Confusion about Lp(a)

Since the recent reader question about Lp(a), I've had several other instances of confusion over Lp(a).

To help you navigate through some of the often confusing issues behind this complex genetic abnormality, here are some common sense rules to follow. When you ask your doctor to draw a Lp(a), try to be certain that:

--the same laboratory is always used. Just going from lab to lab can account for huge variation in Lp(a). As standardization proceeds internationally, this will be become less important. But in 2006, it's still an issue.

--you and your doctor resist the temptation to check Lp(a) frequently. I saw a patient recently who was having Lp(a) levels nearly every month. This is pointless. Lp(a) changes very slowly. Checking it frequently will not allow any treatment to be fully reflected. All you'll observe is random variation that can be frustrating. We wait at least 6 months before re-checking after a new treatment is introduced.

If you have a choice, I would recommend you opt for the measure provided by Liposcience (NMR). The technique they use is a particle count measure, rather than a weight-based measure. This may be more accurate, particularly when Lp(a) is small.

Lp(a) remains among the more difficult patterns to understand and correct. Don't be surprised if you encounter a lot of confusion from your doctor, as well. You may end up providing much of his/her education.

Comments (2) -

  • Anonymous

    11/2/2009 12:24:29 AM |

    I had the lipid test at Berkley about four years ago..and I was told two things..that I had a clotting problem and that I should avoid omega fats..that I had the type cholesterol that omegas were not good for.
    I can't get into see my records at berkley and my cardiologist died a couple weeks ago and I can't get any response on my records. My current doctor and I am midwest instead of south east now..is asking about these and I don't know how to answer him. Why would omega be bad?

  • Anonymous

    11/2/2009 12:25:17 AM |

    sorry I sent the question about omega fats and cholesterol. danellerene@ymail.com

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The ultimate “bioidentical” hormone

The ultimate “bioidentical” hormone

There has been a lot of debate over whether or not “bio-identical” hormones, i.e., hormones identical to the human form, are superior to non-human forms dispensed by the drug industry.

The FDA is currently taking steps to clamp down on availability of bioidentical hormones and their claims of superiority, despite a groundswell of grassroot support for them. The argument has pitted anti-aging practitioners and the public, as well as the likes of Oprah and Suzanne Somers, against Big Pharma and the FDA, the two forces trying to squash the bioidentical hormone movement.

Regardless of what heavy-handed approach the FDA takes, we already have access to hormones identical to the original human form. It requires no prescription and yields downstream hormones that the human body recognizes as human.

That "bioidentical" hormone is pregnenolone.

Pregnenolone is the first biochemical step in the conversion of dietary cholesterol (yes-cholesterol!) to numerous other hormones. Pregnenolone is the source of the hormones that lie at the center of the bioidentical hormone controversy: estrogens, progesterone, and testosterone. We therefore already have our own over-the-counter, non-prescription form of bioidentical hormones.

Supplemental pregnenolone increases estrogens (mildly), progesterone, and testosterone. Prenenonlone supplementation simply provide more of the basic substrate for hormone production. The increase in hormones is usually modest, not as vigorous as direct hormone replacement like, say, testosterone or progesterone topical creams. But pregnenolone can be useful when small to moderate increases are desired, such as for reduction of Lp(a). A theoretical downside is that pregnenonlone can also convert to cortisol, the adrenal gland hormone that regulates fluid and blood pressure. However, I've not seen any measurable increase in cortisol with low doses of pregnenonlone and limited data suggest that it does not. Pregnenolone also converts to the other adrenal gland hormone, DHEA; I call DHEA "the hormone of assertiveness," since some people who take too much pregnenolone (or direct DHEA) acquire excessive assertiveness.

The key to pregnenolone supplementation is to proceed gradually and begin with a small dose, e.g., 5 mg every morning. Hormonal assessment is best conducted periodically to assess the effects and to determine whether a dose adjustment is in order.

