From: Guy R. Schenker, D.C. March, 2001 Dear Doctor, Why did you need four consecutive issues of this Letter devoted to bashing estrogen? Quite simply, because one of the most powerful clinical techniques you can use to benefit many of your most difficult patients is to simply get them off estrogen. Our goal has been to help you succeed in delivering the very best health care to your patients. In all the hundreds of problem cases we review for you and other NUTRI-SPEC Doctors each year, the single most common reason for a patient's resistance to correction with NUTRI-SPEC is an excess of the catabolic stress hormone estrogen. During our discussion of estrogen we referred many times to the essentiality of maintaining hormone balance in your patients. We talked about the important roles played by other hormones -- progesterone, testosterone, pregnenolone and DHEA. The levels of all five of these hormones peak during women's and men's early thirties. From that point the hormone levels begin a steady decline. In this Letter we are going to give you useful information on how to clinically use these very valuable hormones as an adjunct to your NUTRI-SPEC supplements. The most fundamental hormone imbalance that you encounter in your clinic is the one that troubles most women through most of their lives. That is the imbalanced ratio between estrogen and progesterone. The truth is, that due largely to excess dietary intake of vegetable oils and refined carbohydrates, along with inadequate intake of trace minerals through childhood, most females suffer the effects of this imbalance right from the first day of puberty. After nearly three decades of suffering with anxiety, mood swings, food cravings, fluid retention, and all the physical and emotional symptoms associated with premenstrual syndrome that result from this excess estrogen to progesterone ratio, most women stumble into their mid forties and then totally collapse. At this age, progesterone (in a women who is metabolically imbalanced and nutritionally depleted) drops precipitously, which makes this already abnormal ratio far worse. (Testosterone, pregnenolone, and DHEA also tend to drop at the same time.) As this physically and emotionally collapsing woman frantically looks for help, you want to be there. You certainly want to be there before she gets to the Prozac doctor. Natural progesterone is the key to saving some semblance of normal life for the typical "female, fat, forties" syndrome. There are several effective ways to address this high estrogen to progesterone ratio, and the procedure you choose for each patient depends mainly on her age. Here are the guidelines to follow. First, consider your female patients that are under 40 years old. If they show all the signs and symptoms of excess estrogen to progesterone, then ask yourself what metabolic imbalances do they have? If they have electrolyte stress, electrolyte insufficiency, or dysaerobic imbalances, consider them deficient in progesterone. If this woman under forty shows an anaerobic, ketogenic, or parasympathetic imbalance, then consider her primary problem excess estrogen. If the woman tests glucogenic, then she can easily have progesterone insufficiency and excess estrogen. If you have chosen excess estrogen as the primary problem in a particular patient under 40 years of age, then your clinical procedure is quite simple. All you need do, as an adjunct to NUTRI-SPEC supplements and dietary recommendations, is give the woman Calcium D-Glucarate. You will begin with 3,2X daily. Depending on the severity and persistence of symptoms, you can then, after one bottle, usually reduce to 2, 2X daily, and then on the third bottle reduce to 1, 2X daily. Thus, at the end of about three months (three hormonal cycles) she will have not only achieved NUTRI-SPEC metabolic balancing, but been relieved of one of the major hormonal stressors that was causing/caused by her metabolic imbalances. Along with the objective improvement you will see in her NUTRI-SPEC test patterns, she will have experienced very nice improvement in estrogen-related symptoms. If your under age 40 female patient appears to have progesterone insufficiency as the primary contributor to her hormonal imbalance, then you may want to consider several ways of boosting her progesterone. One way is with the use of pregnenolone. The nice thing about pregnenolone is that much of it is converted immediately into the all-important progesterone. The problem with pregnenolone is that some of it is diverted into the production of DHEA, and subsequently to estrogen and testosterone. This can be either helpful or harmful, depending on the individual patient. For this reason we limit the dose of pregnenolone in woman under 40 to a maximum of 50 milligrams daily. Another approach to your progesterone insufficient patients under 40 is to use a progesterone cream. This can be a nuisance for the patient, and presents a challenge for you, the doctor, since the absorption and utilization of progesterone cream is very difficult to monitor and regulate. It is important to administer progesterone such that you match the woman's natural hormone