Ageless: The Naked Truth About Bioidentical Hormones (22 page)

SS:
How do you put acid back and balance it?

PH:
We give a supplement called betaine HCL, which is not a drug. My patients simply take 2 to 4 capsules with meals, and lo and behold, they get tremendous relief from bloating and gas.

SS:
How does betaine work?

PH:
Betaine is a source of hydrochloric acid, a naturally occurring stomach acid. It puts the acid back. So in the GI tract, where people have acid reflux and too much acidity, ironically it really is a result of not having enough acid in the stomach and partially digested food refluxing up into the esophagus, resulting in a heartburn type of phenomenon.

SS:
It seems like everyone should be on betaine, because acid reflux is an epidemic. Just look at the amount of space devoted to heartburn in the drugstore.

PH:
Yes, it’s an epidemic, but the problem is that patients are usually put on precisely the wrong medication for them. They are put on Pepcid or acid blockers. But what these patients really need is acid. When they block the acid, the patient feels better temporarily. But in the long run, it’s not good for their health—they are not extracting the food and the nutrients they really need from their food because they lack the acid to do so.

SS:
This may be somewhat confusing, because the goal is to have more of an alkaline body, correct?

PH:
You want an alkaline body, but a very acid GI tract for digesting food. Without an acid environment in the GI tract, some of your food goes partially undigested. You can develop what is called a “leaky gut,” in which large spaces develop between the cells of the gut wall, and bacteria, toxins, and food can leak in.

SS:
I was diagnosed with that before I became hormonally balanced. It was no fun. I was out of energy. It developed when my mother died, and the stress involved with her death seemed to manifest in my gut.

PH:
Having a leaky gut wreaks havoc on your immune system. A lot of my patients come into my office with the same symptoms you mention—exhaustion and fatigue. I look to the GI tract as a possible cause, and I look into the burden of toxicity they may be carrying around. I also look at hormonal balance, making sure their thyroid is healthy and their sex hormones are where they should be.

SS:
Do you recommend detoxification to your patients?

PH:
Yes. Patients with PMS in particular can be greatly helped by detoxifying the body, for example. I often put my PMS patients on a
low-toxicity diet, taking them off wheat, dairy, and alcohol. If you eat correctly—and that means real food—your health keeps getting better and better. This passage is a great time to clean up your life, to get healthy, and to start instituting a healthy lifestyle pattern for the next fifty years. Taking care of yourself now will carry you through to a radiant age.

I also put my patients on vitamins and supplements. In addition, I work on cleansing the liver so we can move those hormones through faster. I get their GI tract going so they are properly eliminating waste and do not become constipated. These patients end up feeling great.

Next, I go to work on their adrenals by encouraging them to start resting and sleeping. Sleep is such an important component in healing the hormonal system. Both perimenopause and menopause require a multipronged approach, and this is one of the reasons I enjoy this work so much. There are steps to wellness, and when I get a patient who is committed, we can absolutely turn their health and quality of life around.

SS:
How important is the mind/body connection in all of this?

PH:
Thoughts are important because the body follows the mind. Understanding the power of our minds and the way we can use our minds can enhance our bodies and frankly elevate the consciousness of the whole human race.

SS:
And changing thoughts if you tend to think negatively?

PH:
Yes. It is not only a toxic GI tract or a toxic liver. It’s also toxic thoughts. Those must be detoxified as well.

SS:
Tell me about your approach to bioidentical hormone replacement.

PH:
Understanding the benefits of bioidentical hormone replacement must become mainstream medicine. I trained at USC and took my residency there. We were taught to administer daily synthetic hormones with Premarin and Provera (nasty synthetics, in my opinion). What I discovered is that when you give continuous combined hormones like this, this protocol increases insulin resistance and diabetes.

SS:
But how did those conditions manifest themselves? Did your patients get fat?

