Published Articles

 

“Effects of Human Maternal Placentophagy on Maternal Postpartum Iron Status: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.” Gryder LK, Young SM, Zava D, Norris W, Cross CL, Benyshek DC. J Midwifery Women’s Health 2016 Nov 3; online ahead of print.

Summary: This study investigated the efficacy of encapsulated placenta as a source of dietary iron in pregnant women. Hemoglobin, transferrin, and ferritin levels were used as markers of iron status in blood samples drawn during the 36th week of pregnancy, within 96 hours of birth, between days 5-7 postpartum, and during the 3rd week after birth, in women treated with either encapsulated placenta or placebo capsules. The results showed that encapsulated placenta did not significantly change iron status compared to placebo, and was therefore not an adequate source of supplemental iron. See full article.
 

 

“Presence and concentration of 17 hormones in human placenta processed for encapsulation and consumption.” Young SM, Gryder LK, Zava D, Kimball DW, Benyshek DC. Placenta 2016; 43:86-89.

Summary: This is the first study to use state-of-the-art LC-MS/MS methodology to analyze the levels of 17 hormones in placenta samples that had been processed for encapsulation from 28 women who had opted to ingest their postpartum placentas in this form. The benefits of this practice are said to include the fact that hormones contained in the placenta extracts can relieve depressive symptoms and improve milk production. Results showed detectable levels of 16 of the 17 hormones in the placenta samples, and their content of estradiol, progesterone, and allopregnanolone could potentially reach physiological level thresholds after ingestion. Purchase full article.
 

 

“Meditative Movement as a Treatment for Pulmonary Dysfunction in Flight Attendants Exposed to Second-Hand Cigarette Smoke: Study Protocol for a Randomized Trial.” Payne P, Zava D, Fiering S, Crane-Godreau M. Front Psychiatry 2016;7:38.

Summary: This is the protocol for a study that will use ZRT testing in saliva (steroid hormones), dried blood spot (hs-CRP, HbA1c, TSH, Vitamin D), and dried urine (cortisol, cortisone, melatonin, elements) as part of an evaluation of a wide range of physiological systems in flight attendants who were exposed to second-hand smoke before smoking was banned on commercial flights. See full article.
 

 

“Physical Competition Increases Dehydroepiandrosterone (DHEA) and Androstenedione rather than Testosterone among Juvenile Boy Soccer Players.” McHale TS, Zava DT, Hales D, Gray PB. Adaptive Human Behavior & Physiology, 2016;2:44-56.

Summary: Using highly sensitive liquid chromatography/tandem mass spectrometry, the saliva steroids DHEA, androstenedione, cortisol, and testosterone were assayed in saliva samples from boys aged 8-10 collected during soccer practice and soccer match competition. Testosterone levels were below the sensitivity of the assay in most cases (<3 pg/mL), but a statistically significant rise in DHEA was seen during both practice and match play, while androstenedione significantly increased during match play only. Cortisol/DHEA ratios were calculated, and these showed a significant decrease during practice but not during match play. This is the first known study of the impact of athletic competition on salivary steroids in juvenile boy athletes, and it indicates that adrenal hormone release is affected by physical competition and is different to hormonal changes seen in adult males. See full article.
 

 

“Vitamin D Deficiency and Its Predictors in a Country with Thirteen Months of Sunshine: The Case of School Children in Central Ethiopia.”  Wakayo T, Belachew T, Vatanparast H, Whiting SJ. PLoS ONE, 2015;10(3):e0120963.

Summary: ZRT’s blood spot vitamin D testing was used in this study examining vitamin D status in schoolchildren living in the sunny climate of Ethiopia.  Vitamin D deficiency, defined as 25-hydroxyvitamin D levels <50 nmol/L (equivalent to <20 ng/mL) was significantly more prevalent in children living in an urban environment (61.8%) compared with those in a rural setting (21.2%).  Significant predictors of vitamin D deficiency included body fatness, having a TV/computer at home, maternal education, and socioeconomic status.  This study highlights lifestyle factors that can predispose people to vitamin D deficiency even in countries with high sun exposure. See full article.
 

 

"Associations Between Vitamin D Levels and Depressive Symptoms in Healthy Young Adult Women." Kerr DCR, Zava DT, Piper WT, Saturn SR, Frei B, Gombart AF. Psych Res 2015;227:46-51.

