If you're grappling with high cholesterol levels and seeking a natural approach to manage them, you're in the right place. In this article, we'll delve into the specifics of how to control high cholesterol naturally. We'll address the changes you need to make, the timeframe for results, and other crucial aspects of managing cholesterol naturally.

Understanding Cholesterol Levels

Cholesterol testing is a crucial step in assessing one's cardiovascular health. It provides valuable insights into different components, including total cholesterol, triglycerides, HDL (high-density lipoprotein), and LDL (low-density lipoprotein) cholesterol. While all these numbers play a role in understanding overall cholesterol levels, it is LDL cholesterol that poses the greatest risk for heart disease.

LDL cholesterol, often referred to as "bad" cholesterol, is responsible for transporting some cholesterol from the liver to various cells in the body. However, when there is an excess of LDL cholesterol, it can build up in the arteries, leading to plaque formation and potentially increasing the risk of heart disease.

Understanding the significance of LDL cholesterol  (and LDL Particles) is essential in managing high cholesterol levels. By focusing on reducing LDL cholesterol, individuals can take proactive steps towards improving their cardiovascular health. This can be achieved through various lifestyle modifications, particularly dietary adjustments.

Diet and LDL Cholesterol

Saturated fats can disrupt the production of LDL receptors, leading to elevated LDL cholesterol levels.

To take control of your cholesterol and embark on a successful cholesterol management journey, it is essential to start by calculating your daily intake of saturated fats. This step acts as a pivotal foundation in understanding the impact of your diet on your cholesterol levels.  By reducing your saturated fat intake, you can significantly lower your LDL cholesterol levels.

As noted, saturated fats have been found to disrupt the production of LDL receptors. This ultimately leads to elevated LDL cholesterol levels.  By consciously monitoring and reducing your saturated fat intake, you can increase LDL receptors, reduce LDL cholesterol and effectively reduce the risk of heart disease.

When considering the optimal range for saturated fat intake, it is important to tailor it to your individual starting point and body's response. While a daily intake range of 10 to 20 grams may be suitable for some individuals, others may need to further reduce saturated fat to 10 to 15 grams daily for optimal results. It is crucial to note that the focus should be on saturated fat, rather than eliminating all fats from your diet.

Even a modest reduction of 10% in saturated fat intake can have a positive impact on your LDL cholesterol levels. This reduction can be achieved by making simple dietary adjustments, such as choosing leaner cuts of meat, opting for low-fat dairy products, and incorporating more plant-based protein sources into your meals. By making these conscious choices, you can gradually shift towards a healthier and more cholesterol-friendly diet.

Timeline for Results

It is important to keep in mind that the timeline for seeing improvements in your cholesterol levels depends on the extent of your dietary changes and your commitment to consistency. While some individuals may start noticing changes in their lab results within a month of making dietary improvements, it may take up to four to six months for the full effects of these changes to manifest. Patience and perseverance are key in sustaining long-term improvements in your cholesterol levels.

Remember, the goal is not to simply trick the lab results but to maintain a healthy diet over the long term. Finding a dietary approach that you can sustain and enjoy is crucial in keeping your cholesterol levels in check.

Remember, it's not about tricking the lab results but maintaining a healthy diet over the long term. Find a dietary approach that you can sustain to keep cholesterol levels in check.

The path to controlling high cholesterol naturally lies in dietary adjustments, primarily by reducing saturated fat intake. Understanding your cholesterol levels, making calculated changes, and exhibiting patience in observing results are essential elements of this journey.  Small dietary modifications can yield significant improvements in LDL cholesterol levels over time. It's advisable to consult with your healthcare provider for personalized guidance on your natural cholesterol management plan.

Many people who have their blood tested may come across elevated levels of vitamin B12. While vitamin B12 is essential for our health, excessively high levels of B12 in the blood, may indicate an underlying health issue. In such cases, it is important to investigate the underlying cause of the elevated B12 levels. One test that can be used for this purpose is the B12 binding capacity test. In this article, we will discuss the role of the B12 binding capacity test in understanding elevated B12 levels.

When we consume vitamin B12, it is absorbed into the blood stream and eventually it is bound to a protein called transcobalamin. This vitamin B12-transcobalamin complex is then transported to and into our cells.  It is here inside the cells where vitamin B12 is used for its various functions.

Benefits of Vitamin B12

B12 Binding Capacity Test

The B12 binding capacity test measures the amount of transcobalamin molecules in the blood sample.

If a person has a lot of transcobalamin in their blood, they are likely to have a lot of binding capacity. Transcobalamin is one of the binding proteins for B12 and helps transport the b12 throughout the blood. If a person has a lot of binding capacity, it means that there are lot of available places for B12 to bind to. 

Deeper Understating of Your Elevated B12 Levels

People can have high B12 for many different reasons.  The advantage of this test is it helps narrow down what some of those reasons could be.  In the case of elevated B12 levels, a high B12 binding capacity, indicates that a lot of transcobalamin molecules are floating around in the blood.  In this case too even though the b12 level is high there are still plenty of binding place available.  In this scenario we would conclude that this person's body has a surplus of transcobalamin. This can happen in certain health conditions and scenarios.

On the other hand, if a person has elevated B12 levels but a low B12 binding capacity, it indicates all the transcobalamin has b12 on it.  This person is likely  consuming too much B12 through their diet or supplements.  Alternatively they are not making enough transcobalamin binding proteins. 

Using transcobalamin Binding Capacity test

It is important to note that the B12 binding capacity test is not typically a standalone test or diagnostic tool. It should be used to provide additional information and context to the results of other tests and symptoms you might be experiencing.

We would typically use it for people that have persistently elevated B12 levels and experience other ongoing health symptoms.  This will help us understand if the elevated B12 level is coming from too much intake of B12 or from some deeper health issue. 

So elevated B12 levels can be an indication of an underlying health issue, and it is important to investigate the cause of the elevation. The B12 binding capacity test can provide additional information to help understand the elevated B12 levels, but it should not be used as a standalone diagnostic tool. If you are concerned about your B12 levels, click on the link below to get a free consult.

That should give you a better understanding of elevated B12 levels and the role of B12 Binding Capacity Test. If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to control your cholesterol with diet, click in the link below to get started. 

Milk thistle, also known as Silybum marianum, is an herb that has been used for centuries to treat liver problems.  It is a natural remedy that is gaining popularity for these potential benefits. Whether you are already taking milk thistle or are considering it, you may be wondering about the benefits that milk thistle can provide.  In this article, we discuss the top three benefits of milk thistle and how it can help support liver health, regulate blood sugar levels, and potentially prevent cancer.

If you want to explore the top three benefits of milk thistle, keep reading.

Benefits Of Milk Thistle for Liver Support

Milk thistle is most well-known for its support to the liver. It contains a molecule called silymarin, which has antioxidant and anti-inflammatory effects and may even help protect the liver from damage. There is good evidence that milk thistle can help protect against various liver conditions like hepatitis, fatty liver, and cirrhosis. Milk thistle achieves this by enhancing the recycling and utilization of glutathione, which is one of the main antioxidants and detoxification molecules in our bodies.

Milk thistle also protects cell membranes from toxins that might damage liver cells or other cells in the body. Studies have shown that milk thistle increases antioxidant molecules like superoxide dismutase, glutathione, and glutathione peroxidase.

Benefits of Milk Thistle for Blood Sugar Regulation

There is good research and evidence suggesting milk thistle has a positive effect on lowering blood sugar in people with diabetes and blood sugar issues. It likely helps the blood sugar levels through improving insulin sensitivity. Milk thistle contains a specific molecule that acts like a PPAR gamma agonist, which is similar to how some medications used for diabetes called thiazoladinedione medications work.

Benefits Of Milk Thistle for Cancer Prevention

Some studies have suggested that milk thistle may have an anti-cancer effect and may be effective in both preventing the growth and spread of certain types of cancer cells. Milk thistle seems to exert this effect by protecting healthy cells when on chemotherapy and pushing malignant cells into programmed cell death called apoptosis. While this sounds very promising, it's important to note that this research is fairly limited, and more research is needed to fully understand what's going on with milk thistle and its anti-cancer properties. It's important to discuss this with your provider who has knowledge of milk thistle and its effects on cancer, so they can make sure it's going to be beneficial for you in the chemotherapy that you're on.

While milk thistle is generally safe, it is important to note that taking milk thistle should not be used as a substitute for an integrative medical treatment plan.  It is always a good idea to discuss the use of milk thistle and other herbs with your healthcare provider, especially if you are taking medications. They can make sure it's safe for you and potentially beneficial for your health.  Here is a link to a trusted source of milk thistle (Amazon link) we use.  

In conclusion, milk thistle has many potential benefits, including liver support, blood sugar regulation, and cancer prevention. It is a natural remedy that is gaining popularity for its potential to improve overall health and well-being. While more research is needed to fully understand the benefits of milk thistle, it is a relatively low-risk herb with few downsides. If you are interested in taking milk thistle, be sure to discuss it with your healthcare provider to ensure it is safe and potentially beneficial for you.

Are you having ongoing thyroid issues?  Maybe you're feeling fatigued and unwell? Maybe your thyroid medication is  going up and down every other month and you can't figure out why that is.

Perhaps you recently got diagnosed with Hashimoto's thyroiditis and you want to know what this disease actually is.  In this article, we cover what is  with Hashimoto's Thyroiditis, how does it happen and what's actually underneath this disease known as Hashimoto's thyroiditis.

So if you want to know what to do when you have Hashimoto's Disease, keep reading. 

So what is Hashimoto's thyroiditis? Well, first of all, thyroiditis is inflammation in the thyroid gland.  This happens when the thyroid gland becomes irritated or inflamed for one reason or another.  Hashimoto's thyroiditis happens to be the most common form of this health condition, this thyroiditis.  It is caused by your immune system attacking the thyroid tissue.  When it does that, it causes irritation and this immune action against your own thyroid is referred to as an autoimmune disease.

First thing in answering this question, what is Hashimoto's Thyroiditis is, it's an autoimmune disease.  Autoimmune disease occurs when the body's immune system makes a mistake.

How Does Hashimoto's Thyroiditis Start? 

That's right. It makes a mistake, which begins by the immune system making antibodies.  These antibodies are going to attack the cells or tissue of the thyroid gland.  Why would your immune system do this? Now, of course your immune system is unconscious or have its own thoughts.   So it's not thinking that it actually made a mistake.  The exact reasons behind how and why this happens aren't clearly understood.  However, it's thought to be tied in with something known as molecular mimicry.

The principle behind molecular mimicry is that the immune system makes a mistake when it's trying to basically make an antibody against a molecule that is foreign or different from self.  The idea is that there's a bacteria or viral proteins that have a similar molecular structure to the proteins of the thyroid tissue.  Not just any thyroid tissue, but the specific molecular structure of the tissue the antibody attacks. 

So when the immune system is trying to make and antibody against a foreign invader, like a virus or bacteria, it makes a mistake. The mistake happens because the protein on that virus or bacteria looks very similar to the protein on the thyroid tissue.  It may only be a couple amino acid difference in those two molecules.  When it makes that mistake, once that happens, those immune cell making those antibodies divide and proliferates.  Now you have Hashimoto's thyroiditis, and once that process begins is not very easy to unwind that process.  

That doesn't mean it's impossible, and there are ways to calm that down and reduce that autoimmune activity.   It just takes the right approach and persistence.

Now, back to our story on what is Hashimoto's thyroiditis.

What is Hashimoto's Thyroiditis

So because your immune system is having this ongoing attack on the thyroid tissue, the immune cells and inflammation interferes with thyroid hormone  production.

That thyroid gland then can't produce enough thyroid hormone to provide for the whole body, to keep the metabolism going and do all the things that the thyroid hormone does for your bodies.

As a result, people with Hashimoto's thyroiditis end up with an under active thyroid, also known as hypothyroidism.  In some cases, initially there may be an increased activity in the thyroid.  That is known as Graves Disease and it's hyperthyroidism.  This type is usually temporary and usually flips into the hypo state within a few months or possibly even a few years.

Whether it's  hypo or hyper, usually people will take medicine to regulate these high and low levels of thyroid activity.  Now, it's also possible to have Hashimoto's or auto antibodies against your thyroid and not have abnormal thyroid output.

Once your immune system begins to make these auto antibodies against the thyroid tissue, your day to day thyroid output can vary up and down.  This will depending on what's going on with those antibodies.  So that the symptoms that you're having when you have Hashimoto's thyroiditis from one day to the next may not be very predictable. 

So what are Hashimoto's disease symptoms? That's what we're gonna look at in another article. 

That should give you a better understanding of what is Hashimoto's disease.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to treat your Hashimoto's disease, click in the link below to get started. 

Are you a female in your fifties and experiencing hair loss? It could have started abruptly, or been a gradual process. In this video, we'll look at tips to prevent female hair loss after age 50 and how to reverse it if it's already started. We'll examine the causes and solutions of hair loss in females after 50.

Causes Of Hair Loss in Females After 50

Around age 50 is when menopause typically begins for most women.  So menopause is an important factor to consider when looking at hair loss in this age group.  Hair Loss in Females After 50 seems to be linked to a decline in estradiol.  This decline leads to a corresponding decrease in Sex Hormone Binding Globulin, also known as SHBG. This SHBG protein carries around many hormones, including estrogen, as well as other hormones like testosterone, DHT, and other androgens. These hormones are very important in the process of female hair loss, especially in those over the age of 50. 

Both testosterone and DHT are androgens and they cause the hair follicles to miniaturize and deteriorate.  With this miniaturization there is a corresponding reduction in the diameter of the hairs that come out of the hair follicle, how long it gets and it's overall activity.  So with this, essentially, there are fewer hairs, hairs that grow less often, and hairs that are shorter. There is a similar process that happens in males.   This is referred to as androgenic alopecia. The difference between males and females in this androgenic alopecia is that in males, it starts at a much earlier age.

This is because males have much higher testosterone relative to their estrogen, the vast majority of their life.  So if you're a female in your fifties starting menopause (or even further along in your sixties) losing your hair, this process of androgenic alopecia is probably taking place.  It's because a relatively higher amount of testosterone and relatively lower estrogen and corresponding lower SHBG are present. 

Prevention Of Hair Loss in Females After 50

So one of the main tips is to raise the SHBG.  Now, SHGB basically binds up the testosterone and stops it from binding to the androgen receptor on the hair follicle.  This helps to prevent hair loss over time.  

Raising sex hormone binding globulin is relatively easy to do by just taking estrogen replacement therapy, or some hormone replacement therapy that has estrogen in it.  There are other ways to raise sex hormone binding globulin other than hormonal replacement therapy (see below).  Hormone replacement therapy and estrogen replacement therapy are just the most straightforward way to do it.  This way is definitely predictable and you will get a nice raise in your SHBG. 

This hair loss is typically going to start happening six to 12 months after this process (noted above) is happening.  It's not going to kick in a month after you start menopause.  However as the estrogen levels decline, the androgenic effect (caused by testosterone) will increase, and over time, six or 12 months down the road.  This is when the hair miniaturization starts to happen.  It will look normal in the beginning of menopause and at some point, the hair loss will suddenly fall off a cliff.  With this it will seems like it's a sudden hair loss, but it's actually happening more gradually. 

So it takes many, many months of this ongoing, effect of the androgens on the hair follicles to start to miniaturize it.  That's why raising SHBG works to buffer and stabilize some of the effect of those higher androgens.  So what do you do if you don't want to take estrogen or hormone replacement therapy? 

Treatment Of Hair Loss in Females After 50

Phytoestrogens will also raise sex hormone binding globulin as well.
Phytoestrogens are basically plant-based estrogens.   They will stimulate the liver, increase production of this sex hormone binding globulin (shgb). This will help to stabilize things.  Most of these phytoestrogens come from soybeans and soy products. They are collectively known as soy isoflavones.  One particularly potent soy isoflavone that will stimulate sexual binding production is called Genistin.

Here is a link to one that we use and trust genistin (affiliate link). 

Of course, decreased sex hormone binding globulin and estrogen are not the only reasons women over 50 lose their hair.  We will have several more article on this topic coming soon. 

Creatine is a popular supplement among athletes and bodybuilders. Though it's generally considered safe, there is concern that it may cause hair loss.  But does the research actually support this claim? We will examine the research to see what it actually shows and what is the likely cause of any hair loss.

So if you want to know if creatine cause hair loss, keep reading. 

Creatine and Hair Loss Link

Recently, a patient of mine commented that they thought creatine might be causing their hair loss. I was surprised by this and decided to look into the research to see if there was any evidence to support this claim.

After investigating, I found that it is very unlikely that creatine causes hair loss.  However, I understand that the details can be confusing.  So let me present the evidence and you can decide for yourself. The recent study that led to this theory found that supplementing with creatine led to higher levels of DHT in the body.

DHT is a testosterone derivative and is thought to be the leading cause of hair loss in both males and females (known as androgenic alopecia).  Since this study found a higher amount of DHT in those taking creatine, the concern about hair loss emerged.  However, further research is needed to confirm this link.  Here is a link to an important references on creatine and DHT. 

Does Creatine Raise DHT?

Although the study's findings may be misleading, it is worth looking at the details. The study assessed college-aged male rugby players who were supplemented with creatine for 14 days total (25 grams for seven days, followed by five grams for seven additional days). There was a creatine group and a placebo group. The DHT levels in the creatine group rose 56% after the seven day loading period and remained 40% above the baseline levels of DHT.  However, it is unclear if this was truly due to an increase in DHT levels, as the study only had 20 people total between the two groups.  Additionally, the DHT levels in the creatine group started at 23% lower than the control or placebo group.

It's possible that the increased DHT levels in the creatine group was due to an anomaly with one or two people in that group, or vice versa with the placebo group.  For instance, maybe something was going on with the placebo group that caused their DHT levels to be higher at the start of the study, such as getting better sleep.  Also, while the study was being conducted, the control group had a slight decrease in their DHT levels.

These could explain the statistically significant increase in DHT in the creatine group.  The small sample size, lower starting DHT levels in the creatine group, combined with the drop in DHT levels of the placebo group during the study, could account for it.  If it had been a larger study with more people, such anomalies would be washed out.  Because there were only 20 people in this study, the chances of such a coincidence occurring are much higher.  It's also worth noting that this is the only study ever linking creatinine and DHT levels. 

There is also the issue of exercise alone on androgenic hormones.  Studies have shown that intense exercise can lead to an increase in androgenic hormones like testosterone levels and DHT.

The results of the study in question showed that the CRE group had higher DHT levels. However, it is difficult to determine the cause of this increase. The small sample size and coincidental starting parameters are likely to blame for this increase in DHT level rather than the creatine supplementation itself.

In addition, there are lots of studies on creatine demonstrating it's safety. Many studies looking at creatine supplementation have never found it leads to hair loss. It is also hard to believe that people would not have reported or noticed if it did.

Just taking the counter argument on that just for a second too.  It may be that people aren't taking it long enough to actually see hair loss.  You would need to have higher DHT levels for a sustained period (3 plus months) in order for it to create hair loss. 

Creatine supplementation has been around for many years, and there is little evidence that it causes hair loss. In fact, most studies show that creatine does not increase DHT levels.  So if you're worried about creatine causing hair loss, check your DHT levels before and after you start taking it. This will tell you for sure if it's a problem for you. Otherwise, it's probably not an issue and you don't need to worry about it.

That should give you a better understanding if creatine causes hair loss.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to control your hair loss, click in the link below to get started. 

Are you wondering what causes high creatinine levels? Maybe you got a recent blood test and you are looking at some of the things that are flagged as high or low and yours says high creatinine.  Creatinine is a way to measure your kidney function.  In this article, we look at what causes creatinine levels to go up and down and what the actual test is measuring.

So if you want to know what cause high creatinine levels, keep reading. 

Causes Of High Creatinine Levels

Creatinine is a chemical byproduct of creatine, which comes from muscle tissue.  Mostly, creatine helps deliver energy to the muscle when higher energy demands are present.  You have probably heard of creatine in terms of building muscle, body building, and overall athletic performance.  This is the same thing that we are talking about.  However, don't confuse creatine with creatinine. 

Creatine actually turns into creatinine via the enzyme creatinine kinase.  Creatine it's continually being produced by the liver and therefore its production is said to be constant.  Because of that ongoing production of creatine, there's also an ongoing production of creatinine.  The creatinine is eliminated from the body via the kidneys.  Since we know where it comes from and we know how it's eliminated from the body, we know why someone might have high levels or what causes high levels of creatinine.

The Context Behind What Causes High Creatinine Levels

Let me give you a little more context and detail so you can fully grasp this for your own health.  We said that creatinine comes from creatine, which comes from muscle. Therefore, the more muscle mass you have, and the bigger you are overall, the more creatinine you are going to end up with. 

Now, the general utility of the creatinine test is to look at your kidney function or estimated GFR.  GFR stands for glomerular filtration rate.  The Glomeruli are little filtration systems within the kidney itself.  How well those glomeruli filtration systems are working is said to be related to the creatinine.

The higher your blood creatinine level, the lower your kidney filtration rate because the creatinine goes out through the kidneys in the urinary system.  If there's a problem in those filtration systems, the blood creatinine goes up. So that's how we generally think about this test.  However, there are some problems or some ways that this test can be a bit misleading. 

Other Causes of High Creatinine Levels

The first being, it doesn't really factor in your actual weight.  If you are really really small, really really big, or even slightly above or below average it skews the results.  It skews the glomerular filtration rate.  Almost always, when you look at the GFR, there's a little 'e' next to it.  That 'e' stands for estimated.  It's an estimate because it doesn't factor in your weight. It also does not factor in your gender (some labs do) , which is also important because males tend to have more muscle mass than females.

So this is really important.  There are actual calculators that will factor in your weight and gender.  With this you can get a more appropriate measurement.  There are also other tests that don't use creatinine to measure your kidney function.

The other thing that can sometimes happen when looking at causes of high creatinine levels is recent high intensity exercise close to the test.  Because creatinine levels are related to muscle, muscle cells damage can cause higher amounts of creatinine in the blood.  Therefore with exercise you can see the kidney function look a little bit off.  This can happen one to two days away from a high intensity exercise activity.  The same thing can happen with liver enzymes. 

Exercise and Elevated Liver Enzymes

Now, if you are regularly doing exercise and this is just part of your routine, we wouldn't expect much affect on the creatinine level.  If it's something new and really intense for your body, that's when it will influence your creatinine level.  It will cause a high creatinine.  The other thing is if you are taking creatine on a regular basis, it will raise your creatinine levels as well. 

Of course, the most concerning reason for high creatine levels is you actually do have poor kidney functions.  So that's the most obvious thing to look at.  There are other reasons not mentioned that can cause this that have nothing to do with your actual kidney function too. 

That should give you a better understanding of what causes high creatinine levels.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to control your creatinine levels, click in the link below to get started. 

Are you finding that you have high blood pressure which is starting to worry you?  If so, maybe you are asking the question, what causes my blood pressure? In this article, we break down the mechanics of blood pressure and what the main inputs are for raising blood pressure. With this information you can better understand what might be influencing your blood pressure.

If you want to understand what causes high blood pressure, keep reading. 

Causes Of High Blood Pressure

We want to examine some of the causes of high blood pressure.  We will break it down in a simple way, so you can understand what the overall controlling mechanisms are.  If we look at your cardiovascular system as a system of pipes, we can see there are two main things that affect the overall pressure in that system.  One is the overall volume of fluid that's in the tubes.  The other is the amount of tension in the pipes that hold that fluid.  Those pipes are known as arteries, of course.  Your body has various mechanisms to regulate the amount of fluid in the system and the amount of tension that's in those arteries.

This, of course is how many medications work by exploiting these different mechanics that our bodies aren't naturally doing.  We can use that to our advantage, to lower blood pressure, and when needed to raise blood pressure.  So when you have high blood pressure, it means some of the internal mechanisms of your body that regulate blood pressure are not working the way they should.  Let's look a little bit deeper at what some of the mechanisms are controlling the fluid and the tension. 

Fluid Causes High Blood Pressure

The fluid in the system is mainly regulated through your kidneys.  The kidneys do this by changing the concentration of salt, sodium and potassium, that's in your blood.  The water in the arteries then follows sodium.  With higher sodium in the blood there is higher fluid retention in your blood. This is why sometimes it's thought to help blood pressure by reducing sodium intake.  This sometimes does work, but most people are not salt sensitive.  Since this is not the underlying reason, most people have high blood pressure it doesn't always work. 

Cortisol the stress hormone actually encourages more sodium retention and reabsorption of that sodium through the kidneys and back into the blood. This is one way that stress can increase your blood pressure.  As far as tension in those arteries, narrowing of the arteries with atherosclerosis is something that comes into play.

Tension Causes High Blood Pressure

When we think about the overall tension in that system plaque buildup causes stiffening of those arteries.  With this there is less ability of those arteries to expand.  Arteriosclerosis and hardening of the arteries happens through a combination of things like high cholesterol, inflammation, high insulin, and other factors.  These are are referred to collectively as, endothelial dysfunction.

If we look at an artery cross section, the innermost part of the artery structure is called the endothelium.  That internal tissue responds to various inputs from both the local environment and also from systemic hormones that are floating through the blood.  Problems with the endothelium is known as endothelial dysfunction, and that's thought to be an underlying cause for some people that have high blood pressure.  Of course, high stress situations do produce cortisol, which can increase the fluid, and also produces adrenaline and adrenaline like molecules.   These molecules tend to constrict arteries.  That constriction and tension creates more pressure in the system, regardless of how much fluid is present.

So what causes high blood pressure? Well, there are many causative factors involved with elevated blood pressure, but all those causative factors are going to influence these two things.  Either increased volume in the system for one reason or another, or decreased elasticity and hardening of those arteries.

That should give you a better understanding of what causes high blood pressure.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how lower your blood pressure, click in the link below to get started. 

Does low testosterone lead to hair loss?  Are you starting to lose your hair and wondering if your low testosterone may be a culprit behind hair loss?  In this video, we look at the role of testosterone on hair follicles and hair growth. 

If you want to understand the role of low testosterone leading to hair loss, keep reading. 

Low Testosterone and Hair Loss

Yes, actually low testosterone does lead to hair loss, but not the hair on your head.  Low testosterone does cause loss of hair on the body.  Oftentimes it shows up as decreased hair on the lower legs.  When this happens you will start to see finer hairs similar to baby or female body hair.  However, low testosterone absolutely does not lead to loss of hair on the head.  In fact, the opposite is true. Testosterone does go down with age and people do tend to lose more hair as they age, especially males.  This hair loss is not due to the testosterone going down.  Rather it is more of the cumulative effect of the testosterone and overall androgens in the body and in the blood over time.  It is this cumulative effect that deteriorates the hair follicles on the head. 

The testosterone derivative known as DHT or dihydrotestosterone is thought to be the main culprit for damaging the hair follicles on the scalp. The DHT leads hair follicles to be less active, grow less often, and be finer in nature.  Eventually the cumulative effect of that causes those hair follicles to die. Over time the more DHT around to affect the hair follicles, the less the hair follicles are going to grow.  This is why things like Finasteride and Dutasteride are used for hair loss.  These medicines block the production of DHT. 

Now, of course, there are other mechanisms, theories, and thoughts on why humans lose their hair.  However, there is lots of evidence for the DHT model. Clinically, it seems to be the most relevant and produce good results. 

So does low testosterone lead to hair loss on your head? The answer is absolutely not. The opposite is true. In fact, high testosterone and high DHT lead to more facial, arm and back hair.  Basically more hair all over your body except on the top of your head.  So don't think that raising your testosterone will make the hair on your head grow more.  It will likely do the opposite.

That should give you a better understanding of does low testosterone lead to hair loss.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on low testosterone or hair growth, click in the link below to get started. 

Are you having ongoing slight elevations in your liver enzymes?. Maybe you were told it is perfectly normal and you shouldn't worry about it.  In this article we go into some of the details of why that may or may not be appropriate for you. We look at what the optimal levels of liver enzymes are for males and females, so you can better understand what to do for your own health.

If you want to know what level of liver enzymes you should be concerned with keep reading. 

The Level Of Liver Enzymes To Be Concerned With

What level of liver enzyme should I be concerned with? Mainly we are looking at this from the perspective of getting a blood test back that shows you have elevated liver enzymes.   This could be the AST, the ALT or the GGT.  AST is usually written out as as aspirate amino transferase.  ALT is written out as alanine amino transferase.  Most of the time the GGT isn't done, but sometimes if you are looking specifically at a liver function test, the GGT will be included.  There are a few other liver tests that may be included in a liver specific test.  These are the three that are of most importance for assessing liver function. 

In other articles we mentioned why these levels might be high. Also some other testing you might want to consider when you have elevated levels of these liver enzymes. These enzymes do come from your liver, but they can be found to a lesser extent in some other tissues as well.  With all that being said, at what level should you start to be concerned when your liver enzymes are high? How high is too high?

The reference range for your liver enzymes will be slightly different from one lab to the next.  Typically the level for the AST or aspirate amino transferase will be reported as between 10 and 40 units per liter.  Alanine amino transferase will be between 7 to 56 units per liter. These are the reference ranges.  If you fall within those parameters, you will not get flagged as high or low.  Mild elevations are generally considered to be one or two times the normal limit.  Moderate elevations are two to three times the reference range. Severely high levels are in the thousands.  Then the question is, what do you do when your levels are in the sixties, seventies, or even fifties? Are these really a problem? Should you be concerned if your liver enzymes are on the upper end of normal or slightly above? 

It is actually pretty common where to see the lab not flagging the results, but the level is slightly high.  I see this very commonly in my practice.  There is usually a good reason for it, but that doesn't mean the level is actually in the optimal range.  Optimal or a true healthy range for ALT is a range between 29 and 33 units per liter for males and slightly lower for females 19 to 25 units per liter.  Levels consistently above this, meaning multiple tests that are higher than this, should be investigated.  We' are not getting into the causes here because there's other articles on that topic.  