Comments (19) -

  • Jenny

    7/2/2009 12:46:09 PM |

    Dr. Davis,

    I have tried  "bioidentical" female hormones from a compounding pharmacy and ended up with sky high blood pressure and blood sugar. I do very well on the pharmaceutical yam-based estrogen. So I would caution people not to assume these hormones are benign.

    I also have supplemented pregnenolone for a while and had to stop as I also started to see bad results with blood pressure and a hint of masculinizing.

    So I would warn older women to be very careful with these hormones. The doses seem to be set very high and some of them may be optimized for males.

  • Nancy LC

    7/2/2009 4:36:31 PM |

    Dr. Davis, do you recommend any particular brand of pregnenelone?

  • billye

    7/2/2009 9:06:47 PM |

    Dr. Davis,

    Ordinarily I would have no interest in the ultimate " bioidentical" hormone" but, my daughter is going through her changes and is having a bad time with them.  Could pregnenelone be used to alleviate problematic symptoms? She is dead set against hormone therapy because she has a fear of  cancer.

  • Anonymous

    7/3/2009 3:04:08 AM |

    Bioidentical hormones have been a godsend for me... after "toughing out" a particularly long and difficult perimenopause I was in pretty dire straits.  I found a doctor who uses both mainstream Big Pharma hormones and bioidenticals in his ob/gyn practice, depending on the patient and their needs.  He is board certified, highly skilled, and compassionate.  After some trial and error and numerous blood tests, we arrived at compounded estrogen and progesterone as the best for me.  Gone are many horrible symptoms, so of course I would be very upset if the FDA were to "crack down" on "bioidenticals" in favor of manufactured Big Pharma products.

    That being said, if the FDA is so inclined... I will roll with it.  There are several prescription estrogen products, both oral and topical that could meet my needs.  They are for the most part manufactured from soy (as are most bioidenticals).  There are also some progesterone products manufactured by Big Pharma companies... and I am betting we can figure out how to get to the combination and dosage I require to feel good and normal.

    What won't I take?   Well Premarin and Prem-Pro for starters.  They're not bioidentical... in fact they are foreign to the human body.  Equilin,  derived from pregnant mares urine, or manufactured from soy, is not a requisite of the human body and IMO doesn't belong there. Give women a foreign hormone substance for years and wonder why the alarming results?  Hummm...

    As for pregnenolone, I don't think so, at least not for me.  At this late date, I doubt that my body would be efficient in utilizing it, or sending it down the correct pathway.  Why not just use the real things?

    madcook

  • Anonymous

    7/3/2009 3:42:55 AM |

    DHEA can cause substantial hair loss in men, it did suddenly and acutely in me.

  • pmpctek

    7/3/2009 4:42:09 AM |

    I'm no expert but it's my understanding that pregnenolone is the raw material for the production of DHEA, which is the raw material for the production of testosterone, estrogen, and progesterone.

    It's also my understanding that it's always best to try and supplement "bioidentical" hormones that are closest to the natural target hormone.

    If that's true and if pregnenolone is low and DHEA normal (say through supplementation) what's the point of taking pregnenolone at all?

  • Anonymous

    7/3/2009 2:15:38 PM |

    I've been on bioidentical hormones (progesterone) for 18 months and have had incredible success. I'm under the care of a MD who specializes in bioidentical hormones. Bioidenticals are safe and effective if the supplementation is medically supervised.

  • Anna

    7/3/2009 5:27:29 PM |

    At 47 yo, still cycling regularly but definitely perimenopausal the past few years.  New cycles start every 14-20 days (normal in every other way) if I don't use progesterone, but with progesterone, cycles are closer to normal length, every 21-28 days.  

    I've been using bioidentical OTC progesterone cream for a little over two years with very good results and no side effects that I can detect.  Just this week I switched to a higher prog dose via compounded Rx, as symptoms were returning/increasing the past couple months (especially midcycle extreme breast tenderness and increased lumpiness- negative ultrasound and mammograms though thermogram was suspicious, plus last exam indicated return of uterine fibroid - all suggestive of high estrogen/low progesterone imbalance).  