Summary: To investigate the relationship between vitamin D sufficiency and depression, 180 healthy young women completed surveys to assess depressive symptoms at baseline and then once a week for 4 weeks, and serum vitamin D levels were determined at baseline and 4 weeks.   A high rate of vitamin D insufficiency, defined as levels <30 ng/mL, was seen, occurring in 42% and 46% of the women at baseline and week 4, respectively.  Lower vitamin D levels were related to clinically significant depressive symptoms. Purchase full article.

"A Pilot Study Evaluating the Effectiveness of a Mindfulness-Based Intervention on Cortisol Awakening Response and Health Outcomes Among Law Enforcement Officers." Christopher MS, Goerling RJ, Rogers BS, Hunsinger M, Baron G, Bergman AL, Zava DT. J Police Criminal Psych 2015;31:15-28.

Summary: The effectiveness of an 8-week mindfulness-based resilience training program was studied in 43 police officers to determine its potential for mitigating job-related stress. Cortisol was tested in saliva samples collected 0, 30, and 45 minutes after waking on a day prior to starting the program, and again within 5 days after completing the program, to assess the cortisol awakening response as a stress marker. The program significantly improved mindfulness, resilience, stress, burnout, emotional factors, and mental and physical health. The cortisol awakening response was not significantly different after the program compared to before, however the area under the curve for cortisol at the three time points was lower after the program and correlated significantly with the improvement in mental health symptoms. Purchase full article.

 

 

"Steroid Hormone Testing in Different Body Fluids." Zava DT. Townsend Letter 2015; January.

Summary: This article examines the issues surrounding hormone testing for progesterone after topical delivery. Despite demonstrable clinical efficacy, serum and urine progesterone levels do not increase after application of topical progesterone, whereas saliva and capillary blood spot tests do show a dose-dependent increase that indicates efficient tissue uptake of the hormone. The article concludes that saliva and capillary blood spot testing, but not serum or urine testing, can be used to monitor topical progesterone therapy. See full article.
 
 

“Proinflammatory Cytokines and DHEA-S in Women with Fibromyalgia: Impact of Psychological Distress and Menopausal Status.”  Sturgeon JA, Darnall BD, Zwickey HL, Wood LI, Hanes DA, Zava DT, Mackey SC. J Pain Res, 2014;7:707-16.

Summary: Serum levels of proinflammatory cytokines (interleukins 6, 8, and 10 and TNF-α) and blood spot DHEA-S were measured in pre- and postmenopausal women suffering from fibromyalgia, and their relationships with reported pain intensity and level of psychological distress were examined.  There were significant relationships between IL-8 and pain-related symptoms and depression, and the ratio of IL-6 to IL-10 was significantly lower in individuals with greater levels of depressive symptoms.  Although the decline in DHEA-S levels with age has been suggested to be related to the onset of fibromyalgia symptoms across the lifespan, in this study DHEA-S levels did not correlate with pain intensity, psychological distress or cytokine levels. See full article.
 
 

"The trouble with topical progesterone and testing." Zava DT. Townsend Letter 2014; January.

Summary: This article examines the issues surrounding hormone testing for progesterone after topical delivery. Despite demonstrable clinical efficacy, serum and urine progesterone levels do not increase after application of topical progesterone, whereas saliva and capillary blood spot tests do show a dose-dependent increase that indicates efficient tissue uptake of the hormone. The article concludes that saliva and capillary blood spot testing, but not serum or urine testing, can be used to monitor topical progesterone therapy. See full article.

 
 

"Editorial: Percutaneous absorption of progesterone." Zava DT, Groves MN, Stanczyk FZ. Maturitas 2014; 77:91-92.

Summary: This editorial discusses the absorption of progesterone when applied to the skin in topical formulations, referring to our study recently published in Menopause (Du et al., 2013). A reliance on serum levels to assess progesterone absorption from topical formulations could lead to over-use of progesterone in an attempt to achieve levels that counteract the proliferative actions of estrogens used in menopausal hormone therapy. Saliva and capillary blood spot are better choices than serum testing for topically delivered progesterone. Purchase full article.


 

"Theodore Zava Responds.” Zava TT. Townsend Letter 2013; November.

Summary: This is a response to a letter criticizing the conclusions made in our previous article, published in Townsend Letter in January 2013, concerning evaluation of the iodine loading test. The response answers all of the concerns raised in this letter and urges its authors to ensure that their patients are correctly assessed for whole-body iodine sufficiency. See full article.


"Percutaneous progesterone delivery via cream or gel application in postmenopausal women: a randomized cross-over study of progesterone levels in serum, whole blood, saliva, and capillary blood."  Du JY, Sanchez P, Kim L, Azen CG, Zava DT, Stanczyk FZ. Menopause 2013; 20(11):1169-1175.

