As Functional Medicine Physician Dr. Pamela Smith likes to stress, there are three things that we should strive to maintain as we age—-Vision, Memory, and Mobility. So what is the hands down, undisputed, most effective way to hold on to all three as we mature? EXERCISE !!!
Let’s look at vision for a minute.
Almost all of us will have some evidence of cataract formation after the age of 65, with both the incidence and severity increasing with age. By the age of 80, the majority of people will either have cataracts that are visually symptomatic or have already had cataract surgery.
Age related Macular Degeneration is the leading cause of irreversible vision loss in older Americans.
Can regular physical exercise really help you to avoid these conditions and maintain your vision? Absolutely.
A study of 41,000 runners over 7 years found that these men and women had significantly lower rates of these two diseases than the general public. In addition, the higher the level of physical activity, the greater the effect.
A study from the University of Wisconsin followed 4000 men and women over 15 years and monitored visual health and level of exercise. They found that those with an active lifestyle were 70% less likely to develop degenerative eye diseases than those with a sedentary lifestyle. Regular walkers were 30% less likely to develop disease.
A third study found that those people who exercised the most had a 54% lower risk of developing Macular Degeneration when compared to those who exercised the least. When exercise was combined with healthy eating habits in non-smokers the risk was reduced by 71%.
This is about more than just maintaining our vision. With good vision there is a positive effect on our memory and long term mental functioning. With good vision we are able to read, see what is going on around us, and it allows us to be more mentally and socially engaged in our lives. It also has a positive effect on fitness, as we are less likely to get out and walk or engage in other forms of exercise if we can’t see well.
So if you needed one more reason to kick your activity level up a notch–here it is.
This winter has certainly been an odd one. Imagine–over 50 degrees, sunny, and no snow on the ground in Minnesota on January 10th. Two of my patients were going out golfing just to say that they had played in Minnesota in mid-January. Today I watched many people walking outside my office enjoying the weather, and I myself noticed a little lift in my mood being outside for the few minutes that I managed to squeeze in. Despite this, we are still in the time of year when many of our Vitamin D levels are beginning to drop to symptomatic levels. It is likely a bit less noticeable with the nice weather we have been having, but nonetheless, it is still happening. As I have mentioned before Vitamin D is very important for many reasons, not the least of which is mood support.
A study published in the November 2011 edition of Mayo Clinical Proceedings monitored 12,594 men and women between 2006 and 2010. In this study they found a significant association between higher Vitamin D levels and a decreased risk of depressive symptoms, especially among those with a history of depression.
All the more reason to make sure that you know what your Vitamin D level is during the months, when exposed skin is more likely to freeze rather than tan.
A study published in December 2011 in the Journal of Clinical Endocrinology and Metabolism examined testosterone level and its association with loss of lean body mass and lower extremity function in 1183 men 65 years and older.
Researchers found that men with higher baseline testosterone levels lost less lean body mass, and had a slower decline in lower extremity strength over time.
They state in their conclusion that “Endogenous testosterone may contribute to healthy aging”.
Although this study did not examine the effect of treating men with testosterone, it did clearly show that men who have a higher level of testosterone as they age maintain muscle mass and lower extremity strength better than men who have lower testosterone levels. In my opinion, it is not much of a leap of faith to believe that by keeping a man’s testosterone within a healthy range as he ages, we will produce the same positive findings, clearly impacting long term health and the aging process.
Here is yet more evidence of the profound beneficial effects of testosterone on the male body.
According to a research paper presented this month at the International Diabetes Federation World Diabetes Congress, replacing testosterone to normal levels in middle aged and elderly men significantly improved all components of metabolic syndrome in 24 months. Positive benefits were maintained for 5 years, making this one of the longest disease focused studies out there. In addition researchers noted that at 60 months, improvement in some areas was still continuing.
Metabolic Syndrome is defined by the presence of a group of symptoms including central obesity, abnormal cholesterol/triglyceride levels, elevated blood pressure, and insulin/glucose abnormalities.
Highlights of the study included:
-After 48 months there was a substantial decrease in waist circumference (over 3 inches) and a consistent and progressive decline as far out as 60 months in some cases.
-Average body weight was decreased from 234.5 to 206 lbs. Subjects lost about 5% of their original body weight after 15 months, and 10% after 3.5-4 years.
-Average systolic and diastolic blood pressures dropped fro 155/94 to 140/80 at 48 months.
-Total cholesterol dropped from 297.7 to 194.5, LDL cholesterol dropped from 160.4 to 118.3, and triglycerides dropped from 290.4 to 194.2
-Average blood glucose declined from 105.8 to 97.
Additional non-metabolic syndrome improvements included:
-A “marked reduction” in C-reactive protein, a marker for systemic inflammation.
-A significant decrease in liver function enzymes, likely indicating an improvement in fatty liver disease.
-No rise in PSA (prostate)
-A decline in the International Prostate Symptom Score, indicating an improvement in urinary function with testosterone use.
To see see this much improvement in so many critical areas is quite impressive, and indicates the importance of testosterone in males in maintaining optimal health.
This is something I hear frequently from my new male patients.
Now it is natural when a guy has just been told by his significant other that he should consider hormone replacement to assume that the reason for this suggestion is because of libido/performance issues.
