Braverman

 

 

Eric Braverman, M.D.

Medical Director, PATH Medical

offers

Professional Medicinal Suggestions

relative to Brain Aging and Medicinal Applications for

Alzheimer’s Disease

 

Dr. Braverman discusses four core principles of anti-aging medicine including a brain-health checkup and the role of anti-aging hormones.

 

 

DISCLAIMER: This information is offered purely as a prompt suggesting the reader take whatever appropriate steps he or she deems necessary in order to acquire more complete education pertinent to Alzheimer’s Disease. To the best of my knowledge, any and all statements throughout this website have not been evaluated by the Food and Drug Administration, the AMA or any medical professional other than the author of the piece you might read or watch. Any suggestions made or product identified on this website are not intended to diagnose, treat, cure or prevent any disease.

 

 

Article Furnished by…

World Health.net

 

Literature Review 2009

Compiled by Dr. Ronald Klatz, M.D., D.O., President
and
Dr. Robert Goldman, M.D., Ph.D., D.O., FAASP, Chairman -
The American Academy of Anti-Aging Medicine (A4M)
As a Public Information Service

 

 

Subclinical Hyperparathyroidism:
.
A Precursor of Osteoporosis and Dementia?

 

ABSTRACT

Parathyroid hormone is one of the most understood hormones in the body. Parathyroid hormone is anabolic in bone but when secreted in excess it is catabolic. Parathyroid hormone when secreted in excess destroys bone – as it does in most patients with chronic renal failure. Most patients as they age have a blunting of the normal circadian rhythm of parathyroid, or there is a decline in parathyroid pulsing regulation, which results in postmenopausal and other forms of osteoporosis. This paper will discuss the effect of aging and other hormones on parathyroid hormone, parathyroid disease, the relationship between hyperparathyroidism and osteoporosis and dementia, and methods of treating parathyroid disease.

 

INTRODUCTION

Parathyroid hormone is one of the most understood hormones in the body. Parathyroid hormone is anabolic in bone but when secreted in excess it is catabolic.1 Parathyroid hormone when secreted in excess destroys bone – as it does in most patients with chronic renal failure. Most patients as they age have a blunting of the normal circadian rhythm of parathyroid, or there is a decline in parathyroid pulsing regulation, which results in postmenopausal and other forms of osteoporosis. Furthermore, this delay is related in part to growth hormone deficiency, which improves parathyroid sensitivity.2 Adult growth hormone deficiency increases parathyroid hormone activity.3 Growth hormone replacement therapy enhances parathyroid hormone circadian rhythm and increases sensitivity and/or organ responses. A circadian rhythm exists for parathyroid with a bi-phasic pattern showing a late afternoon and early evening rise and fall, and a broader longer lasting increase between late evening and early morning or mid morning. Aging alters the response to calcium and increases the suppression of parathyroid hormone pulsation resulting in decreased bone resorption.

 

PARATHYROID HORMONE AND AGING

The anabolic affect of parathyroid hormone on weight gain also reverses anorexia-induced osteoporosis, uncouples bone remodeling, and restores the circadian variation of bone resorption markers.4 When supplemented with calcium, total body bone mineral and bone mineral density can preserved during weight loss, and also trigger a parathyroid hormone decrease during the weight loss.5

The circadian secretion of parathyroid hormone seems to have a neural mechanism as well, as a result of modulation of adrenal cortex hormones such as DHEA, thyroid, testosterone, estrogen, and progesterone.6 Parathyroid tides are of short duration whilst vitamin D or calcitriol tides are of long duration. Parathyroid is quick in mobilizing bone calcium, while calcitriol tends to increase the absorption of dietary calcium. In the case of low or no dietary calcium calcitriol mobilizes bone calcium and thus increases parathyroid initiation and demineralization, therefore mixed effects occur during vitamin D deficiency and pseudo or secondary hyperparathyroid conditions occur. Furthermore, overnight fasting with reduced absorption of dietary calcium associated with age results in a regulatory set point inducing an increase of parathyroid secretion with age. Parathyroid secretion with age is associated with dementia and aging. Calcium is best absorbed during the morning time.7

Adult growth hormone deficiency (AGHD) is associated with osteoporosis and parathyroid insensitivity. Growth hormone regulates normal parathyroid circadian rhythms and with age AGHD results in significantly lower NcAMP, low bone turnover higher calcium excretion, and the presence of significantly higher parathyroid hormone concentrations.8 Growth hormone itself is secreted in a circadian rhythm and superimposed pulsatility therefore IGF-1 is the best form of measuring this hormone. Growth hormone replacement therapy administered in the form of time intermittent subcutaneous injections is best given at night,9 as is Forteo, so that the anabolic cycle can exist.10 When taking injections, patients are instructed to be sitting or lying down because orthostatic hypertension may occur.11

Melatonin may also play a role in reduction of sleep with age. Parathyroid hormone levels rise as melatonin levels go down.12 Many patients who tried to deal with the hyperparathyroidism of aging by increasing calcium without a significant measurable of serum parathyroid hormone, have continued to march toward osteoporosis even when taking high calcium citrate supplements.13

Patients with primary hyperparathyroidism are frequently marked with severe osteoporosis and reduction in growth hormone effectiveness,14 growth hormone stimulation, and growth hormone levels, resulting in not only bone loss but also muscle wasting. By taking both hormones we address the fragility of aging. Furthermore, with additional vitamin D we suppress parathyroid hormone15 and raise
calcium.16,17

