Sarcopenia: Age-Related Muscle Loss

Sarcopenia: Age-Related Muscle Loss

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

woman lifting weightsSarcopenia, the muscle loss related to aging, may start slowly in your thirties and continue progressing with growing rapidity into your seventies. It is not identified with definite biomarkers as medical practitioners prefer to use today. Sarcopenia tends to get an “I know it when I see it” sort of diagnosis.

Although this difficulty in diagnosing sarcopenia is understandable considering the mental picture of the frailty associated with aging, loss of muscle mass is a major health issue.

  • With a loss of muscle comes a loss of strength
  • It is more difficult to get around, climb stairs, or walk long distances
  • It leads to falls and serious injuries including broken bones
  • When injuries occur, it takes longer to heal
  • Surgeries may be less successful and infections take hold more readily

Unless measures are taken to stop it, sarcopenia may lead to prolonged hospitalizations, nursing homes, and possibly even death.

Anabolism and Catabolism

Our bodies are in the constant process of remodeling. We build and rebuild molecules, break down old cells and tissues to make way for the new, and dispose of or reuse the molecules. When we are young the rate at which we rebuild (anabolism) exceeds the rate at which we break down (catabolism). There are multiple factors that trigger more catabolism than anabolism as we age, including:

  • Changes in neurochemistry
  • Hormone imbalances
  • Production of inflammatory cytokine (cells produced by the immune system that act on other cells)
  • Inadequate nutrition
  • Environmental hazards
  • Declining physical activity

Satellite Cells

Muscle is composed of many different cell types. Muscle stem cells are called satellite cells. Satellite cells are located on the outside membrane of the muscle cells and next to the blood vessels. These cells are not active unless there is some stimulus from injury to the muscle or from the environment carried in the blood stream. When activated, these satellite cells become new muscle cells.

Estradiol and Testosterone

Sarcopenia develops with the decline of sex hormones. Research in the last decade reveals that the satellite cells have receptors for–and respond to—estrogens (such as estradiol) and androgens (such as testosterone). Studies support that estradiol has beneficial effects on muscle strength.

Most muscle cell types have receptors for testosterone, but testosterone receptors predominate in satellite cells. Administration of testosterone increases the number of satellite cells, and also directly inhibits inflammatory cytokines. Higher testosterone levels contribute to increased strength and mass; since women generally have less testosterone than men, this might explain why women tend to develop sarcopenia at twice the rate as men. 

DHEA and Human Growth Hormone

Adrenal DHEA, another androgen, also declines with age, and may affect muscle strength via a number of mechanisms.  DHEA is converted to estrogens and testosterone in the body, which may have a direct effect on receptors. Also, DHEA increases sensitivity to insulin, another anabolic hormone, which may also increase levels of IGF-1 (the active metabolite of growth hormone). Increased IGF-1 may indicate increased levels of growth hormone. Growth hormone has been shown to increase muscle mass in many studies.

The Triad of Frailty

In their article Frailty and the Older Man, Drs. Jeremy Walston and Linda Fried proposed looking at the concept of frailty in the elderly as a triad:

  1. With aging the hypothalamic responses to stress change, cortisol levels increase, and the signals to produce sex hormones and growth hormone decline
  2. The immune system is affected, producing fewer antibodies and more inflammatory cytokines
  3. Both of these effects contribute to sarcopenia

All three systems are interdependent: the endocrine system, the immune system, and the muscular system participate together in a spiral of decline.


Maintaining the health of the body requires collaboration between various factors. Our awareness of these factors gives us the tools to optimize our aging with strong bodies. Such factors include:

  • Eating well and ensuring our digestive systems work
  • Bolstering our metabolic processes with vitamins and minerals
  • Avoiding environmental challenges to our biochemistry

In addition to these factors, our health is profoundly affected by hormones. Sarcopenia illustrates how hormone deficiencies hinder us from achieving optimal health. Fortunately, our ability to supplement the hormones that decline as we age may help stave off the effects of sarcopenia and other age-related conditions.

A validated questionnaire called FRAIL can be used as a simple screen for sarcopenia. Three or more “Yes” answers are considered “frail,” signalling the possibility of sarcopenia.

  1. F. Fatigue: Did you feel tired all or most of the time in the last 4 weeks?
  2. R. Resistance: Is it difficult to walk up 10 steps without resting?
  3. A. Ambulation: Is it difficult to walk several hundred yards?
  4. I. Illnesses: Do you have more than four illnesses?
  5. L. Loss of weight: Have you lost 5% of your normal weight in the last year?
  • La Colla A, et al. 17 Beta Estradiol and testosterone in sarcopenia: Role of satellite cells. Aging ResRev. 2015 Nov:24(Pt B): 166-177. doi: 10.1016/j.arr.2015.07.011. Epub 2015 Aug 3.
  • Health Sciences Institute. This hidden disease will land you in a nursing home. February 2016 (20) 6.
  • Walston J, Fried L. Frailty and the Older Man. Med Clin North Am. 1999 Sept;83(5):1173-1193.
  • Balagopal P, Proctor D, Nair KS. Sarcopenia and Hormonal Changes. Endocr. (1997) 7:57-60.
  • Morley JE, Malmstrom TK. Frailty, Sarcopenia, and Hormones. Endocrinol Metabl Clin N Am. (2013)42:391-405.
  • Morley JE, Malstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012 Jul;16(7):601-8.

