February 2002 Newsletter
Dear Friends and Patients:
A new year is upon us and we hope all of you had a wonderful holiday season. I took my family to south Florida to visit my parents and brother’s family over the holidays. I also got in a little fishing with my sons Brian and Michael. The owner of the boat that we chartered was named Captain Jim. Jim was in his 50′s and about ten years before was stricken with a cancer of the tonsil. He underwent surgical removal of the cancer and lymph nodes of his neck, as well as radiation treatments to the head and neck. At the time he was a corporate executive under a lot of stress and this event dramatically changed his outlook on life and also his habits. In talking with him he no longer smokes cigarettes and now eats a much healthier selection of foods, basically eliminating processed foods and sugar from his diet. Of course, he eats a lot of fish he catches himself. He was lamenting the fact that there was no live bait in the area for several months and that it would be hard to catch sailfish without it. I told him not to sweat the small stuff, and it was all small stuff compared to what he had gone through. (We didn’t catch any sailfish, but got some dolphin and Wahoo and had a wonderful time on the water.)
How many of you realize how important your thoughts and emotions are in influencing your health? How many of you made New Year’s resolutions to improve your health with a better diet and exercise program, and to reduce stress? It has been my experience most people change either from inspiration or desperation, and usually it’s the latter. One of the steps you should consider if you haven’t been seen in a while is to schedule an appointment for a preventive health check up, rather than waiting until you don’t feel well. Are you taking care of your car better than your body?
In the August issue of the newsletter we talked about menopause, breast cancer risk, and natural hormonal replacement therapies. We focused on estrogen and progesterone in that issue. November’s newsletter was a special issue on Anthrax. We will turn our attention to Testosterone in this issue. I will also share some thoughts on medicine and a different model or way to look at disease that makes a lot of sense.
A Menopause for Men
One might assume that if a man went through menopause, it would be dramatic and similar to a woman’s. No man loses 90% of his sex hormones in a couple of years in most cases. Men enter what Dr. Shippen, author of “The Testosterone Syndrome,” calls the gray zone. Most men do not want to talk about it. Nor do they understand it. It creeps in on them over a ten to fifteen year span, when a man wakes up and finally cannot deny his muscles have shrunk, his energy has withered, and his self- confidence has crumbled. What was formerly chalked up to “working too hard” or “job stress” is now recognized as getting older. No one wants to get older but it is unavoidable. However, the aging process can be slowed down by replacing hormones when appropriate, so a person can have a good quality of life. It has been my experience that the first sign of this process in men is a subtle downward shift in energy and strength. There may be a depressive change in personality and a loss of eagerness or self-confidence. Men at times try to compensate for these changes by going through a “mid-life crisis” rather than correcting the hormonal imbalance.
Associated with this decline in testosterone in men is an increased risk of heart disease and elevated cholesterol, diabetes, arthritis, osteoporosis, and decreased sexual performance and desire. You see, testosterone is far more than a sex hormone. It travels to every part of a persons’s body and is involved in the making of protein, the
formation of bone and prevention of osteoporosis, and it helps in mental concentration, mood, and in protecting the brain from Alzheimer’s disease. Testosterone also regulates cholesterol and helps with control of blood sugar. Women make testosterone at about 1/10th the amount of men, and it is critical for them in maintaining strength, muscle mass, bone mass, and sexual desire.
Male impotence — It’s a little more complicated than just giving Testosterone
Researchers and specialists who treat patient’s with impotence standardly claim that only about 5% of impotent men can be successfully treated with testosterone replacement. This has not been our experience at the Center. The causes for impotence are multifactoral, but one of the most common reasons is estrogen excess in men. It may come as a surprise that men’s bodies produce estrogen, just like women’s bodies produce testosterone. An enzyme called aromatase is widely present in the body and converts a certain portion of the male hormone into the female. Estrogen converted by aromatase can actually displace testosterone at its various cellular receptor sites and switch off activities. Illness, alcohol excess, nutritional deficiencies, certain drugs (especially for hypertension), obesity and the aging process accelerate this process. So when a male patient comes to the center for evaluation of impotence, one of the first things we do is get blood levels of estrogen as well as testosterone, and also evaluate for nutritional deficiencies. High estrogen levels in a man is a catch 22 situation where the female hormone occupies some of the receptor sites in the hypothalamus in the brain and this is interpreted as if testosterone were filling those receptor sites. This causes the pituitary to stop sending out the hormones to tell the gonads to produce testosterone. So the testosterone levels decline even further.
