DHEA
The following article appears in the October 1997 issue of Clean Power:
I usually reserve this column to answer members questions or discuss a health topic that I feel is brought up often. This month I will diverge from that. I recently read a powerlifter's letter in Powerlifting USA regarding DHEA. As a doctor and a Board Certified Clinical Nutritionist, I am going to respectively respond to his comments.
In 1994 the U.S. Dietary Supplement Health and Education Act made it possible for DHEA to be sold directly to consumers. Before this it was available by prescription. DHEA is a steroid hormone that is produced primarily by the adrenal glands. Very minute quantities are produced by the gonads. It is formed from cholesterol. An interesting fact is that 95 % of the DHEA in the human body is in the sulfated form, DHEAS. This form increases the water solubility of the hormone. Consequently, this also decreases its biological activity and increases its excretion. Because of this, a small fraction of DHEA is needed or used for regulation while the remainder is degraded. This sulfated form may serve as a transport form for DHEA since the latter's function is that of a precursor for other steroid hormones: androgens or estrogens. Most of the DHEA studies out there are based on rodent studies, certainly not conclusive or applicable to humans since mice and rats do not produce DHEA, humans do.
As most people know, your levels of DHEA/DHEAS decrease as we age. One thing researchers haven't found out yet is if the decline in humans is due to a deprivation of an essential hormone or if it is a natural and normal consequence of aging. They have found that at all ages the individual variability is high and the normal range of serum DHEAS is very wide. For example, Asian men have lower levels than American men and men have levels 10 to 30% higher than women.
One item to consider when thinking about taking DHEA for immune system dysfunctions is that during illness (especially those conditions in which the adrenal glands are highly stressed), mental depression or other stress factors, there is a dissociation between DHEAS and cortisol (another adrenal steroid hormone) levels. DHEAS is decreased during stress situations and cortisol is increased. One question I always ask is this: is it better to take a hormone that could further disrupt endocrine (hormone) equilibrium or is it better to support the health and function of the gland as well as remove or eliminate the stresses to allow the adrenal glands a chance to repair hormone balance?
A hormone is described as a chemical messenger that has SPECIFIC regulatory effects on physiological processes. A dietary nutrient it is not. One has to realize that trying to manipulate a hormone or its levels in the human body is tricky and could be dangerous. The human body has what is called a "natural feedback mechanism" that enables the body to determine when it needs to produce more of a certain hormone or decides not to produce any at that given time because there is enough of it already in the body. The potentially dangerous and tricky thing about taking hormones is that the gland producing that particular hormone is signaled that there are adequate or excess hormone levels in the circulation at that time and there is no need to produce/secrete any amount of this hormone. If this continues over time, the particular gland involved in producing this hormone will eventually cease any hormone production and a dependency for the outside (imitation) hormone develops. One must also realize that the human body and all of its parts do not work independently, especially the endocrine system. When one alters one area, it can affect many other areas. DHEA is known to be involved in a wide variety of functions. Data not available yet is what multiplicity of adverse and long-term effects taking the hormone will have.
Most DHEA supplements are synthetic steroid hormones. Sometimes they are sold as an extract of wild yam labeled as "natural DHEA" or "DHEA precursor complexes." However there is NO DHEA in wild yam and it cannot be converted to DHEA outside of a laboratory (i.e. in the human body). It is also not known if commercial DHEA pills, whether synthetic or chemically-altered wild yam can be naturally sulphated and thus safely neutralized in the body.
The various claims of increased life span, fountain of youth, decreased heart disease, inhibiting atherosclerosis (hardening of the arteries), immune system enhancement, increased libido, decreased body fat, prevention of osteoporosis, helping Alzheimer's patients to name a few, have yet to be proven by good, large randomized placebo-controlled clinical trials that involve humans, not rodents. In some cases, some studies have actually found opposite results than those claimed above. In one experiment, 14 out of 16 rats given DHEA developed cancer. This does not necessarily mean the results are applicable to humans. It is interesting that if this were an experimental drug, it would be banned by the FDA on this basis.
As in any pill/drug, DHEA first must be broken down in the liver. This is normal detoxification for any drug. Too much of DHEA can stress or damage the liver. Various adverse effects can and do occur. Examples of these effects are increased insulin resistance, mood swings, transient hepatitis, a decrease in HDL (known as the "good" cholesterol), fatigue, and elevations in liver function tests. In men, acne and gynecomastia (breast enlargement) have been reported. In women, there can be acne, menstrual changes, breast tenderness and swelling, irritability, deepening of the voice and hirsutism (excessive body and facial hair). Lately, concern is growing regarding the possibility of increased risk of ovarian and breast cancer in women and prostate cancer in men. Many doctors and researchers state that a DHEA serum level be measured before anyone starts taking a supplement and that the level be checked periodically. I also recommend that liver function tests be performed at least every six months to make sure the liver is performing as it should while one is on DHEA.
When DHEA became available over the counter, it was suddenly in the hands of the public. The USOC and the IOC have banned DHEA because it is a STEROID. Steroids are illegal for athletes in USOC and IOC sports and USAPL (ADFPA). Since USAPL (ADFPA) follows USOC guidelines for banned substances, we also ban DHEA. It was not a separate decision. As one person said to me, "Why fool around with what was given to you?" [regarding the amounts of natural hormones in our bodies]. Article references are on file at my office. Next month I will be discussing cortisone and the effects of that drug on the human body.
Please send your questions for the Sports Medicine Committee to:
Dr. Michael Hartle
3835 W. Jefferson Blvd.
Ft. Wayne, IN, 46804.
If you would like a personal response, please send a SASE with $2.00 to cover additional postage and other expenses. I also welcome your comments on the committee/column.
