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This article first appeared in the by Oliver Starr The happy coincidence of VRP's addition
of DHEA to our lineup and the recent release of Dr. Sahelian's landmark book,
DHEA A Practical Guide, has prompted us to sit down and have an in-depth
discussion with Sahelian about what some people are now calling "the
mother hormone." VRP: For what conditions would you advocate
DHEA use? Sahelian: The most common use
of DHEA will be for people who want to take it as hormone replacement
therapy. We know after menopause women lose substantial amounts of their
estrogen production. In men there's a gradual decline of DHEA production with
age. Men do not have that sudden transition period that occurs in women that
make them go into what is called andropause. DHEA gets converted into both
androgens and estrogens. There comes a time where supplementing low levels
could turn out to be beneficial in terms of improved well being, more energy,
better moods and better libido. This will be for both men and women. Other
uses of DHEA would be for autoimmune conditions and heart disease. VRP: When you see people who are presenting
for a variety of conditions, are there any particular complaints that you use
to indicate that a person should have their DHEA levels checked and perhaps
consider replacement therapy? Sahelian: Anyone who is not
feeling as energetic as they were in their youth or does not have as good a
libido as in the past. If other medical conditions that could account for
these have been ruled out it might be appropriate to check DHEA levels. Or,
to be more accurate, DHEA-S levels. The majority of physicians in the country
do not know this yet. There are many alternative physicians who are already
routinely checking these levels on almost everyone in their forties and
beyond. VRP: Would you recommend DHEA therapy for
people who fit those criteria but are considerably younger than 40? Sahelian: I may go as low as
mid thirties but I would really need to have a low blood level on a person
before I started to put them on something that theoretically they will use
for many decades. We've used estrogen for 20 years and there's still a lot of
controversy about the type of estrogen, whether it's estriol, estrone,
estradiol or premarin; we don't know about the appropriate dosages yet. We
don't know whether it's best to take it alone or in combination with
progestrone. So, after all these decades of studying estrogens, we still
don't have all the answers. We have here another hormone, DHEA, to experiment
with. The longest double blind,
well-controlled studies with DHEA have been by Drs. Morales and Yen at U.C.
San Diego. This study went on for six months. So, basically we are making
predictions based on this study and on all the shorter ones that have gone on
in humans. Additionally, we are making predictions based on the influence of
DHEA on animals in laboratory tests. So, we're all making an educated guess.
But the questions arise: should we wait 20 years before we take it? Is there
enough evidence at this time to cautiously start using this as a replacement
therapy? At this point I'm optimistic enough to
recommend low dosages especially with the supervision of a health care
practitioner. Ideally, blood or saliva levels would be taken to make sure
that the dosage taken is not excessive and is not doubling or tripling the
blood levels of DHEA, androgens or estrogens. VRP: In terms of that question, with
intensive exercise, males, in particular, experience a decline in
testosterone production. You can dramatically improve performance by using
supplemental testosterone, even in very low doses. Do you think supplemental
DHEA has a similar potential to improve athletic performance? Sahelian: There is a
theoretical basis for that, but we could also get some estrogenic effects.
It's hard to say which would predominate. I purposely did not focus the book
on DHEA and athletic performance because I know people who work out, and
often, if you tell them 50 mg. is good, they'll take 1500 mg. VRP: You noted in your book that different
doses appear to do different things: low doses tend to bring an improved
sense of well-being and other specific benefits while at higher doses side
effects are apparent. But you seem to see a repartitioning of body mass among
other things. Is that a result of the conversion of DHEA into more androgenic
steroid hormones? Sahelian: Yes with the increase
in muscle mass and other things that have been noted in short-term studies.
But we don't know, if we continued that for a year or two, what kind of
negative effects it may have on blood sugar cholesterol levels and other
lipids. At this point I think it's best not to encourage anyone to go on
those high doses at all. VRP: And you consider a high dose to be
something like 200 mg. per day? Sahelian: I'll go even as low
as 75-100 mg. per day. And I know a 25-year-old who is taking 1500 mg. per
day. I feel very uncomfortable about it. He's gaining a little more muscle
mass but, creatine can do that just as well. VRP: So could a lot of steroids and at a
lower risk than 1500 mg. of DHEA, wouldn't you think? Sahelian: And if you take 30
pills-per-day it's pretty expensive too. VRP: With the availability of pregnenolone
now, do you feel DHEA is a better alternative? Sahelian: There have been few
human studies with pregnenolone to date. If you look at the chemistry,
cholesterol goes to pregnenolone which goes into DHEA. Then DHEA will go to
androgens and estrogens. But pregnenolone, in addition to going into DHEA,
will go into progesterone which in turn can go into cortisol and aldosterone.
