Freedom to Heal

Freedom to Heal: THE BRAIN AND THE CEREBELLUM: BY UNDERSTANDING IT,...

2013-04-06T09:48:00.001-04:00

Freedom to Heal: THE BRAIN AND THE CEREBELLUM: BY UNDERSTANDING IT,...: THE BRAIN AND THE CEREBELLUM: BY UNDERSTANDING IT, WE CAN USE OUR KNOWLEDGE TO OUR ADVANTAGE…. In this series of blogs, my goal is to ge...

THE BRAIN AND THE CEREBELLUM: BY UNDERSTANDING IT, WE CAN USE OUR KNOWLEDGE TO OUR ADVANTAGE….

2013-04-06T09:38:00.003-04:00

THE BRAIN AND THE CEREBELLUM: BY UNDERSTANDING IT, WE CAN USE OUR KNOWLEDGE TO OUR ADVANTAGE….

In this series of blogs, my goal is to get you interested in the brain. The more you know and understand how your body works, the better it is for you!!! This is particularly important when we are talking about the brain.

There is a lot of research and interest in the field of the brain, particularly with the rise in brain issues such as Alzheimer’s disease, attention deficit disorder (ADD) and autism. The concept of the ‘spectrum’ has been also introduced as a means to explain how some people may have some features of these problems but they may be present in milder forms. It is important to know about this because as you become more aware of these problems, you can explore to see if you have them, and by knowing it, your communication with your doctor can improve, and most importantly, you can get the care and attention you deserve.

While it is important to focus on diseases, and the medical problems that plague mankind, it is also essential to focus on prevention. You should know about issues that you may be at risk for by investigating about your family history and truly reviewing your way of life (lifestyle). Being proactive and implementing the power of prevention in your life will reward you. When thinking about your wellbeing, it is time to also focus on the aspects of your life that are good. When it comes to the brain, make it a priority to focus on your brain power, how to maximize it, and how to prevent it from damage and wear and tear.

Today, I will focus on the Cerebellum. In my next blog I will talk about the other parts of the brain which include the brain stem, hypothalamus and the pituitary gland.

My long term goal is to focus on the importance of ‘feeding’ our brain. I want to introduce the term: NEUROPLASTICITY. This term is somewhat of a novel one, yet rest assured, once you understand it; you will enter into a fascinating world where you will hunger for more information with the hopes to maximize your experience in this world…..

THE BRAIN AND ITS PARTS

The first step in understanding the brain is getting to know the parts. There are three parts of the brain: the cerebrum, the cerebellum, and the brain stem.

1. The cerebrum is the largest part of the brain. It controls movements and thoughts and is responsible for helping you see, hear, smell, and touch.

2. The brain stem lies under the cerebrum and in front of the third main part of the brain, the cerebellum, and connects to the spinal cord, which runs through the spine, giving and receiving nerves from the arms and legs.

3. The cerebellum is the part of the brain that is located in the back and lower aspect of the brain. It is responsible for a number of functions including motor skills such as balance, coordination, and posture as well as eye movement. It has many more functions which I will then explain in more detail.

THE CEREBELLUM

The word cerebellum is Latin for “little brain”. The cerebellum is about the size of a plum and is about one-eighth to one-tenth of the size of the cerebrum. But don’t be fooled by its size, is divided into two hemispheres and ten lobes and it contains half of the neurons in the brain. The cerebellum is mainly responsible for the coordination of movement, speech, and senses, and is also crucial in other mental processes such as perception and cognition. It has several different types of cells and neurons, one of which is the Purkinje cell. This particular cell acts somewhat like ‘tower control’. This delicate ‘octopus-like’ neuron (the Purkinje) gives out information from the cerebellum back to the cerebrum and also to the brain stem and spinal cord. As it connects the cerebrum and the brain stem you want to think of it as a ‘coordinator’.

The best way to understand an organ in the human body is to see what happens when it is damaged or missing. The cerebellum is easily damaged because the Purkinje cell is quite sensitive. Decreased blood flow, alcohol, and other toxins, including some medications can cause the cerebellum to not work properly. The cerebellum is also very sensitive to heat stroke.

When the cerebellum is damaged, a person usually experiences problems with balance and coordination of movements. This condition has a medical name; it is called ‘ataxia’. But this is not the only problem that arises when a person has damage to the cerebellum. A person with damage to the cerebellum can also have other neurological and psychiatric changes.

Dr. Leroi and his colleagues published a study of 31 individuals with damage to the cerebellum in the American Journal of Psychiatry in 2002. He stated that 77% of the patients had ‘psychiatric’ disorders, 68% had ‘mood’ disorders, 26% had ‘personality’ change, and lastly 19% had medical criteria for dementia.

Problems of the cerebellum are common in people who have conditions such as Dyslexia, Autism, Schizophrenia, Attention Deficit Hyperactivity Disorder, and in infants born very pre-term. There is also a condition called a Chiari Malformation where there are structural defects in the cerebellum where parts of it are located below the opening to the spinal canal. This malformation develops when the bony space that surrounds the cerebellum at the base of the skull is smaller than normal. This causes the cerebellum and brain stem to be pushed downward and there may be blockage of flow of cerebrospinal fluid (CSF)— the clear liquid that surrounds and cushions the brain and spinal cord—to and from the brain. This can cause severe headaches and complaints that could be caused by damage to the cerebellum as you will see below.

What Does the Cerebellum Do?

The cerebellum is involved not only in movement, but also intellect and emotion. Different parts of cerebellum regulate different functions.

The cerebellum is responsible for a number of functions:

1. Fine tunes motor skills: balance, coordination and posture. In this way, the cerebellum keeps the body moving in a smooth and coordinated way.

2. Links eye movements and muscle movements: If a muscle is about to move in the wrong way, the cerebellum will send its own signals to the muscle to ensure that it moves correctly.

3. Proprioception: Coordinates and allows awareness for the position if the body in space, and gives us an intuitive map of our body parts.

4. Cognitive functions: Attention, and the processing of language, music, and other sensory temporal stimuli.

COGNITION, EMOTION AND THE CEREBELLUM

As I stated before, there has been a lot of interest in the cerebellum because of its important role in coordination and awareness for the human body. But, there is also increased recognition that the cerebellum contributes to thinking and emotional control, in addition to its role in motor coordination. This means that the cerebellum has important roles when it comes to intelligence, emotion and the automatic functions of the body. Cerebellar functions and the mind relate to how a person may relate socially, and the skills that are needed in a social environment.

When a person has had a stroke or tumor in the area of the cerebellum, or when a person has had intense trauma to the base of the skull and trauma to the cerebellum, they may have cognitive and psychiatric manifestations. This condition has a name: cerebellar cognitive affective syndrome (CCAS). Children born very preterm may have disproportionately small cerebella and may also have CCAS. Also if a person has had trauma to the head there is a high risk of cerebellar damage. Trauma to the head involving the base of the skull can involve the cerebellum. If a person had problems during delivery, required forceps, was breech, or had a difficult delivery, it is important to monitor for mild cerebellar disease.

CCAS causes a person to have mild to severe problems with balance, but at the same time they may just have problems in in the realm of emotions, attention, and behavior such as:

1. Difficulty with planning and organizing things in the mind

2. Difficulty with finding words and ‘verbal fluency’ and expressive language
     a. Long latencies, poor initiation, brief responses, lack of elaboration, word finding, confrontation naming

3. Difficulty with abstract reasoning and problem solving

4. Impaired ‘working’ memory and overall memory

5. Difficulty organizing verbal or visual-spatial material

6. Impaired organization when recalling a story; better with multiple-choice

7. Changes in personality
     a. Blunting of affect or exaggerated, disinhibited and inappropriate behavior
     b. Emotional unpredictability, inappropriate extreme sadness, and hopelessness
     c. Difficulty with social cues and interactions
     d. Incongruous feelings, pathological laughing or crying
     e. Passivity, immaturity, childishness, oppositional behavior
     f. Irritable, impulsive, disinhibited emotions
     g. Exaggerated attention to detail, ruminativeness and perseveration
     h. Obsessional thoughts
     i. Inattentiveness and distractibility
     j. Hyperactivity and dis-inhibition
     k. Difficulty shifting focus of attention
     l. Compulsive and ritualistic behaviors

TREATMENT APPROACHES

1. Recognize that there is a problem, and consult with a specialist in the field of neurology and neuropsychiatry

2. Bring actions to conscious awareness and apply cognitive/behavioral therapies where the person is taught to become aware of the problem and use skills to overcome it using other areas of the brain

3. Focus on one task at a time

4. Use medications appropriate to relieve each of the complaints

5. Consider physical rehabilitation strategies that may influence motor control as well as mood and cognition

I hope that you have learned something about the brain and when dealing with issues that sometimes may be mis-diagnosed, knowledge is power! If you have some of the problems I have mentioned here today don’t settle for a simple answer and make sure all the aspects of your brain have been reviewed.

Margarita Ochoa-Maya, MD
www.FreedomToHeal.org
www.AdvancedHealthNH.com

THINKING TO LIVE: THE BRAIN, INTELLIGENCE AND COGNINTION: So what is the Brain For????

2013-02-07T20:13:00.001-05:00

THINKING TO LIVE: THE BRAIN, INTELLIGENCE AND COGNINTION: So what is the Brain For????

In this series of blogs, I will talk about the brain. How does an individual interpret things? How does the human brain interact with our perceptions, feelings and mood? How do we learn from our experiences?

Once we can understand some of these concepts I will attempt to discuss essential nutrients that are important for brain function in order to maximize our brain power. Given that this may become a really long blog, I will divide it into parts. This one I will dedicate to explain the brain…..

SO WHAT IS THE BRAIN FOR? It is the boss....

Some say that the brain is the boss… For something that looks like a big, wrinkly, gray sponge, it doesn’t do so badly. It runs the show and controls just about everything you do, even when you're asleep. The human brain has many different parts that work together. It is divided into 5 major parts:

1. Cerebrum

2. Cerebellum

3. Brain stem

4. Pituitary gland

5. Hypothalamus

THE CEREBRUM: The Thinking Part of the Brain

The cerebrum is the thinking part of the brain and it controls all the voluntary muscles — the ones that move when you want them to. It is the biggest part of the brain and makes up 85% of the brain's weight.

When you're thinking hard, you're using your cerebrum. You need it to solve math problems, figure out a video game, and draw a picture. Your memory lives in the cerebrum. The cerebrum also helps you reason, like when you figure out that you'd better do your homework now because your mom is taking you to a movie later. Let me explain the brain a bit further.

The cerebrum is responsible for a couple of brain functions which include three main ones: Cognition, Intellect and Thought

1. Cognition: Cognition is a group of mental processes that includes attention, memory, producing and understanding language, learning, reasoning, problem solving, and decision making.

2. Intellect: Is the ability of the mind to come to correct conclusions about what is true or real, and about how to solve problems.

3. Thought: Thought generally refers to any mental or intellectual activity involving an individual's subjective consciousness. It can refer either to the act of thinking or the resulting ideas or arrangements of ideas. Similar concepts include cognition, sentience, consciousness, and imagination.

The majority of your thinking happens in the cerebrum. Thinking allows human beings to interpret or model the world in different ways, and more specifically to represent or interpret their vision of the world in ways that are significant to them, in which it agrees with the thinking individual’s needs, attachments, objectives, plans, commitments, ends and desires. You see…. thinking is very personal. No one can read your thoughts.

Memory also lives in the cerebrum. Memory refers to the processes that are used to acquire, store, retain and later bring back information. Much of our stored memory lies outside of our awareness most of the time, except when we actually need to use it. There are three major processes involved in memory: encoding, storage and retrieval. The encoding process means that in order to form new memories, new information must be changed into a usable form for the brain. Once information has been successfully encoded, it must be stored in memory for later use. The retrieval process allows us to bring stored memories into conscious awareness.

There are three separate stages of memory:

1. Sensory memory

2. Short-term memory

3. Long-term memory

Sensory information captured by sight, hearing and touch and becomes the earliest stage of memory. During this stage, sensory information from the environment is stored for a very brief period of time. For example visual information is stored for no longer than a half-second, and auditory information is stored for and 3 or 4 seconds. We attend to only certain aspects of this sensory memory, allowing some of this information to pass into the next stage - short-term memory.

Short-term memory, also known as active memory, is the information we are currently aware of or thinking about. According to Freud, this memory would be referred to as the conscious mind. Paying attention to sensory memories generates the information in short-term memory. Most of the information stored in active memory will be kept for approximately 20 to 30 seconds. While many of our short-term memories are quickly forgotten, attending to this information allows it to continue on the next stage - long-term memory.

Long-term memory refers to the continuing storage of information. Freud called the long-term memory the preconscious and unconscious. This information is largely outside of our awareness, but can be called into working memory to be used when needed. Some of this information is fairly easy to recall, while other memories are much more difficult to access.

So the mystery lies here, how do we access these stored memories? Recall is really important, as you may all know the feeling when under pressure, you know the information it is just at the ‘tip of your tongue’…..

The ability to access and retrieve information from long-term memory allows us to actually use these memories to make decisions, interact with others and solve problems. How long-term memory is organized is not well understood, but researchers do know that these memories are arranged in groups or ‘clusters’. The brain groups memories by a means to organize related information. Information that is categorized becomes easier to remember and recall.

The best way to ‘work’ your memory is by using the semantic network model. This model suggests that certain ‘triggers’ activate associated memories.

For example, when you think of a specific place, with it memories about related things that have occurred in that location might activate.

Another example, thinking about a particular school building might trigger memories of being in class, the teacher, the classmates, even what you were wearing on a particular day…

I think this is awesome! And cognitive researchers think this is awesome too! There are now places that can teach you how to work your memory; one that I recommend is www.Lumosity.com .

But, wait… why is this important to know? Well, certainly improving your cognitive skills is extremely important at every level. It is important for performance and independent living, but it is also important in order to prevent the degeneration and the real ‘burn-out’ of the brain including Alzheimer’s Disease.

Before I go to the next brain structure, I would like to share one more detail about the cerebrum. The cerebrumt has two halves, with one on either side of the head. Some scientists think that the right half helps you think about abstract things like music, colors, and shapes. The left half is said to be more analytical, helping you with math, logic, and speech. Scientists do know for sure that the right half of the cerebrum controls the left side of your body, and the left half controls the right side.
Understanding the cerebrum is important because it is opening the door to new ways of teaching and understanding brain function, and mental illness. Applying this knowledge can be used to help everyone, including those with diagnosed 'learning disabilities'. I think that sometimes understanding how a person learns is better than labeling them with a 'disability'. I also understand that without the ability to determine a person's way of thinking is better than nothing at all. So this is a truly controversial area and I am delighted to share with you that in today's fast paced world, we are paying attention and this can help millions of people around the world. There is active research going on in this field and there is more to come.

Imagine a teaching model that is based on how each individual thinks rather than generalizing it to the whole class….. this would be based on optimized education based on each individual’s way of learning and thinking in order to maximize their potential and knowledge transfer…. IF a particular student learns more visually then a class where hearing is the main way to learn is not suited for that person, but rather a class where it would be through images such as a video, etc.….would be better. This is individualized education!!!

Just imagine the applications and the impact individualized education could have in the future of education.

In health and in particular mental health and illnesses as devastating as Post Traumatic Stress Disorder (PTSD), understanding where the bad memories lie, would be the future for treating mental health problems and help people cope better with their triggers of those bad memories….. Maybe more targeted medications as well as targeted therapies combined with individualized education would benefit people more than the current treatment modalities that are also tainted with side effects. The future is here, and we should know about it!!!

In my next blog I will discuss the role of the Cerebellum, Brain stem, Pituitary gland and the Hypothalamus. I know this is a bit complicated, but when you get interested in the new term ‘neuroplasticity’ you will be amazed at the new information out there, at your fingertips, to make you a better human every day!

Thank you for reading,

Margarita Ochoa-Maya, MD
www.AdvancedHealthNH.com
www.FreedomToHeal.org

THE BODY AND THE THYROID AFTER PREGNANCY: POST PARTUM THYROIDITIS

2012-12-31T18:15:00.004-05:00

THE BODY AND THE THYROID AFTER PREGNANCY: POST PARTUM THYROIDITIS

Life changes after a woman delivers a baby. Having a baby can be one of the most rewarding experiences in a woman's life, but it can also be scary and exhausting. Sometimes it is hard to be prepared for the changes that ensue.

Changes happen to a woman after delivering a baby. Her hormones are in complete disarray, there is a rapid decline in estrogen and progesterone, oxytocin and prolactin are the dominant hormones. Right before delivery, the uterus was 500 times larger than it was before conception and after delivery it needs to shrink back to its original size. The body accomplishes this by contracting, with similar bursts like in labor. These contractions are usually known as afterpains. Within four week after delivery, the uterus has shrunk to its pre-pregnancy size. Not to mention the uterus changing, the muscles of the abdominal wall which had become stretched need to get back to their pre-pregnancy state. The bones are brittle due to the high demand of calcium during pregnancy and breastfeeding. During and after pregnancy the nutritious demand on a woman for calcium and other nutrients are on ‘super’ high. Fatigue, lack of sleep and all the bodily changes for sure take a toll on a woman.

The physical changes are small compared to the psychological changes. The baby does not come with instructions. Up and down all night, unpredictable schedules, added demands and responsibilities -- all of these can cause a new mother to feel stressed. It is not rare to feel overwhelmed and frightened. There are so many questions. Why is the baby crying? Is it time to feed the baby again? Is the baby getting enough milk? Why doesn't the baby sleep more at night? It's a lot to think about.

Having a baby is supposed to make you feel amazing and wonderful; but for some mothers, happy feelings can mix with sad feelings. This is actually due to all the hormone changes in a woman, and some researchers believe that it is normal. They are called the baby blues. They happen about 3 to 5 days after having a baby. Feelings of sadness and irritability are not rare. Frequent crying can be a sign of the baby blues, but by the 10th day after the baby's birth, these sad feelings should go away. If they don't, call your doctor or health care provider. While many women start feeling better anywhere from six weeks to three months after delivery, some will continue to have or develop symptoms in a constant yet chronic way, such as fatigue, anxiety, feeling "blue," poor memory, and lack of concentration.

In some situations the baby blues can be due to ‘postpartum depression’, but sometimes the depressed mood may be due to post-partum thyroiditis.

Postpartum thyroiditis is a temporary, painless inflammation of the thyroid gland that occurs within the first year after delivery. This happens after 5% to 10% of all deliveries. Until the last two decades, there has been little information available about postpartum thyroiditis. However, recent research has demonstrated the need to recognize and, if necessary to treat, women suffering from this disorder.

HIGH RISK FACTORS FOR POSTPARTUM THYROIDITIS

A woman may be more at risk for having a thyroid problem after delivery and post-partum thyroiditis if they have the following:

1. Presence of an enlarged thyroid or goiter

2. High levels of anti-thyroid antibodies during the first trimester

3. History of postpartum thyroiditis after previous pregnancies

4. Strong family history of autoimmune thyroid disease, hypothyroidism or thyroid disorders

5. Strong family history of other autoimmune disorders such as Type I diabetes

THE COURSE OF POSTPARTUM THYROIDITIS

Postpartum thyroiditis occurs within the first year after delivery. The risk is highest from eight weeks to four months postpartum. What a woman will present with or complain about vary from woman to woman. Typically, the complaints start out in a mild fashion. In fact, they can be so mild, that many women are unaware that they exist or dismiss them as a normal part of having a baby. This is why it runs undiagnosed in many cases and awareness is important in order to have a candid conversation with your health care provider or doctor.

There are three courses that postpartum thyroiditis can follow:

1. A hyperthyroid phase (too much thyroid hormone) followed by a return to normal thyroid function

2. A hypothyroid (not enough thyroid hormone) phase alone

3. A hyperthyroid phase (too much thyroid hormone) followed by a hypothyroid phase (not enough thyroid hormone)

SIGNS AND SYMPTOMS OF HYPERTHYROID PHASE

During the hyperthyroid phase, the thyroid gland cannot control the release of thyroid hormone it normally stores and it is usually caused by damage to the thyroid due to antibodies that seek to destroy it. Therefore, too much thyroid hormone is released into the bloodstream. The body then feels hot, anxious, stressed and ‘wired’. Because these symptoms can be mild, some women do not notice any problems and just think this is part of being overwhelmed with the new baby. Some women may experience any symptoms of hyperthyroidism and have one or more of the following signs and symptoms:

1. Goiter (an enlarged thyroid gland) on occasion it may be tender

2. Fatigue

3. Nervousness

4. Irritability

5. Feeling hot and sweaty

6. Hot flashes

7. Rapid heartbeat

8. Inability to concentrate

9. Trembling hands

10. Muscle weakness

11. Weight loss

The hyperthyroid phase can last anywhere from two to eight weeks or until the thyroid hormone supply decreases. In some cases, the thyroid gland recovers and returns to normal function.

SIGNS AND SYMPTOMS OF HYPOTHYROID PHASE

After the hyperthyroid phase, if the damage to the thyroid gland was sufficient, the gland may be temporarily unable to produce enough thyroid hormone. This results in hypothyroidism, or a resulting decrease in the supply of thyroid hormone. In some cases, women with postpartum thyroiditis do not go through a hyperthyroid phase (or do not notice it) until they develop hypothyroidism. During the hypothyroid phase, a woman could have one or more of the following signs and symptoms:

1. Goiter (an enlarged thyroid gland) that may be tender

2. Fatigue

3. Depression

4. Poor memory and decreased concentration

5. Feeling cold

6. Constipation

7. Muscle cramps

8. Difficulty losing weight

The hypothyroid phase can begin between the third and eighth month after delivery and is usually temporary, lasting up to six to eight months. It is important to note that approximately 25% to 30% of the women who have postpartum thyroiditis will eventually develop permanent hypothyroidism.

CAUSES OF POST PARTUM THYROIDITIS

The cause of post-partum thyroiditis is not well known. What is well known is that antibodies against the thyroid are almost always present in the bloodstream of women who develop postpartum thyroiditis. These antibodies are thyroid peroxidase antibodies (TPO ab) also called anti-thyroid antibodies. It is known that as many as 30% to 50% of the women who have TPO ab in their blood during the first trimester of pregnancy will develop postpartum thyroiditis. TPO ab are present in women with Hashimoto's thyroiditis, Graves' disease, and Type 1 diabetes. Therefore, it is not surprising that these women develop postpartum thyroiditis.

During pregnancy, the immune system becomes somewhat suppressed, possibly to prevent the formation of antibodies that could harm the fetus. After delivery, the immune system reactivates. It is during this time that the immune system can produce antibodies that attack the thyroid gland. Antibodies are substances produced by the body's immune system due to a situation when the body’s defenses incorrectly identify the cells of normal body tissue as "invaders". Antibodies are meant to attack these cells.

HOW IS THE DIAGNOSIS OF POST PARTUM THYROIDITIS MADE?

Post-partum thyroiditis can be diagnosed by measuring thyroid hormone levels in the blood. A low TSH (Thyroid Stimulating Hormone) and a high free T4 level indicate hyperthyroidism. To distinguish between postpartum thyroiditis and Graves' disease, a physician or care giver can order a radioactive iodine uptake test. Since Graves' disease makes the thyroid gland overactive, the results of the uptake will be high. However, postpartum thyroiditis damages the thyroid gland, and the uptake will be low. Unfortunately, radioactive iodine can get into breast milk. Therefore, a woman who is nursing will need to discontinue breast feeding for three to five days, or she and her physician may elect to delay the test.

Hypothyroidism is also diagnosed by measuring thyroid hormone levels. A high TSH measurement and a low free T4 level will confirm the diagnosis.

A laboratory test can be done to measure the antibody levels in the body. Anti-peroxidase antibodies (TPO ab), anti-thyroglobulin antibodies, and thyroid stimulating immunoglobulin can be measured as well. These tests can be expensive though. Another test that can be done is a measurement of thyroglobulin. This is usually elevated in the hyperthyroid phase and decreased in the hypothyroid phase.

TREATMENT OF POST-PARTUM THYROIDITIS

Sometimes the most important treatment for postpartum thyroiditis is recognizing that it exists. Most women are relieved to know the reason for their discomfort and that it is temporary.

The hyperthyroid phase of post-partum thyroiditis does not require the same treatments usually offered to women who have permanent forms of hyperthyroidism. If a woman is suffering from tremors and a rapid heart rate, beta-blockers may help. Beta-blockers are medications usually prescribed for elevated blood pressure or migraines. Beta-blockers do not affect thyroid function, but they do provide symptom relief during the short duration of these phase.

Treatment during the hypothyroid phase is tricky. It depends upon how uncomfortable the woman is, and the severity of her complaints. This needs to be correlated with the laboratory tests and how abnormal the thyroid hormone levels and antibody levels are. The treatment goal is to replace the thyroid hormone by giving a woman thyroid hormone and help restore normal thyroid hormone levels. Treatment can be started but within three to six months a repeat evaluation is needed to determine if the damage was temporary or permanent. In order to determine if hypothyroidism is temporary or permanent, the thyroid hormone replacement prescription needs to be discontinued for approximately four to six weeks prior to the test and repeat labs be done and compared to previous values. This can be really tricky and actually expensive. Treatment for hypothyroidism can be done even in the case of breast feeding because only minimal amounts get into breast milk. Of the women who suffer post-partum thyroiditis and hypothyroidism, 25% to 30% of women will develop permanent hypothyroidism and require thyroid hormone replacement for a lifetime.

With this blog I conclude my series on the thyroid and pregnancy.

Thank you for reading.

Margarita Ochoa-Maya, MD
www.AdvancedHealthNH.com
www.FreedomToheal.org

HYPERTHYROIDISM, GRAVES DISEASE AND PREGNANCY

2012-12-31T00:10:00.002-05:00

HYPERTHYROIDISM, GRAVES DISEASE AND PREGNANCY

As I stated in my previous blog, pregnancy is a period of significant hormonal changes and metabolic demands which result in complex effects on thyroid function. We have already discussed the thyroid and pregnancy and hypothyroidism and pregnancy, but hyperthyroidism is also very common in pregnancy. As a matter of fact, there is a transient stimulation of the thyroid gland in the first few weeks of pregnancy that is completely normal. In some cases, morning sickness can go to an extreme called ‘hyper-emesis gravidarum’ and this has been associated with the thyroid.

Some symptoms of hyperthyroidism are common features in normal pregnancies, including increased heart rate, heat intolerance, and fatigue. Other symptoms that are more closely associated with hyperthyroidism include rapid and irregular heartbeat, a slight tremor, unexplained weight loss or failure to have normal pregnancy weight gain, and the severe nausea and vomiting associated with hyperemesis gravidarum. Hyperemesis gravidarum can lead to weight loss and dehydration. This extreme nausea and vomiting is believed to be triggered by high levels of hCG, which can also lead to temporary hyperthyroidism that goes away during the second half of pregnancy.

WHAT CAUSES HYPERTHYROIDISM IN PREGNANCY?