© 2018 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at

Sarcopenia: Age-Related Muscle Loss2019-02-13T09:53:55-05:00

Book Review – The End of Alzheimer’s

Book Review – The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline by Dale E. Bredesen, MD

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

older couple taking a walkAlzheimer’s disease is a grim disease that causes both the mind and body to deteriorate. In 1906, Dr. Aloysius Alzheimer identified plaques in the brain autopsy of a patient who had suffered from dementia, and in doing so he discovered what is generally thought to cause the symptoms of the disease that bears his name. These plaques, made from a protein called amyloid-beta, are thought to interfere with the functioning of our brains.

Since Dr. Alzheimer’s discovery over a century ago, the focus has not been in pinpointing the cause of Alzheimer’s disease, but rather in finding an effective treatment for the related symptoms. Theoretically, if we can find a drug that will stop the formation or contribute to the removal of plaques in the brain, we will be able to prevent or reverse the development of the symptoms associated with Alzheimer’s disease. We have been using this line of thinking to develop drugs since the 1980s, without success.

Dr. Dale Bredesen has turned this thinking upside down. His book, The End of Alzheimer’s, poses the questions: What if the amyloid proteins are there to protect the brain rather than disrupt the brain? Is it only when plaque formation is excessive that it interferes with nervous tissue signaling?

A Leaky Roof

Dr. Bredesen uses the metaphor of a leaky roof for Alzheimer’s disease. The roof has approximately 36 “holes,” though a few more may yet be identified. These holes signify the number of contributors he and his team have identified as playing a role in the development of dementia and Alzheimer’s disease.

The size of the holes—that is, the probability of developing Alzheimer’s disease–depends on the impact of genetics and the environment. Because each hole is a different size (depending on genetics and other factors) for each person, not every single hole needs to be patched; however, if you only patch one hole in the roof, you will still have a leaky roof. Our pharmaceutical model only has touched on one pathway—trying to stop the formation of plaques—and overlooked other possible causes, which is why our attempts at treating Alzheimer’s disease have failed.

What Causes Amyloid Production?

Among the 36 “holes” that contribute to developing Alzheimer’s disease, there are three major categories. These categories contain conditions that can be grouped together. The three major categories are inflammation, deficiencies in hormones or nutrients, and exposure to stress or environmental toxins. All of these conditions force the body to defend the brain by producing amyloid plaques, thus leading to Alzheimer’s disease.

Inflammation is the first category that may increase amyloid production. While inflammation is often related to infection, it may be caused by other things such as food or food sensitivities. Dr. Bredesen uses the example of ingesting trans-fats or sugar, substances that are known to be inflammatory.

The second category includes hormones and nutrient deficiencies and imbalances that interfere with neuronal repair in the brain. For example, vitamin D deficiency may be a critical trigger for amyloid production. See below for a more detailed description of this category.

The third category includes exposure to significant stress, poisoning with heavy metals and mold toxins, or other environmental or chemical exposures. Even the stress of menopause may instigate the disease. Because this category tends to present psychological symptoms (such as depression), which mask the symptoms of Alzheimer’s disease, these contributors can be easily missed.

Alzheimer’s Disease By the Numbers

The Alzheimer’s Association has gathered these statistics about this increasingly-prevalent disease:

  • An estimated one in ten of people over the age of 65 is affected.
  • Two-thirds of those diagnosed are women.
  • It is the sixth leading cause of death in the United States.
  • Life expectancy after diagnosis is 4 to 8 years.
  • The cost of care for Alzheimer’s disease and other dementias in the United States is estimated at $277 billion for 2018 alone.
  • One-third of seniors die with Alzheimer’s disease or another form of dementia.
  • 7 million Americans are living with dementia as of 2018.
  • In the United States, every 65 seconds a patient is diagnosed with Alzheimer’s disease.

Hormones Are a Key

As mentioned above, some of Dr. Bredesen’s findings show that the key to preventing or recovering from Alzheimer’s disease may be restoring depleted hormone levels. Of the 36 and more contributors identified, several involve hormonal imbalance. Dr. Bredesen states, “Reaching optimal hormone levels is one of the most effective and most critical parts of ReCODE (reversing cognitive decline protocol).” Based on his observations, Dr. Bredesen recommends optimizing:

  • Insulin secretion and signaling
  • Estradiol
  • Progesterone
  • The ratio of progesterone to estradiol
  • Free T3 (the active thyroid hormone liothyronine)
  • Free T4 (the thyroid hormone thyroxine which is the precursor to T3)
  • Thyroid stimulating hormone (TSH), made by the pituitary gland to stimulate the thyroid gland to produce T3 and T4
  • Pregnenolone
  • Testosterone
  • Cortisol
  • Dehydroepiandrosterone (DHEA)

Dr. Bredesen takes great care to explain the development of his ideas and the work in his laboratory. With decades of research behind him, he presents a theory addressing everything we do know about Alzheimer’s disease, and as a researcher and physician, he has been able to practically apply this theory to successfully treat patients.

