Ageless: The Naked Truth About Bioidentical Hormones (53 page)

SS:
So using IGF as a measurement, when the levels come back is there any level that is alarming?

RR:
If someone has acromegaly, which is a condition of growth hormone excess from a tumor of the pituitary, the level could be alarming. That is the Andre the Giant look. Sometimes people who don’t understand HGH fear that you could get acromegaly from growth hormone replacement for adult growth hormone deficiency. I have never seen that happen with proper treatment and monitoring. It is possible, however, when HGH is bought without a physician in the loop and used for bodybuilding or sports performance. Sometimes huge doses are taken in this abuse setting—ten times higher than the correct treatment dose. So abuse could be dangerous, but that is completely different from appropriate medical treatment.

SS:
So is that what the controversy is about regarding HGH, because certain athletes abuse this hormone?

RR:
Yes. HGH is not allowed to be used in professional or amateur sports, so use in that setting is cheating. Also, huge abusive doses are sometimes taken, and the athletes are usually young and do not
have adult growth hormone deficiency. There is neither medical supervision nor testing.

SS:
And what could that do to them?

RR:
Anything bought illegally is dangerous. You don’t know the effects because it’s not regulated. You don’t know what’s in the bottle. I mentioned acromegaly before. There’s too much skeletal growth signal. Jaws and hands get bigger. Teeth don’t match anymore. It creates a weird look when abused, and that is not healthy. This condition will create a lot of medical problems, and with this kind of increased level, there might be a risk of certain cancers. Low growth hormone people (which is a pituitary insufficiency) have much higher cancer rates.

SS:
Interesting. Why is that?

RR:
My educated guess is because you need growth hormones for your immune system to get rid of cancer.

SS:
Let’s talk about thyroid.

RR:
Great. I love to talk about thyroid because so many people can be helped by thyroid optimization, and in my opinion, so many people are not treated or are undertreated for hypothyroidism.

The TSH is a number that’s traditionally used to look at thyroid. The pituitary gland tells the thyroid to make some thyroid by producing TSH. It’s an indirect signal. Over the years that I’ve been in medicine, what has been considered normal has gone from 10 to 5 to 2.5 to 2.1 in conventional endocrinology. The optimal value is probably lower. But this wasn’t looking at the right hormone. This is looking at the signal to make thyroid. There are two thyroid hormones to consider: T4 and T3. T3 is the active hormone, and T4 is the prohormone. Your body has to change T4 to T3. So ideally you have to measure T3, and usually that hasn’t been done. If you don’t do that, you really don’t know their active hormone level. Traditionally, we were taught in medicine that all you need is T4 to treat hypothyroidism. This may be pharmaceutical company propaganda, since there are different brands that contain only T4, like Synthroid or Levoxyl. But that’s not even the active hormone. Under times of stress, mental stress, physical stress, trying to lose weight with dieting, illnesses, and anxiety, you stop converting the T4 to T3. It’s a
method of us going into hibernation. When times get stressful, there is a mechanism for shutting off the thyroid. If there’s no food, you’ll survive until you get some. We are looking at the wrong lab test if we just look at TSH. We’re treating with the wrong drug if we just use T4. A better way to treat patients is with a mixture of T4 and T3, like Armour thyroid or a compounded equivalent. Armour thyroid is a porcine (pig) product, but unlike horse estrogen (Premarin), porcine thyroid is bioidentical to human.

SS:
What is thyroxine—where is that from?

RR:
Thyroxine is T4. Thyroxine, Synthroid, and T4 are all the same thing. It is synthetically made, and that is okay. It is bioidentical, but you need the other thyroid hormone, T3, to go with it. So we can have the wrong tests, the wrong drug, even though sometimes the tests might look normal. You can tell by the patient’s symptoms that they are screaming, I’m hypothyroid! Their hair is falling out, they can’t lose weight with exercise, they’re losing the outer third of their eyebrows, their hands and feet are freezing, they’re constipated, there’s no energy in the afternoon, they can’t think. There’s a terrific British book called
Your Thyroid and How to Keep It Healthy
[by Dr. Barry Durrant-Peatfield]. The scandal is that people aren’t being treated properly. And hypothyroidism has been drastically increasing in society.

