Supplement Detective

By Curtis Alexander, Pharm.D.

Summary: The most common sinus infection treatment is antibiotics.  Ideally you should have the bug that is causing your sinus infection cultured as it could be viral or even fungal.  A natural – and very effective – natural treatment for sinus infections is sinus irrigation.  Especially at preventing chronic sinus infections.

Q: I get a few sinus infections every year.  Normally, they last for a week or so.  But this last one went on for weeks.  I’m miserable and am desperate enough that I’m considering the surgery.  Do you have any suggestions before I go that far?  I’d really be open to anything.

A: I struggled for about a year and a half to find a sinus infection treatment that really worked.

Actually, growing up and in college I had never had a sinus infection (to my knowledge).  It wasn’t until after the birth of my second son that I started to get them.

First there was the lack of sleep from a new baby in the house.  Then I got a cold that I just couldn’t seem to get rid of.  Finally, the cold migrated into my head.  It got so bad one night that when I was driving home from work I thought I was suffering from a migraine.

I couldn’t look at the sun at all and had to pull off to the side of the road.  By the time I got home I raced passed my wife and kids and straight to the darkest room in the house – a little windowless bathroom.  I sat there and just laid my head down with my eyes closed for a half hour.  My wife was obviously wondering what the problem was.

I explained to her that I was probably having a migraine.  Boy was my bubble burst when the doctor at the walk in clinic that night asked me to blow my nose.  He took one look at it and shook his head…”that’s no migraine…you have a raging sinus infection!”

Treatment Option #1: Antibiotics

Like most sinus infection sufferers the doctor immediately put me on Amoxicillin.  That did the trick…for a few weeks anyways.  When the sinus infection came back the doctor put me on a second course of a stronger antibiotic.

Same story.  Within a month or two the infections kept coming back.  Within 6 months time I was at the end of my rope because the antibiotics were more of a stop-gap measure and weren’t really taking care of the problem.

After searching around I came across information that was beginning to show that the cause of sinus infections really wasn’t the bacteria, or virus or even fungus.  It was the fact that my sinuses (and yours) weren’t able to properly drain.  When that happens you have bacteria and virus and fungus build up.

So, fix the drainage problem and you’ll likely fix the sinus infection.

Treatment Option #2: Sinus Rinse

Enter the sinus rinse.  The best thing about this is that the ingredients can be found in your cupboard and are extremely cheap.  Secondly, you don’t need a prescription for what I’m about to show you.

The only thing you do need to know is if it’s OK with your doctor to try sinus irrigation.  It most likely will be as most doctors and ear, nose and throat specialists are coming to agreement that sinus irrigation can be an effective treatment for sinus infections.

Ingredients You’ll Need:

• 1/4 tsp non-iodized salt
• 1/8 tsp baking soda
• 8 oz luke warm water.  I use tap water but you’ll want to adjust based on the water quality in your area.

How to Mix:

Real simple.  Measure out the ingredients being careful on your measurements.  You’ll know you screwed it up because when you spray it up your nose you’ll get that feeling of getting water up your nose at the pool.  It will burn a bit.

This solution is designed to be isotonic.  Which means you shouldn’t feel it at all if it is mixed correctly.

So, measure out the ingredients and add the luke warm water.  Be careful to make sure the water is not too hot or it will burn your sinuses – very painful and very dangerous.

When starting out you may find it helpful to perform your irrigations in the shower – that will ensure the water temp isn’t too hot.

Once the solution is measured all you have to find is a blue baby bulb syringe.  They sell them at grocery stores.  They are normally used to suck out a newborn baby’s nose, mouth or ears of debris.  They are usually blue in color.

I’ve used bottles before with a narrow tip.  It really doesn’t matter what it is as long as it has the capability to ’spray’ water.

Technique

There are two different techniques I’ve used.  I’m only going to give you one right now as it is much easier to perform and should help you.

Simply hold your head over a sink or somewhere where you don’t mind water dripping (another reason I do this in the shower).  Place the bulb in one nostril and simply squeeze the solution.  The solution will go up your nostril into your sinus cavity and eventually out your other nostril.

Sounds weird (and it does feel weird the first time you do it) but it works.  Particularly with warmer water you can eventually start to loosen up and remove some of the ‘gunk’ that has built up in your sinuses.

As I said above.  This is the sinus infection treatment option that worked best for me.  Of course, this was in conjunction with a complete change in my eating style which helped a lot too.

But, mechanically, I think the sinus rinse worked better because it addresses the root cause of the problem rather than just treating the the byproduct of poor drainage.

By Curtis Alexander, Pharm.D.

Summary: Cod liver oil benefits are numerous.  Best of all, there is ample evidence supporting cod liver oil’s use – especially in northern areas where direct exposure to sunlight during the winter months may be limited and lead to vitamin D deficiencies.