Why Liver Enzymes Are High

The same approximate ranges can be used for the AST and GGT to make things simple and straightforward. I usually use 25 as a general reference range for both males and females.  If it's above that, that could be a problem. Of course,  there's some leeway depending on if you are a male or female and which tests we are actually looking at.  That's a rule of thumb that I usually go off of.  Now, transient elevations, like one test above 25 is nothing to be concerned about.  It is the consistent elevations, much more than 25, like 50, or even 30 that could be a problem.  The level will really tell you what the next steps should be. 

When it's slightly above, it's not really something to be concerned about. However, when the levels start to get into the upper end of the reference range like the fifties, that's when you should start looking a little deeper.  Especially if they are like that after multiple tests.  So if you want more details on elevated liver enzymes, check out this videos.  There's also a very detailed paper that goes into a lot more detail on why we are establishing 25 as a normal, healthy, optimal liver enzyme range. The basis is, if you take a sick population and try and create a reference range from that, you get a sick reference range.   The paper goes into a lot more detail. 

That should give you a better understanding of what what level of liver enzymes should I be concerned with.   If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on your elevated liver enzymes, click in the link below to get started. 

Did you find you have an MTHFR alteration and you are wondering why is MTHFR important to begin? In this article, we go into detail on why this enzyme is important and what it does for your health.

If you want to understand why MTHFR is important, keep reading. 

MTHFR is an enzyme that's important for making something known as SAMe and also helping support the production of DNA based pairs.  So when we say, why is the MTHFR enzyme important? Really, we are asking why are these things important? What do they do? How do they help our bodies? So first, let's look at why MTHFR is important with regard to SAMe production.

Why MTHFR Is Important

SAMe is basically methylated methionine (an amino acid found in food).  MTHFR is important because it helps bodies make that SAMe. Without SAMe you can't make things like creatine, phospholipids and you can't repair your DNA properly.  You can't detoxify neurotransmitters and do many other things through the methylation process.  You also can't make neurotransmitters and you can't make nitric oxide.   All of these different processes are supported with this product known as SAMe.  Sounds like no big deal, right (sarcasm)?

Actually it is very important because it s connected to so many different things.  This is one of the reasons why MTHFR is so important.  It is an enzyme that has a very broad reach in different areas of our bodies.  We mentioned creatine and creatine is needed in large amounts in our bodies.  It is critical for energy production and as a backup when we need quick energy in an instant.

Phospholipids are basically the building blocks of all of our cellular structure. You can think of a cell like a balloon. The outside part of that balloon is made up up a bunch of smaller balloons closely linked together through a membrane matrix.  The cell membrane like this and the close linked balloons are the phospholipids.   Without SAMe and MTHFR you can't make your cellular membranes. 

Of course, when you have MTHFR enzyme alteration, it's not that the enzyme is completely gone and not working at all.  It still works but has a relative slow down.  How much reduction you have depends on the type of alteration? We mentioned in a previous video that there are other ways that your body can make this SAMe even without MTHFR and methylfolate.

SAMe is also important for the breakdown of different neurotransmitters and hormones.  So it's needed for detoxification. If you're not able to break those down, it can sometimes cause anxiety and unstable mood.  On the other side, you also need SAMe for production of neurotransmitters. That's obviously important for mood related issues as well. Nitric oxide is important because it dilates the arteries when the body is needing more blood in specific area.  These are some of the reasons, but not all the reasons why MTHFR is important. It reaches many different nooks and crannies of the body.

The reason MTHFR is important is because without enough of it, you can't deliver these products to the body in a quick efficient manner. This is why when there is a deficiency in this enzyme activity, it can lead to a lot of decreased overall health.  Even as important as MTHFR is, not all alterations in the MTHFR enzyme lead to critical health problems.

In helping a lot of people with this genetic alteration, a lot of confusions arises from this point.  So I just want to emphasize that there is a lot of redundancy in nature.  Specifically in the biochemistry of how our bodies work.  We don't all need to take the same things based on specific alterations in your MTHFR enzyme.  There's a lot of variation from one person to the next in how all the puzzle pieces fit together.  We may take two people with the same genetic alteration in their MTHFR enzyme,  and they have two totally different optimization strategies.  The question to ask if you are looking at MTHFR alterations as a potential health solution is, what health issue are you trying to solve for?

That means what symptom or diagnosis, do you think you need help with the most? Or are you simply, taking a preventative approach by looking at nutrigenomics (optimize your nutrition based on your genetics).  Those are two important questions you should ask and look at. They won't necessarily give two divergent answers.  They may actually be the same, but the health problems you actually have is a common way to dictate the plan.

So in summary, why is MTHFR important? It's important because it has broad reaching effects on our health.  A reduced activity in your MTHFR enzyme, may mean your body needs more support.

That should give you a better understanding of why MTHFR is important.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan for your MTHFR or genetic SNP's, click in the link below to get started. 

Are you being told you have high cholesterol? Maybe you are looking at different ways to approach cholesterol control with diet.  While there is sometimes conflicting information in the media about this, cholesterol control with diet is fairly straightforward to understand.  With just a little bit of effort on your part, most people can control their cholesterol with diet.  In this article,  I will show you how to get a better understanding how to control your cholesterol with diet.

If you want to know the secret to cholesterol control with diet, keep reading. 

The Impact of Cholesterol In Food

The first thing to understand about this topic is that cholesterol from the food you eat, doesn't contribute that much to the blood levels of cholesterol. In fact, most of the cholesterol that's in our bodies is generated internally from the cells and tissues of our bodies. That production is done through molecules found in fatty acids and carbohydrates.  That molecule is called acetyl CoA. This molecule is used to generate energy as well as cholesterol.  In cholesterol production, acetyl CoA goes on to make something called HMG CoA, and then on to make cholesterol.  Statin drugs, prevent HMG CoA from being produced. 

In the video above there is a diagram to show this in more detail. Statin drugs block the HMG CoA from making mevalonate or mevalonic acid.   As you go further along the cholesterol production pathway you get, different intermediates, and eventually you get cholesterol.

Cholesterol Control With Diet

Now, I mentioned that acetyl CoA comes from fatty acids and carbohydrates. So you may be wondering why is it that saturated fats tend to increase cholesterol more than carbohydrates? The answer is more on the clearance or breakdown side of cholesterol, then the production.  It turns out that saturated fatty acids directly inhibits or down-regulate the production of something known as LDL receptors.  LDL receptors are on the surface of cells.  These degrade circulating cholesterol as it is circulating through the body, through the blood, and in your tissues.  So with less of these, there is less breakdown of the LDL cholesterol.  With less breakdown, there's more circulating through the blood.  Conversely with less circulating saturated, fatty acids, there's an increase in the LDL receptors and an increase in LDL cholesterol clearance from the body.  Therefore the amount of LDL circulating through your blood goes way down. Here is a quick picture from this same article that I think is helpful. 

So this is just a cartoon or diagram that shows how LDL cholesterol is cleared.  The LDL receptor takes up the LDL cholesterol that gets broken down into smaller and smaller parts and eventually cleared from the body.  So it's saturated fat that seems to be a strong contributor or controller of your LDL blood levels.  This isn't the only thing to think about when we are considering cholesterol control with diet.  For instance, some people have genetically determined LDL receptor activity and LDL receptors in general. This can lead to higher levels of LDL cholesterol, even in the presence of a low saturated fat intake (and in some cases very low LDL cholesterol).  This is because there's genetics behind determining those LDL receptors.

However, don't be misled by this statement about genetics.  The vast majority of people do have a significant control over there LDL cholesterol through diet.  If you do have something known as familial hypercholesterolemia, then you will not have much control over your LDL cholesterol numbers compared to someone else.  Familial hypercholesterolemia, doesn't simply mean that you have high cholesterol in your family.  People with this condition have extremely high cholesterol. So the vast majority of people that say they have high cholesterol in their family, are not talking about this specific thing.  Familial hypercholesterolemia occurs in a very small subset of the population. 

So even if high cholesterol runs in your family, there's a good chance that you can actually control cholesterol with your dietary inputs.  What kind of changes does it take and how long will it actually take to see these changes on your blood tests? We will look at this in another article. 

That should give you a better understanding of cholesterol control with diet. If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to control your cholesterol with diet, click in the link below to get started. 

Are you a daily glass of wine drinker? Maybe you are just curious, should I start drinking wine for health reasons? Will it benefit your health, cholesterol, or blood pressure? There are lots of claims out there about what wine can do for your health. In this article, we look to answer this question.  How is it benefiting and what part of your health is it actually helping, if any? We break down the details of this question, is a daily glass of wine healthy?

If you want to understand the benefits and risks of daily wine drinking, keep reading. 

Is Wine Good Or Bad?

My initial, reaction or response to this question is that there is probably not much benefit.  Still, there are some specific things to consider with this question.  Some of the information that I found when researching this topic actually surprised me.  So the first thing to understand is that wine contains resveratrol.  Resveratrol has a lot of research on it because of its activity to work as an antioxidant.  The antioxidant effect occurs through working on specific molecules in the body, partially through increasing NAD levels.  The main effect though seems to be its function as an antioxidant.  Specifically, activating the internal antioxidant systems in your body.  So this is one potential plus side of wine. 

On the other hand, wine contains alcohol and which is toxic.  Toxins are not good for anyone to consume on a regular basis.  Just think, your liver has to process that toxin, no matter how little or large the quantity.  It is a toxin that your body has to eliminate.  If your liver is already overburdened with toxins, adding more, won't help.  It's adding more burden to their system.

Conversely, there's also this principle known as hormesis.  This principal states that little bit of something is good, but a lot of it is bad.  You can put exercise, heat and cold into this category.  Even with a potential hormetic effect. I think the main question to look at is, do the benefits of resveratrol outweigh any downside effects of alcohol.  So this question, is a daily glass of wine healthy, is not always straightforward to answer.  Let's look a what the research says.

Blood Pressure And Daily Wine Consumption

A lot of the research on this question is biased and limited in scope.  It's also based on a lot of epidemiological studies, which are not as helpful as double blind placebo control trials.  Looking at the body of research as a whole, there does seem to be one outstanding area of the body benefiting. If any benefits are present from wine, the cardiovascular system seems to show the most positive outcomes.  This is likely due to the antioxidant effect of resveratrol.  When they take the alcohol out of the wine and make de-alcoholized wine, it looks like there's even a more obvious benefit to the cardiovascular system. That makes a lot of sense since resveratrol is an antioxidant and an anti-inflammatory.  Cardiovascular disease is a disease of  inflammation in the arteries.  Very few people drink non-alcoholic wine though.

We should look at this a little bit closer to see what's going on.  We know that some of the main risk factors for cardiovascular disease are high blood pressure, high cholesterol, and inflammation.  There's no question that moderate to high alcohol intake, which I would define as more than two drinks daily, raises blood pressure.  This increase in blood pressure occurs as a result of the reciprocal response of the body.  Alcohol increases GABA activity, which is a sedative and calms down your body.  As a result, the body will produce more stimulating things to balance and even out the scales a bit.  When the alcohol wears off that stimulating effect is still there. This is what happens when people are going through withdrawal.  Sometimes even after a hangover, you feel anxious. You can't calm down because this residual effect is present.  Even if you are only drinking one or two a day, this is still happening in the background.  This is especially true if you are drinking regularly, and you may not really notice it. 

This stimulating effect will get transferred into your blood pressure.  Below two drinks per day, it probably won't be noticeable.  Above two drinks it probably will be noticeable.  It will really depend on the individual, how you process that alcohol, what your overall stress level is, size etc. Logically though, it's very unlikely for consuming wine with alcohol will help your blood pressure. The research seems to support this.  Drinking moderate amount of alcohol on a regular basis will definitely increase blood pressure.  So what about cholesterol?

Cholesterol And Daily Wine Consumption

Total serum cholesterol, triglycerides, and other cholesterol markers are much higher in alcoholics compared to non alcoholics.  Heavy consumption of alcohol will really mess up your cholesterol levels and put you at more, not less risk for cardiovascular disease risk.  Generally speaking alcohol is an empty calorie and will increase certain cholesterol parameters like triglycerides.  In some cases the LDL cholesterol too.  Your HDL cholesterol, which is often referred to as your "good cholesterol" will go up from alcohol.  This is a positive thing for those people drinking light to moderate amounts of alcohol.  This increase in HDL cholesterol is pretty well documented and not refuted.  Some have argued that the type of HDL or type of good cholesterol that goes up is not the optimal one.  

Studies looking at this specifically have found that in fact, it is the optimal type of good cholesterol or good HDL cholesterol that increases.  The question is, does it go up more than the triglycerides?  The ratio between the HDL and triglycerides that is important.  It looks like the dose will be the major variable to look at when we're trying to answer this question, is a daily glass align healthy for you.

So how big is that glass of wine? Where does any benefit on the polyphenols and resveratrol in the wine get outweighed by the alcohol and empty calories? In order to answer this question, we do have to look at the overall calorie content in the wine itself.  We also have to look at the individual uniqueness of each person that's consuming alcohol based on their genetics.  Some people may not break it down as efficiently as someone else.  There could be genetic alterations in how you are breaking down the aldehydes and alcohol. Difficulty in breaking down alcohol for instance, is commonly seen in Asian populations.  Histamine is also a common component in wine that may not be suitable for everyone that consumes it. So while it may be healthy for one person, may not be healthy for you. 

Now back to the calorie question, alcohol is clearly an empty calorie, not dissimilar to cake, candy and things like this.  All calories equal, it may be better to have the wine since it does have the anti-inflammatory resveratrol in it, as well.  As long as your dose is on the low side to avoid that any toxicity from the alcohol.  Of course, if your total calories are increasing as a result of consuming that wine, you are not doing yourself any favors and undoubtedly will be detrimental to your health.

Is A Daily Glass Of Wine Health?

Here's the bottom line as I see it. If you treat it like a specific dose of medicine or supplement, and not as an excuse to get intoxicated or to fill some kind of craving, it can actually be adding to your overall health.  There may be a specific cardiovascular benefit in terms of blood pressure but this seems less likely.  For sure, the antiiflammatory and effect on HDL cholesterol is likely where the benefit is coming from.  We have to remember that wine and alcohol specifically have a J shaped curved.  There is a reduction in risk and benefit at low doses and this can turn into a liability at higher doses.  So with that in mind, it's best to stay on the very low dose or not indulge at all.  Otherwise you are increase your overall risk for health issues, while trying to improve your health.  We don't really have enough information to actually fully answer this question.  However, if I were to guess is a daily glass of wine healthy, three ounces or less may be beneficial for some people.  That amount goes up slightly if you are a larger person in down slightly if you are a smaller person. 

That should give you a better understanding of is a daily glass of wine healthy.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to optimize your health, click in the link below to get started. 

Do you have ongoing elevated liver enzymes? Are you wondering what you should test to figure out why these are elevated? In this article, we break down further testing for elevated liver enzymes.  We will look at things like viral hepatitis, fatty liver, and more. 

If you want to understand what to test when you have elavated liver enzymes, keep reading. 

Testing for Elevated Liver Enzymes

Anytime there is consistently elevated liver enzymes, further testing should be done.  By consistently we mean that several tests have been done and the results have been high ongoing for several weeks, if not months.   Also, it is assumed when doing further testing for elevated liver enzymes that the tests are done because you don't really know why the liver enzymes are high to begin with.  For instance, you are not drinking alcohol on a regular basis, you're not taking Tylenol on a regular basis, and you're not consuming medications that are known to cause your liver enzymes to be elevated.  

Just to be clear, I mean, consuming Tylenol every single day.  Or alcohol regularly every day or every other day.  It has to be consistently and at least close enough to the test to expect that that could affect it.  So it's has to be within a few days of the test, maybe even up to four days, depending on the amount of alcohol or acetaminophen, that's consumed.  Now, assuming that you have already ruled out that those things are causing your elevated liver enzymes, what then?

In this scenario, there are a couple things right away that you want rule out.  These are fairly straightforward to test for.  One thing to rule out is exercise. Another is viral hepatitis, and the last is Nash also known as fatty liver or non-alcoholic hepatitis.  If you don't really exercise, we know that's probably not an issue.  However, there are some finer details about exercise and liver test that you might want to look at.  Maybe you went for a hike that weekend close to your test or something along those lines.   For finer details about exercise and liver testing see this article.

Can exercise affect liver enzyme tests?

The viral hepatitis tests are fairly black and white.  It's just a blood test that you do.  There are three different types of viral, hepatitis A, B, and C.  Hepatitis A is fairly short lived, and usually accompanied by some digestive symptoms like diarrhea, even vomiting and nausea.  So because it is short lived, you probably don't need to be tested for that one, unless you're in an area where that is common.  It's not that common in the US, but if you are having those GI symptoms, this could be the cause.  For hepatitis B and C, a simple antibody test blood test is done.  If that test is negative, then you should move on and have the testing for non alcoholic hepatitis. Now, these all can be done at the same time.  You can do the testing for Nash or fatty liver at the same time that you're getting your blood test done.  If your antibody test for viral, hepatitis B or C are positive, you will need to follow up tests to confirm that it actually is present.  I'm not going go into that here.  However, just because you have positive antibodies, does not mean that you have viral hepatitis. 

So how do you test for fatty liver? Basically it's an ultrasound of the liver that looks for fatty infiltrates in the liver tissue itself.  If you have elevated triglycerides or blood sugar, it's likely that you also have fatty liver. Some people can still have fatty liver, even if their liver enzyme are not that high.  The ultrasound will confirm how much fatty liver is there or if it's there at all.

So if there's nothing going on exercise wise, you don't have anything going on in terms of fatty liver, and you have ruled out viral hepatitis, then it's time to see a GI specialist.  They can do an internal check for anything obvious. Usually they'll do a colonoscopy and make sure there's no, obvious signs there that could be impacting your liver.  The most worrisome of course, would be some kind of GI cancer.  Now the testing that they do is very important, but they are not really looking at microscopic things.  Sometimes there will be biopsies done and they will look a little closer at the tissue.  However, they are typically not looking for bacterial or fungal overgrowth.  This can be part of the problem.

This leads to the next thing to think about in general which is overall toxic exposure.  This can be any kind of chemicals that you are exposed to consistently.  They could be work chemicals or heavy metals from a well water. It could be something in your house, maybe even mold in your house, which would be a major thing.  These things can definitely cause elevated liver enzymes. There are lots of specialty lab tests that you can do to look deeper at some of these problems like chemical exposures and things coming from your digestive tract.  Whether it's bacteria or yeast, heavy metal testing, lots of other testing can be done to identify where the problem is coming from.  The first step though, is test for the more serious things. They are a little more obvious, and once those are ruled out, then you can move on to test for some of these more nuanced things.

That should give you a better understanding of testing for elevated liver enzymes.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan for your elevated liver enzymes, click in the link below to get started. 

Have you been on TRT or testosterone replacement therapy and concerned about fertility? Maybe you are wondering what the return of fertility after stopping TRT looks like.  In this article, we look at the timeline of the return of your fertility as you are stopping testosterone replacement therapy.   

If you want to understand normalizing fertility after stopping TRT, keep reading. 

Fertility and Testosterone Replacement Therapy

In this article, we talk about the return of fertility after stopping TRT. I previously made a few articles (and videos) on testosterone and fertility.  Here I will give a little bit more detail on this for those interested and struggling to understand what's going on.  We will also look at how you can optimize your fertility after stopping testosterone replacement therapy.  First, a quick little recap. 

Fertility decreases when you are on TRT or testosterone replacement therapy, because the testosterone decreases the amount of LH and FSH that your brain is producing.  These are the hormones that stimulate your testes to make testosterone and spermatozoa (aka sperm).  With reduced amount of those, you have decreased sperm production.  Typically once you remove the testosterone, the FSH and LH will start going back up.  In fact, unless there's something interfering with the production of that organically, like a brain lesion or something like that, the FSH will come surging back.

Also we expect the amount of FSH and LH to start to increase around day 10 to 14 after your last testosterone injection (or application).  It will probably peak around the third or four week time frame.  However, keep in mind, these are just estimations.  These estimations are based on what I have seen when people start to feel better and when the testosterone labs numbers actual start to go back up. 

The Fertility Return Timeline 

So by the time you are about a month off of taking your last testosterone replacement therapy dose, we would expect you to be close to returning to your baseline levels of testosterone.  With that, you will be producing around your baseline amount of FSH and LH.  As it relates to fertility, the FSH is what we are mostly concerned about.  That normal or baseline amount of FSH will exert its effect on your Sertoli cells at this time... the four week time frame.   It is even having an effect earlier as it's coming back online.  The FSH is slowly building, building, building, and having more and more effect on those Sertoli cells.  This is where the spermatogenesis process takes place.

Now, let's say you're making 50% of the amount of FSH compared to baseline while you're on your testosterone replacement therapy.  Sometimes, of course it could be less than that.  Still let's say you are only making 50% of the FSH while you're on testosterone replacement therapy.  That means you will have that much less of the spermatogenesis process happening.  Now, once you stop it, that FSH is coming back online slowly, slowly, and it's building its effect on those Sertoli cells.  At the one month, mark, you are not out of the wood yet.  That full FSH activity needs to be in place for two months.  This is because those spermatozoa take a full two months to be produced.  So that, if the end goal is back to a hundred percent of your baseline or back to what your baseline was, that's probably about three months. 

You need the first month for normal FSH to return, and you can give or take one or two weeks off of that.  Then you need 60 days for those spermatozoa to fully mature.  So by the end of three months, you should be back to full production of whatever your baseline levels were prior to being on TRT.  As I said, this is a general rule of thumb and estimation.  Now, of course you will have some increased fertility the further you get away from your last testosterone dose. 

Some people still have plenty of fertility even when they are on testosterone.  There is a lot of variability from person to person with this.  It depends on your testosterone dose, how often you are taking it, what type of testosterone you're taking and things like this.  You may be able to speed up or shorten that timeline to restore your full production by taking things like HCG and Clomid.  Just remember that this is a fairly delicate process.  Even though we know a lot about the fertility process, we will never have the ability to mimic that natural FSH effect on the testes .

That should give you a better understanding of how to restore fertility after stopping TRT.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to restore or optimize your fertility, click in the link below to get started. 

Are you having ongoing digestive problems like diarrhea, cramping, and pain? If you are wondering wether a recent C. diff. infection can cause problems like this, then you are in the right place.  In this article we look at the impact of C. diff. in causing long-term chronic digestive issues.  This is another form of post-infectious IBS. 

If you want to know if C. Diff can cause long term digestive problems, keep reading. 

The Clostridium Difficile Infection

C. diff. also known as clostridium difficile can cause massive digestive tract disturbances like diarrhea, dehydration, cramping, and pain.  It can even lead to systemic symptoms like fever, body aches, and chills in a similar way as a cold or flu.  The clostridium difficile bacteria can actually be part of our normal digestive flora like the "good commensal bacteria."  When it is allowed to grow unchecked by the other good bacteria in your microbiome, it can get out of control in a sense.  This bacteria typically lives in harmony with the other bacteria in our microbiome.  Not everybody has it in their digestive tract but a lot of people do.  Often it is in relative balance with the other microbes.  It even supports the digestive cells and contributes to our overall digestive health.  This is what happens when it's in normal or small amounts in our digestive tract. 

Typically the problems from this microbe arise when we take antibiotics.  The reason for taking the antibiotic could be any really.  Those antibiotics start to reduce the number of the good bacteria.  These are in competition with the clostridium difficile or c. diff. bacteria constantly.  When some of those get wiped out, the c. diff. has the ability to emerge, grow, and expand its territory.  They will expand outside of the small territory that was supportive for our digestive tract.  Once this happens there are too many of them to keep in check leading to many problems.  This is when we start to have major digestive symptoms.  So the antibiotics reduce your good bacteria.  The c. diff. does not get weakened by the antibiotics depending on which one it is.  It is just not sensitive to many of them.  Meanwhile the good bacteria are dying off.  As they are trying to come back and recover, the c diff is expanding and expanding. 

The C. Diff. Digestive Effects

While they're expanding, they're also producing a toxin.  That toxin can cause your immune system to respond and cause a lot of internal inflammation in the digestive tract.  Also what happens is you get increased water flooding into that digestive tract to flush out that toxin.  When that happens that's when you get the uncontrolled diarrhea.  Once it's treated with either vancomycin or metronidazole, that c diff will recede.  With this you will become less symptomatic. 

However this microbe is fairly crafty and can easily form spores.  Those spores are basically like a capsule that protects the internal DNA and the overall structure of the bacteria.  It doesn't allow the antibiotics to affect them.  When in the spore formation the bacteria are basically in a hibernated state.  Once you are done taking that antibiotic and it flushes through your system, that C. diff. can start to re-emerge again.  Depending on the overall quantities that are there, and what's going on with your good bacteria, they can start gaining territory again.  With this they will produce more of this toxin.  Once that shifts to a point where the toxin is stimulating your immune system, it will cause increased fluid to come in.  Depending on how much of that toxin the C. diff. is producing, determines if you get diarrhea again. 

Long Term Problems From C. Diff. 

So does C. diff. cause long-term problems? Yes, it can if it's not eradicated with that first or second round or antibiotics or goes unnoticed.  You may have less severe symptoms than initially but it can still be there. 

There are some studies looking  at the rates of digestive problems following a C. diff. infection.  They found that there's much higher rates of digestive problems in people whom previously had a C. diff. infection. This lasted for up to 12 months following that original infection.  In fact, the study participants were eight times more likely to be readmitted to the hospital for another digestive problem.  That persisted for up to 12 months.  There's also more general digestive issues like IBS symptoms that can persist for even 24 months or possibly even a longer time period. 

This is just another form of post-infectious IBS.  When you have this problem, there are lingering amounts of the microbe present.  In this scenario either the immune system, the antibiotic, or the local environment has not been able to keep it in check.  It's the persistence of that microbe and the overall long-term damage that happens from that microbe that creates this increased risk for ongoing problems. 

If you want to minimize your chances of having c diff or having problems like this, minimize your antibiotic intake.  If you do need to take an antibiotic, then taking a good probiotic along with it at a different time of day is a great idea.  Here are a few that I often use,

Florastor probiotic (Affiliate link)

Pure GG (Affiliate link)

Saccharomyces boulardi (Affilate link)

That should give you a better understanding of can C. diff. cause long term problems.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on post infectious IBS, click in the link below to get started. 

Are you wondering about the impact of food on your anxiety and mood? Maybe you have heard that there's an influence of dietary amines on anxiety. In this article we look at amines, what they are, how they can influence your mood and physiologically affect your body.  We will discuss what amines are, some of the foods that you might find them in and the genetics involved with breaking down and eliminating dietary amines.

What Is An Amine?

First let's look at what actually is an amine?  Amines are biologically active compounds that can stimulate your nervous system similar to how dopamine and adrenaline stimulate your nervous system.  With this stimulation, they can make you feel anxious, worried and fearful.  Whether we are talking about amines like dopamine, adrenaline (or epinephrine) or other types of amines, they are all structurally similar.  This point on structure we will revisit further along in the article. 

The general purpose and way they work in your body is that they are uplifting to your mood and can help you focus.  However, in some cases it can actually give you anxiety and sleep issues like trouble falling asleep, waking up early, or even panic.  What they do at any given moment depends on how much of them are present and how much your body is burdened with these stimulating chemicals. 

 When there are a lot of them, they are stimulating.  You will get that sense that things are not right, you will feel on edge and anxious.  We should also note that these molecules are not just biologically active in the psyche or in the mind.  They also do things throughout the body.  They have effects on your cardiovascular and can speed up your heart rate.  The also affect your digestive system, respiratory system and many other parts of our bodies. 

Other than the neurotransmitters noted above, there are specific groups of molecules referred to as amines.  For the purpose of this article we will focus on the ones produced or found in food.  Collectively all these amines are called biogenic amines.  Again these amines are found in food or from microbes that generate them.  Microbes produce them when food sits around too long or as the food passes through a digestive tract.  Some examples of the neurotransmitters are dopamine, norepinephrine, epinephrine, serotonin, and histamine.  Some examples of microbial generated amines are putracine, sperimadine, cadaverine, and histamine.  These are also the types of amines that will be found in food because most of them are produced by the microbes. 

As an aside, when we cook food and prepare food, part of the idea to not get sick from that food is to eliminate the microbes.  The cooking reduced the microbes so they are not able to produce too much of these amines.  When the food sits around too long and you get sick, it can be from these biogenic amines that are produced by the microbes.  The microbes that are still present in the food after cooking in small amounts and therefore so are amines.  We cook food to reduce the amount there.  Depending on how long it sits and how well you cooked it, will determine the amine load.

Many foods contain amines naturally and a good example of this is histamine.  This amine can be particularly aggravating for some people.  Amines have a resonance time in the body, meaning they stick around in your in the body for a certain period of time.  During that time that they are biologically active whether it's in the cardiovascular system or the digestive system.  The amount of time that they stick around in your body is based on how quickly they are eliminated.  All amines have similar elimination pathways as the neurotransmitters and the molecules our bodies naturally make in this category.  When you are consuming more of them or there are more being generated in your body, that resonance time will go up. 

Amines Detoxification and Anxiety 

The reason for that is because they have a similar structure.  Structurally similar molecules go through common pathways for detoxification.  In the case that you are consuming, your body is producing, or there are high amounts in your diet, the pathways that remove or detoxify these molecules can get over burdened.  The bucket gets filled up and the molecules start to spill over into your tissues.  Those tissues get more stimulated and you have and you have certain symptoms of high amines.  Since these molecules are stimulating as we noted, some of those symptoms can be higher amounts of anxiety, worry, stress, palpitations,  shortness of breath.  You may be generally not feeling well because your body is revved up.  The same way as if you you have a close call in a car accident.  You will feel a little stimulated.  That is from the epinephrine or adrenaline in your body.  The same thing can happen from certain foods.  Especially when there are a lot of them around and you have genetic alterations in the pathways that eliminate these amines. 