AS stated above, normal production of hCG by the placenta can cause a transient hyperthyroid phase in women and this is normal. In some cases, it can get a bit ‘out of hand’ and it is called hyperemesis gravidarum. If a woman is pregnant with twins, the placenta is bigger. This means more hCG. This translates to higher risk of hyperemesis gravidarum.

Hyperthyroidism in pregnancy can also be due to Graves’ disease. Graves’ disease is an autoimmune disorder that affects the thyroid gland. Normally, the immune system protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. But in autoimmune diseases, the immune system attacks the body’s own cells and organs. With Graves’ disease, the immune system makes an antibody called thyroid-stimulating immunoglobulin (TSI), sometimes called TSH receptor antibody, which mimics TSH and causes the thyroid to make too much thyroid hormone.

In some people with Graves’ disease, this antibody is also associated with eye problems such as irritation, bulging, and puffiness. Although Graves’ disease may first appear during pregnancy, a woman can also have it before she gets pregnant. This would be called preexisting Graves’ disease. Pregnant women with Graves’ disease should be monitored monthly.

As in most autoimmune diseases, women who have these medical problems could actually see an improvement in their symptoms by the second and third trimesters as the natural immune system of a woman is usually tuned down in pregnancy due to hormones in order to not reject the baby inside her. This general suppression of the immune system that occurs during pregnancy can even induce remission of hyperthyroidism caused by Graves’ disease—a disappearance of signs and symptoms. Unfortunately the disease usually worsens again in the first few months after delivery.

HOW DOES HYPERTHYROIDISM AFFECT THE MOTHER AND BABY?

Uncontrolled hyperthyroidism during pregnancy can lead to serious complications for both the mother and the baby. It is important to have the thyroid tested in every woman at least once a year and specifically women who are of child bearing age, and are interested in getting pregnant should have their thyroid tested. In an expecting mother, it is important to consider thyroid hormone tests as part of the first trimester screening especially if she has family history of thyroid disease, and or has complaints that could indicate that there may be a thyroid condition.

A woman who is complaining of excessive morning sickness, extreme vomiting, weight loss, and difficulty gaining weight should have a conversation with their caregiver about thyroid health. If in addition, she feels tremors, is hot, has profuse sweating, hot flashing, and anxiety thyroid disease and in particular hyperthyroidism should be considered.

Untreated hyperthyroidism during pregnancy can increase a pregnant woman’s risk of congestive heart failure, hypertension, preeclampsia, eclampsia, miscarriage, premature birth, low birth weight and thyroid storm—a sudden, severe worsening of hyperthyroid symptoms. Hyperthyroidism in the mother can also cause hyperthyroidism in the newborn. This can result in neonatal rapid heart rate, which can lead to heart failure in the baby. It can also lead to early closure of the soft spot in the skull; poor weight gain; irritability; and sometimes an enlarged thyroid that can press against the windpipe and interfere with breathing.

If a woman has Graves’ disease or was treated for Graves’ disease in the past with surgery or radioactive iodine, the TSI antibodies can still be present in the blood, even when thyroid levels are normal. The TSI antibodies she produces may travel across the placenta to the baby’s bloodstream and stimulate the fetal thyroid. For this reason it is important to discuss your previous thyroid history with your care provider, obstetrician and or midwife.

If the mother has history of Graves’ Disease and is being treated with anti-thyroid medications, it is important to keep in mind that these drugs can cross the placenta. For this reason, hyperthyroidism in the baby is less likely, yet on the other hand, if the mother is being over-treated, the unborn baby can have the effects of the thyroid medications have an effect on his or her thyroid and cause neonatal hypothyroidism. This fact makes it imperative to be extremely careful and overzealous over the thyroid laboratory tests in the mother during pregnancy.

Women who have had surgery or radioactive iodine treatment for Graves’ disease should inform their health care provider, so the baby can be monitored for thyroid-related problems later in the pregnancy.

HOW IS HYPERTHYROIDISM IN PREGNANCY DIAGNOSED?

Women with Graves’ disease and their newborns should be closely monitored by their health care team. In some occasions, pregnant women with Graves’ disease are followed by a high risk specialty obstetrician. For women who are presenting with hyperthyroid symptoms, or have a pre-existing history of hyperthyroidism, thyroid laboratory testing should be done every 4-6 weeks.

Diagnostic blood tests may include a Thyroid Stimulating Hormone (TSH) test. This test detects even tiny amounts of TSH in the blood and is the most accurate measure of thyroid activity available. Generally, below-normal levels of TSH indicate hyperthyroidism. However, low TSH levels may also occur in a normal pregnancy, especially in the first trimester, due to the small increase in thyroid hormones from HCG.

When the TSH is low, another group of blood tests to consider are levels of free T3 and free T4. Because of normal pregnancy-related changes in thyroid function, test results must be interpreted with caution. Elevated levels of free T4—the portion of thyroid hormone not attached to thyroid-binding protein—confirm the diagnosis. Rarely, in a woman with hyperthyroidism, free T4 levels can be normal, but free T3 levels are always high in hyperthyroidism.

Lastly, if a woman has Graves’ disease or has had surgery or radioactive iodine treatment for the disease, her doctor or care provider may also test the blood for the presence of Thyroid Stimulating Immunoglobulin (TSI) antibodies. These are elevated in Graves’ Disease.

HOW IS HYPERTHYROIDISM TREATED DURING PREGNANCY?

During pregnancy, mild hyperthyroidism, in which TSH is low but free T4 is normal, does not require treatment.

More severe hyperthyroidism is treated with anti-thyroid medications, which act by interfering with thyroid hormone production. The most common anti-thyroid medications prescribed for the treatment of hyperthyroidism are methimazole (Tapazole) and or propylthiouracil (PTU). When treating hyperthyroidism during pregnancy it is important to consider that anti-thyroid medications cross the placenta in small amounts and can decrease fetal thyroid hormone production. For this reason it is necessary to use the lowest possible dose to avoid hypothyroidism in the baby. Studies have shown that mothers taking anti-thyroid medications may safely breastfeed yet the final decision is to be made individually taking into consideration the health of the mother, the baby to be born and the dosage of the medication needed.

Anti-thyroid medications can cause side effects in some people, including allergic reactions such as rashes and itching, a decrease in the number of white blood cells in the body, which can lower a person’s resistance to infection and in rare cases it may cause liver failure.

For anyone taking anti-thyroid medications, they should be aware to stop and call their health care provider right away if they develop any of the following signs and symptoms while taking anti-thyroid medications:

1. Severe fatigue

2. Severe weakness

3. Vague abdominal pain

4. Loss of appetite

5. Skin rash and generalized itching

6. Easy bruising

7. Yellowing of the skin or whites of the eyes (jaundice)

8. Persistent sore throat

9. Fever greater than 103

When considering other treatment options for a pregnant woman with hyperthyroidism, radioactive iodine treatment is not an option for pregnant women because it can damage the fetal thyroid gland. Rarely, surgery to remove all or part of the thyroid gland is considered for women who cannot tolerate anti-thyroid medications.

Thank you for reading,

Margarita Ochoa-Maya, MD

www.AdvancedHealthNH.com
www.FreedomToHeal.org

HYPOTHYROIDISM AND PREGNANCY

2012-12-30T18:40:00.005-05:00

HYPOTHYROIDISM AND PREGNANCY

Pregnancy is a period of significant hormonal changes and metabolic demands which result in complex effects on thyroid function.

The most common cause of hypothyroidism in pregnancy is Hashimoto’s disease of the thyroid. It is a form of chronic inflammation of the thyroid gland caused by an autoimmune attack caused by antibodies generated by the body and made to attack itself, in particular the thyroid.

The immune system attacks the thyroid, causing thyroid cells to inflame and in some cases slowly decrease their function and production of thyroid hormones.

Other causes of hypothyroidism during pregnancy may be due to a woman having pre-existing thyroid disease (hypothyroidism) from other causes including prior thyroid surgery or destruction with Radioactive Iodine as a treatment for hyperthyroidism.

Experts differ in their opinions as to whether asymptomatic pregnant women should be routinely screened for hypothyroidism. I think it should be done. Every woman, regardless of being pregnant or not should be aware of one of the most common problems afflicting women, and should have thyroid tests done at least yearly when they have their physical. On the other hand, if a woman is contemplating pregnancy she should have thyroid tests done as well as a folic acid level as a minimum. If a woman is now pregnant, the jury is out, but at the same time if subclinical hypothyroidism is discovered, it is well documented in the medical literature that treatment is recommended to help ensure a healthy pregnancy.

A physician or caregiver needs to know that thyroid hormones play a critical role in neonatal and child neurodevelopment, and maternal thyroid disorders can lead to obstetric complications and irreversible effects on the fetus. These findings point out the need for all pregnant women to be screened for thyroid disorders with a valid biomarker with distinct reference ranges.

Symptoms of hypothyroidism in pregnancy include extreme fatigue, cold intolerance, muscle cramps, constipation, and problems with memory or concentration. High levels of TSH and low levels of free T4 generally indicate hypothyroidism.

The issue lies here…. These symptoms and complaints can also happen in a normal pregnancy. Furthermore, the normal pregnancy-related changes in thyroid function because the test results to be difficult to understand and must be interpreted with caution.

Thyroid hormones are crucial to fetal brain and nervous system development and uncontrolled hypothyroidism—especially during the first trimester—can affect the baby’s growth and brain development.

Uncontrolled hypothyroidism during pregnancy can also lead to health problems in the mother. These include:

1. Preeclampsia

2. Anemia—too few red blood cells in the body, decreasing the delivery of oxygen to the tissues

3. Higher risk of Miscarriage

4. Low birth weight, high birth weight

5. Gestational Diabetes

6. Stillbirth

7. Heart problems such as congestive heart failure

How is hypothyroidism in pregnancy diagnosed?

Hypothyroidism is diagnosed through a careful review of symptoms and complaints, and a thorough review of family history. Laboratory tests that should be done include measurement of TSH, free T4, free T3, thyroglobulin and Anti-peroxidase antibodies. Other antibodies that can be measured include anti-thyroid antibodies, and anti-thyroglobulin antibodies. The results need to be interpreted in the light of the time a woman has been pregnant.

Estimation and interpretation of thyroid function tests in pregnant women is of utmost importance for maternal, fetal and neonatal health. In the first couple of weeks, the laboratories can be tricky as the other hormones being produced in the body and by the placenta can trigger some changes. Alterations in iodine metabolism, production of -chorionic gonadotropin (-hCG) by the placenta, and increases in both thyroid hormone-binding proteins by the liver under the influence of estrogen and thus increases in the total amount thyroid hormones per se are some of the physiologic changes that occur during normal pregnancy. For this reason it is important to measure the free levels of thyroid hormones and consider all the results in the light of the woman’s complaints and examination.

One huge area of controversy and research is when a pregnant woman has subclinical hypothyroidism. This means that the pregnant woman has no apparent symptoms, and her thyroid function test results show high levels of TSH with a normal free T4. Subclinical hypothyroidism occurs in 2 to 3 percent of pregnancies. In my humble opinion this is when repeat studies need to be done no later than 4 weeks after these tests to see if there was influence from the other hormones such as hCG, or if indeed the thyroid condition is progressing to overt hypothyroidism and treatment should be started or adjusted. This is an example of how important individualized medicine is and the value of trust and the doctor patient relationship is at its max. Starting medication is scary during pregnancy and using too much medicine can also be tricky…. It is a decision that needs to be made in a very careful manner.

How is hypothyroidism treated during pregnancy?

Hypothyroidism is treated with synthetic thyroid hormone called thyroxine—a medication which is identical to the T4 made by the thyroid. Synthetic thyroxine is safe and necessary for the well-being of the fetus if the mother has hypothyroidism. It can also be treated with other more natural thyroid prescriptions, yet during pregnancy it is important to be very specific about the doses and I tend to suggest the most accurate medication with the most regulations. I recommend to my patients to use ‘brand name only’ if possible, and I recommend testing every 6 to 8 weeks during pregnancy in case there needs to be an adjustment. Women with preexisting hypothyroidism usually need to increase their pre-pregnancy dose of thyroxine to maintain normal thyroid function.

Are there any risks to the baby due to hypothyroidism?

If a woman has hypothyroidism during pregnancy but she takes her medication as prescribed and goes to the regularly scheduled appointments as well as follows through with routine testing there will be NO complications for the mother or the baby.

Points to Remember

1. Thyroid disease is a disorder that results when the thyroid gland produces more or less thyroid hormone than the body needs.

2. Pregnancy causes normal changes in thyroid function

3. Thyroid disease is very common in women and common in pregnancy.

4. Uncontrolled hypothyroidism during pregnancy can lead to serious health problems in the mother and can affect the unborn baby’s growth and brain development.

5. Hypothyroidism during pregnancy can be treated with thyroid hormone, thyroxine (T4) replacement.

Hypothyroidism doesn't have to mean you can't have a joyous, healthy pregnancy! Although it may make your pregnancy slightly more complicated, in the end, your pregnancy could be as uneventful as that of a woman with a normal functioning thyroid.

Margarita Ochoa-Maya, MD

www.AdvancedHealthNH.com
www.FreedomToHeal.org

THE THYROID AND PREGNANCY

2012-12-02T21:39:00.001-05:00

THE THYROID AND PREGNANCY

Thyroid disease is more common in women than in men, and therefore thyroid disease and pregnancy is a very important topic in women’s health. The thyroid gland is a 2-inch-long, butterfly-shaped gland weighing less than 1 ounce located in the front of the neck area. It produces thyroid hormones which travel through the body and direct the activity of the body’s cells and fuels them with signals for energy. The thyroid gland is regulated by Thyroid Stimulating Hormone (TSH), which is made by the pituitary gland in the brain. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary responds by decreasing TSH production.

The most important thyroid hormones are triiodothyronine (T3) and thyroxine (T4). This means that there are either three or four iodine molecules in the thyroid hormone. T3 is the active hormone and is made from taking one iodine molecule off of T4. They regulate the way the body uses energy (metabolism) and affect nearly every organ in the body. Thyroid hormones affect brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.

When the thyroid has issues, thyroid hormone production is usually affected. Too much thyroid hormone is called hyperthyroidism and can cause many of the body’s functions to speed up. Too little thyroid hormone is called hypothyroidism and can cause many of the body’s functions to slow down.

When a woman gets pregnant, the thyroid gland plays a critical role. Thyroid hormones are very important during pregnancy both for the development of a healthy baby and in maintaining the health of the mother. If a woman has pre-existing thyroid disease, and gets pregnant, this needs to be addressed, and on the other hand, it is important to screen women before and during pregnancy for thyroid disease as it is so common.

Women with thyroid problems can have a healthy pregnancy, yet it is important to know about the effect of pregnancy on the thyroid gland. If there is a family history of thyroid disease, or if there are any concerns about the thyroid gland during pregnancy, it is best to know the facts in order to have a healthy pregnancy and protect the health of the unborn baby. Thyroid function testing can be done and taking the required medications if needed will be the best practice to keep strong during pregnancy if thyroid disease is present.

PREGNANCY AND THYROID HORMONES

During normal pregnancy human chorionic gonadotropin (hCG) and estrogen are elevated. These two hormones may be associated with elevated levels of thyroid hormones in the blood of a pregnant woman as well as other changes in thyroid function tests done in the laboratory. These changes are considered normal hormonal changes but they can make thyroid function tests during pregnancy difficult to interpret.

Human chorionic gonadotropin (hCG) is structurally similar to TSH and to some degree can actually stimulate the thyroid to produce more thyroid hormone. Because of the stimulatory effect of hCG, the thyroid gland can enlarge slightly in healthy women during pregnancy. This enlargement is not enough to be detected by a physical exam. If indeed the thyroid gland in the area of the neck becomes noticeably enlarged, this may be a sign of thyroid disease and should be evaluated.

Increased estrogen during pregnancy may have an influence over thyroid-binding globulin (TBG), also known as thyroxine-binding globulin. TBG is a protein that transports thyroid hormone in the blood and estrogen is known to increase it. For this reason the total amount of thyroid hormone can be elevated, and thus make the laboratory tests difficult to interpret, and a pregnant woman may be thought as to have hyperthyroidism. For this reason it is important to measure both the total and free levels of thyroid hormones.

PREGNANCY DIET AND THE THRYOID

During pregnancy, the body requires higher amounts of nutrients to support the health of the mother and growing baby. It is really important to have a balanced diet as well as supplementing with a prenatal multivitamin.

In addition to vitamins, a pregnant woman also needs important trace minerals. The thyroid needs iodine to make thyroid hormone. Both the mother’s thyroid as well as the thyroid of the unborn baby require iodine and diet alone is not enough most of the time. The dietary requirements of iodine increase during pregnancy to at least 250 micrograms daily. It is estimated that in the United States, about 7 percent of pregnant women may not get enough iodine in their diet or through the prenatal vitamins. A mineral supplement containing iodine should be taken to receive most nutrients necessary for thyroid health. On another note choosing foods rich in iodine and iodized salt (salt supplemented with iodine) over plain salt will ensure this need is met. However, it is important to note that too much of a good thing can become bad. People with autoimmune thyroid disease may be sensitive to harmful side effects from iodine. Taking too much iodine drops or eating foods containing large amounts of iodine—such as seaweed, or kelp—may cause or worsen hyperthyroidism and hypothyroidism. It is important to discuss with your care provider and doctor about over the counter supplements and the amounts that you are taking, each person is different and it is important not to generalize.

THE EFFECTS OF THYROID HORMONES ON THE UNBORN BABY

During the first trimester, the fetus depends on the mother’s supply of thyroid hormone, which comes through the placenta. Thyroid hormone is critical to normal development of the baby’s brain and nervous system. At around 12 weeks, the baby’s thyroid begins to function on its own.

WHAT ARE THE POSSIBLE THYROID PROBLEMS DURING PREGNANCY

1. Hypothyroidism in pregnancy is usually caused by Hashimoto’s disease and occurs in three to five out of every 1,000 pregnancies. This is when the thyroid gland is underactive and does not produce enough thyroid hormone.

2. Hyperthyroidism in pregnancy is usually caused by Graves’ disease and occurs in about one of every 500 pregnancies. This is when the thyroid gland is overactive and produces too much thyroid hormone.

3. Thyroid nodules during pregnancy are usually caused by decreased nutritional intake of iodine, but they can also be associated with thyroid cancer and need to be addressed right away.

In my next blog I will discuss hypothyroidism and pregnancy in more detail.

Thank you for reading,

Margarita Ochoa-Maya, MD

www.AdvancedHealthNH.com

www.FreedomToheal.org

PREGNANCY AND HORMONES: THE FIRST 9 WEEKS ARE THE MOST IMPORTANT IN DEVELOPMENT

2012-11-25T17:06:00.002-05:00

PREGNANCY AND HORMONES: THE FIRST 9 WEEKS ARE THE MOST IMPORTANT IN DEVELOPMENT

In this blog I am going to try to explain pregnancy and the hormones that change week by week, but in the interest of length, as I don’t want to make it toooo long, I will focus on the first nine weeks. We will discuss the hormones used to diagnose pregnancy and also those that are used to determine growth and health of pregnancy. Some topics are controversial but surely contemporary and are widely discussed. My goal is to provide this information to you and allow you to generate questions and furthermore have healthy conversations with your care providers about these topics. I would like to make sure that you, my readers understand that I do not intend to treat or give advice to any individual and that I always encourage you to speak to your physician about your individual needs.

I have gathered information from different sources in order to provide the best information of what normal early fetal development looks like. However this information should be used as a general guide for healthy pregnancy development, although development may vary due to the mother’s health or a miscalculation of ovulation. Gestational age is the age of the pregnancy from the last normal menstrual period (LMP), and fetal age is the actual age of the growing baby. Most references to pregnancy are usually in gestational age rather than fetal age development, but we have included both so that it is clear what stage development is at.

WEEK 1 and 2 OF GESTATIONAL AGE - (CONCEPTION)

The first two weeks of pregnancy are called the weeks of conception. Before conception, the menstrual period has just ended and your body is getting ready for ovulation. For most women, ovulation takes place about 11 - 21 days from the first day of the last menstrual period, and on average it happens on day 14. If a woman has unprotected intercourse and it happens to be during ovulation time, several hundred million sperm are released in the vagina. Sperm will travel through the cervix and into the fallopian tubes, and it migrates right to the egg is if it know where exactly it needed to go. Some researchers have determined that the pH gradient of the vagina, the secretions and other factors specific to each individual sperm make that one special one reach there first.

When conception takes place, the sperm will penetrate the egg which has half the genetic material, and once egg and sperm unite they create a single set of 46 chromosomes called a zygote - the basic cell source for a new developing human being. The egg and sperm unit now starts dividing and as a group of cells they are called the morula. The morula continues to divide and spends a couple of days traveling through the fallopian tube toward the uterus. This multiplication and dividing process is a time in which many chromosomal can abnormalities occur. Keep in mind that most of the time the new mother does not know she is even pregnant. It is important to note here that folic acid deficiency is a cause for spinal and brain malformations that can be prevented with the proper use of a prenatal vitamin. Start one even before thinking about getting pregnant or if you are having unprotected intercourse and there is a possibility of pregnancy. It is an easy fix to a potentially devastating problem.

Eventually the morula becomes big enough and gets a new name: the blastocyst and eventually finds a cozy place in the uterus and it plants itself there. This is called implantation. Anywhere from day 6 - 12 after conception, the blastocyst will imbed into the uterine lining and begin the embryonic stage.

There are different hormones that are super important in this phase, and in the medical world we have learned to use them to our advantage to see where the process is in its development. One of them is Human Chorionic Gonadotropin (hCG).

As a consequence of implantation, hCG will develop and begin to rise and should increase every 48-72 hours for the next several weeks. This hormone is the one used to determine if a woman is pregnant. Human chorionic gonadotropin can be measured in two ways. The one most commonly used in home tests is the qualitative test. It is a version that tells you ‘yes it is present or no it is not’ or a simple yes or no answer. The next step would be to do a quantitative blood test that will measure the ‘exact’ amount of hCG in the blood. This test that measures the exact amount of hCG is used to closely monitor the development of pregnancy. If a mother does not know her last day of the menstrual cycle and it is hard to determine how long a woman has been pregnant, hCG levels can be used. Yet, if the levels are questionable, an ultrasound scan should be used to diagnose the pregnancy outcome. Ultrasound findings are much more accurate than hCG at diagnosing pregnancy viability after 5-6 weeks gestation.

Guideline to HCG Levels During Pregnancy Based On Gestational Age

1. Non-pregnant females: <5 .0=".0" miu="miu" ml="ml">
2. 3 weeks LMP: 5 - 50 mIU/ml

3. 4 weeks LMP: 5 - 426 mIU/ml

4. 5 weeks LMP: 18 - 7,340 mIU/ml

5. 6 weeks LMP: 1,080 - 56,500 mIU/ml

6. 7 - 8 weeks LMP: 7,650 - 229,000 mIU/ml

7. 9 - 12 weeks LMP: 25,700 - 288,000 mIU/ml

8. 13 - 16 weeks LMP: 13,300 - 254,000 mIU/ml

9. 17 - 24 weeks LMP: 4,060 - 165,400 mIU/ml

10. 25 - 40 weeks LMP: 3,640 - 117,000 mIU/ml

11. Postmenopausal: less than 9.5 mIU/ml

WEEKS 3-4 - GESTATIONAL AGE (FETAL AGE 2 WEEKS)

These weeks are when the fetal development really kicks off. Once the blastocyst plants itself in a cozy, rich and fluffy area of the uterus, it causes a “decidual reaction”. What this means is that the place where the blastocyst implanted starts thickening the endometrium- inner lining of the uterus. As it thickens more and more, the blastocyst burrows into it. The decidual reaction is can be seen by an ultrasound yet not always is it detected by ultrasound—sometimes it may take a special eye or very good equipment to see this “reaction” in the endometrium lining.

IN addition to hCG, the other really important hormone in the first weeks of pregnancy and more specifically during weeks 3 and 4 of pregnancy is progesterone.

So let’s refresh on progesterone. Progesterone is produced by the remnant of the egg after ovulation. The corpus luteum will produce progesterone for about 12-16 days, and this is called the luteal phase of your cycle. This remnant is called the ‘corpus luteum’. After ovulation even in the case that pregnancy does not occur, or if it does, progesterone helps thicken and prepare the uterine lining for implantation. In the case that ovulation happens at the same time intercourse happens and both the egg and sperm meet, the uterus is prepared for implantation because of progesterone.

When the egg is fertilized, the corpus luteum will continue to produce progesterone for the developing pregnancy until the placenta takes over. This is for about 10 weeks. After the placenta fully forms it produces progesterone and it maintains the pregnancy until birth. Progesterone also inhibits immune responses, decreases prostaglandins, and prevents the onset of uterine contractions. Sometimes, the corpus luteum cannot keep up with the production of progesterone and failure to adequately support the pregnancy with healthy and robust levels of progesterone can result in an early pregnancy loss. For this reason it is very important to have a conversation with your doctor or care provider about progesterone, especially if you have had a previous miscarriage.

Guideline to Progesterone levels during pregnancy:

1. Mid Luteal Phase: 1-28 ng/ml (average 12-16 ng/ml)

2. First trimester: 9-47 ng/ml (average 28 ng/ml)

3. Second Trimester: 17-146 ng/ml (average 81ng/ml)

4. Third Trimester: 49-300 ng/ml (average 174 ng/ml)

As you can see, there are many averages for progesterone levels. These charts are a very broad guideline—speak with your health care professional for more specific guidelines for you.

When looking at miscarriage, it is known that some women that have had a miscarriage, have a lower progesterone level. The question is: did the low progesterone levels cause a miscarriage or did the impending miscarriage cause the low progesterone levels? And to this date, it remains unanswered…. In trying to help prevent miscarriages, some doctors prescribe progesterone supplements in pregnancy to prevent miscarriage. But the truth is that the information is confusing and misleading. Some studies say that progesterone supplements do not really help prevent miscarriage in the average pregnancy. Some other studies state that progesterone supplementation is imperative in pregnancies that have resulted from certain assisted reproductive technologies such as in vitro fertilization (IVF), and in women who have suffered from three or more miscarriages or are at an advanced age. The hesitation comes when the data comes short when giving someone advice about their future baby. There is simply no proof and yes, there are some risks. So, my opinion, it is up to the person, the couple and the doctor who gives the advice, always keeping in mind that the goal is to do no harm and do what is right for you and your care. The bottom line is that there is a need for more research to be done as both women and those that care for them look to help prevent miscarriage from happening in pregnancy.

WEEK 5 OF GESTATIONAL AGE, FETAL AGE 3 WEEKS

By week 5 the gestational sac is formed, and is the first thing that most transvaginal ultrasounds can detect. This little pouch of fluid is usually seen before any recognizable embryo can be seen. The embryo can be seen at the beginning of the 6th week. During this time a yolk sac can be also be seen inside the gestational sac. The yolk sac will be the earliest source of nutrients for the developing fetus.

The hCG continues to be around and the normal values for hCG around week 5 are between 18 - 7,340 mIU/ml. Although development may be seen earlier, once the hCG levels are higher than 2000 mIU/ml, some type of development is expected to be seen in the uterus using high resolution vaginal ultrasound. Using hCG levels and pairing the levels up with gestational age provide a guide to caregivers to know what to expect and as such, determine if there is a problem if what is expected is not there.

