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The Star Online: Lifestyle: Health


Hormones for health

Posted: 16 Feb 2013 05:08 PM PST

Hormones are of vital importance for good health, both in men and women.

HORMONES are vital to our health. They instruct our cells to do important metabolic functions. Too much or too little hormones can cause cells and organs to malfunction. Since our organs are not independent of one another, any upset in one system will soon affect many or all other organ systems.

There are many hormones that regulate the body. Of these, about a dozen need to be monitored and fine-tuned if you want to be really healthy.

Unfortunately, the role of hormones has not been properly understood by many doctors. This is reflected in the fact that when you do your comprehensive medical check-up, the blood tests will only include one hormone (TSH or FT4).

How can the doctors give an accurate assessment of your health when they don't even check the other important hormones?

Anti-ageing doctors, on the other hand, will investigate at least 10 other hormones to have a better estimation of the state of the body, and to be able to optimise these hormones should they be at sub-optimal levels.

Other doctors have written about the subject, but I would like to share my perspective on this.

How important are these hormones? And how do they function? Let me give three illustrations:

Insulin

On the first day of the fasting month, most Muslims who fast get very tired, and their productivity at work suffers. Then at breaking-fast time, just a glass of syrup water or air bandung will recharge and revitalise them. Of course, they get used to the fasting in the next few days.

This is to illustrate that as we fast, our glucose (and other nutrients as well) level declines and that makes us lethargic, since glucose is the main source of energy for the body. When we consume a sugar-laden drink, the glucose level is promptly restored, and so is our energy level.

But have you ever wondered why those people with diabetes, whose sugar levels are several times higher than ours, are not also several times more energetic? In fact, they are less energetic, and are prone to many diseases (eye disease, heart disease, kidney disease, erectile dysfunction, infections, etc.) because of the high glucose level.

The reason is that while the blood is loaded with glucose, the cells are starving because of lack of instructions by the hormone insulin for the cells to assimilate (take-in) the glucose. Diabetes type 1 patients lack insulin, while type 2 patients have abundant insulin, but their cells have become insulin-resistant.

Insulin regulates glucose and lipid intake by the cells. Insulin resistance is currently believed to be the underlying reason for diabetes, hypertension, central obesity and dyslipidemia (abnormal blood lipid levels). These will in turn predispose to heart disease, stroke, kidney disease, other organ diseases, and possibly cancer, too.

The earliest step towards becoming diabetic is when your fasting insulin level is elevated even though your fasting blood glucose is normal. This may indicate insulin resistance (confirmed after repeated tests). But your doctor will not be able to advise you on this if the fasting insulin level is not tested.

The next step towards becoming diabetic is when your blood glucose becomes slightly elevated, despite the high insulin. You are now "pre-diabetic".

When the glucose level gets even higher, you will then become diabetic. The insulin level is expected to become higher than before (though not always).

Oestrogen

A woman may not be going through any change in her lifestyle, diet and exercise routine, but when she goes into menopause (average age 50-51), she will start ageing at a faster rate than before. Every organ in her body will be affected – especially her brain, heart, bones, skin, and sexual organs. Her libido and sexual activity will be adversely affected.

All these are due to the sudden rapid decline in her oestrogens (female sex hormones). There are three important oestrogens (estrone, estradiol and estriol), but it is sufficient to monitor estradiol only, since it is the most abundant and most important.

Some doctors monitor the "free" or active estradiol levels (usually from saliva), but I have found this unnecessary in my practice.

It is also important to monitor progesterone (the only natural progestogen, which is important for fertility and pregnancy, and also "balances" out many of the negative effects of the oestrogens at other times).

For example, vaginal dryness will become evident during the "peri-menopausal" stage (ie in the months or even years before cessation of menses). This will make sex uncomfortable if untreated.

Libido is likely to be low, and often it is the husband who complains (provided the husband also does not suffer from low libido due to male menopause/andropause).

Women rarely get heart attacks before menopause because her oestrogens protect the heart. After menopause, the woman joins the "heart attack club" because her risk starts rising.

In fact, after 10 years, her risk equals that of men; and after 15 years, her risk exceeds that of men.

So for several decades, doctors were recommending HRT (hormone replacement/replenishment therapy) to women, with the promise of reversing all those problems brought about by menopause.