You may have even more sensitivity to these foods or sensitivity to situations that are causing your body to produce more adrenaline.  Two of the common pathways or enzymes that that are involved in elimination of amines are COMT, MAOa and MAOb.  Both of those enzymes do a lot of the heavy lifting for amine elimination. 

Learn More about COMT and Anxiety

They are not the only enzymes involved though.  If you have a genetic alteration in these enzymes, foods that are high in amines may not be the best for you or they may increase your anxiety.  However, just because you have a genetic alteration in those doesn't necessarily mean you will feel worse from those types of foods.  There are lots of different things that go into a psychological makeup that have nothing to do with your genetics.  With that being said, there can be strong influences of dietary amines on one's psychology and how they feel on a day-to-day basis.  Anxiety and things like that do occur from these foods when your body is overburdened by these biogenic amines.  This process is going to be more common in those that do have genetic alterations.  It can happen when you don't have those genetic alterations as well. 

For instance if you consume a lot of foods that have a high level of amines in them.  Fermented foods have a lot of these biogenic amines in them.  So eating a lot of these may cause issues.  Also people that have a lot of allergic or sensitivity type reactions.  Whether it is from environmental or food, histamine contributes to the slowed elimination of these biogenic amines. 

That should give you a better understanding of the role of dietary amines in anxiety.   If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to improve your anxiety, click in the link below to get started. 

Are you having problems with high DHEA sulfate or low DHEA levels?  Maybe you're wondering what the relationship is between DHEA and DHEA sulfate.  In this article, we answer a question about what it means to have a low level of DHEA and normal level of DHEA-s.  We will look at the relationship between these two molecules, the enzymes involved and other things that might be going on when you have a low DHEA and normal DHEA-s.   Looking at this question will be helpful for those with high and low DHEA levels as it requires us to look at another aspect of where the DHEA is going and coming from.   

DHEA Verses DHEA-s Levels

If you are not familiar the diagram in the video above, it will be helpful to understand how the molecules can be interconverted.   DHEA is the unconjugated form of DHEA and can then turn into the other sex hormones or steroids. The video above contains a diagram showing the relationship and the enzymes involved with the interconversion.  It is generally assumed that DHEA is readily converted into DHEA sulfate via sulfation enzymes. They are referred to as SULT enzymes. 

It is specifically the SULT A1 and SULT B1 that make the conversion from the unconjugated form to the conjugated form.  This enzyme adds on a sulfate molecule on.  The sulfur transferase enzymes takes off the sulfur group.  Then DHEA and not DHEA sulfate, can be used to make androstenedione which then goes on to make testosterone.  It can also turn into estrone via the aromatase enzyme.  Testosterone can be turned into estradiol through the same enzyme. 

The person's question was "what does it mean (or what could the problem be) if you have low DHEA but normal DHEA-s.  Well one thing that could be happening is these SULT enzymes are sped up.  With this more DHEA is converted to DHEA-s.  The activity of enzymes can change based one certain environmental things going on inside your body.  There are also genetic factors that could also be sped up enzymes.  

 One specific SNP associated with this is the rsid rs12861247.  This SNP was associated with lower sulfur transferase enzyme activity.  So that you get a buildup of DHEA-s and maybe less of DHEA.  In our case the level is DHEA-s was normal and the DHEA level was low.  This genetic alteration could still account for this picture. 

Low DHEA Normal DHEA-s Context

It could also be that one of the HSD enzymes is sped up making more androgens or more estrone and estradiol.  So it's hard to say for sure what's going on in any specific scenario.   Context is king when it comes to interpreting what's going on in any individual.  You have to know what's going on at the individual level. 

For instance, are you having hormonal symptoms? Does it seem more like you are having hormonal symptoms (PMS, heavy cycles more symptoms around cycles, headaches, etc)?  Are you having more androgenic symptoms or does it seem more estrogen-based.   These types of questions and answers will help us understand what could be going on with the enzymes.  You can then work backwards to understand what you can do to manipulate the enzymes in your favor.  

The elevation or deficiency in DHEA or DHEA-s may not be a problem depending how high or low they are.  It really just depends on what's going on with your body.  If you do have symptoms or problems, this could be a clue and you can work backwards to understand what's going on with the enzymes.  That should help you understand what you can do to resolve the symptoms that you have. 

This should give you a better understanding of what could be going on with your body when you have low DHEA and normal DHEA-s.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on optimize your DHEA levels, click in the link below to get started. 

Are you having problems with your liver function tests?  Maybe you are seeing elevated levels of AST, ALT, or GGT.  In this article we look at the foods that affect liver function tests.  We answer questions like, what has a bigger impact carbohydrates, fats, or protein and what types of foods you should avoid if you have elevated liver function tests.

If you want to know the foods that affect liver function tests, keep reading. 

Liver Function and Food

I get many questions on liver function tests.  So I wanted to look a little deeper at some of the foods and specifically the role of macronutrients (carbs protein and fats).  To understand this we will review a study that looked at the influence of diet on liver function tests and serum lipids.  The researchers were using this to help differentiate the impact from food versus the medication being studied in clinical trials.  This was a small study and the diets that they looked at were; a balanced normal caloric diet, a high carbohydrate high calorie diet, and a high fat high calorie diet.  Each diet was consumed in a randomized sequence for a total of eight days with a recovery period in between each of the eight days.  The researches collected the blood samples from all the patients to see what the impact of each of those diets was on the liver enzymes.

The main summary or conclusion by the authors was there was rise in transaminases and triglycerides based on carbohydrate consumption rather  than caloric consumption.  Within this high carbohydrate high calorie diet it was sucrose carbohydrates rather than other starches that seem to have the biggest impact.  The long and short of it is carbohydrates and specifically sucrose seems to be a big driver for elevated liver enzymes. 

Now if you want to know a little bit more details here is a link to the study.  I also wanted to point out a few additional things they found.  For the ALT the control diet (not high carb not high calorie) was very low.  The high fat high calorie diet had a mild rise and the high carb high calorie diet had a very high live function tests.   You can see a clear indication of what's going on.  The same thing happens with the other liver enzyme tests  AST (aspartate aminotransferase).  This one did not have as large of an increase but it was still quite high.  They also measured GGT which is a less commonly measured liver function test.  With GGT the same pattern emerges. 

To rule out any impact of exercise, they also measured creatinine kinase.  The also controlled for the impact of exercise on liver enzymes by making sure there was no change in exercise routine for two days before the study began. 

The conclusions of the study stated, there's a clear relationship between the marked rise in transaminases AST and ALT, and the number of days on the high calorie high carb diet.   The same effect was not found on the high calorie high fat diet.  There was still a modest increase in the enzymes.   They proposed that the increase in enzymes was because this diet did have more carbs due to the calories being higher than the control.   That's one hypothesis.  Other studies have found that just overall higher calorie consumption can increase these liver function test as well.  They also noted that a much higher proportion of the calories in the diet was from sucrose than would occur in a typically diet. 

Clearly the sucrose seemed to increase the liver function tests.  If you were just eating potatoes or other starches without the sugar you may not see such a large increase.  The biggest takeaway is that carbohydrates can and do increase liver function tests.  Diet plays a big role on liver function tests and how your liver is actually functioning.  As the carbohydrates creep up, your body can't dispose of them enough.  When your liver can not dispose of them, they get packaged into a triglyceride.  As the triglycerides rise, those excess triglycerides can then start to damage liver cells.  Those cells open up and the enzymes get into the blood and we see higher numbers on the test. 

Sucrose in particular does this.  Sucroses is fructose and glucose together.   We also know that fructose itself is even more problematic than sucrose.  There are lots of studies on detrimental effects of high fructose corn syrup. Plain fructose from whole fruit can also do this.  It is the amplitude of rise of the fructose in the blood and into the liver that dictates how much dame may occur.  If you have small amounts over longer periods of time, it's not going to have the same impact as quick rise (the difference in and apple verse apple juice).

We know that alcohol and Tylenol can definitely damage your liver.  When it  comes to food it's going to be high amounts sugar and fructose.  When you eat sugar you will typically want more once you have that taste.  So that will cause your liver to have to work overtime to package that sugar up and turn into a triglyceride.  If you have elevated liver function tests carbohydrates,  sucrose, and fructose are the big things that have a large impact on your liver function. 

That should give you a better understanding of the foods that affect liver function tests.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to lower your liver function tests, click in the link below to get started. 

Are you confused about what happens if homocysteine is high? Maybe you have heard it doesn't really matter or maybe you heard it's really important.  In this article, we look at some of the impacts of high homocysteine on human health.  Specifically we look at the role of the homocysteine molecule on the cardiovascular system and what the research says about this. 

If you want to know what happens when homocysteine is high, keep reading. 

The Homocysteine Molecule

First we want to look at what is homocysteine.  Homocysteine is a molecule that we can measure in your blood.  This molecule can inform us about things like B12 and folate levels.  It's a reflection of whether or not you are deficient in these vitamins.  It's also a reflection of your overall protein intake and the inflammation occurring in your body.   Protein is made up of amino acids and two of these amino acid are methionine and cystine.  Both of these are important precursors and byproducts of homocysteine.  So that, if you don't have enough protein, you will have low homocysteine levels.  People that eat a lower protein or more vegetarian-based diet may have naturally lower homocysteine levels. 

In terms of inflammation, sometimes when you have of inflammation in your body, your homocysteine can get converted into cysteine to make glutathione.  Glutathione can help lower the overall inflammation in your body and neutralize some of that inflammation that's occurring.  Typically though, high homocysteine reflects a deficiency in the B vitamins stated above, like B12 and folate.  We will talk more specifics about the folate and B12 below.  Back to our question, what happens if homocysteine is high?

There are definitely consequences to a deficiency in these B vitamins.  Changes occur from chronic vitamins deficiencies, but that's not what this article is about.  Instead, we want to look specifically at what happens from the homocysteine molecule.   When homocysteine molecule is elevated does this molecule have a negative detrimental effect on the body?  To understand this, we can look at the research to understand the relationship between high homocysteine and human health.  First, what constitutes a high homocysteine?

Different laboratories will have different reference ranges for homocysteine.  First off you want to make sure to measure your homocysteine in a fasted state, for about 10-12 hours.  As far as values, some labs will cut off at 10 micromoles per liter and others will cut it off at 12 or even 15 micromoles per liter.  In order to have a designation of hyper-homocystinemia, which is high homocysteine in your blood, your level has to be above 15 micromoles per liter.  This is just the specific diagnostic criteria for hyper-homocystinemia.  I like to see homocysteine between 7 and 9. 

Research On What Happens When Homocysteine is High

What does the research say about high homocysteine and the impact of high homocysteine?  Elevated levels of homocysteine have been associated with increased cardiovascular events like coronary artery disease, heart attack, stroke and even increased blood clots.   These associations and evidence seem strongest for high homocysteine with stroke.  One would think that treating high homocysteine with vitamins that lower homocysteine would decrease the risk for stroke and some of decrease the risk for stroke and some of these other cardiovascular issues.

Indeed some studies do find this.  For instance, there's been clear evidence of lowering homocysteine decreasing cardiovascular risk in patients with really high homocysteine levels.  These are extremely high homocysteine levels like in the 20s and higher.  Still many studies don't find a reduced risk in cardiovascular disease from treating  high homocysteine levels for instance high homocysteine levels.  For instance there's a meta-analysis by the American Heart Association that showed lowering homocysteine levels did not significantly reduce reduce the risk for stroke and had a non-significant impact on coronary artery disease.  So the study found a mild a trend on reducing coronary artery disease but there are problems with this meta-analysis.  We will discuss this below.   

Here is my take on what happens if homocysteine is high.  The association between high homocysteine and cardiovascular risk, especially stroke, should not be ignored.  The common reason cited for high homocysteine levels is when you have a genetic alteration in the MTHFR enzyme.  This enzyme converts folic acid enzyme into methylfolate, the active form.  When there's a genetic alteration in mthfr, your body  literally cannot make the methylfolate.  However, the methyl folate is needed in order to convert homocysteine into something else called methionine.  In other words, when you have this gene alteration, taking all the folic acid in the world will not help lower your homocysteine.  It really won't lower it at all if you have genetic genetic alteration in mthfr.  In fact there's some suggestion that it may make it worse.   

Despite this, some research claims that "there's no impact or no benefit in homocysteine lowering therapies."  However, they don't even look to see if the people have alterations in the mthfr enzyme.  They use folic acid even though we know that a lot of people with high homocysteine have genetic alterations in mthfr and therefor would not benefit from folic acid.  That's probably not intentionally, it's  just not a well designed to study.  In addition, there is sound physiological reasons for beneficial impact of methylfolate and other B vitamins on the cardiovascular system.  It's also well documented that elevated homocysteine levels increase risk for blood clots. 

My take is if you have high homocysteine, it's best to find out why it's high and it's best to try to lower your homocysteine levels.  

That should give you a better understanding of what happens when homocysteine is high.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to lower your homocysteine levels, click in the link below to get started. 

Do you have issues with ongoing iron deficiency anemia?  Are you wondering how do you manage iron deficiency anemia? Maybe you are chewing ice or have restless syndrome.  These are all symptoms of low iron levels.  In this article we go into depth on the management of iron  deficiency anemia.  We look at what kinds of tests should be done to understand whether you're getting enough and some alternatives to oral iron to manage your iron deficiency anemia.

If you want to understand the management of iron deficiency anemia, keep reading.

Understanding Iron Deficiency Anemia

The management of iron deficiency anemia is conceptually very easy but but there are a few things issues that can come up during the process of managing iron deficiency anemia.   In this article we go into depth on how to manage iron deficiency anemia to ensure you don't run into these same problems.  Now iron deficiency anemia occurs when you are not consuming enough or not consuming as much as you lose over an extended period of time.  Most of the iron we consume comes from animal products.  Yes there's some in plants but typically it's not very bioavailable iron.  So the iron in plants has minimal absorption compared to the iron that is in animals.  The heme iron that's in animals comes from their blood. 

So if you are someone that's more vegetarian, vegan or you just don't eat a lot of animal, like chicken beef turkey those products,  you may not be getting enough compared to what you loose.  Along those lines, most of the iron deficiency anemia does occur in females due to their menstrual cycles females.  They are losing blood every month, of course.  Once they hit menopause, that will not be the case.  Still, people can be iron deficiency even if they are not menstruating.  Males can become iron .deficient as well.  It's just not as common. 

In the cases of males, it occurs when they don't consume enough animal products to replace their iron.  In addition sometimes there is some ongoing bleeding, usually for a chronic period.  They probably just don't know the bleeding is occurring.  Some people do have absorption issues too.  That can play a role and we also lose some iron every day just due to breakdown of the hemoglobin molecule and through other means.  For instance, long distance runners can lose a lot of iron from the heel strikes.  These types of iron deficiency don't typically lead to the deficiency we see in females. 

There is a separate article on iron deficiency and the reasons people get anemia.  This goes into a little bit more depth, if you want to check that out.  Now you have a basic understanding of why it occurs, we can look at how to manage the iron deficiency anemia. 

First, I also wanted to point out, not all anemia is iron deficiency anemia.  Iron deficiency anemia is defined by a lack of red blood cells or a lack of lack of hemoglobin due to not enough iron.  The iron is needed to make the hemoglobin and the hemoglobin is needed to make the red blood cells.  So not enough iron causes deficiency in one or both of these. There are other causes of anemia not from iron deficiencies too.  We won't go into that here.  Just make sure your issues are from iron, before you start taking iron. 

Management of Iron Deficiency Anemia

So when it's low, you need to increase your intake of iron. This can come from food sources, supplements, injections, or intravenous iron.  When it comes to management of iron deficiency anemia, you need to increase those low levels.  Food and supplements are the easiest and the best way to go about it because it's something you can do on your own at home etc.  However, this route can take a long time for some people depending on their absorption.  If they have issues with absorption, it may take a really long time.  This becomes cumbersome because in some cases the oral iron can also cause constipation or other digestive side effects. 

There's one type of oral iron that I recommend above the others ones.  It is called iron bisglycinate and you can find it here or here.  Some people can also just increase their protein intake from animals that have a lot of blood like beef, elk, and bison.   All animals have some blood in them and will increase your iron if you're eating them on a regular basis.  Beef, liver, and other organ meats are also a rich source of iron.   You just want to make sure you are getting a healthy source. 

How do you know when you actually have enough iron?  The first way you'll know is if you no longer have iron deficiency anemia symptoms. These are symptoms like fatigue, chewing ice, restless leg, and other things like that.  The other way is through getting a blood test.  On this test your hemoglobin will be in the normal range and your serum iron will be normal range.  This is oftentimes where people get hung up. They stop their iron treatment once those things normalize.  They don't check things like their storage forms of iron.  The storage forms of iron also known as ferritin tells us how your total body iron levels are doing.  If you check your storage form, you may actually still be low even though you are no longer anemic.  In this case, when you stop your iron treatment, whether it's intravenous or oral, you quickly return to being anemic.  Since you think everything is good, you may not get tested again for a long time.  Six months or one year later, you're back in the same position again.  You have to stay up with the testing to make sure you're getting enough iron and not dropping off as soon as you stop the treatment. 

That's the first tip I have on managing iron deficiency anemia.  Make sure you are checking all of your levels related to iron.  Like the serum iron, total iron binding capacity, hemoglobin, red blood cells, and ferritin.   Once all your levels are normal and that ferritin is above around 60, it's time to start backing off on your iron supplementation.  If your levels aren't reaching that, you need to keep going.  Some people have to continue consuming the iron because they are menstruating heavier than others.  Checking your levels regularly will give you insight on how much iron you need to consume and whether or not you are trending up trending down or staying even. 

Alternatives to Oral Iron

What are you going to do if you can't tolerate the oral iron or increasing the oral iron or animal protein?  Well in that cases, you can get intravenous iron or injectable iron.  These therapies do carry some risk and there's also the expense.   However, it does get your iron levels up much quicker and you are not battling the ongoing low iron all the time.  A lot of people with low iron don't realize they can just get an IV of iron or take an injection of iron.  Intravenous iron is not recommended if you haven't tried the oral iron but it does provide a much quicker way to get your levels up.

There is also the possibility of overdosing on iron or getting too much iron in your system.  You definitely don't want to do that on an ongoing basis.  That's why its recommend to checking your iron levels, your ferritin, your hemoglobin to make sure things are balanced just right for your system. 

That should give you a better understanding of the management of iron deficiency anemia.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on the management of iron deficiency anemia, click in the link below to get started. 

Do you have ongoing fatigue and trying to figure out what could be going on to cause your fatigue?  Maybe you also have hypothyroid symptoms such as weight gain, dry skin, constipation, etc? In this article, we look at overlooked thyroid hormone causes of fatigue.  This is part of a broader series of articles on overlooked causes of fatigue.  Check out that link to understand the things that we look for when people are struggling with fatigue.

If you want to understand some overlooked thyroid hormone causes of fatigue, keep reading. 

Role of Thyroid Hormone Deficiency in Fatigue

Low thyroid hormone production and hypothyroid are fairly straightforward to diagnose and treat.  Yet there are a few situations around hypothyroidism or insufficient thyroid hormone production, that are overlooked.  These scenarios are not too unusual to see in my practice.  Before we get into them, we should orient you to some terminology.  TSH is a hormone that's produced from your brain (pituitary) and it causes your thyroid hormone to produce T4 and a little bit of T3.   These are the thyroid hormones.   The T4 is then converted into T3 in the tissues when it's needed. 

One of the overlooked thyroid issues that can often lead to ongoing fatigue is the poor conversion between the T4 into T3.   The enzyme that makes this conversion is called deiodinase.  There are several things that can influence these enzymes and how they actually perform their function.  One of these  influencing factors is cortisol and the body's overall stress levels.  When you are under higher stress levels and producing higher cortisol the deiodinases don't work properly.  This can lead to more conversion of T4 into reverse T3. The problem is reverse T3 has no actual thyroid hormone activity.

It's normal for your body to make some reverse T3 but when that reverse T3 is on the high side or high normal side, it suggests a poor conversion of T4 into T3.

You can actually measure the T3 level as well.  This gives you an idea of where the balance of your thyroid hormone is going.  If a lot of it's going into that reverse T3, it means less is going to be available for actual T3.  As a result, your tissues are getting less thyroid hormone stimulation because the T3 is the active form of the thyroid hormone.

In these situations you may have a normal T3 and a normal TSH, meaning within the normal reference range.  That free T3 or total T3 will be on the low side or low normal.  In this case you may still have very much hypothyroid-like symptoms because your body cannot make that T3.  Figuring out and diagnosing this is just a matter of looking at symptoms and doing the proper testing. 

Another Overlooked Thyroid Hormone Cause of Fatigue

Another overlooked thyroid hormone cause of fatigue is when you have a normal TSH but low T4.  In some cases your brain, the hypothalamus and the pituitary gland, are not responding properly to low T4 levels.  Your brain is supposed to get the signal to produce more TSH when there's a lack of T4.  In some cases it doesn't do this.  While your thyroid gland is not making enough of the T4 for your brain, it's also not triggering it or stimulating it to make more T4.  There's a mismatch between the amount of thyroid output and the amount that your brain should be asking for.  This leaves you more fatigued.   A lot of times in those cases it's a deeper overall lack of stimulation and dysfunction within the hypothalamic pituitary axis.   These are some of the overlooked thyroid hormone causes of fatigue I see in practice from time to time. 

It's also common to see just overall subclinical hypothyroidism. This is where people have boarderline hypothyroid but respond favorably to treatment with thyroid hormone.  In cases where you don't have overt hypothyroidism or frank hypothyroidism, treating with thyroid hormone usually won't be very beneficial for you.  You do have to do some trial and error and see whether or not it will benefit you in any way.  If it's not really helping your fatigue, it's may not be worth continuing.

That should give you a better understanding of overlooked thyroid hormone cause of fatigue.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to treat your thyroid disorder, click in the link below to get started. 

Are you wondering where all the inflammation is occurring in your body maybe you've heard that leaky gut might be causing some of the chronic inflammation you are experiencing?  In this article, we look at the truth about leaky gut and its role in chronic inflammation and chronic inflammatory diseases.

If you want to know the truth about leaky gut, keep reading. 

Understanding Leaky Gut

The truth about leaky gut is that the conventional evidence for its role in health and disease broadly speaking is limited but growing.   Despite this limited evidence from conventional medicine, there is plenty of empirical  and even clinical research supporting the role of leaky gut in a wide range of health conditions.  The most broad reaching of these conditions is a general term referred to as chronic inflammatory diseases.  The picture (and video) above shows what happens with leaky gut.  There is normal tissue to the left and as inflammation in the digestive tract progresses there is leaky gut.  What we want to look at is the case for leaky gut being related to other inflammatory diseases outside of the digestive tract.   

The basic idea of leaky gut is as follows.  Inflammation occurs through and via the immune system.  The digestive tract is closely connected anatomically and mechanistically with the immune system.  This relationship and connection is what the scientific research focuses on.  When we look to connect leaky gut and digestive issues to other global issues, this is the first place that we usually look.   Before we look at that research, let's look a little bit more at what is meant by a leaky gut. 

Leaky gut is a simple way to describe a complex process by which the digestive tract barrier is not working the way it should.  In this process there are potentially immune stimulating proteins from inside the digestive tract lumen that can pass unencumbered into the body.  These proteins can be microbial proteins, food proteins, and from other sources.   There are many health conditions where there's really no debate about whether or not this happens.  These include things like, celiac disease, irritable bowel disease (like Crohn's and Ulcerative Colitis), and even IBS.  The debate about leaky gut or increased gut permeability is not a debate about whether or not it happens at all.   The question is whether or not it is occurring in systemic conditions that are seemingly unrelated to the digestive tract but also have an inflammatory component. 

The process by which leaky gut occurs is there's breakdown of this mucous defense layer.  In addition the proteins that hold the digestive cells together breakdown.  This leads to an increased permeability and the immune stimulating proteins can leak through through.  The activation of the immune systems can cause allergy and inflammation.  There are multiple mechanisms by which leaky gut occurs.  All seem to exploit the tight junction protein that hold the intestinal cells together and prevent penetration of these immune stimulating proteins.  One of the proteins that hold the tight junctions together is called zonulin.  Elevated blood levels of zonulin have been associated with many chronic inflammatory diseases.  Included among these are celiac disease, type 1 diabetes, ankylosing spondylitis (an autoimmune condition), obesity, autism, depression and even chronic fatigue syndrome.  While high zonulin in the blood is only associated with these chronic inflammatory diseases, other studies have confirmed this association with other measurements of leaky gut.   Still there is not a consensus on how to measure leaky gut or increased intestinal permeability. 

Whether or not we can say this association as an actual causation is still not clear.  However, given the proximity of the digestive tract to the immune system and the accumulating evidence between leaky gut and chronic inflammatory diseases, it seems likely that there is more than just a casual association.  I am also reminded of the quote by Hippocrates "all disease starts in the gut."  It seems there is accumulating evidence in support of this wise saying.  The main point though is that leaky gut can affect more than just your digestive tract.  Oftentimes can affect multiple areas of your body.  Digestion and leaky gut are definitely related to a lot of immune, inflammatory, and autoimmune disease.  I see this kind of thing frequently.  For instance, with autoimmune diseases treating the digestive tract and finding an underlying trigger often improves or resolves chronic inflammatory diseases like autoimmune diseases. 

If you think you might be suffering from some of these things you can have a blood zonulin test done and it may help you understand what's going on in your body. 

That should give you a better understanding of the truth about leaky gut.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on your leaky gut or chronic inflammatory issues, click in the link below to get started. 

Do you have ongoing fatigue, been diagnosed with chronic fatigue syndrome and trying to determine what's going on with your body?  In this article, we look at some of the overlooked hormone causes of fatigue.  In a previous article we looked at the three main causes of fatigue.  Here we will discuss the physiological causes of fatigue that may have been overlooked.  We specifically look at the things that can go wrong with the hypothalamus and pituitary because of stress.   In addition, how stress can ultimately lead to a decreased production of important hormones that regulate energy and your bodily functions.

If you want to understand some of the overlooked hormone causes of fatigue, keep readings. 

Hypothalamic Control And Cause Of Fatigue

The image below looks at is some of the controlling factors via the hypothalamus to the pituitary.  This is also know as the hypothalamic pituitary axis.  Most of the hormones in our body are controlled centrally by the hypothalamus and the feedback loops that occur through the pituitary and the hypothalamus.  Interruptions in the feedback loops can cause global reduction in hormones, not just in one hormone system but many hormone systems. 

The hypothalamus produces pulsatile rhythmic signals by way of hormones that cause the pituitary to then produce hormones as well.  The hormones that are produced from the pituitary, target the end organ or the gland to produce the hormones that many of us are familiar with.  These are things like cortisol, thyroid hormone, testosterone, etc.  This process or system is referred to as the hypothalamic-pituitary - "whatever organ is involved." This could be the adrenals, the testes, the thyroid etc.   For instance, you might see the hypothalamic-pituitary-adrenal axis or hypothalamic-pituitary- testicular access.  So that's how those connections are referenced.

To make it more clear what happens in the dysfunctional state, let's look at an example like production of cortisol.  In the case of cortisol, the hypothalamus produces a hormone called corticotropin releasing hormone.  This hormone stimulates the pituitary to then produce ACTH (Adrenocorticotropin Releasing Hormone).   The ACTH then goes on to the adrenal glands to stimulate them to produce cortisol and several other hormones.  The cortisol levels then feeds back to the pituitary and shut off the ACTH production.  It also feeds back to the hypothalamus to reduce the amount of corticotropin releasing hormone produced.

It turns out that your hypothalamus is part of a bigger neural network in the brain referred to as your limbic system.  One of the big parts of what the limbic system does is it processes or is the center of our emotions.  It is referred to as the emotional center in the brain.  Stress, whether it's real or imagined, can cause the body to produce an appropriate amount of cortisol via this same mechanisms described above.  In other cases, it could cause production of excess or deficient amounts of cortisol.  Ideally it would produce the appropriate amounts of cortisol but sometimes there is dysfunction the hypothalamic response., as we will see below. 

The same kind of signals are involved with thyroid hormone and testosterone production.  When it comes to stress, cortisol can actually feed back to dampen the response that comes out of the hypothalamus for all of the hormones.  So it can reduce the amount of gonadatropin releasing hormone and thyroid releasing hormone as well.  When you are under a lot of stress, real or imagined you may have less hormone output.  Also depending on how your systems are wired, you may produce more cortisol than you need to.  You may perceive a higher threat (in a low threat situation) and this causes your body to down regulate the amount of these hormones produced.   

Hypothalamic-pituitary-adrenal axis Hormone Cause Of Fatigue

When it comes to overlooked causes of fatigue, there is evidence in fatigue and chronic fatigue, being a problem in the hypothalamic-pituitary-adrenal axis (HPA axis).  For some, it is thought to be a dysfunction in that axis.  The dysfunction is in the response of your body producing cortisol and also how the cortisol feds back to the hypothalamus.  Where does the dysfunction come from? 

Acute traumatic experiences can dysregulate the stress response.  Early childhood development trauma (which is more chronic) can also do this.  Developmental trauma occurs when there are a lot of stressors in early childhood during development of the nervous systems.  The stress input from the environment at early ages lead to a learned stress reponse. We can say that the nervous system is adapted and thereby sensitized to the stressors.  This dysregulated nervous system and stress response can lead to a dampened response or an excess response depending on stressor (and the learned response).   This phenomenon is clearly evident and well documented in acute PTSD.   The acute trauma can also trigger an inappropriate cortisol response and that leads to dysfunction in the hypothalamic-pituitary axis.  It is becoming more apparent that same kind of thing can happen from low level repeated stressors in our bodies, in adulthood and more commonly early childhood development.  

