Ask Dr. Pam
Dear Dr. Pam: Why are you so opposed to natural HRT? I had my hormones tested and my levels showed that I need it, and I'm feeling better since I started taking it.
I have several issues with any form of HRT. First, the body was designed to produce all of the hormones needed for health throughout a human being's entire life cycle. If this production is impaired or abnormal, the cause should be identified and resolved so that the body returns to normal function. HRT does not do this - it simply masks the symptoms of abnormal hormone production, which inevitably leads to the development of other, and sometimes more serious, health issues such as breast cancer.
Another issue is the unsubstantiated claim that bio-identical hormones are safe and therefore can be taken instead of pharmaceutical HRT without worry. This is simply not true. Bio-identical hormones are assumed to be safe, but the reality is that we do not know if they are. We don't have research proving safety, so the result is that women who are taking these hormones are essentially human guinea pigs.
Of equal importance is the issue of testing to determine hormone levels and supplementation needs, which is unreliable. There are three methods of testing hormone levels - blood, saliva and urine. One of the limitations of blood tests is that they represent a brief moment in time, while hormone levels fluctuate throughout the day. Blood tests measuring hormone levels do not show whether the reported levels are a peak, a valley, or someplace in between.
Saliva tests are also limited by the fact that they measure only a moment in time. But they are further limited because saliva testing is affected by eating, drinking, and even brushing the teeth. For example, testosterone levels are generally slightly higher for one hour after brushing your teeth.
Urine tests are not much better - they also represent a snapshot in time, and complicated by the fact that there are many forms of assay which tend to produce different results. The particular lab to which a sample is sent can influence findings significantly.
There are even more issues associated with testing the response to supplementation with HRT. For example, the use of transdermal progesterone has very little impact on serum levels, even though many studies have shown that progesterone administered in this way does reach the tissues of the body and act on those tissues. This can lead to extremely high and sometimes dangerous levels of progesterone supplementation in an attempt to raise serum levels. This is another example of the futility of testing hormone levels in the general population.
By the way, studies reporting that transdermal progesterone has a positive effect on physiology show that the effect is due to opposing high estrogen levels, which is why patients experience relief from symptoms like hot flashes. Abnormally high estrogen levels present significant health risks to women, including increased risk of breast and ovarian cancer. Decreasing estrogen levels should be the goal of treatment, not masking the symptoms of these high levels with progesterone.
The benefits of HRT are almost instantaneous symptom suppression. This is attractive to people who are seeking magical solutions to complex problems. But this approach ignores common sense - when something is wrong, determine the cause and fix it. Don't confuse feeling better with getting better.
Dear Dr. Pam: What do you do if your vitamin D levels are low and it is winter time? Just wait for sun? Take supplements?
Vitamin D has become a big business - some health professionals test almost all patients and claim that low vitamin D levels are the cause of almost all diseases and conditions and that supplementation with D can help to resolve them. The definition of adequate vitamin D levels has changed over the last several years with some health advisors recommending targets of 75-100 ng.mL.
Here is my advice on how to respond to blood test results for vitamin D levels. "Normal" vitamin D levels, according to the Institute of Medicine, are 20-30 ng/mL. Most people fall within this range, and are able to achieve these levels with sunlight exposure
If your blood test shows that you are slightly lower than the reference ranges, this does not mean that you need treatment. Reference ranges are the averages for lots of people who are similar to you (age range and sex) who were tested. About 5% of all people test outside the reference ranges, and this does not necessarily mean that they are sick and require treatment.
Sunlight exposure is the best way to produce vitamin D - human beings were designed to produce vitamin D in this way, not to take it orally via fortified foods or supplementation. The body stores vitamin D for use in the winter, so do not be concerned if you live in a northern climate like I do and don't have access to the sun for 4-5 months per year.
The Institute of Medicine states that supplementation with vitamin D is risky, and that there are few benefits. Lower vitamin D status is observed in many people who have degenerative diseases, but a recent meta analysis of several hundred studies concluded that this is most likely a result of disease conditions, not the cause of them and supplementation has not been proven to improve health.
If your vitamin D levels are low now, you should do several things. If you are overweight, lose weight. And if you have a chronic degenerative condition (type 2 diabetes, arthritis, coronary artery disease, etc.) get some advice from a competent practitioner about how to resolve it. Chronic inflammation, which results from being overweight and sick, results in lower vitamin D levels. Spring will be here soon and you'll be able to spend some time in the sun in order to increase your levels.
There are some people who benefit from vitamin D supplementation - elderly patients with no access to sun and patients with kidney failure, for example. But most people should not supplement.
Vitamin D testing has been added to my list of disease mongering practices that turn healthy people into sick patients. The easiest way to avoid all of this grief is not to consent to the test in the first place.
Autier P, Boniol M, Pizot C, Mullie P. "Vitamin D status and ill health: a systematic review." Lancet Diabetes and Endocrinology Jan 2014;2(1):76-89 doi:10.1016/S2213-8587(13)70165-7