Aug 282009

As our bodies get older they function less efficiently. Like all sophisticated machines, they eventually suffer the wear and tear of prolonged use. To name a few signs of deterioration: our joints start to hurt, our energy level decreases, our digestion is not as efficient, our thought processes slow down, and our arteries start to narrow. To many, the ‘golden years’ are synonymous with taking medication.

Although some medication is necessary to repair a weakening system, they usually come with a list of side effects. In describing these drugs, terms such as ‘inhibiters’, ‘blockers’, and ‘antagonists’ mean that they will be interfering with something in the body to accomplish the desired effect, and forewarn of a negative. In many cases, this negative can be due to nutrient depletion. Nutrients are vitamins, minerals, amino acids, fatty acids, etc., that are usually obtained from the breakdown of food to supply the biochemical building blocks that the body needs to exist, and their depletion often defines the side effect of the drug.

Western medicine is vigilant in its monitoring of nutrients that can interact negatively with a drug, however, the lack of attentiveness regarding the nutrients that are depleted by a drug is very disconcerting. To illustrate this point, let’s look at Coenzyme Q10 (CoQ10), one of the most important nutrients in the human body.

CoQ10 is a fat-soluble vitamin-like compound that is critical in the production of energy in the mitochondria of every human cell. It is also an important antioxidant and plays a major role in preventing the oxidation of LDL cholesterol and the prevention of atherosclerosis (narrowing of the arteries). Further, it is intimately involved in the production of energy. Consequently, a deficiency of CoQ10 first affects the heart and cardiovascular system because the heart is the most energy-demanding muscle in the human body. Coenzyme Q10 deficiency can cause congestive heart failure, high blood pressure, angina, mitral valve prolapse, stroke, cardiac arrhythmias, cardiomyopathies, lack of energy, gingivitis and generalized weakening of the immune system.

There is an extensive list of pharmaceutical drugs that deplete CoQ10. To name a few: statin drugs (e.g. Lipitor®) used to lower cholesterol, beta blockers (e.g. metoprolol) to lower high blood pressure, thiazide diuretics (e.g. hydrochlorthiazide) to lower high blood pressure, and metformin a common medication used to treat insulin resistance and Type II diabetes.

Aging, by way of lower biochemical production and absorption of critical nutrients such as CoQ10 increase our risk of various cardiac problems, weak immune systems, and lower energy levels. The additional intake of a range of drugs that further deplete our levels of crucial nutrients can increase our risk levels substantially. It must be noted that many of these drugs deplete multiple nutrients important to other functions of the body.

Often, when a change of lifestyle has failed to produce the desired change to one’s chronic illness, it becomes necessary to resort to the use of a drug. For this reason, it is important to pay attention to the nutritional needs not only of that illness but of the nutritional needs made necessary by a particular drug. The failure to address this issue may result in the health problems not being resolved, and may lead to other symptoms later on, which may lead to the prescribing of additional drugs. A health care provider, who is familiar with drug nutrient depletion, can help make your medication more effective and cut down on some of the long term risks.

Marvin Malamed is a national award winning pharmacist, certified clinical nutritionist and President of Haber’s Compounding Pharmacy.  For more information, he can be reached at (416) 656 9800.

Aug 282009

I was recently asked the following question:

My doctor said I have osteopenia and recommended that I take calcium. Is there anything else I can do to prevent my bone density from getting worse?

Yes. There are many things to consider. The same amount of calcium in your diet you ingested when you were young and building a strong skeleton may result in bone degeneration when you are older. However, although calcium is important it can not be isolated as the sole cause.

Paying attention to your nutrition from many aspects is critical. A diet which is rich in minerals and vitamins such as magnesium, boron, silicon, manganese, zinc and copper, vitamin B6, vitamin c, vitamin k among others is important. It may be difficult to get the proper amount of nutrients without supplementing your normal diet with a comprehensive formula for bones.