In these cases the hormones from the pituitary can be measured in your blood.  Measuring them can allow you to see that there are deficiencies.  When it comes to overlooked causes of fatigue this is something that we see especially in post-traumatic stress disorder.  Here is a link that goes int o more detail on PTSD and HPA dysfunction, if you are interested. 

This study shows clearly how that cortisol feeds back on the hypothalamus. It also goes into a lot of detail it's a lot of biochemistry that is more recently being discovered and how all the feedback works.  What it is shows is within the hypothalamus, there is the gonadotropin releasing hormone neuron.  This neuron gets fed back on.  This feedback is what causes the pituitary to produce FSH and LH.  These hormones stimulate testosterone production in males and for females their estrogen and progesterone.  We can see that things like stress can feedback and lead to a reduction in the amount of gonadotropin releasing hormone that is released.  There are other things that can influence the feedback too like the actual hormones themselves, inflammation, drugs, metabolic things.  The purpose of this is to show the relationship of stress on the axis.  You can substitute corticotropin releasing hormone or thyroid releasing hormone here.  We assume that the same types of feedback mechanisms are in place for all of these.  With the difference being in the case of thyroid, it is  neuron that stimulates the pituitary to produce TSH and is inhibited by thyroid hormone.

How Stress Causes Fatigue in Sensitized Individuals

The overall gist of it is that stress can have a negative impact on the amount of stimulation your glands are getting to then produce the appropriate amounts of hormones.  Depending on how your stress response system is wired you may have an inappropriate amount of hormones being produced. 

If you think this might be happening to you, one of the things you would want to do is check all the pituitary hormones.  Also look at the amount of hormones that are being produced from the end organs like cortisol, thyroid hormone, testosterone.  If you are not producing large enough amounts of the pituitary hormone and there's also a small amount coming out of the glands themselves, it suggested a dysfunction axis.  For instance, if you have low luteinizing hormone and low testosterone or low ACTH and low cortisol, suggests that some of this may be occurring.  If this is the case, then you want to look more closely at your stress response.  This is easier said than done but there are things you can do, medicines you can take to help that response. 

If you are someone that has ongoing fatigue that is one thing you should look at.  A lot of people do have high stress levels but it's really about the stress response and how your systems are designed through development

That should give you a better understanding of some overlooked hormone causes of fatigue.   If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to overcome your fatigue, click in the link below to get started. 

Are you wondering about the influence of birth control on your hormone levels? Maybe you recently started a birth control and you are having some  side effects or problems.  In this article we look at the question, can birth control mess up hormone levels.  We look at some of the direct and indirect consequences of birth control on sex hormones.  For instance, how long will it take for your natural hormone production come back after you stop birth control?

Affect of Birth Control On Female Hormone Levels

Birth control definitely changes the amount of hormone levels that the female body produces.   This is the main objective of birth control.   In fact, the main way that birth control works is by inhibition of ovulation and follicular development.  This then changes the output of estrogen and progesterone which are the main hormones that females produce.  Because the birth control contains synthetic versions of the estrogen and progesterone, the body still gets a signal that these hormones are present.  The synthetics are molecularly slightly different though.  As a result, you may get an over stimulation or under stimulation in some tissues.  This will vary slightly based on individuals response to the synthetic hormone signals. 

Some people do not respond well to a certain birth control because of how their bodies break them down and respond.  Overall the way the body responds to birth control is not usually apparent on the tissue receptor level and how you feel.  Of course, there are individual cases where people do not respond well to certain types of birth control.  So yes there are changes in the female hormones and changes the hormonal signaling and production. 

Duration of Birth Control Changes

The hormonal changes can last for several months after stopping the birth control.  One study looked at this specifically.  They followed hormone levels of women that were on birth control and then stopped.  The study found that luteinizing hormone and follicle stimulating hormone were much lower in the first month after stopping the birth control.  By the third month, these levels were starting to climb back up again.  Some women also had lower production of progesterone and estrogen in the mid cycle which corresponds with reduction of the luteinizing hormone and follicle stimulating hormone.  

So when stopping birth control we expect that the hormone levels to rebound to pre birth control, in about three months.  This study found that some women took longer than three months.  Depending on which birth control you take, how your body responds, how sensitive you are, etc it may take longer than three months for your hormones to rebound.  This is just one side of the question, can birth control mess up your hormone levels.  The answer is, yes while you are taking them your hormone production will be altered.  The other side is what about other hormones outside of the female hormones like testosterone and cortisol. 

Affect of Birth Control On Testosterone and Cortisol Levels

 It turns out when you are on birth control there are some other unintended hormonal effects on your body.  These may account for some of the side effects that occur with birth control.  For example, many studies have found that sex hormone binding globulin is much higher in females taking birth control.   Sex hormone binding globulin (SHBG) binds to your hormones that are floating around.  In particular, testosterone and estrogen.  The amount of bound verses unbound hormones is referred to as the bioavailable of a hormone.  Any estrogen or testosterone that your body produces can be be bound up.  With high levels of SHBG birth control causes, testosterone and estrogen to be effectively very low.  This leaves your overall libido and sex drive low too.  

It's also commonly known that birth control reduces the amount of overall testosterone output too.   This occurs through the same kind of mechanism that's inhibiting the estrogen and progesterone.   That is, the overall flow of hormones in the hormone cascade is decreased.  The body still has a signal to make hormones but since some of the enzymes are blocked by the birth control, hormone production shifts into producing things like cortisol.    Women on birth control will see much higher blood cortisol.  That will have  an effect on your overall stress response.  The sex hormones are not being produced at the same abundance but you still have the synthetic versions to offset things at the tissue level.  In exchange you have high cortisol and very little testosterone. 

When you start birth control some of the physiological hormone changes described above may account for those side effects  you may experience.  You have to weigh if the risk benefit ratio works out for you and what you need for your health right now. 

That should give you a better understanding of can birth control mess up hormone levels.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on balancing your hormone levels, click in the link below to get started. 

Are you dealing with ongoing fatigue and can't figure out what's going on with your body? Do you have decreased exercise tolerance, decreased motivation and decreased capacity to get things done?  In this article, we break down some of the common causes of fatigue.  We look at each system of your body and how they can contribute to fatigue.  This will be a broad overview of the causes of fatigue.  Subsequent article will look at more of the details on these common causes of fatigue.  

If you want to know what the common causes of fatigue are, keep reading. 

3 Main Causes of Fatigue

Fatigue is such a common cause for people to seek medical attention.  Let's look at some of the common causes of fatigue and categories of fatigue.  We can put common causes of fatigue into three separate categories.  The first cause is physiologic.  With physiologic fatigue there is too much exertion and not enough rest. If you are working increased hours, doing heavy labor or moving or anything that your body is not used to, this can cause fatigue.  This is usually short-lived.  Once you rest enough or your body recovers enough that fatigue should go away.  Another thing is maybe you are not sleeping or resting enough.  Sometimes acute stress is interfering with your sleep, this can also cause fatigue.  These are all examples of physiological causes of fatigue.

Secondary cause of fatigue occur when there is something going on medically speaking like anemia or other physical things we can point to.  These are well known causes of fatigue. 

The third type of fatigue is chronic fatigue.  This is a type of fatigue that lasts longer than a few months.  When your fatigue is present for up to six months without a cause being identified, you start to get the designation of chronic fatigue or Chronic Fatigue Syndrome.  Part of this diagnosis is multiple rounds of evaluation and diagnostic testing to rule out any known secondary causes of fatigue.  If you go through the overall list and you are not able to find a secondary cause of fatigue,  you are put into this chronic fatigue category.  The problem is many times people don't get a thorough evaluation for all these secondary causes.  Yes, they get a basic blood panel, a basic evaluation and questioning.  If those are normal, this is the fall back diagnosis. 

I have personally had many patients with ongoing fatigue (6 or more months), diagnosed with chronic fatigue, where secondary causes are later identified.  After looking at their blood tests in more detail, we find secondary causes of their fatigue.  In these cases, they don't have chronic fatigue, they just have an underlying medical condition causing the fatigue.  Of course, there are cases where it's not as clear and it does take long term investigation and treatment in order to relieve the fatigue.  With all this in mind, I wanted to point out and give you an overview of some of those secondary causes of fatigue.  This will give you some understanding of what to look for in yourself.  These causes basically go through all the systems of your body looking for a cause. 

Common Secondary Causes of Fatigue

One of the main secondary causes of fatigue are endocrine issues and hormonal issues.  If you have hypothyroid (not enough thyroid hormone), not enough cortisol, not enough female hormones, or male hormones, all these can definitely cause fatigue.  Depending on your age that may be more or less likely. 

Diabetes can also cause fatigue.  When your body is not getting the blood glucose it needs you will not be able to make energy.   High insulin levels can also cause fatigue.  There are many endocrine or hormone-related causes of fatigue. 

There is also anemia and vitamin deficiencies that can cause fatigue.  Sometimes you may not even be actually anemic but you have low iron levels or low B12 levels.  These can definitely cause fatigue.  Also immune system problems and chronic infections can also be a problem.  When you are acutely sick with an upper respiratory tract infection you don't really feel like doing much.  This is a signal from your body telling you you need to rest which allows your immune system to fight it off.   Sometimes people have chronic infections going on like urinary tract infection or problems  deeper in their digestive tract.  These things can cause ongoing fatigue but the fatigue may go away short term and then come back.  This is an indicator that there's something going on with your immune system. 

Even cancer which is also related to your immune system, can cause fatigue.  Autoimmune disorders like lupus and rheumatoid arthritis, because of the immune involvement, can also cause fatigue.  It is the increased immune activity that causes your body to want to slow down to fight things off.  In the case of autoimmune its fighting your own body but they are the same chemicals being produced that cause fatigue.

There is, of course, psychological causes of fatigue too.  Low motivation, lack of interest in doing things, lack of interest in the world, are all symptoms of depression.  Mild mood disturbance or even more severe major depression can cause someone to feel more fatigued and have lack of energy to do things.  With mood disorders and fatigue it's important to figure out which is causing which.  Sometimes it's not clear but the low energy can definitely cause depression.  It is also true that depression can sometimes manifest as low energy lack of interest.   

Sometimes mood disorders like anxiety can cause problems with sleep sleep disturbance and that can also lead to lack of energy.  In this case the issue is an underlying chronic sleep disorder.  With sleep problems sometimes people say they had sleep problems their whole life.  If it's a long standing sleep issue where you only sleep six hours per night, this can be "normal."  However, if onset of sleep disturbance correlates with your fatigue, then that's something you want to look at more carefully.

Digestive disturbances whether it's an autoimmune type of digestive issue like irritable bowel disease like Crohn's or Colitis those things can definitely cause fatigue. There are also IBS-like symptoms, post-infectious IBS, SIBO, and other chronic digestive issues that can pull down your energy.  For one reason you are not absorbing food and nutrients.  Also the overall pain and discomfort can cause your mood to be disturbed and also lower your energy.

When it comes to energy production, you need oxygen to be delivered to your tissues.  Any cardiovascular problem can lead to a lack of oxygen deliver to the tissues.  When your tissues are not getting have enough oxygen they cannot produce energy through oxidative phosphorylation.  Oxidative phosphorylation is how our bodies generate energy.  The same problems occur with chronic respiratory issue, like COPD and asthma.  These can cause fatigue due to lack of oxygen being delivered to those tissues. 

This is just the tip of the iceberg look at causes of fatigue.  There are much more in-depth and subtle things that can be going on in your body.  That will be the focus of subsequent article.  

This should give you a better understanding of the common causes of fatigue.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to improve your energy or find the cause of your fatigue, click in the link below to get started. 

Are you concerned about your iodine status?  Are you wondering what happens if you have excess iodine? In this article we look at the consequences of excess iodine inside your thyroid.  We also look at what are the best tests when you have concerns about excess iodine?

Here is What Happens With Excess Iodine

Some of the information is referenced from this review article titled, The consequences of excess iodine.  This article has good information with a good illustration.  The illustration shows what is thought to be going on when you have excess iodine.  Before we jump into the details of that there are a few topics about excess iodine to know about.  If you are looking for information on excess iodine, you may be a little bit worried about seeing excess iodine and reading about the problems that can happen. 

For the most part, people that have excess iodine levels  in a blood test (or urine test), the chances of problems occurring are very very low.   However, in some susceptible individuals excess iodine levels can cause issues for your thyroid gland.  Iodine in general is very well tolerated and is not going to cause any real problems for most people even when you're consuming levels well above the RDA or other similar minimum standards.  Before we look at what happens when you have excess iodine, you need to know how we measure iodine. 

Measuring Iodine

How do we determining what excess iodine actually is? How do we measure excess iodine or iodine in general? Blood tests can be used to measure iodine but blood tests can fluctuate a lot based on your iodine intake.  Because of this urinary iodine is a little bit better at measuring excess iodine.  This type of testing helps us understand when there's excess iodine present since anything that is not used to make thyroid hormone or some other function in your body, is excreted in the urine.  When you have normal levels in your urine or high levels in your urine we could be reassured that it's reflecting a true measurement of the functionality of the iodine in your body.  What does a high urine level mean?

With high levels excreted in your urine we could assume that there is excess iodine in your body.   Anything above 300 micrograms per liter is considered excess iodine on a urine test.  Most of the problems that occur with excess iodine are occurring in the thyroid gland. 

Thyroid And Excess Iodine

What can happen when you have excess iodine is both hypothyroid and hyperthyroid.  These occur through a well-known phenomenon called the Wolff–Chaikoff effect. This phenomenon was described by two doctors from UC Berkeley.  The exact issues that occur with the Wolff–Chaikoff effect are not completely understood.  There are some distinct things that do happen with this effect and described in the article and here.  The normal process that occurs in the thyroid gland to make your thyroid hormones. 

When excess iodine occurs in the thyroid gland there's an acute reduction in thyroid hormone production.  It is thought that the increased iodine negatively interacts with the TPO enzyme ( thyroperoxidase enzyme).  This enzyme is needed to make the T4 and T3 thyroid hormones.  Normally the iodine molecules are oxidized and combined together to produce the T4 and T3 via the TPO enzyme.  With excess iodine and decreased activity of the TPO enzyme there is less T4 and T3 released into the bloodstream.  This leads to hypothyroidism.

Most people are able to adapt to an acute increase in iodine levels.  They are able to adapt to this.  In healthy people, their body does not take as much of the iodine up into the thyroid gland.  Once the thyroid gland has enough it will not take up more and therefore you won't get this excess iodine interfering with thyroid hormone production.  Because of this there's not a reduction in the thyroid hormone.  Those who already have thyroid hormone issues like hashimoto's, autoimmune, and immune system issues may not be able to counteract those high levels of iodine.  Therefore it can lead to the hypothyroidism.  This may be transient or in some cases can be more permanent.  Failure to adapt to those higher levels can lead to prolonged low thyroid hormone output. 

This will mostly occur in those susceptible individuals.  Those with low thyroid output already or those with autoimmune things going on.  People often have autoimmune thyroid issues occurring and they don't even know it, because it's never been measured.  They may not be experiencing any hypothyroid symptoms either.  In the presence of excess iodine it could trigger the Wolff–Chaikoff effect and lead to lower thyroid hormone output. 

The test to figure out if you have autoimmune thyroiditis is pretty straightforward.  It is called the anti-TPO antibody or anti-thyroglobulin antibody.  These can both be done through a simple blood test.  If both of those are normal, we would expect you to not be as susceptible.  We still couldn't rule it out completely but it is less likely. 

In some susceptible individuals excess iodine can also cause a hyperthyroid state.  Usually this occurs in people with goiters.  A goiter is where you have swelling and a broad puffiness in the throat area around the thyroid.  The hyperthyroid state has been reported in people that don't have goiters as well. 

Sources of Iodine

Now you may be asking, how much iodine is too much? To this end it is important to point out some of the sources of iodine that you may not have thought of.  These can cause excess states.  In the article above there is a good list of source of iodine from supplementation, diet, medications, etc.  I wanted to point out a few of them out here too. 

One is  a common medication that's used for atrial fibrillation and tachycardia.  It is called Amiodarone.  This medication contains 75 milligrams of iodine.  Given that the usual dose of iodine is somewhere around 150 micrograms and up to 3-5 milligrams, this is a huge amount of iodine.  In this case it may be a good idea, if you need to take that medication, to make sure you're not susceptible.  In addition there is also some contrast iodine that is used for radiological studies.  This can be up to 13,000 micrograms of free iodine which is a huge amount for your body to take in all at once.  As long as you're not susceptible it shouldn't be a problem.  Still something to keep in mind for those susceptible individuals. 

Iodine is an essential nutrient for your thyroid gland to function normally.  We all need iodine from our diet.   Some people need more iodine because they're not eating the things that are going to give their bodies enough iodine to make thyroid hormone.  In the vast majority of people, iodine consumption will not going to cause any problems even at large doses.  If you think you might be susceptible to high high iodine levels, you should have a blood test to make sure you don't already have a thyroid problem.  If you are considering taking iodine, you might want to do these tests ahead of time to see if you are actually low in iodine.  

That should give you a better understanding of what happens if you have excess iodine.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to optimize your iodine or thyroid, click in the link below to get started. 

Have you been on testosterone replacement therapy and wondering how to safely come off TRT?  Are you worried about high estrogen levels, whether your testosterone levels will come back into normal range, etc?  In this article, we will look at how to safely come off TRT (testosterone replacement therapy) safely.  We will address luteinizing hormone, estrogen, and if you need to take things like HCG or Clomid, etc.  We will also look at some of the questions surrounding testosterone replacement therapy and shutting off the natural production of testosterone when you stop replacement therapy.

If you want to know how to safely come off TRT, keep reading. 

How To Come Safely Come Off TRT?

Once you decide to stop TRT you may ask if it's safe to stop it abruptly or if there's something specific you need to do to reset your body.  Do you need to do something to make sure everything is working the way it was prior to starting, for instance?  The main reason people ask this question is because of the feedback loops between the testes, the pituitary, and the hypothalamus.  These feedback loops can get interrupted when you are taking testosterone from external sources. This is true whether it is an injection, something you take by mouth, a pellet, or even a topical cream.  That outside source of testosterone will actually interrupt the feedback loops between your brain and your testes.  Sometimes it will just turn down or dampen that loop or it will shut it off completely.  This is a dose dependent phenomenon.

First we want to look at the feedback loop itself, then we will look at what happens with testosterone replacement therapy.  Finally, we will look at the things you can do to mitigate the interrupted feedback loop when you stopping TRT. 

Testosterone is produced from specific cells in the testes called the Ledig cells.  Those cells are stimulated to produce the testosterone by a hormone that comes from the pituitary gland in your brain called luteinizing hormone.  When your pituitary gland receives high levels or sufficient levels of testosterone (and to a lesser extent estrogen) it will decrease or dampen the amount of luteinizing hormone it produces.  So when the Ledig cells produce the testosterone, it feeds back and shuts off or decreases the amount of luteinizing hormone that's produced there.  In addition, there is another feedback loop higher in the brain called the hypothalamus. This gland produces gonadotropin releasing hormone (GnRH).  This hormone stimulates the pituitary to produce luteinizing hormone (and other hormones).  The production of GnRH is partially influenced by the luteinizing hormone which feeds back to the hypothalamus to tell it there is enough.  This will then cause a decrease in the amount of gonadotropin releasing hormone that it produces. 

The hypothalamus also has an internal pulsatile stimulus of GnRH too.  So that there is not a constant stream of gonadotropin releasing hormone, it is done in a pulsatile manner.  When the the overall feedback loop is interrupted that pulsatile stimulation of gonadotropin releasing hormone is also interrupted. 

Pituitary Feedback Loop While On TRT

When you are taking an exogenous source of testosterone, the amount of luteinizing hormone goes down.  As that luteinizing hormone decreases, you will have less stimulation to the testes to produce that testosterone.  In this case, it's okay given that you are taking it exogenously.  The moment you stop, it will take some time for your pituitary to reset and produce that luteinizing hormone again.  Keep in mind this is not a light switch it is more like a dimmer switch.  The more testosterone present in your body the less luteinizing hormone you will produce.  If you are doing injections, day one after the injection the luteinizing hormone production will be very low and stay low for several days after.  It may start to kick five days after or so depending on the dose you are taking.  By the end of seven days, you might have more.  The more saturated your body is with the testosterone, the less LH you will produce.  If your free testosterone is up above 200 ng/ml, you probably will not produce much luteinizing hormone.  If however you are on testosterone replacement therapy and your free testosterone is down at around 100 ng/ml you are probably still producing luteinizing hormone.  This is especially true the further away from the injection or the dosing of testosterone.  The same principal is true when you stop testosterone completely.   

Many people have commented to me that they don't want to go on testosterone replacement therapy because they don't want their testosterone production to completely shut off.  The signaling does not really work that way in my experience.  It's more of a dimmer switch and it does come back when you stop taking it.  There seems to be some suggestion that once you start testosterone therapy you have to continue taking it because it shuts off the internal production completely.  Testing many people that have been on testosterone replacement therapy for six months and six years, they still come back to what their baseline was.  While this may be true in some extreme cases I have never seen this clinically.  This doesn't mean it won't happen but it seems to be more extreme cases.  I wouldn't know because i've never seen it. 

How To Come Off TRT Safely

My first tip is, if you want to come off TRT, you can just stop taking it.  You may feel tired and you may feel like all your old symptoms come back.  However, if you really didn't have any symptoms to begin with and you didn't get any benefit from taking the testosterone replacement therapy you're not really going to notice when you stop it.  There is no real internal danger or problem that is going to happen from stopping the testosterone.  You will just have all your old symptoms coming back.  Some people have moderate depression that does come back when they stop testosterone. Whatever you're using for is treatment those symptoms may return.

The next option you can take for a more soft landing to safely come off TRT, is to decrease the dose that you inject.  You can decrease the dose you take over the course of one week to two weeks by about twenty five percent.  If you typically inject 0.5 cc's of a 200 milligrams per ml once a week, you take 100 mg per week.  In this case you would decrease it to 80 milligrams (not quite 25% but close enough) once a week.  You will then take this 80 milligrams for two weeks and then drop down again to 50 milligrams etcetera.  There is no strict rule about how quickly or how slowly you are supposed to come off the testosterone.  If you want an even more smooth landing, you can go down even more slowly and you will notice it less.  As your dose is decreasing, your body's luteinizing hormone is starting to kick in more and more. 

The third tip to safely come off TRT is to start some kind of luteinizing hormone analog.  An analog is something that is similar in molecular structure.   HCG is an analog to luteinizing hormone.  HCG stimulates the testes to make testosterone just like luteinizing hormone does.  This can be taken at 250 units twice a week.  Some people even do it more often and in higher doses.  250 units is a more standard dose.   You can take this for three weeks after stopping the testosterone replacement therapy.  After this just discontinue the HCG all together.  You can do HCG in conjunction with tapering off testosterone as well.  In this case, as you decrease the dose of testosterone you start the HCG.  As the dose of testosterone goes down the dose of HCG goes up.  As you can see, there are many different ways to approach this.  When there are concerns about fertility you are you better off using something like HCG.  Clomid is another option that can increase the amount of luteinizing hormone production.  It can be used similarly to HCG. 

There is sometimes a legitimate concern about increases in estradiol or estrogen levels as you're coming off of TRT.  I prefer to check estrogen levels rather implement a blanket treatment.  If you are someone that already has higher insulin levels, you are more likely to have higher estrogen levels to begin with.   In this case you may want to be a little more cautious. Remember estradiol comes from testosterone.  If you are putting less testosterone in your body, you are less likely to have estrogen as well.  It will naturally just go down.  Your body will not make higher amounts of estrogen if it doesn't have the raw material.  As your body is stimulating the production of LH or if you're taking HCG, these can increase aromatization.  This is going to be a temporary thing though.  You should be checking your estradiol levels to see if that's a problem for you.  You can address that appropriately once you know what the levels of your estradiol are.  Things will change as you get further away from the testosterone replacement therapy or TRT.  

That should give you a better understanding of how to safely come off TRT.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to safely come off TRT, click in the link below to get started. 

Have you recently discovered you have elevated liver enzymes? Maybe you have been exercising more and you want to know, can exercise affect elevated liver enzymes? In this article, we look at this specific question.  We also explore how much exercise would cause this, the difference between being trained and untrained muscle triggering elevated liver enzymes, and how long the liver enzymes might be elevated from this.   What is actually meant by liver enzymes and are these enzymes really just in your liver or are they found in other places?

If you want to know whether exercise can affect liver enzymes, keep reading. 

Can Exercise Affect Liver Enzymes?

Several people have asked this question about the effect of exercise on elevated liver enzymes.  This article will specifically address this topic in detail.  Fist we will look at a case example of someone that had elevated liver enzymes specifically from exercise.  Then we will look at a research study that looks at the effect of exercise on elevated liver enzymes. 

The case example documents a female graduate student that presented to determine whether or not she was eligible for a pharmacological study involving a new psychiatric medication.  She did not consume much alcohol but did drink alcohol one to two times a week.  We would typically expect higher consumption is needed to cause elevated liver enzymes.  They also did a physical exam on her which was all normal.  The laboratory assessment was not, however.  In this they found elevated alanine amino transferase which is ALT at a level of 87.  So it was moderately high.  They also found AST was also high at 120.  She also had elevated lactate dehydrogenase and creatinine kinase.  Other than these findings, she was otherwise very healthy young female, as far as she knew.  With no real symptoms these findings were a surprise for her too.

While reviewing the results with her she did report that she had been training a lot more for a "ToughMudder."  Once she stopped the exercise altogether, three weeks later her repeated results were in the normal range.  This just illustrates the fact that these liver enzymes are also highly concentrated and muscle.  Yes they are more concentrated in the liver but they are also very abundant in other tissues too, specifically the muscles.  AST is in cells of muscle, heart, kidneys, red blood cells, the brain, and the small bowel.  ALT is present in the cells of liver, muscle, and kidneys.

If you look at it on the larger scale, since our muscles have a larger mass than your liver does, they contain more AST and ALT enzymes overall.  These enzymes are just more concentrated in liver cells.  So if you are doing a full body workout, it's possible to get elevated liver enzymes from this, depending on your training level.   You can get elevated liver enzymes from simply exercising.  Tissue damage in muscle occurs with exercise in a dose dependent manor.  As you ramp up the intensity of exercise you are going to get more muscle damage especially if you're not trained. 

This also brings in a larger point that elevated liver enzymes can be signs of other tissue damage too, not just muscle but heart kidney etc.  You can also have an elevation in these enzymes from hemolysis which is just breaking open of red blood cells.  Heart attack and small bowel damage from ischemia or lack of blood flow also can raise these enzyme levels. 

Research On The Effect Of Exercise On Liver Enzymes

This study does go into more detail on some of these things.  It specifically looks to answer the question of the effect of exercise on liver enzymes.  The study enrolled healthy male subjects to perform weight lifting exercises.  They choose people that were not trained for or exercises that were new.  The exercise was done for about one hour.  The results showed significant increases in AST, ALT, lactate dehydrogenase, creatinine kinase and myoglobulin (a muscle protein) levels.  What was kind of interesting to me when reading this study is that the effects were so prolonged.  Most subjects still had increased enzyme concentrations one week after performing the weightlifting program.  This was in line with other studies looking to answer this question too.  They found using strenuous one-arm exercises resulted in significant muscle damage and increases in liver enzymes up to ten days after the exercise. 

By the way, AST and ALT are typically referred to as liver enzymes and generally we call them liver function tests and liver enzymes.  As noted above, they are in other tissues.  Just because we call them liver enzymes doesn't mean they can't be in other tissues.  It is the enzymes within the cells themselves that are spilling out into the blood.   When those tissues and cells are damaged, the contents of the cells go into the blood.  So whether there's damage to the liver, the kidneys, the muscles you can see elevations in these enzymes.  The liver is just the more common culprit. 

The case example also illustrates that the more trained you are, the less likely this is going to happen.  If you go out and do a really big workout but you haven't been exercising much, you are more likely to see this effect.  You may need to wait at least seven or even ten days for this to normalize after the vigorous exercise. 

The other thing is if you have this ongoing liver enzyme elevation and you are not sure if it is from exercise or not, you do more testing.   For instance, you can also do the creatinine kinase test or myoglobulin test.  If these are elevated, it tells us there is muscle damage going on.  This would suggest the "live enzymes" are more likely coming from the muscle tissue and not the liver. For ongoing elevated liver enzymes not related to exercise, check out this article, 

How To Lower High Liver Enzymes?

That should give you a better understanding of can exercise affect liver enzymes.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to lower your liver enzymes, click in the link below to get started. 

Have you heard different information about caffeine and its effect on hormones?  Maybe you are wondering what hormones are affected by caffeine.  In this video we look at research behind caffeine and its effect on hormones.  We will look at how it affects cortisol, insulin, testosterone, and sex hormone binding globulin. 

If you want to know what hormones are affected by caffeine, keep reading. 

Hormones Affected By Caffeine

Caffeine excerpts its effect on many different hormones but most effects seems to be on cortisol, insulin, and testosterone.  Let's look at cortisol first.  In this study, researchers looked at the effects of oral caffeine on plasma ACTH levels and cortisol levels.  ACTH comes from the brain and it stimulates the adrenal glands to produce cortisol, DHEA, and other things in the adrenal glands.  Following caffeine consumption there was significant elevation of ACTH at all times 30 minutes to 180 minutes.  Cortisol is also elevated starting at 60 minutes.  For this study it looks like they used about two to three cups of coffee.  The main conclusion of the study is the effect of caffeine on hormones and they concluded that caffeine is exerting itself on the pituitary adrenal axis.  The caffeine is stimulating the pituitary to produce ACTH which then increases cortisol.   There are probably other effects going on in the body as well.  This pituitary adrenal axis was the angle of this particular study. 

