CyberHealth 21

CyberHealth 21

February 1999

CyberHealth Index


  1. Love, neurochemistry, and chocolate
  2. Low-estrogen bleeding
  3. Firing bad doctors, finding the good ones
  4. Why fructose can be bad for you
  5. The Beauty Corner: “Inner Mascara”
  6. Care of the Soul: Do it anyway

Love, neurochemistry and chocolate: a word from Cupid

by Linda Dopierala




The real secret of true love is that it is not an affair of the heart, but rather chemistry of the brain. A gushing forth of adrenaline-like neurochemicals flooding the brain fuels the attraction between two people.

When three of these chemicals combine, the result is infatuation.

These chemicals — PEA or phenylethylamine (which speeds up the flow of information between nerve cells), DOPAMINE (the feel-good chemical) and NOREPINEPHRINE (which stimulates the production of adrenaline and makes our heart race fast) — are responsible for that energized and euphoric feeling that new lovers experience.

The stimulation of these chemicals has the power to override the activity of the part of the brain that governs logical thinking. And, as many distraught parents and friends have found, no amount of logical discussion can persuade someone that the person they think they are in love with is “all wrong for them.” Love must stand the test of time to determine if it is true and whether or not the object of one’s love is THE ONE!


How long does this test of time take?

Somewhere between six months and three years, these chemicals gradually stop flooding the brain and the relationship either dies or develops into the next stage, which is true love. Should real love develop, then at this stage a new group of chemicals take over — these are those coveted endorphins that healthy, active people thrive on. Though not as exciting or heart-throbbing as the infatuation chemicals, endorphins, which produce feelings of calm, warmth, intimacy and dependability, are steadier and more addictive. In fact, the longer two people are in love, the stronger the endorphins become.

It is the absence of endorphins that make long-time partners yearn for each other when apart and can, in extreme cases such as death, result in the surviving partner dying of a “broken heart.” According to Mark Goulston, M.D., a professor of psychiatry at the University of California, “Adrenaline-based love is all about ourselves; we like being in love. With endorphins, we like loving.”


A fourth “love” chemical that plays a very important and wonderful part in relationships is oxytocin — a peptide composed of nine amino acids. It is responsible for stimulating uterine contractions during birth, triggering the “let-down” reflex during nursing, and giving new moms that mothering, nurturing feeling towards their baby. However, it also plays a very important role in romantic love.

Often called the “cuddling chemical,” oxytocin makes both men and women calmer and more sensitive to the feelings of others. Cuddling and calming are actually Phase II of oxytocin’s effect. Phase I is its power to arouse. In women it signals orgasm by stimulating uterine contractions. Women may be more capable of having multiple or whole-body orgasms as a result of oxytocin overload. In men, moderate concentrations of oxytocin facilitate both erection and ejaculation. Its production is cued by a lover’s voice, a gentle touch, a familiar fragrance, or a certain look. The more partners touch one another, especially the breasts (and, by the way, men’s breasts are even more sensitive than women’s breasts), the more oxytocin is produced resulting in increased arousal and a better likelihood of achieving orgasm.

Other oxytocinogenous zones are the earlobes, lips and nose. Following the ecstasy, oxytocin promotes the desire to cuddle and may even play a role in inducing high quality REM sleep. (Personally, I think oxytocin is a bit sexist — it makes women want to cuddle and men want to sleep!) WOMEN BEWARE: It’s important to note one other very unique aspect of oxytocin production. According to “What is This Crazy Thing Called Love?” by Dr. Shirley Glass, “A trick of nature induces women to bond with an inappropriate partner after sex because of oxytocin which enhances orgasms and increases a woman’s emotional attachment to her sexual partner. That may be why you keep the creep with whom you sleep.”


Chocolate is full of phenylethylamine — a chemical cousin of amphetamine.

So, yes, there’s a definite chemical (upper) response involved. Could this be why chocolate is the #1 choice of lovers on Valentine’s Day?

Chocolate also contains ANANDAMIDE, a compound that binds to the same receptors in the brain as marijuana. Hence the slight feeling of elation.

Now, mind you, the body also produces its own anandamide, and other chemicals in chocolate slow down the breakdown of this interesting anti-depressant.



Let me add some more information on the neurochemistry of love, based on Dr. Theresa Crenshaw’s “Alchemy of Love and Lust.”


Phenyl-ethyl-amine (I’ve broken the term into chunks to show you that those biochemical names are really manageable once you see their building blocks) is indeed the great amphetamine of the romance stage of love. It makes us feel at least slightly euphoric and depresses appetite. It also naturally spikes at ovulation. Is it a coincidence that so many women feel wonderful at midcycle and also eat less, due to lower appetite?

Orgasm is another way to increase PEA levels. In spite of endless Reader’s Digest articles, there is really no way to preserve the dopaminergic/PEA-dominated Stage I love (also known as “romance”) in your marriage — but satisfying love making is perhaps the closest we can get.

PEA can also surge in response to visual stimuli. Is this the secret of “love at first sight”? Watching a romantic movie can also raise PEA. So can romantic fantasies.