Connection with Insulin

Another contributor to inflammation—and by extension, developing Alzheimer’s disease—is insulin resistance. Insulin resistance, metabolic syndrome, and diabetes all involve abnormally high levels of insulin. Some even call Alzheimer’s disease “Type 3 diabetes” because of the problems high insulin levels cause the brain. Dr. Bredesen explains that the enzyme, insulin degrading enzyme (IDE), helps us break down excessive insulin. This same enzyme can break down amyloid. If we follow a lifestyle and eating program that constantly elevates insulin, IDE may not be available in amounts needed to break down and help stop amyloid overproduction.

Sex, Adrenal, and Thyroid Hormones

A common factor of aging is the depletion of adrenal hormones (although cortisol is sometimes high), sex hormones, and thyroid hormones. The loss of hormones parallels an increased risk of Alzheimer’s disease as we age.

For each of the markers that Dr. Bredesen has identified, he also describes how to test or evaluate hormone levels, and presents what he believes are the optimal parameters. Replenishing these depleted hormones may help patients prevent or recover from Alzheimer’s disease. To restore proper hormone function, bioidentical rather than synthetic hormone replacement must be used, as bioidentical hormones are equivalent in structure to the hormones our own bodies make.

Diagnosing Alzheimer's Disease

Alzheimer’s disease used to be diagnosed only after the patient had died. An autopsy would reveal the presence of amyloid plaques, explaining the decline in the patient’s health and eventual death. Now we have testing that can identify the presence of plaques during the patient’s own lifetime. These include scans of the retina, brain scans, and checking the cerebral spinal fluid. A genetic test for Apolipoprotein (APO)E also shows potential to predict susceptibility to this disease.

Mending the Holes in the Roof

Alzheimer’s disease does not follow the “one disease, one treatment” model our current medical system relies upon. Each patient should be evaluated for their individual needs. Successfully treating Alzheimer’s must involve a personalized, complex therapy program, but the reward—giving patients the ability to reclaim their brains and their lives—makes the effort more than worthwhile. The End of Alzheimer’s presents an opportunity to forestall and correct the onslaught of this devastating disease. Thanks to his groundbreaking work, dedication to making this information available, and training practitioners to use his guidelines, Dr. Bredesen demonstrates that patients with Alzheimer’s disease do have treatment options.

© 2018 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at

Book Review – The End of Alzheimer’s2019-08-09T11:06:49-05:00

Book Review – Bursting With Energy by Frank Shallenberger

Book Review – Bursting with Energy by Frank Shallenberger, MD, HMD

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Bursting with Energy Book CoverDo you have an energy crisis? Dr. Frank Shallenberger poses this question on the back of his book, Bursting with Energy.[i] How many people tell their practitioners that they feel fatigued or lack energy? How many illnesses, such as multiple sclerosis, involve debilitating fatigue? How many teenagers are unable to keep up with their peers because of fatigue? How many individuals notice a lack of energy as they age? Studies show that 15% percent of women and 10% of men often feel very tired or exhausted.[ii]

Dr. Shallenberger argues that diminished energy production is the primary cause of many diseases, including allergies, obesity, diabetes, heart disease, infections, and even aging. “Chronic fatigue syndrome (CFS)” and other fatigue-related illnesses exist, yet are difficult to diagnose and understand.[iii]

Energy production occurs in specialized structures called mitochondria in all cells in the body. It is inside the mitochondria that the molecule, adenosine triphosphate (ATP), is produced to store the energy created. Energy levels are affected by how well the mitochondria function, as well as how many and how efficiently ATP molecules are produced.

The sun is required to begin producing energy in the body. The plant world picks up the sun’s energy and uses it to convert carbon dioxide into oxygen. Once oxygen is inhaled, the lungs help deliver it to the blood stream. The heart and circulatory system distribute the oxygen to the cells, where the mitochondria busily produce energy and the ATP needed to store the energy for the body. Energy production also depends upon our nutrient intake of carbohydrates, fats, and proteins.

What exactly is interfering with this cycle of energy production? Conventional practitioners may have a difficult time evaluating a patient’s symptoms when they complain of fatigue and low energy. They will likely test to determine the level of fatigue, the causes, and what may help alleviate the lack of energy.

