The Nuts and Bolts of Bioidentical Hormone Replacement

 

Putting It all Together

Inflammation:The Silent Killer

• Chronic, low-grade inflammation is now recognized as the underlying pathology of many, if not most chronic disease.
• Obesity, diabetes, heart disease, cancer, and any number of neurodegenerative diseases all have a significant inflammatory component.(1)
• Interventions that suppress the development of chronic low-grade inflammation greatly aid in treating these diseases.(2)
  1. Simpson, Graham, “Wellman,” Basic Health, Publications, June 2010, 7.
  2. Simpson, G, ”Inflammation,” Eternity Medicine Quick Start Guide. Basic Health Publications, June 2010;48

The Face of Inflammation: Centralia, Pa.

Underground Mine Fire

• Inflammation occurs primarily in the cardiovascular system.
• Our markers identify inflammatory response, and if treated early, can delay and even reduce heart disease, diabetes, obesity, Alzheimer’s disease among others.
• c Reactive Protein, a marker for inflammation produced in the liver, is elevated in the presence of vascular disease.
• “Normal c RP” 0-4.9 mg/Dl Optimal c RP

LIMITING INFLAMMATION

1. Limit Free Radical Damage
2. Limit Toxic Environmental Exposure
3. Restore Youthful Hormone Levels
4. Activate Telomerase

Lifestyle– Nutrition, Exercise, stress reduction, meditation
Nutraceuticals– Omega 3’s,Resveratrol,Vitamin D3,Turmeric

Limit Free Radical Damage

• Omega 3 Fatty Acids
  • Supports Cardiovascular Health
  • Supports Healthy Mental Functioning
  • Supports Healthy Glucose and Insulin Metabolism
  • Anti-inflammatory
  • Antiplatelet Activity

• Turmeric (Curcumin)
  • Anti-inflammatory
  • Immune Support
  • Liver detoxification
  • Combine w Black Pepper Extract
  • Neutralizes free radicals

NUTRITION

The Standard American, S.A.D.

• Sugar-2014‐We consume over 160 lbs/ year
• Soft drinks-Increased sizes, amounts consumed
  Average intake of 411 calories daily
  Teenage consumption increased 70% from 1979‐1994
• Refined White Flour-We consume over 200 lbs or flour and cereal products/yr.
• Vegetable Oils-Increased consumption over 200%
  More trans fats and fried foods.
• Saturated Fat-Proinflammatory-Key element in the rise of autoimmune and chronic diseases.

Nutrition

1992 USDA Food Pyramid

• Start with plenty of Breads,Cereals, Rice and Pasta;
• Vegetables; and Fruits.
• Add two to three servings from the Meat group.
• Minimize fats, oils and sweets, the foods at the tip of the Pyramid.

Quick Starts

• PaleoCleanse
• Protein Sparing Modified Fast
• HCG + 500-800 Calorie Diet
• Mini Fast with Bone Broth and Exercise

Long Term RX:

• HFLC-High Fat, Low Carbohydrate
• Thyroid Enhancement Diet-Gluten Free
• Menopause Diet-Low in Cruciferous Vegetables
• Testosterone Enhancement Diet-High Protein, Ketogenic

Body Site

Nutrition

• Blood Sugar– Everything consumed in the form of food and drink converts, in the body, to glucose. Chronic elevated blood sugar levels (>100) is a marker for diabetes.
• Diabetes Risk- Every point over 84 on a FBS your risk of diabetes is elevated by 4%.
• “Normal” Blood Sugar” 65-99
  • FBS 98 (normal)
• “Optimal” Blood Sugar 65-84
  • Risk= 56%
• Insulin-produced in the pancreas, enables cells to use glucose for fuel.
• Elevated insulin levels indicate poor utilization resulting in proinflammatory state.
• “Normal” Insulin 2.6-24.9 mL U/ml “Optimal” Insulin