As I stated in the progesterone guidelines, progesterone levels can have quite a variance at this stage of pregnancy. They can range from 9-47ng/ml in the first trimester, with an average of 12-30ng/ml in the first 5-6 weeks of pregnancy.

Another important point to consider is not each individual value but both hormone values (hCG and Progesterone) together and the rate at which these are increasing as the pregnancy progresses. Levels of hCG should be increasing by at least 60 % every 2-3 days, but ideally doubling every 48-72 hours. Progesterone levels rise much differently than hCG levels, with an average of 1-3ng/ml every couple days until they reach their peak for that trimester.

In situations when there is a concern of an ectopic pregnancy or miscarriage, hCG levels will often start out normal, but will not show a significant increase or will stop rising all together, and progesterone levels will be low from the beginning.

WEEK 6 - GESTATIONAL AGE (FETAL AGE 4 WEEKS)

By the sixth week of gestational age a vaginal ultrasound can detect a fetal heart beat and see the fetal pole. The fetal pole is the first visible sign of a developing embryo. This pole structure actually has some curve to it with the embryo’s head at one end and what looks like a tail at the other end. The person doing the ultrasound can measure the length between the crown and the rump (CRL) and these measurements can be used to determine the dates and age of the embryo with even more detail and accuracy. At 6 weeks, the fetal pole may be seen at a crown-rump length (CRL) of 2-4mm, and the heartbeat may be seen as a regular flutter when the CRL has reached 5mm.

In case that the ultrasound does not show a fetal pole or detect cardiac activity, it is usually recommended that a repeat ultrasound be done in 3- 7 days. It is very possible that dating can be wrong, and it is best not to jump to any conclusions. That is why it is important to use all the available tests both hormonal and via ultrasound to make a determination of gestational and fetal age.

WEEK 7 - GESTATIONAL AGE (FETAL AGE 5 WEEKS)

At 7 weeks the heartbeat can be detected for sure. A normal heartbeat at 6-7 weeks would be 90-110 beats per minute. The presence of an embryonic heartbeat is an assuring sign of the health of the pregnancy. A measurement of the fetal pole is also important. If the embryo is less than 5mm CRL, it is possible for it to be healthy without showing a heartbeat, though a follow up scan in 5-7 days should show cardiac activity.

The possible problems can include a miscarriage, an ectopic pregnancy, or a ‘blighted ovum’. If your doctor is concerned about miscarriage, blighted ovum, or ectopic pregnancy, the gestational sac and fetal pole (if visible) will be measured to determine what type of development should be seen. The guideline is that if the gestational sac measures >16-18mm with no fetal pole or the fetal pole measures 5mm with no heartbeat (by vaginal ultrasound), then a diagnosis of miscarriage or blighted ovum is made. If the fetal pole is too small to take an accurate measurement, then a repeat scan should be done in 3-5 days (this may mean that the dates are wrong). If there is absence of a fetal pole, then further testing should be done to rule out the possibility of an ectopic pregnancy.

WEEK 8 and 9 - GESTATIONAL AGE (FETAL AGE 6-7 WEEKS)

By week 8 and 9 of pregnancy the developing embryo has everything an adult human would have, it just needs to develop more and grow. The embryo has reached the end of the embryonic stage and now enters the fetal stage. A strong fetal heartbeat should be detectable by ultrasound, with a heartbeat of 140-170 bpm by the 9th week. If a strong heartbeat is not detected at this point, another ultrasound scan may be done to verify if the fetus is alive. If a pregnancy has been diagnosed as non-viable, most physicians will give the choice of waiting to see if the body will miscarry naturally (pending no other health issues) or to have a Dilation & Curettage (D&C) procedure. About 50% of women do not undergo a D&C procedure when an early pregnancy loss has occurred.

CONCLUSION

In conclusion, in the past two blogs, I have tried to explain the important hormones of pregnancy and the role of hCG and Progesterone in the first 9 weeks. Once a pregnancy crosses the first 9 weeks, the likelihood of miscarriage is lower and the health of the future baby now depends on nutrition and other factors that could affect it.

It is important to establish a relationship with your obstetrician even before planning a pregnancy and discuss your personal and family history as well as your partners. This will allow you to establish healthy routines that will impact your chances of getting pregnant and reduce the potential complications that could have impact on you, your future baby and your family.

Hope you enjoyed reading and found this information useful.

Dr. Margarita Ochoa-Maya

www.AdvancedHealthNH.com

www.FreedomToHeal.org

ESTROGEN, PROGESTERONE AND OTHER HORMONES AND PREGNANCY

2012-11-17T14:09:00.000-05:00

ESTROGEN, PROGESTERONE AND OTHER HORMONES AND PREGNANCY

When speaking about pregnancy, we always think of the obstetrician. Yet, as an endocrinologist, I see pregnancy through the looking glass of hormones. The development of a baby is a very intricate journey.

From the moment that a woman ovulates, and has all the hormones necessary for the growth and maturation of the egg, to the moment the egg and sperm meet, the developmental process is challenged. In these early days lay the foundation for a healthy mother and baby. It is common to have many questions about what this early development truly means and what is to be expected. These early weeks involve a very complex process and things can go wrong to the point that it may end in a pregnancy loss. For this reason it is important to know the role of hormones in pregnancy.

Every pregnancy develops differently, just as every woman is different. The intricate interactions of estrogen, progesterone and other hormones during fetal development are definitely an area of interest. With one hormone triggering the production of another, which in turn regulates the development and release of still others, and with cells changing structure and function as they mature, it’s a complicated story. Yet, I will attempt to explain these today. If you are pregnant, planning pregnancy or have had a history of infertility or miscarriage this may be an interesting article for you.

What are the main hormones in pregnancy?

1. Estrogen

2. Progesterone

3. Human placental Lactogen

4. Relaxin

5. Oxytocin

6. Prolactin

7. Placental Growth Factor

8. Other Hormones

ESTROGEN AND PREGNANCY
Due to estrogen's important role in fertility and pregnancy, the level of estrogen in a woman's body can affect her fertility. Low or high levels can both cause significant problems and lead to infertility. Estrogen levels rise in the first half of a woman's monthly menstrual cycle. It helps to prepare the body and more specifically the uterus for a possible pregnancy.

Estrogen is a growth hormone, it makes things grow. It makes the lining of the uterus grow to be nice and thick, full of cells that will cushion the budding baby in case of pregnancy. If a woman does not become pregnant at the time of ovulation, estrogen levels will drop leading to menstruation. If conception occurs, estrogen continues its important role. Levels continue to rise throughout pregnancy. Estrogen is produced by the ovaries, and later by the placenta. It also promotes the growth and further maturity of the breasts in preparation for milk production.

Estrogen is important as it increases blood flow throughout the body. It allows the healthy growth of the placenta. This increase in blood flow may cause a generalized flushed appearance. Mucous membranes may get congested, and this may cause swelling, causing postnasal drip, and some sinus congestion. This increase in blood flow may also cause the skin to be more sensitive, and may even be associated with some skin discolorations, and increased pigmentation. For this reason, the nipples, areola, and the white line that runs in the midline of your abdomen may become darker. The skin on your forehead, nose, and cheeks may start to look particularly tanned, creating the chloasma, or "mask of pregnancy." It is important to know this in order to use the proper sun block during pregnancy.

When it comes to the relationship of estrogen to other hormones, one of the main roles of estrogen is to regulate progesterone. Progesterone in synchrony with estrogen is necessary to initiate fetal maturation. Without them, a fetus’s lungs, liver and other organs and tissues cannot mature.

THE ROLE PROGESTERONE PLAYS IN PREGNANCY

Progesterone is the other big mama of maternal hormones. It is a "pro-gestational" hormone, hence the name. It is first produced in the ovaries, by the remnant of the egg after ovulation, the corpus luteum. Once the placenta is mature, around the second trimester, it then takes over the production of progesterone. One of the main purposes of progesterone is to keep the uterine lining healthy and thick, full of nutrients for the developing baby. It keeps muscles relaxed and inhibits pre-pregnancy's natural contractions of the smooth muscle of the uterus, allowing the baby to grow in an expanding and expanding, and expanding… womb. One of the side effects of relaxed smooth muscles in the body is well documented with the relaxation of the gastrointestinal tract. Pregnancy can be associated with GI discomforts such as indigestion, heartburn, and constipation, just to name a few. Lax muscles in the lower intestine can allow gases to distend the bowel, bringing about feelings of bloating and stomach aches.

Progesterone also causes cartilage to soften, and therefore promoting the loosening of joints and ligaments, contributing to late-pregnancy aches in the hips and pubic bone. Other effects of progesterone during pregnancy is the stimulation the growth of breast tissue as well as changes in the saliva and dental system where gingivitis and cavities are more evident. There have been some claims to increased sweating caused by progesterone as well.

HUMAN PLACENTAL LACTOGEN: HPL

Human Placental Lactogen is also known as human chorionic somatomammotropin, (yes it is a mouthful). It is a hormone that helps prepare a woman’s breasts for breast feeding. It causes the secretion of colostrum, the first milk like production from the breasts after the baby is born. Colostrum is full of proteins and antibodies to help the new baby’s immune system deal with the new world it was born into.

HPL also has a huge role in a pregnant woman’s metabolism as it allows the mother’s body to use more fatty acids and less glucose in order to leave more sugar and glucose to be available to nourish the growing baby. It has been described in the research that women who have lower levels of HPL have a higher likelihood to have smaller babies. Along with estrogen and the hormone cortisol, HPL can block the action of insulin, causing insulin resistance, elevating blood sugar levels, and in excess may be associated with higher risks for gestational diabetes. Starting around weeks 20 to 24 of pregnancy, if the pancreas can't pump out enough insulin to compensate or it pumps out insulin that does not work properly a mother is at risk of gestational diabetes or babies that are too large for gestational age. There is a lot of research being done in this field now that diabetes is so common.

RELAXIN

Relaxin: As the name implies Relaxin relaxes the body’s muscles, joints, and ligaments. Its main role is to relax the joints of the pelvis, allowing them to stretch during delivery. It also softens and lengthens the cervix and helps relax smooth muscles in the uterus and elsewhere throughout the body. This may cause problems with balance and the way a woman walks during pregnancy, particularly at the end of pregnancy when the belly is ‘large’. Relaxin is also important in preventing premature labor and premature contractions of the uterus.

OXYTOCIN

Oxytocin is pregnancy's muscle-contracting hormone. Oxytocin is present throughout pregnancy, but as the pregnancy progresses, the uterus becomes more sensitive to oxytocin. Once the mother reaches her limit and the due date is near, the cervix becomes mature enough to deal with a delivery. Oxytocin starts up uterine contractions and labor starts. There is a commercial pharmaceutical version of oxytocin and it is sometimes used if labor doesn't progress. It is given in the form of an intravenous injection of oxytocin also called Pitocin. Oxytocin can also be given immediately after delivery to encourage the shrinking, or involution, of the womb (uterus).

Oxytocin is also very important when the baby is born. As the baby starts breast feeding, oxytocin is released causing the breast to contract and leak milk and at the same time it causes the uterus to continue to contract and become smaller and smaller until it is the pre-pregnancy size. In some women, merely thinking about their baby or seeing a picture can initiate this letdown response — and that wet T-shirt effect.

PROLACTIN

Prolactin is the body's chief milk producer. As time goes by after delivering a baby, prolactin is stimulated by the baby as it sucks the milk, so more milk will be produced. Once prolactin starts decreasing so does milk production. Interestingly, prolactin is sometimes called the mothering hormone because it is also thought to cause a tranquilizing effect on nursing mothers that inspires even more of their loving instincts. Prolactin is also important for bone metabolism and there is active research being done right now to study the influence of prolactin on bone mineralization after delivering a baby.

PLACENTAL GROWTH FACTOR

Placental growth factor is as the name implies is a hormone that helps the placenta grow as the unborn baby grows. It is in the family of so-called angiogenic growth factors, which promote blood vessel growth. When the placental growth factor is low, it has been associated to with preeclampsia. Recent studies found very low levels of the hormone in women who eventually got the condition, in which blood vessels in the placenta narrow instead of widen, causing high blood pressure. The development of blood and urine tests to measure the hormone's concentration promises new techniques for early diagnosis and prevention.

OTHER PREGNANCY HORMONES

There are so many more hormones that are important during pregnancy. And the truth is that I am sure there are many more that need to be discovered through research that we may not know about. There are some other significant hormones at work during pregnancy that I will mention briefly. For example, erythropoietin is hormone that regulates red blood cell production this is important during pregnancy as new red cells need to be produced. Calcitonin is a hormone that promotes bone formation and is very important not only for the mother to keep her bones is good standing but for the unborn baby as it promotes the formation of new bones.

Thyroid hormones change dramatically with pregnancy and thus if a woman has thyroid disease and takes thyroid hormone medication it may need to be adjusted. On another hand, it is important to know if you have a family history of thyroid disease in the family so that you can have your thyroid tested if the doctor indicates it.

Insulin controls the metabolism of foods by both mother and baby. If a mother to be has weight problems and a possible history of hormonal imbalance, and a family history of diabetes mellitus, it is suggested that a conversation be had with the caring provider or doctor to discuss testing to check for insulin resistance and diabetes.

The adrenal is really important during pregnancy. A hormone from the brain called Adrenocorticotropic hormone (ACTH) stimulates the adrenal glands to pump out cortisol and other steroid hormones that not only has real effects on the mother but also is a crucial hormone to guide lung maturity.

Other hormones also worth mentioning are prostaglandins and endorphins. Prostaglandin in itself is technically not a hormone but your body depends on it just the same. Prostaglandins soften the cervix in preparation for delivery and are known as a key initiators of labor. Endorphins are known as your brain's natural happy hormones, endorphins. Endorphins help you endure the pain of labor— and perhaps even have some effect on memory in order to help ‘forget’ the pain of labor and ‘remember’ the beauty of your new born once you say hello to that lovely new person you've waited so many months to meet.

This is a series of blogs that I will start on pregnancy. I hope you enjoy.

Margarita Ochoa-Maya, MD

www.AdvancedHealthNH.com

www.FreedomToHeal.org

IS PROGESTERONE THE MOTHER HORMONE? WHAT IS THE DIFFERENCE BETWEEN SYNTHETIC PROGESTINS AND NATURAL PROGESTERONE

2012-10-01T14:34:00.004-04:00

IS PROGESTERONE THE MOTHER HORMONE? WHAT IS THE DIFFERENCE BETWEEN SYNTHETIC PROGESTINS AND NATURAL PROGESTERONE

When thinking about hormones, we really must think of a symphony. Hormonal imbalance humbles me…. The more I learn and review hormones, I realize how important they are as individual entities, yet more daunting is their power as a collective, when each one, married and in synchrony play the most wonderful music for the body…. Margarita Ochoa-Maya, MD

Hormones are the ultimate communicators… and when communication goes awry… Well… We all know that it bears no good news.

So far on my blogs, I have talked about hormonal imbalance. I have tried to make some sense about what each hormone does, what it means when we have too much, too little, or simply no balance…. Each one is a key player, and like playing with a Ruibik’s cube, when one is manipulated, well… it changes each and every other one….

When thinking of the hormonal disorders that affect women today, I worry. We see a growing problem with BALANCE. Women who have too much estrogen, tend to be overweight, women who lack progesterone tend to be depressed and women who have too much androgens have both. I know this is a generalization, but believe me, it makes some sense….

Today I want to specifically talk about PROGESTERONE…..

Progesterone has been somewhat of a myth… In the twenty years of experience I have acquired in the medical field, I have not seen progesterone as a popular hormone. We talk about estrogen, estrogen deficiency, estrogen excess, different kinds of estrogen, controversial estrogen… etc.…… When women start oral contraceptives, they take estrogen, yet they are also introduced to SYNTHETIC PROGESTINS…. They are quite different from the true, bio-identical hormone: PROGESTERONE. So, automatically, people will assume that progesterone and progestins are the same…. BUT THEY ARE NOT!!!

In today’s world, both women and men all seek new and better ways to have optimal health, prevent diseases, and support age related hormonal decline. Isn’t it true? Is 50 the new 30? But when it comes to PROGESTERONE, confusion exists….., even among leading experts in the field of hormone research. The lines between progestins and progesterone are blurry, but not for lack of available information, but because of mis-information. There is a distinct difference between the terms progesterone, progestin, and progestogen. These terms are often used interchangeably, but they are not synonymous and it is a mistake to do so.

Women today use progestins without being informed. They are in the birth control pills that are taken every day, they are in the ‘long term contraceptives’ and I believe that soon, we will see that more information is needed before starting these substances. It will be up to each individual to understand what they are putting in their bodies, and to ask the question: IS THIS RIGHT FOR ME????
TERMS EXPLAINED: PROGESTERONE, PROGESTIN, AND PROGESTOGEN

Progesterone refers to the hormone produced in the body, or produced from a plant source but still chemically and structurally identical to human progesterone, and it is therefore referred to as “bio identical” or “natural”.

A “progestin” refers to a hormone that is synthetically produced and differs in structure from progesterone. There are numerous synthetic progestins used in hormone therapy today. There is increasing evidence that, by virtue of their different chemical structures, synthetic progestins do not always act as progesterone would at the same target tissues. This has long been understood with respect to treatment of pregnancy and fertility issues, when progesterone is effectively prescribed, yet synthetic progestins are contraindicated. While synthetic progestins may mimic some of progesterone's effects, progestins may react differently with progesterone receptors in the body.

A “progestogen” (sometimes spelled “progestogen”) is a general term for hormones that act like progesterone, and therefore includes both progesterone and progestins.

PROGESTERONE

Progesterone could be considered the mother hormone. It is the oldest steroid hormone—some 500 million years old on the evolutionary scale. All animals with a skeleton – vertebrates, produce progesterone. In higher and more evolved species, progesterone is instrumental in the reproductive cycle. In lower vertebrates, progesterone is important for glucose metabolism, the development of intelligence and bone formation. That is a lot of responsibility for a single hormone… particularly one that doesn’t get a lot of buzz in the current and contemporary research circles of today…..

Progesterone is a steroid hormone produced by the adrenal gland in both men and women, the testes in men and the ovaries in women. It must be important since the body does not rely on just one organ to produce it…. And especially in women who inevitably will go through menopause…. This should spark some interest in you right now….If you are premenopausal, it is important for fertility and maintaining pregnancy, and if your post-menopausal, well, aren’t yourself ‘How come I my doctor has not mentioned it?

Progesterone is produced in the ovaries (by the corpus luteum), the adrenal glands (near the kidney), and, during pregnancy, in the placenta. Progesterone is also stored in adipose (fat) tissue.

Progesterone belongs to a class of hormones called progestogens, and is the major naturally occurring human progestogen. Progesterone is also known as P4 (pregn-4-ene-3,20-dione), a C-21 steroid hormone. It is is synthesized from pregnenolone, which in turn is derived from cholesterol. This reaction is catalyzed by cytochrome P450scc. Progesterone in turn is the precursor of a hormone called aldosterone and androstenedione. Aldosterone seeks salt and water and androstenedione can be converted to testosterone, estrone and estradiol. Progesterone, as a molecule has the ability to convert into other hormones via chemical reactions, especially under special circumstances and needs of the body. It can change into cortisol, aldosterone, testosterone and estradiol…. AMAZING!!!

The way progesterone works is by activation of the ‘antenna’ waiting for its signal – the progesterone receptor. The progesterone receptor is thought to be inside the cell. The receptors are in large numbers in the brain, the heart, the blood vessels, the breasts, the gut, the bone and cartilage to name a few.

NATURAL PROGESTERONE

Natural progesterone is made from yams and soybeans. It was discovered by Dr. Russell Marker, a Pennsylvania State College chemistry professor. He was experimenting with some native Mexican Yams that were rich in diosgenin (Discorea Mexicana) in the jungles of Mexico in the 1930s and realized that progesterone could be produced. Since then another yam, native to Taiwan (Discorea pseudojaponica), rich in saponins has also been found to be converted to diosgenin and thence to progesterone.

So even though this appears a bit confusing, and the majority of doctors are mis-informed about the progesterone vs. progestin controversy, and there are wide gaps in our knowledge about the molecular action of progesterone, the people using it and finding it extremely useful in their health are becoming a greater force for advocacy to research it more. We now realize that there are several kinds of progesterone receptors, and that progesterone itself can cross-talks with many other hormones and growth factors in and out of the cell.

In a previous blog I discussed the effects of progesterone. Yet it is worth reviewing the main effects of progesterone as contrasted with the effects of progestins. In order to do that, let me talk first about progestins, and afterwards we can do the comparison. What does progesterone do? Here are some examples:

1. It balances estrogen

2. It converts the inner lining of the uterus (endometrium) to a secretory phase to prepare the uterus for implantation

3. It affects the vaginal epithelium and cervical mucus, making it thick and impenetrable to sperm

4. It increases core temperature (thermogenic function) during ovulation

5. It reduces spasm and relaxes smooth muscle.

6. It is a natural antidepressant

7. It is a natural relaxer

8. It helps promote and maintain sleep

9. It opens airways by widening the lung tubes (bronchi) are and regulating mucus production

10. It acts as an anti-inflammatory agent and regulates the immune response

11. It reduces gall-bladder activity

12. It reduces bladder irritation and reduces incontinence

13. It normalizes blood clotting and vascular tone

14. It balances zinc and copper levels

15. It may affect gum health, increasing risk of gingivitis (gum inflammation) and tooth decay.

16. It plays an important role in the signaling of insulin release and pancreatic function, and may affect the susceptibility to diabetes or gestational diabetes

17. It may have a role in vaginal PH

18. It may have a role in promoting sperm motility towards the egg

19. It may have an important role in the brain, promoting the growth and development of nerve cells, as well as brain protection against damage

SYNTHETIC PROGESTINS

Synthetic progestins were developed with the advent of the birth control pill about 50 years ago. They were first produced in 1938 in hopes of finding a ‘patentable’ drug that could behave like progesterone in the body. Natural progesterone was inconvenient for the designers of birth control pills because the half-life of natural progesterone was very short. They then turned to synthetic progestins. They designed a molecule that would be very similar to natural progesterone yet have a longer half-life in the body. But, even a slight difference in the molecular structure of a compound can produce a totally different response from its natural counterpart. But, because they did have some similarities, synthetic progestins were patented and allowed as a molecule that was chemically and structurally similar.

Since Progestins and Progesterone are different molecules they have different effects on the body. Synthetic progestins are more potent that bio-identical progesterone. This is because they have a longer half-life than progesterone and they also bind ‘tighter’ to the receptor. Progestins can also have some affinity to the androgen receptors and cause some male hormone-like effects, increasing acne, facial hair, and weight.

Progestins and progesterone are metabolized differently as well. The by-products of natural progesterone are dihydroprogesterone, pregnenolone, pregnanediol. To this day, very little is known about the metabolism of progestins. One thing we do know is that the by-products of progestin have biologic activity themselves.

Birth control pills have, in most cases, a synthetic progestin and a synthetic estrogen. Progesterone is crucial to inhibit ovulation. The very potent synthetic progestins prevent ovulation in a very low dose and, therefore, accomplish their function of birth control.

Historically post-menopausal hormone replacement therapy included progestins only if a woman had a uterus. Therefore if a woman had her uterus surgically removed, she would not ‘need’ progestins. This concept is now under further examination and a more controversial concept has emerged with the use of bio-identical hormones and bio-identical natural progesterone. In 1998, an oral bio identical progesterone (the brand name Prometrium) received FDA approval. To make Prometrium, bio identical progesterone is finely ground into very small particles (micronized), then suspended in peanut oil so it that can be better absorbed.

We live in an era when more and more emphasis is being placed on our inner bodies, and the toxins and by-products of synthetic substances that can cause side-effects. Natural substances, natural food supplements and herbal formulations are in demand. Homeopathic and naturopathic physicians and caregivers are gaining popularity; furthermore, physicians who have training in both are rare, yet increasing in numbers. Everyone seems to be asking, "What can we do to help the body repair itself in a more natural fashion?"

Women are asking questions, and people in general are being called to ask questions about their health, and getting involved with the choices they have about their care. Women who take hormone replacement supplements are asking the "natural vs. synthetic" question. Is natural always better?

THE DIFFERENT KINDS OF PROGESTINS

There are many types of progestins, and each has a different profile in terms of progestational and androgenic activity and/or effects.

Progestational Effects:

Progestational effects refer to how the progestin stimulates the progesterone receptors and thus having ‘progesterone’ like effects. Progestational selectivity is also a term used to describe the different progestins. This refers to the degree in which progestational effects are maximized and androgenic effects are minimized.

Androgenic Effects:

Androgenic effects refer to the likelihood that the progestin may cause unpleasant ‘male-like’ side effects. Progestins with higher androgenic activity may increase the chances of androgen-related side effects which mainly include acne, unwanted hair growth or hirsutism, weight gain, changes in metabolism (particularly of sugars) and insulin resistance that may lead to diabetes.

Different classifications:

There are eight types of synthetic progestins. Most of these progestins are chemical derivatives of testosterone (known as 19-nortestosterone derivatives). Once originated from 19-nortestosterone, synthetic progestins can be further divided into two families: Estrane and Gonane.

First Generation Progestins:

The Estrane family is typically considered as first generation progestins. These progestins metabolize to Norethindrone acetate and Ethynodiol diacetate which by themselves have potent activity.

a. Norethindrone

b. Norethynodrel: Enovid

c. Norethindrone acetate: Many brands, commonly Ortho-Novum and Ovcon

d. Ethynodiol diacetate

The Gonane family is further subdivided into two groups second generation and third generation progestins. They have varying degrees of androgenic activity.

Second Generations progestins:

a. Levonorgestrel: Alesse, Trivora-28, Plan B, Mirena

b. Norethisterone

c. Norgestrel

Third Generation Progestins:

These are are reported to have the least androgenic effects and these include:

a. Desogestrel: Nexplanon

b. Gestodene

c. Norgestimate: Ortho Tricyclen, Ortho-Cyclen

Fourth generation Progestins:

They tend to be highly selective and possess minimal androgenic properties. These include:

a. Dienogest

b. Drospirenone

c. Nestorone

d. Nomegestrol acetate

THE JURY IS OUT: PROGESTINS VS. PROGESTERONE

1. Progestins may worsen mood problems and PMS while progesterone may alleviate PMS and mood issues

2. Progestins may worsen migraines while progesterone may alleviate them

3. Progestins may cause fluid retention, while progesterone may work as a natural diuretic

4. Progestins may worsen acne and facial hair, progesterone may balance it and even diminish it

PROGESTERONE IN THE FEMALE CYCLE, REPRODUCTION, AND PREGNANCY

During the first two weeks of the cycle, also called the preovulatory phase, progesterone levels are relatively low. Progesterone levels tend to be < 2 ng/ml prior to ovulation. Ovulation then triggered by a surge in luteinizing hormone (LH), leaves a remnant in the ovary, called the corpus luteum. This remnant produces progesterone and the second two weeks of the cycle are usually known for having higher levels of progesterone. Progesterone levels during this time (after ovulation) tend to be> 5 ng/ml. If pregnancy does not occur, progesterone levels will decrease, leading, in the human, to menstruation. This is why normal menstrual bleeding may also be called progesterone-withdrawal bleeding. In some cases, if ovulation does not occur, and the corpus luteum does not develop, levels of progesterone may be extremely low, leading to anovulatory dysfunctional uterine bleeding. This can be a presentation for polycystic ovarian syndrome.

