Hormone Replacement Therapy E4 Women

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Silverlining
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Re: Hormone Replacement Therapy E4 Women

Postby Silverlining » Mon Jan 06, 2014 4:58 am

This is a bump to let the "girls" know I edited my original post to add recent research links in this subject area. Scientific opinion varies and the picture is very murky, in my opinion...it seems once again "we're damned if we do and damned if we don't". At 49 years old, HRT is an immediate and critical concern of mine and I feel frustrated!

circular
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Re: Hormone Replacement Therapy E4 Women

Postby circular » Mon Jan 06, 2014 9:05 am

Thanks, good to collect these in one place. The Wiki page would be another good place.

I'm in over my head helping my mom downsize, so I can't peruse these in detail, but I wonder ... can they be summarized in terms of degree of significance of the results? One I glanced at looked like just a 1-2 year difference in cognitive function between two groups (really not much in the context of a long life), while the article about accelerating aging shows a 10 year difference in favor of ApoE4 women using HRT. So often articles say "significant" when if you look closely at the numbers it's not significant compared with something else significant.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Julie G
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Re: Hormone Replacement Therapy E4 Women

Postby Julie G » Mon Jan 06, 2014 1:07 pm

Hey Girls, the one that has me most worried is the research based on the Nurse's Home Study group. (Whenever human studies are available, I tend to give little weight to rodent studies.) I noticed the women were followed since 1976. I'm not sure of the timing, but I can't help but wonder if some of the women were using the older, synthetic hormones...wonder if that makes a difference? Also, read the older Framingham data. Post-menopausal ApoE4 women just dropped off. They simply died and were no longer a part of the group :? At the same time, the remaining women's LDL and Apo-B rose pretty dramatically...that was pretty convincing for me. Although, I'll have to re-read to be sure; I don't think they indicated whether or not the women were using HRT- an important piece of the puzzle.

It's a tough decision. I'm using less than the lowest dose of a bio-identical patch; around 3/4 of a 50/140 Combi-patch. It's enough to control symptoms, but hopefully not high enough to do harm :?: FWIW, Dr. Perlmutter was very much in favor of this for ApoE4 women. Lilly's anti-aging specialist felt the same way.

Good work, Silver. I wish the information was clearer :shock:

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Mon Jan 06, 2014 5:49 pm

Then there's estriol, supposedly a weaker estrogen with benefits, but plenty of sites to poo-poo it too. My OB/GYN puts estriol in all her BHRT blends, as well as a smaller amount of estradiol. She also seems to feel strongly that estrogen is good for cognition, but says the science is mixed as to whether it can prevent AD. She was very interested in the accelerated aging of ApoE4s article.
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Re: Hormone Replacement Therapy E4 Women

Postby SusanJ » Tue Jan 07, 2014 9:01 am

It might not be the estrogen that is important for cognition, but the progesterone.

http://www.sciencedaily.com/releases/20 ... 164436.htm

Remember that progesterone typically starts declining well before menopause due to anovulatory cycles. There are some doctors that have found women, who have had a deficit of progesterone, can have worse symptoms when first using it.

When you look at the hormonal pathways, progesterone sits at the front end of the production of other hormones, including cortisol. If you are stressed, the pathway to cortisol is in hyperdrive, which can shut off the spigot to the pregnenolone to DHEA, testosterone and estrogens path. My doc calls it the "cortisol steal".

So, adding some extra progesterone in a system with very little to begin with, could swing the other pathways out of whack. And, it probably also makes sense if you add progesterone without dealing with your stress response, things could get worse.

A good diagram at http://www.gdx.net/images/webinar/Stero ... _Chart.pdf

My best advice is test, and retest to see what your body is actually doing with any added hormones. Even with a reasonable dose, you might also find other SNPs, diseases or nutrition that impact those cycles, such as the metabolism of DHEA and estrogen.

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Re: Hormone Replacement Therapy E4 Women

Postby Schnooks » Wed Jan 08, 2014 4:47 pm

"Post-menopausal ApoE4 women just dropped off. They simply died and were no longer a part of the group"

CRAP .. I am 48 and post-meno 4/4 .. how long do I have to live!!

I guess I need to get to the doctor to check levels!

