Restorative Medicine Conference Stowe, VT 2006

Integrative Natural Hormonal

ModulationBy Al Sears, MD

First Things First

What’s a Hormone? And… What’s not? New from: The Department of Redundancy Department

Why?1. Hormones involved in everything.2. Often most natural option.3. Disease = loss of homeostasis =

hormonal imbalance.4. Bridge gap between disease Rx and

health improvement.5. We are born into altered environs.6. Hormones are primary mediators of

aging.

How?In Preferred Order

1. Enlightenment2. Activity Guidance3. Food4. Exercise5. Nutritional Supplements6. Exogenous Hormones7. Herbal Supplements

5 Modern Hormonal Epidemics

1. Hyperinsulinemia2. Vitamin D Deficiency3. Adrenal Fatigue4. Estrogen Excess5. Abnormal Aging

Hyperinsulinemia

Cholesterolemia (with Iatrogenic Cascade)

Heart Disease Obesity Fatigue Accelerated Aging Environmental Diabetes

Heart Disease: # 1 Killer

Heart disease claims 950,000 lives each year.

More than half who die are women. Heart disease claims more women’s

lives than next 6 killers combined.

Each minute another woman dies from heart disease.

"Heart Disease and Stroke Statistics—2005 Update," American Heart Association.

Cholesterol Mistake

Cholesterol is the Most Fundamentally Important Hormone Precursor!

Cholesterol Provides the Basic Building Blocks for ALL Steroid Hormones

Cholesterol: The Red Herring

80% of people who have heart attacks have the same cholesterol profiles as those who don’t have heart attacks.

National Cholesterol Education Program

Cholesterol-lowering drugs are being prescribed to 13 million people.

The new NCEP guidelines include more people. Under new guidelines, the number may climb to 36 million

But Who Is the NCEP?

8 of the 9 NCEP doctors made money from cholesterol-lowering drugs.

2 own stock in statin drugs. 2 others worked for drug companies

after setting the guidelines. One was a consultant for 10 drug

companies.

Source: USA Today, October, 2004.

Cholesterol Drugs Lipitor made $8 billion for Pfizer

last year. Pfizer sponsors studies for

journals. Recent Pfizer study concluded that people with normal cholesterols benefit.

Statins block production of CoQ10.

Fatique and muscle soreness prevents exercise.

J-Lit (2002)

Japanese Lipid Intervention Trial 6-year study of 47,294 taking simvastatin No correlation between LDL reduction and

death rate LDL below 80 had death rate of 3.5 at 5

years LDL over 200 had death rate of 3.5 at 5

years

Statins and Plaque

American Journal of Cardiology, 2003 Examination of coronary plaque buildup in

182 people taking statins One group took over 80mg a day The other group took less than 80mg a

day No correlation between statins and plaque

reduction– at either dose At the end of 1 year, both groups showed

a 9.2 percent increase in plaque buildup

Statins and Women

ASCOT-LLA (2003) Lipitor vs. Placebo over 3 years No statistical difference in heart

attacks, strokes, or mortality.The University of British Columbia

Therapeutics Initiative Statins offer no benefit to women for

prevention of heart disease

Statins Side Effects, Pt. 1

Muscle Weakness: Most common problem is fatigue. Study found 98% taking Lipitor had muscle problems. Can be debilitating. Rhabdomyolysis, can kill.

Neuropathy: Permanent nerve damage. Starts as weakness, tingling in the hands and feet. Statins increase risk with duration. After one year, risk is 15 percent higher. After two years, 26 percent higher.

Statins Side Effects, Pt. 2 Heart Failure: Statins deplete

CoQ10, risk of heart failure climbs with dose and duration. In the first eight years statins were available, deaths from congestive heart failure more than doubled.

Memory Loss: Many have trouble recalling basic facts about lives – like how old they are or where they live. Some experience global transient amnesia, complete memory loss for a brief period.