PH:
Yes. They gained weight, and they became bloated. Many women are allergic to Premarin, which is synthesized from horse urine. These women also became depressed due to so much progesterone in their bodies, because this form of HRT puts the body into a hormonal state similar to a permanent pregnancy. Pregnancy can actually cause diabetes because it keeps insulin so high. Physicians always screen pregnant women for diabetes. What’s more, abnormally elevated blood sugars increase your cancer risk by elevating insulin, a hormone that can increase the risk of cancer. So if you were to ask me what causes cancer, I would say increased insulin. Fifty percent of people with diabetes develop cancer. Add to that situation toxicity and an abnormal GI tract. When you take estrogen and progesterone continuously, cortisol levels soar in the body, and that creates numerous problems that could also lead to heart attacks.

SS:
How do you feel about periods? Many of the doctors I’ve interviewed for this book feel, “If a woman doesn’t want to have a period, how can I insist?” But when I speak with T. S. Wiley, Dr. Diana Schwarzbein, or Dr. Julie Taguchi, they say there isn’t a choice. There’s a right way and a wrong way, and having a period is the right way.

PH:
What I do is explain to my patients the benefits of having hormones in their bodies—for example, a lower risk of diabetes, heart disease, osteoporosis, Alzheimer’s disease, stroke, and hopefully breast cancer. I tell them that in order to get these benefits, one of the side effects is that they will have a period. Surprisingly, most women are open to the idea; it reminds them of being young. Estrogen builds up uterine lining, and then progesterone sloughs it off, hence a period. It’s not that having a period is the goal; balanced hormones are the goal. To balance them correctly, the woman will have a period.

SS:
Amen. Now let’s talk about perimenopause. Most women do not realize when they are in perimenopause, nor do they think that they need HRT because they feel they are too young.

PH:
Perimenopausal patients are a little tricky because it’s a time of fluctuating hormones. One minute, we’ll measure estradiol levels that are 400 or 500, and the next time the levels are 30. I measure on day 21 of their cycle, which is the progesterone peak. If they are experiencing PMS, I know that often it is due to the presence of
progesterone because women never have PMS in the first two weeks of their cycle when progesterone is absent. Progesterone blunts your estradiol, so the last two weeks of your menstrual cycle or two weeks before your period, we see fairly high levels of progesterone and declining levels of estrogen in perimenopause.

SS:
How do you figure out how to dose them when their numbers are all over the place?

PH:
I say, “Let’s try plan A for one month and see how you feel.” I give them .05 mg of estradiol. That’s a very low dose, and it’s one or two drops in the second half of their cycles. But other women have low progesterone, so I’ll measure their levels. If they are at, say, 6 and it should be around 15 to 25, I can clearly see this patient needs progesterone. So that’s how you individualize this therapy.

I realize that every woman is different, and what works for one might not work for the next. I’ve been using bioidentical hormones for twenty years, with every possible permutation, from progesterone drops to capsules to rings to patches. While there are many different forms of transport you can access, the ultimate goal is to mimic a natural menstrual cycle. Every woman is different, and every woman absorbs differently.

SS:
So where do you start?

PH:
I have a standard dosage that I begin with. If a patient is older and hasn’t had a period for four or five years, I’ll start her on .05 mg of estradiol twice a day. I tell her to take this dose every twelve hours to spread it out. With some women this works better if I divide it into three times a day to keep a steady stream coursing throughout her body—just as when she was young and in her prime.

Then on days 1 through 14 or days 15 to 30 (fourteen days out of the month), I start with a relatively low level of progesterone, usually sublingual progesterone drops. Then as I cycle up with estradiol (for those who need it), I also increase the dosage of progesterone accordingly. If you give patients progesterone who have no estradiol, they will not feel well. They will experience PMS, among other symptoms.

SS:
Once you get them on progesterone, what is the ratio of estradiol to progesterone?