However, that almost came to a halt due to damning results published by the Women's Health Initiative (WHI, US National Institutes of Health) a decade ago and later by The Million Women Study (UK). The WHI studies showed that the most popularly prescribed HRT drug – a combination of horse oestrogen (conjugated equine oestrogen) and a progestin (a synthetic progestogen, the other group of female sex hormones) – caused more harm than good.

This HRT formulation increased heart attacks and stroke; increased breast cancer; and increased blood clots, deep vein thrombosis and pulmonary embolism. It did however, decrease colorectal cancer and fractures. Almost immediately, HRT became unpopular.

The WHI studies have since been severely criticised as being flawed. Last year, a study on over 1,000 postmenopausal women in Europe showed that there was no increase in heart disease, stroke or breast cancer among HRT users. So the debate continues.

What is clear is that women age and become diseased faster as their oestrogens decline. What is not clear is what is safe and effective to delay or reverse this. We know that horse oestrogens and synthetic hormones may cause more harm than good. So I and some other doctors resort to using natural (human) "bio-equivalent" or "bio-identical" hormones to treat our patients.

These are hormones derived from plants, which are then modified in the lab to become exactly the same as the human hormones.

Since what causes menopause (and andropause) is the decline in the natural hormones that flow inside us, it makes sense to replace them with the natural or bio-identical hormones (BIH). The benefits and risks associated with BIH are expected to be the same as in women who have late menopause (who continue to have higher levels of natural oestrogens compared to menopausal women of the same age).

However, evidence-based medicine demands that every claim must be backed by scientific study. Unfortunately, no company is willing to spend the millions to do research on BIH since the natural formula is not patentable and the money spent cannot be recouped.

So, although using natural human hormones or their equivalents makes more sense than using horse hormones or synthetics, we are not allowed to make any claims.

Those of us who prescribe BIH to our patients do so based on the collective experience of BIH experts worldwide, our own experience, and the positive results seen in our patients.

In fact the Malaysian Menopausal Society (MMS) is against doctors using BIH. In contrast, the Society for Anti-Aging, Aesthetics and Regenerative Medicine Malaysia (SAAARMM) and the Society for Advancement of Hormones and Healthy Aging Medicine Malaysia (SAHAMM) both encourage the use of BIH and conducts seminars and courses to improve the doctors' understanding of this controversial subject.

The debate will surely continue among the doctors.

Androgens

Just as oestrogens are required by women for the health of most of their organs, the same applies to androgens and men. And just as the oestrogens decline at menopause, the androgens also decline with age, but not as suddenly as the oestrogens in women.

Partial Androgen Deficiency in Ageing Men (PADAM) is the other name for andropause/male menopause.

The decline of androgens in men is gradual, starting from about age 25 onwards (after the peak growth and stabilisation stages). The rate of declines varies among men due to genetic, lifestyle, diet, body weight, exercise and other factors.

Since we are generally leading less healthy lifestyles and do less physical work than our predecessors, the decline is expected to be faster. Indeed, many men in their 40's already have low testosterone levels.

While women know they have become menopausal by the cessation of their periods, men are clueless. They attribute their weakness, muscle loss, lethargy, obesity (especially central obesity), poor libido and poor erections to various reasons, but very few realise that low testosterone could be the main reason behind many or all of these.

The main androgens are testosterone and DHT (dihydrotestosterone). Testosterone is more abundant, although DHT is more powerful. DHT is also more responsible for male-pattern baldness, and is blamed for prostate disease. Once you have prostate disease, both will worsen it.

Andropause is defined as having low levels of testosterone accompanied by one or more of the symptoms. It is sufficient to monitor just the testosterone. I find that monitoring the free or active testosterone is also important as some men with symptoms have normal testosterone levels but low free testosterone.

Unfortunately, both free testosterone and DHT tests are expensive.

I have listed four hormones (insulin, estradiol, progesterone and testosterone) that you should get tested for if you want to know what's really happening in your body.

Women should also test for testosterone as this may be too low (and may affect their libido) or too much (and may cause infertility, excessive hair growth, and other masculine features), and men should get tested for estradiol because this may be excessive (and may cause fat accumulation and gynecomastia or "man boobs") in some of them.

I will continue with the other hormones in the next article.

> Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Oz-ing praise for tocotrienol

Posted: 16 Feb 2013 05:01 PM PST

Famed American celebrity doctor Dr Mehmet Oz and US alternative health expert Bryce Wylde believe in the health benefits of red palm oil.