Q: What are the cod liver oil benefits – as you see them?  I always see it touted online but it seems like a sales pitch for their particular product.  I’d like a little perspective.

A: OK, I admit it.  There are a lot of supplements out there that have a lot of hype and baseless claims.  As a matter of fact, that’s part of my job here at this website is to steer people in the right direction and give them the straight scoop and raise a bright red flag when I see a scam or an over-hyped supplement.

But, in my humble opinion, cod liver oil is the real deal.  Not only is it relatively low cost but it offers a lot of benefits.

Cod liver oil, unless you are eating superbly and have more than adequate exposure to natural sunlight, is something almost everyone should supplement with in different quantities at different times of year.  And honestly, I eat healthy.  Better than most.  But even I supplement with cod liver oil.

I won’t get into a long discussion of what exactly is in cod liver oil because this question focuses more on the benefits.  But suffice it say, that cod liver oil is one of the riches sources of vitamin A, vitamin D and omega 3 fatty acids.  It’s natural.  Its inexpensive and the benefits are great.

And, speaking of benefits I’m going to try to keep this answer relatively short.  I don’t want it to read like a PhD dissertation.  It will cover the main, proven benefits of cod liver oil.  If you want to go into more detail Google offers you plenty.

Cod Liver Oil Benefits

(1)  Rickets (Vitamin D deficiency)

While almost never seen in industrialized countries nowadays – rickets was pretty common 150 years ago.  It was particularly a problem in northern hemisphere’s where exposure to sunlight was limited and the food source was primarily grain-based.

This is exactly what you had in 19th century England.  Little sun and a very grain-based diet.  Actually, one of the early researchers into rickets, Dr. E. Mellanby was researching rickets in dogs (don’t laugh – physiologically we are pretty close to dogs – particularly our digestive tracts) and discovered in addition to cereal grains promoting rickets it also had the added effect of blocking mineral absorption due to the high phytic acid content in grains and legumes.

This is why phytic acid is considered by many to be an ‘anti nutrient’ and is why I personally try to avoid grains in my own eating style.

(2)  Arthritis

Arthritis researchers in Great Britain have shown that the elongated omega 3 fatty acids in cod liver oil can reduce the pain and inflammation from arthritis.

(3)  Babies Growth and Development

Remember Dr. E. Mellanby above?  Well his wife actually did research in babies and discovered that tooth enamel will not form properly unless the baby is exposed to adequate vitamin D.  This is especially true the more cereal-based foods a baby is fed (i.e., the more cereal you give a baby the more vitamin D they will require).

(4)  Secondary Dentintion

As you and I go through life our body is able to ‘patch’ our teeth.  We know that the more vitamin D a person has the better able they are to ‘patch’ the spots on their teeth as you have up to three times more calcium in your saliva to go to work on your damaged teeth.

(5)  Pregnancy

Women who supplemented with cod liver oil during pregnancy had infants who were at lower risk for Type 1 diabetes.  Incidentally, this same effect has not been seen with women who supplemented with simple multi-vitamins.

Additionally, brain development in the newborn is dependent upon the fatty acid profile of the mothers breast milk.  This is probably one of the reasons why babies born to strict vegetarian mothers may be at risk for stunted brain development.

Also, cod liver oil is high in vitamin A which has a clear role in preventing infections.

SIDENOTE: talk to anyone who is 80 years or older and they’ll likely remember their parents giving them cod liver oil.  Despite our advances the old time doctors knew more about nutrition than we do today.

Incidentally, the practice of giving kids cod liver oil was shunned by none other than Dr. Spock who instead relied heavily on vaccines.

It’s important to note that while cod liver oil has high amounts of vitamin D it doesn’t appear to increase the vitamin D content in breast milk.

Risks During Pregnancy

Over the years women have been advised to avoid any vitamin A containing supplements for risk of the fetus developing deformities.  First of all, the deformities were associated with synthetic vitamin A – or retinoic acid.

Almost all the studies that have been done looking at vitamin A and birth defects have shown that you have to get pretty high amounts of vitamin A – in one famous study over 5,000 IU’s a day with synthetic vitamin A.  Other researchers have concluded that you would likely have to go over 10,000 IU’s per day based on the data.  Other researchers have concluded that you can safely go up to 30,000 IU’s of vitamin A a day.

In short, most dosing regimens of cod liver oil would likely give a pregnant woman somewhere in the neighborhood of 1,000 IU’s to 2000 IU’s per day.  Well within the limits of safety established by researchers.

But, the decision to take cod liver oil while pregnant and how much you should take is up to you and your doctor.  I simply mention it here because I think that there is not a strong link between natural vitamin A and teratogenicity.