Progesterone is sometimes called the "hormone of pregnancy". If conception occurs, human chorionic gonadotropin (hCG) is released, and this maintains the corpus luteum healthy for the next 12 weeks until the placenta is able to produce enough progesterone to maintain the pregnancy. A robust production of progesterone from the corpus luteum is crucial and extremely necessary for the health of the pregnancy and the future baby. If progesterone levels are not enough, miscarriages can occur.

At around 12 weeks the placenta begins to produce enough progesterone in place of the corpus luteum. This process is named the luteal-placental shift. After the shift, progesterone levels start to rise further and may reach 100-200 ng/ml at term. It is thought that these high levels of progesterone inhibit lactation during pregnancy. After delivery of the placenta progesterone levels are very low. It is also thought that the rapid drop in progesterone after delivery is what may trigger milk production.

USES FOR PROGESTINS AND PROGESTERONE

The use of both natural progesterone and its synthetic progestin analogues has many medical applications. Both may be used to address acute situations such as abnormal uterine bleeding, and to address the long-term decline of natural progesterone levels. Synthetic progestins were the substance of choice until bio-identical Progesterone was approved by the United States Food and Drug Administration. It was approved as vaginal gel on July 31, 1997, an oral capsule on May 14, 1998, and in an injection form on April 25, 2001. It was also approved as a vaginal insert on June 21, 2007.

Bio-identical progesterone can also be compounded at a compounding pharmacy, and can also be found over the counter in lower dosages. We have yet to discuss the case when a woman may have too much progesterone and not enough estrogen, and the different uses of natural progesterone. In the interest of time, I will discuss this further in my next blog. Stay tuned….

Thank you for reading,

Margarita Ochoa-Maya, MD

www.AdvancedHealthNH.com

www.FreedomToHeal.org

NUTRITIONAL SUPPLEMENTS TO HELP IN THE TREATMENT OF ESTROGEN DOMINANCE (Part II)

2012-09-09T21:18:00.003-04:00

NUTRITIONAL SUPPLEMENTS TO HELP IN THE TREATMENT OF ESTROGEN DOMINANCE (Part II)

Most women will suffer from estrogen dominance. Many women in their mid-thirties, most women during their peri-menopausal years (mid-forties), and essentially all women during menopause (age 50 and beyond) are overloaded with estrogen. After the age of 40, women may also be suffering from a relative progesterone deficiency because of the severe drop in the production of progesterone as a woman ages. Historically if a woman had a hysterectomy, and was started on hormone replacement, they would not even be put on progesterone. This practice was even frowned upon. The end result: Women have excess estrogen relative to progesterone, a condition now called estrogen dominance. Estrogen dominance is a fact of life. It is in the degree and severity and the associated problems it causes, that lays the treatment.

Estrogen dominance is a significant cause for hormonal imbalance, and it is also a consequence of hormonal imbalance. Whatever the reason, learning about this condition may allow you to have a candid discussion with your health care provider about some issues that you may not otherwise have known were treatable. In this blog, I would like to offer you some suggestions regarding complementary treatments that can be offered to you and the different lifestyle measures you can take to be healthy and have a balanced life. Please know that this blog is not intended to treat or cure any medical ailment, but instead, offer suggestions that you can consider when talking to your personal doctor. Every case is individualized and as such should be considered with your personal history and other medical problems that you may have.

In this blog, I will discuss the use of aminoacids, herbs, and other nutraceuticals for estrogen dominance.

AMINOACIDS

Methionine

Methionine is one of the essential amino acids needed for good health. It cannot be produced by the body, and so must be provided through our diet. Methionine is used by the body to make a substance called choline that is essential for healthy cellular membrane function. Together with choline, and inositol, methionine belongs to a group of compounds called ‘lipotropics’. Lipotropics help the liver process fat in the body. Once in the liver, methionine is converted into SAM(s-adenosyl methionine). Under ideal conditions the liver produces as much as 8 grams of SAM per day. The body can also convert methionine into cysteine, a precursor of glutathione. Methionine therefore protects against glutathione depletion if the body is over loaded with toxins. Because glutathione is the key neutralizer of toxins in the liver, high glutathione level protects the liver from the damaging effects of toxic compounds.

One of the important functions of methionine is its ability to be a supplier of sulfur. Sulfur is a key element vital to our life. Without an adequate intake of sulfur, our body will not be able to make and utilize a number of antioxidant nutrients. Methionine is an especially important nutrient beneficial to those suffering from estrogen dominance because methionine aids in the metabolism of estrogen, converting the stronger and carcinogenic "bad" estrone (E1) into the "good" estrogen, estriol (E3). Because of this ability to enhance estrogen clearance from the liver, methionine supplementation should be considered for anybody with symptoms of estrogen dominance, including breast cancer. The daily requirement varies depending on the body weight, but approximately 100-1000 mg a day is sufficient

SAMe

SAMe is short for adenosylmethionine, the metabolite of methionine and has many good attributes. SAMe can be taken separately or in addition to methionine. It has been used in supplement form to treat depression and inflammation as well as pain. It has also been studied as a treatment for liver disease and osteoarthritis. SAMe is involved in the regulation of hormones and neurotransmitters such as serotonin, melatonin, dopamine, and adrenaline - all key regulators of mood. SAMe's anti-inflammatory properties have also proven helpful with fibromyalgia and chronic fatigue when taken at 1gram a day. A daily dose of up to 1600mg of SAMe has been used to fight hepatitis and cirrhosis. A dose of 800-1600mg a day helps to elevate mood and provide relief to those who are clinically depressed.

Taurine

Taurine is an important amino acid in our body. It is made from two sulfur-containing amino acids called methionine and cysteine in conjunction with vitamin B6. It is found mostly in our central nervous system, skeletal muscle, and in greater concentration in our heart and brain. In cells, taurine keeps potassium and magnesium inside the cell while keeping excessive sodium out. It is also known to maintain proper calcium balance. Taurine works like a diuretic by stimulating kidney function and the elimination of fluid. Because of this reason, it is important to know if you have kidney issues before taking this supplement.

When one considers the effect Taurine has on the body, and fluid retention, it comes as no surprise that it is used to help people with tissue swelling and fluid accumulation. It has also been used as a complement to the treatment of hypertension or high blood pressure. Taurine also helps dampen the sympathetic nervous system, thereby relieving arterial and muscular spasm. When the blood vessels and muscles relax, the body's blood pressure will fall.

For women, Taurine is an important amino acid, but high concentrations of estrogen will depress the formation of taurine in the liver. When there is too much estrogen, women may become deficient in Taurine. The suggested dosage is between 1 and 3g a day. Higher dosages can cause loose stool and increase slightly the secretion of stomach acid.

HERBS AND SUBSTANCES DERIVED FROM PLANTS

Milk Thistle - Silymarin

Numerous research studies have demonstrated that Milk Thistle has protective effects on the liver. The most impressive research has been done on a special extract of milk thistle (Silybum marianum) known as silymarin. These compounds protect the liver from damage and enhance the detoxification process. Silymarin prevents damage to the liver by acting as an antioxidant. It is much more effective than vitamin E and vitamin C. Silymarin also works by preventing the depletion of glutathione and furthermore increase its levels. It has been shown to increase the level of glutathione by up to 35 %. Glutathione is necessary for liver detoxification. As the glutathione content increases, so does the liver's capacity to detoxify harmful chemicals. Silymarin has been shown to exhibit help in the complimentary treatment of liver diseases including cirrhosis, chronic hepatitis, fatty infiltration of the liver, and inflammation of the bile duct. The recommended dosage depends on each individual, and it should be discussed with your care provider.

DIM: DIINDOLYLMETHANE Conversion of estrogen metabolite

Diindolylmethane (DIM) is a balancer of estrogen metabolism. It aids in the metabolism of estrogen into 2 hydroxy-estrone, the good or protective estrogen. It is an isolated form of cruciferous vegetables called Indole-3-Carbinol (I3C) that when combined with stomach acid, it turns into 3,3-Diindolylmethane (DIM). DIM is compatible with other phyto-nutrients such as soy, black cohosh, red clover, and chaste berry extract with the goal to balance estrogen and promote progesterone stability. The suggested dose is 60 mg standardized extract once or twice a day – or as recommended by your caring provider.

WRAPPING IT ALL TOGETHER….

The key to hormonal balance is maintaining proper balance between estrogen and progesterone. To do so, the progesterone to estrogen ratio should be monitored both with symptoms and laboratory tests. Here I suggest some lifestyle treatments for estrogen dominance:

1. Quit smoking

2. Exercise regularly

3. Sleep at least 5 hours daily

4. Check your mood, and consider a journal to monitor patterns of behavior

5. Monitor your exposure to toxins:
     a. Reduce or monitor the intake of tap water
     b. Reduce or monitor your alcohol consumption
     c. Reduce or monitor your caffeine consumption
     d. Reduce or monitor your time in the car or in high traffic areas
     e. Review the pesticides you use and consider less or biologic ones
     f. Use protective equipment when exposed to toxins

6. Reduce the amount of acids in your diet
     a. Reduce processed foods
     b. Increase green foods and cruciferous vegetables
     c. Increase alkaline foods
     d. Consider a macrobiotic diet
     e. Reduce amounts of saturated fats in the diet
     f. Increase fish oils and Omega 3 and 6
     g. Consider a liver detoxification on a regular basis

7. Supplements to consider
     a. Vitamins
          i. B1
          ii. B2
          iii. B3
          iv. B5: Pantothenic acid
          v. B6: Pyridoxine
          vi. B12: methylcobalamine
          vii. Niacin
          viii. Biotin
          ix. Folic Acid
          x. Vitamin D
          xi. Vitamin A
          xii. Vitamin C
          xiii. Vitamin E

     b. Herbs to consider:
          i. Milk Thistle
          ii. Gamma Oryzanol
          iii. Black Cohosh Root Extract
          iv. Dong Quai Root Extract
          v. Licorice Root Extract
          vi. Protykin Root Extract
          vii. Siberian Ginseng (Eluthero)
          viii. Rhodiola Root Extract
          ix. Schizandra Berry Extract
          x. Ashwaganda Root Extract
          xi. Skullcap Root Extract
          xii. Horsetail grass
          xiii. Stinging Nettles Leaf
          xiv. Flavinoids

c. Minerals to consider:
         i. Magnesium
          ii. Zinc
          iii. Copper
          iv. Betaine
          v. Selenium

d. Aminoacids to consider:
          i. Glutathione
          ii. SAMe
          iii. Glycine
          iv. Taurine
          v. Glutamine
          vi. Methionine
          vii. L-Theanine

8. EstroDIM:
    a. I3C: Indole-3-carbinol
     b. DIM: Diindolymethane

With this I conclude my section on Estrogen Dominance in Women. Thank you for reading,

Margarita Ochoa-Maya, MD
www.AdvancedHealthNH.com
www.FreedomToHeal.org

NUTRITIONAL SUPPLEMENTS TO HELP IN THE TREATMENT OF ESTROGEN DOMINANCE

2012-09-02T09:59:00.002-04:00

NUTRITIONAL SUPPLEMENTS TO HELP IN THE TREATMENT OF ESTROGEN DOMINANCE

When talking about hormone imbalances, treatment can be viewed in many different ways. Genetic factors seen through a keen family history, lifestyle factors which include diet, exercise, the amount of sleep the person takes every night and emotional intelligence skills are important considerations when addressing hormone imbalance. They all have a very important role in a woman’s health and wellbeing.

In conventional main stream medicine, in women who are premenopausal and have hormonal imbalance, the use of some form of exogenous synthetic hormone usually in the form of an oral contraceptive (the pill), is the answer for the symptoms the patient displays. Irregular periods, heavy bleeding, PMS, and painful cycles can get better with the use of oral contraceptives (OCP). The main goal of the OCP is to silence the ovaries and shut down their own production of hormones while at the same time replace those hormones with the constant supply of synthetic hormones unique to each OCP brand.

Birth control pills are very helpful indeed. They have indications for their use; especially if a woman is not interested in getting pregnant, and her endogenous production, meaning her own production, of hormones is off balance or even nonexistent. They have been around for 50 years. This is encouraging and disheartening at the same time. Encouraging, because there has been great advances in women’s health, and the dose, the formulations, the delivery systems, among other things, have been under active scrutiny and investigation ever since. This has made the products better every time. On the other hand, it really has only been 50 years… Yes, only 50 years….. This give us perspective on the time that we have had to really understand synthetic hormones, and their effects on the body. This is a field of medicine that is still in baby stages…. The future is upon us, and research and progress in this field will be because of interested women like me and you, push for more.

It is very clear that some women truly cannot tolerate birth control pills and may even have worse side effects when they try them. For this reason it is important to consider other alternative and complimentary options to help them in their issues. And for this reason it is also imperative that the caring provider understand the causes of the problems being dealt with.

Functional and integrative medicine looks to find out what is wrong with your individual hormonal chemistry and seeks to balance what may be either missing or broken. A whole body approach with body, mind and spirit is necessary when considering healing. This approach is the future, as it incorporates prevention and lifestyle coaching and not just a pill that takes care of symptoms.

In today’s blog, I will discuss a group of natural supplements that could help in the treatment considerations for estrogen dominance. Please keep in mind that this is not intended for individual treatment but rather it is meant for informational purposes.

NUTRITIONAL SUPPLEMENTS

1. Fish Oil

2. Vitamins
     a. Vitamin A
     b. Vitamin C
     c. Vitamin E
     d. Vitamin B12
     e. Vitamin B6
     f. Vitamin B1- Thiamine

3. Minerals
     a. Magnesium
     b. Iodine
     c. Zinc

Fish Oil

Fish oil has many wonderful properties. It is derived from the tissues of oily fish that contain the omega-3 fatty acids which are EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). They are known to reduce inflammation throughout the body among other health benefits. Fish do not actually produce omega-3 fatty acids, but instead accumulate them by consuming either microalgae or prey fish that have in turn, accumulated them. Together with other antioxidants such as iodide and selenium they have their effect. The omega-3 fatty acids in fish oil are thought to be beneficial in treating elevated cholesterol, especially high triglycerides, depression, anxiety, cancer, macular degeneration, and brain function. When it comes to estrogen metabolism, fish oil increases the ratio of 2-(OH)- estrogen to 16-alpha-(OH)-estrogen and thereby reduces estrogen toxicity and cancer risk. Fish oil also inhibits the oxidation of arachidonic acid to Prostaglandin E2 which has in turn been associated with increased inflammation and prostate and breast cancer. Suggested Dosage: 500 to 10,000 mg a day.

VITAMINS

Antioxidants such as vitamins A, E, and especially vitamin C are essential for the detoxification process. They help the cells neutralize free radicals that cause mutation and cellular damage. This is critical during the Phase 1 detoxification process in the liver where free radicals are released when drugs and hormones are being cleared. For example, both vitamins A and E are fat-soluble and are found in our fatty tissues. They are particularly effective in preventing the oxidation of cell membranes, which are made up of phospholipids. On the other hand, vitamin C is water-soluble and fights free radicals in the plasma. Vitamin C is especially vital in any detoxification program, as the body needs it for energy to process and eliminate wastes.

The vitamin B family is essential for almost all cellular processes in the body and particularly the nervous system. They play an important role in maintaining health by transporting oxygen into our cells, support healthy nerve function, energy production, and hormone balance. B-vitamins act as coenzymes, helping enzymes to react chemically with other substances, and are involved in energy production. Each B-vitamin fills a different complementary need, which is why they should most often be taken together. Deficiencies in vitamin B6 have been associated with increased levels of estrogen in the body. Suggested dosages vary with each individual and the particular complaints and ailments they have.

MINERALS

Magnesium

A deficiency in magnesium can lead to severe PMS, muscle cramping, and fatigue, among other symptoms. Magnesium is important for hundreds of bodily processes and can have an effect on virtually every organ system within the body. Therefore, it is important to be sure that your body gets adequate daily amounts. When estrogen is balanced, it enhances the utilization and uptake of magnesium by the cells. Too much calcium that is unopposed by magnesium with further create estrogen dominance related issues. Excessive estrogen reduces circulating magnesium, leading to a relative excess of calcium. Magnesium in turn helps neutralize estrogen in the liver. The ideal ratio is Ca/Mg ratio of 1 to 2 for adults. The suggested intake of magnesium should be 500-1000mg a day, or as tolerated because it can cause GI upset and diarrhea.

Iodine

Thyroid disease is more common in women, with an 6-8:1 ratio compared to men. Women who have excess estrogen and in women when they are having at hormonal changes such as in puberty, child bearing age, imbalanced hormones, PCOS, pregnancy, delivery and menopause are at higher risk for thyroid disease.

Iodine has been implicated in higher risk of breast, endometrial, and ovarian cancer show that these cancers. Increasing dietary iodine intake may reduce the risk of these cancers. The ovaries and iodine are related. When iodine levels are low, it has been shown that there are messages sent to make the ovaries work harder. This in turn may cause estrogen to be secreted at higher levels, particularly estrone. On another note, estrogen receptors become more sensitive when iodine is low. It has also been shown that high levels of estrogen inhibit iodine absorption.

Low Iodine can cause a relative state of hypothyroidism that causes thyroid gland to enlarge and in some cases, the labs can still be normal. For these reasons iodine supplementation is very important in women’s health. It may balance estrogen production and metabolism, and in turn aid the thyroid to function better. The recommended dose varies based on the patient, yet it is on average 150-300 mg iodine per day.

Zinc

When it comes to hormone health, zinc has been shown to play an important role in hormone production and balance. It is known to block the enzyme ‘aromatase’. Aromatase is responsible for turning excess testosterone into estrogen, Zinc has also been shown to increase progesterone levels and lower estrogen by promoting its metabolism and excretion. Excess estrogen can in turn, lower serum zinc levels. More than 70% of women do not obtain the minimum daily requirement of zinc from their diets. The recommended dietary allowance of zinc on a daily basis is 8-12 mg per day.

In my next blog I will discuss aminoacids, herbs and phytochemicals and other substances that have been used as complimentary aids in the treatment of estrogen dominance.

Thank you for reading…

Margarita Ochoa-Maya, MD
www.AdvancedHealthNH.com
www.FreedomToHeal.org

TREATMENT CONSIDERATIONS FOR EXCESS ESTROGEN AND ESTROGEN DOMINANCE

2012-08-28T16:43:00.001-04:00

TREATMENT CONSIDERATIONS FOR EXCESS ESTROGEN AND ESTROGEN DOMINANCE

Estrogen dominance is a common problem today. Both men and women can suffer from this case of hormonal imbalance. As I stated in my previous blogs, this is caused by a combination of a modern fast paced stressed lifestyle, significant environmental issues that need to be dealt with and a genetic predisposition to the problem. Unfortunately, there is so much estrogen and estrogen like products around that it is impossible to fully escape from its effects and impact on the body. We are all surrounded by plastics, car exhaust; soaps, synthetic fibers in clothes; carpet and furniture are just some of the examples.

The diagnosis of estrogen dominance can be difficult especially in the case that some main stream physicians are focusing more on symptoms than cause, yet the signs and symptoms are clear when you ask the right questions. A thorough history and physical together with a keen review of lifestyle, supplements and medications as well as hormonal testing can give insight to this problem.

Today’s blog is intended to review potential recommendations for the treatment of estrogen dominance, yet these are recommendations that you should then review with your physician or caring provider. These are suggestions and as such are not intended for treatment unless you discuss this with your doctor and reviewed your personal history, your complaints and your laboratory results.

Here are my suggestions:

NATURAL PROGESTERONE

Natural progesterone balances the estrogen effects throughout the body. For this reason, it is at the cornerstone in the treatment of estrogen dominance. Specific dosages need to be addressed individually given the different ways estrogen dominance can present itself. The body normally produces 20 mg of progesterone a day. Replacement of this physiological amount in natural cream form is suggested in most cases. The one caveat to this is that too much of both can also be a problem. For this reason it is important to understand the metabolism of both of these hormones and encourage healthy detoxification practices for the body.

DIETARY ADJUSTMENTS AND PHYSICAL EXERCISE

A healthy diet is paramount in the treatment of estrogen dominance. Diets are common place today, yet eating is a subconscious thing… When talking about diet, one needs to consider portions. Calories in and calories out, it is simple math. Exercise needs to be coupled with diet. Cardiovascular training, weights, core, flexibility and balance need to be considered. Statistically, life expectancy increases by two hours for every hour spent doing the proper exercises. Yet it is not all about calories.

Modern ways are usually associated with an acidic diet and an alkaline diet is what is recommended when dealing with hormonal imbalances and estrogen dominance. Understanding the difference between and alkaline diet and acid diet can be challenging, but once you start shifting to an alkaline diet, you will see how good it can be. Under acidic circumstances the body will try to neutralize the acid by withdrawing valuable minerals such as magnesium and calcium from the cells. This leads to mineral depletion that can lead to an array of medical problems.

Studies have shown that the estrogen level fell in women who switched from a typical high-fat, refined-carbohydrate diet to a low-fat, high-fiber, plant-based diet even though they did not adjust their total calorie intake. Plants contain over 5,000 known sterols that have progestogenic effects and therefore, there will be less symptoms of hormonal imbalance. A diet rich in unfermented soy and various cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, bok choy, and Brussels sprouts contain a high level of phyto-estrogen but at the same time have progestogenic and hormone balancing effects. These vegetables are part of an alkaline diet. So on conclusion, a plant-based unprocessed whole-food diet, with at least 15 grams of fiber is recommended. Avoid high-glycemic foods such as refined sugar and refined carbohydrates.

Avoid alcohol or drugs that can damage the liver which will lead to an increase in estrogen due to the lack of estrogen breakdown. Caffeine intake from all sources is linked with higher estrogen levels regardless of age, body mass index (BMI), caloric intake, smoking, and alcohol and cholesterol intake, so Tea or yerbamate can be better in these cases. Coffee is highly acidic. In a recent clinical trial 500 women between the ages of 36 to 45 were studied. Those who consumed at least 500 mg of caffeine daily, the equivalent of four or five cups of coffee had nearly 70% more estrogen in the beginning of their cycle when compared to women who consumed less than 100 mg of caffeine daily. . Excessive chronic coffee intake is associated also with adrenal fatigue and reduced progesterone production.

Maintaining a healthy body weight is important to avoid and treat estrogen dominance. Half of the adults in America are overweight. In the fat cells there is an enzyme called AROMATASE. This enzyme helps produce estrone locally within fat cells. When a person is overweight, aromatase is busy at work producing ESTRONE, the most potent estrogen. This in turn makes the brain think there is plenty of it, and for this reason sends a message to the ovaries to slow production of ALL HORMONES, and tis includes the reduction in the production of progesterone. This causes the estrogen dominance. Obesity is also associated with higher testosterone levels, and higher amounts of free radicals that cause inflammation and increased risk for cancer, and in this case, higher risk for breast cancer.

DETOXIFICATION

The goal here is to try to improve the clearance and the metabolism of estrogen. The body gets rid of excess estrogen via the liver detoxification pathway. This pathway has two components: Phase 1 and Phase 2.

The Phase 1 Detoxification Pathway

In the liver, Phase 1 detoxification uses enzymes to help convert toxins into metabolites through a series of chemical reactions (such as oxidation, reduction and hydrolysis). One pathway involves the Cytochrome P-450 enzyme. This phase makes substances such as pesticides, alcohol and several medications become water soluble. Once water soluble the body can excrete them more efficiently via the gastrointestinal system, sweat and urine after going through the Phase 2 detoxification pathway. In order to enhance Phase 1 detoxification pathway and prevent free radical overload, a wide variety of anti-oxidants including ascorbic acid, lipoic acid, grape seed extract, quercetin, and N-acetyl-cysteine is needed by the body.

The Phase 2 Detoxification Pathway

In the liver, Phase two detoxification is about a process called conjugation. The liver adds another substance such as cysteine, glutathione, glucuronide, sulphur or a glycine molecule to estrogen, the toxic drug or chemical which is being eliminated. Once conjugated, the metabolite compound, whether it is toxic or not, is neutralized. This renders it less harmful to the body. In Phase 2, drugs, toxins, and hormones are converted into execretable substances that are in turn removed from the body via watery fluids such as bile or urine. Studies have shown that calcium d-glucurate, a natural ingredient found in certain vegetables and fruits can increase the elimination of toxins from the liver. In addition, methionine, folic acid, Taurine, and N-acetyl-cysteine are very useful synergistic nutrients that will help this pathway.

THE CLEARANCE OF ESTROGEN

Estradiol (E2) is the principal and most active estrogen circulating inside our body, and its breakdown, like many other steroidal hormones, occurs in the liver. In normal circumstances, estradiol (E2) has a half-life of about 3 hours. There are multiple pathways that convert E2 to metabolites that have widely different biological activities. Estrone (E1) is the second most potent estrogen in circulation. It is easily converted back and forth from estradiol through enzymatic reactions. Both estrone and estradiol are metabolized by a process called hydroxylation. Estriol (E3) is a weaker estrogen and a consequence of hydroxylation of both estrone and estradiol at the liver. It is them conjugated and excreted in the urine.

All of the three major estrogens and their metabolites possess estrogenic properties in varying degrees, and are all part of the estrogen family. The degree of production of estrogen is tightly related to the degree of clearance and removal of estrogen in the body. While the production of estrogen is going on, a similar amount of estrogens should be removed from the body. This ongoing production and destruction process results in a constant balance of estradiol in our body.

By products of the breakdown of estrogen are also called metabolites. Some metabolites have good effects and are potent antioxidants while some are toxic to the body, and generate free radicals which can in turn promote mutations and cancer cells to develop.

Examples of good metabolites include 2-(OH)-estrone and 2-(OH)-estradiol. These are considered good estrogen metabolites. These metabolites are usually low in women who are overweight and have a high animal fat, acid diet. The goal is to increase these. They are powerful anti-oxidants and can protect the heart and lower bad cholesterol (LDL) while at the same time elevates the good cholesterol (HDL).

Examples of toxic metabolites of estrogen are 16 alpha-(OH) estrone and 4-(OH)-estrone. These are "bad" estrogen metabolites and are toxic. Sixteen alpha estrone has been shown to be more potent than estradiol. It can have a powerful long lasting effect on the estrogen receptor and it causes for cell changes and mutations. For this reason it is thought that it increases the risk of breast cancer significantly. Four-(OH)-estrone is a free radical generator and has been implicated in some of the bad effects of estrogen in clotting as well as in breast cancer. This is a field of active clinical investigation right now.

