DHEA Benefits Postmenopausal WomenJune 2004
|LE Magazine June 2004|
|DHEA Benefits Postmenopausal Women|
Dehydroepiandrosterone (DHEA) supplementation may be beneficial to women after menopause, according to research published in the medical journal Fertility and Sterility.*
In their report, Italian researchers noted that DHEA has received a great deal of attention lately because many (though not all) studies have shown that the “administration of DHEA greatly improves several endocrine, metabolic, and physiologic parameters both in men and women.”
In an effort to study DHEA’s effect on women after menopause, the researchers gave 20 postmenopausal women 25 mg per day of oral DHEA and followed them closely for one year. They found that DHEA supplementation led to significantly increased levels of estrogen, testosterone, progesterone, and other hormones. The researchers also noted that subjective symptoms of menopause, such as hot flashes, improved significantly and progressively throughout the study period.
The virtue of using DHEA is that it is a natural way of boosting hormones lost to aging, as opposed to ingesting synthetic estrogen and progestin drugs that have been shown to cause lethal side effects.
—Marc Ellman, MD
* Genazzani AD, Stomati M, Bernardi F, Pieri M, Rovati L, Genazzani AR. Long- term low-dose dehydroepiandrosterone oral supplementation in early and late post-menopausal women modulates endocrine parameters and synthesis of neuroactive steroids. Fertil Steril. 2003 Dec;80(6):1495- 501.
|More Folic Acid Advised for Pregnant Women|
Neural tube defects such as spina bifida and anencephaly affect 1 in 1,000 newborns in the US. If you were planning a trip by automobile or airplane and were told there was a 1 in 1,000 chance you would not arrive safely, would you still take the trip?
Such risks are usually not a topic of discussion for most couples contemplating pregnancy. It has been known since the 1980s, however, that the use of supplemental folic acid before pregnancy can significantly reduce the likelihood of neural tube defects, even though women with an affected infant show no evidence of clinical folic acid deficiency. Neural tube defects appear to result from a folic acid receptor blockade by maternal autoantibodies.1 Supplemental, but not dietary, folic acid is able to free up the receptors so that normal embryonic nerve tissue development ensues. Unfortunately, introduction of supplemental folic acid after conception has no apparent neuroprotective effect.
In the UK, where the incidence of neural tube defects is greater than in the US, physicians have advised that in addition to consuming flour and grain products fortified with folic acid, women should take 4000 micrograms of folic acid daily when attempting pregnancy or exposed to pregnancy without contraception.2 The recommended 4000 mcg dose of folic acid has been shown to prevent 83% of neural tube defects, compared to only a 36% reduction with the standard 400 microgram dose of multivitamins.
Based on the current study and applying a dose-response model,3 it is now recommended that women take 5000 micrograms of folic acid during the preconception period and first trimester to maximally reduce the risk of neural tube defects. At least 1000 micrograms of vitamin B12 should also be consumed daily to guard against pernicious anemia.
—Dean S. Cunningham, MD, PhD
1. Rothenberg SP, da Costa MP, Sequeira JM, et al. Autoantibodies against folate receptors in women with a pregnancy complicated by a neural-tube defect. N Engl J Med. 2004 Jan 8;350(2):134-42.
2. MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet. 1991 Jul 20;338(8760):131-7.
3. Wald NJ. Folic acid and the prevention of neural-tube defects. N Engl J Med. 2004 Jan 8;350(2):101-3.
|Higher-dose Folic Acid Improves Endothelial Function|
Medical research has associated elevated homocysteine levels with an increased risk of cardiovascular and cerebrovascular disease. Higher levels of homocysteine are thought to increase oxidative stress and the likelihood of blood clot formation, eventually producing damage to the blood vessel lining or endothelium.
Supplementation with folic acid, vitamin B6, and vitamin B12 has been shown not only to normalize homocysteine levels, but also to reverse the damage done by elevated homocysteine and even to further reduce carotid atherosclerotic plaques in those with normal levels of homocysteine.
The established minimum effective dose of supplementary folic acid to reduce homocysteine levels is 400 mcg per day.1 This dose, which is typically contained in multivitamins, maximally reduces homocysteine levels (by approximately 25%).2
With respect to cardiovascular disease, however, endothelial function (as measured by flow-mediated dilation of the brachial artery) was shown to improve with a higher dose of folic acid (5000 micrograms), even though no further decrease in homocysteine was achieved.3 This suggests that folic acid may directly mediate cardiovascular outcomes independent of its effect on homocysteine levels.
—Dean S. Cunningham, MD, PhD
1. van Oort FV, Melse-Boonstra A, Brouwer IA, et al. Folic acid and reduction of plasma homocysteine concentrations in older adults: a dose-response study. Am J Clin Nutr. 2003 May;77(5):1318-23.
2. Doshi S, McDowell I, Moat S, Lewis M, Goodfellow J. Folate improves endothelial function in patients with coronary heart disease. Clin Chem Lab Med. 2003 Nov;41(11):1505-12.
3. Doshi SN, McDowell IF, Moat SJ, et al. Folic acid improves endothelial function in coronary artery disease via mechanisms largely independent of homocysteine lowering. Circulation. 2002 Jan 1;105(1):22-6.