Dr. Shallenberger has pioneered a testing procedure called “Bio-Energy Testing,” which can measure how much oxygen the body uses and how much carbon dioxide the body produces. From these values, mitochondrial function is determined. His book thoroughly outlines how this new method allows for the assessment of energy production and identification of issues that can affect fatigue. The success (or lack of success) with treatments can be measured with repetitive testing.

Bursting with Energy presents eight secrets to achieve optimal mitochondrial activity. Of particular interest is Secret #8, which is restoring depleted hormones with bioidentical hormone therapies. Throughout the book Dr. Shallenberger explains how the energy production process is directed by hormones. Cortisol, growth hormone, insulin, progesterone, testosterone, and thyroid all contribute to this process. Hormones are intimately intertwined in the energy production in every part of the body.

For example, the adrenal glands function to control the blood sugar, glucose, which feeds energy production in the mitochondria. Stress depletes the adrenal glands. Adrenal hormones, such as cortisol and DHEA, assist in managing stress.  Patients may not seek professional help for fatigue until the functioning of the adrenal glands is exhausted. Dr. Shallenberger writes that a clue to early adrenal exhaustion is the presence of normal energy at rest but a decline in energy when challenged with exercise. Restoring depleted hormones can be an essential part of recovery.

Dr. Shallenberger has condensed decades of his clinical work and research into Bursting with Energy. A primer for the successful operation of your body, this book contains many secrets that anyone can start to apply. The best secret of all is that you can turn back the decline in energy and bring back life’s exuberance.

Book Review – Bursting With Energy by Frank Shallenberger2018-04-07T11:11:17-05:00

Hormones and the Aging Voice

Hormones and the Aging Voice

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

We have all heard it. Your aging mother’s voice has changed. It cracks, it quivers, it wobbles, and the tone is lower. The voice you hear over the phone is breathy and lacks the robustness it once had. You suddenly realize, this is the voice of an old person.

Unlike the dramatic changes a young man’s voice goes through at puberty, the changes that happen to a woman’s voice are gradual, often taking years to present.

A woman may use facelifts, tummy tucks and Botox to “stay young” but her voice will still betray her. She will still have an old person’s voice, and it seems there is nothing she can do about it. Or is there?

As it turns out, the voice is extremely sensitive to hormone changes. We know this from an extensive study done with women who depend on their voices for their livelihood: singers. Women at the top of their vocal careers in their 40s and 50s may find that menopause brings it to a dead stop. With menopause, the voice range often deteriorates and those lovely high notes are no longer attainable; or worse, during a performance, the voice cracks and no note comes out at all. Many professional singers have no option but to end their career at this point.

So, what is going on with hormones to affect the voice? The larynx and the vocal cords contained within are extremely sensitive to thyroid and the sex hormones. In fact, cyclical changes occur in women’s voices starting at menarche. In the first part of the cycle (follicular phase), estrogen dominates and progesterone is at lower levels. During this time, there is more fluid build up in the vocal chords and a relaxation of the nasal passages, changing the perception of the voice. During the second half of the cycle (luteal phase), progesterone dominates, causing the larynx epithelium to slough off, and opposing estrogen-induced proliferation. Singers often find that their ability to reach the high notes is compromised during this phase.

In other words, if progesterone is not abundant enough, the singer suffers from estrogen dominance in the luteal phase (or during PMS), and voice clarity or efficiency suffers. Vibratos wobble and it is difficult to sing softly. This condition is known as dysphonia premensturalis.

Researchers Jean Abitbol and his wife Beatrice performed a study that compared slides of swabs obtained from the vocal cords with slides containing cervical smears, both taken at various intervals of the menstrual cycle. The slides were indistinguishable from each other! Their astounding discovery is that vocal chords and vaginal tissue are the same kind of tissue. The vaginal dryness experienced at menopause is similar to the dryness experienced in the vocal chords.

Research has also demonstrated that progesterone, operating as a neurosteroid, protects the myelin sheath. Ian Duncan at the University of Wisconsin illustrated the effect of progesterone on the brain in 1995. With the significant drop in progesterone production that occurs at menopause, nervous tissue is less protected, which leads to a voice that is less controlled.

Testosterone deficits also have an effect on the voice in that the muscles and cartilage that make up the larynx become flaccid and weakened. Not only that, but low testosterone contributes to less muscular strength throughout the body. Singing is hard work and requires good structure and posture, strong abdomen muscles, great breath control, and plenty of endurance. Perversely enough, women who receive too much testosterone replenishment may find that their voices change to a lower timbre, which is thought to be permanent.

Both hypothyroidism and hyperthyroidism also cause voice disturbances. Low thyroid produces hoarseness and a lack of range. This may be from elevated polysaccharides (think mucin) in the vocal chord folds, leading to fluid retention and thickening of the vocal chords. Treating hypothyroidism generally relieves these symptoms. Too much thyroid hormone also causes hoarseness, which is usually relieved with treatment.

Other chronic diseases that accompany aging can also impair the voice. For example, diabetes sufferers often experience dry mouth, which can be a vocal hindrance. Hearing loss, another hallmark of aging that can also occur with diabetes, can cause difficulties in the quality of the vocal sounds produced.

