DHEA is a hormone (apparently a precursor hormone that is converted into other hormones like testosterone or estrogen) produced in the adrenal glands that decreases with aging. Supplement manufacturers began producing it to replace the diminishing supply as aging progressed with claims that it would:
What is known about DHEA is that it is a hormone, apparently a precursor hormone that is converted into other hormones like testosterone or estrogen.
There are, however, some very basic questions about DHEA. Some of the more fundamental ones are:
The FDA hasn't approved DHEA supplements for any medical condition, and there are no known DHEA-deficiency conditions. The FDA has banned OTC sale of DHEA, although it is commonly sold in health food stores as a dietary supplement, and as such, is unregulated as to safety or effectiveness. Dr. Nippoldt says that the way to get the claimed affects of DHEA is to EXERCISE.
The February 1999, University of California, Berkeley Wellness Letter says much the same thing - there have been at least 21 separate studies of DHEA with inconclusive results.
From the same source - the DHEA being offered in health food stores may not actually be DHEA. This hormone is synthesized in our bodies from cholesterol, but what is sold is synthesized from plants, which as you know, contain no cholesterol. The wild yam extracts that are sold as DHEA really aren't. And even if products are sold as DHEA, there is no guarantee that the product actually contains the amount specified on the label; or any, for that matter. The bottom line is that what you can buy is probably a complete waste of money.
Vitamin B-12 spray has gotten a reputation as an energy booster. Vitamin B-12 functions as a co-enzyme that plays a part in the synthesis of DNA. Because DNA controls synthesis of proteins, it has been theorized that B-12 supplementation can increase development of muscle protein, thereby increasing both explosive strength and power. B-12 is also involved in regenerating red blood cells, which will increase the oxygen-carrying capacity of blood; thus enhancing aerobic capability. Finally, B-12 is involved in formation of seratonin, a neurotransmitter which is related to stress reduction and relaxation, and may lead to improvement in sports like pistol shooting and archery. B-12 supplementation has not been shown to be an effective ergogenic aid (performance enhancing) except in those who are B-12 deficient. As long as your diet provides normal nutrition, a B-12 supplement does not appear to provide any sports performance enhancement. That conclusion is based on a series of tests measuring physiological responses to exercise, like: heart rate, VO2max, muscle strength and endurance, and aerobic/anaerobic performance on standard tests.
One possible concern about B-12 supplementation is overdosing, but the RDA is only 2 mcg daily, and megadoses - thousands of times over the RDA - have resulted in no ill-effects. There is effectively no such thing as a B-12 overdose.
What we have is a supplement that is safe (disregarding the possibility of contaminants), but seemingly effective only for those who are deficient in vitamin B-12.
Dietary sources of this vitamin are muscle meats, eggs, and dairy products; but food from plant sources is completely devoid of it; therefore, deficiencies should be rare except maybe in the case of vegans, who might be susceptible. But a simple multi-vitamin can eliminate this potential problem.
Vitamin B-12 supplements come in at least two forms: spray and lozenge.
The spray delivery system was chosen for its fast-acting characteristic - it is sprayed under the tongue, and theoretically gets into the bloodstream faster by bypassing the digestive tube. That most likely accounts for the "energy lift" experienced by some users. Or maybe it's just a placebo effect, but if it works, it works.
To ERT or not to ERT, that is the question. Whether to engage in either estrogen replacement therapy (ERT) (see Note 1) or hormone replacement therapy (HRT) (see Note 2) is a serious question facing most women at some time in their lives.
Each woman facing this decision must make her own choice in collaboration with her doctor. To be able to do that, she must learn as much as possible about the potential benefits and risks of participating in either ERT or HRT.
First, what is estrogen, and what does it do? It is a sex hormone that affects growth, metabolism, sexual development, and behavior, among other things. Estrogen is present in the body in three forms: 1) estradiol, which is produced in the ovaries during each menstrual period; 2) estriol, which is produced during pregnancy; and 3) estrone, present in small amounts during the post-menopausal years, but is too weak to provide protection for the heart, bones, etc. Measurement of these subspecies of estrogen can indicate where a woman is in her life cycle. Estrogen's role in the body is multifaceted: it provides heart disease protection by raising HDL and lowering LDL, it helps maintenance of bone density, it plumps up and fills out the skin, and has other positive effects on the heart, bladder, and other organs including the brain (mood and memory).
I think it's pretty clear to the women who might read this article that the whole estrogen issue is related to menopause, but what is menopause exactly? To answer that question, let's take a brief and very simplified trip through the female reproductive system. At birth, a female carries all of the eggs (albeit immature) that she will ever have throughout her lifetime. After onset of menstruation, eggs are released monthly; aided by the hormones estrogen and progesterone. As a woman ages, her supply of eggs nears depletion and estrogen production slows down and essentially stops. Menopause is marked by the last menstrual period. There are actually three segments to menopause: 1) perimenopause, the three to five years before her final period, when estrogen production starts slowing down, and some symptoms, as noted below, start to appear 2) menopause-the final menstrual period; and 3) post-menopause, simply the time after the final period.
