Most of my patients seem convinced that their diet can be labelled as “optimum” as long as they avoid cholesterol. Cholesterol is at the centre of an all-out demonization: popular belief, mainstream media, dieticians, nutritionists, doctors…all are convinced of the harmfulness of this omnipresent molecule in animal flesh.

All this nonsense stems from a biased epidemiological study published in 1953 by the Dr. Ancel Keys, a study known as the Seven Countries Study. It seemed to demonstrate the direct link between saturated fat consumption and the prevalence of coronary heart disease. In reality, the available statistics at that time were drawn from 22 countries and if the calculation was re-done today on the same statisticalbasis, but widened, we would obtain a diametrically opposed result, that is, there is no link between saturated fat intake and cardiovascular disease.

This being said, the goal here is not to just dispute historical studies but to set the record straight. Rather, it is simply to look at the facts and discuss some physiology. It has been clearly established that a cholesterol level below the official normal range is associated with increased mortality, especially related to suicides (nervous system disturbance) and cancer (altered immune system). I do not deny that some risks increase with excessive cholesterol, however the relationship of cholesterol to morbidity (illness), and cholesterol to mortality, represents a U-shaped curve, just like almost all biological parameters in fact. After all, there is nothing really revolutionary in saying that, in biology, reaching a balance constitutes the Holy Grail.

In addition for all those who remain convinced of the dangers of cholesterol, how do they explain the most recent epidemiological study of patients over 80 that clearly demonstrates a higher life expectancy for those with higher cholesterol? So if that is true, when are we supposed to suddenly switch from cholesterol being as low as possible, to the opposite: 60 years, 65 years, 70 years or 75 years old?

Let's be reasonable: just consider the many physiological roles of cholesterol. Without it as an inescapable precursor of all steroid hormones (there is a good reason it ends in “sterol”), there would be no sex hormones (œstradiol, progesterone, and testosterone) and no adrenal hormones (glucocorticoids or 17-hydroxysteroids, 17-ketosteroids, or mineralocorticoids). Also without cholesterol there would be no bile acids and therefore no bile salts to emulsify and digest fats.

Without cholesterol, we lose a fundamental component of brain tissue: in the words of the French cardiologist Michel de Lorgeril: “The brain adores cholesterol”! Patients suffering from a deficiency in cholesterol, congenital or not, develop cognitive disorders (memory and/or impaired intelligence). Consequently, should we be surprised at the side effects of statins those very fashionable cholesterol-lowering medications that often result in memory disorders sometimes confused with the onset of Alzheimer's?

Without cholesterol, cell membranes loosen their structure, so much so that increased consumption of omega 3 fatty acids has the capacity to slightly lower blood cholesterol. The reason is that cholesterol must then be incorporated into cell membranes to give them more consistency in response to the greater flexibility of the membrane brought on by the polyunsaturated fatty acids.

In addition, the lack of cholesterol compromises the proper functioning of the intestinal mucosa and therefore its capacity to absorb nutrients, especially fat-soluble vitamins (A, D, E & K), coenzyme Co10 and all unsaturated fatty acids.

No matter that I base my therapeutic interventions on natural treatments (without rejecting allopathic medicines that I reserve for acute problems), I am nevertheless constantly harassed by patients who are worried about their effects!

“They have read” or “they were told” that: vitamin A is very toxic, selenium is a heavy metal, iodine must not be taken with thyroid problems, salt is very dangerous to good health, there is nothing worse than eating cholesterol, that supplementing with vitamin E and with antioxidants increases mortality, and that menopausal women must all take 1.2g of calcium carbonate daily. Actually the list could go on and on!

There is nothing that can upset me more than listening to all these mistaken beliefs! Of course there is some element of truth in these statements, but it is a pity to worry people about these nutrients when they are encouraged to swallow their daily aspirin to prevent thrombosis and heart attacks. In reality, aspirin (salicylic acid) kills up to 12,000 people a year in the United States alone, due to gastrointestinal bleeding.

One must of course be careful in prescribing nutrients: all the ones listed above can lead to toxicity in excess, apart from magnesium and coenzyme Q10. This is why one must avoid taking everything they read or hear for granted. Ideally any significant supplementation (either dosage and/or length) should be based upon an initial biological evaluation of the patient. However, sometimes dietary analysis can demonstrate the lack of a nutrient in the diet.

Consequently, I consistently refuse to recommend supplements based on such generalisations. I abhor the word “protocol” because it systematically implies a generalization while I am utterly convinced of the necessity to personalise treatments to each individual’s needs, according to their complaints and dietary analysis, but tailored to personal records via blood and urine tests. We must always personalise treatment to get the optimum results.

Therefore I do not recommend any supplement without first verifying its necessity. With this in mind, Vitamin A is not toxic but beneficial to the immune system (and for conceiving a baby!) if the patient is in need of it. Of course you should always use a strictly natural form (fish liver oil) and remain within a reasonable dose (e.g. 4,000 IU).