IN a recent American television broadcast that left many gaping with amazement, famed American celebrity doctor Mehmet Oz, better known as Dr Oz, actually sang the praises of palm oil.

Specifically, the doctor was extolling the virtues of red palm oil (RPO), which in industry parlance would be the crude oil extracted from carefully selected fresh fruit bunches of the oil palm tree (Elaeis guineensis).

The beautiful red colour, akin to the colour of a ready-to-drink Ribena (a blackcurrant drink), comes from the high content of beta-carotenes (precursor to Vitamin A) found in the oil palm fruitlets. The manufacturing of RPO via a gentle refining process preserves the maximum amount of natural vitamin content in the oil.

Calling it one of the 13 "miracles for 2013", Dr Oz pointedly said that in this case, the colour red might as well be the "stop sign for ageing, both inside and out".

In his recent television show, Dr Oz, together with alternative health expert Bryce Wylde, both expounded on the properties of RPO to rapturous applause from the live audience.

"Did you know that palm trees contain an ancient remedy that can slow down the ageing process, fight belly fat and combat heart disease?" asked the oft-controversial Dr Oz as he tried to position RPO as one of the most significant nutritional findings of 2013.

Other than carotenes, the health benefits of red palm oil are now also attributed to another phytonutrient called tocotrienols, which are now touted by some as the "Super Vitamin E". Tocotrienols are the primary form of vitamin E in the mesocarp (flesh) of the palm fruit, and initial research findings are suggesting that tocotrienols possess powerful neuroprotective, antioxidant, anti-cancer as well as cholesterol-lowering properties.

Tocotrienols occur at very low levels in nature, and are natural compounds found in rice bran, coconut oil, cocoa butter, barley, wheat germ, annatto, and palm oil. However, crude palm oil contains the highest amount of tocotrienols in nature, mainly consisting of gamma-tocotrienol and alpha-tocotrienol (the other two forms are beta and delta tocotrienols).

The TV host went on to explain how the tocotrienols provide protection against age-related brain and heart diseases such as Alzheimer's disease and dementia; arterial blockage and unhealthy levels of LDL-cholesterol.

"Furthermore, study shows that women who consumed red palm oil enriched with tocotrienols resulted in the loss of belly fat as red palm oil is metabolised immediately and not stored in the abdomen," said Dr Oz, who added that the unique mix of tocotrienols and carotenes puts RPO above other oils in terms of nutritional and health benefits.

Not many people paid heed to tocotrienols 30 years ago, but of late, the scientific community just can't seem to get enough of it.

Just in the last five years alone, dozens of papers have been published on this lesser known form of vitamin E, which can actually exist in four forms, or isomers. The most well studied isomers would come under the tocopherol group, with its alpha, beta, delta and gamma isomers.

Initial research on tocotrienols, which also comes in the alpha, beta, delta and gamma isomers, looked at its value in moderating cholesterol levels.

In the 1990s, scientists started to look at how tocotrienols could be used against cancer.

Wylde also took the opportunity to clear the confusion among some people that equated palm oil with palm kernel oil (PKO). "Palm fruit oil contains mainly palmitic and oleic acids and is around 50% saturated, while PKO contains mainly lauric acid and is more than 89% saturated.

"Uncritical observance by some has led to the general assumption that PKO and palm fruit oil are the same (kind of saturated fat), and this may have led to one of the greatest oversights in modern nutrition," he said in response to Dr Oz's question on why he is only hearing about the benefits of RPO only very recently.

"The stigma attached to the kernel has kept the fruit in the dark – at least until now. Virgin organic sustainable red palm fruit oil is otherwise a bona fide miracle food," Wylde declared on Dr Oz' website at doctoroz.com.

On the recent fascination with coconut oil, Wylde added that even when the marginally higher levels of medium chain triglyceride levels that coconut oil has over palm is accounted for, RPO's carotenoid and tocotrienol antioxidants will "give the latter a significant health advantage over coconut oil".

The high antioxidant content of RPO suggests that it could be a potent "anti-cancer food", with some suggesting that tocotrienols may help fight skin, stomach, pancreas, liver, lung, colon, prostate, breast, and other cancers.

For Dr Oz, the cardioprotective properties of tocotrienols are also important. "Palm oil is used in many countries in the world. Science now understands that inflammation in the artery lining is what warrants cholesterol to deposit in the first place. So, it makes sense that the protective effects come from the high antioxidant, anti-inflammatory content of the red palm oil, which works to quench free radicals and keep inflammation under control."

