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From the Townsend Letter
April 2009

The Lung Health Secret Every Woman Needs to Know
Protect Yourself from Emphysema and COPD – and Even Reverse Damage that's Already Been Done
by Jonathan V. Wright, MD

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Editor's Note: This article first appeared in Dr. Jonathan V. Wright's Nutrition & Healing newsletter

Aside from the fact that, as free citizens of these United States, we should have the right to choose any type of medical treatment we feel is best suited to keeping us healthy, the ongoing threat of los Federales' taking away access to bioidentical hormone replacement therapy puts women at a significant disadvantage in many other ways too. If you're a longtime reader of Nutrition & Healing, you already know that, as part of bioidentical hormone replacement therapy (BHRT), estrogen replacement can lower a woman's risk of Alzheimer's disease and cognitive malfunction, protect her against cardiovascular disease, strengthen her bones, and slow down skin aging. But one of the other important benefits of BHRT is something you've probably never heard about.

A series of research reports from the respected Lung Biology Laboratory at Georgetown University School of Medicine (led by Drs. Donald Massaro and Gloria DeCarlo Massaro) dating back to 1994 have established that estrogen is extremely important to lung health, too, especially for women. Unfortunately, most people have no idea about estrogen's role in lung health, since reporting about these studies has been minimal to nonexistent in newspapers, television, radio, and major internet websites, all of which appear to prefer reprinting financially driven news releases from patent medicine companies, instead of doing their own investigative research and reporting.

But despite the lack of media coverage, these studies made some groundbreaking discoveries. Although chronic obstructive pulmonary disease (COPD) and emphysema are obvious and well-known results of smoking, nonsmokers sometimes develop COPD and emphysema, too. And instances of both conditions are much higher in nonsmoking women than they are in men. These studies help explain why – and show just how simple it can be not only to protect your lungs, but also to repair any damage that's already been done.

Why Women 'Outbreathe' Men
The first research report in this series was published in 1995.1 Working with female rats, the researchers discovered that oxygen uptake almost doubled during pregnancy and nursing, even though the structure and surface area of the lungs remained the same as before (total surface area of the lungs directly correlates with the degree of oxygen-carbon dioxide exchange). They suspected that the hormonal increases of pregnancy were responsible for the increased oxygen uptake.

But even though the female rats' lung surface area didn't change during pregnancy, the research team also found that mature female rats naturally have a higher total lung surface area for oxygen-carbon dioxide exchange than male rats of the same age. The females also had significantly smaller alveoli (the billions of tiny oxygen-carbon dioxide exchanging "sacs" that comprise the lungs' spongy tissue). And the smaller the alveoli in the lungs, the more there are, which accounts for the greater gas-exchange surface area.

A year after they made these initial discoveries, the same research team proved that estrogen is directly responsible for the difference between the lungs of female and male rats in two ways.2 First, they removed the ovaries from immature female rats and found that when they had fully matured, these females had larger alveoli and a smaller gas-exchange surface area than female rats of the same age who hadn't had their ovaries removed. In the second phase of the study, the researchers gave a group of immature female rats extra estrogen and found that these females developed smaller, more numerous alveoli (resulting in greater gas-exchange surface area) than immature rats not given estrogen.

And to rule out the possibility that hormones in general are responsible for lung development, the researchers gave androgens (testosterone and testosterone-related hormones) to a group of newborn female rats. But the extra androgens made no difference to the ultimate size or total oxygen-exchange surface area of their lungs. They also discovered that male newborn rats that had been genetically engineered to be deficient in androgen receptors (so that their own testosterone would be less effective) had the same lung development as newborn male rats with normal androgen receptors.

With all of the information they'd compiled, the researchers concluded that estrogen is primarily responsible for lung function in females. From there, they moved on to test the effects of estrogen loss – and replacement – on lung health.

Reversing Lung Damage with Estrogen
First they found that removing the ovaries (a procedure technically known as ovariectomy) of adult female mice resulted in both loss of alveoli and of lung surface area. Loss of surface area reduces oxygen-carbon dioxide exchange (in other words, it negatively affects the ability to breathe easily).

But when the researchers gave the rats who had had their ovaries removed estrogen replacement, not only did they regain some of the alveoli they'd lost, but the ones that were damaged actually got better.