With the decline of estrogen production after menopause, a number of symptoms may appear, including: loss of bone density (osteoporosis), increased risk for cardiovascular disease, seemingly an increased risk of getting Alzheimer's disease, mental fatigue, hot flashes, night sweats, incontinence , vaginal dryness, increased risk of colon cancer, and other lesser known problems like heel pains, for example.
AND I'VE GOT A GUN!
So, what's the problem? ERT is almost mandatory, isn't it? It would be, but for the fact that after about 10-15 years of estrogen replacement it seems to raise the risk for breast cancer by 20-30%.
There are two important facts that stand out: 1) for many women, breast cancer becomes their number one concern even though 2) the number one killer of both men and women is the ubiquitous heart attack.
Estrogen doesn't cause cancer - it is not a carcinogen - but it stimulates the growth of existing cancer cells. Compounding the problem is the diversity of possible causes of breast cancer including amount of estrogen, and geographical area - more women die of breast cancer in the Northeast than in the South, and the numbers in the Midwest and West are inbetween.
Other risk factors are early onset of menstruation, late menopause, and no pregnancies during a life-time. These factors may increase risk by contributing to longer, uninterrupted exposure to estrogen produced in the body. Even such lifestyle characteristics as indulging in a high fat diet, or drinking more than an ounce of alcohol, four ounces of wine, or 12 ounces of beer, daily, may increase your risk. Teetotalers seem to have the lowest risk.
Another input to your decision comes from a large study reported in the June 19, 1997 issue of the New England Journal of Medicine. It included data collected from 120,000 subjects covering the years from 1976 - 1994, and came to two conclusions: 1) women with one or more risk factors for heart disease (family history (father/brother with heart disease before age 55, or mother/sister before age 65), obesity, smoking, high blood pressure, high cholesterol, at or over age 55) can benefit most from ERT; and 2) try to reduce risk factors through diet and exercise to a point where the need for ERT is eliminated.
Further compounding the "should I, or shouldn't I" question is that not all women get the same menopausal symptoms or intensity. Hot flashes, for example - many women get them, and of those who do, some find them more of an annoyance, while others may be forced into life changes.
For some women there are alternatives to ERT/HRT. For example, hot flashes, some women have had success with taking a vitamin E supplement (using doses from 400 IUs to 1000 IUs per day), but you should always check with your doctor before starting any new therapy, no matter how benign it seems. Other potential hot flash limiters include stress reduction, and reduction of use of alcoholic beverages, caffeine, and spicy foods.
What is a hot flash, anyway? They are the result of chemical changes in the brain resulting from estrogen loss. These chemical changes affect temperature regulation in the hypothalamus (It contains the body's temperature control center.) in the brain. As a result of the changes, the hypothalamus releases hormones that decrease the body's temperature set-point, which causes the skin's blood vessels to dilate, which causes sweating - an attempt to return the setpoint to normal. The result is that your body's thermostat seems to malfunction. The apparent temperature malfunctions are started by estrogen loss, and are often "reset" by the reintroduction of estrogen, which reduces the intensity of "hot flashes" or eliminates them altogether.
For those of you who are looking forward to this "nature's treat," hot flashes are quite variable. They may be anywhere from simply bothersome to debilitating. They typically start above the waist and spread upward into the chest, back, neck, face, and scalp. Their occurrence is also highly variable - from a couple a day to as many as 50 a day. And they may occur for only a year or two, or for many years.
IT'S A POWER SURGE!
By-the-way, "cold flashes" have also been reported, and are also combated by estrogen. Regardless of your "flash" preference, dressing in layers is suggested. Peel it off or put it on to help control the vicissitudes of body temperature.
Some women fear that a weight gain will accompany estrogen therapy, but estrogen does not inherently cause weight gain, although some women report increased hunger, which of course can lead to weight gain. Exercise can help to offset the potential for weight gain, so it is not inevitable, but women, after age 20, tend to gain about 2-8% per decade anyway, although exercise and fewer calories can help to offset that gain.
Are we close to answering the "take it, or don't take it" question? Closer, yes; but we aren't there yet. The answer is still problematic. Some women seem to go through menopause symptom-free, while others are bedeviled by problems. But, sometimes symptom-free isn't problem-free. For instance, osteoporosis; you might not know you had it until a hip fracture sets off an alarm. Maybe ERT is a good precaution unless you have certain risk factors.
How are SERMs involved in the ERT puzzle? They (Selective Estrogen Receptor Modulators; popularly called "designer estrogens") seem to provide another option to taking estrogen forever, and exposing yourself to the increased risk of getting breast cancer that is inherent in long term use.
Raloxifene (brand name: Evista) was the first FDA-approved SERM, and is of course available by prescription only. It can enter bone cells to combat osteoporosis, but is locked out of breast and uterus cells. The expectation is that SERMs (several more are being developed) can protect against breast and uterine cancer, and osteoporosis, heart disease, and maybe more. Evista is not quite as effective as ERT, but tends to avoid the cancer and heart disease (but for heart disease, not as much as estrogen does) problems associated with estrogen. And remember that more are on their way, possibly with stronger effects on osteoporosis. [And don't lose sight of the benefits of weight-bearing exercise (e.g., walking, running, weight training) as an anti-osteoporosis weapon.]
