The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 13 Apr 2013 06:48 PM PDT The acronym, HOT, which stands for hormone optimisation therapy, is about increasing levels of hormones which are within the 'normal' but low range, especially if accompanied by symptoms. IN my previous four articles, I explained the roles of one dozen hormones that are evaluated and corrected by wellness and anti-ageing doctors. I have mentioned that when you go for your "executive profile" blood tests, only one hormone (TSH or T4) is tested. And when this is normal, you are told that you are okay. Well, in fact, many other systems may be going haywire inside you. For example, for the sex hormones, most men past 50 don't have a clue that they are andropausal (male menopause), unlike their female (menopausal) counterparts who know their status because their once regular menses have ceased. In fact, many men in their 40's already have low testosterone, some low enough to be defined as andropause. How can you know that your body is healthy and working well if you don't have a clue about the levels of all the important hormones in your body? For example, many of my patients were shocked to learn of their low HGH (growth/youth hormone) or testosterone levels. Without testing, they would not have a clue. Many unhealthy men are also walking around with excess oestrogens, with some having more oestrogen (oestrodial) than their menopausal wives! An anti-ageing hormone assessment would include at least 10 of the hormones mentioned in the last four articles. In future, when we understand more about the other hormones (and when testing becomes cheaper), many more will be included. The more of these hormones are corrected or optimised (if necessary), the better your health. HRT – Hormone Replacement Therapy I will not discuss the details of hormone therapy, but only the concepts. You should always get the advice of your doctor, and never self-medicate with hormones as the subject requires much understanding, and the wrong treatment can cause more problems for you. In general, therapy should only be carried out by doctors who understand the subject well, after careful evaluation, and with regular reviews/follow-up. Most of you are familiar with the term HRT, which means hormone replacement therapy. It should mean the replacement of any hormone (eg thyroid for hypothyroidism, insulin for diabetes), but the term has been hijacked by gynaecologists to become synonymous with female sex hormone HRT or simply female HRT. Female HRT is further divided into ET/ERT (oestrogen therapy/replacement therapy), PT/PRT (progestogen therapy/replacement therapy, usually only in younger women with "oestrogen dominance"), and EPT/EPRT (combined oestrogen+progestogen therapy/replacement therapy, which is most common for menopause). "Replacement" implies using something to replace what is deficient or absent. For women who undergo natural menopause, the decline is gradual and HRT is "optional" after weighing the pros and cons (made very confusing since even the experts disagree). However, women who have their ovaries removed for whatever reason before natural menopause (ie surgically-induced menopause) should go on HRT because the oestrogen deprivation is sudden and drastic, and the residual oestrogen production by other tissues (eg fat) can be extremely low. There is little controversy in the replacement/replenishment of thyroid hormones, insulin, cortisol and other hormones when these are deficient. The controversy arises in female HRT because of unexpected adverse results after long-term studies; in the use of natural or "bio-identical" hormones as a solution to this; and in replenishing other hormones in patients who have "low normal" levels who want to improve their health. Synthetic and horse oestrogens All the studies, including the WHI (Women's Health Initiative, US) and The Million Women Study (UK), which alerted the world that female HRT was not safe, only studied women who were on synthetic and/or horse hormones. Although their conclusions are still being debated now, these studies virtually halted HRT. It is a pity, because menopause carries many health risks, and women were deprived of the right solution. Two to three decades ago, when I was a full-time gynaecologist, we did not have much choice of female HRT drugs. And the ones most promoted, and therefore the ones we were most familiar with, used CEE or conjugated equine oestrogens (ie oestrogens obtained from pregnant mare urine) as the oestrogen component. The drug insert and reference books listed the active ingredient as CEE. However, since all this controversy, I notice that it is not listed as CEE anymore, but as "natural oestrogens", which hides the fact that it comes from the horse, although it is indeed from nature! It does provide some benefits, and is still widely used by doctors after 70 years in the market. When female HRT was first introduced, doctors only used synthetic and/or horse oestrogens. Soon, they realised that the women were getting uterine cancers. So they added progestins (synthetic progestogens) in combination with the oestrogens. This combination reduced the womb cancers but increased the number of breast cancers instead. Nobody of course bothered to study the bio-identical oestrogens and progesterone (natural human progestogen) because the drug companies cannot patent them. Now we have other choices (apart from conventional synthetic/horse hormones) to treat menopausal problems, including herbal medicines, selective oestrogen receptor modulators (SERMs), selective tissue oestrogenic activity