Ageless: The Naked Truth About Bioidentical Hormones (49 page)

If a woman has estrogen dominance, we would lab test first, to be sure. Numbers from labwork are for clinical diagnosis only. A doctor has to look at other aspects, such as her stress, her weight, and her mental outlook. These are all part of the diagnosis. With estrogen-dominant females, we find out what is blocking the progesterone because that is what balances the estrogen.

SS:
How do you discover this?

PS:
Through clinical history or through saliva testing. Although
there are not many things that block progesterone production, it can be due to dietary deficiencies. For example, vegetarians don’t get enough cholesterol, which is required to manufacture hormones. The other way we can remove the blocking action is by increasing fiber in the woman’s diet. I frequently put estrogen-dominant females on a high-fiber diet, which would include any food that is green and leafy or crunchy when you bite into it, such as apples, pears, apricots, berries, spinach, kale, broccoli, or cauliflower. Increasing your fiber intake helps regulate estrogen levels.

Finally, we replace the estrogen-dominant female with progesterone to help balance the estrogen/progesterone ratio. This brings her back into balance, and she then is no longer estrogen-dominant.

SS:
Does the weight dissipate as long as she continues to eat right and exercise?

PS:
Right. When estrogen is in balance, your metabolism increases. Too much, however, can slow it down. Estrogen can put on fat; progesterone helps take it off. Progesterone is also a diuretic, so it helps you lose water weight. When women are bloating, it indicates that they have too much progesterone. It’s all a fine balance.

SS:
Many women have a difficult time on their progesterone cycle, because they feel bloated and can put on as much as five pounds.

PS:
If you are putting on five pounds, bloating, getting cramps, and feeling irritable, or experiencing any one of these symptoms alone, you are not on enough progesterone.

SS:
It sounds like bioidentical progesterone replacement could be a better remedy for young women than taking over-the-counter pain medication and diuretics. Tell me, what is the average dose of progesterone you give a woman? I know it’s different for everyone, but there must be some kind of “norm.”

PS:
Depending upon the female herself, if she is active, thin with a higher metabolism, she will need more progesterone. By contrast, if she is sedentary, older, and has a slow metabolism, she will need less. Every woman is different. Some need more, some need less.

SS:
What about the person who has high cortisol?

PS:
I diagnose this type very frequently; usually they are younger, active professional females.

SS:
Because they are not sleeping enough?

PS:
Poor sleep quality is definitely one of the things that can increase cortisol levels. But you have to ask yourself, why aren’t you sleeping? Usually stress is the big offender, and it causes cortisol to go up. Cortisol has two functions, and let me explain this in terms of our ancient defense mechanisms. First, it is in your body to help you with the fight-or-flight response; in other words, it helps you mobilize energy to run away from a dinosaur chasing you. Second, it helps cool down your body and your joints after you flee in order to decrease inflammation in your body. Of course, back thirty-five thousand years ago, we didn’t get chased by dinosaurs every moment of the day. But in today’s world we are constantly under stress; we are constantly chased by what I tell patients are “dinosaurs”—family stress, work stress, relational stress, financial stress, and emotional stress. We are constantly pushing ourselves without letting ourselves rest. As a result, our adrenals are constantly pumping out cortisol. Chronically elevated cortisol shuts down your metabolism and says, “Okay, fat, give me all the food you’ve got because we are under attack and we need to store food.” As a result, you start absorbing many more calories than you normally would with a regular working metabolism. All your extra energy is stored as fat because cortisol has actually turned down your metabolism.

SS:
So what’s the remedy?

PS:
The remedy is to get the cortisol to come down by eliminating stress through stress management and life changes. Many people are under the false impression that because they are stressed and constantly on the go, one or two light meals a day is sufficient, instead of breaking down food into five or six different meals every day with sufficient amounts. Eating one or even two meals a day makes your body think that it is starving. This induces stress, and stress increases cortisol.

SS:
I have written about this extensively in my Somersize books, that by skipping meals, you actually
gain
weight because it raises cortisol, and that you must eat properly to lose weight.

PS:
You need a constant influx of food throughout the day so your
body understands that it is not starving and not stressed. Through nutrition, you can bring your cortisol down and thus lose weight.

You also need exercise, even though initially, exercise elevates your cortisol. But exercise also relieves stress, so long-term it will lower your cortisol. Find an activity that you like to do—yoga, tai chi, martial arts, weight lifting, or running—that will relieve your stress level. Vacations are important, too, but the bottom line is to find an activity you like to do to relieve your stress level.

SS:
What about the person with underactive thyroid?

PS:
Underactive thyroid is one of the most underdiagnosed diseases in the United States today. Some studies suggest that 75 percent of women have underactive thyroid and go untreated. For physicians, it is a very complicated issue because we have gotten to the point of using only lab tests to diagnose low thyroid, when other issues are involved. For example: weight gain, sluggishness, constipation, dry skin, depression, or missing the outer corner of the eyebrows. These are all symptoms of low thyroid that you have to stay attuned to, in addition to the blood test.

SS:
So just because your blood test says you are normal, it really is not the indicator. The diagnostic savvy of the doctor plays a role, too, correct?

PS:
Yes. The doctor has to listen to physical symptoms of the patient. Five years ago, if a blood test indicated that the TSH was over 5, that indicated a problem. Now it’s been lowered to 1 or 2 [pg/dL] so we are getting more and more broad on how we treat this disease.

SS:
Let’s talk about adrenal burnout. It’s a difficult concept for people to understand.

PS:
When the adrenals get fatigued, you have too much stress, and you have called on your adrenals too much. Once the adrenals tire out, they no longer produce enough cortisol. We see patients all the time with low cortisol levels, and you can tell by looking at them that they are completely fatigued. They have difficulty waking up in the morning, but feel a little better around noon. At around 4:00, they need a nap, and after dinner, they feel better than they do most of the
day but quickly tire out and have a difficult time sleeping. They are more sensitive to the environment, and they have infections that last longer than is normal.