The ideal ratio of 2-(OH)-estrone to 16-alpha-(OH)-estrone as measured in the urine is 2.0 or more. Studies have shown that 73% of breast cancer patients have a ratio below 2.0. In other words, their 16-alpha- (OH) estrone level is high compared to the 2-(OH)-estrone. Women with such low ratios have been shown to have a 30% greater chance of developing breast cancer compared to those with higher ratios. Fortunately both levels can be measured in the urine.

In summary it is important to consider both the production and source of estrogen as well as how the body breaks it down. The liver needs to be cared for, and substances that will promote healthy liver detoxification and especially healthy pathways of estrogen clearance towards the healthier versions are necessary when considering estrogen dominance.

REDUCE THE ENVIRONMENTAL ESTROGEN (XENOESTROGEN) LOAD

Reducing the external estrogen load is a key component that everyone should follow. Start with your home with the following:

1. Be aware of pesticides, herbicides, and fungicides and consider alternative organic ones

2. Consider organic cosmetics, and reduce or throw away cosmetics that have toxic ingredients

3. Be aware of the chemicals in nail polishes and nail polish removers

4. Try to use organic soaps and toothpaste

5. Avoid synthetic soaps and fabric softeners as they puts petrochemicals right on your skin

6. Consider naturally based perfumes

7. Have a good water filter for your source of water

8. Avoid too much plastic goods and be aware of their influence on your body try not to microwave food in plastic containers, and especially avoid the use of plastic wrap in the microwave

9. Try to use certified organic based whole foods and wash your food well to rid the pesticides

10. If there is a new carpet, allow for plenty of ventilation in your home

11. Avoid excess alcohol

12. Quit smoking

STRESS REDUCTION AND ADRENAL HEALTH

Excess stress makes the adrenal gland constantly work producing adrenaline, cortisone and cortisol. Chronic stress can lead to a condition that has been called adrenal fatigue. This is not always recognized by the traditional medical community, yet I consider it a good name when there is excess stress and the body is pushed to the limit. This is common in today’s fast paced world. Adrenal stress or adrenal fatigue can cause progesterone depletion and thus estrogen dominance. Managing physical and psychological stress is key in treating and avoiding estrogen dominance. I have written some blogs in stress and will discuss adrenal fatigue in more detail in the future.

ESTROGEN DOMINANCE AND THYROID HEALTH

It is no surprise that thyroid disease is more common in women who have excess estrogen and in women when they are having at hormonal changes such as in puberty, child bearing age, imbalanced hormones, PCOS, pregnancy, delivery and menopause.

Geographic differences in the rates of breast, endometrial, and ovarian cancer show that these cancers are more frequent in areas where iodine intake is low. Low iodine intake and low circulating iodine may stimulate the brain to send more messages to the ovaries to work. This in turn may cause estrogen to be secreted at high levels, particularly estrone. This may be an explanation for the higher rate of estrogen dependent cancers. Increasing dietary iodine intake may reduce the risk of these cancers. On another note, estrogen receptors become more sensitive when iodine is low. On the other hand, excess estrogen inhibits iodine absorption. Low Iodine can cause a relative state of hypothyroidism that causes thyroid gland to enlarge and in some cases, the labs can still be normal. For these reasons iodine supplementation is very important in women’s health. It may balance estrogen production and metabolism, and in turn aid the thyroid to function better. The recommended dose varies based on the patient, yet it is on average 150-300 mg iodine per day.

NUTRITIONAL SUPPLEMENTS

Nutritional supplements are essential to ensure your body has the micro and macro nutrients it needs to make and balance hormones appropriately. Many of these nutrients will help balance estrogen. I have chose these, but I am sure there are many more that could be used at any given time depending on the patient, her complaints, and the desired outcome. Here are some nutritional supplements that I recommend when considering estrogen dominance.
1. Fish Oil

2. Vitamins
     a. Vitamin A
     b. Vitamin C
     c. Vitamin E
     d. Vitamin B12
     e. Vitamin B6
     f. Vitamin B1- Thiamine

3. Minerals
    a. Magnesium
    b. Iodine
    c. Zinc

4. Aminoacids
    a. Methionine
    b. SAMe
    c. Taurine
    d. N-acetyl-cysteine (NAC)

5. Herbs
    a. Milk Thistle
    b. DIM: Diindolylmethane
    c. Quercetin
    d. Grape Seed Extract

6. Other
    a. Calcium-d-glucarate
    b. Alpha- Lipoic Acid

In our next blog we will go over these supplements in full detail. We did this to avoid the blog from getting too long… Stay tuned….

Margarita Ochoa-Maya, MD
www.AdvancedHealthNH.com
www.FreedomToHeal.org

WHAT IS ESTROGEN DOMINANCE? THE ROLE OF PROGESTERONE IN WOMEN

2012-08-25T21:13:00.000-04:00

WHAT IS ESTROGEN DOMINANCE? THE ROLE OF PROGESTERONE IN WOMEN

Our body normally functions in perfect homeostasis. This means BALANCE. When things are off balance…. Well…. A problem ensues….

Balance is needed everywhere… Humankind needs balance between our spiritual life, our way we relate to our outside world, our inner conversations and in our daily living. Balance is also necessary within our body, and when it comes to hormones, balance is key. In the human body, it is common to see that one hormone is balanced with the effect of another hormone. For example insulin is balanced by the hormone glucagon. When it comes to women’s hormones, estrogen is balanced by progesterone. The effects of one hormone offset the effects of the other and together they are maintained in optimal balance in our body at all times. Too much of one hormone or the other can lead to significant medical problems.

Estrogen in our body actually is not a single hormone but a trio of hormones working together. The three components of estrogen are: estrone (E1), estradiol (E2), and estriol (E3). In addition, there are at least 24 other identified types of estrogen produced in the woman's body, and more will be discovered. In healthy young women, the typical mix approximates 15/15/70% respectively. This is the combination worked out by Mother Nature as optimum for human females. Today, we use the word estrogen loosely to include also a family of hormones, including animal estrogens, synthetic estrogens, phytoestrogens (plant estrogens), and xenoestrogens (environmental estrogens, usually from toxins such as pesticides).

As I said earlier, estrogen is a hormone that is pro-growth. Since too much of anything is generally not good, the body has another hormone to offset and counterbalance the effects of estrogen. It is called progesterone.

PROGESTERONE

Progesterone was discovered in 1933. That is just 79 years ago. It was not until the 1940’s that it was then produced in a laboratory from yams. But it was not until 1971, when Professor W.S Johnson was able to reproduce the exact formula for progesterone. This is only 41 years ago….

As its name implies, progesterone is a hormone that is pro-gestation. Without a proper amount of progesterone, there can be no successful pregnancy. One of the main roles of progesterone is to favor the growth and well-being of the fetus. When it comes to estrogen, progesterone protects against the "growth effect" of estrogen and balances this growth with maturation and nourishment. When progesterone is at its highest during the second half of the menstrual cycle, further ovulation is prevented from taking place and the cervix and vagina secrete a thick mucus that is hostile to sperm is produced that prevents its passage into the womb.

Progesterone is made in several places of the body: the ovaries, and the adrenal glands. It is stored in the fat cells. Pregnenolone is the mother hormone and this one comes from plain and simple: cholesterol. It is made right after ovulation in high quantities day 14 through 22 of the cycle. It is produced from the remnant called the corpus luteum. These cells were the ones harboring the egg. So now you can understand how important it is for maintaining pregnancy. When ovulation occurs, and the egg happens to get fertilized, progesterone produced by the corpus luteum in the ovary helps maintain the egg and sperm unit alive until the placenta is formed. Around the 8th week of pregnancy all the progesterone is produced in the placenta. After this, the placenta is the main source of progesterone. If fertilization does not take place, under normal conditions the secretion of progesterone decreases and menstruation occurs 12 to 14 days later.

About 20-25 mg of progesterone is produced per day during a woman's monthly cycle. Up to 300-400 mg are produced daily during pregnancy. Of note, if not enough progesterone is produced, there is usually high risk of infertility and miscarriage.

THE PROGESTERONE EFFECT

In simple terms, progesterone acts as an antagonist to estrogen, yet it is very important to note that both hormones are necessary for optimum function. As it is common for hormones, there is a progesterone receptor in the cells.

These are some effects of progesterone:

1. It helps maintain the egg and sperm together and alive until the placenta is formed

2. Makes the inner lining of the uterus mature and rich of nutrients in case of pregnancy

3. It matures the inner lining of the uterus which then falls out in case of no pregnancy

4. It prevents the overgrowth of the inner lining of the uterus

5. It protects the uterus from endometrial cancer

6. Protects against breast cysts

7. Protects against breast cancer

8. It blocks the effect of aldosterone a hormone responsible for water and salt retention

9. It is a natural diuretic It promotes urination and diuresis

10. It lowers blood pressure

11. It helps the sperm move and migrate towards the egg

12. It increases core temperature during ovulation

13. At the cervix it makes a thick mucus that is hostile to sperm several days after ovulation

14. It impairs the entrance of sperm several days after ovulation

15. It inhibits lactation during pregnancy

16. It slows down gut motility

17. It reduces gallbladder activity

18. It may affect gum health, increasing risk of gingivitis (gum inflammation) and tooth decay

19. When progesterone drops in pregnancy it induces labor

20. When progesterone drops during the cycle and no pregnancy it induces menstruation

21. Increases metabolism and the burning of fat

22. It decreases immune reactions and works to reduce inflammation

23. It allows for smooth muscle in the lungs to relax and improve airway function

24. It improves memory and cognitive ability

25. It supports the normal development of neurons in the brain

26. It is implicated in brain protection

27. It is associated with improved memory and cognitive function

28. When progesterone is low it is implicated in premature aging

29. When progesterone is low it is associated with insomnia, anxiety, agitation

30. It is associated with magnesium and zinc metabolism

31. It is associated with Vitamin D levels and together are not just additive, but synergistic

IT IS ALL ABOUT BALANCE: THE YIN AND THE YANG

In Chinese philosophy “yin and yang" literally means "shadow and light". It is used to describe how polar opposites or seemingly contrary forces are interconnected and interdependent. They give rise to each other in their relationship. Yin and yang could appear as opposing forces yet it is necessary to view them as complementary forces that interact to form a greater whole as part of a dynamic system. When talking about hormones and in this case, estrogen and progesterone, it is like the yin and the yang.

Overtime, estrogen and progesterone decline gradually, but there are great differences in the rate of decline of each one. From age 35 to 50, there is a 75% reduction in production of progesterone in the body. Estrogen, during the same period, only declines about 35%. With the gradual drop in estrogen but severe drop in progesterone, there is insufficient progesterone to counteract the amount of estrogen in our body. By menopause, the total amount of progesterone made is extremely low, while estrogen is still present in the body at about half its pre-menopausal level.

For women, what this really means is that some women in their mid-thirties, most women during peri-menopause (mid-forties), and essentially all women during menopause (age 50 and beyond) have an imbalance and possibly an overload of estrogen. It is not the absolute deficiency of estrogen or progesterone but rather the relative ‘dominance’ of estrogen and relative ‘deficiency’ of progesterone that causes the health problems. This state is called estrogen dominance. The key to hormonal balance is the modulation of progesterone to estrogen ratio.

A CLOSER LOOK AT ESTROGEN DOMINANCE

In women, a large part of the hormonal balance is controlled by three major endocrine glands: the adrenal gland, the thyroid gland, and the ovaries. This also means that when there is an imbalance in one, there is probably an imbalance on the other. Maintaining a proper balance among these three glands is of critical importance when dealing with the estrogen dominance syndrome. For example, excessive estrogen affects both thyroid and adrenal function, and in turn, dysfunctional thyroid and adrenal fatigue makes estrogen dominance worse. Unfortunately, conventional medicine, treating mostly symptoms, almost always will miss the root cause. This leads to poly-pharmacy, excessive prescription of antidepressants and sleeping pills and patients can even get worse not better. As a result any attempt to treat the imbalance of one gland without paying attention to the others will likely result in treatment failure and discouragement on both the physician and the patient.

COMMON CONDITIONS ASSOCIATED WITH ESTROGEN DOMINANCE

Estrogen dominance can be the root cause of a myriad of illnesses. Here is a brief list of the common medical problems associated with women who have estrogen dominance:

1. Endometriosis

2. Premenstrual Syndrome (PMS)

3. Premenstrual Dysphoric Disorder (PMDD)

4. Polycystic Ovary Syndrome (PCOS)

5. Infertility

6. Fibrocystic Breast Disease

7. Uterine Fibroids

8. Endometrial polyps

9. Urinary Frequency, irritable bladder, and interstitial cystitis

10. Depression, Anxiety and mood disorders

11. Insomnia

12. Autoimmune disorders

13. Low blood sugar and insulin metabolism problems

14. Hypertension

15. Breast Cancer

WHAT CAUSES ESTROGEN DOMINANCE?

As we discussed, estrogen dominance is the result of excessive estrogen and a relative progesterone deficiency. It affects about one out of two women in the Western Hemisphere. In order to understand this condition first one must look what makes a woman be more at risk for this imbalance, and what the possible explanations and causes are. Once we can establish this we can then attempt to look at possible interventions to promote balance and reduce estrogen while promoting healthy progesterone levels.

Excess Estrogens

Our body normally functions in perfect homeostasis, yet in present time, women are exposed to other estrogens in addition to their own. With the advent of industrialization our body has been subjected to unprecedented insults from environmental estrogen-like hormones. These are also called xenoestrogens, xeno- a prefix that means foreign. These estrogen-like hormones have a very long half-life, and cause a great deal of disruption. For this reason, they are also called “endocrine disruptors”. These include animal estrogens, synthetic estrogens, phytoestrogens (plant estrogens), and environmental estrogens, usually from toxins such as pesticides.

AS part of the industrialization process, over the last 100 years, there has been a change from a diet rich in whole fruits and whole food to fast and processed food. Livestock is now growing confined in cages most of the time and routinely being fed with poor quality food laced with pesticides. They are also being routinely treated with hormones, antibiotics and growth hormones all of which have estrogen-like activities. These are then passed on to humans.

Decreased Metabolism

On the other hand, there is a decrease in the metabolism of estrogen in the body with time. The breakdown of estrogen estrogens occurs in several areas of the body; however the main ones are liver and gastrointestinal tissues. Half of the clearance of estrogen happens in the liver. For this reason toxicity at the liver level significantly affects total circulating levels of estrogen.

The major pathway of estrogen clearance is from estradiol to estrone. Estrone is metabolized further to 2-hydroxyestrone or 16alfa-hydroxyestrone. Finally, 16alfa-hydroxyestrone can be further metabolized into estriol the weakest form of estrogen. The conjugated forms of estrogen are water-soluble and do not bind to transport proteins. Therefore the conjugated forms of estrogen are readily excreted via bile, feces and urine. When the liver is toxic, there is an accumulation of estrone in the body.

Another way estrogen is metabolized and broken down is through the gastrointestinal system. Approximately 50% of the estrogen byproducts pass from the liver and bile into the intestine, and are then further broken down by intestinal bacteria. This is where it is important to have good bacterial balance and the use of a good probiotic is essential for estrogen metabolism.

In summary the most common related causes of estrogen dominance today include:

1. Commercially raised cattle and poultry

2. Commercially grown fruits and vegetables containing pesticides, herbicides, fungicides, and other biocides

3. Petrochemical compounds found in creams, lotions, soaps, shampoos, perfume, hair spray and room deodorizers. They are also found in

4. Industrial solvents enter the body through the skin such as nail polish, paint removers, glues, paints, varnishes, cleaning products, dry-cleaning chemicals and indoor insect sprays as well as garden sprays

5. Practically all plastics, industrial waste such as PCBs and dioxins, synthetic carpets, fiberboard,

6. Car exhaust

7. Hormone Replacement Therapy and Synthetic estrogens from urine of women taking HRT and birth control pills that is flushed down the toilet and eventually found its way into the food chain and back into the body. They are fat soluble and non-biodegradable.

8. Unopposed Estrogen as part of treatment of menopause in women without a uterus.

9. Over-production of the woman’s own estrogen by ovarian cysts and some ovarian tumors

10. Biological and psychological stress causing adrenal gland exhaustion

11. Obesity: Fat tissue is an endocrine organ, it has the ability to convert adrenal steroids to estrogen.

12. A high saturated fat acidic diet, full of fast and processed food low in fiber, high in refined carbohydrate as well as animal protein can cause estrogen dominance and magnesium depletion. Plants have over 5,000 known sterols that have progestogenic effects.

13. Liver diseases, high alcohol consumption, and over medication interfere with the metabolism of estrogen and may even contribute to a higher level of estrogen.

14. Micronutrient deficiencies of iodine, magnesium, and B vitamins that are necessary for the neutralization and detoxification of estrogen in the liver

15. Increased coffee and caffeinated beverages consumption has been associated with increased estrogen levels regardless of age, body mass index (BMI), caloric intake, smoking, alcohol, and cholesterol intake.

In our next blog, I will talk about treatment options for excess estrogen and imbalance between estrogen and progesterone.

Have an awesome weekend,

Margarita Ochoa-Maya, MD
www.AdvancedHealthNH.com
www.FreedomToHeal.org

DO YOU HAVE ESTROGEN DOMINANCE?

2012-08-25T17:08:00.000-04:00

DO YOU HAVE ESTROGEN DOMINANCE?

Being a woman in the 21st century is certainly a high risk profession In the past 40 years, there has been a dramatic increase in female-related illnesses. It it not because we complain more….

It has become a problem so vast that it has never seen before in history. There are reasons for this.

Today, we see the age of puberty (menarche) is dropping precipitously. It is now ‘normal’ to start menstruating at an age as low 10 years of age. Premenstrual Syndrome (PMS) afflicts close to 30% of perimenopausal women. Endometriosis affects approximately 10% of all perimenopausal women. Uterine fibroids affects close to 25 % women between the ages of 35 and 50, and breast cancer is taking a toll on close to 10% of all women. This is causing great dis-ease in women.

In mainstream health, hysterectomies are a norm, misguided hormone replacement is commonplace and can cause more harm than good, and certainly the precipitous rise in breast cancer over the years is indeed ALARMING!!! Fortunately, scientific evidence is mounting that hormone disruption is the key cause of all these seemingly separate but related diseases.

It is the time to pay attention to hormone balance. I invite you to be proactive in your health and once you become informed, share this information with other women. There is a common thread in these diseases, and it is estrogen dominance. It is the relative excess of estrogen and an relative and in some cases absolute deficiency in progesterone that is at the root of the problem.

It is estimated that in the Western Hemisphere, estrogen dominance syndrome can be as common as 50%. That means that out of 10 women, 5 have this problem.

DO YOU HAVE ESTROGEN DOMINANCE?

Please answer with a number value to the question. Assign a value of 10, if you have a severe problem and assign a value of 0 if you don’t have a problem at all. At the end of the Questionnaire, add your results.

1. Do you have chronic fatigue?

2. Do you have bouts of irritability?

3. Do you have frequent mood swings?

4. Do you suffer from depression, anxiety and agitation?

5. Do you suffer from loss and foggy thinking?

6. Have you felt episodes of loss of balance and dizziness?

7. Do you suffer episodes of fear, and apathy?

8. Do you suffer from panic Attacks?

9. Do you suffer from insomnia?

10. Do you suffer from premenstrual syndrome (PMS)?

11. Do you suffer from Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS?

12. Have you ever been told you have fibromyalgia?

13. Do you suffer from frequent menstrual headaches, or menstrual migraines?

14. Do your emotions follow a cyclical pattern?

15. Have you noticed your system following a daily pattern?

16. Have you noticed your system following a monthly pattern?

17. Do you suffer from rapidly growing breasts or dramatic changes in breast size?

18. Do you suffer from breast pain, tenderness?

19. Do you have cysts in your breast or fibrocystic breast disease?

20. Do you have family history of breast cancer?

21. Do you suffer from irregular periods?

22. Do you have a history of long menstrual cycles with a shorter than normal time between cycles?

23. Do you suffer from heavy periods, and large clots?

24. Do you suffer from severe menstrual cramps?

25. Do you suffer from mid-cycle abdominal pain?

26. Do you bleed for most of your menstrual period?

27. Do you have constant or frequent uterine bleeding?

28. Have you ever been told or suspect you have uterine fibroids?

29. Have you ever been told by a physician that the structure of your uterus is abnormal?

30. Have you even been told you have endometriosis?

31. Do you have family history of endometriosis, especially mother or sister?

32. Do you get deathly ill when you have your periods?

33. Do you have nausea, throw up, and or severe pain when you have your periods?

34. Have you ever had an abnormal pap smear or been told you have cervical dysplasia?

35. Are you having a hard time getting pregnant?

36. Have you had problems with infertility?

37. Did you conceive at a late stage of your life?

38. Did you have a hard time breastfeeding?

39. Have you ever breastfed?

40. Do you have family history of uterine cancer?

41. Have you had abnormal weight gain?

42. IS your weight gain mostly around the waist?

43. Do you have difficulty losing weight?

44. Have you noticed your muscles becoming less firm despite the work out?

45. Do you suffer from bloating and water retention?

46. Do you have decreased sexual interest or libido?

47. Do you suffer from thyroid disease / mostly low functioning thyroid?

48. Do you suffer from complaints that seem thyroid related but have normal test?

49. Do you have an autoimmune disease?

50. Do you have family history of autoimmune disease?

51. Do you have family history of Lupus?

52. Do you have hot flashes even if you are not in menopause?

53. Do you suffer from nasal congestion, recurrent respiratory infection?

54. Do you suffer from allergies, including asthma, hives, rash, or sinus congestion?

55. Do you follow a diet high in hydrogenated fat (trans-fat) such as French fries or cookies?

56. Do you have a lot of stress in your life?
...

Now that you have your questions and answers, total your total grade.

IF YOU ANSWERED VALUES THAT TOTAL GREATER THAN 300:

The likelihood that you have estrogen dominance is high. It is recommended that you have a visit with your health care practitioner, and consider a visit with an endocrinologist that specializes in women’s hormones. Hormone testing should be done. A discussion on the different therapeutic approaches, including lifestyle, diet, exercise, sleep, mood, nutraceuticals and even pharmaceuticals should be the main topic of the visit.

IF YOU ANSWERED VALUES THAT TOTAL GREATER THAN 200:

It is possible that you have estrogen dominance. Your case should be reviewed individually and careful considerations should be made regarding your complaints and the root cause of them. Hormone testing should be considered, and the results should be reviewed carefully in the context of your individual health.

IF YOU ANSWERED VALUES THAT TOTAL LESS THAN 200:

The possibility that you may have estrogen dominance still exists. Yet, other problems can also be a cause of your complaints. Review your symptoms and see if there is a pattern to them, and consider discussing them with your health care practitioner. Hormone testing can also be considered, yet other medical issues should also be ruled out.

In our next blogs, we will discuss in greater detail the consequences of estrogen dominance and possible ways to treat estrogen dominance in an integrative way.

From the point of view of an Integrative Endocrinologist, stay tuned for more…. Hope you enjoyed reading….

Margarita Ochoa-Maya, MD

www.AdvancedHealthNH.com
www.FreedomToheal.org

ANOTHER FACE OF HORMONAL IMBALANCE: ESTROGEN DISRUPTION AND DOMINANCE

2012-08-22T12:00:00.001-04:00

ANOTHER FACE OF HORMONAL IMBALANCE: ESTROGEN DISRUPTION AND DOMINANCE

The complex circuits of hormones in the human body are extremely important to the overall functioning of the individual systems, total health and wellbeing. As you well know, hormones are chemical substances that serve as communicators between cells and organs, and serve to help these interact in a healthy way. Usually, hormones have specific landing sites where they are to cause an effect. These landing sites are called receptors. The endocrine system studies hormones and as such it is the study of how the body is communicating within itself.

When thinking in an integrative way, you can consider the inner language you have with yourself, and how you treat yourself. You can also consider how you react to your environment, circumstances and other people including those that are closest to you such as your parents, siblings, and loved ones. It has been well described in the medical literature how hormones can affect your mood, and I know it is no surprise to think about pre-menstrual syndrome (PMS) as a clear example of how hormones in women affect their mood. Yet, you can also think the other way around, how mood could ultimately have an effect on the person’s health. So you can consider hormones like an intricate symphony, where each instrument needs to have a key role in the overall collection of sounds that as a group if working in synchrony can be quite beautiful, and on the contrary, when one is off beat, the whole melody is ruined.

In this new series of blogs, I wish to discuss the importance of each hormone Estrogen, Progesterone and Testosterone individually and what happens when there are imbalances of such. So far I have discussed the excess of androgens, but more recently attention has been also driven to try to understand when a woman has excess estrogen, or not enough of progesterone.

ESTROGENS IN THE FEMALE BODY

Estrogen is produced in the ovaries, and to a much lesser extent in the adrenals. Estrogen receptors are everywhere. Estrogens regulate the menstrual cycle, promote cell division and are largely responsible for the development of secondary female characteristics during puberty, including the growth and development of the breast and pubic hair. Estrogen therefore affects all female sexual organs, including the ovaries, cervix, fallopian tubes, vagina, and breast, but it also has effects on other organs in the body. As a general rule, estrogens promote cell growth. They cause the growth of tissue in the lining of the uterus during the first part of the menstrual cycle and stimulate the maturation of the egg-containing follicle in the ovary. They soften the cervix and produce the right quality of vaginal secretions to lubricate during intercourse and allow the sperm to swim towards the egg.

Estrogens in our body are not actually a single hormone but several hormones working together. The three components of estrogen are: estrone (E1), estradiol (E2), and estriol (E3). In addition, there are at least 24 other identified types of estrogen, and their metabolites being produced in the woman's body, and more are being discovered every day. Of the three main estrogens, 15 percent is estrone, 15 percent is estradiol, and 70 percent is estriol. In non-pregnant, pre-menopausal women, only 100-200 micrograms (mcg) of estrogen are secreted daily. However, during pregnancy, much more estrogen is secreted.

Estrogen exists in high quantities in the brain, breast, uterus, vagina, ovaries, bladder, gut, bones, muscles, heart, blood vessels, and lungs, just to name a few.