(6)  Heart Disease

From what we know, it appears cod liver is not only helpful to prevent a heart attack, it can be beneficial after a heart attack.

That’s because cod liver oil alters the linings of the arteries.  In fact, every ingredient in cod liver oil from omega-3 fatty acids to vitamin A, D and K all are involved in mineral absorption, improving muscle function and elasticity in blood vessels.

Another important component involved in heart disease is inflammation.  Well, there are inflammation reducing components that are made from the EPA in cod liver oil to control the inflammation in arteries.

Work in rats has clearly shown that atheromas (artery blockers) have become smaller and the actual diameter of arteries has increased after treatment with cod liver oil.

Of course, I always caution this isn’t human studies.  But it is promising.  And, for all purposes the evidence that we have to this point for cod liver oil in heart disease is very promising.

As you can see cod liver oils has more than ample amounts of omega-3 fatty acids and important vitamins like A and D which most Americans don’t get near enough of.  Also, this isn’t an exhaustive article by any means.  There’s much more to be said about cod liver oil and the benefits it offers.  But it provides a good overview of a supplement that is inexpensive, readily available, very beneficial and with few side effects.  That’s a good combination any day.

By Curtis Alexander, Pharm.D.

Summary: Black Cohosh Plant has been used for centuries to treat menopausal symptoms and is approved in Germany for that use.  However, each woman responds differently during menopause in regard to how far your hormones drop.  That’s why I’d caution against adding Black Cohosh Plant (or any substance) until you have performed a basic saliva test to see where your hormones are at right now.  Black Cohosh does appear to help short term but also has some side effects to watch out for.

Q: Curt, I’m going through menopause right now and it’s driving me (and my husband) crazy.  I know some women take Premarin® but I’m a little scared of it. I’ve heard about Black Cohosh Plant for menopausal symptoms but is it any better, or safer, than Premarin®?

A: Black Cohosh has been used, literally, for centuries to primarily treat menopausal symptoms.  It’s also approved in Germany for that use.  However, there is conflicting evidence out there about how effective it really is and I have some personal concerns about some women taking it because of its estrogen-like activity.

First of all, before we get into specifics on the Black Cohosh Plant, it’s important for you to understand what we know about menopause at this point.  Menopause is an ovary issue.  It’s a natural process where your body begins shutting down your production of estrogen, progesterone and testosterone (yes, even as a female you have testosterone).

Here’s the kicker though: the hormones don’t all fall to zero.  Estrogen can often see a 40%-60% drop in production.  While progesterone (in some women) can fall nearly to zero.  Menopause therefore can mean more estrogen for some women and less for others.

Knee-Jerk Reaction

Unfortunately, too few doctors actually measure the hormone levels of women who are going through menopause before they give hormone supplements.  That’s like saying you want to make it to Las Vegas but don’t know if you are starting in Omaha, Miami or Seattle.

Compounding the lack of hormone testing is the fact that hormone most commonly used – Premarin® – is undergoing a great deal of scrutiny.

In the Women’s Health Initiative Study Premarin® (from Pregnant Mares Urine) led to an increased risk of dangerous blood clotting disorders.  Estrogen (or, more correctly, estrogen-dominance) is also being looked at in:

• Fat and weight gain in women
• Poor moods, mood swings and even depression.
• Lowered libido (most women’s sex drives rise shortly after ovulation.  No wonder, this is your bodies way of saying that the egg is ready.  After ovulation estrogen plummets and progesterone rises dramatically).  One of the most common side effects from birth control pills is lowered sex drive – and no wonder…the pills are designed to stop a natural process and are loaded with estrogen (and, to be fair, synthetic progesterone).
• Breast Cancer

I am going to write more articles on this subject as they come up because I think with all the estrogen’s in our environment today most men and women have much more estrogen in our systems today than early human did.  Leading to many problems that we don’t fully understand.  Including problems in menopause.

Another Big Push for Estrogen Supplementation in Menopause

Before I get back to Black Cohosh, let me address one other point: osteoporosis.

Many docs prescribe estrogen during menopause to prevent osteoporosis.  The only problem is estrogen isn’t all that effective.  It does cause a 2-3% increase in bone density per year.  But strength training (or, more correctly, force training) can cause a 12-15% increase in bone density each year.

Another step would be to limit your intake of anything containing phosphoric acid (soda is a big culprit but milk also contains this).  Your body will pull calcium from wherever it is available (often times the bones) to neutralize the phosphoric acid.

Back to the Black Cohosh Plant

Here is what I know at this point: Black Cohosh does appear to help (albeit temporarily) the side effects of menopause.  The reputable studies that have been performed to this point for treating menopause symptoms lasted only six months, though.  So, I would NOT consider Black Cohosh a long-term solution.