production. Progesterone is principally produced from day 12 to day 26 of a woman's cycle. This, then, is the ideal time to give progesterone. The problem with the creams, however, is that they are absorbed through the skin and stored in the subcutaneous fatty tissue and released slowly into the blood stream from there. Thus, when a woman uses the cream on day 12 through 26, and then stops on the 27th day, that does not mean that no progesterone enters her blood stream on day 27. In fact, essentially the same amount will enter her blood stream on day 27 as did on day 26, as it is coming out of the quantity that was stored in the subcutaneous fat. I have a proposed protocol which may make progesterone creams clinically useful without making a mess of the woman's endogenous hormone production cycle. Here is what I suggest: Have the woman use a small amount of progesterone cream on day 12 through 26 of her first month; on the second month use that amount daily on day 12 through 25; in month three on day 12 through 24; on the next month, day 12 through 23; and so on until she uses it on day 12 only in the 15th month. This will give the woman a little surge of progesterone on day 12 -- which is very desirable -- but will not build up a huge back-log of progesterone in the subcutaneous tissues that is released continuously in a steady state (which is non-physiological) manner. I have not used this protocol clinically in my own practice, simply because I don't like dealing with the progesterone creams. But for those of you who want to use them I suggest you do it this way to avoid the obvious progesterone overload that I have seen in countless patients who take it on day 12 through 26, month after month after month in an attempt to duplicate their own cycle, when actually they are just building up a tremendous reservoir of progesterone which leaks into the blood every day of the cycle. If you have experience using progesterone cream day 12 through 26 as recommended by the distributors of the product, and you switch to the protocol I am recommending -- I would love to have your feedback on how much improvement you see. By the way, just because a woman appears to have low progesterone, and you are working to boost her progesterone level, does not mean you cannot also use Calcium D-Glucarate, especially for the first month or two, to achieve the normal estrogen to progesterone ratio faster. Let us move on now to your women who are in their forties. Pretty much the same rules apply to these women that applied to women under 40 in terms of determining what their primary need is. However, a higher percentage of these women will need a progesterone boost along with the Calcium D-Glucarate. The only change in your clinical approach to women in their forties compared to women under forty is that you can be a little more at ease with the use of pregnenolone. In most of these cases the pregenenolone will work beautifully in boosting the progesterone levels while at the same time the little bit of extra DHEA, testosterone, and estrogen that you get is beneficial as well. Start your pregnenolone supplementation with these women at 50 milligrams a day but don't hesitate to increase it to 100 or even 150 in divided doses. Also -- don't over look the thyroid in these women. If you use the Calcium D-Glucarate and pregnenolone and/or progesterone and the woman continues to show a persistent low body temperature and slow first pulse, then she very likely has, in addition to her estrogen/ progesterone problem, a T3 insufficiency. A prescription for a very small dose of natural thyroid or of a sustained release T3 may be essential -- but don't even pursue this option until after you have gone as far as you can go with NUTRI-SPEC metabolic balancing and the Calcium D-Glucarate and the pregnenolone or progesterone. Next, consider the women in their fifties. Now menopause is either about to happen or is happening or has recently happened. Your analysis here is the same as for younger women. Your difference in therapeutic approach is that now you will tend not to use Calcium D-Glucarate as much, and, you will now add DHEA to your adjuncts to NUTRI-SPEC metabolic balancing. In these women you will always begin with pregnenolone since it will be converted largely to progesterone, and, you will almost always get an additional benefit from the degree to which the pregnenolone is converted into DHEA, and then into testosterone and estrogen. If the pregnenolone gives you your desired clinical response, then that is all there is to it. If it helps, but does not have quite the clinical impact you are looking for, then it is time to consider adding DHEA. DHEA has a powerful effect on many women at this age, particularly those who persistently test anaerobic. Do not, however, use DHEA if a woman has shown any tendency to be dysaerobic. When there are obvious declining estrogen symptoms such as hot flashes and vaginal dryness, DHEA (when given in addition to pregnenolone) can often be converted into adequate estrogen. DHEA has the additional advantage of being converted into testosterone, which is particularly important for women of all ages. (Testosterone