DHEA: Hype, Hope and Disappointment
Dehydroepiandrosterone (DHEA) is a hormone that has attracted a lot of attention. It’s launched hundreds of websites, product lines and a few books and magazine articles. So what’s all the fuss about, and should we all be chomping down on DHEA tablets?
DHEA is manufactured at several sites in the body, but by far the most important is in one of the outer layers of the adrenal gland. Like all the steroid hormones it is made from cholesterol. It has various protective effects in the body, regulates some enzyme systems, can be converted to estrogen and under certain circumstances to testosterone. It has very weak androgen (male hormone) activity.
In cell culture it has a lot of other actions too, but it is always difficult to jump from effects seen using large doses in isolated cells, to giving advice on what supplements people should be taking.
There has been a lot of talk about the possibility that some people may, as a result of stress or toxins, suffer from exhaustion of the adrenal glands. There is a great long list of symptoms that may be caused by this so-called adrenal fatigue, deficiency or insufficiency: the terms are often – and incorrectly – used interchangeably. And therein lies the problem. It is such a long list that it is non-specific. It’s always a bit of a worry when someone tells me that dozens of different symptoms are all caused by one single biochemical problem. That just isn’t the way that the human body works.
I have seen and treated countless people with a condition known as Addison’s disease: true chronic adrenal insufficiency. It can be a very serious illness and it is quite different from the “adrenal fatigue” that people talk about in some popular books. People with chronic fatigue syndrome do have lower levels of activity in what is known as the hypothalamic-pituitary-adrenal axis, but it is not because the adrenal glands are not working properly, but because the hypothalamus in the brain is not doing it’s job properly. There’s also no proven link between “burnout” and adrenal function.
During my years as an endocrinologist and holistic physician, I’ve spent a great deal of time looking for adrenal fatigue in sick people and I’ve never found it. I’ve done all the tests recommended by proponents of adrenal fatigue and adrenal insufficiency and when we’ve done the tests properly, we’ve drawn a blank. There are a great many parallels between the adrenal insufficiency story, and the old – and discredited – myth about people becoming unwell because of a thyroid deficiency that cannot be picked up on standard thyroid function tests.
So can DHEA do you any good? Or can it be harmful? What exactly is the evidence?
- There is a comprehensive study, called The Dehydroepiandrosterone And WellNess (DAWN) study that should give us some solid answers as to the risks and benefits of DHEA. I shall post details of the findings as they become available. But some things we know already:
- DHEA has been touted as an anti-aging supplement. But in a two-year prospective study done in older people attending the Mayo Clinic in Rochester, Minnesota, neither DHEA nor low-dose testosterone replacement had physiologically relevant beneficial effects on body composition, physical performance, insulin sensitivity, or quality of life. Perhaps the people in the study didn’t get enough DHEA, but it doesn’t look that way. Instead it seems that just giving the supplement doesn’t seem to do very much. But there is increasing evidence that 50-100mg of DHEA each day will improve muscle strength and muscle mass in older people who are doing strength training. Once again, it does nothing in people who are not exercising. Sorry!
- According to the results of a small placebo-controlled, randomized trial published in the Archives of General Psychiatry, DHEA can be effective for midlife-onset minor and major depression. The study was conducted the National Institute of Mental Health Midlife Outpatient Clinic. In the trial, 23 men and 23 women aged 45 to 65 years with midlife-onset major or minor depression were randomized to six weeks of DHEA therapy, 90 mg/day, for three weeks and 450 mg/day for three weeks or to six weeks of placebo followed by six weeks of the other treatment. The subjects did not receive any other antidepressant medications during the study. Both of the doses of DHEA helped improve depression: there was no advantage in going to a higher dose, and there was no difference in the treatment response of men and women. The trouble with this study was not just the small size and the short duration, but the DHEA was not compared against a standard antidepressant. So we are still in the dark as to how effective it really is. It’s nice that it’s better than placebo, but this is just the first step in a larger research program.
- A study from Taiwan indicated that people with higher levels of DHEA sulfate had a lower overall mortality over a three-year period. That is interesting, but absolutely does NOT mean that artificially increasing our levels of DHEA with supplements will make us live forever: we don’t yet have that kind of magic bullet.
- In mice, quite large amounts of DHEA have the effect of slightly reducing the normal increase in stiffness of the left ventricle that can happen as animals get older. We have no idea whether something similar might help in humans, and the amounts of DHEA involved may rule it out as a viable treatment in people.
- 50mg/day improves subjective wellness in people who have no active pituitary gland. A rare condition, and we cannot use this evidence to advise healthy people about what to take.
- Because DHEA is converted into estrogen and/or testosterone, it may have the potential to exacerbate or initiate hormone-responsive tumors. The evidence is not strong one way or the other, but it remains a worry. I don’t think that anyone recommends DHEA to people who have a personal or family history of breast or prostate cancer.
There is a BIG literature on DHEA. But my current conclusions from all this?
- 50-100mg of DHEA is probably worth trying if you are over 50 years of age and doing regular exercise.
- It may help a bit with mild depression.
- It should not be used in people with a personal or family history of breast, prostate or any other type of hormone-sensitive cancer.