I also do not consider Black Cohosh a first line agent.

As I talked about above, I prefer to see your doctor measuring your hormone levels before you decide to supplement with anything – natural or synthetic.  This type of test can run anywhere from $50-$200 depending on how many different levels you have drawn and measured.  Saliva testing can also be performed.

Just willy nilly throwing in a hormone or estrogen replacement without knowing the baseline levels isn’t something I’d recommend.

Secondly, are you ovaries intact?  I don’t mean to get personal but it makes a difference.  Having you ovaries seems to permit women to ‘regulate’ hormone levels better.  Without them, supplementation with a natural estrogen may be required.  If you have your ovaries change your diet first.  I know that most people, probably you included, hate hearing this.  But it’s said so much because it’s true.

The interplay of hormones in your body is complex.  I have my doctorate and I still have a tough time keeping it straight.  Trust me when I say in 99% of cases your body really does know best when you give your body what it wants – which is natural foods.  So, cut out any processed foods, soy products and milk for the time being.

Other steps you can take are related to your adrenal function.  And, in addition to the points above, you can improve that naturally by getting to bed before 10PM.  Also, I would avoid any food two to three hours prior to bedtime, otherwise you’ll likely raise cortisol (stress) hormones.

Give yourself at least a couple of months – that’s how long it will take to make a difference.

If, after doing that, you find things aren’t improving and the symptoms aren’t tolerable you’ll want to talk with your doctor.

Black Cohosh and Estrogen

The medical community doesn’t understand at this point how Black Cohosh works.

Women who are in menopause undergo a bunch of changes.  Not only is their estrogen lower, but their Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) levels are higher.  Some scientists thought that Black Cohosh may be altering LH or FSH.  But that does not appear to be the case.  So that led to the theory that Black Cohosh has estrogen activity in the body.

At this point, the evidence is contradictory.  Black Cohosh does not appear to have binding activity on estrogen receptors in the body.  But the jury is still out on that, so short term use is the rule.

Things to Look For

If you and your doctor decide that Black Cohosh Plant is something worth trying keep a few points in mind:

Short term use only.  From the evidence I’ve seen I wouldn’t recommend taking Black Cohosh beyond six months.

Is not without side effects.  While the Black Cohosh plant is technically an herb, that doesn’t mean it isn’t without problems.  Here is a short list of the most common side effects users report with Black Cohosh (these are all side effects seen with normal estrogen supplementation):

• Headaches
• Weight Gain
• Heaviness in the legs
• Gastric complaints

Dosing

Most Black Cohosh comes in an extract form.  Suggested Dosing:  40mg once or twice daily depending on severity of symptoms.  Preferably before meals or as directed by a health care professional.  Frankly, this is another area where the studies are misleading because many different dosages were used.  However, the dosage range above should be a good starting point.

By Curtis Alexander, Pharm.D.

Summary: A TSH test can be useful when diagnosing hypothyroidism but it can fluctuate.  Even people who have normal TSH test results can present with hypothyroid symptoms and may benefit by talking to their thyroid specialist about supplementing with a thyroid medication.

Q: I had a TSH blood test recently and it came back normal but I still feel very sluggish, have trouble losing weight and am often cold.  Frankly, I just don’t feel that good.  I thought measuring TSH testing should be able to detect thyroid problems but mine is normal.  I’m frustrated.

A: Detecting thyroid problems isn’t as cut and dry as measuring your TSH and then saying you’re hypothyroid.  In fact, you can be hypothyroid with a normal TSH.  But, l’m getting ahead of myself.

Let’s start with what TSH is and where it can help your doctor decide what is going on.

THS Basics

TSH stands for thyroid stimulating hormone.  And, as the name implies, it’s not really a thyroid hormone.  It’s actually released from your pituitary gland and stimulates your thyroid to release more or less hormone depending on your bodies circulating levels.

Now…normally in someone who is hypothyroid their TSH is high.  That is, your thyroid either isn’t releasing enough thyroid hormone or perhaps there is some thyroid resistance in your bodies cells so your body isn’t responding like it should be.  The body recognizes this and sends a signal to the thyroid – via thyroid stimulating hormone – to release more.  This elevates the TSH blood test.

Simple enough.  But, while the TSH can be fairly reliable there are many cases of folks who have true hypothyroid-like symptoms but who have normal TSH levels.  Again, you may have some sort of thyroid resistance.  Also, perhaps your body is having a difficult time converting T4 to T3.  T4 is the ‘inactive’ form of thyroid hormone and T3 is the ‘active’ form.  Also, there may be an actual problem with your pituatary and that it’s not recognizing low thyroid levels.

This is the point where you need to sit down with your doctor and discuss some other options.  Perhaps it would be appropriate for you to go see an endocrinologist or other thyroid specialist?