regulator (STEAR), and natural bio-identical hormones (for more on the subject, please refer to Hormones for health, Fit4life, Feb 17, 2013). BHRT/BIHRT – BIOIDENTICAL HRT The controversy over BIH (bio-identical hormones) and their use in HRT (BIHRT or BHRT) continues unabated. The Malaysian Menopause Society (MMS) is bringing down Dr Tobias Johannes de Villers, the President of the International Menopause Society (IMS), to explain its stand against BIH, while the Society for Anti-Aging, Aesthetic & Regenerative Medicine Malaysia (SAAARMM) will also bring international experts to explain the benefits of BIH at their respective congresses in KL within the next few weeks. Ironically, while MMS officially rejects BIH, its latest newsletter (April 2013) carries advertisements of both bio-identical and horse-derived hormones side by side. Here I quote the position statement of the A4M (American Academy of Anti-Aging and Regenerative Medicine), the world's largest medical anti-ageing organisation, which is adopted by our own SAAARMM: "It is the position of the A4M that the use of hormones in ageing patients to replenish these levels to a youthful physiologic state, when conducted by qualified physicians trained in the practice of treating age-related hormonal decline, constitutes a legitimate and important life-enhancing, life-extending medical application. "Bio-Identical Hormones have the same chemical structure as hormones that are made in the human body. The term 'bio-identical' indicates that the chemical structure of the replacement hormone is identical to that of the hormone naturally found in the human body. In order for a replacement hormone to fully replicate the function of hormones, which were originally naturally produced, and present in the human body, the chemical structure must exactly match the original. "Thus, BIHRT is a method by which replaced hormones follow normal metabolic pathways so that the essential active metabolites are formed in response to the treatment. It is the molecular differences between bio-identical and non-bio-identical that may prove to be the defining aspect in terms of their safety and failure to make this differentiation could be misconstrued. "Regrettably, a number of articles recently appearing in various newspapers and magazines have falsely suggested that BIHRT is unsafe and ineffective. "The goal of BIHRT is to optimise function and prevent morbidity with ageing and to enhance quality of life. With proper modification, adjustment and titration by an experienced anti-ageing physician, the benefits of BIHRT far outweigh the risks." (Extracted from www.saarmm.org) I fully endorse the above statements and have found BIHRT most useful in my own practice. There are many other doctors who have achieved better results with BIHRT compared to synthetic or horse HRT. HOT – Hormone Optimisation Therapy Now I would like to introduce a new acronym, HOT, which stands for hormone optimisation therapy. While the term hormone optimisation therapy is not new, I would like to stress that HRT was meant to replace/replenish severely deficient hormones (as in andropause, menopause and hypothyroidism) while HOT is about increasing levels of hormones which are within the "normal" but in the "low normal" range, especially if accompanied by symptoms. What about those with "low normal" levels but who do not have symptoms? Well, actually, many don't complain because they don't realise or don't know what they are missing. Often, the deterioration in health occurs gradually, and there is a large overlap of symptoms attributed to other problems such that the patients may not complain about it, and doctors may not know if the "low normal" hormone levels are causing or contributing to sub-optimal health. Many patients with "low normal" hormone levels (eg testosterone) report improved health and wellbeing after hormone optimisation (ie therapy to increase levels from low-normal to average or higher levels). Anti-ageing doctors may be accused of over-treating if this concept is not understood by other doctors who just go by the lab results. Many people don't realise that they should and could be much healthier than they are, if only they get their hormones checked and optimised. Even if you live a healthy lifestyle, have adequate sleep, manage stress well, eat a healthy diet (plus supplements as necessary), exercise regularly (including building muscles and of course doing some qigong) and maintain your ideal weight, you should still check and optimise your hormones to achieve the best of health. ■ 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. |
| Posted: 13 Apr 2013 06:44 PM PDT Of the more than 600 plant pigments called carotenoids found in nature, only two carotenoids – zeaxanthin and lutein – selectively accumulate in the retina, macula and lens of the eye. QUITE a number of conditions can lead to deteriorating vision, including near-sightedness, far-sightedness, presbyopia, astigmatism, glaucoma, aged-related macular degeneration and cataracts. As we age, we become increasingly susceptible to many of these problems. However, contrary to popular belief, some of these conditions can be prevented. Did you know that cataracts and aged-related macular degeneration (AMD) are the leading causes of visual impairment and acquired blindness in the world? According to the World Health Organization (WHO), cataract is responsible for 51% of world blindness, which represents about 20 million people. Closer to home, did you know cataracts contribute to 39% of blindness in Malaysia? AMD is another eye condition that can cause