Among supplements, phenylalanine is known to increase PEA levels. And then it’s been suggested that chocolate also does it, but the assertion is disputed by some scientists. They say that it’s rather that chocolate raises serotonin. No mechanism is suggested, but I do have a radically simple suggestion: if you find the taste of chocolate divine, then the sensation of PLEASURE is enough to raise serotonin. (Parenthetically, just as women seem more oxytocin-dependent than men, so they also seem to be more serotonin-dependent.)

The anti-aging drug DEPRENYL also raises PEA levels. With just the right dose of deprenyl, we see expanded life span in lab animals; with too much, lifespan shortens. In humans, too much PEA has been associated with psychiatric disorders (but certainly not depression). There is apparently just the right range of PEA that we need for optimal neurochemistry. Too much romance, deprenyl, or maybe even chocolate is like too much exercise — it is actually harmful. Still, the majority of us could probably use more romance and more chocolate for optimal health.

If romance ends abruptly, one is liable to show signs of PEA withdrawal, which resemble those of amphetamine withdrawal.


According to Dr. Crenshaw, oxytocin may indeed be the reason why women more than men tend to be “love junkies” or “the slaves of love.” Oxytocin and estradiol synergize to produce heightened sensitivity to touch. Apart from that, Dr. Crenshaw points out that little girls tend to get more cuddling, which generally produces a considerable degree of pleasure regardless of estrogen levels; as the girl gets older and parental cuddling gets less, she may suffer from oxytocin withdrawal. Along comes the first boyfriend, bringing again the pleasures of loving touch. Her levels of oxytocin restored, the young woman is a goner.

Cuddling a baby also can make a woman eventually want another baby, so she can have another “cuddle object.” Nursing makes oxytocin rise so high that some new mothers report orgasm-like sensations. Altogether, oxytocin seems to play a larger part in women’s physiology and well-being, and seems to affect women more profoundly than men; touch starvation may be more devastating for women (especially estrogen-rich young women) than for men.

Crenshaw calls this “skin hunger.”

Estrogen and affectionate touching (including intercourse) raise the levels of oxytocin. Nipple stimulation is highly recommended as a way to raise oxytocin, since oxytocin may be one of our defenses against breast cancer.

It is interesting that celibate women such as nuns seem more susceptible to breast cancer than women who have an active sex life, even it doesn’t lead to the anti-cancer benefit of early (or multiple) pregnancies.

Interestingly, just being around a high-Testerone male strongly affects a woman’s hormonal make-up (negatively if the man is stressing her, but positively if she feels cherished and protected); being around a receptive or at least potentially receptive, hormone-rich woman raises a man’s good hormones as well.


By now it is well established that testosterone is an aphrodisiac for BOTH sexes, perhaps through the release of dopamine. Women need much less testosterone to sustain their sex drive, perhaps because estradiol and testosterone synergize so powerfully. For instance, estrogens dramatically increase the density of testosterone receptors in the genital area.

Testosterone then governs the erectile function of this tissue (and of nipples). The perception that testosterone is a “male” hormone is badly in need of revision, since testosterone-deficient women badly need this magnificent hormone.

In men, testosterone is extremely sensitive to stress, and to feelings of winning or defeat. In the average male, testosterone is released in pulses every twenty minutes or so, and is perhaps the most psychoreactive of all hormones. The feeling of being a loser, a failure in life, can really castrate a man. Conversely, successful, socially dominant “alpha males” tend to have higher TESTOSTERONE levels than same-age subservient men. (Gail: . . . easily observed in Washington, D.C., with all those misbehaving politicians.

Ivy: The perennial pattern of alpha males has been getting the comfortable endorphins of a supportive marriage AND the dopaminergic high of affairs.) Being related to dopamine release, testosterone has an obvious influence on the dopaminergic Stage I love. Hence some see it as related to always seeking new lovers in pursuit of that dopaminergic high of new romance. But because testosterone also increases sexual sensation (something Viagra does not do), it could also be argued that the pleasure provided by the regular mate is keener in high-TESTOSTERONE men, and thus thanks to more satisfying marital sex they also experience more bonding.

A TESTOSTERONE-deprived woman tends to sink into sexless lethargy. Feeling she is now a libidoless lump, “invisible” to men — read any menopause list — only makes her all the more depressed. But it’s not just a question of sexuality. She has been promised a new life full of PMZ, but no one told her that PMZ crucially depends on adequate testosterone. Personally, I find low-TESTOSTERONE life, which translates into low dopamine, hardly worth living. The joke is that if a doctor doesn’t take menopause seriously, the woman should pass him a note that says, “I am out of estrogen, and I have a gun.” I can see myself passing a note saying: “I am out of testosterone; what is the number of the suicide hotline?”

Supposedly there are more testosterone receptors in the female brain than in the male brain; don’t ask.

Besides stress, depression, obesity (too much estrone production) and aging, another big factor in low testosterone levels in men is low-fat vegetarian diet. If a man is poorly muscled, becomes impotent before the age of fifty, and is diagnosed with osteoporosis at sixty or even sooner, it is no surprise when he explains that he’s been following a strict vegan diet.

