Dear Friends and Patients:
As the Christmas/Chanukah holidays and a New Year rapidly approach, the staff at the Preventive Medicine Center and I want to say “thank you” for all of your referrals and support this past year. Many of you have worked hard to improve your health and enjoy life, and we celebrate your successes. Our heartfelt wishes go out to you and your families for a healthy and joyous holiday season. As I reflect back on how wonderful it was as a child to visit our Grandparents during this time of year, everything back then seemed “perfect” – the house decorations, the presents, the meals, the family being together. As adults, we realize the holidays can be especially stressful, often times because our expectations exceed what is possible. In this issue of the newsletter we’ll discuss both holiday stress and chronic stress.
Joel and Michelle Levey, co-founders of Innerwork Technologies have worked with hundreds of leading organizations such as AT&T, NASA, many medical centers, professional organizations and world class athletes. Their works provide a unique synthesis of contemporary and traditional disciplines and wisdom. Below, I have condensed some of their suggestions on managing your own responses to the holidays and perhaps increasing your enjoyment of this special time of year.
1. Create realistic expectations – don’t try to make this the perfect holiday. For many people, creating realistic expectations is the most challenging, and the most important principal to apply to the holiday season. It can be so easy to get caught up in cozy, romantic images of a fantasy holiday where everyone is happy together, everything runs smoothly, and the sounds of laughter echo to a backdrop of snowflakes and sleigh bells. A more realistic measure of success may be everyone feeling some happiness.
2. Say ‘no’ to extra obligations that might stress you out. As the calendar fills to the brim, you may start feeling overbooked and overwhelmed. By learning to mindfully reflect on how you plan to spend your time, you can better prioritize your obligations and make conscious choices about your time commitments.
3. Take short relaxation breaks to let go of tension. It is difficult to sustain high levels of activity and stimulation, especially at holiday time, without taking some ‘down time’ to restore yourself. Whenever you notice you are getting stressed or anxious, simply stop and pause for a moment, take in a deep breath, and slowly exhale, releasing the tension you may be carrying. You can also practice relaxation guided imagery to calm your mind and body. By reducing your overall anxiety level in these ways, you will be able to better cope with the stresses of the holidays.
4. Get involved in a volunteer activity where you help others. Few activities result in greater satisfaction than the act of giving selflessly from the heart. When you help others, you are naturally likely to capture a sense of belonging and inner joy for yourself. What better way to balance the craziness of the materialistic holiday stampede than to volunteer and help those in need?
5. Create a hand-made gift. Creating a gift can provide an important outlet for you to express your creativity. Making a gift can also be a calm, meditative experience, and can foster a deeper connection between you and the recipient.
6. Eat and drink sensibly, get plenty of sleep and exercise. Holidays are the time where a lot of people take in too much fat, sugar, caffeine, and alcohol and forget about enough sleep and exercise. One of the easiest ways to combat holiday stress is to pay better attention to your body’s needs for healthy food, adequate sleep, and exercise.
7. Practice being a peacemaker if family squabbles erupt. With the stress of the holiday expectations, it’s easy for people to get their feelings hurt. If this starts happening in your family interactions, shift your view to the bigger picture and help family members make peace with one another. Two simple keys are to listen more attentively and to let others know that they have been heard.
8. Reflect on the deeper meaning and spirit of the holidays. The deeper, more spiritual meaning of the holiday season can become lost when holidays center on the commercial aspects. By pausing to reflect on the meaning of the holidays for you and your family, you can get a better perspective on how to organize your holiday priorities.
Mind-Body Connection and Health
The link between emotions and health was first detected by Hippocrates and his followers, and even in the modern medicine of today the idea that the mind effects the body is generally accepted. Science has shown that emotions can have an impact on headaches, insomnia, weight gain or loss, cardiovascular disease, asthma, and even the effectiveness of cancer treatment.
Chronic stress is very common in Western society and can be the result of all sorts of factors: a difficult job situation or job loss, a stormy marriage or one that is going through a divorce, caring for an ill parent, spouse or relative, being in chronic pain, etc.. Stress can cause the body to react through stimulation of the sympathetic nervous system. This is called the “fight or flight” response. When this happens, epinephrine (adrenaline) is secreted by the adrenal glands, stimulating the release of another hormone ACTH, which in turn causes the release of the hormone cortisol. As with most hormonal systems, there is a negative feedback system to regulate and limit the production of each hormone. During prolonged stress, when the body perceives that survival is at stake, this mechanism does not work. In fact, the body can react to produce elevated levels of cortisol, and this exerts a dampening effect on the negative feedback system. High cortisol can lead to estrogen imbalance, increased salt and water retention, reduced bone mass, impairment of the immune system and reduced insulin sensitivity and increased blood sugar as well as other negative effects.