Caffeine Affect On The Hormone Insulin

Caffeine also seems to have an effect on insulin and it makes sense too since insulin and cortisol have posing effects on glucose.  There are several studies showing that caffeine consumption does decrease insulin sensitivity and cause higher level of insulin to be produced.  This randomized double-blind placebo-controlled trial study looked to understand the relationship between caffeine and insulin.  It was a fairly small study so the conclusions should be taken with a grain of salt.   They looked at consumption of 200 milligrams of caffeine taken twice a day which is a fairly large amount. The participants took this amount for seven days.  They looked at the effects on glucose metabolism, serum cortisol, DHEA-s, insulin, androstenedione, and bedtime salivary melatonin. 

They found is that serum insulin levels were significantly higher in those consuming the caffeine than other parameters.  Glucose, androstenedione, DHEA and melatonin were not changed.   This may be a little confusing by the glucose not changing but allow me to break this down a bit. 

Glucose will not go up or down as long as the body has sufficient insulin to keep the glucose in check.  Insulin acts to put glucose into the cells and tissues.  Cortisol takes glucose out of the tissues and puts it into the blood.  So if caffeine is increasing cortisol, we expect the body to also need more insulin.  This is what the researchers found.  Over time that higher amount of insulin may lead to decreased insulin sensitivity and higher glucose levels, aka insulin resistance. 

Caffeine Affect On The Hormone Testosterone

What is the affect of caffeine on testosterone and other androgens and the overall androgenic effect?  There are few different angles to consider with this, like sex hormone binding globulin (SHBG) and actual androgen levels.  One study looked at the effect of caffeine on testosterone levels and they found that consumption of caffeinated coffee increased total testosterone but decreased free estrogen and testosterone.  Among women decaffeinated coffee decreased total and free testosterone and caffeinated coffee decreased total testosterone.   This does not present a clear picture of what's going on. 

Another study looked at the effect of caffeine on training.   Many people take a pre-workout supplement or drink coffee before the gym.  What kind of effect does this have on your body?  It looks like caffeine has some potential benefit on training outcomes via the anabolic effects.  For instance, if you are able to increase the overall output of exercise you do, maybe you could do more sets more reps, this causes your body to produce more testosterone.  That increased workload, with the caffeine, causes your tissues and hormone centers in your brain to increase testosterone production.  However, that increased testosterone effect may be counteracted by the catabolic effects of caffeine and cortisol. 

Caffeine consumption may not always be aligned with your exercise goals.  If your goal is purely to increase muscle, high caffeine levels may work against you because of the cortisol.  If you're trying to trim down and put on muscle, caffeine may help you with both.  This is because higher cortisol has a catabolic effect but increased testosterone from increased work loads has an anabolic effect. 

Another important variable when looking at androgens and testosterone is the effect of caffeine on sex hormone binding globulin.  SHBG is the thing that binds up your hormones and transports them throughout the body.  When you have more SHBG you have less bioavailable testosterone and estrogen.  Many studies have looked at the effect of caffeine on SHBG.  When comparing caffeinated versus decaffeinated coffee one study found no effect on SHBG.  However, several other studies have looked at men who consumed caffeinated coffee and found higher circulating SHBG levels.  To me it looks like caffeine does increase SHBG.  Taking all information above together what hormones are affected by caffeine? 

Caffeine definitely increases cortisol and there's a strong indicator that it increases insulin.  Over time it may actually lead to insulin resistance.  Caffeine may help you in the gym leading to increased workload and increase the amount of exercise you can do.  In doing so can increase your overall testosterone production.  However, if there is an increase in SHBG that testosterone is not going to be very useful to you.   Because it's not very bioavailable it will not have an overall anabolic or androgenic effect on your tissues.  Looking at individual hormones may give the appearance of an isolated effect. However, it is more likely that the effects on one hormone are balanced out by another opposing hormone.  It does look like there maybe a negative effect on your overall metabolism if it is increasing your insulin output

Of course all these things are going to be dose dependent.  Not many people are having 200 milligrams of caffeine per day.  Most cups of coffee are about 80 milligrams or so.  

That should give you a better understanding of what what hormones are affected by caffeine.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to optimize your hormones, click in the link below to get started. 

Are you losing your hair and wondering what hormones cause hair loss? In this video we look at some of the hormones that are implicated in hair loss or lack of hair growth.  In the case that your hair is just kind of stopped growing, we will address that too.  There are three main categories of hormones androgens like testosterone, thyroid, and cortisol, We look at both their effects when they're high and when they are low. 

If you want to know what hormones cause hair loss, keep reading. 

Hormones And Hair Loss

For a quick orientation here is an article titled "hormonal effects on hair follicles" It shows an overview of the structure of a hair the hair follicle, the blood supply, etc.  It's good representation of the anatomy of a hair follicle as we talk through some of the effects of hormones on hair growth.  All hormones play a role in the hair follicle development and life cycle.  Some seem to play a stronger role than others in whether or not a hair continues to grow or fall out early.  Hormones even contribute to balding patterns.  Let's look at which hormones cause hair loss or limit the ability of hair to fully mature, also known as hair miniaturization.

The complete picture of why one person loses their hair and another person has a full head of hair, is not fully understood at this point, but hormones certainly play a big role.  Androgens play some of the biggest roles in hair loss, lack of growth and poor maturation.  Androgens are hormones like testosterone but also include things like dihydrotestosterone, androstenedione, and androstanadione.  Of course, there are also metabolites of all of these hormones as they are being eliminated from the body.  These hormones can be sulfated by adding a sulfate molecule.  The body can also add glucorate molecule to support elimination from the body.  Androgens like testosterone dihydrotestosterone and their precursors like DHEA, DHEA sulfate, and androstenedione are all key factors in the natural growth of the terminal hair. 

Hair loss is thought to be caused by the interaction of these androgens and an apparent sensitivity of the hair follicle to them.  This interaction and sensitivity depends on the amount of stronger androgens relative to the amount of weaker androgens present at the hair follicle.  The strongest androgen is dihydrotestosterone and its' production is dependent on a specific enzyme.   This enzyme converts testosterone into dihydrotestosterone.  Depending on how robust this enzyme is in your body, it may convert more or less testosterone into dihydrotestosterone.   This then determines the concentrations of those androgens in the peripheral tissues like your scalp. 

Androgen Hormones and Hair Loss

For males we know that this relationship between androgens and hair loss is very strong.  In females it's not always clear that androgens are playing a role.  However in some women, it's very clear that androgens do play a role.  This lack of clarity comes from inconsistent results when looking at blood and serum levels of the circulating androgens in women that lose their hair.  Most women with frontal and central hair pattern baldness have normal circulating androgens and do not present with hyper androgenization, like facial hair growth, acne, and lack of ovulation.   This type of hair loss has also been found in women lacking actual androgen receptors.   On the other hand, many women with hyper-androgenization also exhibit and complain about this same type of hair loss in the front and in the central part of the scalp.   In one sense there is a clear role for androgens.  In another sense, there does not appear to be in the women.   

Some men that have normal circulating androgen levels, but are affected by androgens may have increased activity in that five alpha reductase enzyme.  Largely they have normal testosterone (and other androgens) levels but they are producing more DHT in the hair follicles.   In some cases they may also have increased receptor androgen binding activity.   For some reason their receptors are more sensitive to the DHT, even though there's not that much circulating.   Part of the inconsistency looking at androgen levels in females and males, is their response to the androgens in the scalp.  We can't just biopsy people's scalp to understand what's going on with their receptors.  There appears to be a clear role for androgens in some people and in other people their androgen levels look to be normal yet they could have something going on at the tissue level the receptors or just this scalp is up regulating the amount of androgens that are being produced.  When everything else is normal androgens should be the default culprit for hair loss. 

Thyroid Hormones and Hair loss

Thyroid hormones also play a role in hair follicle development.  Specifically they affect the hair follicle metabolism.   Thyroid hormones are mainly thought to exert their effect through providing enough energy (through the breakdown of fuel) to the hair follicles.  With this energy they can grow and mature and full development.   Of course, excess thyroid hormone can cause diffuse hair losses. 

Cortisol is another hormone that plays a pretty big role in in hair loss and hair follicle development.  The presence of cortisol at high levels is strictly connected with the with the reduction in synthesis and premature degradation of hyaluronics and proteoglycans.  These  are important modulators of hair follicle function and development.  Low cortisol levels can actually promote hair growth by slowing down the degradation of these important nutrients for the hair follicle.   

In summary, the predominate hormones that cause hair loss are androgens.  They play the most important and most obvious role as far as research has found.   However, even those with low or normal circulating androgen levels do not exclude high androgens in your scalp.  Sometimes when there is acne present the same thing can be happening.  This is true for both males and females.  Obvious deficiencies in thyroid can definitely contribute to hair loss and excess cortisol and stress can play a big role in diffuse hair loss.  When thyroid and cortisol are normal, the default culprit should always be androgens.   Of course there are multiple nutrients and other things that can contribute to hair loss including fungal overgrowth on your scalp. 

That should give you a better understanding of what hormone cause hair loss.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on your hormones or hair loss, click in the link below to get started. 

Do you feel like you are gaining weight from your birth control?  Maybe you have heard that birth control can make you gain weight or you are seeing the actual effects of birth control on your weight.  In this article we look at what some of the research says about birth control and its effect on your weight, your metabolism. etc.  

If you want to know if birth control can make you gain weight, keep reading. 

Research on Birth control and Weight Gain

Many studies have looked at the role of birth control and oral contraceptives in trying to answer many different questions around their role in human health.  The results are somewhat inconclusive but there are some suggestions on what might be going on.  The problem with looking at these studies is we already know the efficacy of birth control pills and oral contraceptives.  So having someone take a placebo is a bit unethical or controversial in terms of preventing pregnancy.   That being said, there is some research to look at around this topic.  However, there are limited placebo controlled trials. 

One study in particular found that weight gain does occur and it's more likely to be to be fat based and not water based weight gain.   Another study looked at the use of low dose oral contraceptives and found it was not associated with an impact on weight body composition or fat distribution.  In other words those that took the BCT did not have a change in their distribution of fat.  However they did find that when weight gain did occur, it was due to increase in body fat and not body water. These two studies agree about the weight gain, if and when it occurs, being fat not water based. 

A Cochrane review looking at birth control and weight gain states that the overall studies available for the review were weak.  However, they found there was a clear increase in weight over time equivalent to about four pounds per year.  This is a lot if you start to add that up.  Some studies actually contradict the first one (noted above), stating that the weight gain was more water weight related.  This makes sense given the role of estrogen (and hormones in general) with water retention.  When looking at weight gain in a shorter term horizon, it likely is water weight.   Likely there is a little bit of all this going on.  Because many of the studies are small, they are more subject to individual susceptibility too.  The Cochrane review was looking at several different studies combine them together giving it a broader applicability. 

How Birth Control Can Make You Gain Weight

Looking a little bit deeper at this problem, overall there does seem to be a theoretical role for the influence of birth control on metabolism and an increase in weight too.  This study did a comprehensive look at different metabolic profiles in women taking birth control.   They looked at women using combined oral contraceptive pills or POCP (progestin only contraceptive pills).  They compared these women to women who didn't use any hormone contraception and specifically looked at their metabolic profiles.  They followed them for six years to uncover the metabolic effects.  There were eight hundred sixty nine that either started the oral contraceptives, stopped, or persistently used them.

What they found was the use of combined oral contraceptives  (synthetic estrogens and progestins which are synthetic progesterones) caused widespread metabolic inflammatory effects.  The persistent use does not appear to accumulate the effects over time.  They also found that the metabolic changes are reversed once they are discontinued and that progestins only didn't seem to have the same metabolic and inflammatory effects.   This last part about progestins is opposite to what the Cochrane review found.  The Cochrane review stated that the progestin only do seem to increase weight.  So there seems to be some conflict on which oral contraceptives or hormones in the oral contraceptives are responsible for the weight gain.  Regardless many studies do find that there is either a metabolic change, like decreasing insulin sensitivity or just an overall weight gain, in general.   This last study clearly found those taking oral contraceptives increased insulin, fasting triglycerides, and other things that are associated with insulin resistance.

Taken together both synthetic estrogen and progestins have the potential to cause weight gain.  Most of it is likely based on decreasing insulin sensitivity.  It is through this mechanism that the weight gain is occurring.  Based on your unique susceptibility, you may or may not have this issue with birth control.  If you have diabetes in your family or you are just more prone to that for other reasons, you are going to be more susceptible to gaining weight on birth control.  Remember that decreased insulin sensitivity is something that happens as you age anyways.  All of us are susceptible to it.  It is a phenomenon of being human but it does take years to manifest itself.  Depending on how long the studies are, they may not actually capture this susceptibility to gaining weight.  This also means that if you're younger, you may not be as susceptible to this increased weight as well.  Some people have this going on in their bodies already and they don't even know it.   This is because they're not getting the proper tests to be able to capture what is truly going on.  Insulin resistance is not always clear from fasting glucose or hemoglobin A1C alone. 

What Is Insulin Resistance

The way I look at the research is some people are going to be more susceptible to weight gain from birth control.   Some people are inherently more sensitive to insulin sensitivity and therefore going to be more susceptible to gaining weight on birth control.  If you already have diabetes, pre-diabetes, problems with insulin levels, blood sugar, PCOS, etc, it will make reversing any weight gain more difficult.  This does not make loosing weight impossible, just harder overall.  Keep in mind, there are many different types of birth control pills out there and ways to prevent pregnancy.  It's likely that not all of them are going to carry the same amount of risk for this problem of weight gain and insulin sensitivity.  Be sure to get as much information as possible to make an informed decision.  Ask your doctor what the best option is for you and your unique situation. 

That should give you a better understanding of can birth control make you gain weight.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on your hormones and weight gain due to birth control or otherwise, click in the link below to get started. 

Are you wondering if some of your symptoms are related to vitamin D deficiency? Do you want to know what are the common vitamin D deficiency symptoms?

In this article we look at what some of these common symptoms are, how you know if you have enough vitamin D, who is susceptible to vitamin D deficiency, and other questions surrounding vitamin D deficiency. 

How You Know If You Are Vitamin D Deficient?

We will look at what the common vitamin D deficiency symptoms are.  First, I wanted to point out that the symptoms of vitamin D deficiency are not necessarily unique to vitamin D itself.  Many of these symptoms can also be attributed to other health problems, conditions etc.  So the symptoms alone are not sensitive or specific enough to know if you have a vitamin D deficiency.   That being said, you can use symptoms as a general guide to understand how likely your are to be deficient.  There are other indicators that may suggest vitamin D deficiency as well. 

These include things like where you live.  Vitamin D deficiency is more common as you get further away from the equator.  Also depending on what the weather is like you may be more or less likely to be deficient in vitamin D.  This has to do with the angle of the sun and how much vitamin D your body produces when the sun hits your skin.  The more direct sun the more vitamin D you will produce at any given time.  If you don't spend a lot of time outside you are probably not going to make a lot of vitamin D either.  If you put sunscreen on when you go outside, you are less likely to produce vitamin D too. Especially compared to someone that works outside all the time and wears no sunscreen.  

The Common Vitamin D Deficiency Symptoms

Some of the common vitamin D deficiency symptoms include things like bone pain, arthralgias, myalgias, fatigue, muscle twitching also known as fasciculations, weakness and low back pain.  Arthralgias are joint related pain and myalgia are more muscle related pain.  The weakness associated with vitamin d deficiency often occurs in the proximal muscles like the upper thighs.  There can also be throbbing bone pain.  This bone pain is specific to the sternum or even the tibia (lower leg) area when pressing on it.  These are some of the common reported symptoms in research papers. 

In practice, when people take vitamin D it commonly improves their energy levels and provides additional support to their immune system.   If you are someone that gets sick a lot you may be vitamin D deficient.  The more of these things that align, the more likely you are to be vitamin D deficient.  In this case it makes getting your levels checked more important. 

There are also many associated health conditions with vitamin D deficiency as well.   These are not symptoms in the strictest sense but things that increase the likelihood of vitamin D deficiency.  These are things like diabetes, cardiovascular disease, obesity, and several different cancers.  The cancers  that are associated with vitamin D deficiency are ovarian cancer, breast cancer, prostate cancer.  If you have any of these conditions, it's more likely that you have deficiency.  However it's not that these conditions are causing the deficiency.  Osteoporosis is of course also associated with long term vitamin D deficiency.  

Testing for Vitamin D Deficiency

If you think that you might be deficient it is best to get tested.   We want to define what constitutes deficiency.  When you are doing this test, you want to look at the 25 hydroxy-vitamin D3.  There are two different tests for this.  There is the Mass Spec and Liquid Chromatography test and this is always going to be the better test to do.  The other test that uses more immunoassay (IA).  It is also very sensitive and serves as a useful guide to see where your vitamin D levels are at.  It is not as sensitive and specific as the Mass Spec and Liquid Chromatography test though.   When reading your results, vitamin D deficiency is constituted as anything less than 20 nanograms per ml.  Some labs will even market anything less than 30 nanograms per ml as low.  What you want to look at is do you have optimal levels of vitamin D.  The optimal level of vitamin d is somewhat of a debate.  You may want to factor in genetics and other health issues.   For instance, if there's changes in your vitamin D receptor you may want a higher level.  I like to see the 25 Hydroxy-vitamin D around to 50 nanograms per ml.  It could be a little bit more could be a little bit less.   

With excess vitamin D you run into the risk of high calcium and the problems that may be associated with that.  Anything above 80 ng/ml would be considered excess and more risky.  Anything less than 20 ng/ml you may have problems long term with immune system and bone problems like osteoporosis  (as well as the symptoms mentioned above). 

There are some genetic alterations that play a role in your vitamin D activity in your body.  So when you are looking at your vitamin D status understanding your genetics is important too.  Some VDR (which stands for vitamin D receptor) SNP's (single nucleotide polymorphism) can increase the need for vitamin D overall.   There's also some genetic alterations that might change how efficient your body is at making vitamin D.  These are things to consider when looking at wether you need more vitamin D in your body.   If your levels look good and you're still having these symptoms, you need to look elsewhere for what's causing them. 

Getting Enough vitamin D

In terms of getting adequate vitamin D and prevent vitamin D deficiency, you should spend 15 to 20 minutes in direct sunlight every day with about forty percent, or almost half of your body exposed.   If you have higher concentrations of melanin darker skin, it's going to reduce the amount of vitamin D that you produce when you're out in the sun.   Similarly as you get older and sometimes if you're overweight,  it may reduce the amount of vitamin D that your body produces by sun exposure.   Using sunblock, tinted windows, etc also blocks that ultraviolet radiation.  If you're not working outside, living in more northern area, you're also at risk for vitamin D deficiency. 

Some of the information in this article was gathered from this reference article.

That should give you a better understanding of what are the common vitamin D3 deficiency symptoms.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on optimizing your vitamin levels, click in the link below to get started. 

Do you have signs, symptoms, or health issues related to PCOS? Are you wondering what is the main cause of PCOS is?  In this video, we look at what some of the driving forces are for elevated androgen levels, low sex hormone binding globulin, and genetic environmental things surrounding PCOS. 

Main Cause of PCOS

What are the driving factors or indicators behind your PCOS?  There are many key abnormal labs that are indicators of PCOS.  What's causing these lab values to go up or go down? What are the underlying changes that are seen in women with PCOS.  First off, PCOS is a syndrome polycystic ovarian syndrome.  This is characterized by androgenization (more male characteristics) like more facial hair, hair falling out on the top of your head, increased acne.  There can also be changes in ovulation, menstrual cycles and difficulty with fertility.  Most of the time there is also insulin resistance, weight gain, pre-diabetes etc.  There seems to be two main things going on with PCOS driving these abnormalities. 

There is a decrease in estrogen production and with this an increase in androgen production.  Because PCOS is a syndrome you may not see both of these variables in extremes in every person with PCOS.  For instance, you may have high total testosterone but normal free testosterone and vice versa.  You may not have super low estrogen it may just be on the low side of normal.  Keep that in mind when you are looking at lab values.   Another thing to remember is that lab values change at different times in your cycle. 

How and when to check hormones for imbalance.  

As you will see below, there are both environmental and genetic things driving this decreased estrogen production and higher androgens.  On the androgen side it is not just testosterone, it's androgens in general.  Many times the aromatase enzyme which is shown in the video decreases its activity in women with PCOS.  That decrease in the aromatase activity then cause testosterone flow in the direction towards more androgenic compounds.  The slow down on one side creates a vacuum or suction in the opposite direction.  Testosterone has two main fates.  (there are other pathways too that are not as common. ) It can turn into estradiol or Dihydrotestosterone (DHT).  DHT can also turn into androstanadione.  Both the DHT and and the androstanadione are androgenic.  DHT is somewhere around ten times as potent as testosterone.  Androstanadione is less potent than testosterone but still contributes to androgen load.  Having more of these androgens around increases the binding to androgen receptors.  Relatively speaking, there is only so much of these hormones to go around.  So if they're going in androgen direction there is less estrogen.

We should also note that androstenedione is different than this androstanadione.  They are different molecules with androstanidione being less androgenic than androstanadione.  So what is causing women with PCOS to make more androgens?  Genetic are playing a role but which enzymes are involved?  The slow down in aromatase activity is causing more androgens to be produced.  In addition to that there also seems to be an increased activity of this five alpha reductase enzyme.  This acts like a vacuum sucking all the precursor (testosterone) into more of these androgenic hormones (DHT and androstanadione). 

Another thing as we said that's common with PCOS is insulin resistance. Insulin resistance increase the aromatase activity but it also increases this five alpha reductase enzyme activity.  So you may have a net balancing out if you do have insulin resistance.  However the genetics may be driving things to go toward the androgens in those with PCOS.  The other thing with insulin resistance is the higher insulin levels causes the sex hormone binding globulin to go down.  In addition the low estrogen or relative low estradiol and other estrogens creates low sex hormone binding globulin.  This makes whatever testosterone, DHT, or androgens are around more bioavailable.  These hormones are then able to more easily bind to the androgen receptors.  This binding stimulate those androgen receptors on the skin in the ovaries and other parts of the body.   So what is the main cause of PCOS?

Well it is both genetic and environmental.  It is clear there is both increased production and bioavailability of androgens.  We cannot say conclusively i think there's environmental things that can be controlled to help improve the lab values with PCOS and the overall hormone balance.  There's also genetic things that we can use that information to also improve the lab values and overall hormone balance.   The main cause of PCOS appears to be more androgen production and more androgen bioavailability.   What's driving your unique situation with your androgen production and your PCOS may be slightly different.   You have to take all this into the context of what your lab values are.   Those lab values inform you what needs to occur in your body to help those things balance out.

That should give you a better understanding of what the main cause of PCOS is.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on PCOS or a better understanding of what is causing your PCOS, click in the link below to get started. 

Do you have diabetes and wondering what's going on with your body? What is diabetes? Is it a problem with insulin or is it a problem with glucose? In this video we look at this question, what is diabetes.  I will also explain a simple model to help you better understand what's going on in your body when you have diabetes. 

If you want to understand what is diabetes, keep reading. 

What Is Diabetes?

By definition diabetes is elevated glucose or blood sugar above what the given reference range is.  This can be measured in a fasting state, a fed state and even through the hemoglobin A1C.  We won't go into the reference ranges here since they're pretty well defined by the American Diabetes Association and elsewhere.  We know that if you are above that range, you have diabetes.   What we want to look at in more detail is what is actual diabetes.   What causes diabetes is too little insulin or too little insulin sensitivity at the tissue or cellular level.  These two statements around insulin basically tell us what is type 1 diabetes (too little insulin) and what type 2 diabetes (too little insulin sensitivity). 

In addition, a newer paradigm is starting to emerge where people with type 1 diabetes also have some degree type 2 diabetes.  In addition, some people with type 2 diabetes also have some degree of type 1.  What happens is those with type 1 diabetes that have it for a long time can get resistant to the insulin.  They are putting insulin in your body multiple times a day to mimic the natural process of your pancreas.  In doing this, you can get excess amounts of insulin present.  Over time that higher amount of insulin can lead to some levels of insulin resistance. 

Those with type 2 diabetes can also develop type 1.  The higher blood sugar level can damage the pancreas and lead to a decrease in insulin production. So this is how we think about diabetes and how we define diabetes.  What is it really though, what is diabetes?  In order to explore this more, we really need to look at and understand what insulin is doing.  What is insulin's role in diabetes?

The Role of Insulin In Diabetes and Glucose Control

It turns out that insulin is one of the key variables in the process of diabetes.  Most cases of diabetes are type 2.  There are certainly plenty of people with type 1, but the vast majority have type 2.  With type 2 diabetes, it develops from this lack of insulin sensitivity at the tissue level.  The role of insulin is to increase tissue uptake of the glucose.  Insulin binds to the receptor and causes these secret doors (in the cell), that are otherwise going to be closed, to open up.  It does this in the muscle, in the liver, and in the fat cells.  All cells can uptake glucose.  Some tissues are more sensitive and more likely to take up more,  like the liver and muscle.  In people with type 2 diabetes, due to genetics or environmental things, their tissues stop responding to the insulin. 

The insulin binds but the glut 4 transporter (secret door) no longer opens.  When this occurs your blood glucose goes up.  The pancreas is where your insulin is produced.  It does this in response to higher blood glucose levels.  The pancreas has a little sensor.  When it sees higher glucose, it produces more insulin to drive the glucose into the cell.  Therefore, when the tissues stop responding to the glucose, the pancreas says, "looks like we need to produce more insulin."   Because the blood sugar stays high, it produces more insulin.  Eventually some of the tissues will respond.  Some will respond more than others.  The glucose will go into the cells given enough insulin.  This process of needing higher insulin in the presence of the same glucose load is insulin resistance.  Let's say (hypothetically speaking) in a normal person you need ten units of insulin to get one hundred grams of rice into your tissues.  For the insulin resistance person you may need twenty five units of insulin for that same one hundred grams of rice.  This is just a hypothetical example but gives you the idea.  The insulin resistant person needs more than the normal reference range would expect of insulin to get the glucose into the normal range.   The pancreas produces more insulin when it sees that the blood sugar is not going down.  Over time the higher amounts of insulin won't be enough to get that glucose in either.  This manifests as higher blood sugar and this might start showing up on your labs.  It does not show up the same for everyone though.  It could show up as high fasting glucose or high hemoglobin A1C.  Other times it will be high glucose in a fed state.  The question we want to ask is what's causing this cell not to respond to the insulin? What's causing this not to open up?

The molecular mechanisms behind this is very complex because there's lots of research on this.  We won't go into too much detail on those here.  What I do want to share with you is a very simple model that helps predict what is diabetes and how your body respond in different scenarios when you have diabetes.  At least it helps for those with type 2 diabetes.  This doesn't necessarily apply for those with more purely type 1 diabetes.   

A Model for What Is Diabetes

If we look at this from an individual cell or tissue level, the model of insulin resistance and diabetes is too much fuel for the capacity of the cell to handle.   The Glut 4 transporter will not open when it's overfilled with this carbohydrate.  It's like the glucose is causing a backlog.  In fact, there's so much fuel available, it's interfering with the metabolism or breakdown of the carbohydrates in the cell.  We know this because people with diabetes and insulin resistance have elevated NADH to NAD ratios. That NAD is one of the cofactors needed in order to break down pyruvate.  Pyruvate is a breakdown product of glucose.  When there's not enough NAD present, it's not going to be broken down into smaller and smaller carbon units and turn into energy (ATP).  Basically it just sit there.   Eventually some of it gets turned into fatty acids and even gets exported out of the cell into adipose tissue.  What we also know about this NADH/NAD ratio is that when you fast the amount of NAD goes up and the amount of NADH goes down.  This is more favorable to opening up the Glut 4 transporter.  When you are fasting your body is getting rid of the excess glucose.  You are able to get rid of the glucose and turn it turning it into energy.  When this happens people become more sensitive to the insulin again.

That should give you a better understanding of what is diabetes.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on controlling your diabetes and blood sugar, click in the link below to get started. 

Do you have PCOS and wondering if your estrogen levels are high or low?  Or perhaps, you just want to the general pattern of estrogen that occurs in women with PCOS.  In this video, we explore the question of estrogen levels in PCOS.  We look at the genetics behind estrogen levels, how estrogen is naturally produced in the body, and what might be going wrong in women with PCOS. 

If you want understand if estrogen is high or low in PCOS, keep reading. 

Is Estrogen High or Low In PCOS

Before we get into estrogen levels in PCOS, how it is produced etc, we first need to understand what PCOS is.  PCOS, also known as Polycystic Ovarian Syndrome, it's a combination of things going wrong in the female body.  These include things like increased male characteristics like hair growth on the face and other body parts (This is known as androgenization).  Many patients with PCOS also have menstrual cycle abnormalities, a lack of ovulation, or no menstruation at all.  There can also be cysts on the ovaries but not always.  There's oftentimes insulin resistance, frank diabetes, or blood sugar issues.  Because of the lack ovulation, there can be difficulty with fertility too.   Those are the main findings in those with PCOS. 

Estrogen Production In PCOS

To understand the role and pattern of estrogen in PCOS, we need to look at  the normal process for estrogen production and what's different in women with PCOS.  The typical process of estrogen production occurs from androstenedione turning into estrone.  That estrone can then turn into estradiol and that process is mediated by an enzyme called aromatase.  Aromatase enzyme turns androgens into estrogens.  In some women with PCOS that aromatase enzyme is not working properly.  It is as if there's something blocking it. That can leads too low estrogens and specifically low estradiol. The typically stimulus for the aromatase enzyme to increase its activity is the hormone FSH (follicle stimulating hormone).  This hormone comes from the pituitary gland.  This hormone secretion is normally signaled as part of the normal ovulation process.  FSH increases and that is a strong enough stimulus to stimulate the particular cells in the ovaries to produce more estradiol.  However, in some women with PCOS, there is not enough of that FSH stimuli or there is something inhibiting the aromatase enzyme from increase its activity in the presence of FSH.