Increases Insulin Receptor Activity, Improves Sensitivity to Insulin

• Cinnamon 500 mg/day or 1 tsp/day
• Chromium picolinate (400-600 mcg.Lipoic
• acid (200-600 mg)
• CLA (1,000-3,000 mg)
• Zinc 25-50 mg)
• Vitamin E (600-800 IU natural)
• Taurine (1,000-3,000 mg)
• Magnesium (400-800 mg)
• Biotin (4-8 mg)
• Vanadium (20-50 mg)
• Vitamin D 3
• Co-enzyme Q-10 (30-300 mg)
• B complex (50-100 mg)
• Vitamin C (1,000-3,000 mg)
• Manganese (5-10 mg)
• Inositol
• Fenugreek-Interferes with absorption and digestion of sugars
• Gymnema sylvestre-Improves insulin sensitivity,interferes with the absorption of glucose
• Lentils
• Chickpeas
• Broccoli
• Medications
• Aldactone (spironolactone), Tagamet (cimetidine)
• Testosterone metabolism blockers: Avodart
• Glucophage (metformin)
• Hair growth stimulators: Rogaine solution(minoxidil)
• Hair metabolism inhibitors: Vaniqa cream(eflornithine)
• Insulin

Nutritional Marker

• Homocysteine-Elevated homocysteine indicates B complex or folic acid deficiency. Excess homocysteine damages arteries, increases the risk of blood clotting, strokes, heart attacks and diminished limb circulation.
• “Normal” Homocysteine
• Vitamin D-Necessary for calcium absorption and bone strength, insures adequate immune function, heart, brain and blood vessel integrity, insulin regulation and mood stabilization.
• “Normal” 25-hydroxyvitamin D (25(OH)D) 30-100 ng/ml
• “Optimal” 25-hydroxyvitamin D (25(OH)D) 50-80 ng/ml

20 minutes of sunshine= 20,000 IU Vitamin D3
Rx. Vitamin D3-1000 IU Supplement Raises Approx. 8 ng/ml in 6-8 wks

Vitamin D and Infectious DIsease

1. 1,25(OH)2D acts as an immune system modulator.
2. Prevents excessive expression of inflammatory cytokines and increases the ‘oxidative burst potential of macrophages.
3. Dramatically stimulates the expression of potent anti-microbial peptides, which exist in neutrophils, monocytes, natural killer cells, and in epithelial cells lining the respiratory tract.

Canell J et al. Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129-40.
Study: 1200 IU D3/day; Placebo, double blind, controlled

• Relative Risk getting Influenza A
• All treated children in study – .58 Not previously taking Vitamin D – .36 Started preschool > 3 y/o – .36
• Urashima M et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr March 10, 2010710

Vitamin D and Cardiovascular Dx.

18,000 men 45-75 without CV disease

• 10 year follow up
• 25 (OH) < 15 ng/mL 2.5 x risk
• 15-30 ng/mL 2.0 x risk
• > 30 ng/mL 1.0

Giovannucci E al. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008 Jun 9;168(11):1174-80.

Micronutrient Test

Vitamins

• Vitamin A
• Vitamin B1
• Vitamin B2
• Vitamin B3
• Vitamin B6
• Vitamin B12
• Biotin
• Folate
• Pantothenate
• Vitamin C
• Vitamin D
• Vitamin K

Minerals

• Calcium
• Magnesium
• Manganese
• Zinc
• Copper

Amino Acids

• Asparagine
• Glutamine
• Serine

Fatty Acids

• Oleic Acid

Antioxidants

• Alpha Lipoic Acid
• Coenzyme Q10
• Cysteine
• Glutathione
• Selenium
• Vitamin E

Carbohydrate Metabolism

• Chromium
• Fructose Sensitivity
• Glucose-Insulin Metabolism

Metabolites

• Choline
• Inositol
• Carnitine

SPECTROX™

• for Total Antioxidant Function

IMMUNIDEX™

• Immune Response Score

Hormone Optimization

• SEX HORMONES
  (Estrogen, Progesterone,Testosterone, DHEA)
• THYROID HORMONE
• ADRENAL HORMONES
  (Cortisol, Pregnenolone and DHEA)

Female Hormone Optimization

• Estrogen-Protects the bones, heart brains. Protects against night sweats, hot flashes, mood changes, brain fog.
  • Normal Estradiol
  • Optimal Estradiol 80-100 pg/ml
  • Fractionated E1, E2, E3
• Progesterone deficiency manifests as anxiety, depression, irritability, insomnia, osteoporosis, hypersensitivity, nervousness, migraine headaches,weight gain, decreased libido and decreased HDL (good cholesterol).
  • Normal Progesterone 0.1-0.8 ng/ml
  • “Optimal” Prog. 10-20 ng/ml

