HormoonWellness - Dr. Thierry Hertoghe 23 mei 2014

HormoonWellness - Dr. Thierry Hertoghe

23 mei 2014

Anterior Pituitary

GH

Liver IGF-1 Pancreas Insulin

Males: 2 Testicles Testosterone Dihydrotestosterone (DHT)

2 Adrenal Glands DHEA Cortisol

(Cortex)

Aldosterone

Females: 2 Ovaries Estrogens Progesterone

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23 mei 2014

People age ��.. unnecessarily?

=

New, wellkept house

Age 24, untreated

= Age 64, untreated

House not well cared of, not repaired

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23 mei 2014

= Untreated very old person

How can we partially or even near totally reverse the aging? Ideally

Ruin

= Age 64, untreated

=

Age 68 => Outlook of a treated age 24?

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23 mei 2014

Aim of Medicine: Make the patient as healthy as possible Aim of Reversing Aging Medicine: Make the patient as young as possible to be sure (s)he is at his (her) healthiest

Less healthy

Age 55

Healthier

Age 52

Age 58

Healthiest

Age 56

but looks as a 40-year old (15 years younger)

Age 60

60



Less healthy

Age 55

Healthier

Hormon e therapie s + Paleolith ic- type Age 52 Diet

Age 58

Healthiest

Age 56


Age 60

60


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23 mei 2014


Less healthy

Healthier

Healthiest

Hormone therapies + Paleolithic Hormone -type Diet therapies + Nutritional + therapies Paleolithic + Telmomerase - type Diet activators Age 52 Age 58 + Age 56 Age 60 60 Stem cell therapy? but looks as but looks as a 40-year old a 30-year old (15 years younger) (25 years younger)

Age 55

1. IGF-1- Growth hormone 3. Insulin

2. Testosterone 2. Estradiol

(longacting)

Less healthy

Healthier

Healthiest

Hormone therapies + Hormone therapies + Paleolithic - type Diet

Age 55

Age 52

Age 58

Age 56

Age 60

60

7. Cortisol

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23 mei 2014

human Growth

Hormone

Anterior Pituitary

Growth Hormone

MSH

ACTH LH, FSH TSH

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23 mei 2014

Physical Aging by Growth hormone & IGF-1 deficiency • Thin hair lacking volume Sex hormone, GH, IGF-1 deficiencies • Shorter hair • Forehead Wrinkles

IGF-1/GH defic. • Thin eyebrows (middle) GH, IGF-1

deficiencies deficiencies • Cataract Melatonin , GH • Droopy upper/lower eyelids IGF-1/GH deficiencies

• AGING FACE • • • • •

IGF-1/GH & Sex hormone defic.

Droopy nose tip Sagging cheeks Nasolabial fold Thinner lips Skinfolds under the chin

IGF-1/GH deficiency (Insulin deficiency)

• Dry skin Thyroid, sex hormone, DHEA, GH deficiencies • Muscle hypotrophyIGF-1/GH, testosterone, DHEA deficiencies

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23 mei 2014

Growth hormone deficiency Psychic complaints appear mainly During the day: Exhausted, dramatizing, anxious => In the evening: worsens, complete exhaustion, anxious

Passing bedtime hour aggravates all psychic complaints

Whole day and evening

worsens towards the

More superior, relaxed mind

Improved to spiritual consiousness

Growth hormone Fear Ene r-gy

++

Hap pine ss ++

Jo y

Love

Ser enit y

Fir mn ess

Irrit a bilit y

Hat e

↓↓

↓↓

Run s awa y

Para lyze d

↓↓

↓↓

Sadness Cry Dep -ing ress

Unha Fat ppi igu ness e

ed

↓↓

↓↓

↓↓

↓↓

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23 mei 2014

GH treatment: The change! BEFORE

AFTER 2 months GH & 4 months TESTO

GH treatment: The change!

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23 mei 2014

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23 mei 2014

Magnesium citrate

↓ Mg => ↓ GH Mg therapy => ↑ GH

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23 mei 2014

↓ Mg => ↓ serum GH Mg treatment => ↑ serum GH SUBJECTS: lactating dairy cows + ↓ feed intake (84% concentrate diet) RESULTS:

•

↓ serum Mg => ↓ increase of serum GH caused by ↓ feed intake

•

100.8 g MgO or 121.2 g of Mg(OH)2 supplements => ↑ Serum GH (vs controls) Emery RS, Luoma J, Liesman J, Thomas JW, Tucker HA, Chapin LT. Effect of serum magnesium and feed intake on serum growth hormone concentrations. J Dairy Sci. 1986 Apr;69(4):1148-50.

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23 mei 2014

Magnesium absorption •

Best absorbed: the chelated form of magnesium, such as magnesium citrate, glycinate or malate. This form is by your body. Step 2 • Combine magnesium with calcium. The easiest way is to take a balanced formula of 1 part magnesium to 2 parts calcium. Step 3 • Take vitamin C at the same time. It helps make magnesium more biologically available to your body. Step 4 • Bathe in magnesium sulfate, better known as Epsom salts. The mineral can be absorbed through your skin. Step 5 • Reduce or eliminate your consumption of soft drinks. Their high level of phosphates causes magnesium to be depleted from your body. Step 6 • Lower your fat intake. A high fat intake will also cause magnesium to be depleted from your body. http://www.ehow.com/how_3954_absorb-magnesium-supplements.html#

Mg content of oral supplements

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23 mei 2014

Potassium

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23 mei 2014

K+ => ↑ GH

Potassium deficiency => ↓ GH Potassium therapy => ↑ GH

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23 mei 2014

Niacin

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23 mei 2014

Vit. B3 => HDL, LDL, TG HDL: Niacin => increased HDL levels over 25%, vs an increase of 13.3% due to gemfibrozil. LDL: Gemfibrozil actually raised LDL, while niacin slightly lowered this fraction. TG: Gemfibrozil lowered triglyceride levels by 40%, vs a 30% decrease from niacin. CCL: niacin resulted in an overall improvement in the lipid profile which exceeded that induced by gemfibrozil Guyton, John R., Blazing, Michael A., Hagar, James, et al. Extended-release niacin vs Gemfibrozil for the treatment of low levels of high density lipoprotein cholesterol. Arch Intern Med, 2000, 160: 1177-1184.

Vit. B3 => mortality These results support many previous studies on the use of niacin as a lipid-lowering nutrient. Ex.: in the Coronary Drug Project, which enrolled men with a previous myocardial infarction, niacin use => • 26% decrease in 2nd non-fatal heart attacks over a 6-yr period • 11% decrease in total mortality after 15 yrs of follow up (Canner, et al, 1986) (Fig. 2). References: Canner, P.L., Berge, K.G., Wenger, N.K., et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol, 1986, 8: 1245-1255; Dilman, V., and Dean, W. The Neuroendocrine Theory of Aging and Degenerative Disease, 1992, The Center for Bio-Gerontology, Pensacola; Guyton, John R., Blazing, Michael A., Hagar, James, et al. Extended-release niacin vs Gemfibrozil for the treatment of low levels of high density lipoprotein cholesterol. Arch Intern Med, 2000, 160: 1177-1184; Horowitz, N. Link niacin to longevity after an MI. Medical Tribune, 1985, 26: 12, pp. 1, 17. Muntoni, S. Inhibition of fatty acid oxidation by biguanides: implication for metabolic physiopathology. Adv Lipid Res, 1974, 12: 311-377; Quabbe, H.J., Ramek, W., and Luyckx, A.S. Growth hormone, cortisol and glucagon concentration during plasma free fatty acid depression. Different effects of nicotinic acid and an adenosine derivative. J Clin Endocr Metab, 1983, 57: 410-414.

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23 mei 2014

Niacin deficiency => Pellagra = the disease caused by niacin deficiency => involves • skin (photosensitivity), • gastrointestinal tract • central nervous system. ⇒ progresses through dermatitis, diarrhea, depression & death. Pellagra was endemic in the southern USA (& many other parts of the world) in the early 1900s, partt. among children. It was found to be a dietary deficiency by Joseph Goldberger, a U.S. Public Health Service physician at about the time of the first world war. Pellagra was carried to Europe in the years following Columbus' discovery of the new world as maize (corn) was discovered & became the staple for Europe's poor.

Vit. B3 treatment

=> ↑ GH

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23 mei 2014

Niacin => stimulates GH While extolling the benefits of niacin, one frequently overlooked “side effect” is that niacin = powerful releaser of growth hormone (Quabbe, et al, 1983) (Fig. 3). Quabbe & colleagues administered 500 mg niacin intravenously to humans => dramatic rise in GH. In a 2nd phase of their study, they simultaneously administered an infusion of fatty acids => the fat completely blunted any rise in growth hormone. CCL: anyone using niacin as a GH stimulant should take it on an empty stomach (glucose & insulin also inhibit growth hormone, as well as fatty acids). References:

Quabbe, H.J., Ramek, W., and Luyckx, A.S. Growth hormone, cortisol and glucagon concentration during plasma free fatty acid depression. Different effects of nicotinic acid and an adenosine derivative. J Clin Endocr Metab, 1983, 57: 410-414.

Niacin: oral

at bedtime

Too Low

Optimal dose

Excess

0.1 g ?

0. 2 - 1 g

> 0.8 g ?

Mild to good GH response (only in lean subjects); no response in subjects > 1.5 x ideal weight

Flush 20’ ( histamine release w/ artery dilatation);

Liver damage

(timereleased forms from 0.8 g up)

To optimize: Xanthinol nicotinate passes better the blood-brain barrier

Klatz R. Grow Young with HGH. Harper & Collins 1997

Hertoghe T, Brussels, 9-2000

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23 mei 2014

Vit. B3 => Flush Mechanism: niacin causes fatty acids in the skin => changed into rel. prostaglandins => open the blood vessels. If any part of this system is not working properly, the flush response does not occur such as in some chizophrenics

schizophrenia

healthy

Patch test result from patient with schizophrenia (left) vs healthy

High dose niacin is very safe: =>most frequent “adverse effect” = harmless flushing of the skin + itching => usually resolves over a few days or weeks of use. 3 ways of minimizing the flush: 1. Taking an aspirin 30 ‘ or so before the niacin => helps to reduce this effect. 2. To start with low doses (50-100 mg) & gradually increase the dose as tolerated. 3. Use inositol hexanicotinate (IHN)—another non-flushing form of. IHN, while a bit more costly than niacin, = effective in somewhat lower doses, thereby remaining cost effective

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23 mei 2014

Amino acids known to increase GH release • • • • • •

L-Arginine 7000-12000 mg L-Glutamine 1000-2000 mg L-Ornithine 2500-6000 mg L-Lysine 1000-3000 mg Glycine 4000-6000 mg Tryptophan 5 to 10 g

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23 mei 2014

GH & arginine & obesity STIMULATION

Lean

Obese

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23 mei 2014

Arginine: oral

1h before exercise & sleeping

Lower dose

Optimal dose

Excess

3 g

7 –12 g

> 20 g

moderate Gh response

Highest GH response (esp. in young adults 20-35 yrs those w/ low body fat & high aerobic capacity)

Lowest GH response, diarrhea

mechanism: inhibits somatostatin enhances effects of GHRH when given together Matteini M et al. GH secretion by arginine stimulus: the effect of low doses and oral arginine administered before standard test. Bull Soc Ital Biol Exp. 1980; 56: 2254 Hertoghe T, Brussels, 30-9-00

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23 mei 2014

Glutamine: oral

at bedtime

Too Low

Optimal dose

Excess

0.5 g

2g

>5 g

good GH response (works also in older adults (32-64 yrs)), virtually no side effects

Low Toxicity

mechanism: stimulates GH secretion Welbourne T. Increased plasma bicarbonate and growth hormone after oral glutamine load. Am J Clin Nutr. 1995; 61: 1058-61

Hertoghe T, Brussels, 30-9-00

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23 mei 2014

Ornithine-alpha-ketoglutarate (OKG) => potently ↑ insulin, GH & IGF-1 in trauma patients Ornithine-alpha-ketoglutarate (OKG) = promising anticatabolic agent a. SUBJECTS:14adult, multiple trauma patients who were highly catabolic and hypermetabolic were studied. Whole-bodyprotein ((15)N glycine), fat (2 stage glycerol infusion) and glucose((3H)glucose) kinetics (t/o) and plasma parameters were measured (A) within48-60 h after injury before starting nutritional support and then (B) after 4days of enteral feeding. Group A (n=7, control) received a defined enteralformula (Two Cal HN, 1.4 times BEE calories) and Group B (n=7, OKG) receivedsame isonitrogenous diet replacing 2.62gN/d from the enteral diet by OKG-N (20gOKG/d). RESULTS (Mean+/-SEM): Protein turnover is significantly (P<==0.05)increased in OKG treated patients (4.68+/-0. 15 vs 3.90+/-0.23, gP/kg/day) andglycerol turnover is decreased (0. 87+/-0.16 vs 1.46+/-0.16, micro mole/kg/min).Glucose turnover is not changed. Significant

(P<== 0.05) increases in serum levels of hormones (insulin, 44.2+/-8.4 vs 15.7+/-5.0 ulU/ml, GH 1.68+/-0.33 vs 0.92+/-0.16, ng/ml and IGF-1, 106+/-13 vs 75+/-18,ng/ml) and free amino acids (glutamine, 383+/-20 vs 306+/-25, Proline, 203+/-18vs 146+/-13 and ornithine, 164+/-27 vs 49+/-5 micro mole/l) are found in OKG treated patients, compared to non OKG patients. CONCLUSION: Increased hormonesecretion due to OKG and the rapid interaction between the metabolites of OKG atthe intermediary metabolism level may be responsible for altered substrate fuelkinetics. Jeevanandam M, Petersen SR. Substrate fuel kinetics in enterally fed trauma patients supplemented with ornithine alpha ketoglutarate. Clin Nutr. 1999 Aug;18(4):209-17. Trauma Center, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, Arizona 85013, USA.

Ornithine : oral at bedtime Lower dose 1.5 g moderate Gh response

Optimal dose 2.5 - 5 g Highest GH response (esp. in young adults 20-35 yrs those w/ low body fat & high aerobic capacity)

excess > 10 g Lowest GH response, diarrhea

mechanism: enhances GH release Other effects: regenerates the liver in animals Klatz R. Grow Young with HGH. Harper & Collins 1997 Hertoghe T, Brussels, 30-9-00

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23 mei 2014

NUTRIENT

DOSE to ↑ GH levels/activity

Calcium

500 to 1500 mg/day elemental calcium before bedtime

Magnesium

oral 300-600 mg/day elemental magnesium

+

DURATION 4 to 8 months or permanently 4 to 8 months or permanently

Potassium

oral 0.5 to 3 g/day

1 to 12 months

Vit. B3

oral 1–3 x 500 mg/day

2 to 6 months

Vit. B6

oral 1 to 2 x 125-250 mg/day pyridoxine; or active: 50-100 mg/day Pyridoxal-5-phosphate

4 to 8 mo or permanently

Saturated fatty ac.

oral saturated coconut oil, butter, egg yolk

permanently

oral 2 to 7 grams per day for 2 to 3 months (7 g/day to increase growth hormone)

4 to 12 months

Arginine Glutamine

oral 2 g/day for

2 to 3 months

Tryptophan

0.5 to 2 grams before bedtime. If less sleep less 4 to 3 months => take it in the morning.

Lysine

1 to 3 g/day

2 to 3 months

Glycine

4 to 6 g/day

2 to 3 months

Orninthine

2 to 6 g/day

2 to 3 months

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23 mei 2014

Insulin-like Growth Factor 1

The liver => Secretes most of IGF-1 (Insulin-like Growth factor 1))

Liver

IGF-1

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IGF-1 Deficiency

23 mei 2014

IGF-1 Excess

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23 mei 2014

Pancreas

Insulin Glucagon

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23 mei 2014

IGF-1 treatment

=> ↑ Magnesium

rh IGF-1 & insulin => => ↑ serum erythrocytic Mg SUBJECTS: 3 fasting normotensive & 10 essential hypertensive subjects before & 30, 60, & 120’after incubation w/ a physiologically maximal dose of insulin (200 µU/mL) & w/ diff. doses of r human IGF-I (0.1-100 nmol/L).

TREATMENT: • In normotensive subjects, IGF-I elevated Mg(i) (P <0.05) in a dose- & time-dep. fashion, as did insulin (P < 0.05). • In hypertensive subjects, maximal Mg(i) responses to insulin, but not to IGF-I, were blunted [insulin, 163 to 177 µmol/L (P=NS); IGF-I, 164 to 190 µmol/L (P < 0.05)]. For insulin, but not for IGF-I,cellular Mg(i) responsiveness was closely & directly related to basal Mg(i)levels (insulin: r=0.72; P < 0.01; IGF-I: r=0.18; P=NS).

• blunted Mg (i)responses to insulin could be reversed by preincubation of hypertensive cells with IGF-I. CCL: 1) both IGF-I & insulin stimulate erythrocyteMg(i) levels; 2) cellular Mg(i) responses to insulin, but not to IGF-I, depend onbasal Mg(i) levels, i.e. the higher the Mg(i) the greater the sensitivity toinsulin; and 3) IGF-I potentiates insulin-induced stimulation of Mg(i) at dosesthat themselves do not raise Mg(i). Dominguez LJ, Barbagallo M, Sowers JR, Resnick LM. Magnesium responsiveness to insulin and insulin-like growth factor I in erythrocytes from normotensive and hypertensive subjects. J Clin Endocrinol Metab. 1998 Dec;83(12):4402-7.Division of Endocrinology, Metabolism, and Hypertension, Wayne State University, Detroit, Michigan 48201, USA.

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23 mei 2014

↓ Potassium ⇒ ↓ IGF-1

Potassium treatment ⇒ ↑ IGF-1

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23 mei 2014

↓ Potassium => ↓ serum IGF-1 in young rats FACT: Growth retardation & impaired protein synthesis = major characteristics of potassium (K)-deficiency in animals & man. SUBJECTS: young rats. TREATMENT: K-depleted rats after 10 days on K-def.diet, 4 1/2-week-old (vs controls) • - 54% ↓ serum potassium (s-K) ↑ • -97% ↓ weight gain. • Sign. ↓ length, tibia length, and muscle weight of soleus in animals were all significantly reduced compared with pair-fed controls. * • -46% ↓ s-IGF-I w/ growth retardation • s-insulin showed no decrease. K-repletion in animals depleted for 7 days showed • Complete normalization of s-K within 24 hours, • sign. increase in both s-IGF-I and weight. In 4-week-old rats maintained on K-deficient diet + variable K-content (1 to 260 mmol/kg) for 1 wk, a strong corr. between the K-content of fodder & s-IGF-I could be established (r = .88, P < .001), as well as between s-IGF-I ² weight gain (r = .90, P < .001).Furthermore, a stepwise reduction in basal s-GH was seen with the graded reduction of dietary K-content. Flyvbjerg A, Dørup I, Everts ME, Orskov H. Evidence that potassium deficiency induces growth retardation through reduced circulating levels of growth hormone and insulin-like growth factor I. Metabolism. 1991 Aug;40(8):769-75.Medical Department M (Diabetes and Endocrinology), Aarhus Kommunehospital,Denmark.