    A recent luteal phase test of estradiol showed it to be twice as high (549 pg/ml) as the upper end of the ref range, which explains the dramatically increased symptoms.  Guess those ovaries are screaming in protest during their decommissioning!  Progesterone levels were in the tank.  So was 8am cortisol level.  

    BTW, I've always avoided any supplemental phytoestrogens such as soy, "menopause" herbs, etc.  Numerous lood tests over the past 15 years have indicated no lack of estradiol (esp in recent years), but in fact, chronically low progesterone, despite regular cycles.  

    Along with years of undiagnosed hypothyroidism, I think low progesterone and a slightly shortened luteal phase were likely reasons why I had trouble conceiving 8-15 years ago (despite two infertility work-ups and "expert" review of my tests).  Wish I knew then what I know now (don't we all?)

    This backlash against biodidentical hormones, orchestrated by Wyett and other Big Pharma patent holders is very disturbing.  Like any other drug, the skill, experience, and knowledge of the doctor is crucial in prescribing them for the best effective treatment.  

    I've been cautious about self-treating with OTC hormones without some experienced guidance, including pregnenolone, because I wasn't sure it wouldn't convert to more estradiol instead of the progesterone and testosterone I needed.  But it took a long time to find an MD which the right experience.  Of course, she's not in my HMO-subscribed system so I have to pay out of pocket for office visits or compounded Rx, but it's worth it.  She writes the lab orders on a Rx form, which I take to the HMO lab, so insurance covers any of the lab tests they do.  Results are faxed to the ordering MD, even though she isn't in the system.

  • Jim, Guacamole Diet

    7/5/2009 3:41:40 AM |

    I guess I'm just an ignorant old Luddite, but I'm skeptical of all substances that don't come in natural foods. No prescription or OTC stuff for me if I can avoid it.

  • homertobias

    7/9/2009 3:39:50 PM |

    Anna,

    Late 40's are a rough time of life, kind of like being a 13 year old girl in reverse.  Ovaries are cranky as they rev up and as they rev down.  Next they start behaving like loose lightbulbs. They turn off for a month or three then they turn right back on.  It is hard to relie on hormone levels in that phase because things just keep changing.
    Late 40's usually screams progesterone deficiency.  First up to treat is usually vitex 500mg whole fruit daily.  Takes 3 months for full effect. Dirt cheap.  It works as a prolactin inhibiter and a progesterone booster.  Second is progest cream.  Third compounded progesterone or prometrium.  Route of prometrium varies with symptomatology.  Can't sleep?  Progesterone needs to be oral.  Still can't sleep?  Take it with food at bedtime to enhance absorbtion or up the dose.  Hung over in the morning?  Take it earlier.  Sleep not an issue but can't stand those early periods?  Use the progesterone vaginally at night.  Just shove it in as high as it will go.  The gelatin capsule dissolves and it goes straight to the uterus.

  • Elizabeth

    7/14/2009 9:58:46 PM |

    From my experience, bioidentical hormones really do work! After hearing so many people, like Susanne Somers and Oprah, talk about the
    benefits of hormone replacement
    therapy, I decided to give it a try. I looked around a lot, and I
    finally chose VieNue
    Bioidentical Testosterone Cream. All I have to say is, IT WORKS! My mood
    is so much better. I feel healthier. I have a healthy love life again - I
    used to always feel so "not into it." Now my husband and I are connecting
    again like we did years ago. Definitely give VieNue Bioidentical Testosterone
    Cream a try, you won't regret it. Here's the link vienue bioidentical testosterone cream

  • Anonymous

    7/26/2009 7:09:24 PM |

    You need to do a lot of reserach before starting hormone therapy... You should always have your hormones tested first! Saliva test is the best way to test your hormones levels. Also you need to use a compounding pharmacy that you can trust and a good doctor. This website helped to show why to choice bioidentcal hormones and you can even find a doctor in your area: http://www.bodylogicmd.com/research/safety-of-bioidentical-hormones