High in mono-unsaturated fatty acids, RPO has a mild, neutral taste and is a healthy choice for cooking, frying, baking and in dressings and marinades. However, Wylde is more specific in his recommendation in that he is asking the audience to look for "virgin organic RPO". Virgin oil is the result of a single, simple pressing of the fruit or nut, while the organic status of a product has to come from accredited agencies, like the United States Department of Agriculture, for example.

"The health benefits of olive oil have been touted for many hundreds of years. More recently, coconut oil has become all the rage and hailed by many as the king of oils. But, whatever oil you choose – whether it's olive, coconut, almond, canola, peanut, safflower, walnut, or even avocado oil – none compare to the powerful nutritional virtues of virgin organic red palm fruit oil," said Wylde, who recommended his audience to supplement their diet by incorporating one to two tablespoons of RPO into their daily diet.

In Malaysia, planters had for decades carefully cultivated some special palm hybrids for the production of RPO. While the uptake of RPO in the Malaysian market is low compared to the "normal" (the oft-used golden colour cooking oil found in many homes), it is heartening to note that palm oil as a whole is the world's most consumed vegetable oil, and is used in edible oil as well as in processed foods like chocolate bars, ice cream, instant noodles, and margarine.

To his credit, Wylde also reminded the people to buy sustainably produced palm oil that comes from Roundtable on Sustainable Palm Oil-certified sources. "Besides its known nutritional virtues, private enterprise has recognised palm oil's other lucrative applications.

"The controversy is focused primarily on three issues: Extinction of orangutans, deforestation, and, particularly, the food versus fuel dispute. Besides demolishing the habitat of one of the most wonderful creatures on earth, it is thought that the conversion of the crops currently used for food over to fuel would significantly decrease accessibility to those looking to use the oil for dietary purposes, increasing the number of undernourished people in the world.

"Where some researchers believe that the palm oil industry has the capacity to fulfill both demands, responsible people don't want to create negative environmental impact. So, on top of 'virgin' and 'organic' RPO, we need to look for brands that produce the oil sustainably."

Reference: www.doctoroz.com/videos/miracle-fat-red-palm-fruit-oil-pt-1

Wart a problem!

Posted: 16 Feb 2013 05:00 PM PST

HPV is now inevitably linked to cervical cancer; however, it's primarily the cause of genital warts.

LAST year, the free vaccination programme for human papillomavirus (HPV) for women and girls was rolled out nationwide.

HPV is a sexually-transmitted virus that can cause symptoms in the anogenital tract (anus and genital tract), including cancer. HPV infection is a complex issue, as there are many different types of HPV, each affecting a different part of the body.

Since the launch of the HPV vaccination programme in Malaysia, a lot of attention has been given to one of the major diseases that HPV is linked to: cervical cancer.

However, HPV infection can also cause genital warts. This is what I will be focusing on in this article.

An introduction to HPV

To say that there are many types of HPV is an understatement – there are more than 100 types of the virus that can infect both men and women.

Out of these, more than 40 types specifically infect the anal and genital tract (from these, a further subgroup is responsible for precancerous changes in the uterine and cervix, causing uterine and cervical cancer).

The most common types of HPV that infect the anogenital tract are HPV-6, -11, -16 and -18. These can be further narrowed down to HPV-6 and -11 as the two most common "low-risk" types, as they are associated with genital warts and precancerous cells in the cervix.

On the other hand, HPV-16 and -18 are the "high-risk" types as they are found in the majority of cervical, uterine and anal cancers.

Many people are unaware of this – and usually do not believe me when I tell them – but HPV infection is remarkably common and, for the most part, harmless.

In the US, statistics show that at least 75% of the reproductive-age population has been infected with HPV at some point in their lives. Over six million people are newly infected with HPV every year in the US, with half of them falling between the ages of 15 and 25.

Most people who have been infected with HPV do not develop warts or cancer, or even any symptoms of HPV infection. This is why many people are not even aware that they have or had the virus, although they can potentially pass on the virus to their sexual partners through sexual contact.

One can also live with the HPV virus in the body for many years, without any symptoms occurring, until much later.

The what of warts

Genital warts may look like flesh-coloured spots that are raised or flat, or growths that resemble the top of a cauliflower (think of the wrinkly texture).