William Lovallo, PhD at the University of Oklahoma Health Sciences Center has conducted research on cortisol. “We know that cortisol has a long-term effect on memory and that large amounts over long periods of time can actually damage memory structures in the brain.” Researchers recently discovered that prolonged stress also contributes to cellular aging and could cause the development of a variety of diseases. What was found was that stress effects telomeres, which are DNA-protein complexes stuck onto chromosomes. Telomeres promote genetic stability and play an important role in the number of times a cell divides. Elissa Epel, PhD, an assistant adjunct professor of psychiatry at the University of California, San Francisco, found that women who cared for chronically ill children were more likely to have shortened telomeres than were women who had healthy children.
With prolonged stress, the amount of cortisol produced can initially be elevated, but later the body is unable to keep up and cortisol levels may become suboptimal. A condition called adrenal fatigue can then develop.
What Are the Symptoms of Adrenal Fatigue?
Medical books from the 1800's describe “adrenal fatigue” as a clinical condition. However, conventional medicine does not usually recognize adrenal fatigue as such. It does recognize Addison’s disease, a condition usually caused by autoimmune dysfunction, where low cortisol levels are measured by conventional laboratory tests. Adrenal fatigue, on the other hand, is caused by prolonged stress. Some of the symptoms include lethargy, decreased ability to handle stress, dry or thin skin, hypoglycemia (low blood sugar), low body temperature, irritable bowel type symptoms, heartburn, and mild depression. There may be a tendency to gain weight and inability to lose it. A person may experience difficulty in remembering things, need coffee or stimulants to get going, or crave salty, fatty or high protein foods. Often times the symptoms improve when stress is relieved, such as on a vacation. Of course, these symptoms can occur with other disorders as well.
Why does Traditional Medicine Miss Diagnosing Adrenal Fatigue?
Traditional doctor’s rely on traditional blood tests, and the traditional blood tests detect only a severe deficiency (Addison’s disease) or excess (Cushing’s disease) of adrenal hormones. Here is the problem: there is a wide reference range of “normal” for cortisol levels. In fact, your adrenal hormones can be 50% lower than the optimum level and still be considered “normal.” But such a “normal” level of adrenal hormones does not mean a patient is free of adrenal fatigue. To diagnose adrenal fatigue, a more sensitive laboratory test is required using salivary hormone assays. One advantage of this test is that it measures the free and circulating hormones available for your body to use, rather than the hormones that are bound to protein and are unavailable for use. Traditional lab tests measure the total cortisol and DHEA which does not differentiate between the available and unavailable hormones. Taking oral or transdermal medications with DHEA or other hormones in them can affect test results, as can being under stress while the test is being run. The salivary DHEA can be measured at any time. Four different timed specimens for salivary cortisol are obtained (7 AM, noon, 5PM, midnight). Cortisol levels are normally higher in the morning and decrease through the day.
If you have been under chronic stress and would like to schedule a salivary adrenocortex stress profile, contact us to arrange this. Adrenal fatigue is a treatable condition. At the Center we customize a treatment protocol that is specific for each patient that may involve nutritional supplements, herbal preparations, stress reduction techniques, amino acid therapies, homeopathic remedies, massage therapy, exercise or yoga, and other techniques.
A Story of Estrogen Dominance
Mrs. D is a 38 year old lady who came to see me with a constellation of symptoms. She was concerned about being overweight and was especially upset about the fat deposits in her thighs and hips. “I crave a lot of sugar and sweets and I have a lot of premenstrual mood swings and depression.” On further questioning, Mrs. D admitted to experiencing water retention, breast swelling, heavy periods, and a loss of sex drive. Mrs. D’s family history was that of a mother and also an older sister having had breast cancer. On physical exam her breast exam revealed fibrocystic changes.
Mrs. D. was suffering from estrogen dominance, a condition where there is an imbalance between the two hormones estrogen and progesterone. In a healthy woman, estrogen and progesterone tend to balance each other out. When a woman’s body makes either too much estrogen or too little progesterone, a condition where there is a hormonal imbalance with excessive estrogen may occur. Estrogen dominance is a risk factor for developing breast cancer. As a women goes through menopause, her ovaries stop producing the balance of hormones, and progesterone is usually very low. Is it coincidental that the majority of all breast cancers occur after menopause? Estrogen dominance can also occur if a woman is taking artificial or natural estrogens in too high amounts. Mrs. D had previously called her obstetrician’s office and was advised to go on birth control pills “to balance her hormones.”
A Brief History of Artificial Hormone Replacement and It’s Complications
Over half a century ago physicians began treating women who had entered menopause with an artificial (for humans) estrogen derived from horse urine known as Premarin. Although this drug controlled their hot flushes, mood swings, and other symptoms, women taking this drug began developing uterine cancer at a rate up to 8 times that of women not taking the drug. It was not known at that time that a condition called estrogen dominance was being created by this drug. This increased cancer development was due to a high dose of estrogen continuously stimulating the lining of the uterus. When another drug called Provera (a progestin) was later added, the increased uterine cancer development was reversed. This combination of drugs was prescribed for decades by physicians and gynecologists. Then, in 2002, the results of a revolutionary study called the Women’s Health Initiative (WHI) involving over 161,000 post menopausal women were published. Some of the participants had been given the combination of Premarin and Provera. This group was found to be at greater risk for breast cancer, heart disease and stroke. In fact, the stroke risk was so alarming that the study was terminated early. Other participants were randomly assigned Premarin or placebos. This part of the study found no increased risk of breast cancer in women who had taken Premarin for less than 7 years (the Premarin group did have an increased risk of stroke). Although there were numerous articles that followed in newspapers and medical journals touting the safety of “estrogen” and that it didn’t cause breast cancer, the sales of Prempro, Premarin and Provera plumeted because of the serious side effects.