Does hormone replenishment really make a difference? It seems to. This area certainly warrants further exploration. Keeping oneself in good physical condition with exercise, a healthy diet, and good hydration also goes a long way toward maintaining a youthful voice.

Not surprisingly, there are specific exercise programs that singers use to keep their voices working effectively. Just as they say with regard to sex, “if you don’t use it, you lose it;” yet another parallel between vaginal tissue and the vocal chords.

  • Kadakia S, et al. The Effect of Hormones on the Voice. J Sing. 2013 May/June;69(5):571-4.
  • Benninger MS, Abitbol J. Dysphonia and the Aging Voice. Voice. American Academy of Otolaryngology-Head and Neck Foundation; 2006:67-85.
Hormones and the Aging Voice2017-12-11T16:24:52-05:00

What Does Tinnitus Have To Do With Hormones?

What Does Tinnitus Have To Do With Hormones?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Tinnitus, commonly known as “ringing in the ears,” is prevalent among the elderly and in women. The severity can vary from a mild annoyance to significantly disturbing.

Tinnitus may also be associated with deafness and dizziness. Most will experience a temporary tinnitus when exposed to loud sounds. Loud sounds can also induce a chronic tinnitus.

The “ringing in the ears” can actually be heard as a variety of sounds such as ringing (the word tinnitus comes from the Latin word for “ringing”), buzzing, whooshing, swishing or clicking. These sounds create a background of noise when there is no sound actually present. In his book Musicophilia, Oliver Sachs even reports cases of tinnitus of a musical nature. The American Tinnitus Association website has recordings of the various sounds of tinnitus.

The onset of tinnitus in women seems to be particularly related to periods of hormone variability. It can be triggered by PMS, perimenopause, menopause and pregnancy. Menopausal symptoms such as sweating, hot flashes and mood changes may correlate with tinnitus.

Tinnitus can also be caused by some prescription medications, including antidepressants, aspirin and quinine, some antibiotics, benzodiazepines, anticonvulsants, some chemotherapy and certain diuretics. Sometimes conventional hormone treatments have brought on tinnitus. A review posted at compiled the details on side effects from 69,299 Premarin users, of whom 0.5% have reported tinnitus as a side effect. The incidence increases dramatically with the number of years on Premarin, and no one reported a recovery. While the search for a pharmacologic solution for tinnitus has been on for decades, there have not been any successful candidates thus far.

However, while presenting at the Royal Society of Medicine on May 8, 1985, Dr. Albert Gray successfully treated 7 of 14 patients with an injection of thyroxine (T4) solution through the tympanic membrane of the ear. Tinnitus has been identified as a symptom of both hypo- and hyperthyroidism. This observation should trigger more investigation into the thyroid status of a sufferer.

Tinnitus treatments involving the injection of other drugs (particularly the synthetic analogs to hydrocortisone) through the tympanic membrane have been attempted, also without success. Otologists had reasoned that this procedure would allow a larger concentration of the drug to reach the inner ear, and that the localized treatment would be more likely to have an effect.

Research in the last decade has increased our awareness of hormones acting on the central and peripheral nerves. Low estradiol, for instance, may be responsible for confusion in the transmitting of sound signals from the ear to the brain, possibly resulting in tinnitus.

In 2012, researchers from Nigeria reported on the correlation of vitamins C and B12 and melatonin by examining those levels in a group of elderly people, some with and some without tinnitus. They found no significant correlation with vitamin C levels, but found significantly lower levels of B12 and melatonin in those people with tinnitus.

Treatment options now offered include counseling, cognitive behavioral therapy, auditory stimulation, and neuro feedback. Efforts to mask the noise, such as using white sound or hearing aids, are also sometimes used. Drug therapies are not effective at treating tinnitus but may be offered to treat anxiety, depression or sleep deprivation, which may accompany it.

An evaluation of nutrition (particularly with regard to the B complex vitamins), stress levels, exposure to loud noise and hormone balance may be avenues to explore for tinnitus relief.

What Does Tinnitus Have To Do With Hormones?2018-04-05T11:22:18-05:00

Controlling Stress Promotes Healthy Aging

Controlling Stress Promotes Healthy Aging

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Controlling cortisol and insulin levels are essential strategies in the quest for healthy aging. These hormones cause an increase in metabolic stress which leads to abdominal weight gain, chronic inflammation and telomere shortening. Metabolic aging can be partially offset by an increase in DHEA and testosterone coupled with a decrease in cortisol and insulin. Low hormone levels can be aided by supplementation. Exercise has been shown to increase DHEA and decrease cortisol and insulin levels.

Certain personality types experience an exaggerated stress response with higher than usual cortisol and insulin levels. It is theorized that individuals with anxiety or low self-esteem, who suppress negative feelings like anger and fear being evaluated by others, are prime candidates for premature aging. Progesterone, particularly in capsule form, has a calming effect on the nervous system.

