Dear Reader,

DHEA, short for dehydroepiandrosterone (phew!), is quickly becoming the next big nutritional supplement craze, even predicted to surpass melatonin. So, what is it about DHEA that health food stores can't keep it on their shelves? (Just look at all of the questions Alice has received about DHEA!)

DHEA is a steroid hormone produced (partly from cholesterol) by the adrenal glands (located on top of your kidneys) of both males and females, males making slightly more than females. (Most of the body's DHEA is as the sulfated form, DHEA-sulfate, which may function differently than unsulfated DHEA.) The body converts DHEA into the steroid sex hormones — testosterone, in particular, and estrogen — and other hormones as well. DHEA levels peak (about 30 mg) between age 20 - 30 years, and decline gradually afterwards with age (as does testosterone and estrogen), dropping to about 10 - 20 percent (approximately less than 6 mg) of peak levels by age 70 years. DHEA supplements primarily are being taken to replace the DHEA that has been lost to aging — so, DHEA is being used as a hormone replacement therapy. [A note of caution: Since the specific role of DHEA in the body remains unclear, there may be a very good reason for why our bodies naturally produce less and less DHEA with age, which for now, also remains a mystery.]

So, what's the big hype surrounding DHEA? DHEA is being heavily promoted and touted as a panacea, or cure-all, with anti-aging, anti-obesity, and  anti-cancer effects, even when scientific evidence has not yet proven most of its possible benefits in humans. The potential for DHEA to slow down the aging process has received the most attention of the three. This is a big claim, since people will try anything, especially something as easy as taking a pill, to regain youthful vigor and appearance. Considering aging is generally stigmatized in our society — why else would people say that "youth is wasted on the young"? — no wonder more and more people are jumping on the DHEA bandwagon.

DHEA's long  list of purported benefits are certainly hard to resist and sound too good to be true: DHEA increases energy, elevates mood, improves memory, and rekindles sex drive; maintains and/or builds lean body mass and decreases body fat, thereby increasing muscle strength and improving metabolism; helps protect and boost the immune system (by buffering the effects of stress hormones); helps regulate blood sugar, which could delay or prevent diabetes; reduces hypertension; lowers risk of cancer, heart disease, and possibly Alzheimer's Disease; may improve systemic lupus; may positively impact Multiple Sclerosis; and, may delay the development of full-blown AIDS if already HIV-positive. Wow — that's certainly a mouthful — and definitely leaves Alice feeling a bit skeptical! Consequently, proponents have suggested that DHEA may even extend life expectancy. Alice thinks that's going a bit overboard, but DHEA seems to hold some promise in helping people to age well by enhancing quality of life (physical and psychological well-being) in the golden years; that is, if these benefits actually hold up and serious risks are kept to a minimum. Following this, all of these benefits should not prompt people who are already supplementing with DHEA to take more of it because more may not necessarily be better, and could actually be quite harmful.

In line with that, adverse effects have been noted with DHEA use, certainly making it more of a bitter pill to swallow. When excessive doses (100 mg a day) are taken, women may grow excess facial hair, experience deepened voice, have acne breakouts, lose (head) hair, and increase their risk of heart disease and breast cancer, the first two being irreversible; for men, they may develop enlarged breasts and increase their risk of prostate cancer. Talk about a booby trap! And, research indicates that high doses of DHEA may cause liver damage. Some of these potential risks are serious, especially if you have a family history or other risk factors for these chronic conditions, and they are definitely something to consider before trying DHEA.

Most studies looking at DHEA have been test-tube and animal studies. These studies reported that DHEA slows down the aging process (because it helps maintain more youthful physical appearance and stamina, or energy); prevents or delays diabetes (because it promotes normal insulin production); enhances learning and memory (because it stimulates the development of brain cells); and, helps control obesity (because it inhibits fat production). As a matter of fact, most of the claims being made about DHEA's benefits are based on results from animal, rather than human, studies. This is not logical because the successes found in animals may not be realized in humans.