Micronized Progesterone

• Maintains Pregnancy
• Improves Mood
• Improves Sleep
• Diuretic
• Maintains Estrogen Induced
• Arterial Dilation
• Protects Against CVA
• Reduce Estrogenic Breast
• Stimulation
• Prevents Breast Cancer
• Improves Lipid Profile

Testosterone in Women

Normal 2-45 ng/DL

• Improves sex drive
• Memory
• Skin Turgor
• Bone Strength
• Cognition
• Heart Disease Protection

Optimal 30-40 ng/DL

• Blood Pressure Regulation
• Ant-inflammatory arthritis
• Reduces body fat
• Regulates Blood Sugar
• Antidepressant
• Reduces LDL cholesterol, clotting factors.
• Maintains urinary continence.

Male Hormone Optimization

Normal 300-1000 ng/DL

• Improves sex drive
• Memory
• Skin Turgor
• Bone Strength
• Cognition
• Heart Disease Protection

Optimal 700-1100 ng/DL

• Blood Pressure Regulation
• Ant-inflammatory arthritis
• Reduces body fat
• Regulates Blood Sugar
• Antidepressant
• Reduces LDL cholesterol, clotting factors.
• Maintains urinary continence.

Male Hormone Optimization

Estrogen-15% of all testosterone converts to estradiol. Elevated estradiol levels are associated with enlarged, tender breasts (man boobs), and cardiac disease.

• Normal Estradiol
• Optimal Estradiol

PSA-A protein synthesized in the prostate rises as one ages. A sharp rise over a short period of time may indicate prostatic disease. An elevated PSA, while worrisome, does not mean one has cancer.

• Normal PSA
• Optimal PSA

Male and Female Optimization

DHEA-The “Stage Coach” Stop

• Drives production of testosterone and estrogen.
• Neuroactive steroid
  • Regulates Mood
  • Supports the Immune System
  • Improves Insulin Sensitivity
  • Bone health.
• Normal DHEA 95-345 mcg/dL
  • Male Optimal DHEA 500-600 mcg/dL
  • Female Optimal DHEA 200-250 mcg/dL

Growth Hormone

• IGF-1-A stable indicator of Growth Hormone used to detect deficiencies and excesses. Growth Hormone promotes normal bone and tissue growth and development. Growth Hormone is considered, by some, the “Holy Grail,” the most important hormone to combat aging.
• “Normal IGF-1” 53-190 ng/Ml
• “Optimal” IGF-1 200-250 ng/Ml
• IGFBP 3-Binding Protein. Deterimeins “Free IGF-1”
  “Normal IGFBP 3” 3.4-6.7 mcg/Ml

Thyroid Optimization

• TSH: Produced in pituitary gland. Detects low or high circulating thyroid.
  • “Normal Value 0.40-4.5 mIU/L “Optimal” 0.8-2.0 mIU/L
  • difference between 0.4 to 4.5= 5.5 kg or 12.13 pounds
• free T4: T4 is primary hormone produced by your thyroid. Storage hormone and meant to convert to active hormone T3.
  • “Normal” T4 0.7-1.53 ng/dl “Optimal” 1.15-1.53 ng/dl
• free T3: T3 is your active thyroid hormone. “free” T3 fraction represents amount that is available for use.
  • “Normal” free T3 2.0-4.4 pg/ml “Optimal” 3.8-4.2 pg/ml
• reverse T3 (rT3):. Reverse T3 is an inactive form of T3. T4 can be converted to eir T3 or reverse T3. rT3,
  is not available for metabolic function

Autoimmunity and the Thyroid

• Anti-thyroid peroxidase antibodies (TPO):Antibodies are proteins in your immune system that serve to identify and remove foreign antigens. Peroxidase is an enzyme that is critical in conversion of T4 to T3. TPO is a measure of inappropriate attack of your immune system on.
  • “Normal”
• Thyroglobulin antibodies (TgAb):. Thyroglobulin is a protein that exists solely within your thyroid gland to synthesize T4 and T3 hormones. TgAb is a measurement of inappropriate attack of your immune syst on this particular protein.
  • “Normal”
• Thyroid Antibodies: Graves Disease (Autoimmune Hyperthyroidism)
• Thyroid Stimulating Immunoglobulin (TSI) “Optimal” < 30 IU/mL