Statin Side Effects, Pt. 3

Depression: Multiple studies link low cholesterol and cholesterol treatment with depression

39 percent of women with low cholesterol have depression

HDL More Important than LDL

Castiglioni A, Neuman R. HDL Cholesterol: What Is Its True Clinical Significance? Emergency Medicine. Jan 2003. p30-42.

The Best Predictor of CV Risk

Physician’s Health Study - 15,000 men High homocysteine = 3 times heart attack risk regardless of cholesterol

20 studies linked homocysteine and cardiac events

You can lower homocysteine with B vitamins at less than $10 per month

BIOLOGICAL MARKERS INSULIN plays a key role in aging…

• Increases with age• Tells body to build fat• Keep insulin level below 20• Below 10 even better

Case Study: CF's Body Composition

Weight 325 283 226 222 221% of Fat  55 42 15 8 7

Fat LBS  177 119 33 18 15

L.B.M  148 164 193 205 206

The Big Fat Lie

Pre-Agricultural Diet

Protein31%

Carbs31%

Fats38%

Typical American Diet

Carbs49%

Fats35%

Protein16%

Low Glycemic Load vs. Low Fat Diet

Low GL diet decreases clotting agent plasminogen by 39% vs. a 33% increase from a low fat diet.1

High GL consumption nearly doubles relative risk of heart disease in women.2

1. Ebbeling CB, et al. Effects of an ad libitum low-glycemic load diet on cardiovascular disease risk factors in obese young adults. Am J Clin Nutr 2005; 81(5): 976-82

2. Liu S, Willett WC, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 2000; 71(6): 1455-61

More Advantages to Low Glycemic Load Diet

Low GL diet decreases abdominal obesity better than low fat diet.

Low GL diet increases HDL cholesterol levels -- low fat diet has no effect on HDL levels.

Low GL diet lowers fasting blood glucose -- low fat diet increases it.

Lahaye SA, et al. Comparison between a low glycemic load diet and a Canada Food Guide diet in cardiac rehabilitation patients in Ontario. Can J Cariol 2005; 21(6): 489-94

High Glycemic Foods

Potato (white, boiled) 104

Rice Krispies 82

French Baguette 95 French Fries 76

Corn Flakes 92 Bagel (white) 71

Instant Rice 91 Mac & Cheese 64

Low Glycemic Foods

Grapes 43 Chicken 0

Grapefruit 25 Eggs 0

Cherries 22 Spinach 0

Beef 0 Walnuts 0

Vitamin D as a HormoneStrengthens immunityReduces inflammationPrevents cancerPrevents multiple sclerosisIncreases muscle strengthPrevents diabetesLowers blood sugarIncreases insulin

sensitivityReduces cavitiesImproves moodPrevents depressionStrengthens bonesPrevents arthritis

Reduces risk of heart attackLowers blood pressureReduces cholesterolBalances other hormonesEliminates PMSPrevents hearing lossImproves reaction timeIncreases balanceEliminates back painBoosts fertility both sexesRaises libidoBalances sleep cyclesOptimizes weight

Change in an Ancient Relationship

98% of time humans on this planet, we lived naked in the sun, near the equator

The shift to indoors sudden and recent change

If evolutionary period single day:

Last day we migrated away from equator

Last few hours we put on clothes

Last few minutes we started working inside

Last minute we started traveling in vehicles

Last second we covered ourselves in sunscreen

Sun Wrongly Blamed for Prevalence of Skin Cancer

Skin cancer rare before 1930 – when many worked outside

Rate of melanoma up 1,800% since our grandparents generation

Rate of melanoma up 400% since mid 1970s – start of public awareness regarding “sun protection”

Endemic of Vitamin D Deficiency

• 50,000-70,000 Cancer deaths in US every year from insufficient vitamin D

• 300,000 Deaths in US (all cause) every year from insufficient vitamin D

• 85% of the population is deficient to some degree

• Nearly 100% of African-Americans are vitamin D deficient

Vitamin D Reference Ranges

The ridiculously low Government’s RDA:• 200 IU of vit D for infants• 200 IU men & women 1-50 years • 400 IU for those 50 to 70 years• 600 IU for people over 70

Healthy adult uses 3,000 to 5,000 units per day (if it is available)

You need 3,000 to 5,000 IU cholecalciferol /day from all sources

Vitamin D Replacement

• Sunlight – 15 minutes a day

• Cod liver oil (400 IU / tsp)

• Wild Salmon

• Sardines

• Vitamin D supplements

Adrenal Fatigue

The most misdiagnosed in US today

Stuck in “fight or flight” mode

Bloodstream repeatedly flooded with adrenaline and cortisol with eventual chronic suppression of DHEA.