In conclusion, aging is a complex, multi-factorial phenomenon. The existence of biological rhythms needs to be studied.18,19 It is apparent now that parathyroid levels should be kept below 30-35 in kidney failure patients. The increase in parathyroid hormone levels with age is a major factor responsible for the age-related increase in bone resorption and digestion, and it also contributes to kidney stone formation.20,21 While sleep may be protected against this pattern, slowing the primary aging processes by just caloric restriction has proven unsuccessful.22,23 At this time it is clear that the low pulsatile secretion of parathyroid hormone is related to osteoporosis and results in a higher circulating parathyroid hormone level.24

It is clear that we do not understand all aspects of the circadian rhythm but it appears that Forteo may reduce overall circulating parathyroid hormone levels by substituting for failed pulsatile secretion. Decreases of pulsatile secretion have been documented in patients with primary hyperparathyroidism25. Transcriptional suppression of the parathyroid hormone gene by calcium is nearly maximal at physiologic calcium concentrations. Hypocalcemia increases transcriptional activity within hours. 1,25 (OH)2D3 strongly suppresses parathyroid hormone gene transcription. In patients with renal failure, intravenous administration of supraphysiologic levels of 1,25(OH)2D3, or analogues of the active metabolite, can dramatically suppress parathyroid hormone overproduction, which is sometimes difficult to control due to severe secondary hyperparathyroidism. Regulation of proteolytic destruction of parathyroid hormone (posttranslational regulation of hormone production) is an important mechanism for mediating rapid (minutes) changes in hormone availability. High calcium increases and low calcium inhibits the proteolytic destruction of hormone stores.26 Electrical therapies and calcitonin may have a beneficial affect on its overall aging phenomenon.

Other subtle aspects of the parathyroid disease maybe associated with vitamin K30,31 deficiency, vitamin B deficiency, 32 or a boron, strontium, or aluminum elevation.33 Hyperparathyroidism is also associated with dementia and other cognitive impairments.34 Psychological deterioration can be attributed to parathyroid dysfunction and can be especially reasonable in patients who do not respond well to mental illness treatment. Often, psychological symptoms related to parathyroid disease reduce or disappear with corrective endocrine treatments. Parathyroid hormone is as close to anything as the ideal anabolic agent. An ideal anabolic agent would:

• Stimulate the formation of histologically normal bone
• Increase trabecular, cortical, and total body bone mass to youthful levels after just a few years
• Increase the strength of vertebrae, proximal femur, and other bones of experimental animals
• Eliminate fragility fractures in osteoporotic humans
• Permit normal bone remodeling and repair
• Maintain normal bone shape
• Have no dangerous or distressing side effects
• Be cost-effective and convenient

Although no drug has yet satisfied all of these requirements, prostaglandin E1, prostaglandin E2, insulin-like growth factor 1 (IGF-1), platelet derived growth factor beta (PDGF-β), parathyroid hormone (PTH) and its amino-terminal fragments and analogues, and parathyroid hormone-related protein (PTHrP) have dramatically increased trabecular, cortical and total body bone mass and bone strength in experimental animals. However, only PTH and PTHrP do not have undesirable extra-skeletal effects.

Daily administration of PTH can cure osteoporosis in animals by restoring normal bone mass, structure, and strength.

 

Dr. Braverman’s Charts and Diagrams to be placed here.

 

CONCLUDING REMARKS

Parathyroid levels should be looked at more carefully, for example in a similar way to how we now look at cholesterol. Levels above 30-35 should be coupled with bone density studies and may also be a marker for cognitive decline.41 With age, parathyroid hormone levels increase. Treatment with Forteo™ can help to prevent dementia, and earlier treatments for osteopenia will prevent the development of osteoporosis.

 

REFERENCES

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3 Fraser WD, Ahmad AM, Vora JP. The physiology of the circadian rhythm of parathyroid hormone and its potential
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ABOUT THE AUTHOR

Eric R. Braverman, M.D. is the Director of The Place for Achieving Total Health (PATH Medical), with locations in New York, NY, Penndel, PA (metro-Philadelphia), and a national network of affiliated medical professionals. Dr. Braverman received his B.A. Summa Cum Laude from Brandeis University and his M.D. with honors from New York University Medical School, after which he performed post-graduate work in internal Medicine with Yale Medical School affiliate. Dr. Braverman is a recipient of the American Medical Association’s Physician’s Recognition Award. Dr. Braverman has published over 90 research papers presented to the medical community. Some of his lectures include topics on “Melatonin, Tryptophan and Amino Acids” given at Los Alamos National Laboratories, “The Core Neurotransmitters and Hormones and How They Affect the Aging Process” given at Brookhaven National Laboratories, and most recently he gave a lecture on “P300 Evoked Response as a Predictor of Alzheimer’s” at Oxford University in England. Dr. Braverman is the author of five medical books, including the “PATH Wellness Manual”, which is a user’s guide to alternative treatment. He has appeared on CNN (Larry King Live), PBS, AHN, MSNBC, Fox News Channel and local TV stations. Dr. Braverman has been quoted in the New York Post, New York Times and the Wall Street Journal.

 

 

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