In pre-menopausal women some of the most noticeable functions of estrogen include:

1. Brain:
a. Aids in the formation of serotonin, which in turn decreases depression, irritability, anxiety and pain sensitivity
b. Regulates temperature at the hypothalamus
c. Aids in memory, enhances the production of nerve growth factors, helps fine motor skills, increases reasoning by increasing the number of connections between brain cells thus reducing the risk of demetia

2. Breasts:
a. Enhances the growth of breast tissue and proliferation

3. Uterus:
a. Grows the uterine lining

4. Vagina:
a. Maintains the tissues of the vagina moist, and the cells supple and nurtured
b. Decreases the pH of the vagina, and promotes the growth of healthy bacteria (Lactobacillus)

5. Ovaries:
a. Estrogens serve as a feedback loop to maintain rhythm with egg maturation and ovulation

6. Bladder:
a. Estrogen helps bladder tone, and reduce inflammation and irritation and reduces the risk of an overactive bladder

7. Gut:
a. Estrogen balance is necessary for the proper gut motility, secretion of gastric acid, gallbladder function, secretion of digestive enzymes, and the proper balance between good and bad bacteria

8. Bones:
a. Estrogen stimulates the formation of new bone, helps bone density

9. Muscles:
a. Estrogen helps muscle relaxation and recovery time after exercise, and stimulates muscle repair and reduces inflammation and improves insulin sensitivity

10. Heart:
a. Estrogen reduces homocysteine a risk factor for heart disease, and reduces overall risk of heart disease by having a protective effect on the heart
b. Estrogen has an effect on cholesterol:
c. Estrogen reduces bad cholesterol (LDL) and lipoprotein A (risk factor for heart disease) and increases the good cholesterol (HDL)

11. Blood Vessels:
a. Estrogen reduces vascular tone, and blood pressure, inhibits the growth of smooth muscle, keeps arteries open, decreases accumulation of plaque that may occlude blood vessels, helps maintain elasticity of the blood vessels, increases blood flow

12. Lungs:
a. Estrogen helps keep airways open and reduce inflammation and asthma risk

13. Metabolism:
a. Estrogen can cause salt and water retention, promote loss of zinc and retention of copper, improves insulin sensitivity

14. Skin:
a. Increases water content in skin, maintains amount of collagen

15. Eyes:
a. Reduces the risk of cataracts, and macular degeneration

When estrogen gets imbalanced and there is excess estrogen there are many problems that may occur. So, it is not really about a value, but about BALANCE. Too much estrogen, unbalanced with not enough progesterone can be a problem in women’s health. In my next blog I will discuss the effects of progesterone.

In today’s health environment, physicians are seeing a significant increase in female-related illnesses. This comes as no surprise if you do some simple math. The age at which women are reaching puberty is younger and younger. Having the first period at age 10 is now considered normal. Approximately 100 years ago, the average woman started her menses at age 16. There were more pregnancies, and there was more time spent breastfeeding. Today, women start menstruating sooner, therefore increasing the total number of periods a woman can have twofold. Breastfeeding has decreased and the average pregnancy rate per woman is less than 2. This total hormonal effect has its toll on fertility, cancer, fibroids and uterine health, anemia, migraines, mood problems, gut problems, and endometriosis to name a few. Endometriosis is now a disabling disease that affects 10% of women of child bearing age. Premenstrual syndrome is rising and affects nearly 30% of women. Uterine fibroids and fibrocystic breast disease can affect close to 25% of women between the ages of 35 and 50, and last but not least Breast Cancer affects nearly 10% of women and the age at which it is being diagnosed is younger not older.

What is the problem?

HORMONAL IMBALANCE AND HORMONE DISRUPTION.

Stay tuned for our next blog on Estrogen Dominance….

Margarita Ochoa-Maya, MD
www.AdvancedHealthNH.com
www.FreedomToHeal.org

LIFESTYLE TREATMENT, SLEEP, MOOD, SUPPLEMENTS AND PHARMACEUTICALS FOR PCOS

2012-08-10T23:08:00.001-04:00

LIFESTYLE TREATMENT, SLEEP, MOOD, SUPPLEMENTS AND PHARMACEUTICALS FOR PCOS

THE PCOS DIET

PCOS Diet includes a diet that is specific for PCOS. Food influences your hormones. There is a close association with weight and the severity of the symptoms of PCOS. The goal of the diet that is designed for the patient with PCOS, should be to maintain the INSULIN levels at bay! For this reason, it is important to have frequent small meals that are keeping the liver from entering in a sugar producing mode. Whole foods, low in sugar, and simple carbohydrates, as well as low in the glycemic index should be the main component of the diet. Yet, this is not all….. Hydration is of optimal importance in the diet, as a constant stimulation of the kidneys and the elimination of toxins is a healthy way to maintain proper hormone balance, and low levels of the hormone aldosterone. This leads us to the conversation about salt. Women with PCOS are usually slat cravers, and salt can promote water retention and increase blood pressure. The goal is to have less than 1000 mg of sodium per day…. The truth is that it would even be better if a woman could keep salt intake between 500mg and 1000mg of salt per day.

When considering calories, it is a good idea to have your metabolism tested. This can give you an idea of the calories you burn in a basal state, and allow you to calculate the amount of calories you need to consume based on your activity level. But calories are not the end of it all… You need to consider the relationship between carbohydrates, fats and protein. When talking about a diet specialized for a patient with PCOS, the right fats are very important. Saturated fats should be limited, and unsaturated fats, such as the OMEGA oils are extremely beneficial. Lastly, protein is in itself a topic that can be quite controversial. When considering a diet for PCOS, vegetable protein should be the main source. Examples of protein that comes from vegetables include soybeans, peas, kidney beans, lima beans, black-eyed peas, chickpeas, lentils, tofu, quinoa, spirulina, and mushrooms. Eggs are also a good source of protein in a diet designed for a woman with PCOS.

ADDICTION AWARENESS

Weaning you off your addiction to carbohydrates and sugars, slowly enough to avoid withdrawal symptoms is the goal of a successful diet plan in PCOS. The brain circuits that are stimulated by eating high carb foods/sugars are the same circuits that are affected by drugs such as alcohol, cocaine and heroin. That is why dieting is so difficult and willpower is not enough to make a permanent lifestyle change. The goal is to gradually balance the brain reward circuits so that, in time,your diet and exercise plan will stimulates dopamine, endorphin and serotonin circuits and will become your primary hormonal source of pleasure and contentment.

THE PCOS EXERCISE PLAN

An exercise plan that is designed for a woman with PCOS should acknowledge that when a woman has increased androgens, she will increase her muscle mass. The goal for the plan is to improve circulation, stimulate muscle action and metabolism through activation of the mitochondria, and improve insulin resistance. It is also a fact that exercise releases feel good hormones such as endorphins that cause a generalized sense of wellbeing and improve self-esteem and mood overall.

The PCOS exercise plan should consider cool exercises as well as hot exercises. For example, an exercise routine that focuses on the core muscles, balance and stretching is important. Examples of these could include water based exercises, which proved a great cardiovascular training, but also offer resistance to the muscle to ‘wake it up’. Pilates is also a great work out for a woman with PCOS. Weights alone may appear as not effective, but quite contrary are very effective, it is all in how we look at things. Weights alone bulk the muscle, and therefore may be even associated with an increase in weight initially, as you can imagine a cup of muscle will weigh more than a cup of fat. Weights done in a cardiovascular way, meaning lesser weights, and increased speed and repetitions, may promote weight loss, improvement in the fat to muscle ratio, decrease water retentions and stimulate the metabolism for better muscle energy use.

SLEEP AND PCOS

Women with PCOS have significant trouble getting to sleep and more importantly staying asleep. Not only does hormonal imbalance cause insomnia, but it also fragments sleep, and does not allow for continuous sleep which then goes through the necessary stages that allow for resetting of the internal clock (Circadian rhythm) and stimulating metabolism. When there is decreased sleep and fragmented sleep due to hormonal imbalances, further problems occur. Women with PCOS also have weight problems that may lead to sleep apnea. This in itself is a problem. PCOS is also associated with restless leg syndrome, and women who have PCOS are 2-3 x more likely to have this problem.

Lastly, it is not known which is first, sleeping disorders that cause PCOS or PCOS causing sleeping disorders. According to a study published in the Annals of Internal Medicine, subjects who were allowed only 4 hours of sleep for 2 consecutive nights showed an 18% reduction in leptin and 28% increase in ghrelin. Leptin is a hormone which alerts our brain when we are full or sated. Ghrelin triggers the hunger response. Therefore, lack of sleep can actually make you crave more food, and subconsciously make you consume more calories. This in turn can contribute to weight gain. Another study also showed lack of sleep causes altered glucose metabolism, including a decreased glucose tolerance as well as a decreased response to insulin. This could potentially lead to insulin resistance, metabolic syndrome or PCOS. So when it comes to sleep and PCOS, it is best to make sure you clock in your zzz’s.

MOOD AND PCOS

Hormonal changes are a known cause of emotional symptoms. It is a known fact, and it does not take a doctor or volumes of research to conclude that hormonal variations are associated with mood changes in women. There are even jokes about this topic, yet it is quite sad to see how mainstream healthcare does not make the connection between mood and PCOS. Some women have debilitating mental health issues that get almost literally cured once the hormonal imbalances are addressed. The truth is that women with PCOS are far more likely than women without PCOS to have mood and anxiety symptoms; and seven times more likely to attempt suicide in their lifetime.

PCOS is associated with mood disorders including depression and bipolar disorder and treating PCOS can be a more effective treatment for depression than antidepressants. Obviously, mood disorders can have other causes. Whatever the cause, treatment should be individualized, but keeping an open mind and considering hormonal imbalances in women with mental illness is a must when properly taking care of women’s health and wellbeing.

What is the association? Elevated testosterone levels, elevated luteinizing hormone, insulin resistance and increased inflammation are the connection. Elevated testosterone and luteinizing hormone have been associated with anger and rage, insulin resistance is associated with elevated blood sugars that may cause mental fogginess, and trigger insulin release to a point that causes low blood sugar, causing anxiety, and panic attacks. Chronic inflammation is associated with generalized body pain and fatigue which can be in itself causes for mood problems.

Self-esteem and low confidence can be associated with the symptoms of PCOS such as acne, excessive facial hair, scalp hair loss and obesity as modern times call for very stereotypical definitions of beauty. Infertility and miscarriages also can be very stressful. The goal is to help women find beauty in themselves, and have love and compassion towards themselves and the circumstances that surround them at any given time.

Lastly, it is important to note that some medications used for mood disorders, can in their own, cause hormonal imbalances and PCOS. Antidepressants and mood stabilizers have been associated with increase in body weight, insulin resistance and hormonal imbalances that mimic PCOS. So keep a watch for this as well.

NUTRACEUTICALS, VITAMINS, MINERALS, HERBS, AND OTHER SUPPLEMENTS AND PCOS

When a woman has PCOS there are complementary treatments that can be used and I actually recommend reviewing this section and encourage further reading if you are interested. They are useful when used in combination with lifestyle and possibly other pharmaceuticals if needed.

The goals of the treatment are to decrease circulating testosterone levels and increase sex hormone-binding globulin, which in turn decrease free-floating testosterone and estrone. This will promote menstrual regularity, support healthy hair growth and healthy skin and at the same time supports liver function and detoxification pathways. Treatment should also be geared to help naturally change the interaction of individual cell membranes with insulin, increase the insulin sensitivity of your cells so in turn allow cells to accept glucose more efficiently and help maintain healthy blood glucose levels.

Herbs and vitamins and minerals promote antioxidant activity that supports the vessels of the cardiovascular system as well as cellular vitality and minimize free-radical damage and benefit immune function. In women with PCOS, the interior lining of blood vessels are damaged when insulin levels are elevated and this damage contributes to the formation of Cardiovascular Disease, elevated blood pressure and diabetes.

Using substances that are high in natural fiber can help regulate the absorption of glucose into the bloodstream while helping to maintain healthy cholesterol, triglycerides, blood pressure, and insulin levels.

Here is a list of common nutraceuticals used in the treatment of PCOS:

(Please note that I am in no way recommending these, but encouraging you to read more and consult with your care provider, doctor and naturopath to select the combination that is right for you)

1. Saw Palmetto (berries) - a 5-alpha reductase inhibitor impedes testosterone conversion and reduces circulating testosterone (androgens)

2. Chaste tree berry (Vitex Agnus Castus) - Promotes menstrual regularity, supports luteal phase of menstrual cycle and addresses elevated prolactin

3. Stinging Nettle (root) - Increases sex hormone-binding globulin

4. Flax Seed - Supports estrogen metabolism, which increases the production of protective estrogen metabolites and increases sex hormone-binding globulin

5. Milk Thistle extract (seed) - Supports liver function

6. Vanadyl Sulfate - Maintains healthy blood glucose and cholesterol levels, increases insulin sensitivity, improves glucose tolerance and metabolism, decreases body fat and reduces appetite naturally

7. Chromium (Citrate) - Supports insulin binding to cells and maintains healthy cholesterol and insulin levels, and it also boosts insulin response to glucose

8. Alpha Lipoic Acid - Increases insulin sensitivity and maintains healthy glucose levels, provides antioxidant activity, scavenges free radicals, supports glucose transport and extends the functional capacity of Vitamin C, Vitamin E and CoQ10

9. Magnesium (Citrate) - Positively affects insulin secretion/action and improves cholesterol profile (Lower than normal levels of magnesium are associated with insulin resistance, glucose intolerance and hyperinsulinemia.)

10. Zinc Citrate - Lowers insulin concentration and improves insulin sensitivity

11. L-Carnitine (Tartrate) - Improves insulin sensitivity.

12. Copper (Citrate) - Balances zinc and supports its ability to lower insulin concentration

13. Calcium (Citrate) - Reduces fasting insulin levels, increases insulin sensitivity and regulates fat tissue.

14. Biotin - Involved in the manufacture and release of insulin; a cofactor required for the synthesis and oxidation of fatty acids

15. Manganese (Citrate) - Reverses glucose intolerance

16. Pancreatic Tissue (procine) - Provides nutritional support for the pancreas

17. Adrenal Tissue (bovine) - provides nutritional support for the adrenals

18. Vegetarian Digestive Enzyme Blend - Supports nutrient absorption and digestion

19. Vitamin C from calcium ascorbate - promotes glucose regulation, improves glucose tolerance and scavenges free radicals

20. CoQ10 (Ubiquinone) - Maintains healthy glucose and insulin levels and promotes carbohydrate metabolism as well as helps the use of glucose in the peripheral tissues.

21. Vitamin B12 (Cyanocobalamin) - Supports healthy nerve function, and reduces sorbitol accumulation, muscle weakness and tingling and promotes brain function and improves energy and metabolism fostering weight loss

22. Folic Acid - Ensures sufficient folate status to aid in the support of a healthy cardiovascular system

23. Quercetin - Antioxidant to inhibit free radical production. Reduces intracellular accumulation of sorbitol that is implicated in adverse impacts on eye health

24. Bilberry Extract - Improves microcirculation and protects the very small vessels of the eyes and kidneys

25. Grape Seed Extract - Reduces free radicals and supports healthy blood vessels

26. Thiamin - May help convert carbohydrates into energy and is important for the function of the heart, muscles, and the nervous system

27. Vitamin D - Vitamin D plays an important role in bone health, immunity and wound healing, mood, and cancer prevention. It may also affect insulin secretion and glucose tolerance

28. Cinnamon Extract - helps maintain healthy blood sugar levels

29. Guar Gum - Helps maintain healthy cholesterol, triglycerides and blood pressure, and supports insulin sensitivity.

30. Apple Pectin & Beet Powder - Slow the absorption of glucose into the bloodstream, which reduces insulin response.

31. Fenugreek - Reduces the effect of carbohydrates following a meal, and helps maintain healthy cholesterol levels, and promotes insulin response and glucose tolerance

32. Milk Thistle - Helps maintain healthy blood sugar and insulin levels and supports the liver

PHARMACEUTICALS AND PCOS

Your health care provider may also consider pharmaceuticals in the comprehensive approach life plan for treating PCOS.

The most common pharmaceuticals that doctors who treat PCOS recommend are:

1. Birth control pills: Please understand that not all birth control pills are the same. Some amy even make PCOS worse. What is important to consider, is that your internal hormone production may be even more erratic and imbalanced than any other hormone that you may put in your body from the outside (exogenous hormones). The main goal of the birth control pills are to make the periods regular, and hopefully through the use of a progestin that blocks androgens, treat acne and even help moods. The birth control pills that I recommend are Yasmin, Safyral, Yaz, Beyaz and Natazia. Other methods of birth control such as the Nuva Ring may even help when there is constant abnormal irregular bleeding. It is important to note that birth control pills are exogenous hormones, and when the body is exposed to hormones that are not their own, there may be a problem with your own clotting. This is an important consideration and should be discussed with your doctor. Keep in mind, clotting is associated with hormonal imbalances already to begin with.

2. Metformin also called Glucophage: This medication is special…. It has been around for many years now, and it has many uses…. When used in PCOS, it can help regularize your periods, prevent gestational diabetes and type 2 diabetes, and help weight loss when you follow a healthy diet

3. Depending on the goal of treatment, LH-releasing hormone (LHRH) analogs and Clomiphene citrate, may be used to help the ovaries grow and release eggs. This would be in the case of treatment for women whose goal is to conceive.

ADDITIONAL TREATMENTS FOR PCOS

Additional treatments that are used for women with PCOS include treatments meant to address the consequences of PCOS such as the acne and the facial hair.

1. Spironolactone is a mild diuretic that not only helps fluid retention, but also helps block the conversion of testosterone in the peripheral tissues and thus reduce the effects androgens have on the skin and hair.

2. Eflornithine cream also known as Vaniqa. It is a drug found to be effective in the treatment of facial hirsutism. It is used topically topical administration in women suffering from facial hirsutism

Permanent hair removal options include:

1. Electrolysis

2. Laser hair removal - works best on very dark hair that covers large areas

A pelvic laparoscopy may be done to remove to remove or alter an ovary to treat infertility.

EXPECTATIONS AND PROGNOSIS

With treatment, women with PCOS are usually able to ACHIEVE their goals. These may include weight loss, acne control, hair restoration, pregnancy, mood improvement and so on. When looking at the future, the woman with PCOS is at higher risk of high blood pressure and gestational diabetes during pregnancy and chronic issues with obesity, arthritis, elevated cholesterol diabetes type 2 and issues with menopause.

COMPLICATIONS

Women with PCOS are more likely to develop other problems in their lifetime. These include:

1. Endometrial cancer

2. Infertility

3. Breast cancer

There are other complications that happen, but these are individualized, and develop as women proceed in their journey with PCOS throughout their lives....

My best advice is to associate yourself with the best doctors, food counselors, exercise coaches, and counselors to tackle this problem from all the possible directions you can at any given time, considering your limitations and disposition.... Take every day as a new one, and try really hard to have a wonderful day every day, full of joy, compassion and love for yourself and appreciate every effort you put forth to help yourself be better, healthier, and happier every day knowing that every day you will learn something new, not just about the world around you,but the world inside you, your spirit and your soul....

Dr. Margarita Ochoa-Maya
Endocrinology and Metabolism
Women's Health

www.AdvancedHealthNH.com
www.FreedomToHeal.org

TREATMENT CONSIDERATIONS WHEN A WOMAN HAS POSSIBLE PCOS AND HORMONAL IMBALANCE

2012-08-10T22:09:00.005-04:00

TREATMENT CONSIDERATIONS WHEN A WOMAN HAS POSSIBLE PCOS AND HORMONAL IMBALANCE

It is important to recognize that polycystic ovarian syndrome is a ‘syndrome’. In medicine and psychology a syndrome is defined as the association of several clinically recognizable features:

1. Signs of the problem: these are usually observed by someone other than the patient

2. Symptoms of the problem: these are usually reported by the patient

3. When both signs and symptoms occur together, the presence of one or more of these features alerts the doctor to the possible presence of the others and so forth.

When describing a ‘syndrome’, this usually includes a number of essential characteristics, which when they present together usually lead to the diagnosis of the condition. Frequently these are classified as a combination of typical major symptoms and signs—essential to the diagnosis—together with minor findings, some or all of which may be absent.

In Polycystic Ovarian Syndrome, the signs and symptoms can vary from person to person, depending on their lifestyle, ethnicity and even degree of stress level they are experiencing. Polycystic ovarian syndrome is indeed a problem that affects almost every aspect of the human being, including the biology of the individual systems of the body, the psychology of the person, their self-esteem and emotional intelligence and ability to balance even the slightest stressors and the relationship the person has with themselves.

For example, PCOS well established major and minor findings typical of the syndrome but there may be other signs and symptoms that may be associated with other conditions such as thyroid disease, adrenal disease among others. Also, it is important to know that specifically when dealing with PCOS, these associated conditions occur more frequently than would be expected by chance. Unfortunately, while the syndrome and the associated conditions may be statistically related, they do not have a clear cause and effect relationship. A clear example of this is the association of thyroid disease and PCOS. There is likely to be a separate underlying problem or risk factor that explains the association, such as family history or an iodine deficiency.

This by itself is confusing… don’t you agree???

So when addressing the problem of PCOS and when there are multiple possible presentations as well as multiple reasons for which a woman with PCOS would visit the doctor, treatment will be very different based on the goal and expected outcome.

PCOS presents itself at the different life stages of a woman, for example, younger women will have substantial problems with their periods, whereas women that are older and may have even gone through menopause, will have issues surrounding hypertension and diabetes as a direct relationship to their history of hormonal imbalance.

Nevertheless, there are basic principles of treatment and basic goals. When treating PCOS there are different approaches that need to be considered, and all are equally important in the healing process and the understanding of the condition.

The basic goals of the treatment of PCOS:

1. Lose weight

2. Improve metabolism

3. Increase the muscle to fat ratio

4. Regulate periods and vaginal bleeding

5. Reduce cyst formation

6. Boost fertility if that is what is desired

7. Clear skin of acne

8. Promote healthy and abundant hair

9. Promote healthy self-esteem and a healthy relationship with one’s self

10. Reduce the risk of and prevent associated conditions such as thyroid disease, diabetes, and depression

In order to achieve these goals, there are different approaches:

1. Treat the hormonal imbalance through interventions that may be hormonal in nature to address the androgen excess, estrogen excess or deficiency and progesterone excess or deficiency. This can be achieved through the use of exogenous hormones such as birth control pills (synthetic) or bio-identical hormones (a more natural and less regulated approach), or attempts to help the body regulate itself through other indirect approaches to achieve hormonal balance through the use of vitamins, minerals, herbs and other supplements as well as through lifestyle interventions.

2. Treat the insulin excess and improve metabolism of carbohydrates with the use of metformin

3. Address the mood disorders associated with PCOS as independently associated with the syndrome including anti-anxiety approaches, mood stabilizers, and antidepressants

4. Considering different surgical approaches to treat PCOS

5. Generating a plan for life with strategies for a successful long range approach
I am frequently asked if PCOS is ‘for life’…. PCOS is a condition that will be with you for life as long as you don’t address the cause and instead address the symptoms. Lifestyle is and will forever be the keystone to the treatment. This is an important concept that is hard to grasp.

In my next blog I will discuss the different treatment options in more detail.

Stay tuned,

Dr. Margarita Ochoa-Maya, MD

www.AdvancedHealthNH.com
www.FreedomToHeal.org

POLYCYSTIC OVARIAN SYNDROME… It is a collection of hormonal imbalances that will prove to BE more than one disease…..

2012-07-27T08:24:00.002-04:00

POLYCYSTIC OVARIAN SYNDROME… It is a collection of hormonal imbalances that will prove to be more than one disease…..

Polycystic ovary syndrome is also known by its mnemonic, PCOS. It also has other names: Polycystic ovarian disease; Stein-Leventhal syndrome; and polyfollicular ovarian disease.

Truly, it can represent such a wide spectrum of hormonal imbalances in women that it is as confusing as it is elusive. I say this, because it can present itself in so many different ways in women, it is a difficult diagnosis to make as a physician, requiring a significant knowledge in the matter, as well as confidence in the doctor patient relationship. It takes time to take a good hormonal history and it takes trust to be able to fully disclose ones complaints, which may be judged as vanity, or may not even be thought of as a problem.

For the purpose of this blog, I will address polycystic ovarian syndrome as PCOS.

PCOS is a condition in which a woman has a hormonal imbalance. Please keep in mind that female hormones in the context of medical history are relatively young. Birth control pills are only 50 years old…. When the conversation about birth control pills started, further research started and interest was created into hormonal imbalances in women. Taking that into perspective, I believe that endocrinology and the study of hormones is still growing at the speed of light. Every day there is better understanding of this problem for women and there is increased need for awareness and patient advocacy.

PCOS can be a devastating problem, which not only does it affect the biology and the hormonal balance in a woman; it can be life threatening at the level of the mind and spirit. Depression, self-confidence, self-esteem, and the delicate balance between self and the environment can be affected at different dimensions which can be difficult to understand in this fast paced world. It is difficult to make the connection unless you are aware of the possibilities, and you and your doctor are able to communicate openly about what your complaints are and the possibilities in your treatment plan.

It is very rewarding to tell you that when I can talk to my patients, and allow them to understand that their condition is treatable, and not ‘their fault’, and that there needs not be shame, but instead hope for a better healthier future, we become stronger as women, and motivated to make every day count!!!

What is PCOS?

PCOS is simply put, an imbalance of a female sex hormones. This is as vague as it gets. It usually represents an androgen excess, with the presentation of problems related to elevated male hormone in women. But estrogen and progesterone are also imbalanced, and affected. The easy way to understand it is thinking about a beautiful ballet, or symphonic orchestra. When they are all in synchrony and symmetry, everything appears perfectly balanced, yet imagine a situation where there is no communication amongst the ballerinas or the instrument players…. It would be a terrible mess….

Unfortunately it is not completely understood why or how the changes in the hormone levels occur. In some patients, there may be estrogen dominance, in some, there may be progesterone deficiency, and in others it may be excess androgens either coming from the ovary or the adrenal. What is clear is that the ‘hormonal imbalance’ causes significant problems at many levels in the body. These changes make it difficult for a woman's ovaries to release fully grown (mature) eggs. Under healthy, balanced and normal circumstances, the ovary releases an egg every month. This is called ovulation. When there is a hormonal imbalance, such as when a woman has PCOS, mature eggs are not released from the ovaries, but instead, they are retained within the ovary, and can form very small cysts.

Women with PCOS often have a positive family history, and when questioning other family members, it is not unusual that other women in the family have symptoms similar to those of PCOS. It can affect anyone after puberty, and the symptoms often begin when a girl's periods start. PCOS is most commonly diagnosed at the average age of 20-30.

HOW DOES PCOS PRESENT IN THE FEMALE BODY?

As I stated before, PCOS is so elusive and unique to each woman, the way hormonal imbalance would present in a woman would be significantly influenced by that person’s genetic make, heritage and place of origin, lifestyle – diet and degree of activity, age and mental health.

To further understand PCOS, I divide the presentation into four categories:

1. Women who have a weight problem and have regular periods- which means they may or may not be ovulating, and have PCOS complaints

2. Women who have a weight problem and have irregular periods, are not ovulating and have PCOS complaints

3. Women who are lean and have regular periods – which means they may or may not be ovulating, and have PCOS complaints

4. Women who are lean and have irregular periods- which means they are not ovulating and have PCOS complaints.

It is important to identify the effect of the hormonal imbalance on weight. This may give you a clue which hormone most out of range. Usually there are excess androgens; the problem is that on occasion the androgen levels are not elevated. This may be because there are so many androgens, and their metabolites that it would not be cost effective to measure them all. Furthermore, could excess estrogen, also called estrogen dominance be complicating matters? Could there be a progesterone deficiency?

Because making a diagnosis with a laboratory test can be so difficult, and almost always not clearly defined, it is paramount to be able to see the way it presents in women clinically. Here I will list the possible complaints a woman with PCOS may have. Please keep in mind that not all of the symptoms need to be present for a person to have this problem.

