Interview with Dr. Dirceu Pereira, a specialist in Gynaecology and Obstetrics (CRM: 13834), for the latest edition of AMBO's (Brazilian Medical Association of Orthomolecular Practice) magazine.
Released with his express permission, via AMBO.
1) Question: What has orthomolecular medicine contributed to your medical practice?
Answer: I have an academic background; I graduated in Medicine from UNIFESP/EPM in 1968. I did my postgraduate studies at FMUSP, earning a Master's degree (1983) and a PhD (1985) in Gynecology and Obstetrics. In 1976, I went to Johns Hopkins University (USA) to train in tubal microsurgery. At the end of the decade, I began my training in assisted reproduction, training in Buenos Aires, Bogotá, Paris, Valencia, Barcelona and Kiel. In the 1990s, motivated by the desire to expand my knowledge, I embarked on other areas, including homeopathy, anthroposophy and acupuncture. I still needed to delve into Orthomolecular Medicine to become a holistic or integrative doctor. I started attending congresses, courses, symposiums and lectures given by renowned professionals with extensive experience and dedication in this area of medical practice. I was fascinated by the possibility of treating chronic diseases based on biochemistry and cellular metabolism. Gradually, I expanded my knowledge and created an alchemy between conventional medicine and other areas of practice, always aiming to meet the individual needs of each case. It became clear to me that medicine focused on the individual has a greater chance of preventing and treating chronic diseases. Currently, I use the foundations of Orthomolecular Medicine, aiming for personalized care in order to balance the individual and guarantee them the status of physical and emotional well-being.
2) Question: In which cases is hormone replacement indicated?
Answer: I recommend hormone replacement when the client has symptoms of somatopause, adrenopause, thyroparesis, melatopause or menopause, either together or in combination. I think that the administration of hormones in a supraphysiological dose, with the aim of increasing performance, is reprehensible, as it contradicts the concept of replacement and has adverse effects. I always try to use the base hormones (bioidentical), as I believe they are more consistent with coupling to specific receptors and allow for a more appropriate metabolic pathway. In particular, in the pre-menopause, I start hormone therapy with progesterone in the second phase of the cycle, as the woman is going through a phase of relative hyperestrogenism. In the post-menopausal phase, I use a combination of oestrogen and progesterone and, if necessary, testosterone. In the case of women who prefer phytomedicines, mainly due to cancer phobia, I prescribe soy isoflavones associated with Vitex agnus-castus. The use of DHEA, pregnenolone, melatonin and GH should be discussed with the client, informing her of the risks and benefits.
3) Question: Can cases of PMS benefit from nutrient treatment?
Answer: Certainly, women who have a nutritional imbalance, which leads to an inflammatory state, will benefit from some essential nutrients to restore this dysfunction. Restrictive diets, dietary errors, behavioral deviations, exposure to environmental pollutants and stressors are the pillars that predispose them to a stormy premenstrual period. Thus, the use of B-complex, PUFA sources, magnesium, Vitex agnus-castus, adaptogens, among others, can minimize symptoms and bring women and their families into a comfort zone.
4) Question: What contribution can orthomolecular medicine make to endometriosis?
Answer: Endometriosis is a pleomorphic inflammatory disease whose etiology is still enigmatic. It should be treated holistically, following a line of intervention aimed at correcting the possible etiological causes.
1️⃣ Block menstruation.
2️⃣ Correct the metabolic pathway, leading to a non-inflammatory state.
3️⃣ Reduce hyperestrogenism.
4️⃣ Eliminate environmental pollutants.
5️⃣ Re-educate your diet to achieve the right BMI.
6️⃣ Encourage physical activity and bioenergetic practices.
The obvious association of endometriosis with systemic or local hyperestrogenism prompts us to create an intervention that includes the use of SERMs, micronized progesterone, liver detoxification (phase I and II), reduction of NF-kappa B and aromatase activity, with the use of resveratrol, pycnogenol, PUFA, among others.
5) Question: What is your analysis of infertility and supplements?
Answer: Nutritional supplements can minimize oxidative stress, improving sperm performance, improving the condition of the egg's pellucid membrane and optimizing fertilization and embryo implantation. The use of nutrients has a qualitative effect in cases of infertility with no apparent cause, as well as in assisted reproduction procedures. Several studies have emphasized the fragility of sperm due to the fact that they are very susceptible to the action of free radicals, particularly lipid peroxidation, and also because they have a weak antioxidant system. The resulting oxidative stress causes everything from damaging effects on motility to structural alterations to DNA and apoptosis. The ovum's pellucid membrane, cytoskeleton and cellular organelles (mitochondria and endoplasmic reticulum) are also affected by oxidative stress. Although controversial, the personalized use of nutritional supplements, combined with the adoption of healthy habits - such as proper nutrition, physical activity, abstinence from tobacco, alcohol and drugs, among others - can help couples achieve their dream of having children.