In reality though, she is probably looking at a completely different set of symptoms.
ED/libido issues are what the media has latched on to, and are something that guys tend to pay attention to. However there are a whole host of symptoms which are linked to suboptimal testosterone levels which we as guys we find easy to ignore, or we are simply not aware that they are associated with our testosterone level.
So what other “symptoms” may be associated with suboptimal testosterone levels? Some of the most common include:
-Aches and pains
-Hot flashes and night sweats
-Lack of focus and motivation
-Lack of interest in things you used to like to do
While ED/libido issues are certainly important to my patients, fixing the other things on this list are what can really improve overall quality of life and general health.
So when she brings this up, remember that she really does have your best interests in mind. Also, if she is feeling good, she probably wants you along for the ride as well.
When I recommend using progesterone to a patient, the topic of whether to use cream or the oral form always comes up. The question “Which one is better?” invariably is asked, and my answer is almost always, “That depends.”
My impression is that while both the cream and oral form are equally effective across the entire population, when you consider an individual patient, there may be a good reason to choose one over the other.
In support of the equal effectiveness is a study in the Journal of Clinical Pharmacology which showed no difference in drug exposure when oral and cream forms of progesterone were compared.
The main difference stems from the fact that when any medication is taken by mouth, the liver becomes a major factor, standing there with open arms to try and do what it thinks is right–metabolize it and prepare for removal from the body. This can be a good thing (ridding the body of a toxic substance, or turning a medication into a more active form), or a bad thing (inactivating a helpful substance or creating a toxic metabolite).
When progesterone is applied to the skin, it is dispersed through the body in a more uniform fashion. Thus the liver is not exposed to the high concentration of progesterone that occurs immediately after ingesting the hormone orally.
A few important things to know about the two forms of progesterone are that:
1) Because of the differences in absorption and metabolism, the doses of oral and cream progesterone are quite different. Generally a higher “dose” of progesterone is required when it is used orally. There is also no standard formula for converting between forms as everyone’s absorption and metabolism are different.
2) Oral progesterone is not hard on the liver, does not create any systemic issues (as opposed to oral estrogen), and the metabolites are not harmful. In fact in some individuals the metabolites may improve sleep.
3) Some patients simply “feel better” on one form or the other.
So what are some of the things that I consider when deciding with the patient which form to use?
-Some patients find it easier to remember to take a capsule than to rub on a cream, and it can’t help if you keep forgetting to use it.
-Oral progesterone may worsen reflux symptoms in sensitive individuals, and can also cause a feeling of intestinal bloating. These may be dose dependent.
-Oral progesterone may improve sleep better than cream in some individuals, but may cause grogginess in others.
-May be easier to adjust the dose as changes can be made in smaller increments than you can with capsules.
-High or low cortisol states may make more of a difference with the cream than with the oral form.
-In patients with liver issues, or in those who are using multiple medications or substances which are processed by the liver, the cream may be a better option.
So, like all things in hormone replacement, there is no “one” answer, but there is a “right” answer, and it is up to both of us to find it.
“I was told that since I don’t have a uterus I don’t need to take progesterone.”
This is something that my new patients tell me on a fairly regular basis. While I would agree that progesterone is needed to balance the effect of estrogen on the uterus, I would disagree that this is it’s one and only function in the body. Having had a hysterectomy does not knock you out of contention for the “I love what progesterone does for me” fan club.
For those who need convincing that progesterone works on more than the uterus, one needs only to look at the brain, and specifically, brain injury. The fact that the brain responds positively to (and in fact needs) progesterone is well supported in medical literature. While there are many studies, here are a couple of examples. Also, just as importantly, I am not aware of ANY study which shows that progesterone is harmful to the brain.
Brain Research Review 2008 Mar;57(2) “There is growing evidence that this hormone (progesterone) may be a safe and effective treatment for traumatic brain injury and other neural disorders in humans.”
Annals of Emergency Medicine 2008 Feb 51(2) “There is evidence that the hormone (progesterone) affords protection from several forms of acute central nervous system injury, including penetrating brain trauma, stroke, anoxic brain injury, and spinal cord injury.”
While this is just one small facet of what progesterone can do, when you look at the studies it is pretty easy to see that progesterone is not just a “one trick pony”.
This week while seeing one of my patients for a follow up visit, I asked one of my standard questions–”So, has anything changed since we met last?”
“Yes” she said, “I am getting hit on again!” Cautiously, I asked her if that was ok.
“You bet” she said “it is good to be noticed”.
Now, I wish I could take all the credit for the physical changes that have occurred in her, but my role was only in making suggestions and offering guidance in lifestyle choices, and balancing her hormones. In truth, it was she who did all of the heavy lifting (both literally and figuratively) to get where she was at.
Now she may have assumed that this new attention was due to the physical changes of weight loss, toning, etc. But I think that it is much more than that.
What I see when I look at her is confidence. A confidence in knowing that she was able to make some very marked changes in diet and lifestyle, stick to them, and then see the results of her effort. A confidence that comes from sleeping well and feeling good. A confidence in knowing that although challenges in life are inevitable, she now has more physical and emotional reserve to meet them. She has changed in ways that neither of us could have anticipated.
I am also sure that her new-found smile did not hurt either.