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DHEA: What role in your program?
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The arguments for and against DHEA replacement have zig-zagged from fountain of youth

to dangerous. Here, we cut through the hype and hone in on the issues

important to your plaque-control program.

“I consider DHEA the superstar of the superhormones. It not only works its wonders inside the body by rejuvenating virtually every organ system, but it actually makes you look, feel, and think better…It restores energy, improves mood, increases sex drive, enhances memory, relieves stress, reduces body fat, and even makes your skin softer and your hair shinier. I think that just about every adult age forty-five or older can benefit from taking DHEA.”

William Regelson, MD

The Super-Hormone Promise

"DHEA is the snake oil of the '90s. It makes me very nervous that people are using a drug we don't know anything about. I won't recommend it."

Elizabeth Barrett-Connor, MD

University of California, San Diego.

Debate on DHEA has polarized proponents and critics. Comments like those above reveal just how far apart views on this controversial hormone can be.

Let’s cut through the hype, hyperbole, and hoopla. Don’t believe the extravagant claims of supplement manufacturers. We also don’t want to fall victim to the over-conservative medical community’s reluctance to accept anything that doesn’t require prescription and come with a fancy dinner provided by a drug representative.

Concerns over the safety of DHEA were raised—and rightly so—in the 1980s and 1990s when multiple clinical trials of “mega-dose” DHEA (1600–3000 mg per day) led to undesirable hormonal effects: women experienced masculinizing effects like facial hair and deepened voices, men became emotional. In other words, at high doses, women convert DHEA to testosterone, men convert it to estrogen. We definitely do not want these effects.

More recent experience suggests that, when used at doses that are “physiologic”, or simply replace diminishing levels due to aging and restore youthful blood levels to those you had at age 30 or 40, the hormonal distortions don’t occur. Based on the current state of knowledge about DHEA, we can expect several potential benefits through “physiologic replacement”:

  • A modest reduction in abdominal and visceral fat results with extended use (6 months or longer).
  • A modest improvement in insulin resistance over an extended period (months).
  • People feel better taking DHEA, particularly if starting levels are low.
  • Men gain greater benefit than women. (Sorry, ladies.)

Along with exaggerated side-effects, outsized benefits also occurred with mega-dose DHEA, such as dramatic relief of depression, substantial increases in muscle mass and strength (in men), and intensified libido in women. These are less prominent at lower replacement doses.

Does this fascinating hormone possess any benefits for coronary plaque control? We believe it does. Used intelligently and with realistic expectations, DHEA can add advantage.

What exactly is DHEA?

Dihydroepiandrosterone, or DHEA, is a hormone produced by the two adrenal glands in the abdomen, sitting atop the kidneys. Men also produce up to 25% of total DHEA in their testes. DHEA is distributed throughout the body and is especially abundant in brain tissue, blood, kidneys, and liver. For years, DHEA’s precise role has been debated.

Along with declining muscle mass, bone density, sex hormones, growth hormone, and increasing body fat, DHEA levels decline starting at age 30 in men, age 40 in women, with accelerated decline after age 50. By age 70, both men and women have plummeted to 25% of youthful peak levels (Kroboth PD et al 1999). However, age accounts for only 30% of variation in DHEA blood levels; other factors influence DHEA levels, as well (Haden ST et al 2000).

It is well established that people with features of the metabolic syndrome (low HDL, high triglycerides, small LDL, high blood pressure and blood sugar, excessive abdominal fat) have lower blood levels of DHEA, probably caused by accelerated clearance (into the urine) of DHEA induced by high insulin levels (Lavallee B et al 1997), though the association is more prominent in men than in women (Haffner SM et al 1994). Interestingly, administration of metformin (Glucophage®) to reduce blood sugar also increases DHEA blood levels 50% or more (Nestler JE et al 1994). . Weight loss also results in a substantial rise in DHEA blood levels in men (Jakubowicz DJ et al 1995).

Aging, therefore, with its declining DHEA levels, is associated with increasing levels of insulin resistance, pushing us closer and closer to metabolic syndrome and pre-diabetes.

By far the most convincing demonstration of DHEA’s potential is in people (men and women) whose adrenal glands are dysfunctional and fail to produce its usual panel of hormones (“adrenal insufficiency”); these people do substantially better with replacement of hormones if DHEA is included. People feel better, are less depressed, lose weight, gain muscle, reduce cholesterol, and reduce blood pressure when DHEA is added (Arlt W et al 1999).

A drug manufacturer has seen sufficient promise in DHEA to pursue development as a drug. A pharmaceutical-grade preparation trademarked Prestara™ is in clinical trials for potential use on a prescription basis for treatment of lupus, and an intravenous form is under development to treatment acute asthma attacks and burn injuries.

(We’ve seen this sort of “transformation” before, going from nutritional supplement status to drug status, accompanied by the better-funded clinical trials of the drug companies. The most prominent recent example was fish oil—for many years a nutritional supplement, then a form “developed” by a drug company that passed the FDA drug approval process. The drug company then bashes the nutritional forms on the basis of purity, potency, or other factors that may or may not be important. We’ll likely see the same predictable process with DHEA.)

Established benefits of DHEA

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