Root Causes of Autoimmune Thyroid Disease

• Gluten
• Infectious Diseases
• Heavy Metals
• Adrenal Fatigue
• Iodine/Selenium/Nutrients

To Complete the Thyroid Picture

• B12: Function of red blood cells and nervous system. Stress and deficiency in stomach acid depletes vitamin B12 levels. Low B12 levels will exacerbate symptoms related to fatigue and mental health.
  • “Optimal” > 800 pg/mL.
• Ferritin: Storage form of iron. Releases iron to blood stream.
  • Low=iron deficiency. Iron deficiency exacerbates hypothyroidism.
  • High=cardiac disease
  • “Optimal” 90-110 ng/mL
• 25-hydroxyvitamin D: Low in thyroid disease due to digestive challenges.
  • “Normal” 30-100 ng/mL “Optimal” 50-80 ng/Ml

LOW T3 IS STRONGEST INDEPENDENT PREDICTOR OF CARDIAC DEATH

• Low T3 < 3.1 Free T3
• Low-T3 syndrome is a strong predictor of death in cardiac patients and might be directly implicated in poor prognosis of cardiac patients.
• Strongest independent predictor of death > Lipids or EF
• Iervasi, G et al. Low-T3 Syndrome, A Strong Prognostic Predictor of Death in Patients With Heart Disease Circulation.2003;107:708

Mind/Body: What Do I Want To Be When I Grow Up?

Weekly Homework Assignments

• Each week we assign “homework” to round out your body, mind and spirit.

Week 1

Goals

• Family,
• Spirituality
• Physical Well Being
• Education
• Finances

Week 2

Self Identification

• Rate yourself in 16 categories on a scale of 10 (perfect) to 1 (abysmal) in sixteen different life categories. Return to this and repeat the exercise every 4-8 weeks.

Week 3

What Did You Do To Make Your Life Great?

• Pretend it is six months in the future. Describe your actions that resulted in your new found state of contentment?
• Pretend it is New Year’s Eve 5 years in the future. What actions resulted in your new found state of contentment?

Week 4:

What actions will you take in the next week, next month, and next year, to achieve your goals?

• Specifically outline a plan of action for the next week, month, and year to achieve your goals.

Week 5:

The Bucket List

• What do you want to experience before moving on to another dimension.

Week 6 :

Sit Right Down and Write Yourself a Letter

• Write a letter to yourself. Outline your goals, and how you proposed to achieve them. Re do the Self
  Identification quiz. How this changed? What has improved? What has regressed? Address and stamp an envelope to yourself. Place it in a prominent location. Mail it to yourself in 6 months.

Week 7:

Sit Right Down and Write Yourself a Another Letter

• Repeat Week 6’s assignment but use five years out as the time frame for review.

Week 8:

Review Your Goals From Week 1.

• Make new goals for the next 8 week cycle. Identify three new patterns that will help you stay on
  track and continue reaching your goals.

Oxygen

• Increases Blood Flow
• Reduces Acid
• Removes Toxins
• Moves Nutrients to Needed Sites
• Breath Awareness- Count 25 breaths 3x/day
• Massage
• Epsom Salt Bath
• Craniosacral Breath Techniques
• Aromatherapy
  • Lavender, Blue Tanzi-Calming
  • Lemon and Bergamot-Mood Stabilizer
  • Rosemary-Mental Alertness, Increase Brain Blood Flow
  • Peppermint-Mental Alertness, Brain Blood Flow
  • Oregano and Thyme-Immune Booster, Candida Antagonist
• Exercise
• Aerobics
• Strength
  • 5 min Squats
  • 5 min Lunges
  • 5 min Push Ups

Where Do I Begin ?

• Diet:Review Diet Choices-Paleo Cleanse, Minifast, Liquid Protein, HCG, or Ultimate Lifestyle Plan
• Supplements and or Prescription Appetite Suppressants Exercise:Walk At Least 10 minutes without stopping 5 days a week
• Moment of Gratitude: Name one thing you are grateful for today.
• Buy or Grow Flowers: for your home environment

Week One

Set Goals-3-5/ Category

• Family
• Physical/Nutrition
• Education
• Financial

Action Steps

• Diet/Supplements
• Exercise
• Moment of Gratitude:
• Buy or Grow Flowers:

Week Two

Rate Yourself

• Diet
• Exercise
• Life Plan
• Love of Work
• Romance
• Finishing What You Start
• Children
• Family