is as important for women as it is for men. It is never present in the same high quantities as it is in men, but qualitatively it is every bit as important to maintain libido, skin tone, muscle tone, and bone density.) Since we are on the subject of DHEA, let us digress a bit here and give you a summary of the effective way to use it (and not abuse it) for both men and women. DHEA is a fascinating hormone, but one which is difficult to work with because it affects different people differently. It has a different effect on women than it does on men. It has a different effect on people over 50 years old than it has on younger people. DHEA supplementation for women will actually increase the levels of sex hormones -- testosterone, estrogen, and progesterone. Associated with these hormone increases the woman feels an increased vitality level, a sense of well-being, and usually an increase in libido. These affects are pronounced in women after menopause. They occur only sporadically in younger women. In men, DHEA supplementation does not have any impact whatsoever on their levels of testosterone or any other hormone. Nevertheless, for some unexplained reason, older men also experience an increase in vitality, a sense of well-being, and an increase in libido -- the same as the women do, even though there is no actual increase in downstream hormone levels. Younger men rarely experience any significant change from taking DHEA. Furthermore, DHEA has never been shown in any study to increase muscle mass, nor to increase the anabolic response to exercise, nor to accelerate fat burning -- all the claims made by the advertising hype. Thus, it is not likely that bodybuilders and other athletes have benefited in any way from taking DHEA. It is conceivable that they may actually be harmed in that the DHEA could inhibit their own natural production of anabolic hormones. Indiscriminate use of DHEA can get you into real trouble. One of the problems with DHEA is that it opposes cortisol in many ways. Now, we know that cortisol is a stress hormone that in excess can cause major problems. But, there are also beneficial effects from cortisol, in physiological quantities, and there are many people who suffer from a deficiency of cortisol. This is particularly true of your dysaerobic patients. Most of your auto-immune diseases that are characterized by inflammatory reactions out of control are associated with a dysaerobic imbalance. This applies to rheumatoid arthritis, lupus, scleraderma, and many other auto-immune type conditions. When you have a patient who tests dysaerobic, under no circumstances give DHEA. If you have a patient who has any of the typically dysaerobic auto-immune conditions, do not under any circumstances give DHEA. If you have a patient who has had any clinical condition for which they have responded favorably from a prescription for prednisone, do not give DHEA. The other major problem with DHEA is that so much of it can be converted into estrogen. We have just spent four months explaining to you in great depth how damaging excess estrogen can be to both men and women of any age. The last thing you want to do is complicate a patient's clinical picture by inadvertently increasing estrogen levels with DHEA. For that reason, I make it a rule in my practice never to give DHEA to any patient, man or woman, who is under 45 years of age. I generally reserve it for patients above 50. Now, finally, consider your women patients age 60 or above. For these cases you can follow the same line of reasoning -- using pregnenolone between 50 and 150 milligrams daily, and in these cases you can almost always (unless the patient tests as dysaerobic) use DHEA right from the start. The best way to use these is to give the DHEA (30-50 mg.) at breakfast time and the pregnenolone spread in two or three doses throughout the day. What about your male patients? Estrogen stress is a very common problem here, but in men it often self-corrects when you correct the NUTRI-SPEC metabolic imbalances. Only rarely will you need to use Calcium D-Glucarate. When you do, you can start with a much smaller dose, only 1-2 twice daily. The key in most of these male patients is to get strict adherence to the Prostaglandin Dietary recommendations to help control their estrogen stress symptoms while you work to achieve NUTRI-SPEC metabolic balancing. The use of DHEA in male patients follows the same rules given above. Again, never consider giving DHEA to a man under 45 years old. The only exception to this might be a man who persistently tests both electrolyte insufficient and anaerobic -- but be cautious, because if the DHEA is converted into estrogen the man will get worse, both symptomatically and objectively. Pregnenolone can be helpful in some men over age 40 who are persistently either ketogenic, glucogenic, parasympathetic or dysaerobic. DHEA is an option for men over 45 who are persistently anaerobic. Use these hormones, but use them intelligently and responsibly. And remember -- they will never give the results you expect unless you also give the patient a solid nutritional foundation with NUTRI-SPEC. Sincerely, Guy R Schenker, D.C.