Thyroid Problems are Not Cut and Dry

The one thing I can tell you is that trying to figure out the biochemistry behind thyroid hormones can get really confusing.  And frankly, a lot of other health care providers, including doctors get turned around with it.  While I hope your doctor has an open mind about your problems many doctors simply dismiss sick patients with ‘healthy’ blood tests as hypochondriacs.

TSH Or Clinical Response?

Just to let you know you aren’t crazy there are more and more doctors and providers who simply ignore the TSH level when dealing with hypothyroid patients.

For example, a TSH level may have some value when first diagnosing hypothyroidism.  But, once started on thyroid medications some forward-thinking doctors don’t draw future blood levels of any thyroid indicators.  Instead, they rely on how the patient is doing.  In other words, how do you feel?  They will also monitor other metabolic indicators like pulse rate and body temperature.

In fact, many patients just like you have provided case studies of being started on a thyroid medication and then had their TSH level fall back into the normal level.  The only problem was these patients still didn’t feel good.  They would tell their doctors this but because their TSH was ‘normal’ the docs would not increase the dose.

While you aren’t on medications yet, this is very similar to what your are describing.

The patients that I described above started to feel much better once their thyroid dose was increased.  If they had simply relied only on their TSH levels the dose would have never been increased.  So, a TSH blood test cannot tell you and your doctor the whole story all the time.

If you are really struggling with this issue I’d encourage you to check out this side that focuses heavily on thyroid issues and offers academic papers for your doctor as well as descriptions in laymens terms about thyroid problems for patients.  He also includes some great Q and A with patients across the country who are struggling with thyroid problems.

http://www.drlowe.com

By Curtis Alexander, Pharm.D.

Summary: Bacopa is an Ayurvedic herb with purported effects on memory.  It has a history of long use in India for this purpose.  The available studies on Bacopa are positive.  Although these studies focus on either already healthy people or aren’t focused exclusively on Alzheimer’s patients.

Q: My grandmother has the early stages of Alzheimer’s.  I’ve heard that the herb Bacopa can help with memory loss.  Do you think this would be OK for her?

A: One of the first things I like to do with folks is caution them that I know of NO single supplement, herb, vitamin or prescription medication that is a cure-all or anything close for Alzheimer’s.

And while you probably know that sometimes people get false expectations.

However, Bacopa is on one of those little known herbs that appears to have some positive effects when it comes to cognition.

No Alzheimer Studies

In my preliminary research on Bacopa (also referred to as Bacopa monniera or Bacopa monnieri) I didn’t find any studies specifically looking at it’s use in Alzheimer’s disease.

What I did find was a lot of animal studies (rats) and some various human studies looking at Bacopa and human memory.  Seventy-six adults between age 40 and 65 took part in a study (it was double blinded and placebo controlled – which is good) where the researchers tested various memory functions as well as the participants anxiety levels.  They tested once prior to the study, one after three months on the trial and one six weeks after the study was finished.

They found that the Bacopa significantly helped the retention of NEW information.  Follow up tests also showed the rate of learning was unaffected.  This suggests that the rate of forgetfulness of newly acquired information was decreased.

So…that’s very positive.  But, remember – the study looked at NEWLY acquired information.  So it might be a bit of a stretch to suggest that old information will be recalled better.  Which is what happens often in Alzheimer’s patients.

Non-Alzheimer Patients

There was another promising study out of Australia that looked at the memory and cognition effects of Bacopa.  They found that Bacopa significantly improved performance on the ‘working memory’ factor.  In short, the study designers concluded that the cognitive enhancing effects in humans using Bacopa was real.

But, and this is a biggie, the study looked at healthy volunteers – not actual Alzheimer patients.

Also, the positive effects weren’t seen until after 90 days of Bacopa use.

Combination Products

If you’ve looked around yourself at all for Bacopa you’ll find it a lot with other ‘brain’ nutrients.  So, many of the positive reports that you see online are not just for Bacopa – they are for other herbs and nutrients so please keep that in mind.

Bacopa and Alzheimer’s Conclusion

Frankly, Bacopa to me seems – at the very least – promising for the use of Alzheimer’s.  As an added benefit there weren’t many reported side effects that I saw.

So, if it were my own family member I would certainly consider giving it a shot.

The usual dose of Bacopa is 150mg to 300mg once or twice a day.  And, just to reiterate, Bacopa does need to be taken for extended periods before positive results can be expected.

You may also want to consider purchasing and using a product that is combined with other memory enhancing nutrients.  Some of which include Ashwagandha, Ginkgo biloba, Ginseng, Mucuna pruriens, Reishi, Tyrosine, Choline, Vitamin B-12 and others.