So we are giving something which is even more of a precursor to DHEA with
many more nonspecific functions throughout the body. We have less control
over where that metabolic pathway is going to go. VRP: So you think it's too high up the tree
and therefore provides substrates to some things that may, in essence, be
less predictable? Sahelian: That's a great way of
saying it. And having the lack of much human research with pregnenolone
supplementation, it's difficult to know what it's going to do. Last year at a
meeting sponsored by the New York Academy of Sciences, the whole thing was
mostly on DHEA only a little bit was mentioned about pregnenolone. The reason
is because there is so little done with it right now. However, I am looking
at the research carefully and putting together a small booklet on this
hormone, summarizing what we know so far. I think pregenelone has a lot of
potential. VRP: DHEA also converts to a large number
of other things. Why not try to find out which of those particular
metabolites of DHEA are really most beneficial and then supplement with them
instead? Sahelian: We've tried to do
that for 20 or 30 years with the estrogens and we still don't know for sure.
There are many questions out there that need to be answered and it's going to
take us forever to find out. VRP: Do you think at this time DHEA is our
best option because we're not leaving out potentially important components by
singling out specific metabolites? Sahelian: Exactly. It's
somewhere halfway along the metabolic pathway. It's after pregnenolone and
progesterone and it's before the androgens and estrogens. That's a good
compromise. A U.C. San Diego group is doing some more long-term studies. VRP: We understand you have been in
communication with Dr. Baulieu, in France, who gained notoriety in the US
from his work with the RU486 abortion pill. He is now researching DHEA. What
is he reporting? Sahelian: When I interviewed
Dr. Baulieu he mentioned he's doing some long-term studies which he expects
to publish within a year. Something longer than the six-month study we have
now. So far he's faxed back to me saying his preliminary results look
positive. He's excited that DHEA can offer many benefits. VRP: Do you know or have you heard of any
indication that DHEA may interact with any other hormones or drugs? Sahelian: There are some
theoretical possibilities. One would be taking antidepressants. For one, we
know DHEA is a mood elevator. In fact, a couple of people who I was treating
with prozac, they, on their own, lowered the dosage. They felt the DHEA was
enough of a mood elevator that they could use less of the antidepressant.
DHEA probably would be more effective, not for someone in their twenties who
has good DHEA levels, but for someone in their forties, fifties and sixties.
Theoretically we could lower the dosage of antidepressants when used in
combination with DHEA. Another area of interest would be
medicines that lower cholesterol levels. Since DHEA has shown early promise
in lowering that, perhaps they could be used together in lower dosages. DHEA
has been found to be a little anti-clotting. People who are on anti platelet
medicines like aspirin or other medicines that prevent blood clotting may
need to reduce their dosage. Of course, all this needs to be done under the
guidance of a physician. People who are on the fen-phen
(Fenfluramine and Phenteramine) for weight reduction may also benefit. In one
study on mice, when they were given fenfluramine and DHEA, they basically
stopped eating. So, perhaps, people who are uncomfortable taking two drugs
may find taking one drug and a little bit of DHEA may do the trick. DHEA
could potentially be combined with other anti-fat nutrients too. Also, women who are on estrogen may
need to take less estrogen if they are concurrently taking DHEA, because they
are going to have some DHEA converted into estrogen. It's hard to say how
much but at least one researcher I spoke with estimated perhaps taking half
as much of the estrogen. VRP: In terms of dosage, it seems to us
that you feel the only way to accurately determine dosages is with blood or
salivary tests then titrating the dosage to accurately mimic that of a young
adult. Is that correct? Sahelian: Well, to qualify
that, for people who want to try this for a week or two just to see what the
effects are, there's no reason to take a blood test. For those who are
considering it as a lifelong therapy, it would be best to have initial blood
or saliva tests, which cost somewhere between $35 and $70. Then start on a
low dose which would be 5 or 10 or 15 mg. A month later have the levels
checked, and if the levels have gotten back to the levels of youths, that
might be a good place to keep it. I prefer, at this point, since we know
so little about the long term consequences, for people to err on the side of
low rather than high doses. I just got a call from a woman who read those 50
or 100 mg. studies and is taking 150 mg. thinking that that's the right dose.