Both saturated and MONOUNSATURATED fats (olive oil) tend to raise testosterone levels. WEIGHT LIFTING also increases testosterone levels in both sexes — apparently testosterone is needed for muscle building, and the brain responds to the call from the muscles for more testosterone. Excessive exercise, however, acts like all excess stress: it lowers the levels of beneficial steroids, including testosterone.


In animals, the role of estrogens seems fairly straightforward. The female is not receptive to mating until a surge of estradiol brings her into estrus. When it comes to humans with their year-round mating, I am not sure if we really understand the role of estrogens in female sexuality.

Obviously, they are needed for maintaining secondary sexual characteristics, such as the feminine fat distribution, full lips, bushy hair (you can think of it as the opposite of androgenic baldness), and soft, smooth skin.

They make a woman smell sweet (possibly an antioxidant effect). They make her feel wonderful to touch (Estriol?). They keep her voice expressive and feminine-sounding. Possibly they affect personality, making the woman more gentle and serene (estradiol is in the main a relaxing hormone). The Eternal Feminine?

Naturally, estrogens play a role in maintaining supple genital tissue (Estriol is said to be a particularly effective estrogen for this purpose).

And they create receptors for testosterone. Hence with higher levels of estrogens, you need a mere dab of testosterone cream to enjoy a lively libido and keen sexual sensation. And, as we’ve already discussed, estrogens increase oxytocin levels.

Personally, I notice a kind of sensual feeling, which I call the Marilyn Monroe mode, within half-an-hour or so after taking Estrace, which spikes estradiol (which the body then quickly converts into estrone — regardless of whether you swallow the tablet or take it sublingually; you don’t really linger too long in that high-estrogen glow of feeling like a sex goddess, but even a flash of it is nice to experience).


The idea that serotonin is all we need to feel happy and peppy misses the point completely. What we need is a good neurotransmitter balance, with good neuropeptides thrown in. If one neurotransmitter, be it dopamine or serotonin, is artificially raised, expect trouble.

Dopamine has been called our “reward chemical.” It delivers an emotional high. You feel pleasurably excited, energetic, sexy, passionate, euphoric.

Crenshaw goes so far as to say that “dopamine addicts you to the person you love.” Serotonin, on the other hand, is the tranquility chemical, and it lowers sex drive. In addition, while dopamine lowers insulin, serotonin increases insulin. Now, in men, higher insulin means lower testosterone.

I hasten to say that to my knowledge St. John’s Wort has never been linked to sexual dysfunction; apparently it mildly raises ALL neurotransmitters, not just serotonin.

By the way, dopamine is regarded as having an anti-carcinogenic action, perhaps due to its ability to lower insulin (but I believe there is more to it than that — pleasure has an amazing health-giving power). Now, falling in love has also been known to regress cancer; could dopamine be involved here? (Again, I’m sure that this is not the entire answer, only at best a part of the answer.)

Protein increases dopamine synthesis, since dopamine requires the precursor amino acid tyrosine, abundant in meat and dairy. That’s why the pleasurable surge of energy after a high-protein meal. Carbohydrates increase serotonin only if they produce an insulin surge that pushes tryptophan into the brain.

Note that you don’t have to rely on carbohydrates and insulin surge to increase serotonin. We enumerated non-fattening ways to more serotonin in CyberHealth 15.

Has excess serotonin been linked to cancer? There are some disquieting questions that have been raised about certain drugs in certain dosages.

Now, when you raise serotonin in a natural way such as walking on the beach, you know that’s good for you. Your brain will produce whatever is optimal, and you will metabolize it at a normal rate. So by all means try natural ways of improving your neurochemistry before turning to drugs.


Instead of being preoccupied with ten ways to preserve romance, Reader’s Digest ought to focus on ways to increase endorphins. Touching and smiling is one way. Another way is simply THINKING LOVING THOUGHTS about one’s mate. It’s like making a deposit in your “love account.”

Part of maturity is awakening to the fact that we can CHOOSE to focus on the positive rather than the negative. We can choose to make long lists of everything that is wrong with our partner and rehearse these lists in excruciating detail with our friends. Since no one is perfect, and since no one can fulfill all our fantasies, we are doomed to never find the Prince/Princess.

But we can LEARN to be grateful for the marvelous qualities that we can also see in our mates, or at least used to see during the romance stage. Indeed, one of the amazing qualities of the romance stage is that we are freed of negativity, and thus become radiant and all-loving. With maturity, we can consciously choose to be that way: positive, radiant, loving, and overflowing with feel-good endorphins. Need I say that endorphins have been found to strengthen the immune system, protect against cancer, and be great for health and longevity in general?

One of the greatest lessons of maturity is that we can choose to be loving.

Instead of being stuck in adolescent-like waiting for love, and the depression that follows as the Prince/Princess fails to appear, we can choose to be affectionate. How does that relate to hormones and neurochemistry? All that we can say at this point is that even being affectionate toward a pet improves one’s neurochemistry — making it more likely that we’ll have the right “chemistry” to attract a loving mate.