What should I be taking? What kind of estrogen? I never wanted to do HRT because of risks.

I swear.. part of me really wishes my idiot doctor hadn't tested my APOE (without my knowledge) .. I have a lot of anger toward her. The mental repercussions are just overwhelming. It doesn't help that I found out how bad my 77 yr old uncle is doing with his alzheimer's today.

Is there a list somewhere of everything you can be doing for prevention.. like eating, hormones, etc.

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Re: Hormone Replacement Therapy E4 Women

Postby Schnooks » Wed Jan 08, 2014 4:48 pm

btw.. can someone explain what happens w/ post-meno 4/4 brain without hormone replacement (if needed) .. I just can't read all this stuff. Sorry.
closing on a house and moving

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Julie G
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Re: Hormone Replacement Therapy E4 Women

Postby Julie G » Wed Jan 08, 2014 6:08 pm

Is there a list somewhere of everything you can be doing for prevention.. like eating, hormones, etc.


I wish :? That's basically WHY we created this site to try to hammer out some prevention strategies. It seems like all advice is equivocal. For every study that says something helps; another says it won't.

"Post-menopausal ApoE4 women just dropped off. They simply died and were no longer a part of the group"
CRAP .. I am 48 and post-meno 4/4 .. how long do I have to live!!


Yeah- cheery, right? Read the Framingham Study, as E4 women get older...there's simply less of them.

btw.. can someone explain what happens w/ post-meno 4/4 brain without hormone replacement (if needed) .. I just can't read all this stuff. Sorry.


There's some evidence that estrogen helps regulate glucose transport to the brain...a process that's already impaired, in a dose dependent fashion- with each E4. There's also evidence that post-menopausal E4 carriers demonstrate elevated LDL and Apo B levels.

What should I be taking? What kind of estrogen? I never wanted to do HRT because of risks.


Maybe print a few of the studies and share them with an informed gyn and see what s/he recommends. Many of us use bio-identical patches. Keep in mind, every piece of advice has pros and cons. I you aren't experiencing horrible hot flashes or other menopausal symptoms...you might be OK. (Monitor LDL/Apo B levels to be sure.) Keep in mind our very own Starfish (4/4, 76 y/o) experienced menopause at 43, never took hormones, and is doing great.

(((Schnooks))), I moved shortly after learning my status. I KNOW how overwhelming this can be. Trust that you will sort things out and find a regimen that works for you.

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Re: Hormone Replacement Therapy E4 Women

Postby circular » Wed Jan 08, 2014 6:33 pm

Another way to look at a list that might work for you isn't to think of the items as guarantees, but ones that may really help protect and won't hurt. This makes specific diets and hormone therapies hard to place on the list, because of the potential downsides to them. However, if you make a custom list modified by other aspects of your health and condition, you can include a lot of things like:

regular exercise (clears amyloid)
music (neuroplasticity)
sleep (clears amyloid)
mindfulness meditation (downregulates inflammatory and maybe alters other genes' expression)
exercise *with* social interaction
exercise *with* and/or *to* music
sleep *with* music
mindfulness mediation *with* music
mindfulness mediation with exercise
social interaction
close, healthy emotional ties
coffee
high flavanol cocoa powder
melatonin
keep stress levels low as possible
other things

Check the supplements folder for some other ideas along those lines, but I am rather conservative on supplements. I think with such little research on them it's too easy to be too clever by half. The studies usually track one or a small number of endpoints, when a supplement can influence dozens of downstream endpoints, good or bad, that studies don't evaluate. I follow Isaacson's The Alzheimer's Diet for this since he's a neurologist who's himself at high risk. He's on board for coffee, hf cocoa, curcumin and fish oil (caveats for fish oil success in ApoE4 but he doesn't seem to think it will hurt).

At least I don't know of downsides to these unless you have particular sensitivities to caffeine, moderate exercise ...
ApoE 3/4 > Thanks in advance for any responses made to my posts.

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Julie G
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Re: Hormone Replacement Therapy E4 Women

Postby Julie G » Wed Jan 08, 2014 7:09 pm

Nice list, Circ. I'd like to learn more about Dr. Isaacson's diet recommendations. Post more in the nutrition section when you get a chance-thanks!


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