Are phytoestrogens (plant estrogens) a viable alternative to ERT? There is a lot of recent interest in that question, especially among those who simply don't want to use ERT.
Phytoestrogens seem to reduce some of the menopausal annoyances, like hot flashes, night sweats, insomnia, and vaginal dryness; and may confer some protection against the more long-term and insidious symptoms in the skeletal and cardiovascular systems.
There are different kinds of phytoestrogens, but the variety known as "isoflavones" seem to act more like human estrogen. This is where soy enters the picture.
Soy is a source of the main two isoflavones, and may reduce menopause symptoms as well as reduce risk of osteoporosis, heart disease, and breast cancer. It seems to work well for some, moderately well for others, and not at all for still others.
Soy sources include soy beans, tofu, tempah, miso, soy nuts, soy milk, soy flour, and ready-to-eat products made with soy. Controlling the amount of soy needed is problematic, and its use as an estrogen replacement or supplement to your diet is still in question; but it is healthy and can be beneficial as an addition to your diet independent of its possible ERT role. Research is ongoing about how much soy would have to be consumed to be beneficial as part of the anti-menopause symptoms arsenal.
Incidentally, flaxseed oil may confer similar benefits to those of soy, and both may be a beneficial ingredient in one's diet. Flaxseed oil also contains some of the "essential" fatty acids which are a healthy ingredient in anyone's diet, regardless of its estrogen-like characteristics.
A study reported in the New England Journal of Medicine (Sept 10, 1998) suggested that low-dose estrogen replacement may confer the benefits of protection against osteoporosis, while avoiding the increased risk of breast cancer or heart disease associated with normal ERT. This was a multi-year study of over 9700 women. This is at least something to talk to your doctor about.
If you have a concern about getting breast cancer or Alzheimer's or osteoporosis, irrespective of estrogen replacement; it is recommended that you adopt some healthy habits including exercise (weight bearing exercise like walking or weight training), stop smoking, maintain "normal" body weight, reduce intake of meat or dairy fat, sugar, simple carbohydrates; and increase intake of vegetables, whole grains, legumes, and fish.
Now that some information has been identified for both sides of the "to ERT, or not to ERT" question, the answer has become apparent, or has it? Frankly, I am being overwhelmed by the diversity of both the questions and answers. There are no simple answers, and I find myself faced with echoing the thoughts of many health care professionals - each woman must educate herself about this issue, and be her own advocate in a relationship with her doctor. Take his/her input, and add it to your own knowledge, and then make your own decision. You have to live with it, so do your homework.
It would be helpful to read as much as you can in preparation for making the "decision." I found the book "The Estrogen Answer Book - 150 Most Asked Questions About Estrogen Replacement Therapy" by Ruth Tacobowitz to be quite informative, and surely there are others. There are also Internet sources available. Search for "ERT," for example.
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Note - 1 ERT consists of estrogen and maybe progesterone or progestin (a synthetic version of progesterone). A woman with a uterus normally gets estrogen and progesterone; while women without a uterus gets only estrogen - no risk of endometrial cancer.
Note - 2 HRT consists of estrogen, progesterone/progestin, and some testosterone.
(Q) Does soy protein offer any health benefits?
R.J., Salt Lake City, UT
(A) Yes, according to John Erdman, director of nutritional sciences at the University of Illinois in Urbana. Studies have shown that soy protein can lower LDL cholesterol by 8-12%, lower triglycerides by 10%, and (for women) it increases HDL. One theory is that soy's estrogen-like isoflavones team up with soy protein to achieve the positive impact on blood lipids.
For those who are repulsed by the thought of eating tofu, soy protein powder provides an alternative. It can be mixed with fruit and milk to make soy more palatable. Erdman claims that 20 grams a day is an effective amount.
(Q) Is it true that our bodies actually produce antioxidants? So maybe I don't need to worry about taking extra vitamin E or C or other anti-oxidants to protect against free radicals?.
E.G., Mountain View, CA
(A) It is true that our bodies produce their own versions of anti-oxidants, but it seems that as we age their production decreases. It is becoming increasingly clear that supplementing our natural antioxidants with vitamins C and E, carotenoids like beta-carotene, and the mineral selenium is a good idea, but our first choice for sources of those antioxidants should be food rather than a pharmacy. For vitamin E the best sources are vegetable oils, wheat germ, and nuts and seeds. Good sources of vitamin C are citrus fruits, tomatoes, broccoli, and potatoes. And for beta carotene look to dark green, yellow, and orange vegetables; and yellow fruits like apricots and peaches. Selenium is found in tuna, seafood, chicken, whole grains, and liver.
(Q) I think I am in perimenopause, and I don't really want to start ERT. Are there other options, other than maybe overdosing on soy beans?
N.S., San Ramon, CA
(A) Interestingly enough, birth control pills may be your answer. They work much like ERT, but without raising risk of breast cancer, or ovarian cancer as well. And don't ignore the potential of soy in one form or another.
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Send questions or comments to Michael Fenner: e-mail to Mike Fenner
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