The type of replacement is important
When I was in medical school, it was common practice to give men testosterone shots. What often happened was that the patient felt improved for a short period of time, and then became worse, with increased fatigue and a negative sex life. It was not known that the shot form was driving the testosterone level to an unusually high, non-physiologic range when first administered, and then a large portion of the testosterone was being converted by aromatase into estrogen. Slow release testosterone patches or gels do not seem to do this. In post menopausal women who need testosterone replacement, this is usually combined in trouche form with estrogens and progesterone, or used separately in a cream or gel and applied to the skin.
For alternatives to testosterone replacement and more information please see my article “Testosterone – Its Real Impact” in the Journal of Longevity, Volume 7, No. 9. We have had good success at the Center with a product called b-Vital, which is a natural supplement and can boost a man’s testosterone levels to at times almost double.
Testosterone and Prostate Disorders
The prostate gland is a hormonally sensitive gland, both to testosterone and estrogen. If the male hormone were is some way dangerous to prostate health we should find that a man whose testosterone level is high is at greater risk than one whose level is low. There have been a number of studies that have shown there is no correlation between PSA levels (a marker for prostate cancer risk) and testosterone levels. A Japanese study found an inverse relationship to benign prostatic enlargement (BPH) and testosterone levels – the higher the testosterone, then smaller the prostate size and vice versa. The Japanese scientists concluded too high an estrogen level would cause prostatic enlargement. Saw palmetto extract has been used effectively to treat symptoms of BPH and decreased urinary flow. It suppresses the effect of estrogen on the prostate, and in a study sponsored by Merck pharmaceuticals, it had twice as great an effect in increasing urinary outflow as did the drug Proscar.
Testosterone and Heart Disease
Did you know there are more cellular sites for receiving testosterone in the human heart than in any other muscle in the body? Testosterone controls the production of a natural form of nitroglycerine called nitric oxide. Dr.
Phillips at Columbia University did research to determine whether the degree of coronary artery disease in men would correlate with testosterone levels. Angiograms (x-rays of the coronary arteries) were done on 55 male patients who had experienced chest pain or had abnormal stress tests. The conclusion: the lower the patients’ testosterone levels the greater the degree of narrowing of the coronary arteries. Chinese researchers studied 62 elderly men with angina. They gave testosterone to half and a placebo to the other half. Of the patient’s receiving testosterone, 77% had marked relief of their angina and 69% had improved blood flow to the heart on echocardiography. Only 6 % of the placebo group had improvement in pain.
Medicine at a Crossroads
When I went to medical school in the late 1960′s, the “diagnosis” was the principal goal. Patients are not concerned about diagnosis. They are concerned about their symptoms. The current medical system finds itself being critically reviewed in light of changing consumer needs, biomedical research discoveries, and concerns about the spiraling costs of health care without obvious improvement. In my article published in the fall 2001 issue of the Alachua County Medical Society Journal, I pointed out in a study done at John’s Hopkins University, we spend on average $4500 per person in the U.S. annually on health care. This is more than any other country on the planet, and yet we rank in the lower one half of industrialized nations in quality of health of the population when measuring things such as longevity and infant mortality. Heart disease, cancer, autoimmune diseases, diabetes and obesity are epidemic in this country. The overwhelming majority of healthcare resources are currently spent to treat crisis illness. The most frequently occurring health problems, however, are chronic disease issues rather than acute.