Tips for Trips
I’ve not written any new items for a couple of days while I was in England and out of range of anything resembling a decent Internet connection.
But a grand total of seventeen hours on planes made me think that it’s high time to tell you about some of my tips and techniques for dealing with the rigors of flying.
I’ve got so many of them that my tips will stretch over more than one article.
By now most people will have heard about the importance of:
- Maintaining hydration: the low pressure and dry atmosphere on planes can quickly dehydrate us. I try to drink at least 20 fluid ounces every two hours that I’m in the air.
- Avoid drinking alcohol and coffee.
- Keep mobile. When it is safe to do so: walk up and down the aisle. Stretch your legs and arms and gently rotate your neck while sitting in you seat.
The most worrying things about flying is the risk of developing a Deep Vein Thrombosis (DVT). This is an important topic: one in 2,000 long-distance passengers will suffer a blood clot, which can be fatal if the clot detaches and reaches the lungs: this is known as pulmonary embolism. DVTs are more likely to occur if there is a change in the rate of blood flow, the character of the blood of the normal functioning of the walls of the large veins. There are a number of well-recognized risk factors for the development of DVTs:
- Obesity
- Immobility
- Oral contraceptives
- Some cancers
- Cigarette smoking
There is a great long list of potential causes, but our focus today is on factors that can increase your risk of developing a DVT if you fly.
DVTs have been recognized to occur not just in passengers on planes, but also in people at extremely high altitude.
For many years it has been assumed that the low pressure and the immobility together increase the risk of DVT. But new research from the Universities of Leicester and Aberdeen was published in the Journal of the American Medical Association in May.
In a study of 73 people, the researchers found that sitting for long periods was the main cause, and warned people about all forms of travel.
During the study, the volunteers spent eight hours sitting in chambers with reduced air pressure and oxygen. They were allowed to move around for a couple of minutes each hour. They were then also tested in a chamber without changes in the atmosphere. The idea was to simulate the conditions on a plane. Blood samples were taken before and after each “flight” to check for factors involved in blood clotting.
For all these factors, no significant differences were seen between blood samples taken from volunteers on a simulated flight or exposed to normal air pressure. So it is not the low air pressure and oxygen saturation that is to blame: it is the lack of movement.
It is also unlikely that the advice to take an aspirin before a flight is going to be much help.
During my travels I have seen people selling extracts of horse chestnut (Aesculus hippocastanum) to prevent DVTs. There is actually some research that horse chestnut can help with chronic venous insufficiency. But there is no credible evidence that taking a couple of horse chestnut capsules will prevent a DVT, or the less severe problem of ankle swelling. And horse chestnut is well known to have a number of side effects, so there doesn’t seem to be much point in taking it to prevent ankle swelling and DVTs when flying.
The smart move (ha!) is to do regular exercise during flight, and to avoid dehydration.
I’ll tell you some of my tips for turning flights into highly productive work time and how to avoid jet lag in other posts.
Yoga for Attention Deficit Disorder?
Apart from a sizeable number of pharmacological treatments coupled with psychological and family therapies, an enormous number of unorthodox treatments have been tried for attention deficit disorders and attention deficit hyperactivity disorders (ADD/ADHD). One of the best reviews was published in the Annals of the New York Academy of Sciences. I have the privilege of being a member of the Academy.
There have been some recent attempts to see if ADD/ADHD might be helped with yoga or meditation.
The first study came from Australia and was published in 2004. It was small: only eleven boys with ADHD were enrolled in a 20-session yoga class, but nonetheless, the results were encouraging. The yoga was done as an adjunct to conventional treatment with medications. The authors concluded that yoga increased concentration, promoted mental and physical discipline and induced confidence. The parents of the boys thought that the kids doing yoga were rather less hyperactive.
Another study has just been published from Heidelberg in Germany. The main paper is in German, but there is a short summary in English. This again was a pilot study, this time involving 19 children. These researchers felt that yoga practice, and in particular forward bends that improve breathing were the key to helping the children develop better concentration.
There is a nice summary of mainly peer-reviewed papers on research into yoga. This website doesn’t critically evaluate the research, but it’s a good starting point if you are interested in some of the research going on into the potential health benefits of yoga and some related practices.
Exercise Burn Out
When we think about burnout, most of us concentrate on the psychological, relational and subtle aspects of the problem. But it is really important to be aware that just about any activity that isn’t balanced and moderated can burn us out.
I have just read a very nice article about avoiding workout burnout. We have all known youngsters who have so over-indulged in something like chocolate cake that they have become sick. Despite Mae West assuring us that “Too much of a good thing can be wonderful,” even the most positive of activities can turn around and bite us if not done in moderation. How many of us have returned to the gym and behaved like a bull in a china shop. And paid for it for the next three days….
One thing to add to this nice article. If you do over do it in the gym, and your muscles feel as if you’ve just gone ten rounds with Mike Tyson, you can usually reduce the period of pain and stiffness with the supplement Methylsulfonylmethane (MSM). So long as you are not sensitive to it, three 500mg capsules can be very helpful.
“Temperate temperance is best; intemperate temperance injures the cause of temperance.”
–Mark Twain (a.k.a. Samuel Langhorne Clemens, American Humorist, Writer and Lecturer, 1835-1910)
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