Another study which involved 127,000 nurses, called the Nurse’s Health Study, found women who took artificial hormones for at least 15 years had a markedly higher risk of developing breast cancer. This study also showed women who had naturally high levels of estrogen (estrogen dominance) were at greater risk for developing breast cancer.
There are also environmental sources of xenoestrogens (foreign estrogens) that humans are exposed to everyday. Some of these sources are pesticides or pesticide residues on non-organic vegetables, chemicals from plastics, and hormones that are given to cattle and poultry that end up in our bodies after consuming meat, milk, or dairy products.
Natural vs. Artificial Hormones
I want our readers to understand that Premarin, birth control pills and other artificial hormones are not identical to the hormones the human body produces. They are, in fact, totally different chemical structures and I use the word “artificial” in this article to make this point. Premarin contains absolutely no estriol, the major natural estrogen that makes up 80% of human estrogen. It does contain 10% estrone, which humans make. The other 90% of Premarin is composed of horse estrogens that are totally foreign to human beings but not horses. Unfortunately, the term “estrogen” and “Premarin” are used interchangeably by doctors, the lay press, and medical journals. Even more unfortunate is the fact that bio-identical hormones are lumped into this group when they are the only hormones identical in chemical structure to what the human body produces.
Are natural or bio-identical hormones safer than artificial hormones? We don’t know for certain because there have been no large clinical studies to determine this. Intuitively, physicians who prescribe bio-identical hormones feel they are safer when prescribed in proper, balanced amounts because they are not foreign to the human body and because the human body has the metabolic pathways in place to metabolize our natural hormones.
Is There a Hormone Imbalance in Your Breasts?
Mrs. D was made aware that estrogen dominance was a risk factor for developing breast cancer. Further evaluation included measuring the blood levels of hormones in the 3rd week of her menstrual cycle which showed low progesterone and high estrogen levels. But was this affecting her breasts? I advised Mrs. D to obtain a thermogram of her breasts. If discovered, certain thermographic risk markers can warn a woman that she needs to work with her doctor to improve breast health. Breast thermography is the only non-invasive method that visualizes whether there is an estrogen dominant effect on the breasts. Mammography does not, and is not recommended for women below the age of 40. Mrs. D’s thermographic scan subsequently did show a thermal pattern consistent with her estrogen dominance. If you suspect you have estrogen dominance, or would simply like more information on Breast Thermography, go to our website www.prevent-doc.com and click on the link to Thermography. Or call Gainesville Thermography at 352-332-7212.
CAM Therapies to the Rescue
Mrs. D was advised against using birth control pills. Current studies show birth control pills do increase the risk of developing breast cancer, although this risk is not as great as with estrogen replacement therapy. Instead, natural micronized progesterone cream was prescribed to correct her low progesterone levels. She was instructed to apply the progesterone cream to her breasts, abdomen and arms during the last half of her menstrual cycle. Mrs. D was also advised to increase her intake of soy, cruciferous vegetables, and to try Black Cohosh on a daily basis. These plant products have weak but safe estrogenic substances that help reduce the effects of her high estrogen at the receptor site level.
A repeat breast thermography was performed at three months. Mrs. D was excited to see her breast thermal pattern had improved, proving that the therapies prescribed were working. She also noted the fibrocystic lumps in her breasts were less prominent and no longer tender, and the mood swings and heavy periods had also improved significantly.
Success Story – Patient with Anxiety
Mr. M is a married male in his 60's who came to the Center complaining of anxiety attacks. He had been placed on Xanax, a highly addictive drug, by another physician, and in spite of taking this medication, he still had a lot of anxiety. Mr. M underwent a complete physical exam, kinesthetic testing, lab work and a nutritional evaluation. He was found to have a hormonal imbalance with high estrogen levels. An enzyme called aromatase was converting his testosterone into estrogen. He was placed on Palmetto Plus Forte and Calcium D Glucarate to correct this hormonal imbalance. Within 6 weeks his estradiol dropped from the 70's to below 20 (below 30 is considered normal for males).
He was also found to have imbalances in his neurotransmitters on urine testing, including serotonin and epinephrine. He was placed on a program of targeted amino acid therapy (amino acids are naturally occurring building blocks of neurotransmitters and proteins) to balance his neurotransmitter, as he did not want to take antidepressant drugs. He not only was able to stop his Xanax, but his anxiety was completely gone at the first revisit in 6 weeks. He was back actively working and doing the things he previously enjoyed. His wife was excited to have her husband back to his old self again.
What’s New At The Center?