blindness. Studies have found that approximately 10 million Americans suffer from early signs of AMD and almost half a million people have significant visual loss from late-stage AMD. The twin threats of cataracts and AMD have created interest in ways to either prevent or delay their progression. Nutrition is one promising means of protecting the eyes from such problems. Of the more than 600 plant pigments called carotenoids found in nature, only two carotenoids – zeaxanthin and lutein – selectively accumulate in the retina, macula and lens. Zeaxanthin is the dominant component in the centre of the macula, which is the most critical area for central vision, while lutein dominates at the outer edges. Results from the Eye Disease Case Control Study as well as a dietary study conducted by the Third National Examination Survey (NHANES III) have suggested a minimum of 6-10mg per day of lutein and zeaxanthin to reduce the risk of AMD. In addition, a five-year follow-up to the Beaver Dam Eye Study funded by the US National Eye Institute showed that people who got the most lutein and zeaxanthin had a much lower risk for developing new cataracts than people who had the least amounts. In a similar study, Brown and collaborators studied the association between carotenoids (alpha-carotene, beta-carotene, lutein, lycopene, beta-cryptoxanthin and lycopene) and vitamin A intake on cataracts extraction in 36,344 male health professionals from 45 to 75 years old. Researchers found that men with the highest consumption of lutein and zeaxanthin had a 19% lower risk of cataract extraction compared to men with the lowest consumption. Furthermore, foods high in lutein and zeaxanthin, such as green leafy vegetables like broccoli and colourful vegetables like red peppers and sweet corn, had the strongest association with a lower risk of cataracts. Given the positive connection between lutein and zeaxanthin and age-related eye diseases, it seems prudent for people to obtain higher amounts of these nutrients from the diet or via nutritional supplements. Lutein and zeaxanthin are found together in many food sources. Dark green leafy vegetables such as spinach are the primary source of lutein and zeaxanthin, but you'd have to eat over two bowls of raw spinach every day to get the recommended daily dose of 6mg lutein. Various studies have found that a typical intake of zeaxanthin is less than 0.5mg a day. The adequate amount, however, for the body to reap the benefits of zeaxanthin is between 2mg and 4mg. The easier way to ensure you get enough zeaxanthin is to top it up with nutritional supplements. If zeaxanthin is so essential for eye health, why do most eye supplements have such measly amounts – in the micrograms (mcg)? The reason is simple. Zeaxanthin is very expensive due to its scarcity in nature. It is 20 times less abundant than lutein in our diet. If you look at most eye supplement label facts, you would find that most eye formulas contain only about 6mg of lutein and 320mcg of zeaxanthin, which is extracted simultaneously with the lutein. These minute amounts of zeaxanthin, according to studies, will not allow you to reap its potential eye health benefits. For convenience of dosing, it would make sense to look for a two-in-one formula with concentrated lutein and zeaxanthin to protect the eyes from AMD and cataracts, as well as promote sharper vision and healthier eyes. Try looking for an eye supplement with standardised marigold flower (Tagates erecta) containing a minimum of 15% lutein esters and 40% zeaxanthin to ensure every capsule contains the exact amount of active ingredients as stated on the label. Alternatively, select an eye supplement that contains at least 6mg (preferably 10mg) of standardised lutein and at least 4-5mg of zeaxanthin per dose for expected benefits. You can always ask your pharmacist to choose the right eye supplement for you. References: 1. American Optometric Association (AOA) 2. National Eye Survey 1996, Malaysia 3. US National Eye Institute (NEI) 4. World Health Organisation (WHO) n This article is courtesy of Live-well Nutraceuticals. For more information, please consult your pharmacist or call Live-well INFOline: 03-6142 6570 or e-mail info@livewell2u.com. The information provided is for educational purposes only and should not be considered as medical advice. 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. |
| Posted: 13 Apr 2013 06:41 PM PDT Any pathology affecting the bones, nerve, discs, ligaments and muscles of the back may give rise to back pain. BACK pain is a universal phenomenon. In the United States, up to 84% of the population would have experienced an episode of back pain during their lifetime. In Malaysia, a study carried out in 1988 showed that 10.9% of men and 19.5% of women surveyed had had back pain in the preceding one week. Why do you get back pain? The human backbone (vertebral column) consists of 33 bones called vertebrae. In between the vertebrae are softer intervertebral discs, made of a gel-like material in the middle surrounded by a tougher fibrocartilage outer layer. The discs enable the spine to be able to twist and turn. At the back of the spine runs the spinal cord with nerves going to the arms and legs. The whole vertebral column is stabilised by ligaments and muscles. Any pathology affecting the bones, nerve, discs, ligaments and muscles may give rise to pain. So potentially, there are numerous causes of back pain. Common causes of back pain include degenerative disc disease, facet joint arthritis or a herniated/prolapsed disc ("slipped disc"). Wear and tear can lead to degenerative