Whether hormones help or hurt your brain depends on the type and the dose.
By John R. Lee, M.D. and Virginia Hopkins

The latest revelation about HRT is that not only does conventional HRT not help with Alzheimer's disease and other types of dementia in women, it actually doubles the risk of getting them in women over 65.

This research from the Women's Health Initiative (WHI) was published in the May 28, 2003 Journal of the American Medical Association (JAMA) and is based on a four-year experiment involving 4,532 women. Half took placebos, and half took PremPro, a combination of estrogen and a progestin. In four years, there were 40 cases of dementia in the hormone group, and 21 in the placebo group. If we extrapolate that out to the real numbers of women who were taking conventional HRT before last summer, that's 68,000 additional cases of Alzheimer's annually, caused by a misguided approach to hormone replacement.

Here's what I wrote about HRT and Alzheimer's back in 1998:
“Estrogen has been promoted by the drug companies as a remedy for Alzheimer's but until recently they were all short-term studies or they failed to consider other obvious risk factors. A study reported in the Journal of the American Geriatric Society (July '98) found that women whose own estrogen was higher did not have better cognitive function or a lower risk of cognitive decline (senility), and in fact, some of the women with higher estrone levels did worse on cognitive tests.

There's no doubt that estrogen has a beneficial effect on the brain at normal levels, but I believe that as soon as estrogen dominance or excess occurs, the benefit is lost.”

Here's what I wrote about HRT and Alzheimer's in 1999:
“In April, TV news programs around the U.S. aired a clip reporting that a Journal of the American Medical Association (JAMA) study found that estrogen supplementation improved memory in menopausal women. In fact, the study found that estrogen supplementation increased brain activation patterns, but the authors clearly reported that, “Estrogen did not affect actual performance of the memory tasks.” (emphasis added). Thus, the study merely confirmed what has been long known, namely that estrogen increases brain cell membrane excitability. But it did not show, contrary to the TV news report, that estrogen supplementation improved memory in menopausal women.

It is well known that estrogen increases brain cell membrane excitability. In balance, this has a beneficial effect on the brain. A deficiency of estrogen can lead to depression, and an excess can lead to anxiety and poor sleep. Most postmenopausal women are making plenty of estrogen in their fat cells and don't need supplemental estrogen for good brain function.

It is also known that progesterone has a calming effect on brain cell membranes. In fact, in physiologic doses it allows the brain to concentrate, or focus better. In excess it can cause lethargy or sleepiness, which is often reported when women use oral progesterone. Women using physiologic doses of progesterone notice that their brain performance for memory or for tasks that require concentration is improved; they also note better sleep and less anxiety.

The JAMA study merely reaffirms the fact that excess estrogen can increase brain cell excitability without increasing brain performance. In other words, being hyper, anxious and sleep deprived does not make you smarter. If you think you might be estrogen deficient, it's a good idea to get a saliva hormone test to find out for sure.”

Here's what Virginia Hopkins wrote about HRT and the brain in the Hopkins Health Watch in 2000:
“A few years ago a very small study showed that estrogen increased “brain excitability” in older women, and this was widely and inaccurately reported by the media as proof that estrogen could help treat Alzheimer's victims. Suddenly everything we read about estrogen claimed, without qualification, that it was good for Alzheimer's and/or brain function.

A study done at the University of California at Irvine, and published in the Feb 22, 2000 issue of JAMA (Journal of the American Medical Association) helps debunk the estrogen-Alzheimer's myth. Researchers studied 120 women with mild to moderate Alzheimer's. They were either put on “high” estrogen, “low” estrogen, or a placebo every day for a year. The women were given a variety of cognitive tests, and those taking estrogen fared slightly worse than the placebo group in a rating of dementia.

The researchers concluded that, “Overall, the results of this study do not support the role of estrogen in the treatment of Alzheimer's.”

In other words, the evidence has been there all along that conventional HRT doesn't help with Alzheimer's or dementia. Ironically, PremPro, the focus of the bogus news reports, was never approved to prevent or treat Alzheimer's disease. The hype around HRT and Alzheimer's was created by the media, who unquestioningly spouted press releases put out by the makers of PremPro.

Don't Throw the Baby Out with the Bath Water
The irony of this new evidence on hormones and Alzheimer's is that estrogen and progesterone really can help brain function. I have seen or heard of literally hundreds of cases in the past twenty five years where older women who were cognitively impaired began using progesterone cream and regained their brain function. Progesterone in and of itself is good for the brain, and it also keeps estrogen receptors functioning. I have also heard over and over from estrogen-deficient menopausal women over the decades that their brains work better when they're using a little estrogen. There are good, solid, physiologic and biochemical reasons for this. So why does conventional HRT do more harm than good?