A small study of 36 menopausal women found an association between pessimism and an increase in Interleukin-6, an inflammatory substance, as well as shorter white blood cell telomere length. Both are probable markers of premature aging.

  • Epel ES. Psychological and Metabolic Stress: A Recipe for Accelerated Cellular Aging? Hormones (Athens). 2009 Jan-Mar;8(1):7-22.
  • O’Donovan A, et al. Pessimism Correlates with Leukocyte Telomere Shortness and Elevated Interleukin-6 in Post-Menopausal Women. Brain Behav Immun. 2009 May;23(4):446-9. doi: 10.1016/j.bbi.2008.11.006. Epub 2008 Dec 11.
Controlling Stress Promotes Healthy Aging2017-12-08T12:41:21-05:00

Book Review – The Edge Effect by Eric R. Braverman, MD

Book Review – The Edge Effect: Achieve Total Health and Longevity with the Balanced Brain Advantage by Eric R. Braverman, MD

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


In The Edge Effect: Achieve Total Health and Longevity with the Balanced Brain Advantage, Dr. Eric Braverman introduces the notion of a series of “pauses” that occur as we age, such as menopause. Some women experience their first menopause symptoms as young as in their 30s, characterized by dramatic drops in testosterone and progesterone. Estradiol losses may also start in their early 30s. Diminished bone density, less abundant hair, and cognitive dysfunctions accompany the loss of these sex hormones. Andropause (the male equivalent of menopause) typically starts around the mid-40s and continues over the next 30 years with similar effects.

Dr. Braverman points out that our bodies go through many other “pauses” as we age:

  • Up until about the age of 30, bone mass increases or is near optimal. After that, osteopause begins. The availability of proper nutrients in the diet typically starts to be a concern, plus the ability to absorb and make use of those nutrients has also started to decline.
  • During the 30s and 40s, dermopause begins to show with diminished skin thickness, flexibility, or elasticity, all of which are related to the ability to make collagen. The skin also becomes increasingly dehydrated.
  • The maximum heart rate achieved during exercise typically peaks in the 40s, marking the beginning of cardiopause.
  • Along with cardiopause is vasculopause, which is characterized by high blood pressure and diminished blood flow.
  • Thyropause starts generally in the 50s, when the production of thyroid hormone and calcitonin is reduced.
  • Thymopause starts even earlier. The thymus gland aids our immune system by directing the function of T lymphocytes (or T cells). Although this continues life long, the thymus starts to shrink and accumulate fatty tissue at puberty.
  • From the 50s to the 70s there is a marked decline in lung function or pulmonopause. In fact, the effectiveness of breathing is a prime indicator of longevity. Stress, anxiety, and exposure to pollutants negatively affect pulmonary function.
  • Adrenopause, which is characterized by diminished DHEA, can begin as early as the 30s and up through the 60s. By the 70s, without adequate DHEA, cortisol levels also soar. This unhealthy state has earned cortisol the title of “death hormone” because there are so many issues associated with diminished adrenal function. Primary health concerns include changes in focus, memory and attention, depression, lack of energy, loss of libido (especially with women), anxiety, panic attacks, and increased appetite, all symptoms that we readily associate with advanced aging.
  • The loss of muscle mass is another hallmark of aging. By the 90s, 20-40% of muscle mass is lost. This is known as somatopause, and includes reduced muscle strength as well as reduced mental ability.

All of the above are physical “pauses” that typically occur; however, Dr. Braverman and most people believe that the “pauses” related to brain function are even more critical to measuring how well we age:

  • Sensory pause refers to the loss of sensory functions. Hearing starts to decline in the 20s to 40s. The sense of smell starts diminishing in the 40s and more rapidly declines after age 65. Nearsighted increases in the 40s but the ability to see fine details starts to decline in the 70s.
  • Pituitary pause refers to the decline in function of the pituitary and hypothalamus, which are the glands that are masters to the sex hormones, adrenal hormones, thyroid hormones, and more.
  • Electropause refers to the loss of voltage, speed, rhythm and synchrony. For instance, just a 10% drop in voltage can signal signs of depression. With a 90% drop, dementia is a reality.
  • Biopause relates to the brain mediated control of the cascade of all the other pauses.

Other neuropsychiatric disorders can occur at any age but they are especially prevalent in those over 85 years of age, affecting as many as 50% of that population. These types of disorders include cognitive dysfunction and dementia, substance abuse, and personality disorders.

The neurotransmitter hormones Dr. Braverman believes are at the center of delaying the “pauses” are GABA, dopamine, acetylcholine, and serotonin. He correlates the dominance of one or the other of these neurotransmitters to personality types, such as those used in the Myers-Briggs test. His book is brimming with questionnaires to help identify your personality type and neurotransmitter dominance. In addition, he provides guidance as to “bending one’s chemistry the right way” with diet and exercise, as well as supplementing nutrients and bioidentical hormones, and making changes to your lifestyle and/or environment. Further, he invites you to explore how technology can positively affect your brain chemistry.