Summary: Testosterone replacement therapy is a viable option for a lot of patients.  Because testosterone is a hormone there can be a lot of side effects.  Many men find that lifestyle modifications can help with testosterone levels.

Q: I’m almost 60 years old and I’m getting a lot of the signs and symptoms of low testosterone.  My doctor said this is andropause and expected and that my only viable option is testosterone replacement therapy.  I’m almost ready to pull the trigger but, is it safe?

A: I’ll repeat a mantra of mine…”when you take a hormone lots of things can happen”.  Testosterone might be the poster child for this as their can be a lot of good effects and bothersome side effects.  But it really depends on you and where you are at right now.

You’ve mentioned your 60 and you and your doctor feel that you have a lot of the signs and symptoms of low testosterone.  That’s no surprise.  After age 40 most men see a significant decline in their testosterone levels.  I say ‘most’ because there are some men who maintain youthful testosterone levels into what you and I might consider ‘old age’, seventy and above.

How you ask?  It’s really a combination of things but the main point is how their healthy eating style.  They eat NO processed foods which are infamous for containing estrogen-like compounds.  They consume fats and proteins in their diet which is the building block for testosterone.  They employ reasonable exercises, including compound exercises that recruit large muscle groups like the squat, dead lift and pressing exercises.  They get better sleep.  They have reasonable alcohol consumption (overdoing it on alcohol quashes testosterone production).  Their body fat is low.  Originally this a byproduct of having good testosterone levels in the first place.  But the more fat you have the more estrogen you’ll likely produce as fat can convert testosterone to estrogen.

All of these factors either support testosterone production or promote testosterone being converted to other substances like estradiol and estriol – ‘female’ hormones.

And, in the vast majority of men, that is what happens and what is likely happening to you.  As your testosterone levels decline men become estrogen dominant.  Skinnier arms, less muscle mass, more abdominal weight, lack or lowering sex drive, depression and just less ‘zest’ for life in general.

So obviously, I’d talk to your doctor first and foremost about instituting lifestyle changes that will maximize your circulating testosterone now and prevent more from being converted to estrogen products.  This is, of course, assuming that your are still producing your own testosterone and haven’t succumb to hypogonadism.  Which, as the name implies, is when your gonads (testes) stop producing testosterone either from their own dysfunction or from a dysfunction in your brain (secondary hypogonadism) through feedback loops.

Now, if you have truly addressed this first stage of saving testosterone lets talk a bit about what you might expect from prescription testosterone.

Testosterone Replacement Therapy: What You Might See

Here is a detailed testosterone synthesis chart (opens in a new window).  What this is showing you is how testosterone is made in your body (90% in your testes).  You can also see something I was talking about above.  Once your body makes testosterone (from cholesterol) a few things can happen.  Your body can use it.  It can be converted to dihydrotestosterone (DHT) or it can be converted to estradiol and eventually estriol.  These are ‘estrogens’.  And yes, men need some estrogen just like women need testosterone.

But, generally as American men age they become estrogen dominant.  This is bad.

You first need to understand how testosterone acts in your body to appreciate what replacement therapy will do for you – both good and bad.  Whether you take testosterone injections, gel or patches your body will likely recognize this outside source of testosterone and essentially back off what it is producing in your own testes.  So, there could be testicular shrinkage.  Secondly, what is your body fat level?  And be honest.  If it’s high enough you’ll likely discover that although you are supplementing with testosterone your free testosterone levels don’t rise accordingly.

This is likely due to aromatization of testosterone.  Body fat stores allow this to happen.  Actually, this may be part of the problem in the first place. It also explains why some men can get testosterone supplements and their levels of circulating testosterone don’t increase.

Once that testosterone is aromatized it is converted to estrogen.  You then may experience what recreational steroid users refer to as ‘bitch tits’.  This is estrogen’s feminine side rearing it’s head.

Compound this with a high intake of xeno- and phyto-estrogens from the environment and soy products and you can understand why many young men nowadays are walking a fine line with feminism…literally.

On the flip side, testosterone is known as the feel good hormone.  So you may have your drive for life and sex.

Other Caution with Testosterone Replacement Therapy

• Hepatitis
• Worsening of Sleep Apnea
• Reduced ejaculatory volume
• Cholesterol level changes
• Edema

“Roid’ Rage”

I’m sure you’ve heard the dreaded stories about ’steroid’ users who have a roid rage and attack someone during rush hour traffic.  Don’t.  The doses that these kind of knotheads take are called supraphysiological.  In short, they are far beyond any dose that humans should be taking.

If a man has a healthy testosterone level there will be – as I mentioned above – a healthy zest for life.  A good sex drive.  But not any type of roid rage.