I don't want people to do that. VRP: Is there a diminished need for DHEA by
the body, making it unnecessary for a 70-year-old to have the same level as a
25-year-old? Sahelian: You could ask the
same thing about estrogen. It drops at menopause and by supplementing with
estrogen women will generally have a better quality of life with better heart
condition, fewer bone fractures and they end up living, as a rule, a year or
two longer. Now with DHEA, my hope, and that of many researchers, is that we
may have beneficial effects by doing the same thing with it. What's the
rationale for bringing it back up to youthful levels? It's guess work based
on everything we know. There's no definite proof that that's the ideal level. VRP: So theoretically, a blood DHEA level
which is five times the youthful level could, ostensibly, be optimum for
maintaining youthful appearance and longevity far longer. But, for whatever
reason, the biological cost of producing that much DHEA naturally is simply
too high in other areas? Sahelian: Could be. Is it five
times? Four times? Twice? One-and-a-half? Nobody knows for sure. I suspect
it's different for each person. VRP: In terms of the time of day, the
general consensus is that morning administration most closely mimics the
circadian rhythm. What do you think? Sahelian: That's what most
physicians and researchers are opting for. Plus, some people feel a
stimulatory effect from it which may cause insomnia if high doses are taken
late in the day. I think any type of stimulant medicine, whether it be a
vitamin, a nutrient, an amino acid or whatever, it is best taken in the
morning in order not to interfere with stage-four sleep our deepest stage of
sleep. Interestingly, people who take it in the morning often tell me that
they sleep better at night. I've heard enough similar anecdotes to start
thinking that there might be something to it. VRP: How do you feel about the use of DHEA
and melatonin? Do you feel that it may produce a more significant anti-aging
benefit? Do you think the combination is additive in terms of its results for
health and overall well being? Sahelian: That question will be
asked a lot of times. I did a Med-Line search of DHEA and melatonin and came
up with only one study, in rodents, that found melatonin stimulated DHEA
production. Based on everything that I know, for people in their fifties or
older whose levels of DHEA and Melatonin are both low I would think that it
would be appropriate to take low amounts of melatonin which is probably
somewhere around .5 mg. or so and use a low dose of DHEA. They probably would
work well together, although I cannot give you hard science to prove that and
we're not going to know for a long time. But we have to make a guess; people
are going to be taking both, and at this point, I think low doses would be
OK. VRP: Do you see any reason why using them
together would be contraindicated? Sahelian: No, I can't see any
reason at this point. Plus, generally, if people take the DHEA in the
morning, with the half life being only a few hours, that high they'll get in
the mid part of the day will be back down to normal levels by night time.
While taking the melatonin at night, almost all of it will be gone by
morning. So by taking them at different times, if there is any interference,
it would be minimal. VRP: DHEA has been reported to enhance
libido. Has your research shown this to be true? Sahelian: I have encountered so
many women, especially in their forties and fifties, who start DHEA and tell
me that they now know what it feels like to be male as far as having that
powerful sex drive. One married woman tells me her husband can't keep up with
her, and it's usually the other way around. So why can't women be more like
men? Now we may have the answer. VRP: It's true, then, that even a minute
increase in testosterone is going to have a profound effect on women whereas
with men it would be hardly noticeable. Sahelian: Yes. In fact, I put
my secretary on it; the first day she took 25 mg. The next day she came to
the office and said, "You don't have to pay me anymore, I'll work for
DHEA." I've met so many people who love it,
who have told me this is going to be as big as melatonin. My secretary, all
day long she says, "This is the best. This is the Best." VRP: What about males? Sahelian: Males are generally
not feeling it as intensely as the women are. Usually there is an increased
sense of well being and increased libido. But not everybody. Some people are
taking 50 or 100 mg. and not feeling anything from it. There's a large discrepancy in the sex
drives of men and women and that creates a lot of conflicts because the male
wants to have a lot more with many more women. Perhaps if more women took
DHEA it would equalize that and male-female relationships may improve. I met one 52-year-old woman who came up
to me after a lecture and said she was afraid to take more DHEA because now
she's eyeing every guy that walks by - just like men do with women. VRP: Are there any preexisting medical
conditions which would be severe enough that you would suggest not using
DHEA? Sahelian: As long as we're
talking about low doses that replace it to physiological levels, I can't see
any absolute contraindications. However, if someone is planning to take it
for prolonged periods, I always recommend a physician's supervision. VRP: What about someone with a high
prostatic enlargement ? Sahelian: That's a hard one
because at least one researcher I've talked to thinks that at low doses it
may have a buffer effect. And we have to realize that prostatic enlargement
occurs at a time when our DHEA levels are falling. At our highest levels in
our twenties, our prostate gland is tiny but at our lowest levels, in our
eighties and nineties, our prostate gland is at its largest. I'm just making
an association there, not saying it's cause and effect. But then again you
could make the same association with Melatonin. VRP: What about the potential side effects
of DHEA use? Sahelian: People should know a
little bit about the side effects that may come with high doses of DHEA. They
can get pimples, a little facial hair growth, over stimulation, irritability,
mood changes and insomnia, which could not occur on the low doses another
reason to keep people on the low doses. And people should be skeptical if
they hear things that sound too good to be true, with this or any other
supplement. |