Chapter 95
DHEA
Dehydroepiandrosterone (DHEA) is the steroid hormone found in the greatest abundance in our blood, even though it declines with age after peaking around age 30. It was touted as an “anti-aging” “super hormone” “miracle cure,” because people hoped for a rejuvenating effect from topping levels back up to a youthful range, and thus the sale of DHEA in the United States reached more than 50 million dollars per year. As I show at see.nf/dhea, the initial enthusiasm gave way to sober skepticism, as the “miracle cure” repeatedly failed against placebos in studies. Aside from intravaginal DHEA for vaginal atrophy, which I discuss in the chapter “Maintaining a Sex Life,” the only convincing benefit is improving the birth rate in women in their late 30s undergoing artificial insemination. As with all supplements, there are also concerns here about quality control. Some “DHEA” preparations lie quite unabashedly and contain no DHEA at all, but there are natural ways to boost DHEA.
Lower protein intake is associated with higher DHEA levels, and an intervention study found that higher fiber intake actively increases levels, so why not combine the two? Researchers found that DHEA levels in the blood rise by almost 20 percent if you eat vegetarian and egg-free for just five days. This can also be tested the other way around: When study participants who were already eating plant-based were switched to a conventional diet, their DHEA level fell by up to 20 percent. It appears that the bodies of those who eat plant-based store the hormone better and excrete less in the urine, which otherwise is seen only with fasting.
Avoiding dairy to preserve egg cells
What can women do, in general, to preserve their fertility? It used to be believed that women’s egg reserve remains relatively stable until it rapidly declines at about age 27. Today we know it is more of a steady, gradual loss of eggs that begins after the peak of fertility in the early 20s. As I discuss at see.nf/ovarianreserve, Harvard researchers suspect that the accelerated aging of the ovaries by as much as a decade, which is associated with increased milk consumption, is due either to contamination of dairy products with endocrine-disrupting chemicals or to the presence of natural reproductive hormones. About 60 to 80 percent of the diet-related exposure to estrogens, progesterone, and other placental hormones comes from dairy products. (Cows are usually milked when they are pregnant.) When these bovine hormones enter the human body, they are converted into estrone and estradiol, the main active human estrogens, which could influence ovarian aging.
Menopause
In the animal kingdom, living on after menopause is unusual. The females of most species die soon after their reproductive ability wanes, which was also true for humans until about 100 years ago. (In 1900, the average life expectancy of women in the United States was 48 years.) Nowadays, women have another third of their lives ahead of them after menopause, raising the question of what can be done to help them do well during this transition and afterward.
A pause from menopause
Since 1970, the proportion of women having their first child after age 35 has increased almost tenfold. This may adversely affect their children, because children of older mothers generally have a shorter life expectancy, whereas the late mothers themselves usually live longer. In my video see.nf/delaymenopause, I address this phenomenon, as well as the dietary and lifestyle habits that affect the timing of menopause, including smoking, partnerships, and consumption of plant protein.
The medicalization of menopause
A woman is considered postmenopausal if she has had no menstrual bleeding for twelve consecutive months. American women are, on average, 51.5 years old when menopause begins. About 20 percent of them remain symptom-free, while 20 percent at the other end of the spectrum struggle with severe symptoms due to the hormonal changes. Some nuisances, such as hot flashes, lessen over time, but others tend to get worse, such as vaginal dryness. Hot flashes and night sweats typically last five to seven years, but in 10 to 15 percent of those affected, they can last more than ten years. The response of the medical establishment was hormone replacement therapy.
The very name hormone replacement reflects the medicalization of menopause as a disease. Taking thyroid hormone for hypothyroidism, or insulin for type-1 diabetes when you can’t produce it yourself, that is hormone replacement therapy. In contrast, the drop in hormones like estrogen during menopause is a normal and natural process, which is why this treatment is now simply called hormone therapy or menopausal hormone therapy. Originally, it was marketed not only to relieve symptoms, but as a fountain of youth that exploited older women’s self-esteem, vanity, and fear of aging, popularized in 1986 in the embarrassing bestseller Feminine Forever by a Manhattan gynecologist, Robert Wilson.
“One must face the unpleasant truth that all women after menopause are castrates,” Wilson wrote. He recommended hormones to free women from their “dull, cow-like” state and make “living with them much more pleasant.” Few people know that Wilson’s promotion of these drugs was financed by—yes, you guessed it—the Big Pharma hormone manufacturers, who kicked in more than a million dollars for it. Wilson dismissed the comment that hormones like estrogen and progesterone could cause breast cancer as “against all logic” and claimed that, on the contrary, they would protect women from breast cancer. In the 1990s, up to 40 percent of menopausal women in the United States took these drugs, earning the pharmaceutical industry billions each year. But then the Women’s Health Initiative and the Million Women Study revealed that there was an increased risk of breast cancer, blood clots, and endometrial cancer. The use of menopause hormone therapy fell by 80 percent, and then the number of breast cancer cases fell steeply and significantly as well.
More breast cancer and more cardiovascular disease
As far back as the 1940s, there were concerns that administering estrogens to women could cause breast cancer, but it took almost 100 years for a decision to be made to examine whether a drug prescribed to millions of people was even safe. I tell the whole story in my video see.nf/premarin, but essentially the bombshell hit in the summer of 2002. In the Women’s Health Initiative study, there was so much more invasive breast cancer among users of estrogen and progesterone (PremPro) that the study had to be stopped early. The researchers expected that lower cardiovascular risk would offset this, but the women not only had more breast cancer, they also had more heart attacks, more strokes, and more blood clots in the lungs. In 2003, the Million Women Study was published in Europe, confirming the fears about breast cancer, and in 2004 the part of the Women’s Health Initiative focusing on estrogen (Premarin) was also halted early due to increased stroke rates.