THANKS FOR ASKING
Virginia Responds to Reader Questions
Welcome to “Thanks for Asking,” a forum where I respond to reader questions. Thanks again for asking—your questions teach us all.
Q: Thanks for the great newsletter. I am confused by one part (in your response to “58 y.o. mid-section fat” person): “Mid-section fat is usually caused by too much sugar in the diet, excess cortisol and/or estrogen deficiency.” My impression and what it says in your and Dr. Lee’s book and others is that it is estrogen dominance, not deficiency that contributes to extra weight around the mid-section. Am I misreading or mis-understanding something here?
A: I received a number of e-mails about this from alert readers! It’s not a matter of misunderstanding, but in our book Dr. John Lee’s Hormone Balance Made Simple, we added more specific information to the mid-section fat issue. Estrogen dominance can cause water retention and overall weight gain, but it specifically causes weight gain in the hips, butt and thighs. Estrogen deficiency can cause a kind of “poochy” lower mid-section fat that flattens out when estrogen levels normalize.
Here’s an excerpt from p. 46 of Hormone Balance Made Simple:
- Excess fat around the hips, buttocks and thighs is a hallmark symptom of estrogen dominance.
- Excess fat around the [upper] middle is usually a sign of insulin resistance (too much sugar and refined carbohydrates, too little exercise).
- A poochy tummy [lower middle] (which is different from weight gain around the middle, and different from the saggy tummy caused by pregnancy) can be caused by excess cortisol (stress), and/or estrogen deficiency, and/or constipation.
SKIN CREAMS FOR FACIAL HAIR IN WOMEN
Q: One of my friends says she heard about a skin cream that gets rid of facial hair in older women, but she didn’t know what was in it. Was it progesterone cream? Does progesterone cream get rid of facial hair? I hate my menopausal whiskers and would love to throw away my magnifying mirror and tweezers!
A: Progesterone cream can help reduce facial hair as part of an overall hormone balance regimen, but many menopausal women need to do more to cope with the fuzzy cheeks and stray whiskers created by male hormones, or androgens. Long after the ovaries have stopped producing progesterone altogether, and drastically reduced their estrogen production, the ovaries keep making small amounts of androgens. Women in their 70s may still be making some androgens. This is why older women tend to lose hair on the head and gain it on the face. I suppose we could call it androgen dominance.
The cream you refer to probably contains an ingredient called azelaic acid, which inhibits the action of an enzyme called 5alpha reductase. This enzyme plays a part in prostate enlargement in men because it allows the conversion of testosterone into a potent form called dihydrotestosterone (DHT), which stimulates prostate growth (along with other factors, see Prostate Update for details). In menopausal women, 5alpha reductase can also convert testosterone to DHT, which is the androgen that is most active in the skin and thus stimulates the growth of those pesky whiskers. Azelaic acid can help reduce that conversion, and thus lower DHT levels in the skin and reduce facial hair. Progesterone can also reduce 5alpha reductase levels, but for many women it won’t clear up facial hair by itself.
The other culprit is, you guessed it, sugar and refined carbohydrates! Too much sugar in the diet can cause chronically high insulin, which stimulates androgen production in the ovaries. This is the basis of what causes polycystic ovary syndrome (PCOS) in younger women (see the article What Your Dr. May Not Tell You about PCOS for details), and it can also increase the production of androgens in older women.
I’ve looked for an azelaic acid cream that doesn’t contain a lot of potentially harmful chemicals, but haven’t found one. However, many naturopathic physicians use a saw palmetto extract cream to treat excess facial hair in women because it’s also a 5alpha reductase inhibitor. Many of the saw palmetto creams are for men and also contain the herb pygeum and small amount of progesterone, both of which should help inhibit 5alpha reductase. HM Enterprises has a relatively clean men’s cream called Adam’s that might be worth a try, but test it first to make sure you aren’t sensitive to the oils it contains. There are internet claims that saw palmetto will increase breast size and libido, but I haven't seen or heard any confirmation of that from clinicians or research.
Menopausal facial hair can be reduced in most women with a combination of hormone balance, a low sugar/refined carb diet, and a cream that reduces 5alpha reductase levels.
MORE QUESTIONS ABOUT VITAMIN D DOSAGE
Q: I’ve read your information on vitamin D. Thank you for being so thorough. I understand that you recommend 1,000 to 2,000 IU for those of us who can’t get enough sun, but I still have a question. I took your vitamin D test and was pretty low. It seems like a lot of doctors are recommending 10,000 IU of vitamin D for a few months. Would that be a good way to get my vitamin D?
A: It may be, but I just don’t think we have enough research yet to confidently take that much vitamin D. For many years vitamin D supplement recommendations were way too low, thanks to concerns about toxicity. Now that we know there’s a virtual epidemic of vitamin D deficiency in industrialized countries, with far-reaching health consequences, the pendulum may be swinging too far in the other direction.
According to vitamin D researcher Michael Holick, M.D., your skin can make 3,000 to 20,000 IU of vitamin D with just 10 to 15 minutes in the sun, depending on time of year, latitude and skin pigmentation, so in that context, 10,000 IU may not seem like much. However, we can’t assume the two are equal, because the process by which the body transports, manufactures and delivers vitamin D from sun exposure on the skin is different from what it does when we take an oral (by mouth) supplement that goes through the digestive system. Vitamin D has effects on every major system of the body, and there are intricate systems of checks and balances to make sure it doesn’t do any harm.
What a perfect setup! In the northern latitudes where there’s less sun, we have an abundant food source of vitamin D.
Let’s consider how Mother Nature handles oral vitamin D. The major food source of vitamin D is from the fats and oils of ocean creatures such as seals and whales, and fish such as salmon, cod and mackerel, that live in the northern seas. What a perfect setup! In the northern latitudes where there’s less sun, we have an abundant food source of vitamin D. There’s a little bit of vitamin D in egg yolks and some whole grains and plants, but relative to northern ocean sources the amount is miniscule. So, Mother Nature is very stingy about providing oral sources of vitamin D.
Now let’s consider sun exposure and skin pigmentation. The darker the skin, the less efficiently humans absorb vitamin D. The closer to the equator we get, the more sun we get, and the darker the skin gets. This may be Mother Nature’s way of protecting us from sun damage, and excess vitamin D. Early humans who migrated north, where there’s less sun, developed lighter skin. As double protection, the body has ways of neutralizing the precursors of vitamin D when levels become excessive. Mother Nature is extremely careful about how vitamin D is regulated in the body.
Then, you might ask, before vitamin D supplements and fortified milk, how did we get through the winter, when there’s a lot less sun? Our amazing bodies can store quite a bit of vitamin D in our fat, releasing it slowly as needed—but you should still get out in the sun in the winter!
There is research showing that it takes months and tens of thousands of IUs of vitamin D to induce toxicity, but I don’t trust it… yet. Conventional medicine tends to take a sledgehammer approach to toxicity, meaning that you have to be half dead before something is counted as toxic. By the time you experience the nausea, vomiting and loss of appetite typical of vitamin D toxicity, you’re way over the top.
It may turn out that taking 10,000 IU of vitamin D daily for a few months is perfectly safe, but I wouldn’t do it unless and until there’s more research.
Here’s where to find more info on Vitamin D and Vitamin D testing.
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