Indeed, a study looking at estrogen production in PCOS women looked at this phenomenon.  They found if there was something suppressing the estrogen production by inhibiting those aromatase enzymes.  What they found was increased levels of an androgen in the follicular fluid of women with PCOS.  The androgen called 5-alpha androstane 3-17-diode.  This is also known as androstanedione.  We don't want to confuse that with the other precursor to estrone known as androstenedione.  As you can see in this study the 5-alpha androstane 3-17-diode acts as an inhibitor of the aromatase enzyme.  This androgen was in a higher concentration compared to those without PCOS.  Why is that?

Androstenedione can be converted into estrone through aromatase enzyme or it can be converted into this androstanedione.  The androstanedione is produced through the alpha 5 reductase enzyme.  If one of those pathways is blocked or slowed down then it's going to go the other way.  Having a higher presence of this androstanedione will further inhibit that aromatase enzyme.  So once the concentrations are high, it makes it even harder for the body to produce more estrogen.  This study found that androstanedione was one thousand fold higher in women with PCOS.  The activity of that androgen on the aromatase enzyme doesn't fully account for all that lack of aromatase activity though. 

In this study they also found plenty of FSH present in PCOS women,  at least in the follicular fluid.  There was also plenty of the precursor to the estrone which is the anderstenedione.  For some reason their aromatase enzyme's continue to be slow.  This may be the chicken and egg thing.  Yes it's higher in PCOS women but what causes it to be higher to begin with? 

Genetics and Estrogen Production In PCOS

There also seems to be a genetic component to this problem.  Multiple studies have looked at the aromatase enzyme gene expression in PCOS women.  These studies found that the enzyme activity is slower.  So there is an inhibitory component from increased androgens. There also appears to be a genetic component of naturally slower aromatase activity in PCOS women.  The precursor has two main pathways it can go down.  If one is slowed down or blocked, it goes the other way.  There also appears to be in  some women with PCOS and increased activity in the alpha 5 reductase enzyme.  That may be the key component to all this androgenization, lack of ovulation, and all the things surrounding PCOS.  Back to our question, is estrogen high or low in PCOS?  Well it seems that the trend is that estrogen production is going to be on the lower side as compared to other hormones.  It may not be frankly low and obviously there's a range of what estrogen should be throughout a women's cycle.  There are other videos on this. 

How and When To Check Hormone Levels. 

Check those out, if you want more details.  

That should give you a better understanding of is estrogen high or low in PCOS.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on PCOS or balancing your hormones, click in the link below to get started. 

Are you experiencing upset stomach, burning pain, belching, and a lot nausea? Maybe you are wondering, how do you if you have Helicobacter pylori also known as H. pylori infection.  In this video, we look at this specific question.  We look at the signs and symptoms that make us think you might have H. Pylori and what tests you can do etc. 

If you want to understand and know if you have Helicobacter Pylori, keep reading. 

Most people that get diagnosed with H. pylori first have specific symptoms or clinical signs that make their doctor suspicious enough to test them for it.  It is not something that everyone should rush out and get tested and treated for though.  At this point our knowledge around the harm of H. pylori is somewhat limited.  We don't always know if H. pylori is going to be a problem for you or not.  There are clear cases when it is a problem too.  For instance, H. pylori can cause stomach ulceration and even ulceration further down in the small intestine.  If you don't have symptoms, it may not make sense to get tested.  There are some instance where it makes sense to be tested in the absence of symptoms too.  We will look at those as well. 

How Do If You Have Helicobacter pylori Based on Symptoms

Studies looking for the most common Helicobacter pylori symptoms found nausea to be one of the most prevalent symptoms followed by gastric pain. Gastric pain is pain just below your ribs in the middle of your abdominal cavity.  Heart pain which is chest pain near the heart was another common symptoms found in the study.  This type of pain is referred from the stomach to the chest.  Those with H. pylori or Helicobacter pylori are at increased risk for ulcerations in their stomach and the upper part of their small intestine known as the duodenum.   The most common ulceration type of symptom is abdominal pain.  It can be a dull aching pain in the middle below the rib of area.  This pain does not really go away completely.  It may show up for a few weeks and then go away for a few weeks but it will be there in the background coming and going.   The pain may have a sequence too, based on where the ulceration is at.  It may go away two or three hours after you eat or it may come on right after eating.  This just depends on which part of the stomach and digestive tract is involved with the ulceration.  This sequential pain has to do with the acid content in the digestive tract at the time.  When there's more acid present there's going to be more symptoms in the stomach.  If it comes on right after eating chances are, it is related to ulceration or inflammation in the stomach.  Still this is a big "if."  You can't always go on symptoms for your diagnosis. 

Other symptoms that can come on with Helicobacter pylori include feeling of fullness.  Also there is often lots of bloating and belching or burping, as well as having an upset stomach also known as dyspepsia.   Sometimes there could be acid reflux going on as well.  If that nausea and discomfort in your digestive tract leads to a loss of appetite, then there could be weight loss.  All these symptoms may give you a vague understanding that maybe you have H. pylori or Helicobacter pylori.  However, symptoms alone can't be enough to diagnose this.  There are a lot of things that can mimic these symptoms. For instance,  simply just not producing enough digestive enzymes or acid in your digestive tract can create some of these symptoms.  Something like bacterial overgrowth and even fungal overgrowth can also create that unsettled feeling and different pains in the abdomen as well as bloating, nausea and belching.  Another thing that may raise your suspicion level of having Helicobacter pylori is your geographical area where you were born or where you currently live. 

How Do If You Have Helicobacter pylori Based on Geography

Helicobacter pylori infections or the presence of it is inversely associated with socioeconomic status.  So if you grew up and currently live in a westernized country then the chances are less.   This does not mean you can't have it.  It is just a little bit less.  Whereas if you are from second world or third world country, it may be more likely that you have it.  Also if it is in your family like mothers brothers sisters father, it is more likely that you have it.  Now none of this necessarily mean you have it.  When you do have it, this doesn't necessarily mean it needs to be treated just either.  However, if you are having the symptoms, it would make more sense to be tested. 

Sometimes what happens is one person gets tested and the other people are still carrying it even though they don't have symptoms.  Then they can give it back to that person and vice versa.  It's easily passed along from one person to another through sharing drinks and kissing and things like that.  This is where testing comes in. 

How Do If You Have Helicobacter pylori Based on Testing

It's really helpful understanding what is and isn't going on in your digestive tract.  You wouldn't want to go just based on symptoms alone.  The most common test that's done is the urea breath test.  Some people can also get diagnosed through endoscopy.  The breath test does is perform by consuming a tablet of urea and measuring the output of carbon dioxide.  An enzyme known as urease is present in the Helicobacter pylori bacteria.  They use this enzyme to neutralize the acidic environment.  Using water and urea the enzyme makes carbon dioxide, ammonia, and sodium bicarb.  These can neutralize some of that acidic environment.  This allows for a nice environment for that Helicobacter pylori to live in.  For the test when you ingest the urea tablet, you will have an increased output of carbon dioxide.  This can be measured in your breath.  An increased amount indicates H. pylori is present in the stomach.  The endoscopy route of testing involves getting a sample from the stomach lining and evaluating the presence of H. pylori in the sample.   These are the most common ways to know if you have Helicobacter pylori.  There are also testing that can be done for Helicobacter pylori antibodies through your blood and also through stool testing.  These tests that I outlined here, the breath test and the endoscopy, are more accurate. 

That should help you understanding how do if you have Helicobacter pylori.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on testing or treating your digestive disorder, click in the link below to get started. 

Are you worried about elevated estradiol levels or estrogen levels? Maybe your are having hot flashes sensitive chest or nipples? In this video we look at what causes increased levels of estrogen and estradiol in males.  We look at the aromatase enzyme.   We specifically look at some of the genetics behind that enzyme activity and some environmental things that could be causing your elevated estrogen levels. 

If you want to know what causes increased estrogen in males, keep reading. 

What Causes Increased Estrogen Levels In Males?

Most people look at this question when they are on testosterone replacement therapy or considering it.  Estrogen levels, like any compound in the body, are dictated by the enzyme that produce that compound and the enzymes that break it down.  There is a separate article about what causes high estrogen levels and females.  For males and females there are similar things that cause this.  In that video we talked more about the breakdown of estradiol.  Here we will look more at the aromatase enzyme, what it does, and the influence of genetic alterations and the environment on it's function. 

Estrogen levels in men and women are driven by this aromatase enzyme.  This enzyme also goes by the name cytochrome 19A1 enzyme.  Its main job is to turn testosterone into estradiol.  It does this by oxidation and removing a methyl group.  This is the process that's happening to turn testosterone into estradiol.  There are things that can increase the activity of this enzyme and decrease the activity of this enzyme.  This enzyme is not just working to turn testosterone into estradiol.  It causes aromatization of a lot of different androgens.  Androstenedione can also get turned into a different type of estrogen called estrone.  We usually don't test for this type of estrogen as much. 

From a genetic standpoint this aromatase enzyme can be polymorphic.  This means that the genes that dictate how the enzyme is produced can be different in different people.  These changes alter the outcome of the actual enzyme.  Depending on what location on the gene is altered, will dictate how the resulting enzyme is performing its job.  In some cases it can work a lot more efficient and in other cases it will be slowed down.  When it is slowed down, you get more testosterone and less estradiol.  Vice versa if it's speeding up.  In trying to determine which genetic alterations cause speeding up and slowing down I did a little research. 

Genetic Causes Of Increased Estrogen In Males

I was not able to find anything that I would call conclusive.  What I did find is a study that showed that there are certain RSIDs that can alter the activity of the enzyme.  The RSID is the place along the gene that is changed.   This is how you identify which single nucleotide polymorphism your are referring to.  In this particular study there were four different RSIDs that were looked at.  In the study they measured the circulating estrogen called estrone levels.  Estrone can be derived from androstenedione and that gets turned into estradiol.  The RSIDs that decrease aromatase enzyme activity which decreased estrone levels were rs727479, and rs4646. 

The ones that increase the enzyme activity and produced more estrone were rs749292, rs10046. 

Based on this information, we would predict that those with these genetic alterations (homozygous for those RSIDs, one from each parent) are going to have less estrogens in general.  These alterations change that aromatase enzyme to decrease it's activity.  This means these people get less aromatase activity based on your genetics alone. 

Keep in mind, genetic studies can sometimes go back and forth.  You can find one study that shows this and the next that does not validate that.  Most of the studies that available are trying to determine breast cancer risk.  They look at aromatase inhibitors like anastrozole (and others) and how they affect aromatase activity and breast cancer risk.  When you overlay these studies with the one on estrone, they do seem to match up.  Still there was not anything large enough or conclusive enough.  It's reasonable to assume that these enzymes alterations are going to decrease or increase the enzyme activity.  With this there can be more estradiol and estrogen in general.  More conclusive evidence does exist for the impact of environmental factors on the aromatase enzyme. 

Environmental Causes Of Increased Estrogen In Males

Alcohol consumption is one of the environmental triggers that can definitely increase aromatase activity.  This is cited in several studies.  Hops (part of what beer is made from) seems to independently increase aromatase activity regardless of the alcohol content.  So beer may be a double whammy.  High insulin levels is another thing that increases the aromatase activity.  This goes along with the observation that obesity can also do this too.  It is common when you have higher weight that your insulin levels are going to be higher too.  This is not always the case but a lot of times it is. I have seen high insulin in smaller people though. 

Testing insulin levels can sometimes be tricky though because the stated reference range at your lab are usually quite a bit higher than what is consider normal or optimal.  The range also changes based on how long your are fasting for.  Lower levels are typically healthier.  If you have lower insulin levels on the lower third, you are probably okay.  Overall your aromatase activity is relative and will be based on your genetics, alcohol, your insulin level and many other factors. 

Looking at these known variables you can predict how much estradiol or overall estrogen your are going to be producing.  The amount of estrogen then predicts the amount of estrogen activity in your tissues.   This is particularly important if your are on testosterone replacement therapy.  With this you want to optimize your free testosterone.  Estrogens (in particular estradiol) increases sex hormone binding globulin (SHBG).  SHBG lowers free or bioavailable testosterone.  Therefor you want to keep SHBG low when your are on testosterone replacement therapy. 

Another thing that will increase this aromatase enzyme is LH (luteinizing hormone) and FSH (follicle stimulating hormone).  These are the hormones that stimulate specific cells in the testes to produce testosterone and the spermatozoa.   If you are taking analogs to these (such as hcg or Clomid), you may get more aromatization and more estrogen production. 

This should give you a better understanding of what causes increased estrogen in males.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on testosterone replacement therapy, high estrogen or other hormone imbalance issues, click in the link below to get started. 

Are you wondering about B12 deficiency testing and understanding what your B12 levels are? Maybe you have been told that your B12 levels are not low enough to actually qualify as deficient.  In this article, we look at what some of the B12 deficiency myths are, regarding testing and how to understand when your body needs more B12. 

If you want to understand B12 deficiency, when it is present and what to do, keep reading. 

What Is B12 Deficiency? 

This study (link below) looks at some of the myths surrounding vitamin B12 deficiency from both a functional assessment and also a more standard assessment of B12 deficiency.  Before we get into what the myths are and the assessment techniques, we want to define what deficiency is to begin with.  Generally speaking it means not enough, but not enough for what? When you are deficient you don't have enough B12 for your red blood cells to divide.  You don't have enough to carry out the natural functions that the body is needing to do on a daily basis.  This definition of deficiency is more of a functional way to look at it.  The other way is using a reference lab. 

When you do a test for deficiency this is done at a reference lab like Quest or Labcorp.  They define deficiency based on what they have established as a normal and abnormal range.  When you are using a reference range you do want to understand how they came up with that reference range.  This informs you how it could be flawed and the assumptions involved.  This is not to suggest that it is totally flawed.  Still we want to understand where the reference numbers are coming from.   

Serum B12 is the more standard way to check for B12 deficiency.  How do they come up with their reference ranges?  A lab creates a reference range by looking at a subset of the local population.  For easy numbers, let's say they use 100 "healthy" people to use and check their B12 levels.  Then they will average the numbers and take so many standard deviations above and below the averages to create the reference range.   If you have twenty five people that are very deficient (in B12), it will really skew the results. (of the one hundred)  They have to take a large enough sample size to make sure you're accounting for all subsets of the population.  This also implies that you will miss people using this form of testing.  Therefore you may miss out on some problems that are occurring from B12 deficiency.  This is true for any serum blood test or any reference range.   You will miss some of the people that actually have the problem when you are looking for deficiency or excess etc.  This gets at the relative sensitivity of the test.  Will the test pick up all the the people that have the problem or is it going to pick up half or or what is it? 

B12 Deficiency Myths

There are many myths about B12 deficiency centered around how to look at serum B12 test results.  Whether or not to interpret those as gospel or dig a little bit deeper and have stricter criteria for what we're considering deficient.  It has been noted in case studies and research that even people with normal serum B12 levels can have low functional B12 using functional assessments of tissue levels.  These myths are from that study The many face of cobalamin deficiency.  The first B12 deficiency myth is no anemia, no B12 deficiency. 

Some doctors will say if you don't have anemia, then you don't have B12 deficiency.  This s false because you have to be deficient in B12 for a long time in order for you to stop producing red blood cells.  If you wait until you have anemia, then you are really are going to have a problems.  You can have B12 deficiency even if your serum levels look ok.  The question is do your tissues have enough.  Sometimes problems like neuropathy, fatigue, and other things show up before there is anemia. In fact this happens quite often.  People don't have anemia but they still have B12 deficiency.  We know this because they respond when we give them B12.  All their symptoms go away.  Does that mean you have B12 deficiency?   Yes, I should think so.

The second B12 deficiency myth is, you have no macrocytosis (or macrocystic anemia).  In order for your cells to divide through mitosis they need enough DNA based pairs.  These are things like guanosine cytosine etc.  If you don't have enough of those, then the cells cannot replicate the DNA within themselves to pass it on to the daughter cell.  B12 is one of the critical elements that is needed to produce those new cells.  If you wait until you have Macrocytosis (or macrocytic anemia).  A lot of your tissues will be deficient as well as your red blood cells.   Obviously when you are anemic you don't have enough red blood cells.  You can see evidence of macrocytosis before you become anemic.  Your red blood cells will start to get larger and that suggests B12 deficiency  (there are other reasons this can happen though). 

The next B12 deficiency myth to know about is, serum B12 levels are within the labs reference range.  The myth says, use your labs reference range to determine if your serum B12 level is normal.  If it is not low, then you don't have a problem with B12 and you don't need any more B12.  That's the myth. 

The reference range from your local lab may have more of a picograms per ml reference range.  These units will make your reference a little bit higher. It's usually around 300 to 400 gg/ml or something like that on the low end.  In reality, you can have B12 deficiency symptoms or problems at the tissue level even when you have 600 pg/ ml in your blood.  How do we know that? We do other functional and sensitive tests at picking up B12 deficiency.  It is a myth to only rely on the reference range because this way of testing will inherently miss some people.   We know this because they have some (or all ) of their symptoms or problems resolve when they start taking B12.  The serum test and reference range is designed to capture most of the people with deficiency but not all. 

Another B12 deficiency myth is serum vitamin B12 is only moderately low.  With this myth the assumption is your B12 levels have to be well below the reference range for it to negatively effect your body.  As mentioned above, if you are low on the reference range, there probably is a problem.  

Methylmalonic acid (MMA) is one of the most sensitive ways to look for B12 deficiency.  You may want to look at this test when it is unclear.  Let's say  your B12 levels are low but your MMA is normal.   Since this is a more sensitive way to look at B12 levels, is this normal result telling us you don't need anymore?  No.  There are different stages of B12 deficiency and the deficiency may not be showing up in the MMA levels yet.  It is possible to find someone with B12 deficiency on the serum but the MMA looks normal and they still respond to taking B12?  A low serum B12 levels now may develop into high MMA later ( which is a sign of B12 deficiency).  So any of these tests being abnormal is a sign of B12 deficiency. 

Another B12 deficiency myth is, it only occurs in elderly people.  This is absolutely not true.   As you get older, yes your absorption of B12 does go down and it is more common.  We recently posted an article, how common B12 deficiency and yes it is more common as you get older because of absorption issues.  However it is not unheard in children and young adults.  In fact we see it all the time.  It's really just based based on how well you absorb it, your diet, and sometime it is genetically determined.   

If you're getting tested for B12 deficiency, these are some of the things to keep in mind.  You may do different tests at different times to track your progress with getting your levels up.  I suggest following the blood test that are low over time to see if it's coming into the normal range.  You want to make sure that your treatment is actually getting into your body and getting into the normal ranges.  This will help you know when you need to stop or decrease that therapeutic treatment and decrease the amount you're taking etc 

That should give you a better understanding of what some of the B12 deficiency myths are and how to think about your B12 levels.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on optimizing your B12 levels, click in the link below to get started. 

Can hypoglycemia cause anxiety or panic attacks?  What is the role of blood glucose in triggering panic and anxiety?  Is there a theoretical role or is there actually a role?  Is there any clinical data or research to support this.  In this article we look at the relationship between anxiety and hypoglycemia,  how those two are interrelated, and what you might do about it.  

If you think this could be going on with you and want to know more about the role of hypoglycemia in anxiety, keep reading. 

What Is Hypoglycemia?

The question we want to look at today is can hypoglycemia or blood sugar issues lead to anxiety and panic attacks.   My clinical experience with this is it absolutely can.  It makes a lot of theoretical sense why it would too.  Before you assume this is going on with you, you do have to figure out if you are actually having hypoglycemia.

First of all, what is hypoglycemia?  Hypoglycemia is when you have an acute drop in your blood sugar below what the body senses as normal.  Typically that's going to be below 60 milligrams per deciliter.  However, your threshold may be lower than that or slightly higher than that. This is based on what your body is used to what your pancreas and other tissues in your body are used to.  Generally hypoglycemia comes from an excess of insulin that drives your glucose down very quickly.  Then within 30 minutes to 3 hrs after, your blood sugar drops below that critical threshold.  How quickly the drop occurs is different for different people.  For most it occurs within the first hour.  Once your blood sugar drops, your body starts producing more epinephrine  and cortisol.  Epinephrine and cortisol are there to help release some of the stored glucose and the stored sugar that's in your muscles and in your liver.   What that epinephrine also does is active the fight-or-flight chemicals in your body. That chemical, epinephrine is designed to make you feel anxious.  It is designed to make you fight or flight the area.  It is a danger response. 

Naturally when you have more epinephrine flowing through your system, you will be a little bit more on edge and see the things around you in a panicked way or stressed way.  That panicked feeling will cause you to look for what's wrong.  You may not understand that it is your blood sugar that's causing this in the moment.  Keep in mind that not everyone has hypoglycemia and even those that do may have anxiety in addition to hypoglycemia.  Still there are certain cases where this could be the main thing going on.  Hypoglycemia is not that hard to  fix for people.   The trick is identification of the problem.  First a little more on the epinephrine story.   When that epinephrine is released it's going to bring your blood glucose back up but it doesn't happen immediately.   You may be in an anxious state for some time before things even out and you may not really understand why that is happening. 

The other thing is not everyone that has hypoglycemia is going to feel anxious.  Some people may actually like the feeling.  It really depends on how you're wired, how much epinephrine is being produced and what your normal baseline is.  That's the reasoning or the theory behind why hypoglycemia and low blood sugar can lead to panic attacks and generalized anxiety for some people.   That's not to say that everyone that has this is going to have anxiety or panic attacks.  When you do have hypoglycemia, you're going to have a relatively higher anxiety level, and relatively higher stress level than if you're not hypoglycemic.  That is just by the nature of what epinephrine does to human body and psychology.  Just because this makes a lot of theoretical sense, doesn't mean it is necessarily valid. 

Research Behind Can Hypoglycemia Cause Anxiety?

I have seen this in my practice and there are case reports about this. However, let's see what kind of actual research there is about this.  A relatively older study looked at this question in healthy (non-diabetic) participants.   With diabetics you will definitely have more hypoglycemic events compared to the regular population.  What the researchers found was there was a significant increase in things like hedonic tone, tense arousal, and a decline in energetic arousal compared to the normal glycemic control group.  They also found that there were substantial changes in mood observed in the healthy participants with acute hypoglycemia.  The participants described it generally as a tense tired state that persisted for thirty minutes after normal glucose was restored.  That's where that feeling can linger even after your blood sugar normalizes.

You may start having hypoglycemia and think, I better do something about it.  Yet it may linger for for a while afterwards and that's normal.  Some people experience things like heart palpitations, sweating, anxiety and things like that.  This is what epinephrine and some of the other chemicals that kick in do when you are hypoglycemic. 

Epinephrine can be measured in the urine.  Another study used this to look at this question.  They looked at the association between depression and anxiety symptoms overlaying with twenty four hour urinary catecholamines.  Catecholamines are epinephrine, norepinephrine. dopamine etc.  What they found is interesting.  The epinephrine twenty four hour was positively correlated with anxiety but it wasn't correlated with depression.   Meaning that those that had higher epinephrine levels tended to have anxiety.   Does that mean epinephrine is always what's causing anxiety?  Is anxiety always epinephrine driven?

No it doesn't but in this one fairly small study there was an association or correlation there.  The last study I looked at was with a high glycemic index (GI) diet.  This is a high carbohydrate diet and the researchers found this diet was a risk factor for depression.  Depression is not anxiety but it is mood related.  The study suggests that a high GI diet could be a risk factor for depression in postmenopausal women.  The general theme here is that there's a lot of smoke around the idea of hypoglycemia causing anxiety or contributing to anxiety and panic attacks.   I would predict hypoglycemia is a trigger for panic attacks specifically.  That's because panic attacks are more of an acute event.  It makes sense because panic attacks are typically not happening every single day.  For people with generalized anxiety disorder along with panic attacks, they may have really low blood sugar during the panic attacks and just slightly low during the parts of the day where they're feeling anxious. 

Testing For Hypoglycemia As A Cause for Anxiety

How would you go about testing for hypoglycemia? Generally speaking, you would just do a fasting blood sugar test.  You fast for 12 hours and you see what the glucose is.  If it's low, you have hypoglycemia.   What you want to look at more closely at is the intervals around after eating.  You can test one hour after eating, two hours after eating, and three hour after eating etc.  You are looking to see what's happening with your insulin and what's happening with your glucose during those times.  Those are the times when your insulin is at its peak, usually an hour or two hours after eating.  This is the time when you will be more susceptible to hypoglycemia. 

Glycemic index or GI foods are the foods that are going to have more carbohydrates.  They will raise the blood sugar higher than other foods.  High glycemic and high glucose foods are the types of foods that are also going to raise your insulin levels high.   It's always important to test for these things, if you think it could be there.  You can see if this is a contributing factor and what to do about it.  There are lots of ways to lower blood sugar and balance it out.  If you already know you have insulin resistance, then for sure this is something that could be contributing to your anxiety.  If you don't know, I recommend testing and not making assumptions.  Do the testing that shows you, maybe a two-hour postprandial glucose test or multiple serial testing for your blood sugar after eating. 

That should give you a better understanding of the role of glucose and specifically hypoglycemia and triggering anxiety and panic attacks.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan for your anxiety and panic attacks, click in the link below to get started. 

In this article we look at a case study of high DHEA -s, high testosterone, and low cortisol.  We use this case to illustrate how you can understand what's going on with your hormones by understanding the different enzymes and things that control those enzymes.  Keep in mind that you do have to look at this on an individual basis.  There are so many different things that can influence your enzymes.  These enzymes then control the overall levels of hormones.   Use this as an illustration of how you can go about this and hopefully you get a better understanding on why you have high DHEA -s levels. 

If you want to understand high DHEA in the context of low cortisol, keep reading.  We look at the details below.

The first thing we want to look at when trying to solve, "why one hormone level is high or low" is to look at the enzymes that control the hormone levels.  Specifically we need to understand what things control those individual enzymes.  You can think of these enzymes like a dam to a river or like a train track.  With train tracks you can control which directions the trains are going.  Similarly, there are things that can make hormones go in one direction or another.  The different enzymes that control these hormone levels can be manipulated to change hormone levels. 

This does not necessarily mean they will be changed in absolute terms but in relative terms.  If you have something that is stimulating an enzyme a little bit more than it's stimulating other enzymes, you will get more of those byproducts.  That build up will lead to more hormones flowing directionally down that path.  This is the type of thing we want to look at when we try to answer why one hormone is high or low.  What things are predominantly in the body pushing things in one direction verse another.  Let's look at an example of high DHEA-s in a female. 

In this case example the person had high DHEA-s and high relative testosterone levels as well.  She also had low progesterone and low cortisol.  So what could be causing this? Generally speaking you might need to decrease the activity of 3-beta-hydroxysteroid dehydrogenase enzyme.  You also need to get pregnanalone all the way down into DHEA-s and then into testosterone.  Let's look at the actual example of this. 

Below are the blood test results.  There is a high DHEA-s level.   This DHEA is probably being pushed in to make more testosterone.  She also has a relatively high free testosterone, not outside the reference range.  It is relatively high compared to most.  This suggests a low sex hormone binding globulin as well.  It could be that the testosterone itself is lowering the sex hormone binding globulin.  The question we want to ask is why is the DHEA high.  Moreover, why is that DHEA preferentially, at least from what we can tell, being pushed into testosterone.  Why is it not being pushed into estrogen or something else?  Her estradiol was not that high.  Overall her DHEA level is not extremely high either.  There are definitely people with much higher but for her age it was slightly high.  So what could be driving this process?

The Cause of High DHEA and Low Cortisol

She did have a lot of different symptoms going on, like fatigue, acne, and things that one would expect with high androgens.  She also had some digestive issues but one thing seemed to stick out more than others.  It turned out this was probably critical for what was driving this process.  She was a chronic alcohol consumer.   Not like once a week, it was very regular and more often than not.  What you see with chronic alcohol consumption and hormones, is a decrease in the activity of 3-beta-hydroxysteroid dehydrogenase.  There are many other things that can also influence this enzyme.  You might logically think, if this enzyme is decreased across the board, you would have low levels of testosterone as well.  It turns out that some enzymes are actually stimulated by alcohol.

17- beta-hydroxysteroid dehydrogenase can actually turn DHEA-s into androstenediol.   Androstenediol can also be turned into testosterone through the enzyme 3-beta-hydroxysteroid dehydrogenase (the on we think is inhibited).  In her case, production of many hormones was inhibited.  However, because there is an increased activity of 17-beta-hydroxysteroid dehydrogenase enzyme, there is a relative build up of androstenediol.  Once the levels get high enough, it pushes the process forward into testosterone.  The pregnenolone is shuttled away from progesterone and 17- hydroxy-progesterone as well.  We would expect these to be low but we did not actually check them in her case.  We did previously check cortisol levels which were also low.  For her, everything was shifted in that direction toward testosterone.  Eliminating alcohol would obviously be helpful but what else can we do in a case like this?

Something that may be helpful in modulating some of these hormone levels would be to take some phytoestrogens and maybe even estrogen in general.  Too much estrogen may not be good, but some phytoestrogens from soy plants or soy isoflavones would be helpful in decreasing the activity of 17-beta-hydroxysteroid dehydrogenase.  This would slow down the conversion of DHEA-s into androstenediol.  These estrogen(s) would also increase her sex hormone binding globulin which could further decrease free testosterone. 

With all these different enzymes and scenarios, it really does depend on what the overall environment is.  Each case needs to be taken separately.  You can not really say what to do for high DHEA-s and low cortisol without knowing the person and all of the other hormones.  With this broader knowledge, you can get a clear picture on where the problem is.  This kind of testing is available through blood or urine.  Understanding where each of these are really helps you understand which enzymes are being affected.  Then you can look at the lifestyle things, herbs, etc that can help make the shift.  Shifting enzyme activities will shifts the hormones that are driving those excess or deficient states. 

That should give you a better understanding of high DHEA and low cortisol in females.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to lower your DHEA levels, click in the link below to get started. 

