From the Doctor’s Desk: Salivary Hormone Testing Backed by Science

Testing hormones through saliva is backed by science. But don’t take my word for it. In fact, it is well supported in the medical literature and is the right thing to do.  Below are links to several abstracts regarding salivary hormone testing. Read them for yourself and learn about the science behind this form of hormone testing.

• Belkien LD, Bordt J, Moller P, Hano R, Nieschlag E. Estradiol in saliva for monitoring follicular stimulation in an in vitro fertilization program. Fertil Steril 1985;44:322.
• Bolaji II, Tallon DF, O’Dwyer E, Fottrell PF. Assessment of bioavailability of oral micronized progesterone using a salivary progesterone enzymeimmunoassay. Gynecol Endocrinol 1993;7:101-110.
• Campbell BC, Ellison PT. Menstrual variation in salivary testosterone among regularly cycling women. Horm Res 1992;37:132-136.
• Aardal-Eriksson E, Karlberg BE, Holm AC. Salivary cortisol- and alternative to serum cortisol determinations in dynamic function tests. Clin Chem Lab Med 1998;36:215-222.

These articles are published in well-respected journals; and if you notice, they are not recent.  Salivary testing of hormones has been well published in the medical literature for some time now.

Here are a few quotes from these studies:

• “…salivary cortisol may be used as an alternative parameter in dynamic endocrine tests.”
• “…assessment of ovarian function…can be performed precisely with the saliva estradiol assay.”
• “…saliva collection has provided the medical and research community with an excellent medium for the monitoring of plasma steroid levels.”

Nowhere else in medicine do we blindly treat people without assessing a baseline and post treatment level(s). Balance is the key; not one individual hormone. Unfortunately, the medical field is very slow to learn and change.

From The Doctor’s Desk: Wellness Is Not Band-Aid Medicine

So you wake up one day and you have symptoms. You select a doctor, make an appointment, recite your symptom list, receive a diagnosis, get a prescription, take the prescription and hope that the prescription gets rid of the symptoms.

But the question is this: Are you well?

Symptom relief medicine is great, but it is reactive medicine. I call this band-aid medicine. Just throw a band-aid on it in 5-10 minutes and ignore the real underlying cause. You can relieve symptoms with band-aids, but if the cause is left unchecked (usually an imbalance of some sort), then disease will be the result.

I like to use symptoms as clues to finding the cause. I call it proactive medicine. Symptoms are the result of imbalance. Disease is the result of ignoring the symptoms. It is a progressive cycle: imbalance, symptoms, disease.

Balance is the key.  As I said above, symptoms are the result of imbalance. Medicine today has lost site of this. In the fast pace of the typical doctor’s office (even mine many years ago), all we have time for is symptom focus and treatment. There is no time for focus on cause.

You don’t have to look to far to see the importance of balance.  Look at our bodies.  They are all about balance:  two eyes, two ears, two legs…you get the picture.  This balance is by design. We should not lose sight of the fact that symptoms are the body crying out for help.

Symptoms reveal imbalances, and the imbalances can be quite diverse. They can include hormones: Estrogen/Progesterone, Thyroid/Cortisol, Growth Hormone/Cortisol, just to name a few. But imbalances can involve more than just our hormones. Neurotransmitters can be imbalanced. Have you ever heard of anxiety or depression? Neurotransmitters involve serotinin, glutamic acid, and nor-epinephrine just to name a few.  And no, anxiety and/or depression are not the result of a SSRI deficiency.

Even Fats can be imbalanced.  Everybody has heard of Omega 3.  Omega 3’s are anti-inflammatory, they lower cholesterol and are good for the skin. But have you heard of Omega 6 fats. Omega 6’s are pro-inflammatory. Americans have excessive Omega 6’s in our high processed diets. The typical American diet is 24 to 1 ratio of Omega 6 to Omega 3. A healthy ratio should be 3 to 1.

Symptoms are the body’s way of asking for help. Let’s start listening.

From The Doctor’s Desk: The Moral of the Story? Hormone Balance Key To Reducing Breast Cancer Potential.

I have four kids that range in age from four to eleven. One of my favorite things to do is read them a great story. So today, let’s talk about some very important stories and the moral each one presents.

The story about breast cancer potential has more characters than just estrogen and progesterone as we discussed in my last post. There are other hormones that are integral characters in that story also. As you will learn in this post, the moral to the breast cancer story is balance — balance between all the hormones in your body.

The Story On Dehydroepiandrosterone (DHEA) — Say That One Three Times Fast!

DHEA, a testosterone precursor, is a hormone produced by the adrenal glands and plays a part in breast protection. DHEA plays an important role in supporting the immune system. DHEA stimulates the production of good T-helper lymphocytes-1 and their associated good cytokines: interferon, Interleukin-2 and Tumor Necrosis Factor-beta. This is in contrast to the bad T-helper lymphocytes-2 and their bad cytokines. DHEA levels typically decline as we age. The decrease in DHEA levels are inversely correlated with increasing age-related disease. The strength of this correlation is yet to be determined, but the decline in immune system due to low DHEA is clear. So where does that leave DHEA? Individuals with low DHEA levels have more disease, and in this case, more breast cancer. The moral of this story? Low DHEA = a compromised immune system = breast cancer vulnerability.