SS:
Why?

RR:
First, people are kept alive longer than ever before. At the turn of the century, if a baby was hypothyroid, it wouldn’t have survived chicken pox or any of the diseases we no longer worry about because we now have infant vaccines and better ways to keep people healthy. Hypothyroid people died from infectious diseases such as tuberculosis.

Second, I think, as hypothyroidism increases, hypothyroid men and women are attracted to each other. They both have the same slow lifestyle, and guess what? They reproduce. So now we’ve got even more hypothyroidism.

SS:
So if a woman’s or a man’s thyroid is low, what is the remedy for that?

RR:
First you look at lifestyle. Then micronutrition. Is there adequate selenium and iodine in the diet and supplements? Sometimes just optimizing these minerals can improve thyroid function. Iodine deficiency is rare here in San Diego, where we eat a lot of fish. I am an avid surfer (not a great surfer), so it’s hard for me sitting out there on the water, chewing on kelp, to remember that people in the goiter belt in Michigan don’t get any iodine. Many people don’t even get iodized salt since they are advised to follow a low-salt diet. But most people need iodine. When nutritional and functional treatments do not solve the problem, I treat the patient with a combination of T3 and T4. Most of the time, a patient goes to the doctor, and the doctor treats hypothyroidism with only T4, or thyroxine. As I mentioned earlier, patients feel better, think better, and have a better quality of life on the combination. We follow up with blood and urine lab tests. We make sure there are no side effects; we confirm there is no bone loss or irregular heartbeats. Then we ask the all-important question, “How do you feel?” The most important part of medicine is clinical, not high-tech.

SS:
Let’s talk about the hormone melatonin and using melatonin supplements.

RR:
That’s a good way to sleep.

SS:
Because that’s a natural, normal sleep?

RR:
Yes. That’s the signal to our brain that the sun has gone down. You see, the retina is an outgrowth of the brain. Light shines on the retina, which suppresses melatonin production. Lights off, and melatonin is produced. Melatonin is a very powerful antioxidant, anticancer hormone. So yes, this is a supplement that helps people sleep. And it’s very safe; there’s no such thing as an overdose on it.

SS:
Well then, shouldn’t that be a part of the whole regimen for aging people? Because everyone I speak with has trouble sleeping from middle age on.

RR:
Absolutely, as we age, melatonin production decreases dramatically.

SS:
So shouldn’t melatonin be automatically supplemented? And is some melatonin better than others?

RR:
I think so, because almost everybody feels good on melatonin. Some of my patients tell me they have vivid dreams, which is cool, if you like that. But it can be scary to some people, for whatever reason, so not everyone feels right on it. But you can adjust the dose. Sometimes less is more. Just a tiny dose is all someone needs, say, 0.25 mg. Others need 3 or 6 mg in a time-release form.

SS:
Is it dangerous to take too much?

RR:
No. There are some studies relative to cancer treatment where they give 700 mg along with conventional chemo and radiation, and the patients have a better outcome.

SS:
Can you get melatonin at a health food store?

RR:
Yes, you can get it at a health food store, and it’s probably the real thing. It’s not exact milligrams as getting it from a compounding pharmacy, however.

SS:
Is a prescription necessary?

RR:
Hormones from a compounding pharmacy require a prescription. It’s odd that only in the United States can you purchase melatonin over the counter. Same for DHEA, which is weird, because it’s not a vitamin, it’s a hormone. In Canada, you can’t get DHEA and melatonin at all.

SS:
I think melatonin has been the forgotten hormone.

RR:
In the animal world, melatonin will increase animals’ life span and health span. You give mice melatonin every day (because they’re nocturnal), and they live 50 percent longer.

SS:
Is that because they’re sleeping well?

RR:
Sleeping well and the antioxidant effect of quenching free radicals that can damage DNA.