How reliable are food sensitivity tests? Did you get a result that doesn't make sense or are you sensitive to something you've never consumed?  How do you know how to interpret these results and should you really trust the results?  In this article, we look at the reliability of food sensitivity tests, where these tests may be coming up short in some areas, and where they can be helpful. 

If you want to understand the reliability of food sensitivities tests, keep reading. 

Reliability of Food Sensitivity Tests

Food sensitivity test have become more and more popular in the last five years or so.  What we want to look at is the results that you are getting and their reliability.  Can you trust them and what is it actually telling you about what's going on in your body.  Your results will vary from one company to the next but we won't really look at the reliability of different companies.  Instead we want to look at the overall utility of these results.

The reliability will depend on two things: how clean and pure the reagents used are and what the results mean with respect to your immune system and how our immune systems respond different foods.  First let's look at the test in general, what the test measures and how it is performed.

When you do the food sensitivity test, you are testing you bodies response to a certain number of foods.  It might be ninety six or two hundred and nine different foods.  The way that they perform the test is to fill wells with reagent and mix it with your blood.  The wells are small little circular depressions on a plastic tray. These are coated with the reagent.  The reagents are the individual foods that are being tested.  So they coat all of those individual wells with these reagents.  Then they take the serum from your blood and they put the serum in the coated plates.  Then they incubate the whole tray for a period of time while jostling them around to ensure everything's mixed together.  After the incubation period, the amount of binding of the blood antibodies to the reagent in the wells is quantified.  The more binding of your blood immunoglobulins to the food proteins, the more positive.  The more positive the more sensitive you are considered to be for that particular well.  The question with the reliability comes in if the reagents that are being used are not really clean.  When this occurs, they may produce false positives. 

For instance,  let's say you're being tested for almonds but there's a little bit of peanuts in the reagent.  You may be sensitive to peanuts but now that's going to show positive sensitivity for almonds as well.  Basically this brings up the idea of more false positives when the reagents are not clean.  So make sure the company that you use has good reagents and good quality controls.  As long as the company you are using has good reagents and good quality controls, they should be producing reliable results.  Other problems can also occur too. False positives are a common thing with food sensitivity tests.  So you shouldn't always take the results as one hundred percent accurate.  Even the best company with the best intentions, may still trigger false positives.  If you do get a result that looks really weird, you may ask the company to redo it or get an opinion from a doctor.

Sometimes people that results where almost everything is positive, for instance.  This may be an indicator that the company isn't using a clean reagent as well.  However this can also happen when people have a lot of up-regulated immune activity. In this case it has nothing to do with the reagents and more to do with your immune system.  When you do this test look out for false positives and that could have to do with the reagents or other problems with the overall logic of the test.  So how is your immune system is actually involved with this and what does this means for the reliability of the tests and what's going on in your body.  

Food Sensitivity Tests And Your Immune System

What do the test result mean for your immune system and how does that translate into health issues.?  Many immunologists and allergists suggest that food sensitivities or IgG antibodies in your blood correspond to immune tolerance and are not necessarily a problem.  You can check out this article for more on that.  What they are saying, is that the presence of IgG antibodies isn not really an issue.   They believe you shouldn't really worry about it as it represents immune tolerance.  When you have immune tolerance, it means your immune system isn't really reacting to it the way that it would to an IgE antibody.  IgE antibodies represent a frank allergy. 

Similarly when you get sick with a virus, initially you develop antibodies to that virus.  During the course of the sickness when you are first exposed to that virus, your immune system is going to create immunoglobulins to the virus.  The presence of these antibodies allow your body to have memory of that virus later.  When you get infected a second time you are not really going to feel sick.  This is because the immunoglobulin is going to attack that virus much quicker. This allows your body to isolate it and contain the virus and therefore not need as much immune activity.  Most of the sickness and symptoms that we feel is a result of the immune stimulation and activity.  It is trying to fight the infection.  So how does this related to tolerance with food sensitivity?  

These allergists and immunologists referring to immune tolerance mean that your immune system has seen this food and now recognized it as part of normal background noise.  The immune system doesn't really have to worry about it very much.  This is what many allergist and immunologists believe (regarding IgG immunoglobulins to foods).  These IgG food antibodies reflect immune tolerance because there was a past acute reaction and now there is no acute concern to worry about.  There probably is some validity to the point that IgG represents immune tolerance.  However, clinically there does seem to be some results or improvement in people that look at food sensitivity tests and eliminate those foods.   They do actually get better.  What is actually going on here and how can we explain both?  Both can't be true so maybe there is a little more nuance to look at. 

It turns out as you look closer at these different IgG antibodies, there are actually different subclasses within the category of IgG antibodies.  Some of the subclasses can cause mast cells to degranulate.  Within those granules is histamine.  When they degranulate that means they open up and the granules inside spill out into the blood and the surrounding tissues.  Those granules containing histamine creates inflammation and damage.  Histamine is an immunological stimulant and the release of histamine from certain subclasses of IgG have been observed in test tubes.  There is also the clinical observation that running these tests and eliminating the foods help people feel better.  It does make sense that identification and elimination of foods that trigger more IgG antibodies to be produced may be helpful. Some of the  companies that do food sensitivity testing actually testing specifically this subclasses of IgG that cause this degranulation.  These are going to be the better companies to use.  Others use a mix of all the IgG antibodies. 

The major issue that I see with food sensitivity test is that many times people are not discriminating between the fact that they could be getting some false positives.  Additionally, some people may already have an unregulated immune system and inflammation in their gut.  This will make them have even more false positives.  

Another issue with the food sensitivity test is that sometimes the results are given with no direction as to what you should do.  As a result, some people get really concerned that they're eating things that's bad for them.  This concern may be warranted but it can create problems too.  What should be done with your results is an elimination and challenge for each one of the foods identified on your food sensitivity test.   The challenge will tell you if you are indeed sensitive to it.  When you take the food again you'll be able to determine what health symptom or problem is triggered.  There is a very specific way to go about the elimination and challenge.  I am not going to go into it here but this is the the gold standard. 

Anther problem is for those with an already restrictive diet.  If you already have a very restrictive diet then you get this list of foods to avoid, it may be too restrictive.  If no one's giving you a direction you may just avoid them and never eat them again.  Now you have even more restrictive diets leaving the amount of foods you can eat as very limited.  This is not really good for overall health as it can create gaps in your overall nutrition.  It can also lead to deterioration of your microbiome.  This is not to say that no one should ever do food sensitivity testing.  It can be a very helpful test. It is just that the interpretation and utility should be given proper weight among all of the possible tests and solutions that you have in your arsenal and all the options you have available to you.  I do think food sensitivity tests are reliable and helpful.   We should use them in people that are having a lot of food reactions that we can't identify what's triggering them.  We should just be careful with interpreting the results and also careful in the types of people that we use this test on.  If you already have a lot of inflammation going on in your gut, you may want to calm that down or at least try to before you go do this test.

That should give you a better understanding of the reliability of food sensitivity tests.  If you have questions about your food sensitivity test, please ask it in the comment section below.

If you want a customized plan on food sensitivities or gut healthy, click in the link below to get started. 

Are you taking probiotics for IBS symptoms and they are making things worse? Do you think your probiotics might be causing a bacterial overgrowth scenario?  In this article, we look at the role of probiotics in causing bacterial overgrowth, SIBO or other bacterial overgrowth symptoms.  

If you want to understand the role of probiotics in causing bacterial overgrowth, keep reading. 

Can Probiotics Cause Bacterial Overgrowth?

Probiotics do not cause bacterial overgrowth but they can make it worse.  With bacterial overgrowth, also known as Small Intestinal Bacterial Overgrowth (SIBO), it requires that a significant number of bacteria from the large intestine get into the small intestine live, survive, and thrive there.  Many people take probiotics to support the bacteria in the large intestine.  So it makes sense that some people also believe taking these same probiotics that support the large intestine bacteria, may cause bacterial overgrowth in the small intestine.  This is just not the case though.

Now it's clear from research that taking probiotics do help support the overall balance and health of the microbiome in the large intestine.  However they may not be helping the way you think.  The vast majority of these probiotics that you take by mouth do not survive the trip from the mouth into the large intestine.  You might be thinking that doesn't make sense, how do they help then?

The idea is that the probiotics work like a placeholder for the colonies of good bacteria.  By occupying that space you prevent other pathogenic microbes from infiltrating the colonies of good bacteria.  We said the vast majority of probiotic supplements do not survive the transit from the mouth to the large intestine. Therefore, it would not make much sense that taking probiotics lead to bacterial overgrowth.  I won't say that it cannot happen in any circumstances.  It's just very unlikely and research does support this fact.  Some people do feel worse from taking probiotics though.  They sometimes give them bacterial overgrowth like symptoms or SIBO symptoms.  Why is that?

Probiotic Or Prebiotics?

Many if not most probiotics contain prebiotics.  Prebiotics are good easily digested food for bacteria.  Bacteria digest these prebiotics through a process called fermentation.  The natural byproduct of fermentation is gas. All fermentable carbohydrates do cause this same gas-like effect.  Prebiotics are going to do this a little more than some other fermentable carbohydrate.  It's natural to have a little bit of gas or bloating from prebiotics or probiotics at least at first.  These symptoms should be subtle and short-lived though.  If you start taking probiotics, and you get overt severe and ongoing digestive issues like gas bloating pain etc, it's probably from the prebiotic in your probiotic.  Have a look at the back of the bottle you are taking and look for FOS (fructooligosacarides), inulin, artichoke extract, etc. These are all prebiotics.  For a deeper into the prebiotic world check out this article. 

Prebiotics and SIBO

Just to summarize probiotics do not cause SIBO or bacterial overgrowth but prebiotics in the probiotics can make it worse.  As a result they can make you more aware of the problem that was already exists.  Still, probiotics can be helpful for people with IBS and other digestive symptoms. 

Ok this should give you a better understanding of the role of probiotics causing bacterial overgrowth.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on your IBS or bacterial overgrowth symptoms, click in the link below to get started. 

Are you wondering if you need to take vitamins? Maybe you have the question, why do I need to take vitamins, since you get them from food already? In this video, we look at some of the things that come to mind with this question like why people are deficient to begin with, the testing and symptoms that help inform us if you are deficient.  In addition we look at  what to do when you are deficient and how to get your levels back up if you are not getting enough through the food.  Does this mean you just need to take more orally or get injections?

So if you want to understand if you need to take vitamins and what to do when you level are low, keep reading. 

Do I Need To Take Vitamins and RDA?

This question is important because there is a lot of information on the internet and otherwise about the need to take vitamins but not all of it is accurate, some of it is misleading, and some of it's actually dangerous.   With that being said, the main thing that I hope you get out of this article is the important role vitamins play in our health.  More specifically, I hope you'll gain a better understanding of why you might need a vitamin and or mineral supplement.  We also address questions like, who is a candidate for vitamin supplements? How do we know when you are, or not a candidate?  Where do vitamins minerals nutrients etc work in the body?  What is the best delivery form for these vitamins nutrients minerals?  A lot of these questions and topics can be expanded on so think about this as a foundation.  If you do have questions about some of the specifics of what is covered, just drop it in the comment section. 

The first thing to discuss with the topic, do I need to take vitamins, is the RDA.  RDA stands for the recommended daily allowance and that comes from the FDA.  It represents the minimum amount needed to prevent serious medical issues from lack of a specific vitamin.  There are specific conditions associated with a lack of each vitamin that we know about.  There is Scurvy for vitamin C,Beriberi for thiamin or B1 deficiency and many other well documented health issues from vitamin deficiency.  The issue with the RDA is that it does not account for many different variables of individual human physiology and it's basically looking to prevent serious illness from vitamin deficiency.  As a result, the RDA is not the recommended range for optimal health.  Instead it is the amount needed to prevent serious disease in the population as a whole.  That being said, there are a lot of reasons why you might need much more than what the RDA suggests.  This is where individual medicine comes in.  So let me give you some examples. 

Conditionally essential refers to the body's need for higher amounts of certain vitamins and nutrients during periods of stress on the body.  These are periods where there are certain physiological processes happening in the body and stressing certain systems out.  As a result, you may need more of a certain nutrients vitamins etc. 

One example of this that comes to mind is with vitamin C.  Our bodies cannot make vitamin C but we do get it from food.  During periods of infection, for instance, we may need more vitamin C.  Vitamin C has been shown to increase immune activity and shorten the duration of sickness.  During periods of high amounts of immune activity our bodies are burning through vitamin C at a more rapid rate.  That condition requires more vitamin C for that period of time.  If you are taking the minimum amount needed, you can prevent scurvy.  If you take more than the minimum amount needed you can get rid of your cold a lot quicker.  There are many other examples like this. 

So the RDA is concerned with preventing serious illness from lack of a vitamin or mineral.  This gives us a benchmark or starting that you really don't want to go below.  However, this is not really the upper limit either.  It is a bit misleading to say that the RDA is what everyone needs because some people need a lot more.  So do you know if you're meeting the RDA for your nutrition intake with just food alone? Let me know in the comment section below. 

Do I Need To Take Vitamins? I eat healthy.

The CDC reported in 2009 that only about thirty percent of people get three or more servings of fruits or vegetables per day.  We all know that this is where most of our vitamins and nutrients are coming from.  Of course, some come from animal protein and different organ meats and things like that.  Most of us are getting the majority of our vitamins and nutrients from plant sources.  After all, the plant sources are what the animals eat too.  Plants are very important part of our nutrition.  If you are only eating three or four servings of fruits and vegetables (or possibly less), you may be very micronutrient depleted (vitamins minerals etc). 

The other thing to think about is what has occurred with our soil and the agricultural industry over the last 100 years.  What does this do to the nutrient content in the plants that we are actually eating on a day-to-day basis.  The nutrients in the plants come from the soil.  If the soil is depleted, those plants are going to be depleted in specific nutrients as well.   This is because a lot of these newer farming practices are more concerned with quantity not quality.  As a result they are not rotating crops properly.  Using the same crop over and over will continue to pull those nutrients out leaving depleted soil.  Ideally crops should be rotated to give the soil a chance to naturally replenish any nutrients that were depleted.  There are certain plants and crops that should be used to do this.  Over the last hundred or so years this practice has lost favor especially with big agricultural farming.  As a result, we have soil and food that is really depleted and devoid of a lot of the vitamins and minerals that we need to meet the minimum amount not to mention optimal amounts.   

With that being said, how many fruits and vegetables do you think you need to meet the RDA for all your vitamins and minerals?  Let me know what you think in the comment section.  Some of us consume things on a daily basis that may be depleting our nutrient status or causing us to get rid of certain vitamins and minerals faster than we should.  Alcohol and caffeine are common examples that deplete your vitamin levels nutrient levels etc. 

So if you are following along, you might say, "I already eat a good quantity of fruits and vegetables, I don't drink caffeine or alcohol, so do i need to take vitamins?"  This leads us into the next thing we should look at with this question and that is absorption. 

Do I Need To Take Vitamins, What about Absorption?

Depending on what you eat, you may be consuming plenty of vitamins, minerals, and nutrients.   However, there can still be a problem with that getting into your body, meaning you may not be absorbing those nutrients.  Let's look at some digestive issues and conditions that suggest you may not be absorbing or have compromised absorption. There are actual digestive system issues that do this like pernicious anemia, Gastroesophageal reflux, IBS (Irritable Bowel Syndrome), IBD like Crohn's, and ulcerative colitis.  There are also functional digestive issues (leading to inflammation or altered bowels) that can do this too.  These are usually things that you see a GI doctor for and don't find anything (and say everything looks normal).  Still you are having symptoms and so it would be considered IBS or functional digestive disorder.  Symptoms might be loose stools, indigestion, gas, bloating, acid reflux, constipation etc.

This picture above is of the villi and microvilli of the digestive tract.  The open section is a cross section of the intestinal lining cell.  All the little projections are where the food is absorbed through.  These can get damaged from inflammation and which means you're not getting as much nutrients.  As food is being broken down it passes through these digestive cells and into your body.  If you are not absorbing these foods,  you are obviously not doing yourself any good by eating more fruits and vegetables.  It is better than eating a poor diet but you still need to take care of the absorption issue.  It might mean that you need more of specific vitamin, nutrient, minerals etc depending on what's going on. 

Pernicious anemia, for instance, is an autoimmune condition where your body attacks the intrinsic factor that is needed to absorb vitamin B12.   If you have this, all your vitamin B12 in the world is not going to help you.  You actually need to take injections or take a sublingual B12.   All this absorption stuff is also important so if you have a lot of inflammation going on it's important to look at that and address it.  It also points to the fact that you may need to take more vitamins

Now you might say,  "I consume a good quality diet (lots of fruits and vegetables), I don't consume any caffeine or alcohol, and I don't have any apparent digestive issues, do I need to take vitamins?"  Well let's look at another issues that may require you to take more vitamins. 

Do I Need To Take Vitamins, What about Medications?

Some medications definitely increase the need to take vitamins.  It's because they increase the excretion of vitamins, decrease the absorption of vitamins, or increase the demand for certain vitamins in the body.  Let's look at a few examples of that.  Antidepressants like tricyclic antidepressants are a family of medications one is called Elavil.  They are going to increase the need for B vitamins and they can also actually deplete your B vitamin levels.  Diabetic medications like metformin deplete B12, probably folate, and magnesium.  If you are taking metformin, you may need more of these specific vitamins.  At least it means you should be evaluated a little bit more thoroughly for vitamin deficiencies. 

Acid reducing medications are a big one because they deplete the stomach acid and the ability to produce intrinsic factor.  Intrinsic factor was mentioned earlier.  As a result of decline in intrinsic factor they decrease B12 absorption.   Also on the absorption side you will have less magnesium, zinc, calcium, folate, iron etc.  All of these vitamins can be depleted just by taking certain acid-reducing medications.  This occurs over time and will not happen just from taking it once or for short periods of time It is the long insidious consumption of these medications that will deplete your vitamin stores.  If you're taking medications, it's important to look at what they might deplete in your body. 

Alright so now you say, "I consume plenty of fruits and vegetables, I don't consume any caffeine or alcohol, I don't have any apparent digestive symptoms and I don't take any medications,  do I need to take vitamins?"

What about Genetics?

Do my genetics cause my body to need more of certain vitamins minerals etc?  When we refer to genetics, in this case, we are referring to single nucleotide polymorphisms or SNP's.  This is a single point along your genetic code that is changed.  The gene is the code or the blueprint that then tells your body how to make the protein.  When there is a change in the the gene, the outcome of the protein changes.  In cases of significant single point mutation or significant SNP's, the outcome of that protein will be more significant.  This may increase the demand for certain nutrients or certain vitamins that the body needs. 

You can think about it as an analogy to a car factory.  If we have a car factory,  the blueprint for the car is what's being altered.  When altered the car may come out with three wheels instead of four.  As you might guess that car will still be somewhat functional with three wheels.  You might be able to get it to roll with some balancing efforts but it's not going to roll very well.  It will not be as functional as if there are four wheels.  This same thing happens with the body when there is a significant SNP. 

Vitamins and nutrients act as cofactors, which we will discuss more below.  They help support that fourth wheel so that things still work.  The cofactors will not make it work as good as new though.  Why do we care about this?  We can support the enzymes with nutrition when those enzymes or proteins are altered due to genetics.  This field of medicine is called nutrigenomics.  It is the use of nutrition to improve your health based on specific genetic alterations. 

An example that many people maybe have heard of is the MTHFR enzyme. Everyone has an MTHFR enzyme functioning in their body.  MTHFR stands for methyltetrahydrofolate reductase.  This enzyme turns different forms of less active folate into more active folate.  When you have an alteration in the MTHFR enzyme, due to one of these single nucleotide polymorphisms, it can reduce the functionality.  A lot of people do have this MTHFR alteration, as much as seventy percent of the population.  However not all of the alterations are as significant as the other ones.  Somewhere closer to a third of the population have moderate to severe MTHFR genetic alterations.  One of the most common symptoms that people will have is fatigue depression and mental fog. Those with significant MTHFR are also more prone to blood clots related to homocysteine. 

There's also one SNP known as COMT.  COMT stands for catechol methyl transferase and this enzyme facilitates the breakdown of stimulating neurotransmitters known as catecholamines.  These are things like adrenaline, dopamine etc.  When you have this alteration, these build up in your system making you feel a little bit more stimulated and anxious.  You  may also have more insomnia and high blood pressure issues and even bipolar.  These are all associated with the COMT SNP.   There are many other examples of the single nucleotide polymorphisms where a vitamin or mineral is needed in higher amounts in order to allow that enzyme to function properly.  There are also some problems that can happen from vitamin mineral transporters.   These transport things like thiamine, magnesium and other nutrients.  So the nutrients can get into the body but they just can't be transported into  the cells and tissues well.

These are some of the things you can look at through doing a genetic analysis and looking deeper at your genetics.  The bottom line is genetics do play a role in our need for more vitamins.   For some people it is very important and others not so much.   

So now back to our question, if I consume enough, don't have any caffeine or alcohol, have good absorption, don't take any medications, and no genetic issues do I need to take vitamins?  If this is the case for you,  chances are you don't have a vitamin deficiency.   Still another way to get at this question is do you have any signs and symptoms that may suggest you have a vitamin deficiency. 

Testing to Determine, If I Need To Take Vitamins 

Of course, you might be asking, why can't i just check to see if i have a vitamin deficiency?  Yes you can test for vitamins but you may not catch all of the issues that are occurring.  In the case of transport issues you may be sub-optimal in certain vitamins.  Yet when you do a blood test it can look normal.  Functionally speaking you may have symptoms indicating there is something wrong but the blood test wouldn't show it.  The vitamin level looks fine but your tissues are actually asking for more because they are not delivered to the tissues.  That's why signs and symptoms are helpful as they can suggest when you need more of a specific vitamin. 

Signs are objective measurements like lab tests and things that we can see and measure.  Symptoms are more subjective things you're feeling personally and can't necessarily be measured.  First let's look at some of these signs.  A few signs that are helpful are macrocytosis, homocysteine, and certain vitamin levels.  Macrocytosis can be observed on standard blood tests during a physical exam. 

A CBC known as complete blood count looks at red blood cells and white blood cells.  In the red blood cell part you can look at the relative size of those red blood cells.  When the cells start to enlarge that's called macrocytosis.  That is an indicator of B12 and folate deficiency.  What's happening there is the cells start out small then they get bigger and bigger.  Right before they're ready to divide they are in a larger state and then they divide.  They split in the middle and divide.  Part of that splitting requires DNA replicating.   Half of that DNA goes to one cell and the other half goes to the other.  The DNA is really dependent on B12 and folate.  When you don't have enough of those you'll have more cells stuck in the larger state.  That's called macrocytosis.  Each lab has a slightly different reference range but the higher the number the more likely thee is a problem.   That test is on the CBC that looks at this is called MCV. 

Another test is called homocysteine.  This can also be elevated when there is B12 and folate deficiency as well.  Homocysteine elevation can also be an indicator of B12 deficiency.  Some of these vitamins can be measured directly in your blood. You can measure B12, riboflavin and other vitamin levels.  A lot of times they're not covered by insurance and in some cases they are not very accurate.  So it's not always telling us when you need more of these vitamins and that's where functional assessment, intracellular vitamin, etc come into play.

There are tests like red blood cell folate and other red blood cell tests that can be more useful in identifying when there's a intracellular need versus just what's floating around in the blood.  Not all vitamins can be checked that way though.   So depending on which vitamin you're looking at, you may have to do it through the serum.   Another functional way to look at vitamin status is called a white blood cell nutrient analysis.  This test is a functional way to look at whether or not your cells have enough of these vitamins and nutrients.  This test takes your white blood cells and it puts them on petri dish.  Each petri dish is depleted in one specific vitamin mineral or nutrient.  The test then looks at the length of time the white blood cells live in the depleted petri dish compared to controls.  This tell us what the functional stores are of that vitamin or nutrient.  When they are devoid of those nutrients, they don't live long.  Cell should be able to sustain themselves for a period of time without getting nutrients from the environment.  The length of time your cells live compared to the reference range can be an indicator of deficiency.  This specialty lab test is done by Spectra Cell. 

Another functional tests similar to this is called an organic acid test.  This test will not measure every single nutrient or vitamin that have a questions about.  It can cover a lot of them though.  This test will looks for metabolites that are elevated when there is a deficiency of a vitamin, nutrient, or mineral and urine levels of actual vitamins.

Now you should have a very good understanding of how to look at the question, "do I need to take vitamins."  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on which vitamins you need to take, click in the link below to get started. 

Are you experiencing burning irritation in your esophagus?  That might be a classic symptoms of acid reflux.  In this video we are going to look at what triggers acid reflux.  We also look at some of the common triggers that I see in my practice both conventional and non-conventional and a few ideas on what you can do about it. 

If you want to know what triggers acid reflux and what to do about it keep reading.

When we look at the question, what triggers acid reflux first we want to look at what is acid reflux.  Basically, it is a sensation of burning that occurs from the stomach acid irritating the lining of the esophagus.  This irritation occurs by the acid regurgitating or refluxing up through the lower esophageal sphincter.  You have your esophagus going down your throat and at the very bottom before it gets to the stomach, the lower esophageal sphincter.  This is a one-way valve uh where you wouldn't expect things to come back up.  Sometimes this is part of the issue the valve opens up and the acid that is in the stomach can get into the esophagus and irritate that lining. 

The lining of the esophagus is much more delicate and soft tissue compared to the lining of the stomach.  The stomach has a more thick and tough lining.  This difference allows the lining the stomach to tolerate the acidic environment easier.  When the esophagus encounters that acid it creates a lot of pain burning and irritation.  If you were to look at the esophageal lining with a camera or an endoscopy, you can see that the tissue is irritated and become red inflamed and sometimes even damaged.  The question we want to look at is what's triggering the acid reflux or what's triggering the acid to actually get into the esophagus .

What Triggers Acid Reflux?

There are two main things to think about with this question, the integrity of the lower esophageal sphincter and = the total amount of acid that's being produced.  Stomach acid is produced by specific cells in the stomach called parietal cells.  Those cells can be encouraged to produce more acid by the presence of histamine.  Histamine is found in certain foods can actually up-regulate the amount of acid that's being produced in the stomach.  That increased acid can then lead to increased irritation in the esophagus.  You will find that a lot of the food triggers that need to be eliminated for acid reflux are commonly high histamine food.  Still, acid reflux will only occur if the acid can get through that lower esophageal sphincter into the esophagus.   

We said that the lower esophageal sphincter allows food to get in and it's supposed to prevent things from going back up.  It's a one-way valve that allows things to flow in one direction.  Mechanical problems like hiatal hernia can do this.  In this process, part of the stomach slides up between the lower esophageal sphincter and interfere with the closing.  The closing is a little more flimsy and actually can not close properly.  Something like this can be surgically repaired in cases where it's really causing a lot of problems.  This problem is not really the majority of cases that have acid reflux. 

Another problem that can happen is from gas and pressure.  The lower esophageal sphincter is susceptible to pressure and may not close properly due to the pressure that is in the stomach.   When thee is increased pressure in the stomach, it can pushing up against that lower esophageal sphincter.  This typically occurs from things like bacterial and fungal overgrowth as they cause gas and increased pressure in the stomach.  This can push up against that lower esophageal sphincter and cause it to open up in the wrong direction.  These types of problems are usually thought to occur more in the small intestine than in the stomach.  Still, we have had multiple cases of treating bacterial and fungal overgrowth resolve acid reflux symptoms. 

Another cause for increased pressure in the stomach is when there's lack of enzymes in the stomach.  With this, there can be increased peristalsis because the lack of acid and enzymes, not breaking down the food properly. In these cases,  taking digestive enzymes or taking acid like apple cider vinegar or lemon juice can help activate some of the enzymes  present in the stomach.  With more acid and enzyme activity, you get a more even breakdown of the food and not as much of the mechanical peristalsis is needed. As a result there is less pressure on that lower esophageal sphincter.

These are some of the common triggers common things that i see in my practice as causes for acid reflux;  hiatal hernia, histamine intolerance or excess histamine, decreased acid or enzymes, and also infectious problems. Those are the most common acid reflux triggers I see.  Of course the most common conventional approach is to say there's too much acid in general. With this theory, give you an acid blocker either short term or long term.  This is certainly necessary in some cases, but the vast majority do not and should not take acid blockers over the long term.  Here is another article  that goes into more detail on

The Harmful Effects of Antacids Daily.

If you are taking an acid blocker, make sure you check with your doctor before you discontinue it.  There are some very good reasons to take acid blockers, even long-term.  Ok that should give you a better understanding of what triggers acid reflux.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to treat your acid reflux, click in the link below to get started. 

Are you having B12 side effects, like heart palpitations or digestive issue after taking B12 or B vitamins?  In this article, we look at these side effects and what typically causes them.  We also look at what some of the common side effects are and how common they occur. 

If you want to know what cause B12 side effects, keep reading. 

B12 Side Effects

B12 side effects are not very common.  However, they do occur in a segment of the population.  Most of the time these "side effects" are not a true B12 side effect.  Think about it.  B12 is an essential part of our natural biochemistry.  To have a side effect to that is contradictory to how your biochemistry naturally works.  That doesn't mean you can't be sensitive to something in the B12 or B complex that you took or even B12 itself.  Because B12 is an essential part of how your biochemistry works, it's not very common that it is actually B12 causing the side effects or reactions.  More common it is something that's in with the B12 that you took.  Before we get into the common reasons for these side effects or triggers from B12, let's look at the.  Let's look at what some of these side effect reactions etc that people have from taking B12. 