I hope that neither Linda nor I will be accused of trying to reduce the mystery of love to a few chemicals. Of course it is all tremendously complicated. Looking at the chemistry, however, is useful, because it shows us that there are indeed different chemicals at work depending on the stage of love. Women especially need to understand that their particular chemistry makes it easier for them to bond (oxytocin), and thus they need to be more cautious about having “just a fling” with Mr. Wrong. There is a tremendous difference between an infatuation, and loving someone perceived as the right person. Maybe trying to explain “the right person” in terms of endorphins doesn’t get us very far — but heck, I’m thrilled that we have even this tiny bit of insight!



Tom Matthews, a dedicated life extensionist who practices calorie restriction, writes this:

Chocolate contains valuable phytochemicals. I eat 1 oz every day as my end of meal treat with hot drink. I eat the bittersweet kind only. The analysis on large bars of it that I get says 72% pure chocolate, so that leaves room for only 8 g of sugar per oz. Since I eat it in three divided doses at the eat of each meal, I do not see that as any problem. Once again, it’s one of these trade-off things, and my evaluation is that the benefits outweigh the harm. I tried totally pure bitter chocolate, but simply cannot take it. Currently, I am buying bittersweet bulk chocolate chips.



The polyphenols in chocolate are supposed to be even more powerful than those in red wine. There’s been a flurry of excitement recently over a Harvard study that showed that men who ate one to three chocolate bars a month had a 36% lower mortality rate than “abstainers.” (I don’t know the size of those bars; I favor bittersweet baking chocolate, so my bars are large enough for three of them to yield about 1 oz per day.) Tom is right: having a bit of chocolate with hot tea is a wonderful treat!

And now we can think of it as a life-extension practice.

Besides polyphenols, chocolate also provides stearic fatty acid, which lowers cholesterol.

Now, the longest lived person in the world, Jeanne Calment, who died at 122, was of course often asked about her longevity secret. Knowing very well how naughty that sounded, she’d reply it was cognac and chocolate. In the light of our knowledge of the benefits of moderate drinking and of chocolate polyphenols, this sounds quite right on!

One of early CyberHealth issues carried an article on chocolate. Let me reprint a portion of it for the benefit of those readers who joined us later:


The main reason is its flavonoid PHENOLICS—powerful antioxidants which have been shown to inhibit peroxide and superoxide free radicals. A report in Lancet (Sept 21 1996, p.834) states that COCOA POWDER INHIBITED LDL OXIDATION IN VITRO BY 75%, WHILE VARIOUS KINDS OF RED WINE INHIBITED IT BY 37-65%. According to the Lancet report, BAKING CHOCOLATE CONTAINS 8.4MG OF POLYPHENOLS PER GRAM, WHICH MAKES IT A STARTLING 260.4 MG PER OUNCE.

Look for chocolate that’s not loaded with sugar, and to which no extra fat (usually hydrogenated) was added. Chocolate has its own wonderful fat, cocoa butter, the saturated part of which contains a large proportion of stearic fatty acid, considered a benign fat (it doesn’t raise cholesterol while providing sustained energy; some studies have found that stearic acid actually lowers cholesterol).

If you are a purist, there is such a thing as pure chocolate. The least expensive brand, I’ve discovered, is Hershey’s Unsweetened Baking Chocolate. Ingredients? 100% chocolate. It’s on the bitter side, but you can develop a taste for it, if you are motivated enough to get those polyphenols. Great for hiking, since it doesn’t melt as easily as “candy”-type chocolate, and provides steady, sustaining energy.

Another wonderful thing about pure chocolate is that you are not likely to eat too much. One or two little squares, and you feel perfectly satisfied. This is chocolate without fear, chocolate without guilt—health and pleasure combined.

The usual caveat about chocolate is that it contains caffeine and thus shouldn’t be consumed in the evening, at least not by those sensitive to caffeine. Well, I am fairly sensitive to caffeine, and just about anything can disturb my sleep, yet I’ve never had those problems with pure chocolate, or bittersweet chocolate. The commercial hot chocolate mix, on the other hand, proved to be a disaster for me at any time of day, bringing on a sugar high followed by a hypoglycemic crash. So I suspect that the problems with chocolate reported by some people—insomnia and cravings—are really caused by the added sugar, not chocolate. Just a speculation. Again, please don’t misunderstand: pure chocolate, or bittersweet baking chocolate, is not the same thing as a typical chocolate bar, loaded with sugar and added hydrogenated fat.

Chocolate, like coffee, has also been accused of aggravating the fibrocystic breast disease. Research evidence is inconclusive. For about three miserable premenopausal years, I denied myself all coffee, tea, and chocolate, and my breasts only got more sore as I became ever more progesterone-deficient with age (I didn’t know anything about hormones back then, and my gynecologists seemed equally ignorant). So I ended up not only progesterone-deficient, but chocolate-deficient as well. I wish this were merely a joke, but think of all the disease-preventing, anti-aging polyphenols I was missing from tea, coffee, and chocolate. It’s criminal!

But then it’s possible that too much chocolate does have a bad effect on fibrocystic breasts in some women. As the ancient Greeks said: nothing in excess.

Chocolate’s treasure house of polyphenols is a boon to those who can’t tolerate red wine. (In any case, women on ORAL estrogens should limit their alcohol intake; we’ll have more on that in a future issue.) Some suggest that chocolate and red wine should be consumed together for a synergistic effect. I don’t think we have any studies on this, but on the anecdotal side, Jeanne Calment, who lived to be 122, was known for her fondness for both. One time, asked about the secret of her longevity, she is supposed to have replied, “Two pounds of chocolate a week.” She may have been joking, but . . .