↓

Potassium => ↓ serum IGF-1 in rats

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23 mei 2014

↓ Vit. A => ↓ IGF-1

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23 mei 2014

↓ Vit. A diet => ↓ serum IGF-1 in rats SUBJECTS:

Male rats (3-wk-old) => Vitamin A-deficient diet for 11 wk d

↓ ↓ serum retinol & hepatic retinyl palmitate. Sign. ↓ body weight (p < 0.05) Sign. ↓ serum IGF-I than the rats fed the control diet. Approx. 40% lower levels of the IGF-I mRNA in the liver & lungs. 2x ↑ IGF-I receptor (IGF-IR) mRNA in the heart 2x ↓ IGFBP-6 mRNA in the lungs did not alter the expression of IGF-II, IGFBP-1, IGFBP-3, IGFBP-4 or IGFBP-5 in all tissues VA-deficient rats => single inj. of retinoic acid (2 mg/rat) • tissue IGF-I & IGF-IR gene expression did not change after 4or 8 h • the expression of IGF-II, IGFBP-4, & IGFBP-6 mRNAs in some tissues increased rapidly. • • • • • • •

Fu Z, Yoneyama M, Noguchi T, Kato H. Response of the insulin-like growth factor system to vitamin A depletion and repletion in rats. J Nutr Sci Vitaminol (Tokyo). 2002 Dec;48(6):453-60.Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Yayoi 1-1-1. Bunkyo-ku, Tokyo 113-8657,Japan.

Vit A interacts with IGF1 expression IGF-1 Weight Weight IGF-1

in Rats

Response of the insulin-like growth factor system to vitamin A depletion and repletion in rats. J Nutr Sci Vitaminol (Tokyo). 2002 Dec;48(6):453-60.

Fu Z, Yoneyama M, Noguchi T, Kato H.

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23 mei 2014

Vit. A treatment

=> ↑ IGF-1

Retinoic acid restores IGF1 in alcohol-reduced plasma IGF1 mRNA IGF-1 IGF-1

IGF-1 IGF-1

mRNA IGF-1 mRNA IGF-1

Alcohol-reduced plasma IGF-I levels and hepatic IGF-I expression can be partially restored by retinoic acid supplementation in rats. Lian F, Chung J, Russell RM, Wang XD. J Nutr. 2004 Nov;134(11):2953-6

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23 mei 2014

↑ serum vit. D => ↑ serum IGF-1

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23 mei 2014

IGF1 POSITIVELY CORRELATED VIT D IN AGING MEN Only 25(OH)D and total testosterone are positively associated with serum IGF-I IGF1 regulates 25(OH)D3 in men FAT MASS regulates 25(OH)D3 in women IGF-I is a significant predictor of BMD at the total hip, femoral neck and femoral trochanter neck Relationship between 25-(OH) D3, the IGF-I system, leptin, anthropometric and body composition variables in a healthy, randomly selected population. Gomez JM, Maravall FJ, Gomez N, Navarro MA, Casamitjana R, Soler J.Horm Metab Res. 2004 Jan;36(1):48-53. IGF-I and testosterone levels as predictors of bone mineral density in healthy, community-dwelling men. Rucker D, Ezzat S, Diamandi A, Khosravi J, Hanley DA.

Clin Endocrinol (Oxf). 2004 Apr;60(4):491-9.

Vit. D treatment

=> ↑ IGF-1

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23 mei 2014

2 µg/day CALCITRIOL => => ↑ serum IGF-1 I osteoporotic women SUBJECTS: 18 osteoporotic women [1,25(OH)2D3] => 2 doses (1µg/day & 2 µg/day) for 14 days The biological effectiveness of the treatment => controlled by ↓ serum intact parathyroid hormone TREATMENT: CALCITRIOL 1,25(OH)2 vitamin D3 vs before treatment • ↑ sign. plasma IGF-I, beta 2 microglobulin, & serum osteocalcin => effects were only apparent after the higher dose of the drug (169 vs 134 ng/ml, P < 0.01; 2.08 vs 1.92 µg/ml, P < 0.05; & 8.5 vs 5.4 ng/ml, P < 0.01, resp.).

CCL: exogenous 1,25(OH)2D3 => ↑ production of IGF-I & beta 2 microglobulin in osteoporotic patients in parallel to the marker of osteoblastic function, osteocalcin Zofková I, Kancheva RL, Bendlová B. Effect of 1,25(OH)2 vitamin D3 on circulating insulin-like growth factor-I and beta 2 microglobulin in patients with osteoporosis. Calcif Tissue Int. 1997 Mar;60(3):236-9.Institute of Endocrinology, Prague I, Czech Republic.

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23 mei 2014

Vit. D converter VITAMIN D Cholecalciferol (vit. D3)

1 µg 1 IU

40 IU 0.025 µg

Ergocalciferol (vit. D2)

1 µg 1 IU

40 IU 0.025 µg

Note: IU: International Units; mg: milligrams; mcg: micrograms

http://www.robertforbes.com/public_html/index.php?option=com_content&view=article&id=61&Itemid= 90

Vit. D converter VIT. D TYPE

µg

IU

Cholecalciferol (vit. D3)

100 µg

4000 IU recommended


100 µg

4000 IU

VIT. D TYPE

IU

µg

Cholecalciferol (vit. D3)

1000 IU

25 µg recommended


1000 IU

25 µg

Note: IU: International Units; mg: milligrams; mcg: micrograms

http://www.robertforbes.com/public_html/index.php?option=com_content&view=article&id=61&Itemid= 90

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23 mei 2014

PUFA treatment

=> ↑ IGF-1

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23 mei 2014

BURN PATIENTS : FISH OIL IMPROVES SPEED & AMOUNT OF IGF1 RECOVERY IGF1

Decreased serum insulin-like growth factor-I in burn patients: relationship with serum insulin-like growth factor binding protein-3 proteolysis and the influence of lipid composition in nutritional support. Abribat T, Nedelec B, Jobin N, Garrel Crit Care Med. DR. 2000 Jul;28(7):2366-72.

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23 mei 2014

Zinc treatment

=> ↑ IGF-1

Zinc treatment in 22 Children –short stature OVER 6 weeks

IGF-1

IGF-1

IGF-BP-3

IGF-BP-3

Effect of zinc supplementation on growth hormone ,IGF1,IGFBP3,Somatomedin generation,alkaline phosphatase, osteocalcin and growth on prepubertal children with idiopathic short stature. Imamoglu,Bereket,Turan,Taga J Pediatr Endocrinol Metab 2005 Jan 18, 69-74

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23 mei 2014

Ratio IGF1/IGFBP3 bioavailability of IGF1 Direct stimulatory effect of Zinc

Effect of zinc supplementation on growth hormone ,IGF1,IGFBP3,Somatomedin generation,alkaline phosphatase, osteocalcin and growth on prepubertal children with idiopathic short stature. Imamoglu,Bereket,Turan,Taga J Pediatr Endocrinol Metab 2005 Jan 18, 69-74

Protein, zinc => increase IGF-1 SUBJECTS: 226 free-living healthy middle-aged & elderly men aged 42-76 y; 24-h dietary telephone interviews performed over 1 yr RESULTS: We observed statistically significant positive associations between intakes of protein (P for trend = 0.001) & zinc (P for trend = 0.002)and serum IGF-I concentrations after adjusting for age. The difference in mean serum IGF-I for the highest vs the lowest quintile of intake was approx.

• + 17% (162 µg/L vs 139 µg/L) for protein & • + 16% (166 µg/L vs 143 µg/L) for zinc. Consumption of red meat (P for trend = 0.05) & fish & seafood (P =0.07) was modestly positively associated with serum IGF-I. Other dietary factors were not associated with IGF-I concentrations.

CCL: greater dietary intakes of protein, zinc, red meat, & fish & seafood => associated with higher serum IGF-I Larsson SC, Wolk K, Brismar K, Wolk A. Association of diet with serum insulin-like growth factor I in middle-aged and elderly men. Am J Clin Nutr. 2005 May;81(5):1163-7. Division of Nutritional Epidemiology, The National Institute of Environmental Medicine and Molecular Medicine, Unit of Endocrinology and Diabetes, Karolinska Institutet, Stockholm, Sweden. [email protected]

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23 mei 2014

Zinc stimulates growth hormone�. More than meat ?? 226 Free living healthy men ; 42-76 yr

PROTEIN

MEAT/FISH

ASSOCIATION OF DIET WITH SERUM INSULIN-LIKE GROWTH FACTOR 1 IN MIDDLE-AGED AND ELDERLY MEN. AM J CLIN NUTR 2005 MAY 81(5)1163-7 LARSSON,WOLK,BRISMAR,WOLK,;division nutr epidemiology stockolm Sweden

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23 mei 2014

Carnitine treatment

=> ↑ IGF-1

L-Carnitine => IGF-1 in sows

SUBJECTS: sows (female swine, pig) TREATMENT: L-Carnitine-treated sows => ↑ plasma IGF-I on day 80 of pregnancy (experiment 2, p <0.05) & on day 95 (experiment 1, p < 0.10), & ↑ plasma IGF-II on day 80 (experiment 2, p < 0.05) than control sows. . Doberenz J, Birkenfeld C, Kluge H, Eder K. Effects of L-carnitine supplementation in pregnant sows on plasma concentrations of insulin-like growth factors, various hormones and metabolites and chorion characteristics. J Anim Physiol Anim Nutr (Berl). 2006 Dec;90(11-12):487-99.Institut für Ernährungswissenschaften, MartinLuther-Universität Halle-Wittenberg, Halle/Saale, Germany.

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23 mei 2014

L-Carnitine => ↑ serum IGF-1 in chicks + adequate protein, not + low protein, nor excess CARN. SUBJECTS:

chicks => diets + varying dietary protein (50, 200 & 400 g/kg) for 10 days Dietary L-Carnitine supplementation provided 0, 200, 500 & 1000 mg/kg. L-Carnitine as 500 or 1000 mg/kg => sign. improved body weight gain in birds + 200 & 400 g protein/kg diets => little influence on plasma IGF-I in birds + low protein (50 g/kg) diet. dietary L-Carnitine increased from 0 to 1000 mg/kg in the adequate protein (200g/kg) diet => plasma IGF-I also increased. dietary L-Carnitine content was > 500 mg/kg in the 400 g/kg protein group =>plasma IGF-I decreased with increasing dietary L-Carnitine content Note: Body weight change correlated sign. w/ change in plasma IGF-I in chicks + adequate dietary protein. CCL: the improvement in body weight gain caused by dietary L-Carnitine supplementation was achieved when chicks were given their dietary protein requirement, which may be partially explained by an increase in plasma IGF-I. Kita K, Kato S, Amanyaman M, Okumura J, Yokota H. Dietary L-carnitine increases plasma insulin-like growth factor-I concentration in chicks fed a diet with adequate dietary protein level. Br Poult Sci. 2002 Mar;43(1):117-21.Laboratory of Grassland Science, University Farm, Graduate School of Bioagricultural Sciences, Nagoya University, Aichi, Japan. [email protected]

Carnitine => ↑ serum IGF-1 in rats SUBJECTS: Diabetic rats RESULTS: Diabetic rats • sign. lower carnitine in serum & liver vs normal rats. Carnitine treatment • dose-dep. ↑ serum total carnitine concentrations • dose-dep. ↑ serum Total IGF-I in serum from diabetic rats by carnitine treatment, but was stat. sign.only in the D200 group. • restored serum total IGF-I in STZ-induced diabetic rats to nearly normal levels • The expression of liver IGF-ImRNA was lower in diabetic rats than in normal rats => increased by L-Carnitine treatment. • no effect on the levels of IGF-II in serum, liver, and kidney. Heo YR, Kang CW, Cha YS. L-Carnitine changes the levels of insulin-like growth factors (IGFs) and IGF binding proteins in streptozotocin-induced diabetic rat. J Nutr Sci Vitaminol (Tokyo). 2001 Oct;47(5):32934.Department of Food Science & Human Nutrition and Institute for Molecular Biology and Genetics, Chonbuk National University, Chonju, Korea.

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23 mei 2014

Acetyl-L-Carnitine (3 g/day) => ↑ serum IGF-1 SUBJECTS: 11 asymptomatic, HIV-1-infected subjects TREATMENT: Acetyl-L-Carnitine (3 g/day) for 5 months • substantial impact on the main immunologic abnormality associated with HIV infection, ↓ loss of CD4 cells, by ↓ rate of apoptotic lymphocyte death. 2 impt mechanisms underlying the observed antiapoptotic effects of Acetyl-L-Carnitine • ↓ ceramide generation • ↑ serum IGF-1, a major survival factor able to protect cells from apoptosis by different stimuli & conditions Di Marzio L, Moretti S, D'Alò S, Zazzeroni F, Marcellini S, Smacchia C, Alesse E, Cifone MG, De Simone C. Acetyl-L-carnitine administration increases insulin-like growth factor 1 levels in asymptomatic HIV-1-infected subjects: correlation with its suppressive effect on lymphocyte apoptosis and ceramide generation. Clin Immunol. 1999 Jul;92(1):103-10.Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy.

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23 mei 2014

Creatine treatment

=> ↑ IGF-1

Resistance training & Creatine => ↑ muscle IGF-1 in young adults SUBJECTS: 24 young men & 18 young women + minimal resistanceexercise-training experience (=1 year) + at least 30 min of structured physical activity (i.e., walking, jogging,cycling) 3-5 x/wk => supplement with creatine (CR: 0.25 g/kg lean-tissue mass for 7 days; 0.06 g/kg lean-tissue mass for 49 days; n=22, 12 males, 10 female) or isocaloric placebo (PL: n=20, 12 male, 8 female) and engage in a whole-body resistance-exercise training program for 8 wk. 18 = vegetarians (lacto-ovo or vegan; CR: 5 male, 5 female; PL: 3 male, 5 female) => Muscle biopsies (vastus lateralis) Resistance-exercise training (RET) • ↑ intramuscular IGF-I content by 67%,=>greater accumulation with creatine supplementation (CR) (+78%) than placebo (+54%; p=.06). • no diff. in IGF-I between vegetarians & nonvegetarians. CCL: Creatine supplementation during resistance-exercise training => ↑ intramuscular IGF-I in healthy men & women, indep. of habitual diet. Burke DG, Candow DG, Chilibeck PD, MacNeil LG, Roy BD, Tarnopolsky MA, Ziegenfuss T. Effect of creatine supplementation and resistance-exercise training on muscle insulin-like growth factor in young adults. Int J Sport Nutr Exerc Metab. 2008 Aug;18(4):38998.Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada.

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23 mei 2014

DURATION NUTRIENT

DOSE to ↑

Calcium

500 to 1500 mg/day elem. calcium prior bed

4 to 8 months

Magnesium


4 to 8 months

Phosphorus

oral 0.5-2 g/day of Na/K+ phosphate; animal food.

4 to 8 months

Potassium

oral 0.5 to 3 g/day

1 to12 months

Vit. A (retinol)

oral 25’000 to 100’000 IU/day

4- 8 months

Vit. B7 (biotin)

2 mg/day; hair regrowth: 3x 2mg/wk IM inj. (18x)

4 to 8 months

Vit. D3 (cholecalciferol)

oral 1000 to 4000 IU/day or; 600 000 IU/ 3-4 mo 4 to 8 months

Vit. E (?)

Oral 200 -1000 mg/day (mixed tocpherols & tocotrienols

4 to 8 months

oral 2-4 g/day fish oil for EPA and DHA or 1/2 table/souppoon/day of rapeseed or flaxseed oil

6 to 8 months

Omega-3 PUFA Iron

oral 80-100 mg/day elem.iron (±

2 to 12 months

Manganese

Oral 10 to 50 mg/day

Zinc

oral 50 mg/day zinc citrate or sulphate prior bed 4 to 8 months oral L-Carnitine: 3 (women) to 4 (men) g/day; oral Acetyl-L-Carnitine: 2 (women) to 3 (men) g/day

4 to 8 months

Carnitine Glutamine

oral 2 g/day

2 to 8 months

Creatine

oral 3 to 10 g/day

1 to 3 months

IGF-1 levels/activity

500 mg complexed)

50


23 mei 2014

51


23 mei 2014

Insulin therapy => ↓ plasma amino acids in old as in young men STUDY: healthy postabsorptive young (n = 5, mean age, 25 years) elderly (n = 5, mean age, 76 years) men RESULTS: • Glucose disposal rates adjusted for lean body mass (LBM) were lower in the elderly than in the young at the 6, 10, and 30 mU insulin infusion rates & similar in the two age groups in the 400 mU studies. • Insulin dose-depe. ↓ in 8 of 10 plasma amino acids & not influenced by age. • an insulin dose-depe. ↓ in plasma leucine flux which was similar in both age groups.

Fukagawa NK, Minaker KL, Rowe JW, Matthews DE, Bier DM, Young VR. Glucose and amino acid metabolism in aging man: differential effects of insulin. Metabolism. 1988 Apr;37(4):371-7. Department of Applied Biological Sciences, Massachusetts Institute of Technology, Cambridge.

Insulin => ↑ speed of amino acid uptake in the fibroblasts MATERIAL: cultured human fibroblasts. INFO: Among the 6amino acid transport systems operating in cultured human fibroblasts => 2systems (A and X-C) are strongly stimulated by insulin & 4(ASC, X-AG, y+ and L) are essentially not sensitive to the presence of the hormone in the incubation medium. RESULTS: The hormonal stimulation of system A and system X-C => became significant after 3 h of incubation & increased up to 12 h. The stimulatory effect was related to insulin concentration, with a halfmaximal stimulation at 10(-9) M hormone concentration. Insulin enhanced transport activity by increasing the maximal velocity (Vmax) of transport, without significant changes in Km values.

Longo N, Franchi-Gazzola R, Bussolati O, Dall'Asta V, Foà PP, Guidotti GG, Gazzola GC. Effect of insulin on the activity of amino acid transport systems in cultured human fibroblasts. Biochim Biophys Acta. 1985 Feb 21;844(2):216-23.