PCOS can present in a woman who has:

1. Early puberty

2. Early puberty, but late onset of periods

3. Irregular periods, that come and go as they please

4. Very light to very heavy periods

5. Terrible PMS (premenstrual symptoms)

6. PMDD- Premenstrual dysphoric disorder

7. Decreased breast size

8. Abnormal hair growing on the thighs, belly, chest, around the nipples, upper lip, chin, and sideburns

9. Scalp hair thinning and even loss particularly over the top of the head and crown

10. Deep voice

11. Oily skin and – or oily hair

12. Acne in face, chest or back

13. Dark or thick skin markings and creases around the armpits, groin, neck, and breasts

14. Skin tags, or little skin growths around the neck, underarms, groin

15. Difficulty getting pregnant - infertility

16. Increased hunger and cravings for carbohydrates

17. Weight problems particularly around the middle

18. Increased weight and muscle size in the upper body as compared to the lower body

19. Increased risk for Diabetes type 2

20. Increased risk for elevated cholesterol, particularly high triglycerides, and low HDL

21. Increased risk for high blood pressure

22. Increased risk of heart disease

23. Increased risk for liver disease: Nonalcoholic fatty liver disease (NAFLD)

24. Increased risk of endometriosis

25. Increased risk of depression and other mood disorders

26. When pregnant: Increased risk for gestational diabetes, increased blood pressure, pre-eclampsia, and complications at birth due to a large baby and small pelvis

On physical exam, and a pelvic exam women may present with:

1. Increased weight to height ratio: BMI

2. Increased abdominal girth

3. Increased blood pressure

4. Tender and increased size and swollen ovaries

As I stated earlier, a single test will not diagnose PCOS. Blood tests and a pelvic ultrasound can be done to confirm the diagnosis, but truly the diagnosis is clinical.

Blood tests should be done in the first week of the cycle. The blood tests that can be done include:

1. Luteinizing Hormone (LH)

2. Follicle Stimulating Hormone (FSH)

3. Calculate the LH to FSH ratio

4. Fractionated estrogens: estrone, estradiol, estriol

5. 17 OH Progesterone

6. Free and Total Testosterone

7. Androstenedione

8. Dehydroepiandrostenedione (DHEA)

9. Dehydroepiandrostenedione sulfate (DHEA-s)

10. 17-ketosteroids

11. Prolactin

12. Thyroid function tests: TSH, free T3 and Free T4, and thyroid antibodies

13. Comprehensive metabolic panel- to measure fasting sugar, kidney and liver function

14. Fasting cholesterol profile

15. Hemoglobin A1c

16. Insulin level

17. C-Peptide and Proinsulin

18. If needed; a pregnancy test

The ultrasound is sometimes needed to visualize the ovaries, and it can be done across the belly (transabdominal) yet sometimes getting a bit closer to the ovaries allows a better view, and this kind of ultrasound is done through the vagina – transvaginal ultrasound. Further tests and surgery can be done…. In some cases a laparoscopy is needed…. This is when they go inside your belly with a camera and take a direct look at the ovaries, the uterus and the surrounding organs.

TREATMENT

Having PCOS myself, I have been an avid patient advocate and throughout my career I have tried to associate myself with the thought and research leaders in this field. I have worked with thousands of women with this problem and the treatment should be individualized. Each woman is different.

There are different approaches to the treatment of PCOS. Lifestyle treatment is paramount with good dietary habits, aerobic exercises, yoga and meditation. Natural remedies including particular herbs, vitamins and minerals are also very important. And lastly pharmaceuticals including birth control pills, metformin and spironolactone can be used when appropriate. In summary all contribute to regularizing hormonal levels and monthly periods, restoring fertility, controlling acne and hirsutism and normalizing blood sugar and lipid levels.

Please keep in mind, emotional and spiritual health is as important to the biological health in a woman. Emotional health, self-confidence, self-acceptance, self-esteem can be severely affected when a woman has PCOS.

In the coming days I hope to share with the readers my experience with the efficacy of these treatments. I hope you may find benefit for yourself or someone you know by generating awareness. Join the medical knowledge and patient advocacy revolution…..

Margarita Ochoa-Maya, MD

www.AdvancedHealthNH.com

www.FreedomToHeal.org

When there is a hormonal imbalance….. How to determine if in a woman there is too much male hormone or androgens….

2012-07-24T12:06:00.001-04:00

When there is a hormonal imbalance….. How to determine if in a woman there is too much male hormone or androgens….

In biology, we have almost always tried to define the two opposites, and when it comes to males and women, there has always been controversy. Starting from social roles all the way down to the genes and chromosomes we have tried to define the differences. Even in the definition of words, "androgen" comes from the Greek "maker of males," and "estrogen" signifies the maker of the estrus cycle, the boss of ovulation and menstruation, the essence of womanhood. But things are not always black and white, and nature does not work in absolutes. As it turns out, men have estrogens and women have androgens. This has been a well-known fact, and scientists have known this for years. Unfortunately, when it comes to studying how testosterone and other androgens work in a woman's body, we have been lacking. There is renewed interest though, and in this blog, I will try to explain the effects of androgens in women.

The principle androgens in the human body are testosterone and androstenedione. Other androgens include dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEA-S). Androgens may be called "male hormones," but don't let the name confuse you. As I have discussed before in previous blogs, androgens are a group of hormones present in both males and females which play a role in reproductive activity. In men they assist in the development of the characteristic male traits, and in women they have a significant role as well. Both men's and women's bodies produce androgens; it is just that the production is in different amounts. In fact, androgens have more than 200 actions in women.

Men have between 300 and 900 nanograms of testosterone for every deciliter of blood; much of it generated by the testicles, but some originating in the adrenals (a nanogram is a billionth of a gram). In women, a high measurement of testosterone is 100 nanograms, but the average is around 40.

Where do androgens come from in women?

In women, androgens are produced in the ovaries, adrenal glands and fat cells. In fact, among the more common hormonal disorders in women are associated with too much or too little of these hormones. In trying to understand where exactly androgens come from, studies have shown that after removal of the ovaries, blood levels of testosterone and androstenedione fell by half each, suggesting that there is equal contribution from the ovaries and the adrenals. Interestingly, menopausal women have a significant drop in androstenedione but not testosterone, suggesting that even after menopause, the ovaries continue to produce testosterone. DHEA and DHEA-s seem to be excreted exclusively by the adrenal glands. Testosterone from the ovaries, is secreted in unison with the menstrual cycle, and there is a peak around the same time estrogen peaks at the time of ovulation.

What are the roles of androgens in women?

Unfortunately there has not been a great deal of research on this topic specifically, and it has been difficult to experiment on this topic, and the information is mostly observational based on women that had deficiencies and were then treated, or in women that had excess and had complaints.

Women produce increased amounts of testosterone during puberty. In women, androgens are associated with the hormone leptin and they play a key role in the hormonal events that trigger the start of puberty, stimulating hair growth in the pubic area and underarm area. Levels of testosterone peak for women in their early twenties.

In women, androgens, when in balance, convey powerful anti-aging effects. Androgens are known for:

1. Their key role in reproduction

2. Increase sexual desire and satisfaction (libido)

3. Decrease fat mass and increase muscle mass, and thus decrease the fat to muscle ratio

4. They keep skin supple and increase the moisture and oiliness of the skin

5. They increase bone formation and bone strength and therefore bone mineral density

6. They have an effect on mood, usually a positive one and boost the ability to handle stress

7. They support cognitive functioning

8. They have an effect on the liver, by increasing its metabolism, and energy expenditure

9. They have an effect on cholesterol metabolism and regulation

10. They have an effect on insulin metabolism and glucose disposal.

What happens when there is too much androgens and there is an imbalance of the hormones?

When androgens get unbalanced and are in excess in the female body, problems start to occur. This is called "virilizing effects". Excess amounts of androgens in women cause a constellation of changes and symptoms.

Symptoms of excess androgens in women may include:

1. Excess hair growth

2. Irregular periods and even prolonged absence of periods

3. Infertility

4. Acne in face, back and chest

5. Thinning of the hair and hair loss in the scalp particularly in the area of the sides and top of the head

6. Excess hair in unusual places such as the upper lip, sideburns, chest, nipples, abdomen, and thighs

7. Increased oiliness of the skin

8. Irritability and mood changes

9. Excessive libido and unusual sexual fantasies

10. Incresed muscle mass

11. Increased body weight and difficulty to lose weight

12. Increased body weight in the upper body as compared to the lower body

13. Increased abdominal girth and intra-abdominal fat

14. Increased liver fat, and non-acoholic fatty liver disease

15. Insulin resistance, pre diabetes, and diabetes

16. Gestational diabetes

17. Ovarian Cysts

18. Ingrown hairs that cause infection: hydradenitis supurativa

19. Tendency for the skin to develop infections and abcesses

How to determine what is normal or what is abnormal or imbalanced…

The line between normal and abnormal levels of androgens in women is blurry and arbitrarily assigned. For this reason, what may be considered unacceptable on women in one culture and considered a symptom of a hormone imbalance, may be viewed as ordinary and even sexy on women in another culture. This is common when addressing the differences between Hispanic, Mediterranean and Greek women as compared to women in Norway, Iceland and even Japan. As an example, it is not unusual for a Latina woman to have some facial hair, but it is very unusual for a Japanese woman to have it.

As a woman, I know and I share my opinion with many of my patients: "What society says is normal and what is normal for women can be very different”.

The big problem is that there are different androgens, and then, there are the by-products of the androgen’s metabolism, therefore, one laboratory test may not be enough to confirm what is suspected by an abnormal clinical presentation or complaint. So which one to measure? Testosterone? Free and total values? Andostenedione? Dihydrotestosterone? Dehydroepiandrostenedione (DHEA)? Dehydroepiandrostenedione sulfate (DHEA-s)? Sex hormone binding globulin?

Another concept to consider, is the balance of androgens with respect to estrogen and progesterone and other hormones including cortisol….Sometimes, there is excess estrogen, and not enough progesterone and on the other hand, there is excess progesterone and not enough estrogen…. And sometimes, there is an altered cortisol and adrenal function that makes it all very confusing….

Normal ranges of androgens have a great deal of variation and there is a wide range of what is considered within the ‘normal range’, leaving a lot to the imagination…. Traditional doctors do not like this…. It forces them to make a decision based on their clinical acumen rather than an abnormal or normal blood test and to make matters worse, there is no significant consensus or research to back up the decision to be made. This is by far, one of the biggest controversies in woman’s health today.

In my next blog, I will discuss the potential reasons for androgenic imbalance and the common disorders associated with androgen excess in women….

Stay tuned,

Margarita Ochoa-Maya, MD

www.AdvancedHealthNH.com

www.FreedomToheal.org

HORMONAL IMBALANCES IN WOMEN ARE VERY COMMON... DO YOU HAVE A PROBLEM WITH YOUR HORMONES? COULD IT BE PCOS?

2012-07-11T13:11:00.001-04:00

WOMEN: DO YOU HAVE A HORMONAL IMBALANCE? COULD IT BE PCOS?

As a woman who has suffered personally with Polycystic Ovarian Syndrome (PCOS), I have had a journey of my own. This was the reason I decided to become an endocrinologist. When I was in my mid-twenties, I was concerned if I would ever be able to have children. I asked around to other doctors, and even went to specialists, but I was not given much help. I had to find it on my own… and so, I did…..

When I was first diagnosed was a while back, but I believe even today, young women suffer in silence with this problem. It is often misunderstood by physicians, and women don’t get the care they need. This is unfortunate. Yet, for this reason, it is time to become proactive about this condition, and promote education regarding this subject.

In this blog, I will start as usual with a questionnaire. When you answer the questions, please grade them with a 10 if you have a severe problem with this and with a 0 if you have no problem at all with the question at hand.

1. Were you really young when you developed your first period?

2. Did you have your first period before the age of 10?

3. Did your breast develop early as compared to your friends at the time?

4. Did you develop acne young?

5. Do you suffer from facial acne?

6. Do you suffer from back acne?

7. Do you suffer from unwanted hair?

8. Do you have more than the usual hair in your face, upper lip, chest, thighs or other areas?

9. Do you have to shave, pluck or wax your face?

10. Do you get ingrown hairs under your arms or in other areas?

11. Do you get ingrown hairs in the areas that you shave or wax?

12. Have you ever suffered from an infected cyst (ball like structure) under your arms or thighs?

13. Do you have an unusual darkening of the skin under your arms (armpits), thighs, groin or other areas not usually affected by sun?

14. Do you have more than 5 skin tags total anywhere in your body?

15. Do you have skin tags in the areas of the neck, abdomen or thighs?

16. Do you have irregular, erratic, unpredictable periods?

17. Do you need to take birth control pills to bring on a period?

18. Do you have less than 6 periods per year?

19. Do you have heavy periods?

20. Do you have mood changes prior to the periods?

21. Does your acne get worse prior to the periods?

22. Have you had problems getting pregnant without success?

23. Have you needed fertility treatments to get pregnant?

24. Do you think you have a weight problem?

25. Are you 20 lbs. or more over your ideal weight?

26. Do you carry the excess weight around your middle?

27. Have you ever gained 10 lbs. or more unexpectedly?

28. Are you experiencing difficulty losing weight?

29. Do you suffer from excessive hair loss?

30. Is the hair on the top of your head thinning?

31. Are you tired all the time?

32. Could you take a nap anytime?

33. Do you experience depression and anxiety?

34. Do you have any other mood disorder?

35. Have you ever been told that you have or have had ovarian cysts?

36. Have you every had extreme abdominal pain that resolved spontaneously?

37. Do you every feel shaky, hungry, irritable, moody, sleepy, fatigued, ‘fuzzy’, clouded thinking within 2 hours of eating a heavy carb and fat meal such as large portion of pizza, Italian or Chinese food?

38. Have you ever been told you have low blood sugar?

39. Have you ever thought you may have blood sugar swings?

40. Have you been told you have a blood pressure issue?

41. Have you had menstrual migraines or headaches around your period?

42. Do you snore?

43. Have you ever been told you have sleep apnea?

44. Has anyone in your family ever had ovarian cysts?

45. Has anyone in your family had infertility?

46. Has anyone in your family had twins or triplets naturally?

47. Do you have a family history of Diabetes?

48. Does anybody else in your family have a weight problem?

49. Do you have a family history of a heart problem, heart attack or stroke?

50. Does anyone in your family have history of uterine cancer?

If you scored greater than 250:

You likely have a hormonal imbalance, and it may very well be polycystic ovarian syndrome. It would be a good idea to read further and schedule a visit with your provider, and consider visiting an endocrinologist.

If you tested greater than 150:

There is a possibility that you have a hormonal imbalance and I suggest you start tracking your periods, and also tracking your complaints and try to see if there is a pattern to what you are feeling.

If you tested less than 50:

Likely you do not have a hormonal imbalance. Yet, it is always good to know about these things in case you know of a friend or someone you love that may benefit from this questionnaire.

If you have these problems or suspect someone you know has these issues, please get informed. There are more and more resources and websites now dedicated just to help women with PCOS. Determining if you have PCOS can be a confusing and sometimes difficult process. The reason is that PCOS is a syndrome - each person will have a different set of symptoms. These include excess weight, fatigue, infertility, hormone imbalance, sleep apnea, excess facial or body hair, and a variety of skin problems among other problems that we will discuss further in the next few blogs.

Stay tuned, we will start a new set of blogs, trying to explain the details of hormonal imbalances in women.

Thank you for reading….

Margarita Ochoa-Maya, MD

www.AdvancedHealthNH.com

www.FreedomToHeal.org

THE DIFFERENT FORMULATIONS AND WAYS USED BY DOCTORS TO INCREASE TESTOSTERONE, What is new???

2012-06-20T16:56:00.001-04:00

Low stamina and low testosterone in men is common. It affects several millions of men in the United States and it is becoming more and more common now that the conversation is getting to be more open. Men don’t like to talk about these issues, but as I stated in my previous blog, once the door is opened, and men get the treatment that is needed overall health and wellbeing is achieved.

There is a lot of activity in the research world regarding low testosterone in men. Several studies have associated low testosterone to obesity, cardiovascular disease, metabolic syndrome, glucose intolerance and diabetes among other chronic illnesses. Another study showed that replacing testosterone improvements in metabolic parameters in diabetic men. These observations made doctors think a little deeper about testosterone replacement and the impact it has not just on male performance but overall health and wellbeing and the associated treatment of other medical conditions that are more common as a person ages.

So, for this reason as well as general awareness and comfort level when talking about low testosterone has led to the dramatic increase in the number of prescriptions written for testosterone. Prescribing patterns and formulations have also changed significantly as more research and development is done in this area. It is well established that testosterone taken via the mouth or ‘orally’ has been associated with liver cancer, so this form of administration is not indicated nor recommended. For this reason testosterone has been used for men as an injection or a patch.

CURRENT AND NEW TESTOSTERONE FORMULATIONS

The various formulations of testosterone differ in several ways. The main goal is for the testosterone formulation to be able to restore and maintain physiologic levels of testosterone. The route of administration, meaning how it is delivered is also important. There are injectables, transdermal patches, transdermal creams, transdermal gels, and formulations that work through the mucosal lining of the mouth (buccal).

The preferred technique of androgen replacement and the gold standard has been intramuscular (IM) testosterone, but wide variations in testosterone levels are often seen. Injectables are inexpensive and effective in relieving the symptoms of low testosterone. There are two formulations of injectable testosterone available: testosterone enanthate and testosterone cypionate. The cypionate is more commonly used as the enanthate tends to burn more after injection. The typical dose is 200 mg every 2 weeks or 100 mg weekly. Unfortunately the intramuscular injection can be painful. As it is a ‘depot’ shot, there are significant fluctuations in the dose and the blood levels of testosterone. There are peaks and there are valleys in the levels, making this form of testosterone replacement not the ideal form.

Transdermal patches became available more than a decade ago. One or two patches deliver testosterone up to 5 mg per day. , and are sold at a moderate cost. They are discreet yet there has been some controversy in the patch’s ability to maintain adequate and steady testosterone concentrations, they may cause some skin irritation due to the adhesive, and some require daily administration.

The transdermal gels and creams are meant to mimic the daily variations in hormone and follow a circadian rhythm, but may be more expensive and there are serious concerns about transference to the partner or children in the family. As with the patches, there is variable absorption. The creams and gels may be considered messy by some and are also administered daily.

Lastly, newer formulations are being introduced in the market. There is a troche, which is like a gummy candy that can be placed in the mouth and it would gradually dissolve over a period of several minutes. This is a new way to administer testosterone and other hormones that can be dissolved in the saliva and then absorbed via the lymphatic system. They can also be expensive, and need to be administered up to twice daily and can cause some oral mucosal irritation.

Even more recently, in Canada, there was a study that presented a different approach to the administration of the injectable testosterone, and rather than administering it intramuscularly, it is administered subcutaneously, at 30 mg dose, three times a week. This is usually done with a compounding pharmacy that can make the testosterone solution more concentrated, and therefore less amount, less painful and minimizing the large peaks and valleys seen in the larger dosed intramuscular injections. These subcutaneous injections would be self-administered and easier. The location to inject is usually the anterior abdomen.

Testosterone implants in the form of pellets are also available. They are not very popular as a small surgical procedure needs to be done in order to implant the pellets.

Under active investigation is testosterone undecanoate. This is a novel, long lasting injectable form of testosterone. It is a concentrated form, and that achieves and maintains testosterone levels in desired ranges over several weeks. It has been approved and launched in 75 countries throughout Europe and Asia. The recommended administration is every 10 to 14 weeks, 750mg dose. The safety profile was studied carefully and was comparable to the current available formulations.

SIDE EFFECTS OF TESTOSTERONE

Testosterone has its side effects. It is important to know the different side effects testosterone can have on men. It’s important to know that if you’ve had prostate cancer or breast cancer you are absolutely not a candidate for testosterone therapy. Testosterone can make either of these cancers grow faster.

Other negative side effects to consider when using testosterone therapy include:

1. Fluid Retention: It is possible to notice some swelling and fluid retention within the first few months of treatment.

2. Acne and increased oiliness of skin

3. Changes in Cholesterol profile: Increased triglycerides and decreased HDL

4. Worsening of high blood pressure

5. Liver Toxicity: Even that there have been no reports of liver toxicity from transdermal testosterone replacement, every manufacturer of testosterone for humans mentions the possibility of liver problems.

6. Problems with Fertility: The production of sperm (spermatogenesis) in all men is dependent on production of testosterone by the testes. If testosterone is given from outside, the testes will stop producing their own testosterone. This will shut down sperm production either significantly or completely in nearly all men. This may be a temporary or permanent testosterone side effect. Younger men, who still plan to have a family, must take this into account when considering the effects of testosterone replacement therapy. Some men have "banked" their sperm (for more information on this subject visit www.SpermBankDirectory.com.) Other men have delayed testosterone replacement until they have finished having children. It is important that any man considering a family be very careful in starting testosterone treatment of any kind.

7. Problems with mood and aggression- especially if the dose is very high

8. Sleep apnea: There have been reports that increased testosterone levels exacerbate pre-existing sleep apnea. Sleep apnea is a condition in which individuals stop breathing for periods of time while sleeping.

9. Tender breasts or enlargement of breasts: This may occur when starting testosterone therapy. This may be due to the conversion of testosterone to estrogen. Breast tissue in both men and women is very estrogen sensitive. Sometimes this testosterone side effect can be overcome by decreasing the dosage of the testosterone, and addressing the balance between estrogens and testosterone. Estrogen dominance can be addressed with your doctor and other agents may be used to avoid this.

10. Increased Red Blood Cell Concentration (Polycythemia): One of the most important side effects of testosterone replacement therapy can be an increase in the red blood cell mass and hemoglobin levels. Increased blood cells may increase clot formation (thromboembolic events) which could present as increased risk for heart attacks, strokes or peripheral clotting in the veins. Men who develop increased hematocrit can decrease testosterone replacement or can donate blood to decrease their blood cell mass.

11. Prostate Growth: The growth of the prostate can have a negative effect on men in two ways. First, the prostate may increase in size (benign prostatic hyperplasia or BPH). This may cause problems with urination. Second, it may promote the growth of cancerous prostate cells. It is important to remember that prostate cancer is a common cancer for men as they get older and is the second most common cause of cancer death in older men.

When administering testosterone it is paramount that blood tests be monitored.

The most important blood tests that need to be done are:

1. Baseline tests: LH and FSH, Prolactin, Hormone levels of total and free testosterone, fractionated estrogens, progesterone levels and DHEA-s levels.

2. A comprehensive metabolic test to measure glucose, kidney function and liver function

3. PSA- Prostate Specific Antigen

4. Complete Blood Count- As testosterone can increase the red cells (polycythemia)

5. Cholesterol profile

OTHER AGENTS BEING INVESTIGATED FOR THE TREATMENT OF LOW TESTOSTERONE

Selective estrogen receptor modulators (SERMs) are also used for the treatment of low Testosterone are being actively investigated. These agents are pills, and compete with estradiol for the estrogen receptor. The goal is to increase the stimulus from the hypothalamus in secreting gonadotropin which in turn stimulates the testosterone and sperm production. The drug being studied is called enclomiphene (25 mg). Another drug that is used with this purpose is clomiphene also known as Clomid. These agents have a role in the treatment of central or brain induced low testosterone and in the treatment of male infertility. Another drug in clinical development is called fispemifene (300mg). This drug blocks the estrogen feedback to the pituitary gland, and thus increasing the LH and FSH secretion, which in turn increase the testosterone levels to the normal range.

In Europe, 5-alpha-dihydrotestosterone is available as a 2% hydroalcoholic gel. The usual dosage is 5 mg or 10 mg daily. This drug is not aromatized to estrogen, and does not have conversion to testosterone. When using this agent, serum DHT levels are monitored, and blood levels of testosterone, estradiol and SHBG decrease.

Selective androgen receptor modulators (SARMs) are exciting new agents in the field of testosterone replacement. Estuarine is an example of a SARM in development right now. These agents will have tissue specific effects, and have the potential to increase the muscle effects and improve muscle strength and body composition as well as restore bone mineral density without affecting the prostate gland.

SUMMARY

In summary, now that there is increased ability to talk about the subject of low testosterone, increased testing and detection as well as increased availability to treat this condition, there are more clinical trials and research being done. This has driven to the development of new treatment approaches, and options for dose and formulation.

Keep in mind that none of the formulations is ideal, and further research is done every day, but being aware of these potential new formulations promise an exciting era in the treatment of low testosterone in men in the years to come.

Keep informed….

Margarita Ochoa-Maya, MD
Endocrinology and Metabolism

http://www.advancedhealthnh.com/
http://www.freedomtoheal.org/

MENS HEALTH: LIFESTYLE, DIET AND NUTRITIONAL SUPPLEMENTS FOR OPTIMAL MALE PERFORMANCE

2012-06-02T12:20:00.004-04:00

MENS HEALTH: LIFESTYLE, DIET AND NUTRITIONAL SUPPLEMENTS FOR OPTIMAL MALE PERFORMANCE

In today’s active fast paced environment, optimal health and wellness are a pre-requisite for success. When talking about men’s health, the challenges are still determined by their ability to get to the doctor and have the proper work up and necessary tools to be healthy from a prevention point of view. Men do not like to see the doctor and have far less complaints about their health.

It is a fact: Men die at higher rates than women for all of the leading causes of death. A survey conducted by the U.S. Department of Health and Human Services, states that men don't use the health care system as often as women do; in fact, they're twice as likely to have gone two or more years without contact with a physician.

They avoid the doctor with excuses such as “not enough time”, “going to the doctor is a ‘chick’ thing”, “it’s too expensive”, “I don’t have a comfortable relationship with my doctor”, “I’m afraid of what I might find out” and the most common one, “I'm fine”. It is not surprising as the main topics that will be discussed at the regular check-up for men over the age of 40 should include:

1. A prostate exam, a digital rectal examination and a stool check for blood
2. A testicular exam and thorough conversation about male issues including erections and sexual performance
3. A conversation about lifestyle, diet, and cardiovascular risk factors

SO, WHY THE RELUCTANCE TO VISIT THE DOCTOR?

The American Journal of Public Health performed a survey that required men to select the appropriate reason or reasons why they don’t like to go to the doctor. These were the results:

• 39% of men said that NOTHING prevented them from going to the doctor, they just didn’t go…
• 36% of men only go to the doctor if EXTREMELY sick
• 23% of men believed themselves to be healthy and had NO REASON to go to a doctor
• 12% of men would rather be treated ‘NATURALLY’
• 12% of men don’t have TIME to go to the doctor
• 11% of men don’t have health insurance (and this number may be rising)
• 8% of men DO NOT LIKE DOCTORS…. Period….
• 7% of men are afraid of finding out that something is wrong
• 4% of men don't know of a good doctor in their area: 4%

When trying to understand the reasons why men are so reluctant to see the doctor there are several hypotheses. The first one is that men would rather wait and see. A poll done in 2007 found that 92% of men like to wait at least a few days to see if they feel better first before heading to the doctor’s office. Unfortunately, this “wait and see attitude” keeps on for several days and even months ultimately leading to an exceptional delay before seeking proper treatment. Another hypothesis is that men believe that ‘toughing out illness’ is a good attitude, and that admitting to illness equals to weakness. This is linked to a risk taking attitude by men, and for sure this mentality is not a healthy approach.
Women live longer and it is a fact that women see the doctor far more frequently than men. Doesn’t it surprise you the fact that waiting rooms are scattered with magazines that are mainly aimed at women? Whereas there is a paradox: most physicians are MEN. But, please, pay attention, PREVENTION IS BETTER THAN CURE!