• The dose of estrogen is too high. Excess estrogen causes over-excitation of the brain, which damages the brain and causes insomnia and anxiety. Excess estrogen also increases the risk of blood clots. This may not show up as an actual stroke, but can damage tiny blood vessels in the brain, which interferes with brain function.
• The estrogen is combined with medroxyprogesterone acetate (Provera), a progestin with a long list of nasty side effects, some of which include negative effects on brain function. There is no reason for a menopausal woman to ever take a progestin. Estrogen should always be combined with progesterone.

A Few Fundamentals about Good Brain Health
Although conventional medicine has no cure for Alzheimer's disease or even dementia, there is a lot we know about what causes brain dysfunction and how to prevent it. Here are some keys to optimal brain health. You can find out more about maintaining optimal brain function in my booklet, Get Smart about Your Brain.

Take Physiologic Doses of Natural Hormones as Needed: Menopausal women should get a saliva hormone level test to find out if they have a hormonal imbalance. Deficiencies can be supplemented with doses of natural hormones that match what the body made when the ovaries were functioning properly. It is counter-productive to use high doses of hormones, and this includes progesterone.

Details on saliva hormone level testing, as well as specifics on recommended dosages and timing of hormone use can be found in all of my “What Your Doctor May Not Tell You” books.

Avoid Sugar and Refined Carbohydrates: Good circulation and B blood vessels are one of the foundations of good brain function. It is well established that the chronically high blood sugar and insulin levels created by eating too much sugar and refined carbohydrates damage blood vessels, making them weak and “leaky.” This is most clearly demonstrated in people with diabetes, who have a greatly increased risk of Alzheimer's and dementia. Regular exercise is also one of the fundamentals of good circulation.

Avoid Brain Toxins: You wouldn't sniff glue, because you know it can damage your brain, but how about stripping varnish, repairing an irrigation pipe, using paint thinner to clean a brush, putting on or taking off fingernail polish, or breathing the fumes while you put gas in your car? In every case you're unnecessarily exposing your brain to toxic fumes. Don't do that! Wear a mask and work in a well-ventilated area when using a volatile chemical, and stay upwind of gas fumes.

Avoid Aluminum: We don't know how or why aluminum contributes to the plaques that are seen in Alzheimer's disease, but we do know it's there and it makes sense to avoid it. Don't cook in aluminum pans, use deodorant sprays that contain aluminum, eat food that's been wrapped in aluminum foil or drink water that's been fluoridated with aluminum fluoride. (Don't drink water that's been fluoridated, period.) Heavy metals such as mercury and lead also clearly have devastating effects on brain function.

Use It or Lose It: It's true – people who use their brains more have a lower risk of Alzheimer's and dementia. In fact, autopsies show that the effects of Alzheimer's can be greatly reduced by education. A study in the journal Neurology showed that the plaques typical of Alzheimer's patients had less effect on the brain performance in those with more education.

Brain expert Joseph LeDoux, author of Synaptic Self: How Our Brains Become Who We Are, maintains the brain becomes accustomed to whatever you give it. If you stimulate your brain and learn new things, new pathways are forged and your brain power is expanded. This could be something as simple as learning your way around a new town, doing crossword puzzles, or playing bridge every Thursday night. Balance your checkbook without the calculator, help a child with homework, learn how to play a musical instrument, and exercise your curiosity. While daily routines are comforting and reassuring, it will perk up your brain if you change things now and then.

The bottom line is that if you pay attention to your brain health and take an active interest in the world around you, your brain will be the better for it. As Dr. Phil likes to say, “I want you to get excited about your life!”

Buddhist Brains Light Up
Researchers in Wisconsin studying the brains of Buddhists who meditate regularly found that their left prefrontal lobes “light up” the testing equipment even when they aren't meditating. These areas of the brain, just behind the forehead, play a major role in foresight, planning and self-control, as well as a lesser role in emotion, mood and temperament. The persistent activity indicates positive emotion and good mood.

Researchers in San Francisco are also studying the brains of Buddhists, and so far have found that experienced meditators aren't shocked or flustered by unpredictable sounds as easily as ordinary people. This may be an indication of a state of calm in the amygdala, an area of the brain involved with more primitive emotional and behavioral responses.

This research Bly indicates that we can create more happiness and contentment within ourselves through focused spiritual practice. Who needs Prozac when you can chant a tone?

This article was originally published in the John R. Lee, M.D. Medical Letter. Although the Medical Letter is no longer published, you will find many articles from it on this website.