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23 mei 2014

Insulin excess => <= Insulin deficit

Insulin Deficient

Insulin Excess

Insulin Sufficient

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23 mei 2014

Vit. E in lower half of reference => ↑ type 2 Diabetes mellitus

54


23 mei 2014

Vit. E treatment => ↑ insulin production

Vit. E => ↑ pancreatic insulinproduction in type 2 diabetes SUBJECTS: 41 patients + type II diabetes mellitus => 4 groups: (1) diets, (2) predian, (3) glibenclamide, & (4) sugar-reducing drugs & insulin => All patients + 600 & 1200 mg/day vit. E

RESULTS: Vit. E in ↑ doses

↑ pancreatic insulin-production

conducive to normalization of lipid peroxidation

no matter what kind of therapy is administered. Balabolkin MI, Mikhailova EV, Kniazeva AP, Pankova SS. [Effect of high doses of tocopherol on the processes of lipid peroxidation and insulin secretion in patients with non-insulin-dependent diabetes mellitus] Probl Endokrinol (Mosk). 1994 May-Jun;40(3):10-2

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23 mei 2014

Vit. E + Vit. B3 Combination treatment => Delays type 1 Diabetes (Human study)

Vit. E => delays diabetes type 1 in mice SUBJECTS: non-obese diabetic (NOD) mice => treated from 3 weeks of age until 30 weeks of age + vit. E-rich diet or control diet RESULTS: Vit. E did not reduce the incidence of diabetes (type 1) by 30 wks of age did sign. delay the onset of the disease (p <0.01) no diff. in the degree of lymphocytic infiltration of the pancreas (insulitis) with respect to control mice. CCL: Vitamin E delays diabetes onset in NOD mice without having an apparent effect on the autoimmune process Beales PE, Williams AJ, Albertini MC, Pozzilli P. Vitamin E delays diabetes onset in the non-obese diabetic mouse. Horm Metab Res. 1994 Oct;26(10):450-2. Department of Diabetes and Metabolism, St. Bartholomew's Hospital, London, United Kingdom

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23 mei 2014

Vit. D supplements => ↓ Hyperglycaemia & Diabetes I

Vit. D in infancy => ↓ type 1 diabetes

57


23 mei 2014

Vit. D treatment => ↑ (Human study)

Vit. D3 => ↑ insulin secretion

58


23 mei 2014

L-Arginine Treatment => ↑ C-peptide production (Human studies)

Arginine => ↑ C-peptide peak response

59


23 mei 2014

60


23 mei 2014

2 Adrenal Glands (Cortex)

DHEA Cortisol Aldosterone Adrenal cortex Adrenal cortex

Adrenal medulla

.. Adrenal medulla

• Cortisol => provides energy, takes inflammation away • DHEA => builds up, protects against cortisol catabolism • Aldosterone => keeps blood pressure up /water in the body

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23 mei 2014

Cortisol Deficiency

Adequate Cortisol

Cortisol deficiency Psychic complaints appear mainly at moment of At moments & in the evening: Nervous, irritable, tensed, tired person

stress

7h

or

standing up

19h

23h

In between: Kind, extrovert person

62


23 mei 2014

More combative mind, punch

Improved earth-to-earth consiousness

Cortisol

Fear Ene r-gy

++

Hap pine ss ++

Jo y

++

Love

Ser enit y

Fir mn ess

Irrit a bilit y

Hat e

↓↓

↓↓

Run s awa y

Para lyze d

(++)

↓↓



ed

↓↓

↓↓

↓↓

Adrenal gland Cortisol

63


23 mei 2014

To boost Cortisol & other Adrenal hormones => a good understanding of Minerals

Example of Marathon runnining

64


23 mei 2014

Lack of Sodium = Global (Mental + Muscular) & Diffuse (all over) fatigue :

+ drowsiness

65


23 mei 2014

↑ Sodium => ↓ Cortisol

↑ sodium => ↑ urinary Cortisol, but similar serum ACTH & Cortisol SUBJECTS: 10 normal control subjects => 4 days of low sodium diet (intake 40 mEq/day = 0.9 g/day) & after 6 days of high sodium diet (intake 320 mEq/day = 7.36 g/day)). TREATMENT: high sodium diet (8x higher in Na, vs low sodium diet) • 1.5x ↑ urinary cortisol from 26.2 to 36.8 µg/day • similar plasma ACTH & serum cortisol measured every 2 h for a 24h period CCL: altered handling of cortisol by kidneys during high salt intak.

Wambach G, Bleienheuft C, Bönner G. Sodium loading raises urinary cortisol in man. J Endocrinol Invest. 1986 Jun;9(3):257-9.

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23 mei 2014

Sodium treatment

=> ↓ Cortisol

Sodium lactate IV => ↓ cortisol + panic attack SUBJECTS: 103 patients + panic disorder or agoraphobia + panic attacks, & 32 normal controls. TREATMENT: Sodium lactate infusions => panic attacks in patients + panic disorder, but not in normal controls - Baseline cortisol levels did not distinguish early panickers from nonpanickers & controls, but late panickers - sign. elevated baseline cortisol levels. - In addition, a higher % of late panickers => increase in cortisol during the baseline period vs the other groups. early panickers - sign. greater somatic distress as measured by the Acute Panic inventory. infusion of 0.5 mol/L of sodium lactate - no increase in cortisol with lactate-induced panic - cortisol levels fell sign. during the lactate infusion in all groups. CCL: Cortisol elevation occurred + moderate anxiety but not + severe panic anxiety. => different pathophysiologic mechanisms .

Hollander E, Liebowitz MR, Gorman JM, Cohen B, Fyer A, Klein DF. Cortisol and sodium lactate-induced panic. Arch Gen Psychiatry. 1989 Feb;46(2):135-40.Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY.

67


23 mei 2014

Lack of Magnesium = Cramps in legs & feet

68


23 mei 2014

Mg supplements alone => ↑ ACTH Mg + Exercise => ↑ resting serum Cortisol SUBJECTS: Supplementation with 10 mg of magnesium (as magnesiumsulfate) per kilogram of body weight. • & exercise & magnesium supplements => sign. ACTH increases (p < 0.05). • increased cortisol in training subjects + supplements (p <0.05) but not so in subjects that either trained or received magnesium supplements in an independent manner. • higher cortisol levels measured in resting individuals were in the supplemented and non-supplemented athletes than those in sedentary subjects (p < 0.05). CCL: exercise &/or magnesium supplementation => rise of ACTH, whereas cortisol is increased only as a result of combined exhaustion and magnesium supplements. Cinar V, Mogulkoc R, Baltaci AK, Polat Y. Adrenocorticotropic hormone and cortisol levels in athletes and sedentary subjects at rest and exhaustion: effects of magnesium supplementation. Biol Trace Elem Res. 2008 Mar;121(3):215-20.Karaman High School of Physical Education and Sport, Selcuk University, Karaman, Turkey. [email protected]

Mg => ↓ serum cortisol & prevents the ↑ serum cortisol during exercise in healthy men SUBJECTS: 9 healthy men => one hour ergometer exercise MG TREATMENT: after 14 day magnesium aspartate supplementation • NO observation of the usual aldosterone & cortisol increase during exercise • sign. lower. serum cortisol • Na & K in plasma increased during the exercise; these changes were not affected by Mg. • The Mg concentration was elevated in plasma and erythrocytes • During the ergometer course plasma Mg was unchanged but decreased sign. in the redblood cells. • Mg and K concentration in sweat decreased during the exercise. • No influence of Mg on urinary electrolyte excretion was observed. Golf SW, Happel O, Graef V, Seim KE. Plasma aldosterone, cortisol and electrolyte concentrations in physical exercise after magnesium supplementation. J Clin Chem Clin Biochem. 1984 Nov;22(11):717-21.

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23 mei 2014

Calcium treatment

=> ↑ Cortisol

70


23 mei 2014

Calcium => ↑ serum ACTH in humans => ↑ serum cortisol & aldosterone SUBJECTS: 4 normal subjects, one patient + hypoparathyroidism & one patient + hypothyroidism 6 normal subjects and 4thyroidectomized patients as controls TREATMENT: iv calcium gluconate • a decrease in plasma renin activity but only in the normal subjects. • higher Plasma ACTH, cortisol & aldosterone were when calcium was administered. • Plasma ACTH and cortisol responses to calcium were abolished whereas plasma aldosterone response persisted in 2 normal subjects pre-treated + dexamethasone. • Plasma renin activity was not statistically different whether or not calcium had been injected in the subjects studied twice. CCL: direct effect ofcalcium on ACTH and aldosterone secretion which is not mediated by calcitonin & parathyroid hormone. The stimulatory effect of calcium on cortisol secretion depends on the increase in plasma ACTH. Isaac R, Raymond JP, Rainfray M, Ardaillou R. Effects of an acute calcium load on plasma ACTH, cortisol, aldosterone and renin activity in man. Acta Endocrinol (Copenh). 1984 Feb;105(2):251-7.

71


23 mei 2014

Lack of Potassium = Fatigue in lower legs

↑ Potassium

=> ↑ Cortisol

72


23 mei 2014

Potassium treatment => ↑ urinary sodium & water excretion

=> ↓ serum Sodium => ↑ serum cortisol

73


23 mei 2014

Vit. C treatment

=> ↑ Cortisol

Vit. C => ↑ serum ACTH & cortisol in a healthy man SUBJECTS: a healthy male volunteer. TREATMENT: Vitamin C infusion • initial to moderate stages :distinct ↓ plasma cortisol & vit. C from the circulation • middle stage a small ↑ plasma cortisol • terminal stage => skyrocket-like ↑ ↑ plasma ACTH & cortisol Methylprednisolone in vit. C infusion • initial to moderate stages ↓ ↓ suppressed the depletion of plasma vitamin C & cortisol of the initial tomoderate stages. • middle stage: No effect on the small surge of plasma cortisol. • terminal stage: ↓ ↓ ↓ completely suppressed the emergence of the plasma ACTH/cortisol surges of the terminal stage Kodama M, Kodama T, Murakami M, Kodama M. Vitamin C infusion treatment enhances cortisol production of the adrenal via the pituitary ACTH route. In Vivo. 1994 Nov-Dec;8(6):107985.Kodama Research Institute of Preventive Medicine, Nagoya, Japan.

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23 mei 2014

Vit. C => ↑ cortisol production & delays its turnover in rats FACT: ↑ effect of vitamin C on adrenal glucocorticoid prod. repeatedly observed in human experiments SUBJECTS: scurvy-prone ODS rats vs scurvy-resistant Wistar rats PRETREATMENT: vit. C (ascobic acid) intraperitoneally • ↑ release of endogenous glucocorticoid • ↓ delay the turnover of the tracer cortisol in plasma. • the effect of vitamin C = of physiological significance. • The responses of the adrenal glands, testes & liver to vitamin C pretreatment were generally more distinct in scurvy-prone ODS rats than in Wistar rats, but varied from one organ to another. Kodama M, Inoue F, Kodama T, Kodama M. Intraperitoneal administration of ascorbic acid delays the turnover of 3H-labelled cortisol in the plasma of an ODS rat, but not in the Wistar rat. Evidence in support of the cardinal role of vitamin C in the progression of glucocorticoid synthesis. In Vivo. 1996 Jan-Feb;10(1):97102.Biophysics Division, National Cancer Center Research Institute, Tokyo, Japan.

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23 mei 2014

Acetyl-L-Carnitine treatment

=> ↑ Cortisol

Acetyl-L-Carnitine => ↑ serum cortisol

Acetyl-L-Carnitine => acutely administered => raises serum beta-endorphin & cortisol in humans

Martignoni E, Facchinetti F, Sances G, Petraglia F, Nappi G, Genazzani AR. Acetyl-Lcarnitine acutely administered raises beta-endorphin and cortisol plasma levels in humans. Clin Neuropharmacol. 1988 Oct;11(5):472-7.Department of Neurology, C. Mondino Foundation, University of Pavia, Italy.

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23 mei 2014

Glutamate treatment

=> ↑ Corticosterone

Neonatal Glutamate => ↑ corticosterone in mice SUBJECTS: Male mice TREATMENT: Neonatal administration of sodium glutamate (4 mg/g) on (postnatal days 1, 3, 5, 7, & 9) • ↓ numbers of square crossings, vertical rearings, excursions to the center, and the time spent in the center in adulthood, vs mice + physiological saline • In the light-dark test, ↑ time spent by mice in the light sector, but did not differ from that in intact animals. • In the acoustic startle reflex test, ↓ startle amplitude but had no effect onthe magnitude of prestimulus inhibition. • ↓ sexual motivation, physiological saline producing a tendency to decreased sexual motivation. • 4x ↑ basal blood corticosterone in adult males, while physiological

saline had no effect. CCL: neonatal sodium glutamate => decreases motor and investigative activity, anxiety, and sexual motivation in adult male mice => increases basal corticosterone. Physiological saline increased all these parameters apart from sexual motivation, though this was not associated with changes in basal corticosterone. Kuznetsova EG, Amstislavskaya TG, Bulygina VV, Il'nitskaya SI, Tibeikina MA, Skrinskaya YA. Effects of administration of sodium glutamate during the neonatal period on behavior and blood corticosterone levels in male mice. Neurosci Behav Physiol. 2007 Oct;37(8):827-33.Institute of Cytology and Genetics, Russian Academy of Sciences, Novosibirsk, Russia.

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23 mei 2014

Omega-3 (esp. EPA) ⇒ ↑ Cortisol

Omega-6 treatment (esp. DHGLA) ⇒ ↓ Cortisol

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23 mei 2014

PUFA: EPA, (DHA) & ARA => ↑ cortisol prod. DHGLA => ↓ cortisol prod. in fish interrenal cells SUBJECTS : fish => in vitro studies of sea bream interrenal cells TREATMENT: essential fatty acids on ACTH-ind. cortisol prod. /release • Arachidonic acid (ARA) & part. eicosapentaenoic acid (EPA) => ↑ cortisol production in sea bream interrenal cells • Indometacin (INDO= eicosanoidproduction inhibitor) => ↓ the increased cortisol prod. induced by EPA & ARA, suggesting mediation by their cyclooxygenase-derived products • Docosahexaenoic acid => ↑ cortisol prod. to a lesser extent than that caused by EPA or ARA, but the inhibitory effect of INDO was not as marked as it was for the other fatty acids. • dihomogammalinolenic acid => ↓ cortisol production = inhibitor effect of this fatty acid on cortisol secretion. Ganga R, Tort L, Acerete L, Montero D, Izquierdo MS. Modulation of ACTH-induced cortisol release by polyunsaturated fatty acids in interrenal cells from gilthead seabream, Sparus aurata. J Endocrinol. 2006 Jul;190(1):39-45.Grupo de Investigación en Acuicultura, Instituto Canario de Ciencias Marinas, PO Box 56, 35200-Telde, Las Palmas, Canary Islands, Spain. [email protected]

79


Cortisol

23 mei 2014

+

NUTRIENT

DOSE to ↑ CORTISOL levels/activity

DURATION

Calcium


4 to 8 months or permanently

Potassium

oral 0.5 to 3 g/day

1 to 12 months

Magnesium (?)



Vit. B5

oral 1 to 3 x 100 mg daily as oral capsules scalp hair growth: 3 x 500 mg IM inj. of vit. B5

Vit. C (?)

oral 1 to 2 g/day

2 to 8 months 4 to 8 months

Vit. K1 (pylloquinone) oral 1-10 mg/day of safe (phylloquinone)

2 to 12 months

Omega-3 PUFA (EPA, (DHA))

oral 2-4 g/day fish oil for EPA and DHA or 1/2 table/souppoon/day of rapeseed or flaxseed oil

6 to 8 months

Saturated fatty ac.


permanently

Cholesterol

oral : consume more foods rich in cholesterol


Carnitine

oral L-carnitine: 3 (women) to 4 (men) g/day; oral Acetyl-L-carnitine: 2 (women) to 3 (men) g/day

4 to 8 months

Cortisol

-

NUTRIENT

DOSE to ↓ excess CORTISOL

Sodium

oral 1 to 3 g/day of sodium (1 g/day per 1000 kcal consumed per day)

Magnesium (?)


DURATION 1 to 12 months


Vit. B5

100 mg/day for; Migraines: 400 mg/day

2 to 6 months

Vit. C (?)

oral 1 to 2 g/day

4 to 8 months

Omega-6 PUFA oral 500 to 1000 mg/day of borage oil or evening (DHGLA) primrose oil (combine w/ vit. E 100 -400 mg/day)

4 to 8 months

oral 0.2 to 2 mg/day, preferably nicotinate or tripicolinate chromium; active = GTF chromium (Glucose Tolerance Factor =chromium nicotinate)

4 to 12 months

Chromium Zinc

oral 50 mg/day zinc citrate/sulphate prior bed

4 to 8 months

Arginine

oral 2 to 7 grams per day for 2 to 3 months (7 g/day to increase growth hormone)

4 to 12 months

Lysine

oral 2.5 g g/day

2 to 8 months

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23 mei 2014

Aldosterone deficiency

Desire to lay down

81


23 mei 2014

Low aldosterone => low blood pressure

82


23 mei 2014

↑ sodium => ↓↓ serum Aldosterone, but similar serum ACTH SUBJECTS: 10 normal control subjects => 4 days of low sodium diet (intake 40 mEq/day = 0.9 g/day) & after 6 days of high sodium diet (intake 320 mEq/day = 7.36 g/day)). TREATMENT: high

sodium diet (8x higher in Na, vs low sodium diet)

• 6x ↓ Urinary aldosterone excretion from 17.9 to 2.8 µg/day •

1.5x ↑ urinary cortisol from 26.2 to 36.8 µg/day

• similar plasma ACTH & serum cortisol measured every 2 h for a 24-h period CCL: altered handling of cortisol by kidneys during high salt intak. Wambach G, Bleienheuft C, Bönner G. Sodium loading raises urinary cortisol in man. J Endocrinol Invest. 1986 Jun;9(3):257-9.

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23 mei 2014

Potassium => ↑ serum aldosterone Potassium –depleted diets=> ↓ serum aldost. SUBJECTS: 16 normal & 8 hypertensive subjects TREATMENT: at three levels of dietary potassium: 85 meq/day (low = 3.3 g/day ) for 5 days, 185 meq/day (normal potassium = 7.2 g/day) for 7 days, & 25 meq/day (very low potassium diet = 0.9 g/day) for 10 days • ↓ excretion of aldosterone in progressively more potassium –depleted diets • changes in excretion of kallikrein & aldosterone support the hypothesis that changes in effective levels of aldosterone induce changes in the excretion of kallikrein. Horwitz D, Margolius HS, Keiser HR. Effects of dietary potassium and race on urinary excretion of kallikrein and aldosterone in man. J Clin Endocrinol Metab. 1978 Aug;47(2):296-9.

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23 mei 2014

Potassium => linear ↑ serum aldosterone SUBJECTS: 10 normals : 5 + 230 mg (10 mEq)/day sodium 5 + 4.6 g (200 mEq)/day sodium => 40 mEq & 200 mEq potassium sequentially REPORTS: infusion of 75 mEq (3 g) of potassium chloride over 120’ • Regardless of dietary intake, increases of serum potassium of 0.5-1.5 mEq/liter above preinfusion levels => usually assoc. w/ sign. increments in plasma aldosterone. CCL: potassium ion stim. adrenal cortex directly to secrete aldosterone. • Peripheral renin activity did not increase after the potassium infusion. • Plasma cortisol & corticosterone levels followed the expected diurnal decline during the infusion, implying that ACTH secretion did not increase. • The plasma aldosterone response to incremental changes in serum potassium => linear on each of 4 diets; slopes of linear relationships increased sign. when potassium intake increased from 40 to 200 mEq. • No increase in slope occurred on either potassium intake when dietary sodium was restricted from 200 to 10 mEq. • Thus, identical increases in serum potassium => assoc. w/ greater increments in plasma aldosterone above preinfusion levels on either sodium intake when the 200 mEq potassium diet was compared with the 40 mEq potassium intake. Dluhy RG, Axelrod L, Underwood RH, Williams GH. Studies of the control of plasma aldosterone concentration in normal man. II. Effect of dietary potassium and acute potassium infusion. J Clin Invest. 1972 Aug;51(8):1950-7.

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23 mei 2014

+ NUTRIENT

DOSE to ↑ ALDOSTERONE levels/activity

DURATION

oral 1 to 3 g/day of sodium (1 g/day per 1000 kcal consumed per day)

1 to 12 months

Sodium Magnesium


4 to 8 months or

-

NUTRIENT

DOSE to ↓ excess ALDOSTERONE

Potassium

oral 0.5 to 3 g/day

Calcium


permanently

DURATION 1 to 12 months 4 to 8 months or permanently

86


Cortisol & DHEA Deficiency

23 mei 2014

Adequate Cortisol & DHEA

DHEA => ↓ visceral & subcutaneous fat in elderly persons In a 6-month study of elderly people, researchers at Washington University School of Medicine in St. Louis found that the hormone dehydroepiandrosterone (DHEA) significantly reduced abdominal fat and improved insulin action.

Before and after MRI images of a crosssection of a patient’s abdomen in the clinical trial of DHEA show the reduction in visceral and subcutaneous fat.