(Parenthetically, the U.S. is #16 in life expectancy; France is #2.) Sometimes I have some raisins or red grapes with my chocolate as a kind of wine substitute. Raisins are known to be very rich in antioxidants.

Antioxidants are, in effect, nature’s own preservatives. I like Pearson and Shaw’s motto: “Preservatives preserve YOU.”

A historical note: chocolate was brought to Europe by Columbus.

Late-breaking news: it is possible that a cup of freshly brewed coffee has the antioxidant power of three oranges! At least these are the in-vitro results of a UC Davis professor, Dr. Shibamoto.


Through a happy synchronicity, I have found a good discussion of various types of dysfunctional bleeding in a textbook of gynecological endocrinology that I purchased for $2 in a thriftshop in Temecula, California. Let me quote:

Relatively low doses of estrogen yield intermittent spotting which may be prolonged, but is generally light in quantity of flow. On the other hand, high levels of estrogen and sustained availability lead to prolonged periods of amenorrhea followed by acute, often profuse bleeds with excessive loss of blood.

Progestin breakthrough bleeding occurs only in the presence of an unfavorably high ratio of progesterone to estrogen. In the absence of sufficient estrogen, continuous progestin therapy will yield intermittent bleeding of variable duration, similar to low-dose estrogen breakthrough bleeding.

Intermittent vaginal spotting is frequently associated with minimal (low) estrogen stimulation. In this circumstance, where minimal endometrium exists, the beneficial effect of progestin treatment is not achieved because there is insufficient tissue on which the progestin can exert action.

[In progestin-only therapy, or high-progestin/low-estrogen replacement] In the absence of sufficient endogenous and exogenous estrogen, the endometrium shrinks by pharmacologically induced pseudoatrophy. Furthermore, it is composed almost exclusively of pseudodecidual stroma and blood vessels with minimal glands. Experience has shown that this type of endometrium also leads to the FRAGILITY BLEEDING more typical of pure estrogen stimulation.

Speroff, L, editor, Clinical Gynecologic Endocrinology, 1989, p. 278



For me, the most enlightening information was the part about the fragility of the endometrium and its peculiar structure (stroma, or the supportive framework tissue, and blood vessels rather than glands) when estradiol is either minimal or very low in ratio to continuous progesterone. Some postmenopausal women NOT ON HRT experience occasional light bleeding for no apparent reason — well, if you question them closely, it seems to be during or following a period of unusual stress.

Again, we are back to the question of the best E/P ratio. This is not to say that high P/low E ratio may not be the best thing for some women, or an excellent way to prevent breast cancer. Once you understand the underlying cause of occasional spotting on this kind of regimen — endometrial tissue fragility — it just isn’t a cause for alarm, providing of course that it is very light and self-limiting. If the bleeding becomes troublesome, an adjustment in doses should be considered.


So how can you tell if spotting is due to low estrogen or to inadequate P?


This is where having a competent gynecologist really helps. By “competent” I mean someone who is not a “yanker” eager to do hysterectomies. I mean someone who’ll patiently experiment with different doses and seek a hormonal solution first.

I’ve had very slight breakthrough bleeding a few times in my four years on NHRT, and practically every time I could clearly see stress as the cause.

Increasing P dose was 100% effective, usually within a very short time. But some women report that increasing P works like a charm for a while, and then they start spotting again. In that case, seek medical help — taking care to avoid the type whose eyes light up at the thought of a hysterectomy. I’ve been told that some gynecologists hold the opinion that ALL menopausal women should get a hysterectomy. Perhaps that’s why the US is notorious for the huge number of hysterectomies, an estimated 90% of which are medically unjustifiable. (One woman said to me, “At my high-school reunion, I was the only one with a uterus!”)


Shira writes:

Re: << subclinical hypothyroidism >>

WOW! That happened to me too. …my doctor taking me off thyroid and refusing to put me back on when I complained of similar symptoms. So, I fired him and got a doctor who had some common sense….Not so easy to find.



Not easy indeed. But find them we must. CyberHealth is honored to have among its subscribers Dr. Philip Lee Miller, MD, Medical Director of the Los Gatos Longevity Institute. He has graciously agreed to permit me to publish his email message. I think it is important to show that yes, there are doctors out there who know a lot about hormones and, even more important, are constantly learning.


Philip Miller, MD, writes:

Schachter and Debled have it exactly right (or as exactly as we can be today) [Ivy: Schachter and Debled find that early TESTOSTERONE replacement actually prevents prostate problems; they also stress the importance of estrogen/androgen balance.] No one in the American community is looking at the influence of estrogen on the prostate. I refer you to Bruno deLignieres and Vermuelin who are European researchers treating prostate cancers with testosterone or even with DHT. I also refer you to Steven Fowkes who just wrote the most eloquent and powerful article on aromatase inhibitors and the balance between estrogen and testosterone on the prostate.