With this introduction I would like to segway into a discussion about the optimal health and wellness for men’s health. The most common challenges men have over the age of 40 are low energy, mild memory changes, and lower potency and libido. This is clearly minor compared to diabetes, cardiovascular disease, elevated cholesterol, hypertension and obesity, yet know that there is a link between the two. The most common complaints a man will have when they have these bigger and life threatening medical problems will initially present with fatigue, and non-specific complaints such as those that I commented on initially. Paying attention to those subtle complaints may be life-saving!!

PREVENTION and KNOWLEDGE are the key to wellbeing, longevity and OPTIMAL HEALTH.

OPTIMAL HEALTH FOR MEN

The ability to produce and metabolize testosterone declines as men age. Reproductive hormones are delicate and sensitive to the overall health of the individual as they are the key to future generations, thus if you are unhealthy the body ‘senses’ it is not a good idea to reproduce. Contrary to women, men don’t have a specific time of menopause, and if at all, andropause is a gradual, slow and steady reduction of the production of the hormones.

Men do not experience a complete and permanent physiological shutting down of the reproductive system as a normal event like women do. SO Andropause is the term that has been used to talk about hormonal decline with age. Another term that is frequently used is "androgen deficiency of the aging male" (ADAM). This term is better and more accurate when discussing loss of testosterone production as a gradual and asymptotic situation in men as they age. This is in contrast to the more abrupt change associated with other medical reasons that may cause an abrupt decline in testosterone. Andropause or ADAM is common: 2.4 million men ages 40 to 69 have androgen deficiency.

With age, and with poor life choices, male health can be affected. Andropause is more common and usually present when a man has the following:

1. Poor diet: Increased fat, sugar, alcohol intake
2. Increased stress
3. Inactivity and Sedentary Lifestyle: Decreased exercise
4. Decreased sleep
5. Decreased muscle strength
6. Decreased sexual function, decreased potency, decreased libido and desire
7. Increased depression, decreased motivation, increased ‘grumpiness’
8. Abnormal blood tests: In the fasting blood stream, increased levels of glucose, insulin, cortisol and markers of inflammation such as C-Reactive Protein and decreased levels of homocysteine, vitamin B12 levels among others
9. Abnormal physical exam: In the body, an increase in the abdominal fat, usually called the ‘apple’ shape of the body, increased breast tissue formation, decreased muscle mass
10. Medical history: Obesity, Metabolic Syndrome, Insulin Resistance, Diabetes, Increased cholesterol, blood pressure, and cardiovascular disease
11. Increased prostate size, increased risk of prostate cancer
12. Decreased bone mass, increased osteoporosis

THE CAUSES OF ANDROGEN IMBALANCE

1. Poor lifestyle choices, increased stress
2. Aging
3. Illness—thyroid disease, diabetes, CVD, immune and inflammatory Conditions
4. Medications (i.e., blood pressure medications, hair loss medications, steroids)
5. Genetic factors

At a hormonal level, changes also happen that cause an overall hormonal imbalance in male hormones with age and poor lifestyle choices:

1. Total and free levels of testosterone decline, sometimes prematurely

2. Increase in the enzyme that metabolizes testosterone to estrogen called ‘ aromatase’ causing an increase in estrogen levels in the male, this is also called ‘estrogen dominance’

3. Sex hormone binding proteins (SHBG), the proteins that carry the testosterone and other androgens around get imbalanced, and increase, causing a lower level of the free un-carried testosterone

4. Testosterone metabolite, 5alpha-dihydrotestosterone (DHT) also known as androstanolone, is produced when the enzyme 5α-reductase metabolizes testosterone. This enzyme is present in the prostate, testes, hair follicles, and adrenal glands, and is about 5 x more potent and has a significant role in the development and exacerbation of benign prostatic hyperplasia, as well as prostate cancer, by enlarging the prostate gland

5. Testosterone metabolizes to estrogen and the metabolism of estrogen is different in males compared to females. The breakdown of estrogen produces two molecules, 2-hydroxyestrone (2-OT), and 16 alpha-hydroxyestrone. The first one is easy to metabolize and the second one is much more potent and harder to metabolize. Unfortunately men have a predominance of the second one and low 2-hydroxyestrone.

So, with age, and poor habits, not only do total and free hormone levels decline, but the metabolism of hormones, the relationship between androgens and estrogens, and a complete arrays of metabolic functions get out of balance. This pattern of change has been documented by multiple studies.

COMMON SYMPTOMS OF ANDROPAUSE AND MALE HORMONAL IMBALANCE

Hormonal imbalance in men and testosterone changes express themselves in the male with the following changes:

1. Mood changes: A decline in free testosterone has been implicated in mood swings, changes in aggression and ‘grumpiness’, nervousness, depression

2. Memory changes: Impaired memory, the inability to concentrate and higher risk of Alzheimer’s disease among other cognitive concerns have been associated with lower levels of free testosterone

3. Sleep changes: Insomnia, restless legs, and sleep apnea have been associated with declining and low levels of free testosterone

4. Metabolic changes: Weight gain, obesity, central adiposity, increased abdominal fat, and reduced fat to muscle ratio have been associated with declining male hormone levels

5. Muscular changes: Decreased strength, muscle tone, and overall muscle mass has been associated with low male hormones

6. Hair patterns: Male pattern baldness is associated with increased DHT

7. Breast Changes and Appearance: Increased breast tissue and apparent breast enlargement occurs when estrogen levels increased inappropriately, and there is an altered relationship between estrogen and testosterone (estrogen dominance)

8. Colon Health: Increased risk of diverticulitis and diverticulosis as well as other colon problems such as increased risk of colon cancer have been associated with low levels of male hormones

9. Prostate Health: Changes in hormone levels such as increased DHT and a decrease in 2-hydroxyestrone

10. Cardiovascular changes: Changes in androgens influence total cholesterol levels as well as increase triglycerides, and lower HDL

11. Sexual function: Decreased and altered male hormones are associated with low libido, low potency and decreased sperm count and overall decreased sexual function

12. Bone Health: Low testosterone levels have been associated with osteoporosis

13. Immune health: Low testosterone levels have been associated with decreased immunity and increased autoimmunity

AFTER ALL THIS BAD NEWS, WHAT NEXT! THE GOOD NEWS! THE FUTURE OF MEDICINE IS IN PREVENTION AND WITH A HEALTHY LIFESTYLE, HEALTHY DIET AND EXERCISE BALANCE, AND TARGETED NUTRITION OPTIMAL HEALTH CAN BE ACHIEVED!!!!

WHAT DEFINES OPTIMAL HEALTH FOR MEN?

1. Overall wellness, high energy and vitality
2. Lean, strong muscular bodies
3. Optimal health, and optimal body composition, stamina
4. Healthy sexual function throughout their life
5. Avert premature baldness
6. Sex hormone balance for healthy sexual function
7. Healthy heart and circulation, healthy cholesterol levels, healthy blood pressure
8. Prostate health
9. Hormone-sensitive cell protection
10. Overcome dietary insufficiencies

HOW TO ACHIEVE OPTIMAL HEALTH FOR MEN: KEEPING ANDROGENS IN BALANCE

1. Exercise
2. Reduce chronic stress
3. Eat an alkaline diet rich in fruits, vegetables, legumes, and alkaline water
4. Supplement with a specialized male formula that targets androgen balance

FOODS RICH IN PHYTOCHEMICALS PREVENT PREMATURE ANDROGEN IMBALANCE

Foods high in phytochemicals include the following:

• broccoli
• berries
• soynuts
• pears
• turnips
• celery
• carrots
• spinach
• olives
• tomatoes
• lentils
• cantaloupe
• garlic
• apricots
• onions
• seeds
• soybeans
• green tea
• apples
• cabbage
• Brussels sprouts
• bok choy
• kale
• red wine

SUPPLEMENTS TO ENHANCE ANDROGEN BALANCE AND PREVENT ANDROGEN DECLINE WITH AGE

A healthy diet may not be enough. There may be underlying dietary insufficiencies and deficiencies that routine laboratory testing cannot determine.

Targeted supplements and nutritional approaches can increase the bioavailable testosterone and decrease the estrogen load in men. These supplements may work by inhibiting the aromatase that transforms testosterone to estrogen therefore decreasing the total estrogen load in men. These supplements can also mildly inhibit the activity of the enzyme 5-alpha-reductase, and thus limiting and even decreasing the level of DHT- the potent testosterone by-product. Other supplements can work by enhancing and increasing the hydroxylation process to increase production of weaker byproducts such as 2-hydroxyestrone and avoid these harmful metabolites to toxify the body. The goal is for these supplements to encourage cellular resiliency and provide antioxidant cell protection.

Examples:

1. Flax, lignans, isoflavones and green tea are known to inhibit aromatase, limits conversion of testosterone to estrogen

2. Zinc and Selenium PROMOTE testosterone synthesis

3. Phytosterols, Green Tea, and Olealonic acid inhibit 5 alpha reductase and limits conversion to DHT

4. Folic Acid, Vitamin B6, and Betaine HCL promote healthy estrogen metabolism and methylation to 2-hydroxyestrone

5. Green Tea, Cucurmin, Lycopene, and Vitamin D are associated with Cellular protection, mitochondrial energy production, anti- oxidation and cancer prevention

RECOMMENDED SUPPLEMENTS:

I here list the most common supplements and herb extracts that are associated with promoting optimal hormonal health and male performance. Please note that I have not listed them in any particular order, and I do not recommend the use of these without the recommendation and supervision by a person that knows about these and understands their metabolism and interaction with other medications and each other. The reason I do mention these, is that I would like to encourage you to look further into your health, your diet, and the supplements that you are taking. I encourage you to have a healthy discussion with your doctor or health care provider.

1. B vitamins: Folic acid, vitamin B6 (pyridoxine), vitamin B12 (methylcobalamin)
2. Zinc
3. Selenium
4. Flax Seed
5. Green Tea
6. Oleanolic Acid – Olive leaf extract
7. Tumeric Rhizome extract
8. Lycopene
9. Betaine
10. Vitamin D
11. Calcium
12. Magnesium
13. Phosphorus
14. Saw Palmetto
15. Nettle Root
16. L-Alanine
17. L-Arginine
18. L-Glutamic Acid
19. Liposomal DHEA
20. Tribulus fruit and herb Extract
21. Ashwagandha Root Extract
22. Cowage Seed Extract
23. EPA-DHA Fish Oil Extract
24. Vitamin E

Please note that it is PARAMOUNT to consult with your doctor before starting these supplements, and as I am writing to inform you of these supplements, I am in no shape or form recommending their use without the supervision of your doctor.

I HOPE YOU HAVE ENJOYED READING….

Have a great day!

Margarita Ochoa-Maya, MD
Endocrinology and Metabolism

http://www.advancedhealthnh.com/
http://www.freedomtoheal.org/

WHAT HAPPENS WHEN A MAN HAS LOW TESTOSTERONE? IS IT ANDROPAUSE (MALE MENOPAUSE) OR IS IT SOMETHING ELSE? WHAT ARE THE CAUSES?

2012-05-28T09:22:00.003-04:00

WHAT HAPPENS WHEN A MAN HAS LOW TESTOSTERONE? IS IT ANDROPAUSE (MALE MENOPAUSE) OR IS IT SOMETHING ELSE? WHAT ARE THE CAUSES?

Unlike female menopause, which happens to every woman, and is abrupt and associated with aging, not all men become testosterone deficient with aging. It varies from man to man, and it is mostly associated between genetics, and environmental and behavioral factors. Male menopause is another name used to describe the decrease that happens with men as they age. There are other reasons a man can develop low testosterone and it is important to properly identify the cause of the problem. Unfortunately, there are no well-defined criteria on how to make a diagnosis, and when to start treatment. It remains an art. There are guidelines though, and the use of them helps the medical community make better decisions.

The diagnosis of low testosterone has increased in recent years. It has been reported that 12%, 19%, 28%, and 49% of men greater than 50, 60, 70, or 80 years of age, respectively, fit the criteria of having low testosterone.

There are a lot of factors that need to be taken into account when considering if a man has low male hormone. A thorough clinical history and physical examination and a comprehensive set of laboratory tests and even radiological tests need to be performed with your doctor in order to make a clear cut determination if a man has low testosterone.

Questionnaires are a good resource when considering if this may be a problem and may guide you to seek medical attention sooner. This is a set of questions set to be asked to a man, so when I use the word you in the questions, I am referring to a man. You can answer in two different ways; a YES or NO format, or give it a numeric value, meaning 0 if you have never had the problem and 10 if you always have the problem. In the case it is a definite YES, you can assign it a 10, and if it is a straightforward NO assign it a 0 value. At the end of the questionnaire, you can then add up your scores.

1. Do you notice that you developed male sexual characteristics late in life?

2. Do you have decreased libido, sex drive or sense of desire?

3. Have you noticed a decrease in your sexual activity?

4. Have you noticed a decrease in the morning or spontaneous erections?

5. Are your erections less frequent, less strong?

6. Do you climax?

7. Do you have a decreased amount of semen ejaculate?

8. Have you noticed your testicles change in size or become smaller?

9. Have you had inability to father a child or have been evaluated for infertility?

10. Have you noticed that you are feeling more and more tired as time goes by?

11. Have you noticed that your motivation or energy levels have dropped over time?

12. Have you noticed a decrease in ‘enjoyment of life in recent years?

13. Do you feel less confident?

14. Has there been a decrease in your work performance?

15. Have you noticed decreased memory or a change in your ability to concentrate?

16. Are you feeling sleepier during the day?

17. Do you suffer from insomnia?

18. DO you snore frequently?

19. Are you sad or grumpy?

20. DO you suffer from depression?

21. Are you overweight?

22. Have you noticed an increase in your abdominal fat and thinning of your arms and legs?

23. Have you noticed a decreased sense of strength or endurance?

24. Have you noticed a recent deterioration in your ability to play sports?

25. Have you noticed your muscles decrease in size?

26. Do your muscles ache?

27. Have you developed arthritic symptoms in the recent past?

28. Have you lost height?

29. Have you had a fracture falling from your own height?

30. Do you have osteoporosis?

31. Do you have dry skin?

32. Do you suffer from elevated cholesterol?

33. Do you suffer from diabetes?

34. Do you suffer from high blood pressure?

35. Are you on prescription medication for blood pressure?

36. Do you drink more than 2 alcoholic beverages every day?

37. Do you have breast discomfort or enlargement?

38. Have you noticed loss of body hair, reduced shaving?

39. Have you felt hot flushes or sweating episodes?

40. Have you tried Viagra, Cialis or other ED drugs and noticed they did not work?

41. Have you used marihuana in the recent past?

42. Have you been on prescription pain killers?

Now that we have asked the questions, you can add your scores.

If you answers totaled a score >250: You need to discuss this with your physician or care provider to consider testing for low testosterone as well as other medical conditions such as diabetes or elevated glucose, elevated cholesterol, high blood pressure and heart disease .

If you scored between 100 and 250, you are likely to have a problem and it would be a great benefit to you to have a conversation about the problems you are having with your health care provider, and consider testing for low testosterone and other medical problems that could be causing the way you feel.

If you scored 100 or less, it is still probable that you may have some problems with your health, and again, if you feel these issues are connected, you may want to look into these matters further and consider a visit with your doctor and health care provider.

HOW TO GET THE RIGHT DIAGNOSIS AND FIND OUT THE REASON FOR THE PROBLEM:

There have been many debates on this issue. Low testosterone, also called Hypogonadism, is often overlooked, even in the presence of complaints and physical changes. This is because men tend not to want to discuss this with their doctor, or the complaints are attributed to aging or other medical problems.

As men age, there is an increased risk of cardiovascular disease, depression, osteoporosis, and diabetes. Unfortunately, despite studies that have shown the association between declining levels of testosterone, and men’s health and wellbeing, the diagnosis needs to be a clinical one where both the patient’s complaints as well as the laboratory levels need to be taken into consideration. There have been numerous articles, committees and recommendations published by leaders in the medical field. Some look at at this problem from an endocrinologist point of view, some look from an urologist point of view.

In 2009, in order to ensure broad outreach, the International Society of Andrology (ISA), the International Society for the Study of the Aging Male (ISSAM), the European Association of Urology (EAU), the European Academy of Andrology (EAA) and the American Soceity of Andrology (ASA) published recommendations in all their journals simultaneously.

DEFINITION OF LOW TESTOSTERONE:

Low testosterone in a man, Hypogonadism, is a clinical and laboratory (biochemical) problem that can be associated with advanced age, and this condition may result insignificant detriment to the quality of life of an individual and may even adversely affect the function of multiple organs in the body.

At the time of the diagnosis, the person needs to have the presence of complaints and clinical signs on examination that would be suggestive of testosterone deficiency. This presentation needs to be correlated to an abnormal laboratory test.

An abnormal laboratory test is when the value of the Total testosterone is 2.5 standard deviations below the mean normal testosterone in young adults (627ng/dl). One standard deviation is equivalent to 123ng/dl. So in essence to have a clinically relevant low testosterone the Total Testosterone value should be LESS THAN 381ng/dl. Some studies round it up to less than 300ng/dl to be clinically significant.

Unfortunately it does not stop there. It is not enough to have low testosterone, the reason by which it decreased needs to be identified, and thus a more in-depth clinical, physical and laboratory assessment is necessary.

WHAT IS THE CAUSE OF LOW TESTOSTERONE?

When a man has low testosterone, it can be because of two major pathways:

a. Primary: If the brain is sending the messages to the testicles to work, but they are not doing the ‘job’, then it is a primary problem of the testicles, Primary Hypogonadism.

b. Secondary: If the brain is not sending message to the testicles to produce enough testosterone, it is called Central. Also called Secondary Hypogonadism, because the problem really does not lie in the testicles, the problem is in the brain.

WHAT OTHER TESTS NEED TO BE ORDERED?

As I stated above, it is not enough to just know that a man has low Testosterone (Low T). The cause needs to be identified because this will determine the course of the treatment and may even identify even more serious problems that need attention. Please make sure to discuss the following tests so they can be ordered if necessary when considering other causes of low testosterone with your doctor.

After screening with Total Testosterone and a low value has been found, such as lower than 300 ng/dl, a repeat test is needed. This time please make sure you go to the lab, in a fasting state. This means that you have not had food for the last 8 hours. It is also important that you have the lab test done early in the morning, as hormone levels are very sensitive to the time you wake up (circadian rhythm).

When considering other tests, they need to be taken into the context of other complaints that may be present and lead the doctor to make informed decisions and avoid excessive testing and high lab bills. This is a list of the tests that should be considered when doing a thorough work up for low testosterone:

1. Total testosterone

2. Free Testosterone

3. Sex Hormone Binding Globulin

4. Comprehensive Metabolic Profile (CMP)

5. Luteinizing Hormone (LH)

6. Follicular Stimulating Hormone (FSH)

7. Prolactin (PRL)

8. Fractionated Estrogens

9. Progesterone

10. Thyroid Stimulating Hormone

11. Am Cortisol

When doing these tests, the doctor can determine if the cause of the Low Testosterone. The different possibilities that cause a low testosterone in the blood are as follows:

1. Andropause, or low T associated with aging

2. Primary failure of the Testicles to produce testosterone

          a. Genetic Disorders (Klinefelter’s syndrome)

          b. Orchitis – or inflammation of the testicles

          c. Trauma

          d. Radiation and Chemotherapy

          e. Undescended Testicles

3. Secondary failure of the Testicles due to a brain problem that does not secrete LH and FSH the hormones necessary to stimulate their function

          a. Damage to the pituitary gland

                i. Kallman Syndrome

                ii. Brain tumor

                iii. Brain Trauma

                iv. Radiation

                v. Hematochromatosis

                vi. Sarcoidosis

                vii. Tuberculosis

So, in summary, I have presented to you a set of questions that can help a man determine if there may be any reason to think that there is low testosterone in the body. If that is the case, it should be addressed with the doctor or care provider so that the appropriate tests can be done, and treatment not only for the complaint but also for the cause, be initiated. In doing so, this may be done early and avoid future complications later as a consequence of low testosterone, and the original problem itself.

In my next blog, I will address andropause, male low testosterone associated with aging, and we will address the different kinds of treatment available.

Stay tuned,

Margarita Ochoa-Maya, MD

http://www.advancedhealthnh.com/

www.FreedomToHeal.org

WHAT DOES TESTOSTERONE DO TO MEN…

2012-05-20T09:36:00.000-04:00

WHAT DOES TESTOSTERONE DO TO MEN…

We are often bombarded with the question and the statement of low virility. In this series of blogs about male hormonal health, I have been discussing libido and erectile dysfunction. In some cases it may be due to low testosterone. But, in order to understand what is low, we first need to understand what testosterone is, what its main function is and then by doing so, we can understand what happens when it goes low.

What is Testosterone?

Testosterone is a steroid hormone. Hormones are the main communicators of the body and generate effects throughout the systems. Testosterone is found in mammals, reptiles, birds and other vertebrates. In humans, testosterone is primarily secreted by the Leydig cells in male testicles, and at lower levels it is also secreted by the female ovary and the adrenal glands. Secretions of hormones usually follow an internal clock and are highest early in the morning. On average, an adult male produces about 7-8 times more testosterone than an adult female, but females are more sensitive to the hormone.

Testosterone is the primary and the most well-known of many hormones that belong to the androgen group. Androgens are also called androgenic steroid hormones or testoids. It is the generic term given to any natural or synthetic compound that stimulates or controls the development and maintenance of male characteristics. It classically binds to specific androgen receptors everywhere in the body. Androgens control the development and activity of the male sex organs and development of male secondary sex characteristics. Androgens are the original anabolic steroids and the precursor of all estrogens, the female sex hormones.

How is Testosterone Measured?

There are many ways to measure testosterone; the most common one is via a blood test. When measuring testosterone and the different hormones that are related to its proper function, doctors usually measure the brain hormones that drive the production. The brain hormones associated with sexual differentiation are Follicular Stimulating Hormone (FSH) and Luteinizing Hormone (LH). Testosterone is also carried in the blood by Sex Hormone Binding Hormone (SHBH) and therefore there is a total pool of the carried ones, and the free ones: Total Testosterone and Free Testosterone.

In males, the normal range of Testosterone in blood is between 270 to 1,070 nanograms, with an ideal average level of 679 nanograms. (Pennsylvania State University Study)

Testosterone can also be measured in the saliva. These values are usually measure the bioavailable levels of steroid hormones active in the tissue.

What are the effects of Androgens and Testosterone?

In general, androgens promote protein synthesis and growth of those tissues with androgen receptors. Testosterone effects are mostly dependent on the levels and duration of circulating free testosterone in the body. The effects on the body are both virilizing and anabolic. This means that in men, testosterone will further the maturation of the sex organs and promote male characteristics. In women, high levels of testosterone can cause for the presence of more male-like characteristics. The anabolic effects of androgens are the ones that cause growth of muscle mass and strength, increased bone density and strength, and stimulation of linear growth and bone maturation.

Effects of Testosterone in the body (in chronological order):

1. Between 4 and 6 weeks of the gestation testosterone starts being produced and the effects of the hormone cause genital virilization and the formation of the penis, prostate and seminal vesicles.

2. During the 2nd trimester of pregnancy increasing androgen and testosterone levels have been associated with gender identity. Some studies state that during this period, intrauterine exposure to high androgens may be a predictor to feminine or masculine behaviors. This is still controversial.

3. In the first weeks of life for male infants testosterone levels rise. The levels remain in a pubertal range for a few months, but usually reach the barely detectable levels of childhood by 4–6 months of age. The reason for this is not clearly understood. . It has been speculated that "brain masculinization" is occurring since no significant changes have been identified in other parts of the body.

4. During puberty one of the first signs of the effect of androgens are the following:

Adult type body odor
Increased oiliness of skin and hair
Acne
Face changes where there is loss of subcutaneous fat and development of masculine facial features such as growth of jaw, brow, chin, nose, and remodeling of facial bone contours
The appearance of pubic hair is first, then comes axillary hair and last is chest and facial hair
Growth spurt
Increased muscle strength and mass
Shoulders become broader and rib cage expands
Voice changes and deepens
Development and growth of the Adam's apple
Accelerated bone maturation
Enlargement of the scrotum, penis and testicles
Increased libido and frequency of erection
Growth of spermatogenic tissue in testicles, male fertility

5. Adult: Aa a male adult, the male features are maintained, yet there continues to be constant effects of testosterone and androgens in the body.

Testosterone is necessary for normal sperm development. It activates genes in Sertoli cells, which promote differentiation of sperm. Throughout adulthood, androgens, testosterone and FSH cooperatively act on Sertoli cells in the testes to support sperm production
Maintains muscle tone and promotes muscle enlargement under stimulation with exercise and weights
Regulates bleeding and clotting via effects of thromboxane A2 receptors
In the brain, androgens can influence human behavior, and change the structure of the brain, and induce a sense of wellbeing, motivation, exhilaration and euphoria
Increases libido
Increased aggression
Regulates cognitive and physical energy
Inhibition of fat deposition and the ability for the fat cell to store lipids

What about other Androgens?

Other androgenic steroid hormones are also very important in the body. They are produced mainly in the adrenal cortex and support the main effects of testosterone. These hormones can also be found in the form of supplements. I will discuss this in further detail in my next blogs about low testosterone and the different treatments available.

Other androgens include:

Dehydroepiandrosterone (DHEA): a steroid hormone produced in the adrenal cortex from cholesterol. It is the primary precursor of natural estrogens. DHEA is also called dehydroisoandrosterone or dehydroandrosterone.

Androstenedione: an androgenic steroid produced by the testes, adrenal cortex, and ovaries. While androstenediones are converted metabolically to testosterone and other androgens, they are also the parent structure of estrone. Use of androstenedione as an athletic or body building supplement has been banned by the International Olympic Committee as well as other sporting organizations.

Androstenediol: the steroid metabolite that is thought to act as the main regulator of gonadotropin secretion.

Androsterone: a chemical by-product created during the breakdown of androgens, or derived from progesterone, that also exerts minor masculinizing effects, but with one-seventh the intensity of testosterone. It is found in approximately equal amounts in the plasma and urine of both males and females.

Dihydrotestosterone (DHT): a metabolite of testosterone, and a more potent androgen than testosterone in that it binds more strongly to androgen receptors. It is produced in the adrenal cortex.

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Now that I have explained the effects of testosterone in men, in my next blog I will present to you a questionnaire about testosterone and androgen deficiency. This will further interest you in the next blog explaining what is low testosterone and what a person can do about this situation. Stay tuned…. And have a great weekend.

Margarita Ochoa-Maya, MD
http://www.advancedhealthnh.com/
www.FreedomToHeal.org