In women, the warts may be found inside or outside the vagina or anus, or on areas of skin near these body parts. They may also grow on the cervix, which is the top end of the vagina that joins with the lower part of the uterus inside the body.

In men, the warts are commonly found on the penis, testicles, groin area, thighs, as well as inside or around the anus.

It may be commonly perceived that genital warts are generally very large and obvious, but this is not true. Some may be so tiny that you cannot spot them.

A word about non-genital warts: HPV infection can also cause warts to develop on the lips, mouth, tongue and throat.

Along with the warts themselves, other symptoms may occur, including increased dampness in the genital area near the warts, unusual vaginal discharge or bleeding (during or after sex) and itching/burning/tenderness in the genital area. However, these symptoms are rare and may not necessarily occur in every case.

Diagnosing genital warts

There is no actual test for warts itself, as they are usually diagnosed through physical examination. For warts that cannot be seen with the naked eye, the doctor may use colposcopy to magnify the view of the cervix and vagina.

However, there are ways to test for the presence of HPV in the body. The most common test is the Pap smear, which identifies abnormal or precancerous cells in the cervix caused by HPV infection, although it does not actually identify the virus itself.

To know whether you have been infected by the high-risk types of HPV, you may need a HPV DNA test, which can look for the presence of HPV-16 or -18. The DNA test is carried out if Pap smear screening shows that precancerous cells have developed.

Treatment

If the warts are obvious, your doctor may prescribe treatment immediately without further testing.

While genital warts can be treated and removed, there is, unfortunately, no treatment for the HPV virus itself. This means that even though you treat the warts this time around, they may recur later.

You are also still able to spread the virus to your sexual partners even if your warts have been removed.

Your doctor may prescribe a 0.5% solution or gel of podofilox, which is to be applied to the warts twice per day for three days, followed by four days without treatment.

This routine is to be continued for up to three to four weeks, or until the lesions are gone.

Another form of treatment is a 5% cream of imiquimod, which stimulates the body's immune response. This cream is to be applied to the warts three times a week before going to bed, and washed off upon waking up the next morning.

This routine is continued for up to 16 weeks or until the warts are gone.

Some treatments have to be administered by the doctor. One of them is a 10-25% solution of podophyllin resin, applied on the warts and then washed off several hours later.

This is done every week until the warts are gone.

Another treatment you can get at the clinic is an 80-90% solution of trichloroacetic acid (TCA) or bichloracetic acid (BCA), applied weekly on the warts.

Apart from topical treatments, some people may require injections, either of 5-flurouracil epinephrine gel or interferon alpha. These injections also require several weeks of visits to the clinic.

If these non-invasive therapies do not work, laser surgery or surgical excision of the warts may be necessary.

Preventing genital warts

The burden of HPV infection usually lies on the woman, as men carrying the HPV virus never develop problems or symptoms. However, men can pass on the virus to their partners. Therefore, the most effective way of preventing HPV infection and warts is by having safe sex.

Obviously, abstaining from sexual contact altogether is the most foolproof way of avoiding genital warts. Recognising that this is not possible for most people, other measures that women can take are to have as few sexual partners as possible.

Using condoms can reduce the risk of HPV transmission, though it will not eliminate it completely. This is because HPV is transmitted through skin contact, not through bodily fluids.

Finally, there is the HPV vaccination, which I mentioned at the beginning of this article. There are two types of vaccines in the market – one of them protects against HPV-6, -11, -16 and -18, while the other only protects against the two high-risk types, HPV-16 and -18.

These vaccines can be given to girls and boys, and can greatly reduce the risk of developing warts and cervical cancer, as they protect against the HPV types that are most commonly implicated in tese conditions.

The vaccinations are most effective if administered before a girl or woman becomes sexually active.

Many women find it difficult to address the issue of genital warts, but I urge them to be open with their partner and doctor if they develop the symptoms.

Women who have genital warts also need to be aware that regular Pap smears are very important to screen for cervical cancer and precancerous changes.

> Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit www.primanora.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Kredit: www.thestar.com.my

2 ulasan:

Unknown on 18 Februari 2013 4:35 PG berkata...

Breast aesthetics, there is a lot I do not know about. There are those from Turkey you recommend Dr. Ali mezdeği. Do you have that information?
Meme estetiği

Unknown on 18 Februari 2013 4:37 PG berkata...

Breast aesthetics, there is a lot I do not know about. There are those from Turkey you recommend Dr. Ali mezdeği. Do you have that information?
Meme estetiği

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