They concluded in part that "estrogen is required for maintenance of already formed alveoli and induces alveolar regeneration after their loss in adult ovariectomized mice, and [this research] offers the possibility that estrogen can slow alveolar loss and induce alveolar regeneration in women with COPD."3 In 2006, the research team finished their series of studies with a review article of their own work as well as research of others.4 The review pointed out that normal aging already results in loss of lung alveoli, and that menopause further accelerates the loss of lung surface area, which, in turn, reduces oxygen-carbon dioxide exchange and makes breathing more difficult. In other words, since estrogen is critical to long-term protection of women's lungs, after menopause, there's just not enough estrogen for some women, and their lungs suffer.

They also pointed out that their work and work in other laboratories "has disproved the notion that pulmonary alveoli are incapable of regeneration," and that research indicates that the factors regulating both alveolar loss and regeneration are "conserved" (scientese for "the same") for rats, mice, and humans.

Breathe Easier with BHRT
So what do all of these study results mean for you (or at least the women in the audience)? Well, there are several implications of this research work. First, even if you're healthy, you should seriously consider BHRT if you want to maximize your lungs' ability to absorb oxygen and get rid of carbon dioxide as you get older. This is especially important if you're an athlete, and want to continue your athletic activities for as long as you can – but maintaining healthy lungs also helps make simple daily tasks like walking up and down the stairs easier.

And BHRT may be especially important for women (nonsmokers) who have emphysema and/or COPD. If your estrogen levels are low enough to have caused (or at least contributed to) these problems, chances are that you're also at a significantly higher risk for the other problems associated with low estrogen levels, such as Alzheimer's disease, heart attack and other cardiovascular disease, and osteoporosis. But BHRT can help protect you from all of these conditions while it's helping to repair the damage that has been done to your lungs.

Even if your emphysema and/or COPD can be linked to smoking, BHRT is still worth trying. It may not help as much as if you'd never smoked, but if you're past menopause, your estrogens are already low, so replacing what your body is missing certainly won't hurt.

And what about men? As the researchers pointed out, male lungs and their alveoli aren't nearly as sensitive to hormonal variation as women's. However, there is at least one potential exception: Men whose testosterone gets so low that their bodies can't make much estrogen at all. (Remember, in both sexes the body makes estrogen by converting testosterone to estrogen – a process known as aromatization.) So if you're a man who has been diagnosed with emphysema or COPD, you might want to get your estrogens checked along with your testosterone. If it turns out that your levels are too low, BHRT (in different proportions than those given to women, of course), may very well help you too.

Whether you're a woman or a man – with or without emphysema or COPD – if you're considering having your hormones checked and possibly using BHRT, make sure to consult a physician skilled and knowledgeable not only in BHRT but in nutritional and other natural therapies as well.

Author's Note: This article is taken from the revised version of the book about bioidentical hormone replacement written by Lane Lenard, PhD, and me – the very first one published on this topic (in 1997). It will be available (with a revised title) later in the spring or summer of this year.

Jonathan V. Wright, MD, has degrees from both Harvard University (cum laude) and the University of Michigan. More than any other doctor, he practically invented the modern science of applied nutritional biochemistry, and he has advanced nutritional medicine for nearly three decades. Dr. Wright is credited with introducing the nutritional remedy for benign prostate disease (BPH), the first successful treatment to reverse macular degeneration, the safe medical use of DHEA therapy, natural hormone replacement therapy for women, and many other revolutionary natural cures.

To learn more about Dr. Wright's seven-volume Library of Nutritional Cures and his newsletter Nutrition & Healing and/or to subscribe to the newsletter, please visit, or call 888-213-0685 (ask for code WNAHWEB).

1. Massaro GD, Mortola JP, Massaro D. Sexual dimorphism in the architecture of the lung's gas-exchange region. Proc Natl Acad Sci USA. 1995;92(4):1105-1107.
2. Massaro GD, Mortola JP, Massaro D. Estrogen modulates the dimensions of the lung's gas-exchange surface area and alveoli in female rats. Am J Physiol. 1996;270(1Pt1):L110-L114.
3. Massaro D, Massaro GD. Estrogen regulates pulmonary alveolar formation, loss, and regeneration in mice. Am J Physiol Lung Cell Mol Physiol. 2004;287(6):L1,154-L1,159.
4. Massaro D, Massaro GD. Toward therapeutic pulmonary alveolar regeneration in humans. Proc Am Thorac Soc. 2006;3(8):709-712.



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