SS:
I was reading in
New York
magazine recently about Bill Clinton. In the last year since his heart problems, we’ve all noticed that he looks more fragile. Now, being president of the United States has got to be probably the most stressful job; and then there was the whole Monica thing. So we can assume this stress has blunted his hormone production. In this article, it mentions that he wears out his colleagues because they have to stay up playing cards with him until 3:00 and 4:00 in the morning. The guy never sleeps; he goes to bed at
4:00 a.m., and then he’s back up again at 6:30 or 7:00. As a doctor, what do you think when you hear this?

RR:
Bad for the former president in terms of premature aging. He apparently has cardiovascular disease, since he had a bypass operation. The major factor in cardiovascular disease and other diseases of aging appears to be inflammation. Lack of sleep and lack of healthy lifestyle can increase inflammation and cause premature aging.

SS:
They make fun of President Bush going to bed so early, but whenever I hear this I think that’s a good example. He goes to bed early, and he takes vacations. There is something to learn from that.

RR:
And he rides his mountain bike around the ranch. When you look at him, he looks healthy.

SS:
He really does. He doesn’t drink, he doesn’t smoke, he goes to bed early, he takes a vacation, and he gets mocked for that, but I feel it’s a good example. In Europe vacations are considered as important as work. In this country, that seems weird.

What do you see in the future of antiaging medicine?

RR:
The next generation of doctors is already hungry for this information. It’s all right there in the regular medical research. This isn’t some alternative medicine. This is out of the
New England Journal of Medicine
, in
Circulation
, in the
Journal of Clinical Endocrinology
. As physicians, we have got to find the articles that relate to what we’re interested in and then read and absorb them.

SS:
So you’re hopeful?

RR:
Yes, I’m more than hopeful. There has been a change happening in just the last nine or ten years. I realize this when other physicians are referring patients to me for hormone optimization. Or urologists are saying to me, “Well, okay, you can put the guy on testosterone, and I’ll follow him with you.” Men and women can live long, healthy lives if we take advantage of the newest information. I see it every day in my practice, and it’s a great feeling as a physician to see these improvements in my patients. It makes all the hard work worth it.

SS:
Thank you so much for your time.

RR:
You’re welcome. Thank you for allowing me to share my passion for this field of medicine with you.

DR. ROTHENBERG’S TOP FIVE ANTIAGING RECOMMENDATIONS

1. You would want to take HGH only to treat a deficiency disease, such as adult growth hormone deficiency, which is a known disease entity. I usually start treatment at 0.2 mg a day, and then after about a month, if there are no side effects, go up to 0.4 mg a day. Most men end up in that range. After another month in most women, I will increase to 0.6 mg a day.

2. Even though you might take HGH to help you control your weight, you must still follow a healthy diet and an exercise program. You’ve got to have the right lifestyle with it for HGH to work.

3. When someone has a low thyroid, I’ll start him or her on Armour thyroid. If there’s a philosophical or religious objection since Armour is derived from pigs, I’ll have a compounding pharmacy make up an individually tailored mixture of T3 and T4. Then I wait to see how the patient feels.

4. Sleep is a huge component of antiaging. Sleep and growth go together, meaning you make growth hormones only in deep sleep. But if sleep is poor, people today take a sleeping pill, which is
not sleep
. It’s simply a suspended state, and none of the healing hormones are doing their work.

5. Taking melatonin is a great way to help with sleep, plus it is a potent antioxidant. You can adjust your dose. Sometimes less is more; just a tiny dose is all someone needs, .25 mg. Others need 3 or 6 mg, perhaps in a time-release form.

CHAPTER 29
Y
OGA AND
E
XERCISE

F
or years, I have been getting the message “You should do yoga.” It was said to me by my doctor, by my friends, by overhearing something on television, in magazine articles—I was even left a gift certificate on my front gate to “join them at the local yoga center for a complimentary free trial class.” I was deaf and blind and resistant, probably because it was coming at me too hard and strong, and since I’m stubborn, probably because it wasn’t my idea.