It is essential to try to reach this person by explaining the importance of nutrition, exercise, and lifestyle. You try to get them to stop doing the things that are stressing the adrenals, such as not eating properly, not exercising enough, and having too much stress.

After that, I talk to them about herbal agents, supplements, and vitamins that can help increase the production of the adrenals. If I still can’t reach them and I realize they are not going to change, my last resort is to give them hydrocortisone. Cortisone is only for people at end-stage adrenal fatigue. It is not a jump start, and it should not be used frivolously. Its side effects include osteoporosis and psychosis.

SS:
I know how burned-out adrenals feel because in my career, I have burned out my adrenals five times. I have vowed to myself that I will never do that again, but at the time I did not understand the effects of overwork on my body. I guess you learn from your mistakes. I now value my good health so much that I will go to bed before pulling an all-nighter and figure out tomorrow how to finish the job when I am well rested. Maybe it’s called “maturity.”

PS:
Statistically, 83 percent of women and 80 percent of people under the age of forty have adrenal stress, meaning they are producing too much cortisol. You can tell an adrenal-fatigued person by how many cups of coffee they drink in a day.

SS:
That’s interesting, but isn’t coffee in small amounts an antioxidant?

PS:
A cup a day is fine, and there are theories about its antioxidant effects, but when you start putting too much caffeine into your system, it stimulates the adrenals in a negative way. Like everything else, it’s about balance. Take wine, for example. A glass of red has positive effects on your blood pressure, but if you exceed two or three glasses daily, you can start having liver problems.

SS:
Let’s talk about men. Men seem to be reluctant to investigate antiaging medicine on their own.

PS:
As a man myself, finding out what was at the root of my
problems—weight gain, fatigue, stress, lifestyle, and hormonal imbalance—was astounding. Then I began to realize that other men were having the same problems. I consider it an honor that I have hundreds of men in my practice, and I do very well with them. I am treating them for adrenal, cortisol, thyroid, and their testosterone. But I have to say it’s usually the women who come to me first, who get the biochemistry of it, and then sign up their husbands.

The thing about male menopause that is different from menopause is that women lose over 90 percent of their estrogen within about twenty months, while men lose their testosterone over two to three decades. It’s so gradual for them that we don’t have that sudden feeling of falling off a cliff. Instead, we just take this long stroll down this never-ending path, and then one day we turn right and go, “You know what? I don’t feel the same. I don’t feel energized, I don’t feel vital, I don’t feel mentally sharp, I don’t feel as sexual, I don’t feel as strong as I used to feel.” One of the great misconceptions held by men is that they feel that testosterone causes prostate cancer. Unfortunately, this belief keeps men from entertaining the idea of replacing testosterone.

SS:
It is an environment of balanced testosterone that prevents prostate cancer.

PS:
When you read the literature on testosterone and prostate cancer, you find the predominance of this literature shows that, in fact, testosterone does not cause prostate cancer. Further, testosterone is beneficial for a man’s mood, memory, mind, libido, heart health, strength, metabolism, and bone health. When you see an elderly man flopped over, thin skin, pale, no energy, poor vision, can’t pee, irritable, grouchy, isolated—these are all symptoms of a testosterone deficiency. I try to prevent that from happening with my male patients, because once a man gets to that point, trying to bring him back is very difficult. I do not feel that testosterone, or any hormone for that matter, should diminish with age.

SS:
You seem to have a great passion for your work. When you leave your office each day, how do you feel?

PS:
Tired, but satisfied, extremely satisfied. The greatest thrill
comes when I am outside of my office and someone will come up to me and say, “I saw you on television, and what you said makes sense.” Or when other doctors come up to me and say, “How can I learn to do what you are doing?” It is absolutely wonderful to know that I can impact physicians’ lives and work, because when you impact a physician, you are in turn impacting their patients.

SS:
Thank you for your time, Dr. Savage, and continue doing your great work.

DR. SAVAGE’S TOP FIVE ANTIAGING RECOMMENDATIONS

1. Dietary deficiencies can compromise progesterone production. For example, vegetarians don’t get enough cholesterol, which is required to manufacture hormones. The other way we can remove the blocking action is by increasing fiber in the woman’s diet—adding any food that is green and leafy or crunchy, such as apples, pears, apricots, berries, spinach, kale, broccoli, or cauliflower. Increasing fiber intake helps regulate estrogen levels.

2. When estrogen is in balance, metabolism increases. Too much, however, can slow it down. Estrogen can put on fat; progesterone helps take it off if it is in the right ratio. Progesterone is also a diuretic, so it helps the body lose water weight. When women are bloating, it indicates that they have too much progesterone. It’s all a fine balance.

3. Poor sleep quality is definitely one of the things that can increase cortisol levels. But you have to ask yourself, why aren’t you sleeping? Usually stress is the big offender, and it causes cortisol to go up. Cortisol will come down by eliminating stress through stress management and life changes.

4. Many people are under the false impression that because they are stressed and constantly on the go, one or two light meals a day is sufficient, instead of breaking down food into five or six different meals every day with sufficient amounts. Eating one or even two
meals a day makes the body think that it is starving. This induces stress, and stress increases cortisol.

5. Exercise also relieves stress, so long-term it will lower cortisol. Find an activity that you like to do—yoga, tai chi, martial arts, weight lifting, or running—that will relieve your stress level. Vacations are important, too, but the bottom line is to find an activity you like to do to relieve your stress level.

CHAPTER 27
P
AUL
S
CHULICK:
H
ERBS AND
A
NTIAGING