Prostate Cancer

Ten years ago your doctor probably would have been very reluctant to prescribe any sort of testosterone treatment because we all thought testosterone was the root cause of prostate cancer.  In fact, my grandfather passed away from prostate cancer in 1998.  And, at that time, testosterone was the culprit – or so we thought.

But, if that’s the case, why don’t more 20 year old men get prostate cancer?  Men who are absolutely filled to capacity with testosterone.  So obviously there are other factors at play.  In fact, in some countries they are now using testosterone to treat certain prostate cancers.

In short, unless you already have prostate cancer or some sort of prostate problem like benign prostatic hypertrophy I wouldn’t concern yourself too much with replacement therapy.

While I’ve only known a few men who were clinically diagnosed as testosterone deficient I would suspect that many men today are, they just don’t know it.

I would encourage you to talk to your doctor about natural testosterone replacement.  Not necessarily through pills or so forth (you’ll simply run into the same problem that you did with prescription testosterone replacement).  But through lifestyle modifications.

Frankly, most men are the sole cause of their low testosterone.  Once you have exhausted those options (and there are many) you can look into supplementation and replacement therapy.

But, at 60 years of age, prescription testosterone replacement may be the only viable way to increase your testosterone blood levels.  With lifestyle modifications that I talked about above it will help you body ‘hold onto’ the testosterone better.

By Curtis Alexander, Pharm.D.

Summary: For your body to synthesize natural Vitamin D sunlight is a requirement.  It’s true too much sunlight can cause skin cancer.  But sensible sun exposure is frankly a very healthy thing to do and you’ll gain much benefit from it.

Q: I know it’s important that I increase my Vitamin D intake.  But I don’t want to get skin cancer from exposing my body to sunlight.  Can’t I just get it through my diet?

A: I can only answer this from my personal standpoint and how I handle the problem.  And there are two parts to your question:

Some folks are concerned that if they increase their vitamin D intake through sun exposure they’ll get cancer.  Instead, they want it from diet.  Here is my personal viewpoint on the question of getting adequate amounts from my diet:

1. No.  I could never get the the minimum of 1,000 IU’s (I’m personally comfortable with 2,000 IU’s) a day of Vitamin D just from food because I very rarely drink milk or any other ‘fortified’ foods.  I suppose someone could, but it would take a lot of milk and breads.  Which, frankly, most people should cut back on or avoid altogether.  Especially breads.  Yes, you’ll get more Vitamin D but you’d also likely get fatter, more joint problems and a whole host of other problems.
2. Unless there has been some sort of study that I’m not aware of, you have about as much chance of getting skin cancer from sensible sun exposure as hell freezing over.  Again, I don’t consider myself a Vitamin D expert per se, but I have read the works of other Vitamin D experts and beyond the militant stance of some dermatology associations it’s widely believed, and proven with research,  that sensible sun exposure is not only safe, but beneficial.

Sensible Sun Exposure

So the question becomes, how much sunlight is enough?

Frankly, it’s a tough question to answer and the short version would be, “it depends”.  That is, it depends mainly on your skin color.  Dark skin people are estimated to require two to three times longer exposure to the sun to synthesize the same amount of Vitamin D that a fair skinned person would.

For a fair skinned person like myself the general consensus is that five to ten minutes every other day is probably adequate.  In the summer, I personally shoot for 10 minutes every day.  I’ll simply just wear a pair of shorts and shoes, exposing my head, upper body and part of my legs.  Once the ten minutes is done I’ll cover back up and put sunscreen on any exposed body parts if I plan out being out the rest of the day.

Latitude

Another point to consider is where you live.  Multiple Sclerosis has long been known to be more prevalent at higher latitudes (i.e., lower sun exposure rear round).  So, during the winter months I supplement with Cod Liver Oil.  And, to get back to the first part of your question, even the kind of high quality Cod Liver Oil I take only provides about 600 IU’s a day.  So I still wouldn’t reach my goal of 2,000 IU’s a day.  So, I and my family supplement with 2,000 IU’s a day of vitamin D3.

When spring comes back around we get our vitamin D from the sun.

Sunlight Conclusion

After viewing the evidence for years I can tell you that even with a family history of skin cancer I’m completely comfortable with sensible sun exposure.  Radical ideas like tanning and so forth are frankly what has given sunlight a bad rap.  You need it in small amounts and should get it.

Also keep in mind that UV rays can’t pass through glass so driving during a summer day does nothing for your Vitamin D synthesis.  Also, even a low grade sunscreen at an SPF of 8 will block up to 95% of Vitamin D synthesis.

Summary: Mainstream advice on how to lower triglycerides is often a mix of good and bad information.  This probably explains why you are either seeing your triglycerides drop agonizingly slow or not at all.

