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TESTING - SALIVA VS. BLOOD
By: the Anti-Aging Clinic in collaboration with
our compounding pharmacist and clinical nutrition
WHAT IS THE ISSUE?
Many medical doctors question the
effectiveness of sublingual steroid hormones such as testosterone and
progesterone. They say that these hormones are not appreciably absorbed into
the bloodstream from the sublingual lozenge form and therefore, they do not
have a significant physiological effect. This argument is based on the
traditional medical training that when these hormones are used sublingually,
they do not significantly raise the "blood" levels of the hormones. This is
not only what doctors have been taught, but also what has been reinforced by
the pharmaceutical industry, which sells high-impact, unnatural (not
bio-identical) steroid hormones.
From most of the medical community's
perspective, the pharmaceutical perspective is the end of the argument. That is an understandable way
to deal with the fact that neither doctors nor anyone else can keep up with
the speed of biochemical and medical discoveries. Much less breakthroughs in
the wellness and prevention industry where doctors would not typically be
advised. It's really up to doctors
who are willing to expand their knowledge in this area or the patient in
most cases can become knowledgeable
about his or her problem and attempt to educate themselves and afterwards,
to the doctor.
In contrast to conventional medicine, in the wellness industry, a small group of scientists and
alternative Nature-O-Paths as well as some medical doctors have been successfully improving the health of
women and men by balancing hormones by using bioidentical hormone therapy.
With the use of saliva 30-day panel testing that has the patient collect 11
different samplings in home at prescribed times and methods.
This method is
far superior to serum blood testing because of a woman's cycle. Men do not
cycle but most free testosterone is taken up by the red blood cells as we
explain further on.
The dosage of these hormones is
adjusted by analyzing the results of saliva tests and referring to the
questionnaire utilizing a method of compounding called micronization of the
correct dosages of hormones.
This report has two primary objectives:
(1) to determine whether saliva testing or blood testing is more accurate
for steroid hormones, and
(2) to determine whether sublingual application of steroid hormones does or
does not raise blood concentrations of the hormones.
To achieve these objectives it is necessary to know some of the scientific
details that support each position.
WHAT ARE STEROID HORMONES?
An endocrine steroid hormone is a chemical substance that is formed in a
gland and is carried in the blood to target cells to exert specific
A steroid is any of numerous compounds that is derived from cholesterol.
Cholesterol, itself, is derived from acetyl groups (a unit containing two
carbon atoms) by a complex enzymatic process. The acetyl groups are formed
in the biochemical processing of food into energy. The hormone pathway
starting with cholesterol is below:
Although steroid hormones are present in the body in extremely low
concentrations (parts per trillion in the blood and saliva), they exert
potent physiological effects on sensitive tissues. The steroid hormones act
on target cells to regulate gene expression and consequent protein
biosynthesis. All steroid hormones are lipophilic (fat-soluble) and most are
carried in the aqueous bloodstream bound to carrier proteins, which are
water-soluble. However, a small amount of steroid hormones are being carried
in the aqueous part of the bloodstream not bound to anything. These "free"
hormones are available to enter cells.
The "free" steroid hormones can diffuse through the target cell membrane,
which is made of fat and readily allows the passage to the interior of the
cell. The hormone is attracted to high-affinity steroid receptor proteins.
The hormone-receptor complex is then translocated into the nucleus of the
cell, which contains the genetic information. A particular genetic process
is initiated in which specific proteins are synthesized. Those proteins go
on to exert physiological effects that are then attributed to the steroid
Since this report is concerned with blood analysis, it is important to
understand the general composition and characteristics of blood. Blood is a
fluid consisting of red and white cells suspended in an aqueous plasma. The
cells make up about 45 percent of the mixture (called the "hematocrit"), and
the watery plasma is about 55 percent of the mixture. The majority of cells
in the blood are red blood cells (erythrocytes). The most important
constituent of the red blood cell is hemoglobin whose main function is to
transport oxygen from the lungs to the somatic (body) cells.
The other cells in blood are white blood cells (leukocytes) that include
platelets. The white blood cells are nearly twice the size of red blood
cells and are concerned with immunity. For example, the white cells can
engulf bacteria and foreign particles in a process called "phagocytosis."
The platelets function to control bleeding after an injury. The platelets
liberate serotonin when the blood vessels are damaged. This causes small
blood vessels (capillaries) to strongly contract, which reduces bleeding.
The blood also contains fibrinogen and other factors that cause blood to
clot. The fibrinogen is a soluble protein precursor of fibrin, which is an
insoluble protein that forms the main part of a blood clot.
Another interesting aspect of blood is how much glucose (sugar) it contains.