I am seeing more and more that there is no such thing as “female” and “male” hormones. We all have the same hormones. It’s just a matter of balance, and to a lesser extent where the hormones are produced. I am beginning to calculate P/E, T/E and P/T ratios on many of my patients that get the full hormonal profile. I have one young 20 y/o lady who came to see me for menstrual irregularities which I was certain was low progesterone. Indeed she had very low progesterone levels. However, the interesting thing is that, despite very healthy breast development, her T/E ratio is greater than 1.

Would really tend to cut though some interesting stereotypes and preconceptions of these two major hormones. Her total TESTOSTERONE level is much higher than most of the men I see in their 50’s.

Again, she is exceptionally well developed and pretty and there is no doubt as to her femininity. What I have seen is that woman have much higher levels of SBG (as are their HDLs) so that even though their total TESTOSTERONE is higher their free TESTOSTERONE is still much lower than men.

I am also seeing prostate and breast problems as basically the same process.

Maybe different location but they seem to have the same incidence and significance to each sex. Both are related to changing hormonal ratios as well as the problem with an imbalance between oncogenes, promoters and suppressor genes.

Ratios … that is the key to the next 5-10 years of hormonal research because it is the answer to the clinical end-point of restoring balance.

At the risk of immodesty, the work we do achieves a level of expertise that I think is rarely exceeded in clinical practice in the US. I am medical Director of Los Gatos Longevity Institute which is one of the few centers in the US solely dedicated to Anti-Aging Medicine. Obviously, I see and treat a great many women in their late forties suffering from the mid-portion of peri-menopause. Many times the results even astound me when professional women come to me “a wreck” and are virtually “my old self” within 1-2 weeks. I am now seeing more men come to have their andropausal symptoms treated. Seeing men is a tougher sell because men are so much more reluctant to seek help than women are.



It is a real toughie to break through that male denial about the belly growing bigger and bigger and while muscles and potency wane. So many times, as soon as I mention andropause as a general topic, without meaning to be personal, the man will exclaim, “But my libido is great!” Seventy-year-olds and beyond claim to be horny all the time as though to prove they couldn’t possibly be TESTOSTERONE-deficient. It takes someone like Ky, formerly a pharmacist at WIP, to mournfully remark, “We start going downhill beginning at 25.” That’s why some anti-aging experts believe that low-dose testosterone replacement should start already at 35 or 40 — or at whatever age the pot belly starts looming as a portent of the andropausal slump.

About the ratios: the “fearful symmetry” between aging men and women is that men become more estrogenic, and women more androgenic. Of course these days we see pot-bellied women at ever younger ages. But at least we do talk about hyperandrogenic women, while the term “hyperestrogenic male” isn’t even in the vocabulary!

But I don’t mean to get into the estrogen/androgen issues. I have quoted the email from Dr. Philip Miller to show that physicians of this caliber do exist, and should be recognized for their knowledge and pioneering work. If you are interested in learning more about Dr. Miller’s anti-aging practice, please look up


Since sucrose, or table sugar, is supposed to be utterly bad, some people have turned to fructose. Indeed, fructose is turning up in endless processed foods, probably because manufacturers think it looks better on the label than “sugar.”

Table sugar is not a simple sugar. It is composed of glucose and fructose.

Only glucose can immediately enter the bloodstream and be used for energy (if your muscles are active, they take up glucose through a mechanism that does not depend on insulin; hence exercise is extremely effective in lowering blood sugar and insulin).

Fructose can be converted to glucose if there is need for extra energy. Most likely, however, there is already plenty of glucose in the bloodstream, and the fructose we consume ends up being converted to acetones, which are then transformed into cholesterol and triglycerides.

If you want to raise your triglycerides, eating a lot of fruit and drinking fruit juice is a quick way. Triglycerides are escorted to the fat cells as our energy reserve in the event of famine, which these days rarely happens.

Are these new discoveries? A biochemist friend told me those things back in the early seventies, but I didn’t want to hear. Fruit was then being presented as the food of the gods, and people were encouraged to become “fruitarians,” with fruitarianism as the ultimately refinement of vegetarianism and the most enlightened diet. But I kept remembering the biochemist’s somber look as he said, “Fructose is REALLY horrible.”


If you drink orange juice in the hope of protection against colds, think again. Foods with high content of simple sugars are notoriously immunosuppressive.

I know that a lot of you are going to object that after all “fruit is good for you.” Actually the kind of fruit that is best for us is BERRIES such as blueberries, strawberries, and cranberries, and these are fine as long as you don’t juice them or load them with sugar —whether table sugar or fructose. Low-glycemic, non-sweet citrus such as grapefruit is excellent also, and rich in its own variety of protective bioflavonoids. I am also not against “an apple a day” — apples with the skin on are a valuable source of fiber (pectin), boron (good for bones) and quercetin (protects against cancer), and green apples are relatively low-glycemic.

Just moderation, please.

High-glycemic fruit has a high glucose/fructose ratio. Some people aren’t even aware that there is glucose in fruit! It comes as a surprise to them that fruit such as ripe bananas is very high on the glycemic index — above 80, meaning it is a rapid inducer of insulin.

