Symposium on Science-Based Medicine
- Presenters: Dr. Steven Joyal, Dr. Robert Fishman, Dr. Eldred Taylor, Dr. Lynn Lafferty, Dr. Joe Veltmann, Dr. Elizabeth Redmond, Dr. Maria Mahmoodi, Dr. Charles Caldwell, Dr. Rosella Menta, Dr. John Crisler, Dr. Scott Fogle, Dr. Tracey Hunter, Dr. Stacey Nottingham, Dr. Ralph Moss and Dr. Judy Woolger.
- Location: Fort Lauderdale, Florida
- Date: October 3-4, 2009
- Attendee: Joanne Quinn, Ph.D., RMA
The Foundation for Alternative and Integrative Medicine attended this conference in hopes of learning more about anti-aging principles and new approaches to medicine. It was sponsored by The Robert Fishman Institute for Training and Research. Dr. Robert Fishman has worked for 20 years to reeducate the world on hormones and nutrition. The United States has a long way to go to catch up with the rest of the world when it comes to nutrition.
Following is a summary of the keynote address by Dr. Eldred Taylor.
Dr. Eldred Taylor is a gynecologist who practices functional medicine at his medical center. He argues we need to balance hormones and uses statements from the father of hormones in conventional medicine, Dr. Leon Speroff, author of Clinical Gynecologic Endocrinology and Infertility. If the medical community will follow science and physiology we will advance. This involves getting out of line. If you educate yourself you will have the courage to question the establishment and follow a new path regarding bio-identical hormone therapy.
Estrogen stimulates growth, progesterone stimulates development. Hormones that are bio-identical to what are in the body will be recognized as legitimate hormones.
According to Dr. Speroff: "When you change the position of only one substituent this can lead to inactive isomers which makes the compound inactive." Synthetic hormones look different structurally which makes them inactive. If you study the metabolic pathways of hormones one can see how with a slight unnatural change to a hormone, the hydroxylase pathways cannot occur.
Dr. Speroff: "Most hormones are bound so there aren't radical reactions. One percent is available. Serum is unable to easily distinguish between bound and free estrogen and testosterone, providing limited clinically useful information. Once estrodial gets into the cell it is retained and recycled/reused turning on DNA." Hormones gravitate to the lipid environment out of the blood where they can become unbound and active. They can get into the cell and become exposed to the DNA. Saliva registers the amount in the acinar cell and this is parallel to the amount of free hormone that is retained by the other tissues in the body. Sex hormone binding is decreased by many factors including weight, fibroids, etc and is increased by hormones.
Dr. Speroff: "Duration of exposure to hormones is more important than the dose. As estrogen is increased in the body, the body will increase its receptor sites to accommodate this." If you supplement estrogen and then reduce it, the patient will have hot flashes. Progesterone, on the other hand blocks replenishment/recycling of estrogen in the cell and will get rid of these extra estrogen receptors. To accomplish this, the patient adds progesterone and tapers down the estrogen.
Dr. Speroff: "The ultimate biologic response reflects the balance of actions of the different hormones with their respective receptors ." We have receptors that are in the steroid pathway. It is important to use bioidentical hormones as the body has receptors for these. These must be used carefully because of the need to balance the action.
If you supplement too much potassium you will get a cardiac arrhythmia. Of course this is not considered "standard of care." If you take too much estrogen you will get growths in the breast. This is considered "standard of care" and when this results the hormone is discontinued. Why is the first treatment considered laughable and the second one standard practice?
Dr. Speroff: "Progesterone antagonizes estrogen stimulation. It also leads to excretion of estrogen from the cell and suppressed estrogen mediated transcription of oncogenes."
Polycystic Ovarian Syndrome (PCOS), Annovulaton and insulin resistance all have a link with hormone involvement. PCOS is treated with birth control pills usually in women under 45 years old. If the patient is over 45 they are usually given hormone replacement. Both age groups get antidepressants. Then when there is no response… surgery. PCOS is a problem with ovulation so it would be better to look at the dance the hormones are doing throughout the month, determine the imbalance and address it. Also it is important to mediate life factors like stress. Cortisol has an effect on all hormones and cortisol is the body's response to stress.
Dr. Speroff: "If you give estrogen and progesterone lone you will increase endogenous opiates." So given alone you can make the patient feel good, but you do not create balance. To get ultimate response the hormones must be balanced. Patients who over exercise to the point of a runners high release endorphins. Endorphins lower GnRH which ultimately causes ammenorria in the athlete. This explains why professional athletes suffer from this imbalance.
Dr. Speroff: "Women who began the use of birth control pills as teenagers, younger than 20, have a 20% higher risk of developing breast cancer." Early use of birth control pills is linked to breast cancer in women under the age of 40. Metabolizing estrogen is very complicated. If you don't have the cofactors the estrogen will not be metabolized and will continue to recycle, increasing the duration of exposure (and remember, according to Speroff it is the duration that is deleterious more than the dose).
Breast cancer: look for urinary metabolites to determine duration of exposure. If this is low you aren't giving enough or there is a metabolism block. The patient can measure free hormones in the saliva. If you want to know the total free and bound hormones you can measure serum. Dr. Speroff says there is an estrogen link but whether it is total, free or duration is unknown. If tissue is atruated it will leave the cell and go into the blood. Metabolism must be good or you will be toxic. You will see different amounts in urine, saliva and blood. It is simply measuring different things. It is important to just understand what is being measured.
There are progesterone receptors all over the body so if you do a hysterectomy you still need progesterone. Progesterone protects the breast and the uterus.
According to Dr. Taylor, mammograms are not as effective in women who are young and have dense tissue. They are more likely to die from cancer. One mm to one cm is the mammogram window to see the tumor. Early on you can measure the balance of estrogen and progesterone. Between 30 and 50 years of age more women die of breast cancer than heart disease.