Summary: Saliva, capillary blood spot, serum, and whole venous blood levels of progesterone were measured after application of progesterone cream or gel in 10 postmenopausal women in this randomized, cross-over study using ZRT testing.  While serum and whole venous blood levels rose slightly, peaking at around 8 hours after application, saliva levels peaked earlier and were 10 fold higher than serum and venous whole blood levels; capillary blood spot levels were 100-fold higher than serum and whole venous blood, peaking at 8 hours after application.  The much higher levels in saliva and blood spot than in serum and venous blood indicate a high level of absorption of progesterone cream and its transport to tissues, and demonstrate the lack of utility of serum measurements, which underestimate progesterone absorption, to monitor topical progesterone treatment. See article abstract.


"Evaluation of the Iodine Loading Test: Urine Iodine Excretion Kinetics after Consumption of 50 mg Iodine/Iodide."  Zava T.  Townsend Letter 2013; January. 

Summary: This study at ZRT Laboratory analyzed iodine excretion before and after a 50 mg loading dose of iodine/iodide, to determine whether a popular "iodine loading test" can accurately determine iodine sufficiency.  The study concluded that the cutoff of 90% excretion used in this test does not allow it to realistically assess whole body iodine sufficiency or deficiency.  See full article.


“Iodine and creatinine testing in urine dried on filter paper.” Zava TT, Kapur S, Zava DT.  Anal Chim Acta 2013; 764:64-69.

Summary: This paper describes ZRT Laboratory’s novel test in dried urine for iodine and creatinine.  This test makes urine collection for iodine testing simple and convenient, unlike typical liquid urine collections over 24 hours. See full article.


"Testosterone implants in women: Pharmacological dosing for a physiologic effect." Glaser R, Kalantaridou S, Dimitrakakis C. Maturitas 2013;74(2):179-84. 

Summary: ZRT dried blood spot testing was used in this study investigating testosterone levels in women who received subcutaneous testosterone implants.  Testosterone levels were found to fluctuate throughout the day in a similar manner to the circadian variation seen with endogenous testosterone release.  See article abstract.


"Vitamin D Supplement Doses and Serum 25-Hydroxyvitamin D in the Range Associated with Cancer Prevention." Garland CF, French CB, Baggerly LL, Heaney RP. Anticancer Research 2011; 31(607-612).

Summary: This study used ZRT's Vitamin D testing to examine the relationship of measured vitamin D status to vitamin D supplementation, both as practiced by health conscious individuals and as related to cancer prevention. See full article

 

"Assessment of Japanese iodine intake based on seaweed consumption in Japan: A literature-based analysis." Zava TT, Zava DT. Thyroid Res 2011; 4 (1):14.

Summary: This thorough review of the pertinent literature clears up much of the confusion surrounding the iodine content of the Japanese diet.  The authors present a combined analysis based on dietary recall studies, surveys, urinary iodine testing, and the iodine content of various seaweeds, and estimate the average Japanese iodine intake to be between 1 and 3 milligrams per day. See full article.


 “Agreement of blood spot card measurements of vitamin D levels with serum, whole blood specimen types and a dietary recall instrument.”  Larkin EK, Gebretsadik T, Koestner N, Newman MS, et al.  PloS ONE 2011;6(1).

Summary: This study found relatively good agreement between 25-hydroxy vitamin D measurements using blood spot cards, serum, and whole blood samples.  The authors note that dried blood spot samples are less invasive than traditional venipuncture and provide a convenient method for assessing vitamin D status in population studies and in children.  See full article.


“Low salivary testosterone levels in patients with breast cancer.” Dimitrakakis C, Glaser R, Zava D, Marinopoulos S, Tsigginou A, Antsaklis A. BMC Cancer 2010; 10(547):1-8.  

Summary: The role of endogenous hormones in breast cancer was studied using saliva testing of 347 women with breast cancer and 184 age-matched control women.  The women with breast cancer had significantly lower salivary testosterone, estriol, and DHEA-S levels than the controls, while estradiol and estrone levels were higher in the breast cancer cases than the controls.  The authors suggest that bioavailable testosterone protects against the proliferative effects of estrogens on breast tissue. See full article.


"Female social and sexual interest across the menstrual cycle: the roles of pain, sleep and hormones.” Guillermo CJ, Manlove HA, Gray PB, Zava DT, Marrs CR. BMC-Womens Health 2010; 10(19):1-10.  