Selenium plays an important role in metabolism because it is part of an amino acid called selenocysteine. This is part of the chain of amino acids which is an essential component of many proteins, especially in the thyroid gland and for the conversion of thyroid pro-hormone T4 into the active hormone T3. Without selenium there cannot be any selenocysteine. We need selenocysteine as it plays a critical role in the structure of the active site of the enzyme, which means that portion of the protein involved in the biochemical reaction that the enzyme requires to be effective. Selenium is absolutely essential to human health.

Deficits of selenium are common in Western Europe, especially since the elimination of US grown grains, which are naturally much more abundant in this trace element. It is even more abundant in Brazil, hence the huge selenium concentration found in Brazil nuts. One can see that supplementing with selenium is frequently necessary but that doesn’t mean everyone needs it - and certainly not in the typical 200mcg dosage for a long period of time. Here too, there is a U-shaped curve where risk of disease increases both in cases of deficiency as well as in cases of excess…

Iodine supplementation is also a well-known bone of contention: many patients “have read things about it” or are verbally berated by others because I have recommended iodine to them. It is fact you should know; too much iodine can be a contributing factor for autoimmune thyroiditis (a pathology caused by antibodies destroying the thyroid gland).

However, too little iodine – especially when the deficiency is combined with a lack of selenium – can lead to increased oxidative stress in the thyrocytes (specialised cells that secrete thyroid hormones T4 and T3). Hydrogen Peroxide (H₂O₂), normally produced by these cells, is not properly utilised to produce these hormones due to the lack of iodine (which is part of the composition of thyroid hormones).

Poisoning of the thyrocyte by hydrogen peroxide can then result, a natural agent of course, but very aggressive when it accumulates in a cell, and usually kept at bay by the antioxidant enzyme superoxide dismutase (SOD). This enzyme can only work in combination with selenium. Thus, the double whammy of iodine and selenium deficiency can become a very explosive cocktail. I am sorry to overload you with so many technical details but I must convince you of the necessity of iodine for a healthy thyroid.

So, why is there so much acrimony from the medical profession against iodine when it is so essential? It is true, as has been demonstrated for other nutrients, that the U-shaped curve applies to iodine, meaning that the risk of thyroid dysfunctions increase when there is excess and when there is a deficit. But here's the simple explanation: you are advised not to take iodine in order to prevent you from being exposed to its excess and the possible collateral damage. In reality, what should happen is that iodine level should be measured, and based on the results, iodine should be prescribed to all those who need it, at precisely the correct dose. The reluctance to determine iodine levels finds its origin in the fact that it's very low concentration in the human body makes blood testing unreliable. Ideally, it should be measured in a 24-hour urine collection, which takes time and effort to explain to patients how to collect the sample properly!

You will find the scientific basis in relation to the above discussion in the conference on the thyroid gland on my website www.gmouton.com (Conferences / Functional Hormonology/Thyroid). You will also find on the website the information regarding the correct way to collect a 24 hours urine sample, which if not done properly can result in many errors.

Now let’s turn to the thorny issue of Vitamin E where it is now said that there is nothing worse to take, despite it having been so long revered. I do not refute the findings of the meta-analyses (a systematic method of evaluating statistical data based on results of several independent studies of the same problem) that indicate a doubtful need to supplement with vitamin E. I would even say that their negative findings do not surprise me: unfortunately the researchers have used, in the majority of cases, a synthetic vitamin E. This one has 8 different isomers, meaning molecules sharing the same chemical formula but having different spatial conformation as when you compare a left glove with a right glove, giving an idea of what are two isomers (but this happens for each of the three different sites in the molecule sharing this peculiarity). Only one of these eight isomers contains the natural form of vitamin E that must systematically be used for human therapy. Moreover, the dominant physiological form of vitamin E is the gamma-tocopherol: why do we relentlessly supplement the alpha-tocopherol form which obviously leads to a relative scarcity of the gamma form required by the body?

Most importantly, where does this absurd principle of supplementing vitamin E to a cohort of patients where a large number are not deficient in vitamin E in the first place come from? In this instance we run the risk of doing them more harm than good! It would be wiser to test first.

Always in the context of respect for the physiological norms that need to be restored for optimal heath, it is time to address the sensitive issue of sex hormones after the menopause. Contrary to what most people think, women continue to produce low levels of hormones after their periods have stopped; this minimal secretion should normally continue with any woman in good health.

Let’s take for example the main oestrogen, namely œstradiol: its blood concentration falls by a factor of 10 (to make it simple) once the ovaries stop functioning. However, the sex hormones produced in the adrenal cortex persist and should provide, if the adrenal function is not itself defective, residual levels of female hormones, not only œstradiol but also progesterone.