PH:
It’s usually .1 mg of estradiol to 4 to 6 drops of progesterone.
I never give estradiol orally in capsules. I just don’t like it, but progesterone is tolerated quite well in capsule form. Sometimes I have women insert their morning dose vaginally. Some women have less breast tenderness when I do that.

SS:
I’ve read about that, to give the progesterone vaginally on days 19, 20, and 21 of the cycle to open up their receptor sites.

PH:
This is important. High levels of progesterone are good because progesterone actually decreases cancers through apoptosis.

SS:
What is apoptosis?

PH:
Apoptosis is the death of unneeded cells—in other words, the menstrual cycle, which is the sloughing off of the lining of the uterus each month to make new lining for the next month. It’s all about the brain preparing the body to make a baby, each month. Even though at menopause we no longer have any eggs left, it is still important that the brain perceives us as reproductive.

It takes time and patience in the beginning, but the good news is that even when we haven’t attained perfect balance, my patients usually feel so much better than they did when they first came in that they are willing to ride it out with me. In time we find balance, and that is a joyous experience for both my patients and me. That is why I became a doctor: to make people well. It’s what keeps me going.

When you have patients who feel dramatically better, they have their sex drive back, they are no longer diabetic or have high blood pressure, this is a patient who is sold. So it’s not about me trying to convince them. It’s about them seeing the results for themselves and the benefits they now have as a result. When you add to this the spiritual dimensions and understanding the power of our mind and the way we can use our mind to enhance our body, and to know by doing this you can help elevate the consciousness of the whole human race, it truly is the best work I can think of to do. This is not just medicine; this is helping our patients to love themselves enough to pursue this kind of care. It requires self-respect, and self-love. These go hand in hand with good health.

SS:
You helped me work out the problem I was having with severe hyperplasia (precancer) in my uterus. Through your wisdom and advice, you guided me through my hysterectomy. I was at the time very
concerned about losing my sex drive, which I have worked so hard (through hormone replacement) to restore. Because you are my doctor, and because I was informed about hormones, we both knew that we were going to remove only my uterus. I say this because one of the tragedies that befall women with bleeding problems and hyperplasia are those doctors who tell women, “As long as we’re in there, let’s also remove your ovaries and cervix so you never have to worry about getting cancer.” Excuse my French, but what a crock! How many women have lost their ovaries and cervix (which is the equivalent of female castration) for no reason?

PH:
It is so unnecessary. There are a number of reasons women get hysterectomies; one of the major reasons is fibroid tumors. These are abnormal growths on the uterus that can be very painful and can result in a lot of abnormal bleeding and pain.

SS:
Where do these fibroids come from?

PH:
There are a number of causes, but one of the causes is inflammation. You can measure inflammation with a simple blood test, the C-reactive protein (CRP) test.

SS:
The CRP test is one of the most important tests to prevent heart attacks.

PH:
I agree. Inflammation stems from, number one, imbalanced hormones; and number two, food intolerances and allergies to foods such as wheat, dairy, soy, citrus, and so forth. Where food intolerances exist, I put patients on an oligo-antigenic diet, which means a nonallergic type of diet. Then we again deal with the GI tract. An unhealthy GI tract fuels inflammation in our body, and nutrients cannot be adequately absorbed, setting you up for vitamin and mineral deficiencies, even chronic fatigue. But back to fibroids: Most are caused by a hormonal imbalance. This imbalance causes bleeding and pain.

SS:
It truly is a tragedy that doctors have been so eager to remove the entire reproductive system of women when it is not necessary. This old thinking of proactive removal is truly debilitating. Most women are not informed of the consequences physically and emotionally from having this radical surgery. At this point, a woman is left an emotional mess. Now there are no hormones left to keep her healthy and happy, and no sex drive at all.

PH:
The irony is that
without
balanced hormones, she has a much greater chance of contracting cancer. No body part should ever be removed unless it is absolutely essential to a person’s survival. Removing parts “proactively” makes no sense at all.