Summary: Saliva testing was used to study changing hormone levels throughout the menstrual cycle in healthy women, who were either taking oral contraceptives or were not using oral contraceptives.  Hormones tested were DHEA-S, progesterone, cortisol, testosterone, estradiol, and estriol.  Estrogen levels correlated with socio-sexual and physical activity during menstruation and the luteal phase in the non-OC users, but these activities were more closely associated with progesterone, cortisol, and DHEA-S in the OC users throughout the cycle.  OC users showed higher overall social and physical attraction.  The authors conclude that a broader range of hormones could be associated with sexual attraction than previously thought. See full article.


 “Postprandial insulin and triglycerides after different breakfast meal challenges: use of finger stick capillary dried blood spots to study postprandial dysmetabolism.”  Kapur S, Groves MN, Zava DT, Kapur S.  Journal of Diabetes Science and Technology 2010; 4(2):236-243.

Summary: Dried blood spot technology was used to study the phenomenon of postprandial dysmetabolism, which has been characterized by sustained high levels of insulin and triglycerides in the blood after eating.  This has been found to increase risk of atherosclerosis and coronary heart disease, but routine monitoring of dysmetabolism in the general population is hampered by the inconvenience of blood collection.  The study demonstrated the ease of repeated blood spot collection at various times after eating typical breakfast meals.  It also showed differences in levels of insulin and triglycerides after eating the different meals, which varied in nutritional content.  Dried blood spots were found to be a convenient and simple tool to look at the effects of different diets on postprandial dysmetabolism.  This method could therefore be used in larger-scale studies of the effects of diet on cardiometabolic risk. See article abstract. To purchase the full article, visit the journal’s website at www.jdst.org


“Poster presentation report: safety of maternal testosterone therapy during breast feeding.”  Glaser RL, Newman M, Parsons M, Zava D, Glaser-Garbrick D.   International Journal of Pharmaceutical Compounding, 2009: 13(4):314-7.

Summary: This article summarizes a poster presentation from the 13th Annual International Congress on Steroidal Hormones and Cancer in September 2008 (the poster is included in the list below).  The study found that in a woman undergoing testosterone supplementation for relief of depression, anxiety, irritability, memory loss, aches, and pains, testosterone was not passed on to her nursing infant during breast feeding.  Blood spot testosterone levels were measured in the mother, her infant, and breast milk.  Testosterone levels were increased during therapy in the mother’s blood, but not in the breast milk or in the infant’s blood. See article abstract. To purchase the full article, visit the journal’s website at www.ijpc.com


“The physiologic role and use of estriol.”  Paoletti JE.  International Journal of Pharmaceutical Compounding, 2009: 13(4):270-5.

Summary: Estriol is one of the three main circulating estrogens in the body.  The author explains the role of estriol in the body, particularly in protecting against breast cancer, and therefore the importance of balancing the estradiol/estriol ratio in women using bioidentical hormone restoration therapy. See article abstract. To purchase the full article, visit the journal’s website at www.ijpc.com


“A liquid chromatography/tandem mass spectrometry method for determination of 25-hydroxy vitamin D2 and 25-hydroxy vitamin D3 in dried blood spots: a potential adjunct to diabetes and cardiometabolic risk screening.” Mark S. Newman, Theodore R Brandon, Margaret N. Groves, William L. Gregory, Sanjay Kapur, David T. Zava. Journal of Diabetes Science and Technology 2009; 3(1):156-62. 

Summary: This study demonstrated an excellent correlation between levels of 25-hydroxy vitamin D2 and 25-hydroxyvitamin D3 in blood spots and serum, allowing the blood spot assay to be used for accurate assessments of vitamin D status in screening situations. Low levels of vitamin D have been linked to both type I and type II diabetes, and vitamin D deficiency is also emerging as a risk factor for cardiovascular disease. The paper discusses these implications. See the article abstract. To purchase the full article, visit the journal’s website at www.jdst.org.


“Differentiation and treatment of hypothyroidism, functional hypothyroidism and functional metabolism.” Paoletti JE. International Journal of Pharmaceutical Compounding, 2008; 12(6): 489-497. 

Summary: This article looks at the different levels at which thyroid production, metabolism, and dysfunctions of utilization can lead to classical symptoms of hypothyroidism. An understanding of how to use and interpret thyroid function measurements to allow determination of where the problems exist, and how to choose appropriate treatment, is presented also. See the article abstract. To purchase the full article, visit the journal’s website at www.ijpc.com.


“Pilot study: absorption and efficacy of multiple hormones delivered in a single cream applied to the mucous membranes of the labia and vagina.” Glaser RL, Zava DT, Wurtzbacher D. Gynecologic and Obstetric Investigation 2008; 66(2):111-8. 

