Wednesday, September 14, 2016

Wisdom Wednesday: Hormones and Cardiovascular Disease

Last weekend I attended a seminar on the relationship between hormones and cardiovascular disease. It was taught by Dr. Jack Monaco. He was an Ob/Gyn for 25 years, then switched to functional medicine. Of note, he became interested in holistic health because of his own health issues and while searching for (and finding) a medical alternative that worked, he found a new career.

Functional medicine as practiced by Dr. Monaco is much closer to mainstream medicine than my practice. I would not choose to practice using his model, but he has collected a wealth of information that I can adapt to my practice.

His treatment is based on the fact that hormone decline with age. Some, like growth hormone decline in our 20’s. Others, like testosterone and estrogen begin to drop typically in our 40’s. He believes that supplementing with bio-identical hormones improves the quality of life and actually reduces the incidence of CVD (cardiovascular disease) and morbidity.

He makes a compelling argument in that all the studies that relate increased CVD and cancer from HRT involved equine and synthetic hormones, not bio-identical hormones. However, I remain skeptical and continue to believe that it is much better to support the body to produce endogenous hormones. Exogenous hormones will always suppress natural hormone production.

If the patient has no capacity to produce their own hormones then bio-identical hormone therapy makes more sense. Even in my practice, patients often choose HRT before giving more natural alternatives a real chance. More typically, it’s the patient that has been taking bio-identical hormones that wants to get off them and still enjoy the benefits that seeks my advice.

As I say to all my female patients going through menopause, “it’s unfair of me to criticize you for wanting the relief provided by HRT.” “Despite the fact that I disagree philosophically, I support your right to choose your own therapy.”

I have long believed that supplementing progesterone for the first six months of menopause has definite value. Again, I prefer to do so with Wild Yam given orally.

All the adaptogens – Ashwaganda, Tribulus, Korean Ginseng, Rehmannia and Schisandra can be very effective in stimulating natural hormone production in both men and women. Black and Blue Cohosh, White Peony, and California Poppy are all effective in reducing hot flashes and mood swings. Velvet antler and Maca can remedy ED and low libido in men but Tribulus is generally more effective for both sexes.

Many studies indicate that adequate hormone levels do provide significant protection against cardiovascular disease. Reduction of inflammation is probably the most obvious benefit. Hormones also help maintain the intima of the artery wall and keep plaque from becoming vulnerable due to loss of calcium from the plaque cap. Hormones also help keep serum lipids balanced although that concept has been over emphasized for many years.

The Bottom Line:
Maintaining healthy hormone levels as we age has many benefits, including reducing the risk of CVA. However, I still believe you are much better off with endogenous production. If you are taking HRT, please insist on bio-identical hormone therapy. Don’t settle for bio-similar or worse yet, equine (horse) hormone therapy.

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