A normal blood glucose reading of 90 mg/dl translates to about 5 grams in
the whole bloodstream throughout the body. When a soft drink or morning
cereal containing 30-40 grams of sugar comes down the hatch, it overwhelms
the balance and stability of the glucose being supplied to all the cells of
the body. The pancreas quickly secretes insulin to drive down the glucose,
and a wild, unbalanced cycling occurs. This hyper-dose of sugar affects
smaller bodies (young children) in ways that create Attention-
Deficit-Hyperactivity-Disorder (ADHD). It is commonly treated in traditional
medicine, not by removing the source of sugar nutritional changes, but by
drugging the child with amphetamines (Ritalin). We have an instrument that
measures and analyzes the body's food triggers utilizing biofeedback. This
report will identify foods that will cause your insulin to rise and will
advise what to eat and to stay away from.
Now that we have reviewed some about the nature of steroid hormones and
blood, what is it like for those hormones to travel in the bloodstream?
STEROID HORMONES IN THE BLOOD
Let us use testosterone as an
example that is representative of all steroid hormones. Over 90% of the
testosterone in the bloodstream is carried by water-soluble proteins (sex
hormone binding globulin [SHBG] and albumin). The testosterone bound to
those proteins is not readily bioavailable to target tissues because it is
on its way to the liver for excretion in bile, which enters the intestines
when fat is eaten. Along the intestines, about 90% of the bile and
testosterone is reabsorbed and recycled to the liver for new processing -
thus conserving these valuable biochemicals.
Part of the testosterone-SHBG and testosterone- albumin complexes that went
to the liver is converted into water-soluble chemicals that are excreted in
the urine. Sometimes, a urine specimen is used to estimate the testosterone
in the blood.
Less than 10% of total testosterone is bioavailable. More than 80% of this
bioavailable (called "free") testosterone travels in the blood attracted to
(adsorbed on) fatty red blood cell membranes. The other 20% of bioavailable
testosterone (2% of total testosterone) is unbound traveling in the plasma,
and is readily available to stimulate target tissues.
THE FALLACY OF BLOOD TESTS FOR
When blood is drawn from a vein (low pressure going to the heart), it
contains plasma and red and white blood cells. To analyze the blood, the
plasma is separated from the blood cells by centrifugation. Since the plasma
still contains clotting factors, an anticoagulant is added. This, then, is
the plasma used for blood analysis. If the blood is allowed to coagulate,
the cell-depleted fluid phase, devoid of fibrinogen, is called "serum." The
serum may also be used for analysis. In either case, the blood being
analyzed does not contain the red blood cells that held the free
hormones. What is being analyzed are hormones that are attached to
binding proteins from the liver and is not bioavailable.
When hormones are tested via saliva and/or applied sublingually, they are
part of the equation as being present in the body and when applied in
sublingual lozenge are absorbed into the
bloodstream as "free" hormones. They have not been packaged with a binding
protein by the liver because the liver did not have access to the
hormones. Most of the "free" hormones are taken up by the red blood
cell membranes, which are not analyzed by a common blood test.
Conclusion: Common blood tests that use plasma or serum are not accurate for
assessing bioavailable steroid hormone concentrations because neither the
plasma nor the serum contains the red blood cells, which hold the
REFLECTS THE BIOAVAILABLE CONCENTRATION OF HORMONES PRESENT IN THE
Some background on saliva. There are three salivary glands in the mouth that
produce about two pints of saliva per day. The saliva is about 99.5% water
and 0.5% solute. Saliva is used for chewing, swallowing and the initiation
of digestion by the enzyme amylase, which begins the breakdown of
carbohydrates. In addition, for the most part saliva is protective against
pathogens. It is antibacterial, antifungal and antiviral to a certain degree. That's probably
why rubbing saliva on an injury feels so good. Saliva also contains
immunoglobulin-A, which provides protection for the eyes, nose, throat, intestines and
lungs from infectious diseases.
The secretion of saliva is entirely under the control of the nervous system.
Sympathetic nervous system stimulation dominates during stress, resulting in
dryness of the mouth. During dehydration, the salivary glands stop secreting
to conserve water and resulting in dryness of the mouth and this contributes to the
sensation of thirst.
The salivary glands have an extremely high blood flow, which is about ten
times that of an equal mass of contracting skeletal muscle. Researchers have
found that the "free" hormones from the red blood cells and plasma readily
filter through the saliva glands into saliva where they can be measured
accurately (in parts per trillion).
Conclusion: Saliva reflects the
bioavailable level of hormones present in the bloodstream, therefore saliva
testing is a far more accurate and relevant test than blood when
measuring bioavailable steroid hormones.
The following graph is of a
42-year-old woman before bioidentical hormone therapy and the second is
after being on the program for 90 days.
This is before taking BHRT
This is after taking BHRT
There is strong opinion that if
bioidentical hormone therapy and saliva testing were available 50 years ago
that today there would be very little endometrial, uterine or breast cancer.
These things are available today and yet many doctors are unaware of them
and still others are unwilling to alter their thinking from medical
training they received and therefore are very slow to adapt to new
BHRT bioidentical hormone replacement
[disclaimer] “These statements have not
been evaluated by FDA. Treatments or
products are not intended to diagnose, treat, cure or
prevent any disease.”