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23 mei 2014

Adrenal gland DHEA

88


23 mei 2014

Early ↓ ↓ Vit. E => Later: ↓ synthesis of adrenal & testic. androgens in rats MATERIAL: Adrenal homogenates from rats deficient in vitamin E & from rats given vitamin E from weaning to a maximum of 293 days. RESULTS: vit. E deficiency ( rats deficient in vita. E) • delayed peak of incorporation of 14C into adrenal steroids, androgens & corticosterone = delayed or prolonged period of puberty. • Later in adulthood: incorporated consistently less 14C into adrenal steroids & testicular androgens than did the control rats, although the diff. = not statistically sign. Barnes MM, Smith AJ. The effect of vitamin E deficiency on androgen and corticosterone synthesis. Int J Vitam Nutr Res. 1975;45(3):342-8.

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23 mei 2014

Rats deficient in vit. E Pregnandiol

Vitamin E & DHEA Urinary androgens µg/24 h

Normal rats Etiocholanolone

DHEA Etiocholanolone No preg- no nandiol DHEA

Figure: Adeficiency in vitamin E blocks the production of DHEA in the rat & slows down the one of the adrenal androgen etiocholanolone and deviates its metabolism towards less active derivatives in the animal (Pinelli A et al., Pharmacology, 1973, 9 : 201 - 203)

200 mg/d

Vit. E

=> No effect on serum DHEAs

SUBJECTS: 100 relatively healthy Dutch elderly subjects included, 50 were supplemented + vitamin E & 50 + placebo. TREATMENT: vs placebo, 15 month’s of 200 mg/day vitamin E supplementation affected neither serum DHEA-S nor serum neopterin level.

Morton DJ, James MF. Effect of magnesium ions on rat pineal N-acetyltransferase (EC 2.3.1.5) activity. J Pineal Res. 1985;2(4):387-91.

90


23 mei 2014

Adrenal glands

Vit. E

+

DHEA

NUTRIENT

DOSE to ↑ DHEA levels/activity

DURATION

Vit. E

oral 400 to 800 mg/day of γ- and αtocopherol

6 to 8 months

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23 mei 2014

Estrogens Progesterone Testosterone Females: 2

Ovaries

92


Before pregnancy

23 mei 2014

After pregnancy

Slight estrogen & progesterone deficiency

93


23 mei 2014

Women with Prior pregnancy => lower serum E2 metabolites SUBJECTS: healthy, premenop. women, 411 women age 18-39 yrs => biomarkers of ovarian fn (daily urinary metabolites of estrogen & progesterone) => about 1,500 cycles RESULTS:

Estrogen metabolite levels

• elevations of 10-13% in both baseline (days 1-5) & average follicular-phase estrogen metabolite levels in cycles + short follicular phase • 7-13% higher in the follicular & luteal phases in Hispanics > whites, slightly higher > nonwhite, non-Hispanic women (primarily Asians). • lower in women + prior pregnancy • lower in women + later age at menarche •Epidemiology. 2002 Nov;13(6):675-84. Ovarian hormones in premenopausal women: variation by demographic, reproductive and menstrual cycle characteristics. Windham GC, Elkin E, Fenster L, Waller K, Anderson M, Mitchell PR, Lasley B, Swan SH. Department of Health Services, Division of Environmental and Occupational Disease Control, Oakland, CA 94612, USA. [email protected]

187

Research at the University of St. Andrews

↑ Hair volume

↑ Rose cheeks ↑ Volume of face

low estrogen levels

women + high levels of estrogen

Men tended to rate women with higher levels of estrogen as more attractive, healthier & more feminine-looking

94


Estrogen Deficiency

23 mei 2014

Estrogen Excess

95


23 mei 2014

Vitamin B6 deficiency => impairs biological responsiveness to oestrogens SUBJECTS: Rats => depleted of vitamin B6 by treatment with isoniazid, and then maintainedon diets providing: no vitamin B6, an adequate amount (1.2 mg/kg diet) or a very large amount (120 mg/kg) for 5 weeks. The uptake of a tracer dose of[3H]oestradiol into the nuclei of liver and uterus was significantly greater in deficient animals than in those receiving an adequate or greater than adequateamount of the vitamin. Similarly the accumulation of oestradiol in the region of the brain corresponding to the hypothalamus, pre-optic area and septum (the majoroestradiol sensitive regions of the central nervous system) was higher indeficient animals than in other groups. There were significant inverse correlations => between the uptake of oestradiol into target tissues & vitamin B6 nutritional status as determined by the concentrations of pyridoxal phosphate in plasma and liver. Uteri from deficient animals were significantly smaller than those from animals receiving an adequate or greater amount of vitamin B6, and the induction of uterine peroxidase by oestradiol was impaired. It therefore seems likely that despite the greater net accumulation of steroid in target tissues, vitamin B6 deficiency impairs biological responsiveness to oestrogens. It is suggested that this may be due to a failure of the recycling of oestradiol receptors from the nucleus. Holley J, Bender DA, Coulson WF, Symes EK. Effects of vitamin B6 nutritional status on the uptake of [3H]oestradiol into the uterus, liver and hypothalamus of the rat. J Steroid Biochem. 1983 Feb;18(2):161-5

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23 mei 2014

Vitamin B6 => inhibits the estrogen receptor Previous observations suggested that pyridoxal 5'-phosphate was capable of inhibiting estrogen . receptor (R . E2) activation, or translocation to thenucleus, or both. The present study attempts to define more specifically thelocus of this action. To this end we have examined the physicochemical alterationproduced by interaction of pyridoxal 5'-phosphate with estrogen . receptorcomplex, using sucrose density gradient analysis and dissociation kinetics.Receptor transformation was inhibited when activation was performed in thepresence of pyridoxal 5'-phosphate. This effect was protein- and pyridoxal5'-phosphate concentration-dependent. When pyridoxal 5'-phosphate was introduced postactivation it did not have any effect on the activated receptor, but whensimilar treatment was followed by NABH4 reduction, the complex reverted to themonomeric entity. The dissociation behavior obtained with cytosol R . E2, warmed in the presence of pyridoxal 5'-phosphate, showed a biphasic curve suggestingthat a significant portion of receptors remained nonactivated as demonstrated by the fast dissociating component. Due to the fact that Tris buffers cannot be usedfor pyridoxal 5'-phosphate experiments, we have used a borate buffer whichresulted in a displacement of the sedimentation values from a 4S to 4.6 S for theunactivated receptor and 5S to 6 S for the activated form. The observationsreported suggest that at least the initial effect of pyridoxal 5'phosphateresults in the inhibition of cytosolic receptor transformation from then on activated to the activated form. Traish A, Müller RE, Wotiz HH. Effects of pyridoxal 5'-phosphate on uterine estrogen receptor. II. Inhibition of estrogen . receptor transformation. J Biol Chem. 1980 May 10;255(9):4068-72.

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23 mei 2014

Vit. C (500 mg), B6 (25 mg), B12 (1 mg) &

Folate (5 mg) => + 26% ↑ serum Estradiol

SUBJECTS: 20 obese postmenopausal women: body mass index >

or = 30 DBPC study TREATMENT: 8-week open-label supplement + vitamins C (500 mg), B6 (25 mg), B12 (1 mg), & folate (5 mg) blinded fashion. • Folate & vit. B12 levels rose sign => supplement well absorbed & thatparticipants adhered to the protocol. • Weight, blood pressure, and serum lipidsremained stable. Creactive protein, interleukin-6, and leptin levels remained unchanged. • + 26% serum Estradiol levels rose from a median of 22.0 pg/mL (IQR = 15.9-25.8) at baseline to a median of 27.8 pg/mL (IQR = 23.1-33.9) at follow-up (p = 0.003). Palmas W. Effects of short-term supplementation with ascorbate, folate, and vitamins B6 and B12 on inflammatory factors and estrogen levels in obese postmenopausal women. Int J Vitam Nutr Res. 2006 Jan;76(1):34-8.Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. [email protected]

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23 mei 2014

3 mg/day of boron => ↑ serum E2 & T,

esp. in low Mg states SUBJECTS: 12 women between the ages of 48 & 82 => 3 mg/day boron • markedly affected several indices of mineral metabolism of 7 women + a lowmagnesium diet & 5 women consuming a diet adequate in magnesium; the women + conventional diet supplying about 0.25 mg boron/day for 119 days. • markedly reduced the urinary excretion of calcium & magnesium; => more marked when dietary magnesium was low. • depressed the urinary excretion of phosphorus by th elow-magnesium, but not by the adequate-magnesium, women. • markedly elevated the serum 17 beta-estradiol and testosterone; the elevation seemed more marked when dietary magnesium was low. • Neither high dietary aluminum (1000 mg/day) nor an interaction between boron • CCL: boron commonly found in diets high in fruits & vegetables => changes in postmenopausal women consistent with the prevention of calcium loss and bone demineralization. Nielsen FH, Hunt CD, Mullen LM, Hunt JR. Effect of dietary boron on mineral, estrogen, and testosterone metabolism in postmenopausal women. FASEB J. 1987 Nov;1(5):394-7.United States Department of Agriculture, Grand Forks Human Nutrition Research Center, North Dakota 58202.

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23 mei 2014

Arginine =>

↑ serum Estrogens & Progesterone

in ewes

SUBJECTS: 12 Awassi ewes aged between 3.5-4.0 years weighing 53.30 kg :

RESULTS: Serum levels

Control

Estrogen

Lower: 4. 56 pg/ml

1.3x ↑ : 5.92 pg/ml

Progesterone

Lower: 1.79 pg/ml

2.4x↑ : 4. 21 pg/ml

Lower: 1.00

2.4x↑ : 2.38

Lambing

-

↑

Twinning rate

-

↑

Number of corpora lutea

Arginine 0.5 g/kg for 15 days

Al-Dabbas FM, Hamra AH, Awawdeh FT. The effect of arginine supplementation on some blood parameters, ovulation rate and concentrations of estrogen and progesterone in female Awassi sheep. Pak J Biol Sci. 2008 Oct 15;11(20):238994.Department of Applied Science, Al-Salt University College, Al-Balq'a Applied University, P.O. Box 387, Postal Code 19110, Al-Salt, Jordan.

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23 mei 2014

+

NUTRIENT

DOSE to ↑ ESTROGEN levels/activity

Calcium

0.5 to 1.5 g/day elem.l calcium before bedtime

4 mo to permanently

Vit. A (retinol)

oral 25’000 to 100’000 IU/day

4- 8 months

Vit. C

oral 1 to 2 g/day

4 to 8 months

Vit. K (phylloquinone)

oral 1-10 mg/day of safe phylloquinone

2 to 12 months

Saturated fatty ac.


permanently

Cholesterol


permanently

Zinc

oral 50 mg/day zinc citrate/sulphate prior bed

4 to 8 months

Arginine

oral 2 to 7 grams per day for 2 to 3 months

4 to 12 months

-

DURATION

NUTRIENT

DOSE to ↓ excess ESTROGEN

Magnesium


4 to 8 months

Potassium

oral 0.5 to 3 g/day

1 to 12 months

DURATION

Vit. E


6 to 8 months

Vit. B6



Vit. K2 (menaquinone)

oral 0.1-0.5 mg/day of menaquinone

2 to 12 months

Omega-6 PUFA

oral 0.5 to 1 g/day of evening primrose oil

4 to 8 months

Iodine

oral 200 to 600 µg/day; as lugol 1-8 drops/day

101


23 mei 2014

2 Testicles

Testosterone Dihydrotestosterone (DHT)

Estrogens Progesterone

Testosterone provides a masculine body

102


Testosterone deficient

23 mei 2014

Testosterone improved

Testosterone deficiency Psychic complaints appear mainly Hesitations, anxiety, lack of self-assurance and capacity to make decisions are found the whole day Fatigue and other complaints increase at physical exercise

103


23 mei 2014

Courageous, dominant mind Improved or excessive self-consiousness

Testosterone

Fear Ene r-gy

++

Hap pine ss

Jo y

Love

Ser enit y

Fir mn ess

Irrit a bilit y

Hat e

↓↓

++

Run s awa y

Para lyze d

↓↓

↓↓



ed

↓↓

↓↓

↓↓

↓↓

or ↓

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23 mei 2014

The 2 testicles ⇒ secrete testosterone (T) & dihydrotestosterone (DHT)

Some main actions of testosterone & DHT: PSYCHIC • ↑ parasympathic system => ↑ calmness and self-control • •

↑ mood => protect against depression ↑ feelings of malehood (well-being of being a man) => dress ↑ attractively, more dominant character

PHYSICAL • • • • •

↑ vasodilation => improve blood flow to skin, heart and organs Improves mucosa (glans penis, eyes, mouth) and skin => ↓ premature aging ↑ sex drive , erection & ejaculation ↑ fertilty & reproduction by ↓ risk of cardiovascular diseases, stroke, rheumatoid disorders, Alzheimer’s

105


23 mei 2014

Zinc => Hormones

106


23 mei 2014

Zinc deficiency => 4 x less serum testo. in young men Zinc repletion => 2 x higher serum testo. in elderly men

107


23 mei 2014

VIT. A => TESTOSTERONE Vit. A Deficient diet

Testosterone ng/ml

Normal diet

protein (testicle) 3,14

After 10 weeks : nl testicles, ⇓ testosterone after 14 weeks: marked degeneration of tubules, cessation of spermatogenesis, testicular atrophy

1,31 N=

N = 21

Figure : decreased testosterone steroidogenesis in testicular tissue of rats fed a vit. A : < 10 µg vit.A/per gram wet liver weight Steinberg KK, Exp Biol & Med, 1981, 110-115)

108


DOSE to ↑ NUTRIENT

23 mei 2014

TESTOSTERONE/

DURATION

levels/activity

TESTICLES Vit. A (retinol)

oral 25’000 to 100’000 IU/day

4- 8 months

Vit. B1

oral 10 to 50 mg/day

2 to 6 months

Vit. B6




4 to 8 months

Vit. B7 (biotin) Vit. E


6 to 8 months

Omega-9 PUFA

& soupspoon olive oil/day or tallow oil

4 to 8 months

Saturated fatty ac.


permanently

Cholesterol



Boron

3 to 10 mg/day oral 50 mg/day zinc citrate or sulphate before bedtime

4 to 8 months

Zinc


4 to 8 months

Carnitine Glutamine

oral 2 g/day for

2 to 8 months

For color copy of the presentation

[email protected]

109


23 mei 2014

Thank you for your attention

110

HormoonWellness - Dr. Paul Musarella

23 Mei 2014

HORMOON WELLNESS DR. P. MUSARELLA Anti-aging-, natuur- en orthomoleculair arts Zeist (Nederland)

Het ‘s Graevenhof Schilde 23-05-2014

SPECIALE DANK AAN : • Danny DIGNEFFE • Het team van ENERGETICA NATURA • Dr. Thierry HERTOGHE

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23 Mei 2014

MENOPAUZE

MENOPAUZE: DEFINITIE • het einde van de vruchtbare periode • refereert naar de laatste menstruatie van de vrouw • productie van oestrogenen en progesteronen door de eierstokken neemt af • voorraad vruchtbare eicellen raakt uitgeput • voortplantingssysteem verliest zijn functie • menstruatie neemt geleidelijk af - De menopauze kan alleen achteraf vastgesteld worden als bij een vrouw gedurende een jaar na de laatste menstruatie geen nieuwe menstruatie meer is opgetreden • “Overgangsperiode” = langere periode - verschillende fasen

een natuurlijk verschijnsel, geen ziekte...

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23 Mei 2014

DE MENOPAUZE

Cardiovasculaire pathologieën

Vroegtijdige veroudering

Warmteopwellingen

Urogenitale klachten Osteoporose

Gemiddeld op 52 jaar

Menopauze: verschillende fasen = overgangsperiode • Premenopauze •menstruatiepatroon verandert •langere periodes tussen menstruaties •menstruatie zelf duurt minder lang maar heviger

vanaf +/- 40 jaar

• Peri-menopauze •late periode van premenopauze tot 1 jaar na de menopauze •overgangsverschijnselen

vanaf +/- 45 jaar

• Menopauze •de laatste menstruatie • moment kan pas achteraf vastgesteld worden • bij 90% na 56 jaar voorbij

+/- 50 jaar

• Post-menopauze •geen menstruatie meer •overgangsverschijnselen nemen af

na 56 jaar

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23 Mei 2014

BELANGRIJKE PUNTEN: • Iedere vrouw is uniek • Er is een hormonale symfonie • Een vrouw kan de tweede helft van haar leven zonder menstruatie (en dus zonder drie belangrijke hormonen) leven! • Menstrueren na 55 kan het risico van borstkanker verhogen

FUNCTIES VAN OESTROGENEN Brain

In postmenopausale vrouwen, zijn oestrogenen (o.a.) belangrijk voor de botdensiteit, de bloedvaten , de collageenproductie, de activiteit van de hersenen en voor de troficiteit van de vagina.

Hart Borst Lever Uterus Bot

From: Hormones, 2nd ed. Norman AW and Litwack G. Academic Press: 1997. http://www.genovadiagnostics.com/files/profile_assets/sample _ report/HormonalHealth_Meno_HRT.pdf, Accessed 8/28/10

Source: http://www.cancer.gov/cancertopics /understandingcancer/estrogenrece ptors/Slide2, Accessed 9/4/10

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23 Mei 2014

SYMPTOMEN VAN DE MENOPAUZE (1) • • • • • • • •

Hot flushes (opvliegers) Nachtelijk zweten Vaginale atrofie Angst Stemmingswisselingen Snelle irritatie Verstoorde slaap Depressie

5


23 Mei 2014

HOT FLASHES “RECYCLING”

MENOPAUZE EN STEMMINGSWISSELINGEN

6


23 Mei 2014

SYMPTOMEN VAN DE MENOPAUZE (2) • • • • • • • • •

Minder libido Haargroei in het gezicht Pijnlijke seks Paniekaanvallen Rare droomen Urinaire infecties Vaginale jeuk Pijn bij de onderrug Opgeblazen buik


Winderigheid Verminderde spijsvertering Osteoporose Pijn bij de gewrichten Haaruitval Behoefte om vaker te plassen Snurken Gevoelige borsten

7


23 Mei 2014

Courtesy Dr. Hertoghe


Hartkloppingen Varicose Urinaire incontinentie Vroegtijdige veroudering van de huid Hoofdpijn, migraine aanvallen Geheugenverlies Duizeligheid Toename van het gewicht

8


23 Mei 2014

OESTROGENENTEKORT

Courtesy Dr. T. Hertoghe


9


23 Mei 2014

Overzicht Menopauze: drastische terugval oestrogenen en progesteron

10


23 Mei 2014

PREVALENTIE OVERGANGSKLACHTEN

VERHOOGDE INCIDENTIE VAN CVA NA DE MENOPAUZE Val van oestrogeenniveaus: • LDL-cholesterol gaat stijgen, maar HDL- cholesterol gaat ook dalen. • Stijging van het triglyceriden gehalte • Stijging van bloeddruk na de menopauze (duidelijker en sneller bij vrouwen met familieleden die aan hypertensie lijden)

11


B

23 Mei 2014

BOTONTKALKING

De botmatrix wordt permanent opgebouwd en afgebroken door KALKING twee types cellen: osteoblasten (aanmaak) en osteoclasten (afbraak). Tot 30-35 jaar meer opbouw dan afbraak Daarna keert dit proces zich langzaam om. Tijdens de overgang gaat de botontkalking nog sneller. -> botten in hoge mate beschermd worden door oestrogenen. Een toename van het risico op breuken (o.m. heup) en wervelinzakking zijn de belangrijkste gevolgen van die versnelde afbraak van botweefsel. Naast grote problemen qua mobiliteit, heeft het maatschappelijk ook een grote impact op het budget voor de gezondheidszorg.