This litany of “pauses” presents a grim picture of aging. However, Dr. Braverman suggests that there is no reason we can’t slow down their progression. He believes that the brain, and our ability to make and make use of the neurotransmitter hormones in a balanced fashion, is the key to doing so.

  • Braverman ER. The Edge Effect: Achieve Total Health and Longevity with the Balanced Brain Advantage. New York, NY: Sterling Publishing Company, Inc.; 2005.
Book Review – The Edge Effect by Eric R. Braverman, MD2018-05-02T12:15:55-05:00

Blood Sugar and the Aging Brain

Blood Sugar and the Aging Brain

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


Alzheimer’s Disease is sometimes called the “Disease of the Baby Boomers.” So it is not surprising that current brain research is focusing on this disorder.

A recent study on blood sugar levels and brain deterioration by Dr. Cherbuin and associates looked at 266 healthy, non-diabetic individuals, ages 60-64. The results indicated that high normal-fasting blood sugar levels were associated with brain wasting, particularly in areas relevant to aging. In another study, abnormally high blood sugar levels were associated with shrinkage of parts of the teenage brain as well.

Low testosterone, as well as high cortisol levels and estrogen/progesterone imbalances, can also lead to blood sugar/insulin disturbances.

Although more research needs to be done, controlling blood sugar levels through a healthy diet and exercise may prove to be beneficial in maintaining healthy brain function throughout life.

  • Cherbuin N, et al. Higher normal fasting plasma glucose is associated with hippocampal atrophy: The PATH Study. Neurology. 2012 Sep 4;79(10):1019-26. doi: 10.1212/WNL.0b013e31826846de.
  • Yau PL, et al. Obesity and Metabolic Syndrome and Functional and Structural Brain Impairments in Adolescence. Pediatrics. 2012 Oct; 130(4).
Blood Sugar and the Aging Brain2018-04-03T16:59:57-05:00

Book Review – Moods, Emotions, and Aging by Phyllis Bronson, PhD

Book Review – Moods, Emotions and Aging: Hormones and the Mind-Body Connection by Phyllis Bronson, PhD

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Dr. Phyllis Bronson’s book, Moods, Emotions, and Aging, could not have been published at a better time. Brisdelle, a version of Paxil or paroxetine, has just been approved by the FDA as a treatment for hot flashes, despite an advisory committee vote of 10-4 against it. Hot flashes, a symptom of menopause believed to be an effect of hormone deficiencies, may now be treated with a potent and highly addictive SSRI (selective serotonin reuptake inhibitor) that has extremely dangerous side effects, including suicidal thoughts.

It is time for the “silver tsunami” that is the powerful baby boomer demographic to wake up to the fact that we don’t have to drug ourselves into oblivion to address the consequences of age-related hormonal changes. Hot flashes are NOT the result of an SSRI deficiency! There are better answers and we have the power to demand them.

Dr. Bronson’s book will equip anyone facing the challenges of hormone deficiencies. Because she works with and writes about real people with serious mood and hormone imbalances, her readers may see themselves in the patient stories she tells and be inspired to take action to resolve their own health issues.

Phyllis Bronson is a rare individual who brings science to practice in her role as a clinical biochemist. Too often, the science and studies are readily available but clinicians don’t or won’t seek them out. Or, if they do, they are ostracized by their peers for stepping out of the box their medical education has defined for them.

Dr.  Bronson asks the hard questions of our organized medical providers:

  • Since the WHI studies (which are discussed at length in the book) revealed significant problems with the use of Premarin and Prempro, why are patients still being prescribed these products (albeit in “lower” doses)?
  • Why are women being offered antidepressant drugs instead of estrogen hormones, when she has seen women with low estradiol levels resolve their complaint about brain fog within an hour after supplementing with estradiol?
  • Why are women systematically being denied the use of progesterone when their ovaries are removed, when the bioidentical hormone progesterone has been shown to be protective of nerve tissue and potentially protect against cancer?

In addition to the hormones made from cholesterol in our bodies (e.g., the sex and adrenal hormones), there are also hormones derived from amino acids. Amino acids are the building blocks of the proteins we eat, and they become available to the body when protein is digested. Dr. Bronson found that it is easy to supplement amino acids to help balance hormones such as dopamine and serotonin. Here’s a radical thought: Instead of blocking the metabolism and reuptake of serotonin in the nerve synapse, which is what SSRIs do to raise serotonin levels, what if we supplement the body with the building block amino acids needed to make more serotonin? This is the path Dr. Bronson prefers, and she describes in her book how this has worked successfully for her clients.

In the book Honest Medicine, Dr. Burt Berkson describes how medical students are not encouraged to question or think. Their education is now just “training” consisting of whatever the current consensus determines to be the current standard of care. Unfortunately, standards of care can be influenced by people with motives that are not necessarily in line with what might be best for individual patient care.