Scale 1-10 (10 is Perfect)

• Financial Planning
• Music, Dance, Art
• Hobbies
• Adventure
• Risk
• Down Time
• Giving Back
• Gratitude

Diet

1. Remove Oils except recommended plant based oils.
2. Remove artificial coloring
3. Eat broccoli two times weekly
4. Add a Solutions 4 protein supplement.
5. No white bread, white sugar or white flour.
6. Substitute Green Tea for at least one cup of coffee a day
7. Eat Cold Northern fish (Wild salmon, kippers, once per week)

• Supplements/Hormones
• Exercise Walk At Least 15 minutes without stopping 5/ week
• Moment of Gratitude: Name one thing you are grateful today.
• Buy or Grow Flowers: for your home environment

Week Three

The Big Question

If we are to meet back in 6 months what would have to happen in your life to make you feel great?

Answer:

• Supplements/Hormones
• Exercise: Walk At Least 20 minutes without stopping 5days/ wk Consider Stress Reduction Techniques Ex: Tai Chi, Yoga/Stretching
• Moment of Gratitude: Name one thing you are grateful today.
• Buy or Grow Flowers: for your home environment

Week Four

Specific Goal For Each Category
Family:

• This week I will…
• This month I will
• This year I will…

Education:

• This week I will…
• This month I will
• This year I will…

Physical/Nutrition

• This week I will…
• This month I will
• This year I will…

Financial

• This week I will…
• This month I will
• This year I will…

• Supplements/Hormones
• Exercise:Walk At Least 25 minutes without stopping 5days/ wk Consider Stress Reduction Techniques Ex:Tai Chi,Yoga/Stretching
• Moment of Gratitude: Name one thing you are grateful today.
• Buy or Grow Flowers: for your home environment

Consider A No News Day

Week Five

The Bucket List:

What Do You Want to Experience Before Moving to the Next Life Plain

• Diet:
  • Make a root ginger tea
  • ½ tsp grated root into a cup of boiling water
  • cover pot and steep for 10-15 minutes
  • strain-hot or iced
• Supplements/Hormones
• Exercise: Walk At Least 35 minutes without stopping 5days/ wk
• Moment of Gratitude: Name one thing you are grateful today.
• Buy or Grow Flowers
• Enjoy an Inspirational Book or Music

Week Six

Write Yourself A Letter.

• How have the parts on your Life Happiness Scale Changed?
• What do they look like now?
• Address an envelope to yourself.
• Seal it and put it in a safe place, or give it to a friend or loved one.
• Open it in 6 months.

• Diet: Add Cooked Greens
• Supplements/Hormones
• Exercise: Walk At Least 40 minutes without stopping 5days/ wk
• Moment of Gratitude: Name one thing you are grateful today.
• Buy or Grow Flowers
• List friends who are happy, alive and energetic.Spend time with one this week
• Visit a park, woods or nature preserve

Week Seven

5 Year Vision
Write Yourself Another Letter.

• Review it in 5 Years to Compare Your Desires With Your Reality.
• How have the parts on your Life Happiness Scale Changed?
• What do they look like now?
• Address an envelope to yourself.
• Seal it and put it in a safe place, or give it to a friend or loved one.
• Open it in 5 Years.
• Diet: Add An Adaptogenic Remedy and Bone Broth Daily
• Supplements/Hormones
• Exercise:Walk At Least 45 minutes without stopping 5days/ wk
• Moment of Gratitude: Name one thing you are grateful today.
• Buy or Grow Flowers
• Reach Out to Someone You Are Estranged From Visit a park, woods or nature preserve

Week Eight

You Are Never Done

• Write Down 5 Things New Goals to Pursue in the next 8 Weeks
• Identify 2 Actions You Have Learned to Support Others
• Identify Three New Patterns That Will Help You Stay on Track
• Review all the changes you have made.
• Diet: Ask for Help IF YOu Go Off Track
• Supplements/Hormones
• Exercise: Walk At Least 50 minutes without stopping 5days/ wk
• Moment of Gratitude: Name one thing you are grateful today.
• Buy or Grow Flowers for Yourself and Someone Else
• Reach Out to Someone You Are Estranged From Visit a park, woods or nature preserve

Thank You!

drbill@rejuvenatereno.com
https://drclearfield.net