24

12


23 Mei 2014

Valsamis et al. Nutrition & Metabolism 2006 3:36 doi:10.1186/1743-7075-3-36

IN HET BLOED: • Oestradiol - folliculaire fase: 0,040 – 0,605 nmol/L - ovulatie fase: 0,536 – 1,930 nmol/L - luteale fase: 0,121 – 0,719 nmol/L - postmenopausaal: < 0,136 nmol/L • Progesteron - folliculaire fase: 0,48 – 4,45 nmol/L - mid luteale fase: 14,12 – 89,13 nmol/L - luteale fase: 10,62 – 81,28 nmol/L - postmenopausaal: < 2,32 nmol/L

13


23 Mei 2014

KLASSIEKE BEHANDELING: HORMONALE SUBSTITUTIETHERAPIE (HST)) • Synthetische oestrogenen of natuurlijke paardenoestrogenen,

• meestal gecombineerd met synthetische progestatieven

14


23 Mei 2014

KLASSIEKE BEHANDELING: HORMONALE SUBSTITUTIETHERAPIE (HST) ACTUELE CONSENSUS omtrent HST bij gynecologen: - lagere doseringen - beperking in duur gebruik (max. 5 jaar) - alternatieve toedieningsvormen bijv. Transdermale patches -> Bio-identieke hormonale suppletie -> Alternatieven als fyto-oestrogenen

Waarom geen synthetische hormonale suppletie ? • De helft van de patiënten stopt na 1 jaar de suppletie met synthetische hormonen omdat er teveel bijeffecten ontstaan. • Synthetishe hormonen geven verkeerde signalen aan de receptoren en kunnen niet de hormonale disbalans in zijn geheel herstellen. Zij kosten energie voor het lichaam.

15


23 Mei 2014

BIO-IDENTIEKE HORMONEN • Dezelfde chemische structuur als in het lichaam • Redelijk veilig • 100% geaccepteerd • Efficiënter dan de synthetische producten (?) • Weinig bijeffecten • Gemaakt in erkende compound apotheek (en niet te kopen via internet!)

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23 Mei 2014

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23 Mei 2014

Int J Cancer. 2005 Apr 10;114(3):448-54. Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Fournier A, Berrino F, Riboli E, Avenel V, Clavel-Chapelon F. Source Equipe E3N, Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France. Abstract Most epidemiological studies have shown an increase in breast cancer risk related to hormone replacement therapy (HRT) use. A recent large cohort study showed effects of similar magnitude for different types of progestogens and for different routes of administration of estrogens evaluated. Further investigation of these issues is of importance. We assessed the risk of breast cancer associated with HRT use in 54,548 postmenopausal women who had never taken any HRT 1 year before entering the E3NEPIC cohort study (mean age at inclusion: 52.8 years); 948 primary invasive breast cancers were diagnosed during follow-up (mean duration: 5.8 years). Data were analyzed using multivariate Cox proportional hazards models. In this cohort where the mean duration of HRT use was 2.8 years, an increased risk in HRT users compared to nonusers was found (relative risk (RR) 1.2 [95% confidence interval 1.1-1.4]). The RR was 1.1 [0.8-1.6] for estrogens used alone and 1.3 [1.1-1.5] when used in combination with oral progestogens. The risk was significantly greater (p <0.001) with HRT containing synthetic progestins than with HRT containing micronized progesterone, the RRs being 1.4 [1.2-1.7] and 0.9 [0.7-1.2], respectively. When combined with synthetic progestins, both oral and transdermal/percutaneous estrogens use were associated with a significantly increased risk; for transdermal/percutaneous estrogens, this was the case even when exposure was less than 2 years. Our results suggest that, when combined with synthetic progestins, even short-term use of estrogens may

Micronized progesterone may be preferred to synthetic progestins in short-term HRT. This finding needs further investigation. increase breast cancer risk.

18


23 Mei 2014

Breast Cancer Res Treat. 2008 Jan;107(1):103-11. Epub 2007 Feb 27. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Fournier A, Berrino F, Clavel-Chapelon F. Source Institut National de la Santé et de la Recherche Médicale, ERI 20, Institut Gustave Roussy, Villejuif, France. Erratum in Breast Cancer Res Treat. 2008 Jan;107(2):307-8. Abstract Large numbers of hormone replacement therapies (HRTs) are available for the treatment of menopausal symptoms. It is still unclear whether some are more deleterious than others regarding breast cancer risk. The goal of this study was to assess and compare the association between different HRTs and breast cancer risk, using data from the French E3N cohort study. Invasive breast cancer cases were identified through biennial self-administered questionnaires completed from 1990 to 2002. During follow-up (mean duration 8.1 postmenopausal years), 2,354 cases of invasive breast cancer occurred among 80,377 postmenopausal women. Compared with HRT never-use, use of estrogen alone was associated with a significant 1.29-fold increased risk (95% confidence interval 1.02-1.65). The association of

estrogen-progestagen combinations with breast cancer risk varied significantly according to the type of progestagen: the relative risk was 1.00 (0.83-1.22) for estrogen-progesterone, 1.16 (0.94-1.43) for estrogen-dydrogesterone, and 1.69 (1.50-1.91) for estrogen combined with other progestagens. This latter category involves progestins with different physiologic activities (androgenic, nonandrogenic, antiandrogenic), but their associations with breast cancer risk did not differ significantly from one another. This study found no evidence of an association with risk according to the route of estrogen administration (oral or transdermal/percutaneous). These findings suggest that the choice of the progestagen

component in combined HRT is of importance regarding breast cancer risk; it could be preferable to use progesterone or dydrogesterone.

19


23 Mei 2014

J Womens Health (Larchmt). 2011 Apr;20(4):559-65. doi: 10.1089/jwh.2009.1915. Use of bioidentical compounded hormones for menopausal concerns: cross-sectional survey in an academic menopause center. Iftikhar S, Shuster LT, Johnson RE, Jenkins SM, Wahner-Roedler DL. Source Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA. [email protected] Abstract BACKGROUND: We aimed to assess the frequency of and experiences with use of bioidentical compounded hormone therapy (BCH) by women seen at an academic women's health clinic and menopause center. METHODS: Women seeking consultation for menopausal concerns from October 2005 to October 2006 were given a 19-item survey about their experiences with BCH and conventional hormone therapy (CHT). RESULTS: Of 208 consecutive patients invited to take the survey, 184 consented and responded. Thirty-seven (20%) reported ever use of BCH, and 25 (14%) reported current use of BCH; 59% of BCH preparations used included androgens. Twenty-four of 31 BCH users (77%) believed BCH was safer than CHT. Menopausal symptoms leading to use of hormones were similar between BCH and CHT users. Symptom relief with use of CHT and BCH was similar, but relief of sexual symptoms was reported significantly more frequently by BCH than CHT users (78% vs 33%, p < 0.001). CONCLUSIONS: Women lacked knowledge of safety concerns with BCH, reporting a belief that it was safer than CHT.

Menopausal symptoms prompting BCH and CHT use were similar, but sexual symptoms were more frequently relieved by BCH, possibly because of the inclusion of androgens. Visits to health care providers for menopausal symptoms are ideal for physicians to educate women that in the absence of data to the contrary, BCH should be considered to have the same risks as CHT. Our findings of reported improvements in sexual symptoms among women using BCH merit further evaluation, with better identification of constituents in the products

SYMPTOMEN VAN TESTOSTERONTEKORT • • • • • • • • • • •

Slechte spieren Gewichtstoename Vermoeidheid Lagere zelf waardering Lage HDL Droge en dunne huid met minder elasticiteit Droge en dunne haar Hangende bovenoogleden Minder strakke kaaklijn en meer hangende wangen Dunne lippen Angst

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23 Mei 2014


TESTOSTERONTEKORT


21


23 Mei 2014

OORZAKEN VAN TESTOSTERONTEKORT • • • • • • • • • •

Menopauze Geboorte van kinderen Chemotherapie Stress met uitputing van de bijnieren Burn-out Endometriose Depressie Psychisch trauma Gebruik van de anticonceptiepil Gebruik van HMG-CoA-reductaseremmers (statines)

TESTOSTERONE EN SEX DRIVE

Sexual health is an important component of overall health and well being. Multiple factors clearly influence an individual's sexuality; however, there is a general trend in Western societies to blame psychosocial factors for diminished sexuality in women. Sex steroid hormones are important determinants of sexual function in women and men, and there is increasing agreement that androgens play a key role in female sexuality. Androgen levels in women decline substantially during the reproductive years, with little change subsequent to spontaneous menopause. The most

common complaint of women experiencing androgen deficiency is loss of sexual desire, and several studies have now shown improvements in a number of parameters of sexuality in postmenopausal women treated with exogenous testosterone Davis SR. J Sex Marital Ther. 1998 Jul; 24(3):153-63.

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23 Mei 2014

23


23 Mei 2014

TESTOSTERON • • • • • • •

Verhoogt de sexuele drift Verhoogt het gevoel van “well being” Verhoogt de spiermassa en de spierkracht Helpt voor een goed geheugen Versterkt de slappe huid Vermindert de vetmassa in het lichaam Verhoogt de noradrenaline in de hersenen (anti-depressivum effect)

HOE KAN DE TESTOSTERON GESTIMULEERD WORDEN? • Met calorierestrictie • Met meer eiwitten • Met bepaalde aminozuren zoals o.a. arginine, leucine en glutamine • Met sport (krachttraining) • Met voldoende slaap • Met afslanken • Met minder stress • Met zinksuppletie (zink is nodig voor de testosteronmetabolisme). Pas op met de balans zink/koper. • Met Tribulus terrestris • Met glandulars

24


23 Mei 2014

BEHANDELING MENOPAUZE MET BIO-IDENTIEKE HORMONEN • Estradiol 0,06% gel (of Bi-Est 0,35 gel) 1 à 4 pompjes/dag in de ochtend • Progesteron 1% gel 1 à 4 pompjes/dag voor naar bed gaan • Of Utrogestan (gemicroniseerde progesterone) 100 à 200 mg voor naar bed gaan • Testosterone 1% gel 0,5 g/dag • Stoppen 4 à 5 dagen per maand

25


23 Mei 2014

5-ALPHA-REDUCTASE • Enzym die nodig is voor de conversie van de testosteron in DHT (dihydrotestosteron) • DHT is verantwoordelijk voor de mannelijkheid en de mannelijke lichaamsmerken (E2 is verantwoordelijk voor de vrouwelijkheid en de vrouwelijke lichaamsmerken). • Finasteride en dutasteride blokkeren de 5-alpha-reductase

26


23 Mei 2014

NUTRIËNTEN DIE DE 5 ALPHAREDUCTASE INHIBEREN: • Zink • GLA, DHA • Saw palmetto • Beta-sitosterol • Quercitin

DHEA DEHYDRO-EPIANDROSTERON

Prof. BEAULIEU

27


23 Mei 2014

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23 Mei 2014

DHEA ( DEHYDRO-EPIANDROSTERON ) • Genoemd “de moeder van alle hormonen” omdat zij een prohormoon is dat meerdere steroïde hormonen kan maken zoals o.a oestrogenen, testosteron en progesterone. • DHEA wordt aangemaakt in de bijnieren en in mindere mate in de hersenen en de huid. • Naarmate men ouder wordt, produceert het lichaam minder DHEA. Op 60-jarige leeftijd bedraagt de DHEA productie nog slechts 10 à 20 % van de hoeveelheid die werd aangemaakt toen men 25 jaar was.

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23 Mei 2014

FUNCTIES VAN DE DHEA (2) • • • • • •

Verhoogt het welzijnsgevoel Helpt tegen stress Activeert het afweersysteem Verjongt de huid Vermindert allergische reacties Verlaagt de triglyceriden

FUNCTIES VAN DE DHEA • • • • • •

Verlaagt de cholesterol Vecht tegen de vorming van vetophopingen Voorkomt trombose Versterkt de botten Verbetert de hersenenprestaties Stimuleert de spiermassa

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23 Mei 2014

DHEA TEKORT


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23 Mei 2014

BEHANDELING MET DHEA Vrouwen hebben DHEA nodig maar in mindere mate dan mannen (5 à 15 mg/dag)

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23 Mei 2014

FYTO-OESTROGENEN EN OESTROGENENRECEPTOREN

FYTO-OESTROGENEN ZIJN ZWAKKE OESTROGENEN “Phytoestrogens exhibit weak estrogenic activity on the order of 10-2 – 10-3 that of 17 β-estradiol.”

Tham et al. J Clin Endocrinol Metab 83:2223-2235,1998; Figure: Oseni et al. Planta Med 2008 Oct; 74(13):1656-65.

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23 Mei 2014

Zijn fyto-oestrogenen veilig? • Meta-analyse

• • •

•

– 174 gerandomiseerde, gecontroleerde onderzoeken Veilig neveneffectenprofiel Licht verhoogde cijfers van gastrointestinale effecten Cijfers van hormoon-gerelateerde effecten niet significant hoger bij gebruikers Kunnen gunstige resultaten opleveren in verband met cardiovasculaire ziekten, kanker, osteoporose en menopauzale symptomen Tham et al. J Clin Endocrinol Metab 83:2223–2235, 1998 Tempfer et al. Am J Med. 2009 Oct;122(10):939-46.e9.

Algemeenheden soja Culturele verschillen in de consumptie van sojaproducten resulteren in een enorme variatie in de inname van isoflavonen. De isoflavonenconsumptie varieert in oosterse landen van 25 tot 50 mg/dag, terwijl in het Westen de gemiddelde inname kleiner is dan 1 mg/dag.

In Azië, waar de isoflavonenconsumptie relatief hoog is, komen de zogenaamde ‘westerse’ ziekten, zoals borst-, endometrium-, colon- en prostaatkanker veel minder voor.

> Gegevens beschikbaar van isoflavongehalte van diverse planten: USDAIowa State University Database on the Isoflavone content of foods - 1999

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23 Mei 2014

Gunstige effecten soja

Fyto-oestrogenen en borstkanker

SOJA EN HORMOONAFHANKELIJKE KANKERRISICO Hormoonafhankelijke kankerrisico daalt met soja. Humane studies bewijzen de beschermende rol van soja- isoflavonen: op voorwaarde dat ze van jongs af aan genomen worden.

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23 Mei 2014

LIGNANEN • Lignanen zijn insecticidaal & antimicrobieel voor de planten; sommige werken ook als structurele subeenheden • Voornaamste bron van lignanen uit het dieet met hormonale activiteit: lijnzaad • Bronnen uit het dieet: pompoenpitten, groene thee, bessen

LIJNZAADLIGNANEN • Hebben een positieve invloed op evenwicht van slechte vs. goede oestrogeenmetabolieten • Anticarcinogene effecten in vitro • Inhiberen de aromatase-activiteit • Stimuleren de synthese van sex hormone binding globulin (SHBG) • Verminderen de inititatie van borsttumoren en inhiberen de groei van borsttumorcellen bij de mens • Hoge gehaltes plasmalignanen in verband met lager risico op borstkanker, colonkanker, prostaatkanker • “De inname via de voeding van 10 gram gemalen lijnzaad per dag gedurende zeven weken had de meest duidelijke invloed op het oestrogeenmetabolisme, terwijl we gematigdere effecten vaststelden bij de inname van vijf gram per dag ..” (Lord et al., Altern Med Rev. 2002 Apr;7(2):112-29.) Haggans et al., Nutr Cancer. 1999;33(2):188-95.; Lord et al., Altern Med Rev. 2002 Apr;7(2):112-29.

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23 Mei 2014

Wijzigingen in de levensstijl bij menopauze kunnen resultaat verbeteren “Wijzigingen in de levensstijl, waaronder de regulatie van de lichaamstemperatuur, relaxatietechnieken, regelmatige lichaamsbeweging, gewichtsverlies en stoppen met roken kunnen helpen om het risico op vasomotorische symptomen te verminderen (VMS) en zijn aan te bevelen voor alle vrouwen met menopauzegerelateerde VMS.” 73

Umland EM. J Manag Care Pharm. 2008; 14(3):S14-19.

Stress-vrij voedselplan

• Bij het ontbijt proteïnen van hoge kwaliteit eten om stress te verminderen • Voedingsmiddelen met veel fyto-oestrogenen • Volwaardige voedingsmiddelen met lage glycemische index eten • Meerdere kleine maaltijden • Zich onthouden van “emotioneel eten”

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23 Mei 2014

TIPS OM KOEL TE BLIJVEN Freedman, Am J Med. 2005 Dec 19;118 Suppl 12B:124-30.

Regelmatige lichaamsbeweging, het vermijden van pikante voedingsmiddelen en warmte en het onder controle houden van stress, helpen tegen warmteopwellingen.

CIMICIFUGA RACEMOSA • Black cohosh of zilverkaars • Verbetert de menopauzeklachten zoals hot flushes en het nachtzweten • Betere effecten in combinatie met StJanskruid ( Hypericum ) • Bevordert het ontstaan van borstkanker niet (maar wel gecontraindiceerd bij herceptingevoelige borstkanker)

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23 Mei 2014

.

Black cohosh, a menopausal remedy, does not have estrogenic activity and does not promote breast cancer cell growth. Lupu R, Mehmi I, Atlas E, Tsai MS, Pisha E, Oketch-Rabah HA, Nuntanakorn P, Kennelly EJ, Kronenberg F. Evanston Northwestern Healthcare Research Institute, Northwestern Medical School, Department of Medicine, Evanston, IL 60201, USA. [email protected] Int J Oncol. 2003 Nov;23(5):1407-12.

PROTOCOL VAN DR. E. VALSTAR VOOR OVERGANGSKLACHTEN • Cimicifuga racemosa: 40 mg per dag • Genisteïne: 54 mg per dag • Yoga waarschijnlijk zinvol (stimulatie productie melatonine) • Hypericum voor psychische klachten (maar niet tegelijk met reguliere antidepressiva) • Hop: 100 microg hopeïne per dag

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23 Mei 2014

ORTHOMOLECULAIRE BEHANDELING VAN DE MENOPAUZE (1) • Cimicifuga racemosa • Isoflavones • Vitex agnus castus, reguleert hypofyse functie • Melissa officinalis, kalmerend effect • Rhodiola rosea, stressadaptogeen • Resveratrol • Omega’s 3/6/9 • Symbiovag

BIO-SOY FLAVONES™ • Isoflavonen uit soja (Natuurlijk mengsel glucosiden) (ratio Genisteine/Daidzeine/Glyciteine = 1:1:0,2) • Gebruiken bij: • Overgangsklachten • Post-menopauzale osteoporose (preventie) • Adviesdosering: 1 capsule per dag • Bio-Soy Flavones is een veilig, natuurlijk alternatief voor synthetische oestrogenen. • Dit preparaat vermindert klachten als gevolg van de menopauze

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23 Mei 2014

ORTHOMOLECULAIRE BEHANDELING VAN DE MENOPAUZE ( 2 ) Vitaminen, mineralen en chondroïtinesulfaat voor sterkere botten: – Vitamine D – Vitamine K2 – Calcium/magnesium/zink – Vitamines B – Borium – Silicium

OMEGA 3 EN HOT FLASHES • Supplementation with EPA compared to placebo significantly reduced HF frequency and score after 8 weeks • Study limitation – baseline HF were low to start (2.8 per day) • 1050 mg EPA/150 mg DHA was daily dose • Sunflower oil as control Lucas et al. Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Menopause. 2009 Mar-Apr;16(2):35766.