Fewer studies have looked at the effects of DHEA on humans. Most of these studies were short-term, clinical trials looking at insufficient numbers of older people taking relatively low doses of DHEA. Although these studies have reported benefits and few side effects, the results of these studies are insubstantial because they do not provide conclusive insight on the positive and negative effects of DHEA on the body from chronic (long-term) and acute (high dose) use, as well as on how DHEA affects populations other than a subgroup of older people. For more definitive information on whether or not benefits remain and if serious side effects exist with continued use, long-term, double-blind, and controlled clinical trials studying DHEA use in humans are currently underway, but results are unlikely to be available for some time (don't hold your breath).

Apparently, DHEA was sold as oral supplements in health food stores until 1985, when the Food and Drug Administration (FDA) banned its sales to the public based on a lack of evidence that DHEA was either safe or effective. This ban on DHEA sales was lifted with the passing of the Dietary Supplement Health and Education Act (which allows nutritional supplements to be sold over-the-counter as long as their labels don't contain unsubstantiated health claims) by Congress in 1994, and particularly with the June 1996 FDA approval for its distribution over-the-counter as a nutritional supplement. (During the ban, DHEA was available only with a prescription, which also made it fairly costly.) Since nutritional supplements are not regulated by the FDA, quality, purity, and effectiveness of DHEA supplements vary by manufacturer (which is why some critics say that only prescribed DHEA is effective). Check with a health food store about which brands they recommend.

Two types of DHEA supplements are widely available: yam-based and "real" DHEA. The DHEA precursors using Mexican wild yams, also known as Dioscorea, generally have not been recommended because research has found that these precursors may not convert to DHEA in the body, meaning they are practically ineffective .

"Real" DHEA supplements, based on 100% natural botanical sources (non-synthetic), are pure, pharmaceutical grade. In contrast to yam-based, "real" DHEA supplements apparently are effective in raising the body's DHEA levels. Of the "real" DHEA supplements available on the market, the micronized, wax-coated, and 12-hour release ones are recommended because they have been claimed to enter the bloodstream predominantly as DHEA, rather than as testosterone. This means that androgenic (male-like) side effects in women could be minimized.

As for how much DHEA you should take, the recommended dosage is 1/4 to one 25mg tablet daily for adults. It is better to take DHEA along with food that has some fat in it to improve its absorption. DHEA's benefits supposedly take effect within two to three weeks of usage. As for who should be taking DHEA supplements, it is recommended that anyone older than 30 years of age and in good health (check with a physician first) take the supplements in order to sustain youthful levels of DHEA (because natural DHEA levels begin to drop at this age).

Alice wonders if DHEA advocates and users are actually benefiting from DHEA at all? While taking it, they may have changed the way they eat and/or exercise, which are more likely to make an impact on how they look and feel. In addition, Alice must emphasize to you that it remains to be seen whether or not DHEA can keep its promise of youthful benefits and limited or no risks in the future with continued use.

The best advice Alice can give you is to think twice before trying DHEA — and that you exercise regularly and eat a healthful and varied diet instead. It's not as easy as just taking a DHEA supplement — you've gotta work! — but at least this is a safer, less costly, and more guaranteed way of achieving weight management and/or loss, lean body mass build-up, stronger bones, body fat reduction, boosted energy levels, elevated mood, more restful sleep, and enhanced libido.

If you decide to try DHEA, Alice recommends that you be cautious and take DHEA under physician supervision only. A blood or saliva test can be done to determine your current DHEA levels. Based on the results of these tests, and also depending on your physician's opinion of DHEA and your health status/medical history, the doctor can advise you to take an appropriate dosage of DHEA that would help you return to either normal (based on your age and physiology) or young adult DHEA blood or saliva levels, the former generally being preferred. It is best not to take more than these doses until results from long-term, clinical trials on humans have determined DHEA's safety and efficacy more definitively. Alice knows this could be a long wait, but it's better to be safe(r), than sorry. And even if you're on DHEA, you should still adhere to a healthy diet and regular exercise routine for best results.

Alice

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