Q: One year ago my triglycerides were over 200 so my doctor enrolled me in a ‘cholesterol’ study where I get my blood drawn frequently.  Now, the triglycerides are at 200 and I’m eating low fat.  Why aren’t the triglycerides going down more?

A: If you want a baseline understanding of triglycerides and some of the things that really makes your blood levels go up and down take a look at my article called what are triglycerides.  Too often, because triglycerides are fat, dietitians and other health care providers tell you to avoid fats.

I talk to a fair amount of people who desperately want to lose weight and get their cholesterol lower.  As part of that they want to get their triglycerides lower.  But people needlessly struggle with this.  And it’s understandable when you consider that the advice they are following is WRONG.

What Are Triglycerides?

It’s a false theory because triglycerides are in all food groups.  More so, the types of triglycerides you’re getting are even more important.

But, to prove my point lets look at one of the top sites online showing visitors how to lower triglycerides.  Now, I know dietitians and respect them but this advice is off base and if you are following advice similar to this then it’s no wonder your triglycerides aren’t dropping.

Here’s what they recommend with my commentary after each:
Keep an active lifestyle (good).  Focus on a diet low in saturated fats (correct, although some saturated fat is needed. They then go on to recommend low fat dairy or cheese instead of regular version.  And to avoid butter.  They think all fat is the enemy which is a misnomer).  Include high fiber foods like whole grains, oatmeal and fruits (keep some fruits but ditch the oatmeal and grains).  Limit sugar intake like pop, Kool-aid, etc. (good, but where is the advice on limiting the biggest sugar culprit – processed foods?).  Limit alcohol to 1 drink/day (Not bad advice per say).  Use BMI calculator (Bad.  The BMI is notoriously inaccurate.  In fact, the last time I checked mine I was borderline obese at 6′1″ and 180 pounds.  I would guess that by body fat hovers around 10% to 12%).  Eat an Omega 3 rich diet (good)

How to Lower Your Triglycerides: The First Step

I do NOT follow any sort of USDA Food Pyramid which most dietitians I encounter seem to love.  Instead I follow some simple rules that I have laid out in my healthy eating section but that I’ll summarize for you here.

Stop eating processed foods.  Either transition away from them slowly over three or four weeks or go cold turkey.  But, within a month your goal should be no processed foods.  I emphasize all processed foods including bagels, breads, pasta, rice, flavored yogurts (and regular yogurts except in rare circumstances), energy bars, “gainer drinks”, creamers, etc.  If man made it then you shouldn’t eat it.  Dietitians will argue that whole grains are needed for fiber.  They aren’t.  The best source of fiber are vegetables and fruits (in that order).  Whole grains must also be milled and processed for consumption.  In short, they are processed and could not be consumed by man without preparation.  Coffee is OK.  No creamer though.  Eliminate margarine with all of it’s trans fats and other vegetable shortening.  If I cook eggs in the morning (another maligned food because of cholesterol levels – don’t pay any attention an egg is an excellent food) I line the pan with real butter.  I have basically cut my once high dairy consumption to little or nothing.  If I do consume dairy it is whole milk or half and half with real cheese.  Low fat labeling you will not find in my fridge.  I drink alcoholic beverages.  For example, on my days off I’ll have one, usually two beers around lunch time or a glass of wine.

I could go into more depth and if you’d like simply check out my healthy eating section.  But you get the point.

The Results Speak for Themselves

You may find that if you eat the traditional, dietitian-recommended route your triglycerides may slowly trickle down.  But they often stabilize around 200 or a little lower.  But, once they stabilize they still tend to be higher than either doctors or the patients want so then they put them on a prescription medication.

Another thing about the processed foods that I don’t see mainstream mention is how they trigger insulin release in your body which also triggers your body to assimilate triglycerides.  So, high carb foods are already high in triglycerides.  Then you eat them and make even more because of the insulin trigger that is pulled.

So, does my eating style produce results?  I recently had my triglycerides measured at 33 which is extremely low.  Incidentally, my HDL was 54 which puts one of my main cardiac risk ratios (TG/HDL) at basically an undetectable level.  So I would say it’s done it’s job.

And what is everybody’s favorite number: total cholesterol?  I could care less because it’s not important but as an aside it’s 145.

As an aside, my thinking is clear and my weight is a complete non-issue.  My wife has followed a similar path.  While she hasn’t had her labs measured I would assume they are similar.  In addition, her gastrointestinal problems of the past have disappeared.  This is a similar path to others who’ve adopted my eating style.

So, is your current eating style doing you any favor in regard to actually lowering your triglycerides and other cholesterol levels?  Likely not as much as you like.  If you aren’t sure simply compute your cardiac risk factor I gave above.  I bet the number will shock you – it should be below 2.

If it’s high, lower it.  But do it in an effective, natural way.  They way your body is designed to work.