro D. Genazzani, now with the University of Modena, and associates from the University of Pisa treated 31 women with oral DHEA 50 mg daily for 6 months. The subjects were grouped according to age and body mass index. Hormone evaluations and a growth hormone releasing hormone (GHRH) test were performed before and after the trial. "Oral DHEA treatment annulled the differences observed between early and late postmenopause, including those strictly related to excess body weight," the physicians write in the August issue of Fertility and Sterility. Plasma levels of steroids that derived from DHEA metabolism increased, as did osteocalcin, growth hormone (GH), and insulin-like growth factor 1 (IGF-1). Levels of luteinizing hormone and follicle stimulating hormone decreased. DHEA treatment was similar in its effect on the GHRH-GH-IGF-1 axis as treatment with estrogen-progestin, Dr. Genazzani's group concludes. They recommend that DHEA be considered not just a diet supplement but an effective hormone replacement treatment.