The proper amount of vitamin D is essential to help absorb the calcium that is ingested in food a/o supplements. Eating enough protein is also vital. Digestive issues should also be considered. As we get older we produce less stomach acid and digestive enzymes. We are therefore less likely to break down our food (and even our supplements) and extract the nutrients.

Whether our diet is alkaline forming or acidic forming is important. An acidic forming diet will help leach calcium from your bones. This is easy to monitor with appropriate ph strips.

Exercise is important throughout life to help maintain bone density and strengthen the soft tissue supporting our skeletons. It is important to incorporate a routine of resistance exercise.

Medical conditions and medications are contributors to osteoporosis as well. Diabetes, Cushing’s syndrome, Hyperparathyroidism, and Rheumatoid Arthritis are some of the conditions that are associated with an increase risk of osteoporosis. Many medications deplete nutrients that are important for maintaining strong bones. It is important to realize what these nutrients are and to supplement accordingly so as not to increase your risk. The overuse of acid blockers for heartburn further decreases the availability of gastric acid, the importance of which has already been mentioned.  

Last but not least, you must look at your hormonal scenario. Estrogen, Progesterone, Testosterone, Dihydroepiandrosterone, and Cortisol balance play a part in maintaining strong bones. The age at which hormonal balance is lost is when the risk of osteoporosis is at its highest.

So often I see people relying on their intake of 1500mg of calcium, while completely ignoring the other issues, only to be pronounced osteoportic two years later. 

Marvin Malamed is a national award winning pharmacist, certified clinical nutritionist and President of Haber’s Compounding Pharmacy.  For more information, he can be reached at (416) 656 9800.

Aug 252009

Recently, I was asked the following question:

I am using bio-identical hormones for my hot flashes and night sweats. How long do I have to keep using them?

Hormone balance in addition to proper nutrition and exercise is essential to optimum health. Most disease states exhibit themselves after many years of asymptomatic progression. Often people feeling well and seemingly in good health are told much to their surprise that they have a serious illness as revealed by some test.

In my view the necessity of using bio-identical hormones is not only for symptom relief but also for good health. Just like taking calcium and vitamin D to prevent osteoporosis, proper hormone balance is essential to perpetuate the many biochemical tasks of good health that are prevalent at a younger age.

To illustrate this point, I recently came across an article written by Sergey A. Dzugan, Ph.D. and R. Arnold Smith, M.D. with regards to cholesterol. Cholesterol is the precursor to steroidal hormones such as estrogen, progesterone, dhea, testosterone, etc.

Dzugan and Smith conducted a clinical study for 6 years between 1997 and 2003 on 41 patients with high cholesterol. Their hypothesis was that a deficiency of hormones is the underlying cause of many disorders associated with normal aging including hypercholesterolemia. They treated these patients with hormone restorative therapy using human identical hormones such as oral pregnenolone and dhea capsules as well as topical triestrogen, progesterone and testosterone gels. All patients responded positively with mean serum total cholesterol dropping by 25.6%.

Their reasoning for these results is that many of the body’s biochemical mechanisms work by means of a biofeedback mechanism. Human aging lowers hormone levels. This in turn will trigger the body to make more cholesterol. The cholesterol acts as a feedback mechanism to provide more substrate with which to make more of these below-optimal-level-hormones.

Therefore providing bio-identical hormones to make up for the deficiency offers a feedback mechanism to lower the high cholesterol levels correcting the possible reason for the rise in the first place.

This is only one of many reasons why hormone balance is important for optimum health regardless of hormone deficiency symptoms such as hot flashes and night sweats.

I therefore think it incumbent to keep balancing your hormones as long as you want to optimize your health. This means that you may want to supplement with bio-identical hormones for the rest of your life, but it also means that you should adjust your dosage from time to time to properly balance your levels

Marvin Malamed,B.Sc.Phm.,C.C.N., has owned Haber’s Compounding Pharmacy for over 17 years. He is an award winning pharmacist and a certified clinical nutritionist. He can be contacted at
© 2008 Haber’s Compounding Pharmacy. All Rights Reserved.