Adrenal Response

Natural “fight or flight” response evolved to deal with different world of ancient times

Today’s loud/stressful environment over stimulates adrenals and constantly triggers “fight or flight”

Signs of Deficiency

Muscle wasting Bone loss Increased body fat Anxiety, worry, irritability Tendonitis, fasciitis, bursitis Chronic fatigue Multiple chronic diseases Sequential cascade

DHEA: Reference Ranges

Men:Serum – 110 to 370 mcg/dLSaliva – 137 to 336 pg/ml

Women:Serum – 40 to 325 mcg/dLSaliva – 106 to 300 pg/ml

Rebalancing DHEA

Martial Arts Meditation Acupuncture Yoga Massage PACE exercise program

Boosting DHEA

DHEA Supplementation:

Start with 5 mg a day. No more than 10 mg a day without

testing blood levels.Course often only 1-3 mos.Adrenal recovery common.

Case Study: “DC”

Adrenal FatigueTreatment: DHEA

November,2002

64 mcg/dL

April,2004

377 mcg/dL

August,2006

505mcg/dL

PACE & DHEA

Training for Recovery

Periods of “exertion and recovery” retrain your body to recover from stress

Allows your body to exit “fight or flight” response

Estrogen Excess Syndrome

Adulterated Food Supply Endocrine Disruptors in thousands of

everyday products Precocious Puberty – Girls reaching

puberty by age 6 Men developing feminine features Growing rates of hormone based

cancers – breast, ovarian, endometrial, cervical & prostatic

Xenoestrogens Affects Fertility 15% of US couples are infertile

In 30% to 40% of these cases, male infertility is the problem

British researchers suspected estrogen-mimicking chemical HPTE, commonly found in pesticides

By experimenting on rats, they found that HPTE directly interferes with testosterone production in the testes

Estrogen and Men’s Health1.Tufts University found that crop dusters who

handled estrogen-impersonating pesticides: > Lost their sexual desire > Developed very low sperm counts

2.German researchers found that estrogen levels in prostatic tissue increase as men get older

3.The journal Prostate reported that estrogen increases your risk of benign prostatic hyperplasia (BPH)

4.Japanese researchers discovered link between estrogens and prostate size: “Estrogens are the key hormones for the induction and development of BPH”

Estrogen: Reference RangesMen:Serum - < 130 pg/mLSaliva - < 2.5 pg/mL

Women:Serum – Early Follicular Phase – 70 to 400 pm/mLLate Follicular Phase – 100 to 900 pm/mLLuteal Phase – 70 to 700 pm/mLPostmenopausal - < 130 pm/mL

Saliva –Pre-menopausal – 1 to 10.8Post-menopausal – 1 to 3.2

Symptoms of Estrogen in Men

• Feminization: Gynecomastia • Fat gain • Muscle loss • Cancer • Loss of sex drive • Moodiness & depression

Dangers of a Plastic World

Endocrine Disruptors:Chemicals in everyday products that

mimic estrogen

Vinyl flooring, Deodorants, Hair spray, Moisturizers, Pesticides, Detergents, Perfumes, Garden hoses, Fertilizers, Shampoo, Inflatable toys, Plastics

Estrogen Dangers: 2 Big Offenders

Bisphenol A and Phthalates: Chemicals have structures that look

strikingly similar to estrogen.

Perfluorooctanoic acids (PFOA): CDC results: Every person tested - without exception - had trace amounts of these chemicals in their bloodstream.