The Story On Melatonin — The Sandman Hormone.

Melatonin is the hormone that regulates your sleep cycle. It is produced from the pineal gland in the brain. Low melatonin levels have been linked to breast cancer through the additional benefits of melatonin. Melatonin boosts the immune system, decreases estrogen and progesterone production, and acts as an anti-oxidant. Bench studies (non-human studies) have shown significant increase risks of breast cancer with low melatonin levels. Can you guess what happens as we age? Yes, you guessed it. Our melatonin levels fall. Ever talk to a post-menopausal woman? Most women of that age have sleep-related complaints. The moral of this story? Low melatonin = a compromised immune system = breast cancer vulnerability.

The Story on Thyroid — The Energy Hormone.

How about the thyroid hormone?  The breast cancer link reaches to all hormones and everything seems to involve the thyroid these days! T4 (or better known as synthroid, levoxy, levothryoixine) is one of the most prescribed medicines today. But T4 is a very weak thyroid hormone. In fact, the body is looking for T3, a result of T4 to T3 conversion. The problem is that many individuals don’t convert T4 to T3 well. (Very often I see patients who have been on synthroid for years without symptomatic improvement even though their “levels” are said to be “good”.  I digress. That’s a subject for another post. Let’s get back to the breast cancer link.) Low T4 and T3 levels result in low sex hormone binding globulin levels (SHBG). SHBG is how some hormones are transported. When SHBG levels drop, the free availability of the hormone it transports goes up. In this case, the levels of free estradiol go up. Remember the negative breast implications of estrogen dominance from last weeks post (link)? The moral of this story? Low thyroid = low SHBG = high estradiol = estrogen dominance = breast cancer vulnerability.

The Story On Insulin — The Sugar Storer

Finally, Insulin. Insulin’s primary role is in the storage of glucose. However, due to the large percentage of simple or refined sugars in our diet, insulin resistance has become a major epidemic, and, yes, insulin resistance increases the risk of breast cancer. How, you ask? High simple sugars leads to insulin resistance and PCOS (Polycystic Ovarian Syndrome). As a result, estrogen dominance and excess testosterone are produced which leads to weight gain. Remember that fat cells produce even more estrogen and estrogen stimulates breast cell growth (link). Young women will start their cycles at an earlier age and thus will increase their lifetime exposure to estrogen without appropriate progesterone balance. And to make matters worse, traditional therapy with birth control pills for these young women increases the breast cancer risk even further. The moral of this story? Insulin resistance = estrogen dominance = breast cancer vulnerability.

Change The Ending Of The Story.

Just because any of these hormone deficiencies might produce in you symptoms which you recognize in this post doesn’t mean that you are going to have breast cancer. However, the sooner you seek hormone balance, the quicker you are going to lower your breast cancer vulnerability/potential. As you can see, the hormonal symphony is what is important. Balance! When your hormones are balanced, the result is a symphony, and in turn, your body is in tune and makes beautiful music. But when your hormones are not balanced, then…well, you know the ending of that story.

From The Doctor’s Desk: Hormone Imbalance A Contributing Factor In Breast Cancer

Hormone Replacement Therapy (HRT) increases breast cancer. Have you read headlines like that? Or perhaps you were told that HRT caused someone’s breast cancer.

Do hormones really cause or lead to breast cancer? Think about this: every women continues to produce hormones, even after menopause. So, it cannot be that hormones in and of themselves cause cancer. Scientific evidence indicates that synthetic hormones and hormone imbalance do contribute to breast cancer.

The ABC’s of Estrogen.

Estrogen’s effects in the body are regulated through two different kinds of receptors: alpha and beta receptors. Estrogen-alpha receptors stimulate breast cell growth. Estrogen-beta receptors inhibit breast cell growth.

• Estradiol, the most potent estrogen, equally stimulates alpha and beta receptors = growth stable
• Estrone, the second most potent estrogen, stimulates alpha receptors 5:1 over beta receptors = pro growth
• Estriol, the weakest variety of estrogen, actually stimulates beta receptors 3:1 = growth inhibitory

The key element here is balance of hormones. Higher levels of estrone present in your body (produced by fat cells) result in more breast stimulation. Higher levels of estriol present in your body results in less breast cell stimulation and, therefore, breast protection. Estriol = Good. Estrone = Bad. If you have heard of someone developing breast cancer after starting Premarin, there’s a logical explanation for that. Guess what Premarin is loaded with? Premarin contains (48%) estrone (estrone = bad = breast cell stimulation).