Aug 242009

Recently, I was asked the following question:

My doctor said I was hypothyroid and put me on Synthroid. I have been on Synthroid for 6 month, but I don’t feel any better. Why don’t I feel better and what can I do about it?

Synthroid contains T4 (levothyroxin) the main hormone produced by the thyroid gland, however T4 is not very active. The major active hormone is T3 (triiodothyronine). T4 has to be converted by the body to T3 to exhibit benefits as only T3 stimulates activity at the receptor sites.

There are many reasons why supplementation with just T4 may not be effective. If for any number of many reasons, the T4 (even with sufficient dosage) is not being converted to the active T3 form, you will not see the benefits of the thyroid supplementation.

There are many reasons why you might be hypothyroid. The most prevalent factor might simply be a lack of iodine. We all need some form of iodine. If we don’t get it in our diet, it is essential to take it in the form of supplements. The need for and lack of iodine is the reason why salt was iodized. However, with the current emphasis on decreasing salt intake, salt has lost its importance as an iodine source.

There are also many cofactors that are necessary for T4 to be converted to T3 such as zinc, copper, vitamins A, B2, B3, B6, and C. If any of these are missing in sufficient amounts, your supplemental T4 (Synthroid) will not be converted to T3 and you will still exhibit the symptoms of a low thyroid.

There are many factors that influence the enzyme which converts T4 to T3 such as: selenium deficiency, stress, heavy metal toxicity, dieting, inadequate protein intake, high carbohydrate diet, elevated cortisol, chronic illness, and decreased kidney or liver function.

In addition there are many medications that block this conversion such as beta blockers,   birth control pills, estrogen, lithium, phenytoin, theophylline, chemotherapy, glucocorticoids and clomipramine. There are also environmental toxins to consider such as dioxins, PCB, phtalates (chemicals added to plastics).

As you can see hypothyroidism can be very complicated and may need further investigation. Paying attention to your diet, supplementing with the appropriate supplements as previously mentioned, and dealing with stress issues are important first steps.

A better scenario than synthroid might be the use of dessicated thyroid. Dessicated thyroid derives from pig thyroid which is very close in composition to human thyroid i.e. a mix of T4 and T3. Adding supplemental sustained release T3 made by compounding pharmacists, along with adjustment to your synthroid dosage might also be helpful.

Treatment of thyroid dysfunction should be individualized and customized to each patient. It is therefore very important to work with your physician to solve your thyroid issues, keeping some of these options in mind.

Marvin Malamed,B.Sc.Phm.,C.C.N., has owned Haber’s Compounding Pharmacy for over 17 years. He is an award winning pharmacist and a certified clinical nutritionist. He can be contacted at
© 2008 Haber’s Compounding Pharmacy. All Rights Reserved.

Aug 212009

For those who are not familiar with the acronym, BHRT stands for Bio-Identical Hormone Replacement Therapy. Bio-identical hormones are hormones that are biologically identical to those produced by your body, and therefore the most appropriate hormones for replacement. For approximately forty years, the gold standard in hormone replacement therapy was a concoction of horse estrogen and a synthetic foreign-to-the-planet progestin like medroxyprogesterone (MPA). The most recent studies showed this combination not only to be unhelpful but in fact detrimental to a woman’s health.  The subsequent fall-out from these studies led to a lot of confusion and possibly poor decision choices. So let’s dispel some of the confusion and put some logic into the topic.

When women are pre-menopausal i.e. all the years of their adult life before peri-menopause, they have a much healthier scenario than their male counterparts. Only when they start to lose their hormonal balance do the risks to their health start to increase to those of men. This fluctuation in hormones causes symptoms in many women, which is the primary reason why they seek HRT help.

So, why give estrogen extracted from the urine of a pregnant mare? Historically an easily obtainable resource produced an inexpensive by-product (the estrogen) that would have otherwise been wasted. It resolved the issue of uncomfortable symptoms for which women sought help and it was patentable.