disc disease, or the breakdown of the spinal discs, with small cracks and tears and/or loss of fluid in the discs. This can lead to other changes, including the formation of bone spurs. Degenerative disease of the spine is also called "spondylosis", so "lumbar spondylosis" means degenerative disease in the lower spine. When there is too much wear and tear on the disc, the outer covering of the disc can become weak or torn and the soft gel inside the disc extrudes out (thus "slipped disc"). If the herniated disc touches a nerve, it can cause leg pain. Facet joint arthritis occurs in the joints connecting the vertebrae to one another (facet joints). This can lead to bone spurs around the joint and may cause low back pain. However, degenerative disc disease, facet joint arthritis, bone spurs and herniated discs are part of the ageing process and are frequently seen on x-rays or MRIs, even in people with no low back pain. Less common but more serious causes of back pain include vertebral fracture due to osteoporosis, ankylosing spondylitis (a type of arthritis), spinal infection, tumour and cauda equina syndrome (where the spinal cord is compressed). Having mentioned all that, it must be emphasised that in 90% of cases, back pain is not associated with serious pathology; rather, it is due to sprains or minor injuries to the muscles, ligaments or tendons in the back. Thus, spontaneous resolution of the symptoms is usually the rule. When should I see a doctor? As the vast majority of cases of back pain resolve spontaneously, it may not always be necessary to see a doctor. Even if you do see a doctor, he/she may not immediately order x-rays or scans of your back. For example, if there is a herniated disc seen on the scan, it may well heal over time because the body breaks down and absorbs the excess disc material and water within the disc, relieving pressure or irritation on the nerve. However, there are several warning signs, known as "red flag" signs, which may indicate that your back pain is caused by a more serious condition. Therefore, you should see the doctor if you have numbness or weakness in your legs, have problems with bowel or bladder control, have a fever or feel sick in other ways, take steroid medicine, such as prednisolone on a regular basis, or have a history of cancer or osteoporosis. Medical advice should also be sought if the back pain does not improve with rest or a change in position, and is so severe that you cannot perform simple tasks or if your back pain does not start to improve within three to four weeks. For the majority of cases of non-specific/musculoskeletal causes of back pain, the current recommendations are that you remain active; most experts now agree that staying in bed, lying down or being inactive for long periods is bad for your back. Recovery is just as rapid and complete without bed rest. Keeping active under such circumstances will not cause deterioration in the back pain. If the back pain is severe, bed rest may be necessary, but usually for no more than a day. The aim is for a rapid return to the normal activities of daily living. There may not be any need to take much time off work either. White collar office workers may be able to go back to work promptly. Those with more manual jobs should still be encouraged to get back to work, but perhaps on light duties until the back pain is better. Your doctor may prescribe simple painkillers such as paracetamol, or non-steroidal anti-inflammatory drugs (NSAIDs), which can be taken on a short-term basis for symptomatic relief of the pain. Once the pain is resolving, exercises can be started. How can I prevent further back pain? For people with non-specific back pain, exercises such as back flexibility and strengthening exercises combined with general fitness/aerobic exercises, have been shown to reduce the rate of recurrence of low back pain. Exercises that strengthen the abdomen/torso, hip and pelvic muscles are particularly useful ("core strengthening", Pilates, McKenzie method, Alexander techniques, are some examples). Some examples of exercises that can be done at home are listed below: 1. Back exercises in 15 minutes a day, from the Mayo Clinic: http://www.mayoclinic.com/health/back-pain/LB00001_D 2. Good and bad exercises for low back pain, from WebMD: http://www.webmd.com/back-pain/lower-back-pain-10/slideshow-exercises 3. Lower back pain exercises, from NHS UK: http://www.nhs.uk/Livewell/Backpain/Pages/low-back-pain-exercises.aspx It is also important to avoid activities that involve repetitive bending or twisting and high-impact activities that increase stress on the spine. In addition, people with low back pain should learn the right way to bend and lift. For example, lifting should always be done with the knees bent and the abdominal muscles tightened to avoid straining the weaker muscles in the lower back. People who sit or stand for long periods should also change positions often. In conclusion, remember that back pain is common but self-limiting in most cases. However, please see a doctor if there are any "red flag" signs which may suggest a more serious cause for the back pain. Exercise and ergonomic adjustments to activity may help prevent recurrences of back pain. References: 1. Veerapen K, Wigley RD and Valkenburg H. Musculoskeletal pain in Malaysia: a COPCORD survey. J Rheumatol 2007; 34; 207-13. ■ This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information 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 Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article. |
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