Here are some more ugly facts about Premarin, also know as conjugated equine estrogen. Premarin actually decreases estrogen beta receptors. So, if you take Premarin, then you are taking high doses of estrone (estrone = bad) and decreasing your estrogen receptors that inhibit breast cell growth. In a nutshell: you are taking more of the bad estrogen and decreasing your amount of the good estrogen. This equates to a prime set up for breast cancer.  Don’t take my word for it. See the wonderful article by Kent Holtorf.

Progesterone: The Growth-Inhibitor Hormone

The confusion out there about estrogen and breast cancer is bad enough, but the confusion is even greater on the subject of progesterone.

Pregesterone is the key hormone in the second half of a woman’s cycle. Estrogen is the dominant hormone in the first half of your cycle (estrogen = growth = growth of the uterine lining to support implantation of an egg). The counteractive hormone to this growth phase is progesterone (progesterone = no growth = sloughing off of the uterine lining). It’s the amazing and fascinating way that woman was created.

Synthetic progestins, often prescribed, are NOT the same as the progesterone your body produces. Just look at the structure and you see that they are not. The one thing they do have in common is they both protect the lining of the uterus against excessive estrogen growth. But, that is where the similarities end.

While there are many differences between the two, our focus here will be on the difference in breast cancer potential. Simply stated, synthetic progestins are pro-breast cancer and bioidentical progesterone is breast protective. The Women’s Health Initiative (link) revealed a 26% increase in breast cancer as a result of taking synthetic progestin. The Nurse’s Health Study (link) found that synthetic progestins tripled breast cancer risk over that of estrogen only. The use of Provera, a synthetic progestin and component of Prempro, has been shown to increase the risk of breast cancer by 800%!

The statistics for bioidentical progesterone are the opposite. Bioidentical progesterone has many positive breast benefits:

• Progesterone decreases estrogen production
• Progesterone moves estradiol to weaker estrone
• Progesterone moves estrone to inactive (sulfated) form
• Progesterone moves estrone to weakest/safest estriol
• Progesterone down-regulates estrogen receptors all together
• Progesterone activates the cancer protection gene, p53

The idea that progesterone is a safer alternative to synthetic progestins is not new at all.  As early as the early 80’s, there has been a call for safer progesterone over synthetic progestin counterparts. In 1981, nearly 30 years ago, L.D. Cowan showed that just having low progesterone levels increases the risk of premenopausal breast cancer risk 5.4 times.

Unfortunately, progesterone-deficient states, (or estrogen dominance) are very common in women today as a result of many factors: being overweight, PCOS, environmental xenoestrogens, excessive estrogen therapy, and perimenopause. Another study, showed progesterone to have a 400% decreased breast growth rate.

The Scientific Evidence Is Clear.

The evidence in the scientific literature is clear with regards to estrogens, progesterone, and hormone balance.

Bioidentical and synthetic hormones should NOT be used interchangeably. They are not equal. They have very different physiologic effects on the breast:  synthetic progestins (Provera notably) increase breast cancer (800%) and bioidentical progesterone protects against breast cancer (400% decrease breast growth rate).

Estrogen therapy is not for everybody and is definitely not a panacea drug; in fact estrogen dominance is a major contributor to breast cancer risk. But if estrogen therapy is needed, then estriol (Estriol = good) is the best.

Hormone balance is the key. Without estrogen and progesterone balance, a women’s cycles are irregular, and infertility can be a big problem.

You know, once we understand hormones and the balancing cycle between estrogen and progesterone, it makes perfect sense that imbalance would cause breast problems. And the scientific evidence indicates just that. In honor of Breast Cancer Awareness Month, it’s time make sure your hormones are balanced and protect yourself from breast cancer.

From the Doctor’s Desk: What’s All The Fuss About Saliva Testing?

Confused about saliva testing? Don’t worry, your physician may be just as confused.

I don’t mean to suggest that the science of saliva testing is new. In fact, the clinical use of saliva testing of hormones has been validated over the past 25+ years, and it is well documented in journal publications such as Gynecology Endocrinology, Journal of Clinical Endocrinology, and Menopause. I know, you’re probably not going to run out and subscribe to those now, but these journals are important to doctors. They range from hard-core bench research to more clinical research.

So why use saliva testing for hormones? The short answer is accuracy.

This is going to get technical, so stick with me. See, hormones in the blood stream are mostly bound to carrier proteins (95-99%) for transportation to target tissues. In this transportation form, hormones are inactivated and not available for use. Only when the hormone is released inside the cells of the target tissue does it begin to have an effect. Saliva testing allows us to see your hormone levels inside the cells at the tissue level. That is where these free hormones can cause symptoms like hot flashes, irritability, breast tenderness, and dry skin.

You’re probably wondering, “Then why isn’t every doctor checking my hormones with a saliva test?” Or even worse, you may have been told that saliva testing is dangerous or inaccurate. Unfortunately, physicians are slow to apply new evidence into practice. History has shown this before. The medical community knew vitamin C replacement prevented scurvy on long sea journeys for 193 years before action was taken.

Hopefully, we will not wait that long this go around.