So, why develop a synthetic alien progestin like medroxyprogesterone (MPA)? After several years of supplementation with horse estrogens many women were falling ill to uterine cancer. MPA was designed to act like progesterone (a bio-identical hormone) and protect the uterus from the proliferative effects of the estrogens. MPA does accomplish this task, however, it does NOT perform many of the other positive functions of progesterone. The production of progesterone was not feasible at that time as it was very expensive and not well absorbed. This is no longer the case as progesterone can be readily made from a precursor molecule in yam and soy and the micronization process has solved the issues with absorbability.

Women produce three main estrogens: estradiol, estone, and estriol. Estrogen has approximately 400 hundred functions in the body. Some of those functions are: helping with the absorption of calcium, magnesium & zinc, maintaining proper cholesterol levels, bones and memory, improving sleep, and decreasing fatigue.

Bio-identical estrogen can now also be made from yam and soy precursor molecules. This allows us to maintain these four hundred functions in the body by supplementing with exactly the same hormones that are diminishing, rather than substituting with many different estrogens belonging to horses.

You need the proper amount of estrogen for optimum health. A horse has many estrogens which are indigenious only to the horse and foreign to the human. We now have the alternative of giving women bio-identical human estrogens. Does it make sense to continue giving women horse estrogen? Where’s the logic? Why should the prescribing of bio-identical hormones be dictated by the negative studies done with horse estrogen and synthetic progestins?  There are no scientific grounds for this approach.

Much attention is given nowadays to the damaging effects on our health caused by trans fats. There is even talk of banning trans fats from our prepared foods. The  difference between a trans fat and otherwise healthy fat is just a twist in the chemical structure of the fat. No molecules added or taken away, just a twist! Natural Vitamin E is four times as potent as synthetic Vitamin E for the simple reason that the process in making the synthetic produces equal amounts of a mirror image molecule. Nothing has been added or taken away! The only difference is the mere positioning of the molecule! The difference between a free radical and an anti-oxidant can be that of one electron (a minute part of an atom). So how can we equate the effect of MPA to progesterone where the difference in chemical structure is the addition of many atoms? How can we paint progesterone with the same brush as MPA? Where is the logic? To give just one example of the difference (of which there are many), MPA is contraindicated to be given during pregnancy because of its damaging effects, whereas progesterone is readily prescribed in fertility clinics to help conceive and prevent miscarriage during pregnancy.  Some of the other functions of progesterone are: helping balance estrogen and sleep, lowering blood pressure and cholesterol, increasing scalp hair and metabolic rate as well as acting as a natural antidepressant. MPA is foreign to the human body and does not provide many of the positive effects of progesterone. It has many side effects not seen with progesterone yet the reason for not prescribing progesterone are often based on studies that are done with MPA.

Where is the logic? This is compounded by the fact that many in the medical community and often medical literature refer to progestins as progesterone. No wonder the confusion!

As I mentioned earlier in this article, women’s health scenarios are much better when they are younger and their hormone levels are higher and balanced. When they start to age their hormones start to drop and lose their balance. Some of these health risks are: breast cancer, osteoporosis, cardiovascular and alzheimer’s disease. The prescribing of the combination pregnant mare’s urine estrogens and the MPA has dropped considerably over the past few years due to the negative results from both the WHI and the HERS 11 studies. During the same period the prescribing and use of bio-identical hormones has risen tremendously. It is interesting that over this very same period the incidence of breast cancer has declined.

It is important for optimum health to look at the whole picture. It is just as crucial for thyroid and adrenal hormones, testosterone, dhea and insulin to be balanced as they affect estrogen and progesterone levels and visa versa.

To be highly effective the proper administration of bio-identical hormones is vital.
Although symptoms are the driving force and a viable reason to use hormones, many diseases do not have symptoms until they are well entrenched. Hormones are an important part of one’s well-being and should be extensively assessed and responsibly administered in our striving for optimum health.

Marvin Malamed,B.Sc.Phm.,C.C.N., has owned Haber’s Compounding Pharmacy for over 17 years. He is an award winning pharmacist and a certified clinical nutritionist. He can be contacted at
© 2008 Haber’s Compounding Pharmacy. All Rights Reserved.