  • Amir

    8/21/2009 1:27:30 AM |

    I have been researching the bioidentical hormone therapy topic for a while and would like to see what people's opinions on the health benefits of bioidentical hormones like the reduction of breast cancer as explained in this article,

    http://bodylogicmd.com/hormone-articles/review-of-hormones-and-breast-cancer-can-we-use-them-in-ways-that-could-reduce-the-risk

  • Gloria Ives

    8/24/2009 4:01:45 AM |

    Can you address the cardiovascular risks associated with bioidentical supplementation as compared to typical pharmaceutical hrt?

  • Bioidentical Hormones UK

    9/24/2009 7:21:21 PM |

    Bioidentical hormones are products that are chemically identical to what's made in a woman's body.
    Some are approved as medications; others are supplements. Learn more about it from professionals in the field.

  • Anonymous

    9/25/2009 2:36:53 AM |

    Why not simply increase dietary cholesterol?

  • Lance Chambers

    3/1/2010 1:51:02 AM |

    I have watched the video and it's sad that corporate pharmaceutical industries have to chemically alter a natural substance in order to get patent for synthetic medicine or synthetic hormones but I think synthetic hormone should not have been approved for human use in the first place. It must have helped many people but in the long run it did more harm than good.

  • Lance Chambers

    3/1/2010 2:02:38 AM |

    Bioidentical hormones refer to hormones that are identical to the chemical structure of the hormones produced by a woman’s body therefore it is better and safer than synthetic hormones. Understanding your symptoms will also help you prepare for it and modification of lifestyle issues like healthy diet of organic foods to resist minor signs, light exercise to improve blood circulation level can help regulate the symptoms of hormone imbalance. Compounded bio-identical hormones are pills, creams, gels, suppositories, injectables, sublingual drops or lozenges that are prescribed by health care providers who tailor the dose to a woman’s individual symptoms and concerns.

  • buy jeans

    11/2/2010 8:16:26 PM |

    Pregnenolone is the first biochemical step in the conversion of dietary cholesterol (yes-cholesterol!) to numerous other hormones. Pregnenolone is the source of the hormones that lie at the center of the bioidentical hormone controversy: estrogens, progesterone, and testosterone. We therefore already have our own over-the-counter, non-prescription form of bioidentical hormones.

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Prevention: Bad news in bits and pieces

Prevention: Bad news in bits and pieces

Jan clearly did not want to talk about her heart scan. Her score of 502 came as a shock to her. After all, she'd survived breast cancer just a year earlier, having been through dozens of radiation treatments, chemotherapy, not the mention the emotional upheaval.

Now I was telling Jan that she had a very high heart scan score with a heart attack risk of 5% per year. Then we got to her lipoprotein patterns: Jan had several striking abnormalities, including a misleading LDL cholesterol that underestimated her true LDL by nearly 100% (LDL particle number), small LDL, and the dreaded lipoprotein(a).

"I can't handle this! Why did I get the stupid scan in the first place?!"

Giving her a chance to collect her emotions, I discussed how, even though this business can be frightening, it's far--FAR--better than the alternative: heart attack at 3 am, rush to the hospital, stents, bypass surgery, etc. Or, death for the >30% of people who don't make it to the hospital in time.

That's why I often tell people that prevention of disease is bad news in bits and pieces. But it's a lot more manageable this way. Coronary plaque is a controllable process. You don't have much control in the midst of a heart attack.

Comments (1) -

  • fanatic cook

    10/2/2006 11:38:00 AM |

    I find it curious why people don't want to know or talk about their numbers ... blood sugar, blood pressure, blood fats.  My brain tells me it's a form of denial, but choosing not to see it won't make it go away.  I know it's not easy quitting smoking or starting an exercise program, but at least you're alive.
    That's all, don't mean to sound bleak  Smile

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