Is your practitioner willing to go beyond the “training” received in medical school? Is she or he ready to partner with you to achieve optimal individualized care? Then Dr. Bronson’s book will be an asset to both of you as you jointly evaluate your biochemical individuality and consider treatment accordingly.

Another valuable facet of Dr. Bronson’s book is the discussions of how emotional issues can both provoke and be a result of hormone disarray. With the myriad of tools provided in this book, people who may have “lost” themselves emotionally may be able to find a pathway back.

Book Review – Moods, Emotions, and Aging by Phyllis Bronson, PhD2017-12-14T12:27:47-05:00

September is Healthy Aging Month

September is Healthy Aging Month

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


In The Singularity is Near, Ray Kurzweil and Dr. Terry Grossman write that if we manage to keep ourselves going for the next 20 years, there is reason to believe that we will have learned enough about human physiology that the potential for living indefinitely could become a reality.

This interest in healthy, successful aging has spawned several professional medical groups that are actively addressing the issues, including the American Academy for Anti-Aging Medicine (A4M), the Age Management Medicine Group (AMMG), the American College for the Advancement in Medicine (ACAM) and the International College of Integrative Medicine (ICIM).

Although it is not their primary focus, the practitioners in these groups support the belief that adequate and balanced levels of hormones are one of the foundations of successful aging.

Here are some of the health issues they are up against in their quest for understanding how we age, and what might be explored to help improve the aging process:

  • The cardiovascular system becomes compromised as the heart struggles to pump blood efficiently and arterial walls are weakened. High blood pressure, arrhythmias, and heart failure symptoms may ensue. However, testosterone is one of the most heart-healthy hormones, and growth hormone supplementation has proven to be of great benefit to a failing heart. Dr. Broda Barnes reported that, with adequate thyroid supplementation, his patients did not get heart attacks.
  • Bones, joints, and muscles continually weaken, and pain is often a consequence when these tissues become compromised. Sarcopenia, the medical term for loss of muscle mass, also contributes to an overall frailty and weakness. These symptoms are all correlated with low growth hormone, low testosterone, low DHEA, low estrogens, low progesterone, low thyroid, and low vitamin D. The stress hormone cortisol may be contributing to tissue damage as well if it remains high over extended periods of time.
  • The digestive system becomes compromised with low stomach acid, and a tendency toward constipation increases with age. If there is not enough thyroid activity in the body, the entire digestive tract slows and stagnates.
  • Weight gain, particularly around the middle, is very common in people as they age. While proper utilization of insulin and glucose are critical, low thyroid hormones are also typically part of pre-diabetic and diabetic dysfunction. Hormones such as testosterone and progesterone help to stabilize blood sugar levels. Excess cortisol (the stress hormone) encourages fat deposits.
  • Urinary and bladder issues become a major factor in a deteriorating quality of life. Estrogens, particularly estriol, are needed to keep the urinary tract and bladder tissue healthy. Testosterone is needed to maintain the strength and integrity of the tissues.
  • “I am worried about losing my mind” is a very common concern for people as they age. All of the sex and adrenal hormones are “neuro” steroids, which means that they actually concentrate and function in the brain. Thyroid hormones contribute to keeping memory sharp.
  • Losing eyesight and hearing are also debilitating problems associated with aging. The upper eyelids droop when growth hormone is deficient. Tears need estrogen, testosterone and DHEA for an adequate composition of the fatty component. Aldosterone has demonstrated some effectiveness in treating age-related deafness.
  • The teeth may become more brittle and the gums retract. Associated with osteoporosis, these symptoms are linked to deficiencies of vitamin D, the estrogens, testosterone, DHEA and growth hormone.
  • The skin becomes increasingly wrinkled, thin, and prone to bruising. Estrogens maintain the moisture and structure of the skin. Testosterone and growth hormone are needed to retain skin thickness and structure.
  • For many people, sexuality has just about disappeared. With low testosterone and low estrogens, many men and women may not be able to function sexually, and they may not even care because those hormones also control sexual interest (the libido).

This litany of ailments sure paints a dismal picture of what lies ahead. However, this is an exciting time for medicine, and the professional focus on successful, healthy aging shows great promise. After all, what practitioner does not take great joy in seeing patients continually improve?

Our goal is to plant a seed for you—right now, during Healthy Aging month, no matter what age you are—to start exploring the knowledge and tools readily available to better prepare yourself for the aging process.

You can be tested and evaluated clinically to determine which hormones may be deficient and which may be excessive. You can choose to make important lifestyle changes so the basic needs of good food, as well as clean air and water are met. You can keep your body running smoothly by physical activity, healthy play and exercise. And, with the help of practitioners attuned to healthy aging, you can choose to replenish those hormones that decline with age and take steps to moderate the ones that tend toward excess.

September is Healthy Aging Month2019-04-25T17:12:56-05:00