Jim Pirkle, deputy director at the CDC's Environmental Laboratory: "The big concern with phthalates is that they have anti-androgen activity."

Reduce Estrogens Daily: Drink only purified water. Trim excess fat from meat before

cooking. (Hormones only in fat.) Estrogen-fighting foods: Berries,

citrus, pineapples, pears, grapes, squash, onions, green beans, figs, melons and pumpkin seeds.

Cruciferous vegetables: Broccoli, cauliflower, Brussels’s sprouts, cabbage - excrete estrogen.

Vegetables high in fiber. Longer stool in bowel, more estrogen absorbed.

Free-range poultry and grass-fed beef whenever possible.

Case Study: B.C.

Estrogen Levels:

Treatment:

DIM 400 mg /day

PACE TIW

April, 2003

180pg/mL

July, 2003 178pg/mL

August, 2003

149pg/mL

October,2003

134pg/mL

BC: Before & After

Case Study: “KB”

Post-Menopausal;Estrogen Levels

Treatment: DIM

August,2005

543 pg/mL

October,2005

268pg/mL

December,2005

171pg/mL

Androgens

Testosterone Precursors

Treatment Dosages

Androstenedione ---- 10mg4-Androstendediol ---- 5mg19-Nor-4 Androstenedione ---- 5mg19-Nor- 4-Androstendediol ---- 5mg

BIOLOGICAL MARKERS Testosterone/Estrogen Ratio

Low Testosterone – loss of energy, mental clarity, bone density, muscle mass and sexual activity M & W.

High Estrogen – obesity, uterine and breast cancer for women, prostate disease for men

Men: 4 to 1 PM Women: from 1 to 2 to 1 to 4

Case Study: “VT” Body Composition

Weight 125 125 118 112 114 118

% of Fat 27 20 17 16 15 13

LBS of Fat 34 25 20 17 17 15

L.B.M 91 100 98 95 97 103

Testosterone Reference Ranges

Men:Serum – 241 to 827 ng/dLSaliva – 30.1 to 142.5 pg/mL

Women: Serum – 20 to 76 ng/dLSaliva – 4.5 to 49 pg/mL

Treatment Strategies

Boosting Testosterone: Increase protein and fat in diet Oral precursor androgens Testosterone shots, gels, patches PACE

Lowering Estrogen: DIM Indole-3 Carbinol Chrysin Durational exercise or PACE

Case Study: “DF”

Initial Meeting: 12/2004Testosterone: 42

Most Recent Follow Up:7/2006Testosterone: 410

Dangers of Testosterone ReplacementEstrogen Excess

Dihydrotestosterone

Converted from testosterone

Loss of free testosterone Loss of hair Prostate growth – BPH Rx = DHT blockers + progesterone

BIOLOGICAL MARKERS INSULIN plays a key role in aging…

(Even if you’re not diabetic.)

• Increases with age• Tells body to build fat• Keep insulin level below 20• Below 10 even better

Hyperinsulinemia

Treatment Options Low Glycemic Diet Non-Traditional Exercise (Periods of Exertion and Recovery) Chromium GTF Gymnema sylvestre

Changes that Occur with Aging

Lung capacity Cardiac output Muscle mass Bone density Excess fat

Age Related Loss of Lung Function

0

10

20

30

40

50

60

70

80

90

100

30 40 50 60 70 80

AGE

Pe

rce

nt

Re

ma

inin

g

Vital Capacity Maximal Breathing Capacity

PHYSICAL MARKERSMaximum Heart Rate

140

150

160

170

180

190

Hea

rt R

ate

30 35 40 757045 50 55 60 65

Resources

Websites:

www.AlSearsMD.com

www.WellnessResearch.org

Additional Information

12 Secrets to Virility (Download) http://www.AlSearsMD.com/stoweconf

Slideshow: http://www.AlSearsMD.com/Stowe/slideshow

Health Confidential Newsletter: http://www.AlSearsMD.com/healthconfidentials/HCE8.html