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23 Mei 2014

OMEGA 3 Wetenschappelijk onderzoek heeft aangetoond dat omega 3vetzuren ons lichaam soepel kunnen houden. Aangezien het functioneren van de miljarden cellen van ons organisme afhankelijk is van de doorlaatbaarheid en de soepelheid van de celwanden, speelt het gehalte aan meervoudig onverzadigde vetzuren daarin een uiterst belangrijke rol. Dierlijk (vast) vet, dat hoofdzakelijk verzadigde (stroeve) vetzuren bevat, maakt de celwanden minder flexibel en bemoeilijkt ook de uitwisseling van voeding- en afvalstoffen doorheen de celwand. Bij een ideale verhouding van 1 tot 4 à 5 (nu veelal 1 tot 40!) tussen de onverzadigde omega 3vetzuren (in lijnzaad en vette vis) en omega 6-vetzuren (in vele plantenzaden) wordt er optimale bescherming geboden. Onverzadigde vetzuren hebben een belangrijke beschermende functie, bijvoorbeeld bij het helpen optimaliseren van de cholesterol; ze hebben ook een gunstige invloed op de bloedsomloop, de soepelheid van de gewrichten en het behoud van een jeugdige huid.

Vit. C (500 mg), B6 (25 mg), B12 (1 mg) & Folate (5 mg)

=> + 26% ↑ serum Estradiol

SUBJECTS: 20 obese postmenopausal women: body mass index > or = 30

DBPC study TREATMENT: 8-week open-label supplement + vitamins C (500 mg), B6 (25 mg), B12 (1 mg), & folate (5 mg) blinded fashion. • Folate & vit. B12 levels rose sign => supplement well absorbed & thatparticipants adhered to the protocol. • Weight, blood pressure, and serum lipidsremained stable. C-reactive protein, interleukin-6, and leptin levels remained unchanged. • + 26% serum Estradiol levels rose from a median of 22.0 pg/mL (IQR = 15.9-25.8) at baseline to a median of 27.8 pg/mL (IQR = 23.1-33.9) at follow-up (p = 0.003).

Palmas W. Effects of short-term supplementation with ascorbate, folate, and vitamins B6 and B12 on inflammatory factors and estrogen levels in obese postmenopausal women. Int J Vitam Nutr Res. 2006 Jan;76(1):34-8.Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. [email protected]

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23 Mei 2014

HORMONENRECEPTOREN IN DE HERSENEN

OESTROGENEN EN NEUROTRANSMITTERS

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23 Mei 2014

L-TYROSINE 500mg • 1 à 3 capsules per dag (tussen de maaltijden) • Het aminozuur tyrosine, dat aangemaakt kan worden uit het aminozuur fenylalanine, is nodig voor de aanmaak van schildklierhormonen. Het heeft daarom een algemene activerende werking. Tyrosine is tevens nodig voor de productie van de neurotransmitters dopamine, adrenaline en noradrenaline, en van de pigmentstof melanine.

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23 Mei 2014

TRYPTOZOL™ 300mg • L-tryptofaan (ter vermindering van de stressgevoeligheid) • 1 à 2 capsules om 17h met een stuk fruit • En/of een 1/2 uur voor het slapengaan (ter bestrijding van slapeloosheid) • Voorloper van diverse belangrijke stoffen, waaronder serotonine. Serotonine is een belangrijk antistress hormoon, dat op zijn beurt weer als grondstof dient voor de vorming van het hormoon melatonine.

FOSFATIDYLCHOLINE • De krachtigste vorm van lecithine voor het zenuwstelsel • 3x daags 1 capsule bij de maaltijden • Op basis van sojalecithine • Als goede bron van choline kan fosfatidylcholine zorgen voor een toename van acetylcholine in de hersenen. Geheugen en concentratie zijn gedeeltelijk afhankelijk van een goede voorziening van deze voor de hersenen nodige stoffen (40% van de hersenen bestaat uit lecithine).

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23 Mei 2014

Cognitief MENOPAUZE EN COGNIETIVE VERANDERINGEN • Gebrek aan oestrogenen: kans op de ziekte van Alzheimer (dementie) neemt toe • Incidentie van de ziekte stijgt meer bij vrouwen boven de 65 jaar dan bij mannen. Afhankelijk van de leeftijd krijgen vrouwen 1,5-3 keer vaker de ziekte dan mannen.

OMEGA 3 EN DEMENTIE • DHA emerging as a new potential agent for prevention of cognitive decline and treatment of Alzheimer's disease. • Preclinical studies suggest that DHA maintains membrane fluidity, improves synaptic and neurotransmitter functioning, enhances learning and memory performances and displays neuroprotective properties. • Several epidemiological studies support the association between omega-3 PUFA consumption and a lower prevalence of dementia.

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23 Mei 2014

OMEGA-3 EN SYNAPTISCHE PLASTICITEIT

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23 Mei 2014

GLANDULARS: KLIERCONCENTRATEN

• “Similia similibus curantur” Paracelcus (1493-1541): het hart geneest het hart, de bijnier geneest de bijnier, enz. • Orgaantherapie dateert reeds vanuit het oude Griekse rijk. • Dr. Claude Bernard (1813-1878) : “endocrien materiaal kan fysiologische veranderingen starten bij mensen”.

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23 Mei 2014

CYTOZYME-O™ • Gebruiken bij: • Zwakke eierstokfunctie • 1 à 2 tabletten per dag bij de maaltijd • Eierstokconcentraat (varken) • De rijke verscheidenheid aan opbouwende, regulerende en voedende stoffen uit de eierstokglandular biedt de eierstokken een ideaal voedingsmilieu

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23 Mei 2014

EQUI-FEM™ • Gebruiken bij: • Vrouwelijke hormoonhuishouding • Premenstruele en menopausale klachten • Adviesdosering: 2 x daags 1 tablet (bij maaltijden en evt. voor het slapen). • Zeer complete formule voor de vrouw met een uitgebalanceerde samenstelling van vitamines, mineralen, enzymen, glandulars en andere orthomoleculaire voedingsstoffen, overeenkomstig de behoeften van de vrouw.

Biopause AM - PM • Ondersteunen alle stressgerelateerde klachten • Bio-Pause AM: kruiden die in de ochtend rust en energie geven: Zilverkaars, Rhodiola, Agnus castus, Hartgespan • Bio-Pause PM: kruiden die ons tijdens de nacht ondersteunen, minder zweten, betere nachtrust: Passiebloem, Citroenmelisse, Zilverkaars

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23 Mei 2014

AGNUZOL™ • Gebruiken bij (o.a.): • Overgangsproblemen • Verlaagd libido • 1 à 2 capsules per dag bij of net na de maaltijden • Vitex Agnus castus - extract (Kuisboom) • Vooral in de eerste stadia van de menopauze is dit middel zeer goed werkzaam.

BLACKCURRANT SEED OIL • Zwarte bessenzaadolie, rijk aan GLA en ALA • 1 capsule per dag (bij de maaltijden). • Hoewel zwarte bessenzaadolie minder GLA bevat dan bernageolie, is het gehalte toch bijna twee maal zo hoog als dat van teunisbloemolie. Een voordeel van zwarte bessenzaadolie is daarnaast dat het na lijnzaadolie een van de rijkste plantaardige bronnen is van het omega-3 vetzuur alfa-linoleenzuur (14%). • Omzetting van alfa-linoleenzuur naar prostaglandinen van de serie 3. • Efficiënte en evenwichtige aanmaak van prostaglandinen van zowel de series 1 als 2.

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23 Mei 2014

MACA of ‘PERUAANSE VIAGRA’ • Gebruiken bij (o.a.): • als natuurlijk afrodisiacum • potentie-, erectieproblemen • vruchtbaarheidsproblemen • klachten samenhangend met (post)menopauze • Bij zowel mannen als vrouwen werkt Maca als afrodisiacum. Vrouwen kunnen profijt hebben van Maca voor, tijdens en na de menopauze.

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23 Mei 2014

OESTROGENEN METABOLIETEN

Steroidogenic Pathway

Source: Genova Diagnostics http://www.genovadiagnostics.com/files/profile_assets/sample_report/EssentialEstrogens_FMV.pdf, Accessed 9/11/10

CYP1B1 en 4OH-OESTROGENEN

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23 Mei 2014

XENO-OESTROGENEN

Environmental Health Perspectives * VOLUME 108 NUMBER 8 August 2000

Arch. Environ. Contam. Toxicol. 53, 126–133 (2007)

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23 Mei 2014

Step

Clinical Markers

Nutritional Therapy

Estrogen input

Evaluate T and E levels; BMI

Decrease aromatization with phytochemicals (isoflavones, tea catechins, pomegranate, licorice flavonoids, resveratrol, hop flavonoids, flax lignans,); Reduce body weight and toxin load with detox/body comp program

Phase I

Evaluate 2:16αOH; Increase cruciferous vegetable consumption (indole-3carbinol), flax lignans, isoflavones, omega-3 fatty acids; SNPs for CYP450 enzymes Decrease omega-6 fatty acids

Protection

Evaluate 4OH and 16αOH

Increase antioxidants: vitamins E, A, and C, mixed carotenoids, bioflavonoids, selenium, curcumin, Nacetylcysteine, green tea catechins (polyphenols), lycopene, alpha-lipoic acid

Methylation

Check homocysteine levels; MTHFR SNP; 2-MeOHE

Folic acid, B12, B6, trimethylglycine

Excretion

Evaluate E levels

Lipotropic factors (choline, vitamins B6 and B12, folic acid) for bile synthesis; Probiotics; Increase fiber and decrease fat.

Tissue Availability

Evaluate E levels

Phytoestrogens (lignans, isoflavones); Dietary factors such as fiber and fat may influence

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23 Mei 2014

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23 Mei 2014

SPIRITUELE DIMENSIE VAN DE VROUW “The Menstrual Matrix:

Menarche, Menstruation and Menopause encompasses a series of transformational processes,unique to the female and essential to her personal evolution.” Tamara Slayton

ANDROPAUSE

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23 Mei 2014

“PENOPAUZE”

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23 Mei 2014

TESTOSTERONE?

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NA

23 Mei 2014

VOOR

Courtesy Dr. Life (V.S.)

TESTOSTERONE

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23 Mei 2014

Courtesy Prof. C. Schulman

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23 Mei 2014

TESTOSTERON BIJ MAN • Belangrijkste mannelijke hormoon • Gemaakt in de testis en bijnieren • Testosteron kan omgezet in DHT (dihydrotestosterone) en in oestrogenen

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23 Mei 2014

Te veel Dihydrotestosterone => kaalheid


↑ DHT / DHT to T in premature baldness Male-pattern baldness (MPB) is not started from occipital, but frontal or scalp of head. We can assume that distribution of androgenic steroids is different for each region of the head. SUBJECTS: 22 subjects + baldness, 13 + non-baldness RESULTS:

• The level of dihydrotestosterone (DHT) & the ratio of testosterone to epitestosterone(T/E ratio) in vertex hair from premature baldness subjects were higher than in the sample of non-baldness subjects (P<0.001, 0.001), whereas the levels of androgens in occipital hair from the same baldness group were not different. •

the levels of DHT, testosterone, & DHT/T ratio in plasma from premature MPB were higher than in those of control subjects(P<0.001, 0.001,

0.005). CCL: • the distribution of androgenic steroids is unlike in various regions of individual subjects. • the increased DHT/T ratio in balding plasma indirectly confirms the high activity of 5alpha-reductase type II. Bang HJ, Yang YJ, Lho DS, Lee WY, Sim WY, Chung BC. Comparative studies on level of androgens in hair and plasma with premature male-pattern baldness. J Dermatol Sci. 2004 Feb;34(1):11-6. Bioanalysis and Biotransformation Research Center, Korea Institute of Science and Technology, PO Box 131, Cheongryang, Seoul 130-650, South Korea.

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23 Mei 2014

TESTOSTERONTEKORT


LAGE TESTOSTERONE => VERANDERINGEN IN HET LICHAAM (1) Arnold Schwarzenegger

Clint Eastwood


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23 Mei 2014

LAGE TESTOSTERONE => VERANDERINGEN IN HETLICHAAM (2) Flat hair Jack Nicholson

Male pattern hair loss Pale face Loss of firmness of the face Small wrinkles Gynecomastia Loss of firmness of muscles

Fat accumulation Courtesy Dr. T. Hertoghe

Testosterone tekort Man voelt zich niet meer als een man


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23 Mei 2014

MANNEN KUNNEN OOK AAN HOT FLASHES LIJDEN !

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23 Mei 2014

LAGE TESTOSTERONE EN DEPRESSIE

THE MALE CLIMACTERIC SYNDROME : •

• • • • • • • •

Nervousness, subjective Irritability Ill at ease Excitability Fear Worry, unnecessary Loss of self confidence Futility

• • • • • • • • •

Fatigability & lassitude (80,2 %) Depression (77,2 %) Loss of interest (58,5 %) Insociability (23,8 %) Crying (25,3 %) Thoughts of self destruction (2,4 %) Self accusation (2,4 %) Psychosis (2,4 %) Suicide attempted (2 on 273)

•

Memory and concentration decreased (75,8 %) Sleep disturbed (59,3 %)

•

(90,5 %) (86,2 %) (56,4 %) (49,0 %) (40,6 %) (33,7 %) (27,1 %) (27,1 %)

• • • • • • •

Occipitocervical aching (41,9 %) Decreased or absent potency Decreased or absent libido Headache Aching in the vertex Scotomas Hot flushes Sweating

•

Tachycardia, palpitation & dyspnea

(90,1 %) (80,5 %) (31,8 %) (17,5 %) (26,0 %) (29,3 %) (17,9 %)

• •

(51,2 %) Numbness and tingling (53,9 %) Vague pains Tinnitus

(32,9 %) (10,6 %)

• •

Cold hands & feet Chilly sensations

(32,9 %) (6,2 %)

• •

Obesity Constipation

(21,5 %) (24,9 %)

•

136

(August A. Werner, JAMA, 1946, 132(4): 188-194)

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23 Mei 2014

SEX EN TESTOSTERONE

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23 Mei 2014

VERANDERINGEN VAN GEDACHTEN…

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23 Mei 2014

ONGEZONDE MAN Apparently healthy men

(Debled G , Au-delà de cette limite votre ticket est encore valable, Albin Michel-Paris, 1992)


Courtesy Dr.T. Hertoghe

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23 Mei 2014

TESTOSTERONE EN VET

Courtesy Dr.T. Hertoghe

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23 Mei 2014

De verhouding tussen vetweefsel en testosteron

TESTOSTERONE EN OESTROGENEN BIJ MAN

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23 Mei 2014

LAGE TESTOSTERONE EN VETMETABOLISME

LAGE TESTOSTERONE EN METABOL SYNDROOM

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23 Mei 2014

LAGE TESTOSTERONE EN HOGER RISICO VAN MORTALITEIT

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23 Mei 2014

Reduced testosterone levels in men linked to increased mortality over 7 year period A report published in the November, 2010 issue of the British journal Heart reveals an increased risk of premature death from all causes and cardiovascular disease among men whose testosterone levels were deficient. Low serum testosterone and increased mortality in men with coronary heart disease.Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, Channer KS. Heart. 2010 Nov; 96(22):1821-5. Epub 2010 Oct 19.

ANDERE REFERENTIES • Annewieke, W, et al., “Measures of bioavailable serum testosterone and estradiol and their relationships with muscle strength, bone density, and body composition in elderly men,” The Journ of Clin Endo & Met 2000; 85(9):3276-3282. • Harman, S., et al., “Male menopause, myth or menace,” The Endocrinologist 1994; 4(3):212-217. • Swerdloff, R., et al., “Androgen deficiency and aging in men,” West Journ of Med 1993; 159(5):579-585 • Vermeulen, A., et al., “Androgens in the aging male,” Journ of Clin Endocrin & Met 1991; 73(2):221-224. •

Korenman, S., et al., “Secondary hypogonadism in older men: its relationship to impotence,” Journ Clin Endocinol Met 1990; 71:963-969.

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23 Mei 2014

SHBG • SHBG is een eiwit. Het wordt vooral aangemaakt in de lever. • SHBG transporteert testosterone en oestradiol. • SHBG stijgt met verouderen – Yeap, B., “Testosterone and ill-health in aging men,” Nat Clin Pract Endocrinol Metab 2009; 5(2):113-21. – Kronenberg, H., et al., (Ed.,) Williams Textbook of Endocrinology. Philadelphia, PA: Elsevier, 2008.

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SHBG EN TESTOSTERONE

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23 Mei 2014

REFERENTIES - Cumming, D., et al., “Non-sex hormone-binding globulinbound testosterone as a marker for hyperandrogenism,” Jour Clin Endocrinol Metab 1985; 61(5):873-76. - Nankin, ., et al., “Decreased bioavailable testosterone in aging normal and impotent men,” Jour Clin Endocrinol Metab 1986; 63(6):1418-2 - Van den Beld, A., et al., “Measures of bioavailable serum testosterone and estradiol and their relationships with muscle strength, bone density, and body composition in elderly men,” Jour Clin Endocrinol Metab 2000; 85(9):3276-82

TESTOSTERON In het bloed: • Testosteron (man) 3000 – 10000 pg/mL • Testosteron (vrouw) 80 – 350 pg/mL • S.H.B.G. (man) 20 – 55 pmol/mL • S.H.B.G. (vrouw) 41 – 79 pmol/mL • Vrij testosteron (man) 50 – 280 pg/mL • Vrij testosteron (vrouw) 1,9 – 15,0 pg/mL

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23 Mei 2014

TESTOSTERONE EN SPEEKSELTESTEN

TESTOSTERONE SUPPLETIE

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23 Mei 2014

BEHANDELING MET TESTOSTERON • Transdermal gels (1% voor vrouw, 5 à 10 % voor man) • Intramusculair (Sustanon, Nebido)

KOMISCHE FILMS…

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23 Mei 2014

KOMISCHE FILMS STIMULEREN TESTOSTERONE ! The effect of viewing a humorous film on salivary testosterone levels and transepidermal water loss (TEWL) values on the back of the neck in 36 elderly healthy people (36 male, mean 70 years) and 36 elderly patients with atopic dermatitis (AD) (36 male, mean age 70 years) were studied. Salivary testosterone levels were decreased while TEWL values were increased in elderly patients with AD compared to those in elderly healthy people. Viewing a humorous film (The Best Bits of Mr. Bean, Universal studios, 1996) slightly, but significantly (P<0.05), elevated salivary testosterone levels and reduced TEWL values in elderly healthy people, while viewing a control non-humorous film (weather information) failed to do so. Similarly, but more pronouncedly, viewing a humorous film markedly elevated salivary testosterone levels and reduced TEWL values in elderly patients with AD, while viewing a control non-humorous film failed to do so. These finding indicate that viewing a humorous film may be useful in the study of testosterone and TEWL, and treatment for dry skin in elderly people with or without AD. Kimata H. Elevation of testosterone and reduction of transepidermal water loss by viewing a humorous film in elderly patients with atopic dermatitis. Acta Medica (Hradec Kralove). 2007;50(2):135-7

SPORTAUTO’S…

Porsche 911 Carrera 4S Cabriolet

1990 Toyota Camry wagon

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23 Mei 2014

Sportauto => ↑testosterone SUBJECTS: 39 young heterosexual men drive both "a 2006 Porsche 911 Carrera 4S Cabriolet estimated to be worth over $150,000" and a "a dilapidated 1990 Toyota Camry wagon having over 186,000 miles," each for an hour, split evenly between city &highway driving. They randomly assigned subjects to driving either the Porsche or Camry first. They took a total of 6 "T" samples from each young man at various stages on the process. Most crucial for our purposes are the changes in "T" that occurred after driving the Porsche vs. the Camry, but also relevant are the two "baseline" samples taken before and after the experience. RESULT: Driving the Camry did not seem to lead in a significant change in T levels, but -- no doubt to the delight of many people & perhaps the disgust of many others -- the young guys who drove the Porsche experienced significant and substantial increases in T levels after driving the Porsche (in the final sample of 31 guys, 8 were excluded from the day analysis because their samples were tainted by excessive blood in their mouths).