Sure, just looking at the glycemic index, that is not as bad as white bread — but do you know anyone who ever eats white bread all by itself? This is what the Wurtmans advise as a way to raise serotonin by causing an insulin surge — a plain bagel all by itself — but I don’t think the advice has been popular.

Bread, rice, and similar starches are usually eaten together with protein and fats; bananas, however, are very often eaten as a snack between meals. Quite soon the eater becomes hungry again, and reaches for another banana — and/or a candy bar, a carton of fruit-and-syrup-sweetened non-fat yogurt, and the like junk food.

Did you ever wonder why women who always snack on fruit and drink a lot of fruit juice tend to be overweight? Well, think of bears who fatten themselves up for winter by eating a lot of fruit in the fall.

Generally, the good nutrients in fruit can be found in vegetables as well, minus a load of fructose and glucose. Potassium, vitamins, flavonoids and other biochemicals are found in abundance in vegetables and in beverages such as tea. It is interesting that study after study finds that protection against heart disease and cancer comes chiefly from vegetables, not fruit.

I admit that it is possible that there are some unique nutrients in fruit that we haven’t discovered yet. And there is no question that the antioxidants in berries and quercetin and boron in green apples are very valuable. Since variety is so important, no one advocates zero fruit. Zero fruit juice, yes — that idea is catching on. But not “zero fruit.” Just moderation.


Tom writes:

While it is being converted to glucose, fructose is cross-linking with proteins at a much higher rate than is glucose [Ivy: this could be called “fructosylation” rather than glycosylation]. That more than anything else is why I am trying to cut back on my fruits, even though I believe they are also filled with many good bioflavonoids.

One way to “have your cake and eat it” is to be very selective about which fruits you eat much of. The idea that fructose accelerates aging is actually a well proven fact, even though it tends to be ignored because everyone only thinks in terms of glucose and insulin.

Here is a very recent abstract which illustrates my point. [Ivy: I have abbreviated the abstract to make it less technical; also, the emphasis is mine]


Fructose intake has increased steadily during the past two decades.

Fructose, like other reducing sugars, can react with proteins through the Maillard reaction (glycation), which may account for several complications of diabetes mellitus and accelerating aging. In this study, we evaluated the effect of fructose intake on some age-related variables. Rats were fed for 1 y a commercial nonpurified diet, and had free access to water or 250 g/L solutions of fructose, glucose or sucrose.

The tested sugars had no effect on plasma glucose concentrations. Blood fructose, CHOLESTEROL, fructosamine and GLYCATED HEMOGLOBIN levels [Ivy: these last two are biomarkers of glycosylation], and urine LIPID PEROXIDATION products WERE SIGNIFICANTLY HIGHER IN FRUCTOSE-FED RATS compared with the other sugar-fed and control rats. Acid-soluble collagen and the type-III to type-I ratio were significantly lower, whereas insoluble collagen, the beta to alpha ratio and collagen-bound fluorescence [Ivy: indicators of cross-linking, which would show as wrinkling of the skin] were significantly higher in fructose-fed rats than in the other groups. The data suggest that LONG-TERM FRUCTOSE CONSUMPTION INDUCES ADVERSE EFFECTS ON AGING; further studies are required to clarify the precise role of fructose in the aging process.



And here is a statement from another abstract also sent to us by Tom: “fructose causes far more protein damage than glucose” (Clin Chem 1992 Jul;38(7):1301-3).

Some of our long-time subscribers may remember an early article, “Does sugar accelerate aging?” Of course we see the effects of high blood glucose in adult-onset diabetics — the endless pathologies: atherosclerosis, blindness, gangrenes, nerve degeneration, stroke, kidney failure (high blood sugar is extremely damaging to the kidneys) — and the extremely wrinkled skin, similar to what you see in long-time heavy smokers (a diabetic friend of mine looks at least 20 years older than her age; for years and years she refused to stop eating fruit, in spite of medical advice based on the mounting evidence that fructose is very harmful to diabetics). In the last thirty years, the incidence of diabetes in the U.S. has increased six times, making some speak of a diabetes epidemic.

Dr. Sears calls diabetics “canaries in the coal mine of aging.” Possibly the main reason for the rapid aging associated with high blood glucose levels is GLYCOSYLATION, or cross-linking between glucose and proteins.

Glycosylated proteins gunk up our system; for example, glycosylated amyloid protein becomes the deadly amyloid plaque in Alzheimer’s disease. While some glycosylation is inevitable as we age, we should strive to keep the rate as slow as possible. As Tom points out, avoiding excess fructose is part of it.

I hate to tell you this, but we are barely beginning to figure out if there is any way to break up those cross-linkages that are regarded as a major factor in aging. Most experts tend to consider the process irreversible and thus all they can advise is trying to keep your blood sugar in the low-normal range.

As for the wonderful bioflavonoids that some types of fruit provide, these nutrients are richly available in veggies and in less sweet (low glucose/low-fructose) fruit. An avocado supplies a lot more potassium than a banana — and plenty of those wonderful monos, in a tastier form than olive oil. Again, limiting fructose doesn’t mean zero fruit; it means moderation. Don’t go bananas over fruit; emphasize low-glycemic veggies instead. Likewise, juicy, tart fruit is typically both richer in antioxidants and less loaded with simple sugars than ripe bananas.