Contrary to what happened during the reproductive years, women’s hormonal secretions during the menopause don’t fluctuate with the monthly cycle; indeed, it is precisely the cessation of menstruation that characterises this new state. It is now a plateau of low hormonal concentrations but it is certainly not a case of the total disappearance of sex hormones.

It is essential to understand that despite the absence of the monthly cycle, menopausal women should continue to benefit from the many physiological functions of their residual hormone production; in fact, it is essential to their wellbeing. It is the œstradiol that boosts morale to start the day, while progesterone promotes relaxation and restful sleep. A postmenopausal woman devoid of these physiological sex hormones thus loses her circadian rhythm: never really fit for the day and never really relaxed at night!

I remain shocked by the total lack of interest from the more conventional medical establishment (or should we say more conservative?) in this area. In Britain for example, the National Health Service (NHS) only expresses the blood level of œstradiol in women of menopausal age as less than the threshold value. To be clear, their laboratories only indicate that the patient has fallen below the values established for premenopausal women. They might confirm menopausal status but they provide no value: they cannot assess the merits of hormone replacement therapy (HRT) for a particular patient.

Let me say it bluntly: HRT suffers from an appalling reputation, especially since the famous WHI (Women’s Health Initiative) study, published in two parts in the Journal of the American Medical Association (JAMA) in 2002 and in 2004. It must be recognized that the explosive results of this study were not surprising… using a hormonal replacement therapy utilising a strong dose of conjugated equine œstrogen (noting that mare œstrogen is much more powerful than human oestrogen) to an artificial progesterone. This involves a high and standardized dosage (which means all women receive the same treatment) combining two hormones foreign to the human body and, more importantly, orally administered. In short, here is everything you need to increase the risk of breast cancer and cardiovascular events.

In my opinion, hormone replacement therapy created and administered in such a way represents a threefold mistake: there is no personalised dosage; it uses artificial hormones (or non-human, which is the same thing); and entails orally administered pills involving the digestive tract and thus directly exposing the patient to potentially carcinogenic effects of oestrogen detoxification in the liver.

Let’s be clear, I will never be in favour of Hormone Replacement Therapy (HRT) given in pill form and supplying a fixed combination of non-human oestrogens (equine oestrogens) and synthetic progesterone. The mere presence of artificial progesterone, even if it is coupled to a bio-identical œstradiol, for me condemns this type of preparation due to the risk of cancer (breast).

To make matters worse, Tibolone is often prescribed in a single daily standardised dosage to relieve menopausal symptoms and protect bone density. This synthetic steroid has undoubted carcinogenic effects that have been the subject of several publications. Considering the well documented and known risks, Tibolone should be withdrawn from the market!

So, what do we do to help women complaining of insomnia due to hot flashes, vaginal dryness, low mood, or failing memory since their menopause? A possibility to alleviate their symptoms does exist without exposing them to unnecessary risks through the restoration of physiological hormonal values both of œstradiol and progesterone, as long as we have had the opportunity to measure their relative levels via evaluating their blood work.

This more natural approach is only for women complaining of symptoms typical of the menopause and who have no – or too low – hormone levels post-menopause. Among the indications for such a treatment (let us all agree not to call it HRT given the pejorative connotations associated with this term!), one must add established osteoporosis. There again, one should rather consider the age of the patient (Z-score of bone density) rather than the absolute value (T-Score), which is too often put forward to frighten patients and, perhaps, used to encourage them to take the maligned biphosphonates…

Mucosal lubrication during the menopause constitutes a major indication for the physiological correction of the two sex hormones. Affected women readily mention vaginal dryness, or sometimes a problem with dry eyes. One should also add recurrent cystitis, that is sometimes more inflammatory than infectious, along with the lack of lubrication of the intestinal mucosa. This easily leads to malabsorption of nutrients (especially fat-soluble vitamins), or to a significant weakening of the intestinal mucosa synonymous with leaky gut syndrome (increased intestinal permeability).

We can see that many women would benefit from these corrective treatments but most are now terrorized by the mere mention of hormone therapy. We need to defuse the situation by explaining exactly what it is, and that is precisely the purpose of this article: there are excellent ways to avoid the pitfalls of conventional HRT…

The oral route should be avoided to avert what we call the first pass (directly from the intestine to the liver via the portal vein), hence the preference for a gel or a patch. However, gel holds the advantage over the patch, as it can be administered in such a way to give a boost in the morning (œstradiol) and the slowdown effect in the evening (progesterone). In all cases, dosage must be carefully adjusted on an individual basis according to blood tests: initial requirements are determined by baseline blood levels, and if they prove low, then the dosage can be initiated little by little. We must take into account possible side effects (warranting an immediate reduction in the dosage) and insist on blood tests being conducted after a few months, which will ultimately help to identify the optimal dosages suitable for each patient.

Such treatments that respect physiology, regardless of patient age, need not be limited in time, in contrast to conventional HRT. Women can benefit from this treatment for as long as necessary!