G. Saad, J.G. Vongas / Organizational Behavior and Human Decision Processes 110 (2009) 80–92

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Bernhardt PC, Dabbs JM Jr, Fielden JA, Lutter CD. Testosterone changes during vicarious experiences of winning and losing among fans at sporting events. Physiol Behav. 1998 Aug;65(1):5962University of Utah, Salt Lake City, USA.

EROTISCHE FILM KIJKEN...

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23 Mei 2014

Erotic film=> ↑ testosterone

Erotic

Erotic Erotic

Testosterone is hoger in de zomer El-Migdadi F, Nusier M, Bashir N. Seasonal pattern of leutinizing, follicle-stimulating hormone, testosterone and progesterone in adult population of both sexes in the Jordan Valley. Endocr Res. 2000 Feb;26(1):41-8. PubMed PMID: 10711721. Differences were observed in hormonal levels between in both sexes of people living in Irbid City (620 meters above sea level) and in the Jordan Valley (360 meters below sea level). In addition, exercise was shown to differentially affect hormonal levels of both sexes at the above and below sea level locations. Serum levels of leutinizing hormone (LH) and testosterone (T) in adult male and serum levels of follicle-stimulating hormone (FSH) and progesterone (P) in adult female people were investigated in Irbid City and in the Jordan Valley during the years 1997 and 1998. The levels of these hormones were followed each month during this period. In males living in Irbid City, , and in females at the same site, FSH and P also peaked from March through June. These data confirm the seasonal variation in sex hormones reported elsewhere in (wo)man and in other species. In males and females of the Jordan Valley, serum levels of LH, FSH, T and P were all higher than those of Irbid City throughout the year. Additionally, peaks of LH and T in male and FSH and P in female subjects in the Jordan Valley were observed from March through September. The high levels of these hormones and the extension of their peaks are suggested to be due to effects of the environmental factors of the Jordan Valley (high temperature, high barometric pressure) compared to those in Irbid City and other areas located at above sea level altitude.

LH and T peaked from March through June

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23 Mei 2014

Zinc => ↑serum testo & fertility in men + low testo

Zinc deficiency => 4 x less serum testo. in young men Zinc repletion => 2 x higher serum testo. in elderly men

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23 Mei 2014

Zinc deficiency => smaller ejaculate volume

In a cohort of older men, magnesium levels are strongly and independently associated with the anabolic hormones testosterone and IGF-1. Int J Androl. 2011 Dec;34(6 Pt 2):e594-600. doi: 10.1111/j.1365-2605.2011.01193.x. Epub 2011 Jun 15. Magnesium and anabolic hormones in older men. Maggio M, Ceda GP, Lauretani F, Cattabiani C, Avantaggiato E, Morganti S, Ablondi F, Bandinelli S, Dominguez LJ, Barbagallo M, Paolisso G, Semba RD, Ferrucci L. Source: Section of Geriatrics, Department of Internal Medicine and Biomedical Sciences, University of Parma, Parma, Italy. marcellAbstract Optimal nutritional and hormonal statuses are determinants of successful ageing. The age associated decline in anabolic hormones such as testosterone and insulin-like growth factor 1 (IGF-1) is a strong predictor of metabolic syndrome, diabetes and mortality in older men. Studies have shown that magnesium intake affects the secretion of total IGF-1 and increase testosterone bioactivity. This observation suggests that magnesium can be a modulator of the anabolic/catabolic equilibrium disrupted in the elderly people. However, the relationship between magnesium and anabolic hormones in men has not been investigated. We evaluated 399 ≥65-year-old men of CHIANTI in a study population representative of two municipalities of Tuscany (Italy) with complete data on testosterone, total IGF-1, sex hormone binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS) and serum magnesium levels. Linear regression models were used to test the relationship between magnesium and testosterone and IGF-1. Mean age of the population was 74.18 ± 6.43 (years ± SD, age range 65.2-92.4). After adjusting for age, magnesium

was positively associated with total testosterone (β ± SE, 34.9 ± 10.3; p = 0.001) and with total IGF-1 (β ± SE, 15.9 ± 4.8; p = 0.001). After further adjustment for body mass index (BMI), log (IL-6), log (DHEAS), log (SHBG), log (insulin), total IGF-1, grip strength, Parkinson's disease and chronic heart failure, the relationship between magnesium and total testosterone remained strong and highly significant (β ± SE, 48.72 ± 12.61; p = 0.001). In the multivariate analysis adjusted for age, BMI, log (IL-6), liver function, energy intake, log (insulin), log (DHEAS), selenium, magnesium

levels were also still significantly associated with IGF-1 (β ± SE, 16.43 ± 4.90; p = 0.001) and remained significant after adjusting for total testosterone (β ± SE, 14.4 ± 4.9; p = 0.01). In a cohort of older men, magnesium levels are strongly and independently associated with the anabolic hormones testosterone and IGF-1.

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↓

23 Mei 2014

Vit. B6 => ↓ serum testosterone in rats

Lage VIT. A => Lage TESTOSTERONE Vit. A Deficient diet

Testosterone ng/ml

Normal diet

protein (testicle) 3,14

After 10 weeks : nl testicles, ⇓ testosterone after 14 weeks: marked degeneration of tubules, cessation of spermatogenesis, testicular atrophy

1,31 N=

N = 21

Figure : decreased testosterone steroidogenesis in testicular tissue of rats fed a vit. A : < 10 µg vit.A/per gram wet liver weight Steinberg KK, Exp Biol & Med, 1981, 110-115)

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23 Mei 2014

L-Carnitine => ↑ male sexual potency (better than oral testosterone), ↑ heart fn, ↓ fatigue & depression

DOSE to ↑ NUTRIENT

TESTOSTERONE/

DURATION

levels/activity

TESTICLES Vit. A (retinol)

oral 25’000 to 100’000 IU/day

4- 8 months

Vit. B1

oral 10 to 50 mg/day

2 to 6 months

Vit. B6



Vit. B7 (biotin)


Vit. E


6 to 8 months

Omega-9 PUFA

& soupspoon olive oil/day or tallow oil

4 to 8 months

Saturated fatty ac.


permanently

Cholesterol



Boron

3 to 10 mg/day oral 50 mg/day zinc citrate or sulphate before bedtime

4 to 8 months

Zinc


4 to 8 months

Carnitine Glutamine

oral 2 g/day for

2 to 8 months

4 to 8 months

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23 Mei 2014

DHEA

• Voorloper van de steroidhormonen • Kan uitgeput raken bij chronische stress • Lage niveaus zijn gerelateerd aan vermoeidheid en libidoproblemen

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23 Mei 2014

DHEA In het bloed: • DHEA sulfaat (man) 45 – 330 microg/dL • DHEA sulfaat (vrouw) 10 – 160 microg/dL In de urine van 24 uur : • DHEA (man) 0,2 – 1,6 micromol/24 uur • DHEA (vrouw) 0,2 – 0,9 micromol/24 uur • 17-keto’s (berekend)(man) 9,9 – 30,6 micromol/24 uur • 17-keto’s (berekend)(vrouw) 6,0 – 22,2 micromol/24 uur

BEHANDELING MET DHEA BIJ MAN • Alleen na het meten van DHEA sulfaatspiegels • Gebruikelijke doseringen: 20 à 30 mg/dag • Gevaar: verhoging risico op steroïde gevoelige kanker (bijv. prostaat) • Bijwerkingen: lichaamsbeharing en acne

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23 Mei 2014

CYTOZYME-ORCHIC™ • Gebruiken bij: • Optimalisering van de productie van mannelijke geslachtshormonen (invloed op potentie en vruchtbaarheid man) • Krachtsport • 3 x daags 1 tablet bij de maaltijd • Testikelconcentraat (rund) • Buiten problemen met potentie en vruchtbaarheid bij de man, wordt vanwege een optimalisering van de productie van mannelijke geslachtshormonen, cytozyme-orchic ook wel bij sport, met name krachtsport, ingezet.

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23 Mei 2014

OPTIMAL EFAS™ • Omega-3, 6 & 9 vetzuren in optimaal evenwicht • Adviesdosering: 2 x 2 capsules per dag • Samenstelling: - Lijnzaadolie (n-3, n-6, n-9*) 57% ALA, 19% OA* - Visolie (n-3) 18% EPA, 12% DHA - Borageolie (n-6, n-9*) 22% GLA, 17% OA*

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23 Mei 2014

How to boost testosterone naturally with Tribulus terrestris Tribulus terrestris is a herb containing saponins which specifically raise the amount of luteinising hormone secreted from the pituitary gland. As luteinising hormone is the specific trigger for testosterone production, this would lead to increased testosterone levels in men and so increase sperm production, improved erectile function and increased libido.

REFERENTIES TRIBULUS TERRESTRIS Xu YJ, Xie SX, Zhao HF, Han D, Xu TH, Xu DM. Studies on the chemical constituents from Tribulus terrestris. Yao Xue Xue Bao. 2001 Oct; 36 (10): 750-3 Gauthaman K, Ganesan AP, Prasad RN. Sexual effects of puncturevine (Tribulus terrestris) extract (protodioscin): an evaluation using a rat model. J Altern Complement Med. 2003 Apr;9(2):257-65. Adaikan PG, Gauthaman K, Prasad RN Ng SC. Proerectile pharmacological effects of Tribulus terrestris extract on the rabbit corpus cavernosum. Ann Acad Med Singapore. 2000 Jan;29(1):22-6. Gauthaman K, Adaikan PG, Prasad RN. Aphrodisiac properties of Tribulus terrestris extract (Protodioscin) in normal and castrated rats. Life Sci. 2002 Aug 9;71(12):1385-96. Gauthaman K, Adaikan PG. Effect of Tribulus terrestris on nicotinamide adenine dinucleotide phosphate-diaphorase activity and androgen receptors in rat brain. J Ethnopharmacol. 2005 Jan 4; 96 (1-2): 127-32

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23 Mei 2014

MACA of ‘Peruaanse viagra’ • Gebruiken bij (o.a.): • Als natuurlijk afrodisiacum • Potentie-, erectieproblemen • Vruchtbaarheidsproblemen • Bij een geconstateerde PSA-verhoging dient het gebruik van Maca afgeraden te worden • Bij zowel mannen als vrouwen werkt Maca als afrodisiacum.

HORMONALE BALANS… Bij man

Bij vrouw

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23 Mei 2014

Interpretatie van laboratoriumtesten

Eur J Endocrinol. 2003 Aug;149(2):91-7.

Intrinsic imperfections of endocrine replacement therapy. Romijn JA, Smit JW, Lamberts SW. Source Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands. [email protected] Abstract Hormonal substitution therapy has been extremely successful, with respect to morbidity and mortality, in the treatment of the major syndromes of endocrine insufficiency. However, many patients treated for endocrine insufficiencies still suffer from more or less vague complaints and a decreased quality of life. It is likely that these complaints are, at least in part, caused by intrinsic imperfections of hormone replacement strategies in mimicking normal hormone secretion. Unfortunately, these complaints are often difficult to assess by clinicometric or biochemical tests, because the effects of hormones in general, and thus of hormone replacement strategies in particular, are difficult to quantify at the tIssue level. Therefore,

in clinical practice we rely mostly on plasma variables - 'plasma endocrinology' - which are a poor reflection of hormone action at the tissue level. Appreciation of these intrinsic shortcomings of endocrine therapy is of utmost importance to prevent incorrect labelling of the complaints of many endocrine patients and to achieve further improvement in endocrine replacement strategies.

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23 Mei 2014

PROSTAATONDERZOEK…

SARCOPENIA: MEER EIWITTEN ETEN !

• • • • • •

RDA is 1,25 g/kg/dag Aminozuren ( AMINO SPORT ) BCAA’s Tribulus terrestris Testosterone Beweging

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23 Mei 2014

SARCOPENIA? KENT HIJ NIET!

LEVERFUNCTIE STEUNEN

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23 Mei 2014

LEVER DETOX

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23 Mei 2014

DE BALANS ZOEKEN…

Functies van verteringstelsel

Energetisch metabolisme en oxidatieve stress

Essentiële vetzuren

Intestinaal ecosysteem

Nutritionele en Functionele Geneeskunde

Leverontgifting

Metabolisme vetzuren koolhydraten-vettenmetabolisme

Methylatie

Immuniteit Ontsteking

Courtesy Prof. Castronovo

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23 Mei 2014

CONCLUSIE • Menopauze en penopauze kunnen meestal goed behandeld worden met de functionele geneeskunde. • In sommige gevallen is een hormonale suppletie echt nodig: onze voorkeur gaat dan naar de bio identieke hormonen (die kunnen gebruikt worden met orthomoleculaire suppletie) . • Een samenwerking met specialisten (gynaecoloog, uroloog) en regelmatige bloedtesten doen, is essentieel.

AAN TE RADEN !: • Het eerste boek in Nederland over hormoontherapie en antiaging geneeskunde • Prettig leesbaar • Veel tips • Leuke zelftesten • Test over uw potentiële levensduur • Wetenshappelijk onderbouwd

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23 Mei 2014

BEDANKT VOOR UW VOL GEHOUDEN AANDACHT !

DR. P. MUSARELLA, Anti-aging, orthomoleculair- en natuurarts [email protected]

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HormoonWellness - Dr. Rudy Proesmans

23 mei 2014

Schildklier Dr. Rudy Proesmans Orthomoleculaire geneeskunde

Anatomie

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23 mei 2014

Histologie

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23 mei 2014

Schildklierhormoon

Schildklierhormoon

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23 mei 2014

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23 mei 2014

T4-conversie in perifere weefsels naar T3, dit is het actieve schildklierhormoon

Deiodinase polymorfisme SNP of the deiodinase gene polymorphism in the D2 gene, Thr92Ala, is associated with reduced T4 to T3 activation in skeletal muscle and thyroid, linked to obesity and alterations in thyroid-pituitary feedback, and in responses to thyroid hormone treatment.

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23 mei 2014

T3-T4 A suggestive clue to the presence of this polymorphism could be a higher than normal free T4/free T3 ratio. Clinicians could consider adding T3 as a therapeutic trial in selected patients.

Wartofsky L. Combination L-T3 and L-T4 therapy for hypothyroidism. Curr Opin Endocrinol Diabetes Obes. 2013 Oct;

Welke nutriënten zijn belangrijk in de vorming van het actieve T3? Voor de vorming van thyroxine

Tyrosine Jodium Voor de omzetting van T4 naar T3 ( enzyme deiodinase)

Selenium Zink Ijzer Magnesium Vit B 12 (cortisol)

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23 mei 2014

MEDA-STIM Kan ingezet worden bij subklinische hypothyroïdie zonder bloed- en/of urinetesten

1-2 capsules voor de maaltijd Bevat jodium, selenium, zink en andere cofactoren die de aanmaak van T4 bevorderen en ook de omzetting naar T3 stimuleren

Wordt veel gecombineerd met GTA-Forte

GTA-Forte Schildklierconcentraat zonder thyroxine Bevat koper, zink en selenium Kan gebruikt worden bij patiënten die in theorie thyroxine nodig hebben maar dit niet verdragen (hartkloppingen, zweten, onrustig, opgejaagd, beklemmend gevoel in de halsstreek)

Heeft een regulerend effect, kan dus gebruikt worden bij hypo- en hyperfunctie van schildklier

1-2 caps. per dag op een lege maag

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23 mei 2014

Goïtrogenen Goïtrogenen zijn plantaardige stoffen (het isoflavone, genisteïne en isothyocyanaten) die het enzyme thyroid peroxidase kunnen blokkeren

Crucifere groenten zijn belangrijke bron van isothyocyanaten

Bij een normale inname en een normaal werkende schildklier zijn er geen problemen te verwachten

Sulforaphane (een isothyocyanate in broccoli) heeft een anticarcinogeen effect (CYT P450)

Goïtrogenen Broccoli, spruitjes, kool, bloemkool, boerenkool, koolrabi, mosterd, knolraap

Gierst Perziken Pinda’s Radijsjes Sojaboon en sojaproducten incl. Spinazie Aardbeien

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23 mei 2014

Functie van schildklierhormoon Schildklierhormoon reguleert de stofwisseling Elke cel bezit op de kernmembraan T3 receptoren Deze receptoren stimuleren de eiwitsynthese en energieproductie

Schildklierhormoon stimuleert de thermogenese Dit is één van de eerste symptomen van te traag werkende schildklier: ‘steeds koud hebben’

Hypothyroïdie Vermoeidheid, zelfs bij minimale lichamelijke inspanning. Spierzwakte

Gewichtstoename of moeite hebben met het verliezen van gewicht

Obstipatie, moeilijke trage vertering Hese stem, diepere stem of krakende stem Overgevoeligheid voor kou, kouwelijk Opzetten van gezicht (pafferig gezicht), gezwollen ogen en een droge, opgezette huid, dikke enkels (myxoedeem)

Algemene haaruitval (van hoofdhaar maar ook van de wenkbrauwen, buitenste rand)

Broos haar, breekbare nagels

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23 mei 2014

Langzame spraak Onregelmatige of zware menstruatie bij vrouwen Spierpijn en krampen (stijve, pijnlijke spieren en gewrichten met name in armen, benen, heupen en handen)

Depressie Apathie, lusteloosheid Geheugenverlies, concentratiestoornissen, vertraagd denken en vertraagde mentale activiteit

Emotionele labiliteit, depressie Verhoogd cholesterolgehalte in het bloed Libidoverlies, vruchtbaarheidsstoornissen Langzame hartslag

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23 mei 2014

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23 mei 2014

Oorzaken van hypothyroïdie primaire hypothyroïdie - een aandoening waardoor de schildklier zelf niet genoeg schildklierhormonen kan maken (thyroxine en tri-joodthyronine)

secundaire hypothyroïdie - een aandoening aan de hypofyse met verminderde productie van TSH

tertiaire hypothyroïdie - een aandoening aan de hypothalamus die te weinig TRH produceert (Thyrotropine releasing hormoon)

Oorzaken van hypothyroïdie Auto-immuunhypothyroïdie - het lichaam maakt antistoffen tegen de schildklier. Bijv. de ziekte van Hashimoto

Post-partum thyreoiditis. Een ontsteking aan de schildklier na de geboorte van een kind. Deze aandoening is meestal tijdelijk en over het algemeen zonder blijvende gevolgen.

Endemische hypothyroidie - een ernstig jodiumtekort, door te weinig jodium in de voeding, hetgeen kan leiden tot hypothyroïdie, struma -ook wel krop of goiter- genoemd.

Teveel aan jodium. Bijvoorbeeld in het geval er een contrastfoto is gemaakt of het te vaak en te veel innemen van jodium (jodiumhoudende farmaca).