Fruit as nature intended —millennia ago — wasn’t actually as sweet as it is now. Most of it was probably fairly tart. But we started selecting and hybridizing, and have by now genetically engineered cloying sweet apple and pear varieties and the like.

As for commercial fructose-sweetened products, these are highly processed, and it doesn’t really matter what the sweetener is: honey, fruit juice, high-fructose corn syrup, sugar, or aspartame. Why put garbage into your body? As an act of self-love, eat a light balanced meal instead; eat a combination of real foods that provides not only carbohydrates, but also sufficient protein, fat, and fiber. It doesn’t matter if it’s only a snack.

A snack has to be balanced also.

If you are interested in lowering your blood glucose and thus the rate of glycosylation, a low-carbo, low-glycemic diet is obviously a must; so is moderate exercise. Among supplements, good fatty acids such as fish oil, perilla oil (similar to flax oil, but better), CLA, and green tea have been documented to lower blood glucose. But diet is primary. Even taking 50 different supplements with each meal (yes, some people do) will not compensate for a pro-aging diet. (Still, I do recommend green tea to keep the blood glucose from surging, particularly if your meal includes a high-glycemic food such as rice or cooked carrots. I also recommend methylating agents such as trimethylglycine and/or folic acid if you eat animal protein — just to be on the safe side in terms of homocysteine. I also recommend the good fatty acids, wonderful helpers with sugar and metabolism. A note to women hesitating about HRT: estrogens in the right dose range lower both blood glucose and homocysteine.)


A lot of people react with dismay to the idea of limiting carbohydrates; life without unlimited cornflakes, bagels, pasta, bananas and fruit juice seems unimaginable to them. The question I often hear is, “So what am I supposed to eat?”

It’s interesting that optimal chow for laboratory monkeys has been developed in order to keep those very expensive animals healthy, and that likewise great care is taken to prevent nutritional deficiencies in farm animals, but when it comes to humans, we don’t really know the answers.

We do have some clues, however, and these come from studying centenarians.

The place with the highest percentage of centenarians is the island of Okinawa in Japan. It turns out that the Okinawan diet differs in some crucial ways from the average Japanese diet. Much to the disgust of diet gurus, the most famous regional dish is fried pork. Indeed, the Okinawans consume more protein than the rest of Japanese, both from meat and seafood.

They also eat less rice, but more vegetables — three to four times more.

Their intake of green tea is presumably comparable to elsewhere in Japan.

So perhaps the answer is indeed lots of seafood, some meat, lots of veggies, some rice, lots of green tea.

Or, if you’d rather follow the advice of Jeanne Calment, lots of chocolate.

Or, following Tom’s advice, green tea AND chocolate.


My December was such a pressure cooker that I knew I needed something truly effective against colds and flu. And I discovered that indeed there is something that works: NAC, or N-acetyl-cysteine. It’s a sulfur-rich antioxidant amino acid. It is also supposed to provide great protection against lung cancer and breast cancer.

So what does it have to do with “the inner mascara”? Well, here is what I noticed after a few months of taking NAC: lusher, thicker eyelashes. I first noticed this effect just with nhrt, but NAC seems to have given the eyelashes a little extra density.

Stronger fingernails seem another visible benefit.

It’s worth trying. You can’t lose.


Linda sent us this:


People are often unreasonable, illogical, and self-centered;
Forgive them anyway.

If you are kind, people may accuse you of selfish, ulterior motives;
Be kind anyway.

If you are successful, you will win some false friends and some true enemies;
Succeed anyway.

If you are honest and frank, people may cheat you;
Be honest and frank anyway.
What you spend years building, someone could destroy overnight;
Build anyway.

If you find serenity and happiness, they may be jealous;
Be happy anyway.

The good you do today, people will often forget tomorrow;
Do good anyway.

Give the world the best you have, and it may never be enough;
Give the world the best you’ve got anyway.

You see, in the final analysis, it is between you and God;
It never was between you and them anyway.

(Author Unknown)



I love this. When we are young, we tend to feel so competitive! We want to “show them up” — whoever “they” happen to be. Once I met a graduate student who was still preoccupied with trying to “show up” his former high-school classmates!

To me, the definition of “God” that makes me the most sense is “that which is the highest.” One story that comes to my mind is about nuns dedicated to works of charity. In the fifties, some of them worked in the South, helping impoverished AfroAmericans. White racists called them “nigger sisters” and jeered at them as the nuns walked in the street. One day a few young nuns came to see their Mother Superior, and complained about the verbal abuse heaped on them by some passers-by that day. Mother Superior replied, “Did you pray for them?”

It was never between the nuns and the racists. It was between them and their highest ideal.


This newsletter is presented as a free service for women and health professionals interested in women’s health.

Editorial and research assistants: Gail Peterson, Monica Smith

Staff writer: Linda Dopierala

Special thanks to Tom Matthews

The material contained herein is intended as information only, and not as medical advice.

Books by Ivy Greenwell:

  • HORMONES WITHOUT FEAR (available from College Pharmacy, 800-888-9358)
  • HOW TO REVERSE OSTEOARTHRITIS (including extensive information on hormones and arthritis)