6) Question: From an orthomolecular perspective, what is the relationship between breast cancer, antioxidants and herbal medicines?
Answer: The etiology of breast cancer is still unclear. The genetic framework, polymorphisms, poor lifestyle habits, obesity, the use of synthetic hormones and exposure to pollutants are the main causes. It is important to know the SNIPs (single nucleotide polymorphisms) that condition the estrogen metabolic pathway. Several publications emphasize the disposing effect of 16-OH and 4-OH hydroxylation of estrone as a potential oncogen. On the other hand, clients who metabolize androgens via the 2-OH route are in a state of oncogenic protection. Urinary assessment of these metabolites can characterize a woman's risk and allow preventive corrections to be made to avoid breast cancer. Orthomolecular medicine provides us with various tools to correct this metabolic misconception, including correcting the inadequacies mentioned above, adopting a diet with functional foods and prescribing nutraceuticals with the aim of acting on liver detoxification, enterohepatic circulation, metabolic inflammation, stress and the elimination of pollutants. Hormonal modulation, the individualized prescription of vitamins, minerals, methylation agents (SAMe, methylcobalamin, among others) and PUFA complete a list of interventions, helping to create a healthy environment in the female organism and preventing it from becoming affected by malignant neoplasms.
7) Question: How is the use of nutrients during pregnancy, from the first to the third semester?
Answer: According to Cunningham, pregnant women go through a period of adaptation. There are changes involving the vascular framework, body weight, the endocrine system and the immune system, among others. It's impressive how women undergo local and systemic transformations during this period. Unfortunately, most women become pregnant unplanned, without taking the time to assess their endocrine-metabolic-nutritional status beforehand. A striking example of this is their exposure to fetal malformations due to a lack of B vitamins, especially folic acid. Ideally, every woman should prepare herself to become pregnant, but this rarely happens. In a society where 50% of the population is overweight or obese, the chance of insulin resistance syndrome occurring is significant, increasing maternal and fetal risk. From a nutritional point of view, pregnant women have a catabolic state in the first trimester, an anabolic state in the second trimester and, in the last trimester, maternal catabolism occurs with fetal anabolism. The obstetrician needs to be careful to monitor the pregnant woman's weight gain throughout the trimesters, correlating it with the physiology and pathophysiology of the pregnancy cycle. Various factors explain weight loss, malaise, adynamia and fatigue, among others, in the first trimester of pregnancy: nausea and vomiting, food intolerance, catabolic state, plasma expansion, hormonal changes, among others. During this period, the doses of minerals and multivitamins should be adjusted to meet individual needs. The prescription of PUFA is important, especially sources of DHA and EPA, to modulate prostaglandins and contribute to the anatomical and functional health of the CNS. From preconception, the intestinal microbiota should be modulated with the use of symbiotics. Pay close attention to the iron reserve, which can be low due to plasma expansion, leading to a drop in erythrocytes and hemoglobin. The prescription of chelated iron, possibly combined with folic acid and copper, may be necessary. In the second trimester, the woman moves into an anabolic state, requiring a greater intake of proteins and amino acids in the diet. This is perhaps the calmest period of pregnancy. However, at the end of this period, the gynecologist redoubles his attention to the risk of hypertensive disease in pregnancy, especially pre-eclampsia, which is the most frequent complication in pregnancy and the most responsible for maternal and perinatal morbidity and mortality. Currently, some markers, such as Beta HCG, PAPP-A and PLGF, can signal an imminent risk of this complication, triggering early intervention. The hypochlorite and hyperprotein diet, calcium and magnesium chelate supplementation, resveratrol, silymarin, PUFA, vitamins C, E and D are extremely important for vascular and liver protection (phase 2 detoxification). Acetylsalicylic acid has been used to act on thromboxane A, reducing the risk of thrombosis. In the transition from the second to the third trimester, the insulin-glycemic curve can become unbalanced, with the consequent possibility of gestational diabetes appearing to varying degrees. A strict diet and personalized physical activity are necessary, together with metformin, chromium, vanadium and alpha lipoic acid, among others. It's worth remembering that prenatal care is of fundamental importance for preventive guidance and early intervention, with the aim of guaranteeing a safe maternal-fetal haven. Intrauterine life is too important to underestimate.
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