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23 mei 2014

Congenitale hypothyroïdie - een aangeboren schildklierafwijking (erfelijke aanleg), hetgeen kan leiden tot cretinisme. Bij cretinisme is er sprake van een typisch gelaat, dwerggroei en (ernstige) geestelijke achterstand. Door jodiumtekort kwam dit vroeger vaker voor. De afwijking wordt door de hielprik binnen een week na de geboorte opgespoord. Door vroegtijdige toediening van schildklierhormoon kan de lichamelijke en geestelijke ontwikkeling redelijk normaal verlopen. Deze aangeboren aandoening is vrij zeldzaam (ca. 70 kinderen, d.w.z. 1 op de 3000 geboortes).

Hyperactiviteit bijnierschors (te veel cortisol productie)

Diagnose Klassieke test: TSH-bepaling in het serum Een grote populatie patiënten met subklinische hypothyroïdie wordt echter gemist als men alleen TSH als parameter gebruikt om de diagnose van hypothyroïdie te stellen

T4- en T3-bepaling in 24 uur urine correleert beter met de klinische symptomen

Behandel de patiënt en niet de labo uitslag!

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23 mei 2014

Basale lichaampstemperatuur Hoe meten? Gedurende 3 dagen na elkaar. Vrouwen die menstrueren op dag 3-4-5

Met een digitale thermometer In de oksel gemeten Geen infecties aanwezig Onmiddellijk bij het wakker worden, voor het opstaan < 36,4 is te laag

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23 mei 2014

Bijnieren hypofunctie Lage bloeddruk, lage hartslag Hypoglycemie Gewrichtsklachten Recidiverende infecties Erg uitgeput na een lichte inspanning Niet op dreef komen in de morgen Geen stresstolerantie

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23 mei 2014

Behandeling: jodium Werelwijd tekorten aan jodium voor een optimale werking van de schildklier

In 2002 had 2 miljard van de wereldpopulatie een jodiumtekort Dagelijkse behoefte is min. 150µg. Zwangeren en vrouwen die borstvoeding geven min. 250 µg

Onze voeding levert maar +/- 50-70 µg , Optimaal 0,3 -0,5 mg !! Bron van jodium: vis en zeewier Samen met vit. D het meest voorkomend tekort, suppletie is voor iedereen aangewezen

Angst voor jodiumtoxiciteit is ongegrond. Een teveel wordt via de nieren uitgescheiden

Minimaal- optimaal www.jodiumtekort.nl

Iodine deficiency and the foetus Iodine requirements are increased ≥ 50% during pregnancy.

Miscarriage Stillbirths Congenital anomalies-cretinism Brain Damage-mental retardation

Increased perinatal morbidity d mortality

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23 mei 2014

Zimmermann MB. The effects of iodine deficiency in pregnancy and infancy. Paediatr Perinat Epidemiol. 2012 Jul

.... Two meta-analyses have estimated that iodinedeficient populations experience a mean reduction in IQ of 12-13.5 points.

Iodine deficiency and the neonatus Endemic cretinism Neonatal Goiter Neonatal hypothyrodism Endemic mental retardation

Effect of inadequate iodine status in UK pregnant women on

Cognitive outcomes in their children: results from the Avon

Longitudinal Study of Parents and Children (ALSPAC)

Bath ea

Lancet , 2013

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23 mei 2014

Iodine deficiency and the adolescent Goiter (Subclinical) Hypothyroidism School performance and IQ impaired Retarded growth, hearing, speech ADHD

Taylor PN, et al. Therapy of endocrine disease: Impact of iodine supplementation in mild-to-moderate iodine deficiency: systematic review and meta-analysis. Eur J Endocrinol. 2013 Nov 22;

Iodine supplementation improves some maternal thyroid indices and may benefit aspects of cognitive function in school-age children, even in marginally iodine-deficient areas

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23 mei 2014

Iodine deficiency WHO: iodine deficiency is the most important ‘single cause’ of mental retardation which is preventable.

WHO: 300.000.000 school age children are iodine deficient

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23 mei 2014

This pyramid illustrates the fact that the visible effects of IDD (cretinism) account for only as much as 10% of the ramifications. At least 90% of IDD consequences remain hidden.

Jodiumtekort WHO; jodium deficiëntie is de belangrijkste ‘single cause’ van mentale retardatie die voorkoombaar is

WHO: 300.000.000 schoolgaande kinderen zijn jodium deficiënt

Jodiumtekort is medeoorzaak van aderverkalking Risico sterfte door CAD is 3,5 maal hoger bij personen met een goiter

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23 mei 2014

Jodium intake via brood Ann Endocrinol (Paris). 2011 Apr;72(2):158-61. Epub 2011 Apr 21. Optimization of iodine intake in Belgium. Moreno-Reyes R, Van Oyen H, Vandevijvere S.

Mild iodine deficiency (MID) is a long-standing problem in Belgium and was recognized only recently as public health issue by the Ministry of Health (MOH). The main MID-related health problems in Belgium are a high prevalence of thyroid nodules and multinodular goiter. The economic cost of thyroid nodular disease only in Belgium was estimated at about €40 millions per year. The Belgian health authorities adopted a selective strategy to optimize iodine intake through the fortification of bread with iodized salt.

75% van de Belgen hebben een mild tot ernstig jodiumtekort!!

Jodium Biofactors. 2003;19(3-4):121-30. Role of iodine in antioxidant defence in thyroid and breast disease. Smyth PP.

“the Japanese experience may indicate a protective effect against breast cancer for an iodine rich seaweed containing diet”.

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23 mei 2014

Jodium Een duidelijk verband tussen lage inname van jodium en het voorkomen van borstkanker

Inname jodium van Japanse vrouwen is 25 x hoger dan van westerse vrouwen Funahashi H, et al. Seaweed prevents breast cancer? Jpn J Cancer Res. 2001 May;92(5):483-7.

Aceves C, Anguiano B, Delgado G. Is iodine a gatekeeper of the integrity of the mammary gland? J Mammary Gland Biol Neoplasia. 2005 Apr;10(2):18996.

Jodiumtekort Suboptimale mentale ontwikkeling ADD, autisme (Zimmerman, 2009) Jodiumtekort tijdens zwangerschap verhoogt het risico op ADHD bij het kind op latere leeftijd

Cholesterolprofiel bij kinderen verbetert na jodiumsuppletie (Zhao, 2010)

Jodium is een anti-oxidant, bij een tekort vermindert de afweer tegen bacteriën en virussen

Infertilitieit (Stewart, 1991) Verhoogd risico op borst-, prostaat-, endometrium-, ovarium- en andere kankers

Cysten in borsten, ovaria

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23 mei 2014

Jodium Onder invloed van UVB wordt vit. D aangemaakt in de huid

Onderzoek bij Surfers in Hawaiï (Binkley, 2007) toont aan dat ondanks een overvloed aan zon er toch tekorten zijn

UvB oxidatieve stress te weinig vit. C en jodium verminderde aanmaak van vit. D

Jodiumdruppels 1 druppel = 75 microgr jodium Kinderen: 5 dr. (Jodium zeer belangrijk voor een optimale cerebrale ontwikkeling!)

Volwassenen: 5 - 10 dr. In principe heeft iedereen een jodiumtekort, behalve diegene die dagelijks zeewier eet

Bij Japanners is de jodium intake 25 maal hoger Bij personen met een goiter moet je langzaam opbouwen, nodulen in schildklier gaan soms teveel T4 aanmaken en dan krijg je een hyperthyroïdie

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23 mei 2014

Jodiumdruppels Bij infecties: rhinitis, sinusitis, luchtweginfecties Dosering: 3 x 30 druppels ged. max. 10 dagen Bij cysten in borsten (cystische mammopathie), cysten ovaria

Dosering: 30 dr. per dag Lugol druppels: 1 druppel = 6 mg jodium + jood (jodine + jodide ), 2 x per week, 2 dr., in de preventie van borstkanker

Breast J. 2004 Jul-Aug;10(4):328-36. The effect of supraphysiologic levels of iodine on patients with cyclic mastalgia. Kessler JH

111 patients; 4 groups . Placebo, 1,5 mg iodine, 3 mg iodine en 6 mg iodine

After 3 months significant reduction in pain in the group with 3 and 6 mg, not in the 1,5 mg group and placebo

6 mg group : > 50 % pain reduction No side effects

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23 mei 2014

Broom Jodium, chloor en broom zijn halogenen Broom gaat in competitie met jodium op moleculair niveau en zo vermindert de werking van jodium

Er is dus veel meer jodium nodig (tot 12 mg per dag!) om broom en chloor uit het lichaam te elimineren en de plaats in te nemen op moleculair niveau van broom (en Cl)

Haarverzorgingsmiddelen, vooral die moeten zorgen voor een sterke fixatie bevatten veelal broom. In vlamvertragers, waardoor het toegepast wordt in allerlei materialen die we in huis kunnen hebben, zoals vinyl behang, vloerbedekking, in matrassen, etc. Geneesmiddelen die broom bevatten, Bisolvon (een slijmoplosser), Impromen (een antipsychoticum), Parlodel (Parkinson)

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23 mei 2014

Schildklierpreparaten zonder T3 en/of T4 GTA (schildklierconcentraat 10 mg + selenium 10 mcg) 1-2 nuchter GTA-Forte ( schildkl. Conc. 40 mg + Cu 2 mg + zink 20 mg+ selen 52 mcg)

1-2 nuchter Meda-Stim (bevat geen schildklierextract maar nutriënten ter ondersteuning van schildklier en bijnieren) gebruiken bij hypothyroïdie t.g.v. hyperactiviteit van bijnieren

1-2 nuchter

Schildklierpreparaat zonder T3 en/of T4 Thyrotabs Bevat nutriënten voor optimale functie van schildklier Glandulars van hypofyse en hypothalamus die ook de werking van schildklier reguleren

Bevat jodium en tyrosine voor aanmaak van thyroxine Bevat selenium, koper, mangaan, magnesium

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23 mei 2014

Thyroxine preparaten Thyroxine- Elthyrone (T4) Novothyral (T4 + T3) Armour Thyroid , Thyroid erfa (T4 + T3, uit gestandaardiseerd varkensschildklier extract)

Ijzer Bij een normale jodium concentratie in het bloed kan men toch een verminderde T4 productie hebben door verminderde functie van het thyroidperoxidase door ijzertekort

Das S, Bhansali A, Dutta P, Aggarwal A, Bansal MP, Garg D, Ravikiran M, Walia R, Upreti V, Ramakrishnan S, Sachdeva N, Bhadada SK. Persistence of goitre in the post-iodization phase: micronutrient deficiency or thyroid autoimmunity? Indian J Med Res. 2011 Jan;133:103-9.

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23 mei 2014

Hyperthyroïdie Warmte-intolerantie (het heel snel warm hebben) Gewichtsverlies (ondanks normale voedselinname) Overmatige transpiratie Gejaagd gevoel Tachycardie (snelle hartslag van soms meer dan 100 slagen per minuut) Tremor (trillen van meestal de vingers, handen) Diarree Ontregelde menstruatiecyclus Hartritmestoornissen - heel zelden Vermoeidheid Spierzwakte Oogklachten (scheelzien, verandering van de gezichtsscherpte, exoftalmie)

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23 mei 2014

Graves exophthalmie Bouzas EA, Karadimas P, Mastorakos G, Koutras DA. Antioxidant agents in the treatment of Graves' ophthalmopathy. Am J Ophthalmol. 2000 May;129(5):618-22.

Niacinamide 300 mg/d + allopurinal 300 mg/d 82% positief resultaat t.o.v. 27% in placebogroep

Oorzaken hyperthyroïdie Ziekte van Graves, autoimmuunproces waarbij het lichaam antistoffen aanmaakt tegen de TSH-receptoren van de schildklier. Het gevolg is een enorme stimulatie van de aanmaak van schildklierhormoon.

Goedaardige tumor in de schildklier (Toxisch adenoom). Een solitaire tumor in de schildklier kan resulteren in een verstoorde aanmaak van schildklierhormoon.

Meerdere goedaardige tumoren in de schildklier (Toxisch multinodulair struma)

Thyreoïditis (ziekte van Hashimoto), door een (virus)infectie of een auto-immuunproces ontstaat een ontsteking van het schildklierweefsel. De al geproduceerde en opgeslagen schildklierhormonen komen vrij, wat resulteert in een hyperthyroïdie. Na een korte hyperthyreotische fase zal de ontsteking resulteren in een mindere werking van de schildklier Hypothyroïdie

Adenoom in de hypofyse. TSH producerende cellen stimuleren overmatig de schildklier.

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23 mei 2014

Bloedtesten T3 + T4 TSH TPO antistoffen (Hashimoto, Graves) Thyroid stimulating immunoglobulin (TSI): Immunoglobulin G (IgG) that can bind to thyrotropin (TSH) receptors on the thyroid gland. TSIs mimic the action of TSH, causing excess secretion of thyroxine and triiodothyronine. Verhoogd bij Graves.

Behandeling Acute behandeling Strumazol (propylthiouracil) blokkeert thyroidperoxidase enzyme

Radioactief jodium Cave radioactief jodium: verhoogd risico op kanker Metso S, Auvinen A, Huhtala H, Salmi J, Oksala H, Jaatinen P. Increased cancer incidence after radioiodine treatment for hyperthyroidism. Cancer. 2007

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23 mei 2014

Complementaire behandeling Hoge dosis jodium SSKI (Saturated Solution of Kalium Iodide): 2 x 10 dr. ged. 1 wk , 2 x 5 dr., 1 week en dan 5 dr. ged. enkele weken, afbouwen i.f.v. respons

1 dr. SSKI = 35 mg jodium Wolff-Chaikoff effect: hoge dosis jodium blokkeert aanmaak van T4 ( bijv. amiodarone, Cordarone)

Na 10 dagen onstaat een ‘escape’ fenomeen Jod-Basedow effect: hyperthyroïdie na toediening van jodium bij patiënten die een goiter hebben

Complementaire behandeling

Lithium geeft een suppressie van T4 productie Lithium veroorzaakt een goiter en hypothyroïdie bij patiënten die behandeld worden voor manischdepressieve psychosen met lithium in hoge dosis (lithiumcarbonaat 400-1200 mg per dag)

Lithiumcarbonaat 300 mg/dag

Lazarus JH. Lithium and thyroid. Best Pract Res Clin Endocrinol Metab. 2009 Dec;23(6):723-33

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23 mei 2014

Lithium: een essentieel element Het kan helpen bij alcoholverslaafden die steeds hervallen, beschermt hersencellen tegen toxisch effect van alcohol

Bij recidiverende herpes In combinatie met zink tegen wratten Beschermt de hersencellen tegen toxische stoffen en aftakeling

Stimuleert de vorming van nieuwe bloedvaten na een herseninfarct

Lithium is neuroprotectief !

42 Engel T, Lithium, a potential protective drug in Alzheimer's disease. Neurodegener Dis. 2008;5(3-4):247-9.

Zhong J, Lee WH, Lithium: a novel treatment for Alzheimer's disease? Expert Opin Drug Saf. 2007 Jul;6(4):375-83

43 Schrauzer GN, Shrestha KP, Lithium in drinking water and the incidences of crimes, suicides, and arrests related to drug addictions. Biol Trace Elem Res. 1990 May;25(2):105-13

44 Feng HL et al. Combined lithium and valproate treatment delays disease onset, reduces neurological deficits and prolongs survival in an amyotrophic lateral sclerosis mouse model. Neuroscience. 2008 Aug 26;155

45 Guo S, Arai K, Stins MF, Chuang DM, Lo EH. Lithium Upregulates Vascular Endothelial Growth Factor in Brain Endothelial Cells and Astrocytes. Stroke. 2008 Oct 30.

Chiu CT, Chuang DM. Neuroprotective action of lithium in disorders of the central nervous system. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2011 Jun;36(6):461-76

Luo J. Lithium-mediated protection against ethanol neurotoxicity. Front Neurosci. 2010 Jun 28;4:41

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23 mei 2014

Lithium: een essentieel element

Li-Zyme Forte (0,150 mg Li): als anti-aging, neuroprotectie , 3 t per dag

Lithiumorotaat 100 mg = 4 mg elementair lithium Lithiumcarbonaat 100 mg = 19 mg elementair lithium

Noot: omega 3 voorkomen de nevenwerkingen van lithium

Geef steeds bij Lithiumtherapie Biomega-3, 2-4 caps/dag

Mol Med Rep. 2012 Mar Effects of lithium on oxidative stress parameters in healthy subjects. Khairova R et all

….This reduction in the SOD/CAT ratio may lead to lower OxS, indicated primarily by a decrease in the concentration of cell hydrogen peroxide. Overall, the present findings indicate a potential role for the antioxidant effects of lithium in healthy subjects, supporting its neuroprotective profile in bipolar disorder (BD) and, possibly, in neurodegenerative processes.

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23 mei 2014

Complementaire Behandeling Lycopus europaeus MT 3 x 30 dr. Beer AM, Wiebelitz KR, Schmidt-Gayk H. Lycopus europaeus (Gypsywort): effects on the thyroidal parameters and symptoms associated with thyroid function. Phytomedicine. 2008 Jan;15(1-2):16-22.

GTA-Forte 2 x 1/dag

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23 mei 2014

Gluten en auto-immuunaandoeningen Er is frequent een correlatie te vinden tussen Hashimoto hyperthyroïdie en glutenallergie (coeliakie) en glutenintolerantie

Start een glutenvrij dieet gedurende 3 maanden en evalueer resultaat

Glutenintolerantie, diabetes type 1 en auto-immuun thyroïditis komen frequent samen voor

Hadithi M, et al. Coeliac disease in Dutch patients with Hashimoto's thyroiditis and vice versa. World J Gastroenterol. 2007 Mar 21

Fröhlich-Reiterer EE, et al. Screening frequency for celiac disease and autoimmune thyroiditis in children and adolescents with type 1 diabetes mellitus--data from a German/Austrian multicentre survey. Pediatr Diabetes. 2008 Dec;9(6):546-53.

James Braly MD. ‘Dangerous grains: Why Gluten Cereal Grains May Be Hazardous To Your Health

Vitamine D en auto-immuun thyroïditis

Vitamine D tekort is duidelijk gerelateerd aan autoimmuunaandoeningen

Hoe lager vitamine D, hoe hoger risico voor anti-TPO Bio-D-Mulsion 10 dr./dag Vitamine D concentratie bloed > 40 ng/ml bloed

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23 mei 2014

Casus Vrouw 42 jaar Steeds moe, koude gevoel, snel infecties in de winter Slaapt voldoende, na een dagtaak steeds uitgeput, weekend nodig om te recupereren

Bloedonderzoek bij huisarts normaal (TSH 2,2) Start Tyrosine 500 mg, 2 nuchter + jodium 10 dr. + Bio-DMulsion 10 dr. (vet!) + GTA-Forte 2 caps. nuchter

Na 3 maanden evaluatie: minder koud, minder vermoeid, algemeen meer energie

Na 1 jaar: toestand blijft goed, veel minder infecties die sneller genezen

Onderhoudsbehandeling: L-Tyrosine 1 caps. + Jodium 10 dr. + GTA 1 caps. + Bio-D-Mulsion 10 dr.

Take home message Behandel de patiënt, niet de labo uitslag Jodium wereldwijd tekort Lithium is neuroprotectief Gluten bij auto-immuunaandoeningen High risk breast cancer: jodium 2-3 x/ week 12 mg (+ vit D 5000 iu)

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HormoonWellness - Dr. Thierry Hertoghe 23 mei 2014

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