Summary: This is the first study to document absorption of multiple hormones applied topically to the vagina by measuring their levels in both saliva and blood. Hormones included in the cream were estriol, estradiol, progesterone, DHEA, and testosterone. There was a measurable increase in health-related quality of life after using the cream in the 12 postmenopausal women involved in the study. See the article abstract. To access the full article, visit the publisher’s website.


"Cardiometabolic risk factors assessed by a finger stick dried blood spot method." Sanjay Kapur, PhD, Sonia Kapur, PhD, and David Zava, PhD. Journal of Diabetes Science and Technology 2008; 2(2): 236-241. 

Summary: This article describes analytical methods for measurement of insulin, high-sensitivity C-reactive protein, and triglycerides from dried blood spots and validation of these methods by comparison with analysis performed in serum. The article shows that dried blood spot samples may be used as the sample of choice when convenience is desired and in situations where conventional blood collection is not available. See the article abstract. To access the full article, visit the journal’s website at www.jdst.org.


“Analysis of the Use of Dried Blood Spot Measurements in Disease Screening." Ramakrishnan Lakshmy, Ph.D. Journal of Diabetes Science and Technology 2008; 2(2): 242-243. 

Summary: The use of dried blood spots for the measurement of insulin, high sensitivity C-reactive protein, and triglycerides is reported in this article. A good correlation between measurement of these analytes in dried blood and serum suggests that the method is valid and has the potential to be used for the screening of cardiometabolic risk factors. While this article is not a ZRT publication, it is included here because it mentions ZRT's Research Director, Sanjay Kapur, and his article listed above indicating that there is good correlation between dried capillary blood and serum obtained through venipuncture. See the article abstract. To access the full article, visit the journal’s website at www.jdst.org.


"A comparison of blood spot vs. plasma analysis of gonadotropin and ovarian steroid hormone levels in reproductive-age women." Edelman A, Stouffer R, Zava DT, Jensen JT. Fertility and Sterility 2007; 88(5): 1404-1407. 

Summary: This article documents a study comparing LH, FSH, progesterone, and estradiol levels obtained from blood spot versus plasma and concludes that blood spot testing can be just as valid as blood serum testing in documenting circulating hormone levels seen during ovulatory cycles. See the article abstract. To access the full article, click here for purchase options: Elsevier Full-Text Article link.


“Correcting misconceptions about compounding bioidentical hormones: a review of the literature.”  Paoletti J.  International Journal of Pharmaceutical Compounding 2007;11(4):269-272.

To purchase the full article, visit the journal’s website at www.ijpc.com


“Saliva hormone testing.” David Zava, PhD, Townsend Letter for Doctors and Patients 2004; January:120-124.

Summary: This review discusses the rationale for, as well as advantages and disadvantages, of saliva testing. It describes and explains the phenomenon of higher saliva than serum levels of hormones when they are delivered topically, and details how salivary hormone testing can help detect hormone imbalances that affect health and wellbeing. See full article.


“A perspective on hormone replacement for women: picking up the pieces after the Women’s Health Initiative Trial.”  Gillson GR, Zava DT.  Part 1 – International Journal of Pharmaceutical Compounding 2003;7(4):250-256. Part II – International Journal of Pharmaceutical Compounding 2003;7(5):330-358.

To purchase the full articles, visit the journal’s website at www.ijpc.com.


“The hormonal link to breast cancer: the estrogen matrix.”  Zava, DT.  International Journal of Pharmaceutical Compounding 2002:6(4):250-254.

Summary: The biochemical and hormonal imbalances that increase the levels of unopposed estrogens in breast tissue, and therefore increase the risk of breast cancer, are described.  Factors leading to increased risk include obesity, conventional HRT, pollutants, stress, and adrenal dysfunction. To purchase the full article, visit the journal’s website at www.ijpc.com


“Overall self-confidence, self-confidence in mathematics, and sex-role stereotyping in relation to salivary free testosterone in university women.” Johnson W, Zava D, McCoy N. Perceptual and Motor Skills 2000; 91(2):391-401. 

Summary: The relationship between salivary free testosterone levels and measures of self-confidence was studied in 40 young women. See the article abstract.


“Estrogen and progestin bioactivity of foods, herbs, and spices.”  Zava DT, Dollbaum CM, Blen M.  Proceedings of the Society for Experimental Biology and Medicine 1998;217(3):369-378. 

Summary: This study demonstrates that various common foods, herbs, and spices contain phytoestrogens and phytoprogestins, which then exert biological activity when consumed. See the article abstract.