In his book Demanding Medical Excellence, M. Millenson states as much as 85 percent of everyday medical treatments have never been scientifically validated. “At the same time effective therapies can take years to make their way into common use.” As this generation of baby boomers matures, it is becoming apparent that they are interested in a good quality of life and staying as healthy for as long as possible. In fact, it is this consumer led movement toward preventive health care and wellness using alternative therapies, diet, and lifestyle changes rather than just drugs that is forcing medicine to change.
The Evolution of a New Medical Model
In an article published in Lancet in 1950, it was pointed out by the authors that the etiology of many chronic diseases of aging results from a conflict between the genotype (genetic constitution) of the individual and his or her environment. You cannot change your genetics, but you can modify your environment. This relationship between the genotype and the environment determines the phenotype (physical, biochemical, physiological traits of the individual). Expressed another way, identical twins having the same genes and DNA patterns may have a gene for cancer or some other disease, and yet only one of the twins actually develops the disease. Genes do not act autonomously. Most genes operate in what we have assumed is their fatalistic role only when they are switched on by other factors.
I recently attended an intense, one day medical conference on neuroendocrinology and functional medicine. It was given by Jeffrey Bland, PhD, a brilliant biochemist, author, lecturer and scientist. He pointed out (in a very complicated biochemical way) that this model of genotype/environment/phenotype connection challenge’s medicine’s former view that nothing could be done for the individual who carried the genes for heart disease, cancer, diabetes, etc. Dr. Bland went on to say that it was his opinion that 25% of disease is caused directly by the genetics and 75% by environmental factors and stressors activating gene expression.
Why Do We Get Sick?
Why is this important? Have you ever thought “Why do we get sick?” This defines how we treat illness. As patient’s age, they often present with a multiplicity of symptoms: fatigue, weight gain, depression, cold hands and feet, mental fog, decreased sex drive, anxiety, high cholesterol, diabetes, stomach and bowel dysfunction. Their hormonal and biological systems are out of balance. In traditional medicine patients are then put on a multiplicity of drugs to treat these symptoms: anti-hypertensives, cholesterol lowering agents, stomach acid blockers, anti-depressants, anti-anxiety drugs, etc. This is a symptom based model of disease or illness. Using the genotype/environment/phenotype model, environmental and other stressors create chronic neuroendocrinological imbalance in the nervous system and endocrine systems of the body in people with genetic susceptibility. By changing a hostile environment into a more friendly environment, one could in many cases turn off gene expression and go back to improved functioning and balance. This is not done through a “one size fits all” treatment for a disease, but the therapy is individualized in each case. For example, if a patient’s cholesterol was elevated due to stress, help the patient deal with the stress in a more effective manner with stress management and/or herbals to reduce the sensitivity of the adrenal cortex receptor sites to stress hormones, rather than putting the patient on a statin drug and ignoring all the other biochemical problems going on, or putting the patient on a drug for each symptom. This is why we customize nutritional programs for each of our patient’s and do not treat everybody the same. Dr. Bland observed that the millions of genetic differences are not diseases, but rather codes for “uniqueness.” The technology to screen a single sample of blood for thousands of genetic susceptibility factors is here today. The ability to make this cost-effective for patients is just around the corner to assist in making preventive health care even more effective.
What’s New At The Center?
*Growing pains We apologize if some of you have had to wait a bit longer than usual at times. We are growing thanks to all of your referrals of friends and family. This is the highest compliment we receive. We are pleased to welcome Peg Donda, LPN. She is joining our staff in February 2002 on a part-time basis and will assist Dr. Erickson in patient care, IV therapies and chelation. Introduce yourself to Peg at your next visit.
* Chelation services Dr. Erickson will be taking advanced training in chelation therapy through the International College of Integrative Medicine in March 2002. We will be offering chelation services with EDTA after he completes his training and certification.
* prevent-doc.com Our Web site is finally operational!! If has taken a lot of work and effort, but after almost five months, we are on-line. Please log on to prevent-doc.com and take a tour of the site. The primary purpose of the site is to provide general information to new and established patients, rather than specific medical advice. You can keep up to date by visiting the “What’s New” section on a monthly basis.