Causes of Digestive B12 Side Effects

Nausea, bloating, upset stomach, and various digestive symptoms are one of the more commonly reported side effects from taking B12.  In these cases, they are often taking a B complex that they swallow.  This contains B12 but also has the other B vitamins other than B12.  All B vitamins feed bacteria.  If you get digestive symptoms after taking B12, often there is a bacterial overgrowth or possibly fungal overgrowth creating the digestive symptoms. Anytime patients tell me they have a reaction from taking B vitamins, like nausea or some kind of digestive symptom, I automatically think that they might have some microbial issue.  It's not always the case but it does come to mind.  If that happens to be your issue, taking your B vitamins or B12 in the form of injection, might resolve the issue.  We wouldn't expect the injection to do this because it bypasses the overgrowth. 

Causes of Anxiety B12 Side Effects

Another common side effect or issue reported from taking B12 or B vitamins is anxiety, heart palpitations and difficulty sleeping.  B12 definitely can do this but it is more common for other B vitamins to do this.  If you get a B12 injection and it stings, that means it's not just B12.  B12 does not sting but the other B vitamins do.  You want to differentiate which one of them is causing the issue. You could just get B12 alone and see how you react to that.  If you are getting these palpitations from just B12, then you know it from the B12 only. 

If you know for sure that you only take B12, swallowing or injection, and you get anxiety or heart palpitations, consider taking a much smaller dose.  Take the smallest amount that you think would not create a reaction.  Start with that and gradually work up to higher doses.  Once you find the dose that is not creating these problems, over time your body may adjust to it and you won't have such a strong reaction.  Sometimes palpitations and anxiety occur when there is a big deficient.  As result, your body will get very stimulated from the B12.  Sometimes the same bacterial issue that causes digestive issues from swallowing the B12 can also cause these heart palpitations, anxiety etc.  The same issue wouldn't be expected though when you take an injection.  If you have both the digestive issues and the anxiety and palpitations when you swallow it, we wouldn't expect the same thing when you take an injection. 

Other Cause of B12 Side Effects

Another thing to consider is what's in the B vitamins too.  Sometimes people think they are just taking a plain B 12 or B complex and there are other things in there,  like probiotics or prebiotics and other herbs.  These can cause reactions too.  Make sure you check all the ingredients to ensure you are not sensitive to one of those things.  Also when you take B12 as a sublingual tablet or chewable form, it will usually contain sugar alcohols like xylitol etc.  That gives it sweet taste but those can can definitely cause digestive issue for some people. 

If switching the route of administration and dosage don't help, you may also have like a substrate issue.   B12 is used to recycle homocysteine.  Homocysteine comes from amino acid cysteine and methionine.  If your levels of cysteine and methionine are low, the B12 has nothing to do once you intake it.  That's called methyl trapping.  You can check your fasting homocysteine to see if your homocysteine levels are low.  This may indicate  a bigger problem going on (inflammation) or just simply a protein deficiency.  However people with low homocysteine, mostly don't have these negative reactions to taking B12 as an injection or oral.  Still it could be part of the problem in your situation. 

In terms of the injections, the type of injection you're getting actually does matter.  If you're getting a cyanocobalamin (also present in oral and sublingual B12) that's more likely to cause negative reactions.  The cobalamin molecule is bound to different functional groups.  If your functional group is cyanide that's called cyanocobalamin.  While it is a very small amount of cyanide that you're getting, you are getting cyanide.  Cyanide is poisonous to our mitochondria and cells and tissues.  You really don't want to be taking that one.  Not everyone will have a reaction or a negative reaction to it.  In fact, most people don't.  Still, if that's what you're getting, then I would suspect that as potentially the problem.  You can easily get another form called hydroxy and in some cases you can get the methylcobalamin.  The methylcobalamin does have to be compounded but it is available in most areas. 

That should give you a better understanding of what causes B12 side effects.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on identifying what is causing your B12 side effects, click in the link below to get started. 

Are you wondering, how do I lower high liver enzymes? In this article, we discuss strategies and techniques that you can use to lower your liver enzymes.  We will look at what liver enzymes are, how they function, and what you can do to get your levels down in a normal range.  

If you want to know how to lower high liver enzymes, keep reading. 

How To Lower High Liver Enzymes

Lowering high liver enzymes or elevated liver enzymes can be pretty straightforward.  However, you don't want to try to lower the levels without first finding out what caused them to be high.  So first let's talk a little bit about what liver enzymes are.  Liver enzymes are proteins, all enzymes are made of proteins.  Liver enzymes are proteins that are inside the liver cells and the liver tissue.  They help support the normal functioning of the liver which is mostly detoxification.  There are three main liver enzymes, the AST which is aspartate amino transferase.  There is also ALT which is alanine amino transfer.  Finally there is GGT which is gamma-glutamyl transferase.  All these enzymes are basically transferring a molecule onto a toxin to help it get eliminated from the body.  When these enzymes are high, it means that you have inflammation in your liver.  So it makes sense that you would want to get them down, or reduce them so you no longer have inflammation in your liver.  It is normal to have these enzymes in your blood but when high suggests increased stress and burden on the liver. 

The first step is to remove any known cause that could trigger this issues.  That would be things like alcohol, Tylenol, sometimes fatty liver is a contributing factor, and viruses like viral hepatitis .  These are the most  common causes of elevated liver enzymes.  If you don't remove these causes first, taking any vitamin, nutrient, supplement will have limited benefits or may not work at all.   

If you are taking a lot of Tylenol for pain, for instance, you may need to find a different pain alternative.  You should talk to your doctor about different options for that.  If you consume a lot of alcohol or even mild to moderate amounts, you may need to cut that out or cut back to see if that has an effect on your liver enzymes.  When you are consuming a lot of alcohol, you may need extra help through a medical detox, for instance.  In the case of fatty liver, or what's also known as NASH or non-alcoholic steato-hepatitis, the problem occurs from excess triglycerides.  Excess triglycerides usually occur from excess carbohydrate intake.  It would make sense that lowering your carbohydrate intake, specifically things like the refined carbohydrates would improve fatty liver.  Sometimes there is combination or multiple things causing your liver inflammation.  To find out, get some lab work done or diagnostic tests to get a clear understanding of the cause.  From there you will have a better idea how to lower the numbers. 

Herbal and Nutrient Ways to Lower High Liver Enzymes

There are some nutrient deficiencies that can make one more susceptible to elevated liver enzymes or high liver enzymes.  Generally the deficiency's that make one more susceptible are B vitamin deficiencies.  The main reason is, B vitamins are needed to make choline.  Choline is an essential part of making the transportation proteins to get triglycerides out of your liver and into the peripheral tissues to be stored as fat.  Specifically it is B12 and methylfolate that are needed to make choline.  Supplementing with any of those B12, folate, and choline, can help your liver recover. This is especially true when the numbers are high from the fatty liver.  In some cases these will help even when there is no fatty liver.

Glutathione is one of the main antioxidants in our body.  It is also important for overall detoxification.  Anything that helps with glutathione production or recycling will support the liver function.  Things like milk thistle for instance help increase the amount of glutathione.  It works by taking glutathione from the oxidized state to the reduced state.  This can really help with your liver in terms of the reducing the inflammation and helping it with detoxification.  

That should give you a better understanding of how to lower high liver enzymes.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to lower high liver enzymes, click in the link below to get started. 

Are you wondering about the role of iodine in your health? Where does iodine work in the body and how might it help you? How do you figure out if you need extra iodine?  Are you consuming enough in your diet or do you even need iodine?  You might have lots of questions about iodine and in this article we look at some of these questions around iodine.   We look at what sign or symptom can tell you about iodine what tests you can do to determine your iodine status and what makes one curious about their iodine status to begin with.  

So if you want to understand how you know if you need more iodine, keep reading. 

How Do You Know If You Need Iodine? Symptoms and Diet

There are a few different ways to understand when someone might need iodine.  We will cover the considerations I look at when approaching this question.  The first thing though is to mention is that iodine is essential.  We all need it.  Really what we want to look at is how do you know if you need more iodine, outside of what you are getting from your diet.  There are two main categories of things to look at. Those are signs and symptoms and direct iodine testing.  On the testing side there are direct and indirect measurements of iodine.  There are also other measurements and assessment techniques that suggest iodine deficiency.   With any of these tests you want to look at how likely it is that you are getting an accurate result.  What is the sensitivity and specificity of the test in terms of detecting the people that actually do have iodine deficiency?

The first sign and symptom that comes to mind with iodine deficiency are for hypothyroid.   Most of the iodine in our bodies is used for thyroid hormone production.  In fact about 90% of the iodine your body holds onto is used for your thyroid.  That's why these signs and symptoms are critical to look at for iodine deficiency. 

In the u.s, most people get plenty of iodine because it comes from food sources like salt specifically.  If you eat prepared foods like soups and things like this, or you eat take out on a regular basis, you are probably getting plenty of iodine.  Most of these prepared foods contain iodized salt.  Iodine is also in some vegetables and other plants that we consume.  This is especially true if they are grown close to the coastal areas.  This is where most of the iodine is naturally occurring because of its proximity to the ocean.  Similarly, seafood seaweed and things like this have lots of iodine.  You really don't need a lot of iodine as long as you've been maintaining your levels over time.  When you are not getting enough from your daily food eventually your stores go down.  In some cases, you do need more based on environmental things as well.  If you have signs and symptoms of hypothyroid, like fatigue, constipation, weight gain or actual labs showing hypothyroidism, consider an iodine test. 

Also just consider your intake of some of the foods mentioned.  If you don't use iodized salt, you don't eat out, have more of a restrictive diet, don't eat prepared foods, you might consider getting your iodine tested.  For instance, some people use salt but they only use Himalayan sea salt, which is not iodized (unless it says it is).  So if you have a more controlled diet, you may be restricting some of the foods that are supplying your iodine.  These are some of the dietary lifestyle things that make me think someone might have iodine deficiency.  If any of this describes you and you have not done thyroid labs, consider doing a TSH, T4 and T3 test.  Low T4 and high TSH are indicators of iodine deficiency.  You need the iodine in order to make thyroid hormone that is what your T4 is made of. 

Testing to See If You Need Iodine

I mentioned that most of the iodine is used for thyroid hormone production.  Some is used in other tissues too.  In particular, breast tissue where it is thought to support healthy breakdown of estrogen.  If you are someone with fibrocystic breast disease, that may also be a sign or symptom to be evaluated for iodine deficiency.  These signs and symptoms should be looked at in the in the context of  your diet.  No test is 100% sensitive or specific.  That's why it is best to use multiple ways to evaluate and look at the question, how do you know if you need more iodine.  As a general rule, the iodine that's consumed in your daily diet gets excreted through the urine.  The remaining is used for making thyroid hormone and any other tissues that may need extra iodine.  Because of this, urinary iodine is a very sensitive and specific way to test for iodine deficiency.  If the level excreted is low, that means you are deficient in iodine.  You are deficient in the amount that you consume on a daily basis, this suggests your diet leading up to the test is devoid in iodine.  Urinary iodine test is one of the better tests for detecting iodine deficiency.  However, it may not be covered by your insurance even though it is the better test.  This test is done usually as a first morning void.  When you do the test you want to avoid any extra supplemental iodine before the test.  For the urinary test you want to make sure it uses a mass spectrometry to measure the iodine.  This is the gold standard and ensures you are getting the most accurate result. 

There is also a whole blood iodine. This test looks at the levels of iodine in your plasma and serum.  Just like with the urinary iodine test, you do want to avoid taking extra supplemental iodine before the test.  The idea is when you are taking iodine on a regular basis your tissue levels are getting saturated.  When you go to do the test you should have a much higher overall baseline and the blood test will show up as more normal.  As you supplement regularly, your tissues are saturated and you the excrete more because less is going to be sucked up by the tissues.  With the blood test a low or low normal level suggests iodine deficiency.  This is especially true in the context of hypothyroid symptoms or actual hypothyroidism. 

There is also a a test called urinary iodine challenge test.  This test, in theory, accounts for goitrogens.  Goitrogens are the things that can prevent iodine uptake by the thyroid cells.  The idea with this is you take a large bolus, several milligrams of iodine.  Then you see how much urinary iodine comes out.  As mentioned previously, ninety percent of what you consume should go out through the urine.  The remaining ten percent goes to the cells and tissues mostly the thyroid.  This  assumes that your cells and tissues are adequately saturated.  However if very little iodine comes out after you do the challenge, it assumes that some of that iodine is displacing (because of the large quantity) some of those goitrogens.  Then the tissues are becoming more saturated and less goes out through the urine.  What are goitrogens? 

Goitrogens are things like fluoride, chloride, glucoscinnalates.  Glucosinolates are from uncooked cruciferous vegetables.  They are in cooked cruciferous vegetables as well but to a lesser extent.  It is best if you're going to eat them, to cook them first.  Usually you would have to consume large copious amounts of these things to have an impact on your thyroid hormone production.   I have also heard of an empirical test where you drop iodine on your skin and see if it how long it takes to absorb.  I don't recommend using this method.  It it's not really sensitive and it's not very specific either.  In my practice we use the combination of looking at diet in conjunction with signs and symptoms hypothyroid and the blood test.  When you are low, we suggest supplementation gradually. 

Here is a separate video looking at problems of excess iodine. 

That should give you a better understanding of How you know if you need iodine.  Let me know what your experience is with iodine testing and if you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to test and treat iodine deficiency, click in the link below to get started. 

Are you wondering why do I have IBS all of the sudden, struggling with digestive symptoms upset stomach, bloating, etc?  In this article, we look at how to narrow down where your IBS symptoms are coming from, why you have these symptoms, and what you can do about it. 

If you ant to know what to do for sudden IBS, keep reading. 

Why Do I Have IBS Suddenly?

Many people with digestive symptoms ask this question. In their experience, they didn't have IBS and then suddenly they have a lot of IBS like symptoms.  This creates a lot of questions around why the sudden change and how did this happen? Often times people question their diet if it something they are doing differently.  They might think it is a certain food they have become sensitive to, a change in diet, or something their body is reacting to.  Because it seems to come on suddenly they think it's something that changed in their body.  What can you do to figure this out?

Just like many health conditions, the actual problem typically starts long before you became conscious of it.  Prior to having symptoms, there were things happening in your body that you were not paying attention or were happening on a subclinical level (without your knowledge and in the background).  When those symptoms do appear, they are more intense and sudden.

In other cases the underlying problem and the symptoms really do come on suddenly.  In these cases there is a clear connection to something new happening, such as having a gastroenteritis, some kind of bug, food poisoning, travelers diarrhea, the flu etc.  As a side note, a similar phenomenon is occurring with some COVID-19 patients.  Not all patients with COVID even have digestive symptoms whereas other people predominantly do have digestive symptoms.   The bottom line is, many viruses and bacteria can create IBS symptoms that can be persistent long after an infection has subsided. This is referred to as post-infectious IBS. 

Post-infectious IBS is the predominant reason why people actually have IBS.  Whether you got IBS all of the sudden or it was gradual worsening of your symptoms over time, knowing why you have it is helpful for treatment.  Because post infectious is the most predominant form of IBS, it really doesn't matter if it came on suddenly, over weeks, months, or years.  There is an actual test for to determine if you have IBS from an infectious source or not.  This test is called IBS smart. 

What To Do For Sudden IBS- Testing

Most bacteria that cause IBS create a toxin known as 'cytolethal distending toxin B.' It is referred to as CDTB.  When that toxin is secreted your immune system is going to create an antibody against it and that antibody is known as anti-cdtb.   As your immune system is attacking this toxin and the bacteria that are present, in some cases, it creates antibodies against important proteins that hold your digestive cells together.  There are different proteins that do that but one of the important proteins is called vinculin.  When that protein is damaged the immune system can also create an antibody to it, in the process of fighting off the bacteria and CDTB. This antibody is known as anti-vinculin antibody.  Because that is part of the proteins that hold your digestive cells together, it can lead to a lot of tissue damage and nerve damage in your digestive tract. 

This damage is a key part of the symptoms of IBS.  It is this damage and ongoing low-grade infection, that leads to a lot of the digestive symptoms.  The ongoing damage also makes the makes it difficult for the body to fully recover and repair from this damage.  The test actually looks at the anti-vinculin and anti-cdtb antibody.   You can have both positive or one or the other positive.   When both of these are positive, it suggests that part of your problem is coming from the damage and part from the infection.  If one of them is positive, you may have a different treatment than if both are positive.  With the information from this test we can design more targeted treatments. 

As I mentioned this post-infectious IBS can come from viruses, parasites, and other sources as well.  The test narrows the cause down to bacteria.  It also tells us how much damage is occurring in your digestive tract.  If the test is negative it does tell us that it's likely not from bacteria.  However this is only one protein of many that could be damaged during this process.  Simply because the anti-vincilin antibody is negative, doesn't mean you don't have damage.  When positive, the test can tell us what's going.  However, it can miss some people that have post-infectious IBS for bacterial reasons.  It can also miss people with ongoing intestinal damage and their bodies are not making an antibody to this particular protein.  The test is only looking for that particular protein.  It will only be positive if there is damage to that protein and, more importantly, the immune system is actually attacking that protein.   Some people have damage going on but the immune system doesn't attack that protein.  Still doing a test like this or something similar, helps us rule things out and narrow down where your treatment focus should be. 

It is common for people with IBS to struggle.  These emerging tests can really help fill in some of the gaps in our knowledge and pinpoint what's going on in your particular situation.  Not all IBS scenarios are the same,  most are coming from an infectious source or chronic damage that your body needs help supporting or healing.  However, taking antimicrobial agents either antibiotics, anti-fungals, or herbal antimicrobials in a hope to improve things can actually make things worse.  In the case that you choose the wrong one, you can make another infections more problematic.  If you take an anti-fungal and you have a bacterial issue,  it can make the bacterial issue worse and vice versa.  This is why it is important to test and narrow down where the problem is coming from. 

That should give you a better understanding of what to do for sudden IBS.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on your sudden onset IBS, click in the link below to get started. 

Are you trying to find out what is the difference between food sensitivity and food allergy?  Which one is more important?  How do you know which tests to do and what do the results actually mean?  In this article, we answer these questions.  Specifically we look at what some of the immune responses are and what is the difference between IgE and IgG mediated food reactions. 

So if you want to understand the difference between food sensitivity and food allergy, keep reading. 

A food allergy is the immune system's response to certain proteins present in specific foods.  These proteins create the severe allergic response.  A classic example is with peanut allergies.  When someone with a severe peanut allergy is exposed to peanuts, their immune system sees that protein from the peanuts as a threat.  As a result the immune system tries to prevent it from spreading or moving throughout the body.  In this case the peanut proteins are seen by the immune system as a foreign invader.  This is a similar response to a bacteria or virus.  That immune response can be so strong though that it can actually be life-threatening.   This cascade of reaction starts by the immune system producing immunoglobulins called IgE from previous exposures to peanuts.   The next time the peanut comes in contact with the body the IgE immunoglobulin is able to attach to it and creates a cascade of events that results in the allergic reaction.  The amount of IgE immunoglobulin present in the body to the peanut, partially determines the severity of the peanut allergy.  For those that are susceptible to allergies, the more they're exposed to the peanuts the more likely a severe reaction is going to happen.  This can happen even if the initial exposure is not that severe.  The next time the proteins from the peanut come in contact with the body, the IgE immunoglobulin will attach to the peanut protein.  That creates the cascade of reactions that results in the allergic reaction.   So what's the difference between this type of allergic reaction and food sensitivity reaction? 

The Difference Between Food Sensitivity and Food Allergy

The difference between food sensitivity and food allergy comes down to a few different variables.  A similar type of response or reaction is happening with a food sensitivity but it involves IgG immunoglobulins versus IgE with the food allergy.  Food sensitivities are still the product of immune activity so that's where there's similarity with the food allergy.   However it's just a different severity of response.   Food sensitivities are thought to be less severe and also delayed.   Food allergies are more immediate and also potentially life-threatening.  Food sensitivity reactions are also thought to be more involved with IBS type symptoms, skin sensitivity, eczema and things like this. 

There is still active on ongoing debate on the value in detecting IgG immunoglobulins in the blood.  The debate is whether or not this really equates to a problem or if it just reflects immune tolerance.  Generally IgG antibodies to a virus, for instance, are thought to represent the presence of a past infection.  These allow the body to recognize when that pathogen comes into the body again.  The immune system is able to respond more quickly.   It is said that the body is tolerant or the immune system is tolerant to that virus.   As a result not as strong of reaction is going to happen when you come in contact with that virus again.  Many immunologists and allergists argue that this is the same thing that happens with IgG food antibodies.  We will discuss that topic in more detail in an upcoming article. 

Sometimes food sensitivities and food intolerances are used interchangeably.  I will just point out that usually food sensitivity is actually an immune reaction.  So when you are tested and you have an IgG immunoglobulin to that particular food you have a sensitivity.   Whereas an intolerance is something more like lactose intolerance.  This an empirically observation when you eat lactose you don't process it very well.   This intolerance could be more of an enzyme deficiency for example.  Other times people observe that they have more digestive symptoms when they consume gluten.  This would be example of a food intolerance too.   If you did a IgG blood sample and found that you had elevated IgG antibody, it's a food sensitivity. 

The difference between food sensitivity and food allergy is that a food sensitivity is measured by IgG antibodies and food allergies measured by IgE antibodies.  In addition there's also differences in the reactions that we would expect from a food sensitivity versus a food allergy.  Food allergies are more severe and food sensitivities are more mild.  With both tests there's a high rate of false positives and also some false negatives.  We will be discussing that in an upcoming article that looks at the reliability of food sensitivity testing. 

That should give you a better understanding of what is the difference between food sensitivity and food allergy.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on your food allergies, sensitivities, or food reactions, click in the link below to get started. 

What does it mean when your liver enzymes are high or elevated? Does it mean you have some liver disease; does it mean you have hepatitis; what exactly is going on with these liver enzymes? In this article we discuss what liver enzymes do, why they might be high, and some of the things you should consider when you get this result in your blood test.

If you want to understand what it means when your liver enzymes are high, keep reading. 

What Are Liver Enzymes?

Before we get into what does it mean when liver enzymes are high, we should first discuss what a liver enzyme is.  Like all enzymes, liver enzymes help processes move forward in a more efficient way.  They act like a catalyst to help a process move forward that otherwise would not move forward without the enzyme.  There are three main enzymes that are checked to evaluate liver function, and they are AST, ALT, and GGT.  These enzymes are involved with detoxification and typically tested as part of a general screening and physical exam.  You may have these enzymes tested on a regular basis with your annual exam.  Other times they are tested when you have symptoms that correlate with liver function. 

These enzymes carry out some of the most fundamental aspects of what your liver does, detoxify.  When they are high it does mean that you have hepatitis.  Now hepatitis is really just inflammation of the liver.  If you break down the words into it's root, this is clear.   'Hepa' means liver and 'itis' means inflammation, therefore inflammation of the liver.  Anytime the liver enzymes are high, that means that you have hepatitis.  A lot of times when people hear hepatitis, they automatically think they have some kind of virus.  This is not necessarily true. 

People can have hepatitis from viruses, from drinking too much alcohol (one night, two nights or on a regular basis), consuming too much Tylenol, etc.  There are many many causes or reasons why you can have elevated liver enzymes also known as hepatitis.   Anytime you have elevated liver enzymes, you do have hepatitis.  Usually it's temporary but not always.   That is why it is important to investigate why it there and do follow up labs to determine the cause.   

That should give you a better understanding of what it means when liver enzymes are high.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to lower your liver enzymes, click in the link below to get started. 

Are you confused about which type of B12 is best for you? Are you wondering which form of Vitamin B12 is best, in general?  In this article we will look at the different types of B12 and different ways to take B12 .  We will look at types of B12 based on genetics and using signs and symptoms to point you in the right direction. 

If you want to know which form of B12 is best for you, keep reading. 

Best Form Of B12

First we need to understand the different routes of administration and the different types of B12.  From here we can understand which form a B12 is best for you.  When it comes to the different types of B12, it really comes down to which molecules are attached to the cobalamin molecule.  This structure allows us to determine which one might be best for you.  It's also worth pointing out that there are some types of B12 we can exclude from taking at all. 

B12 is known as cobalamin.  The type of B12 is based on what functional group is attached to it.  It could be a 'methyl' group as in methylcobalamin.  It can also be a cyanide group as in cyanocobalamin or a hydroxyl group as in hydroxycobalamin, and finally an adenosine as in adenosylcobalamin.  Each of those molecules on the front of the cobalamin name are the functional groups.  In the case of the 'cyano' and 'hydroxyl' those two molecules are not really adding much value to the physiology of your body.  In the case of the 'cyano' group or cyanocobalamin you probably don't want to take it at all.  Cyanide is poisonous to our mitochondria and it's just not good for our bodies.  In a pinch it will help if you are really really low on vitamin B12 (cobalamin).  If no other sources are available, it's ok to take it.  It's generally not recommended to put cyanide in your body no matter how small it is, however.  Hydroxyl groups do not cause any harm but they are not as beneficial either.  So both 'cyano' and hydroxyl are not necessarily that functional and don't add much benefit to the body.  Now let's look at those that do add benefit. 

Methylcobalamin and adenosylcobalamin do have functional uses.  Methylcobalamin has a 'methyl' group on it.  If you do have genetic issues with recycling B12, such as an alteration in MTRR (or even MTHFR or MTR), you may need more vitamin B12 in the form of methyl-B12.  This will keep those enzymes functioning at their normal capacity.   This is a genetic reasons why you might need methylcobalamin.  Another reason to look at methylcobalamin is if you have a high homocysteine.  High homocysteine occurs in B12 deficiency. 

A methylmalonic acid test will be elevated when you have low B12 levels too.  The methylmalonic is a more sensitive way to test for B12 deficiency, however.  The methylmalonic molecules increase when there is a lack of  adenosylcobalamin.  This is a type of B12 which is needed for fatty acid and myelin sheath production.  The myelin is an important component of your nerves.  When you have a lot of nerve issues you may want to use the adenosyl form.  The problem with this form is that doesn't come in injectable forms.  It is less stable so harder to make in injectable form.  There are also limited sources of adenosylcobalamin.  Here is a link to adenosylcobalmin you can take by mouth. 

Adenosylcobalamin is used more for the nerve conduction and myelin sheath production.  If you have issues with methylmelonyl CoA mutase genetically, you may need more of the adenosylcobalamin as well.  Adenosyl and methylcobalamin are two of the best forms you can get.  Because the adenosine does not come in the injectable form, you may want to use the methylcobalamin instead.   Hydroxylcobalamin is a good substitute instead of the cyanocobalamin. 

Routes of B12 Administration

The main routes of administration for B12 are oral (swallowing), sublingual  (dissolves in your mouth), and injectable or intravenous.   We discussed the different types that are available through injectable and intravenous.  All the types are available to swallow and I believe sublingual as well.  The best route to administer your B12 is injection or intravenous.  Of course, that's not  freely available to everyone.  The next best option is sublingual or under the tongue.  The reason sublingual is better has to do with what happens when you swallow the B12.   Some people don't have the ability to absorb it.  In most cases this is why people become deficient to begin with.  Be sure you talk to your doctor if you have questions about this as there are many different things to consider.   Clearly if you are deficient you need more B12 and a lot of these different forms can work. 

That should give you a better understanding of which form of B12 is best.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on vitamin B12 supplementation or methylation support , click in the link below to get started. 

Are you wondering if you have a hormone imbalance or how you can get your hormone levels checked for imbalance? In this article, we look at this question and specifically look at what hormones you should check, when you should check them, and what some of the levels suggests.  We will looking at estrogen, progesterone, some androgens and imbalances scenarios.  As we make our way through these different scenarios you will begin to understand how some of the enzymes involved with production and breakdown of androgens and estrogen can influence your hormone balance.

If you want to know how to get your hormone checked for imbalance, keep reading. 

Seeking Hormone Balance

Specifically we will look at how to get evaluated or checked for hormone imbalance.  There are several ways to check your level of hormones for balance.  There are urine tests, blood tests and even salivary tests.   Be careful though.  Just because your lab results look normal doesn't necessarily mean your hormones are all good and balanced.  Sometimes the lab stated reference range is not what you want to look at.  Part of the focus of this article will be looking at what values to check, when to check and what some of those values could mean. 

When we say hormone imbalance generally we are referring to female hormone imbalance.  It is the relative levels of the estrogen and progesterone that create the balance or imbalance.  That doesn't mean that estrogen and progesterone need to be in a one-to-one ratio.  We will discuss more details on this further along.  Before we get into those details, it's important to mention, there are other ways that hormones can be imbalanced  as well.  There are cortisol issues both high and low. DHEA-s can also be high and low and of course, thyroid levels can be low or high too. So there are many other hormones and ways to look at balance.  The specifics of this article will be more so on female hormone imbalance (estrogen and progesterone). 

When to Test For Hormone Imbalance

So when do we want to test your estrogen and progesterone to best understand what the relative balance or imbalance is? Most of the time when there's hormone imbalance going on, the women is premenopausal or perimenopausal.  This would be from age 17-18 all the way up to say 50 or even 55.  If you are still menstruating you are susceptible to the relative balance of estrogen and progesterone.  Imbalance is more common closer to menopause though.  When we check your estrogen and progesterone typically, we want to do this at the peak of the progesterone.  We do that because low progesterone is often times part of the problem and causing the imbalance and other times it is high estrogen.  To verify this you want to check the levels at a specific time of the month when the progesterone is peaking.  For any female that is menstruating, we want to tested for estrogen and progesterone on cycle day 21 or close to it.  If you have a shorter cycle that peak of progesterone may come a little bit earlier.  If that is the case, you may want to do it on cycle day 19 or something close to day 21. 

The hormone levels that we check are estradiol and progesterone.  The specific test that we use for estradiol is done through mass spectrometry and liquid chromatography.  There are also standard estradiol tests that are fairly accurate.  If there is suspicion of hormone imbalance though, it is a good idea to check the ultra-sensitive estradiol because sometimes they are incongruent.  The incongruence occurs because something that is similar to estradiol is interfering with the standard estradiol test (the non-mass spectrometry).  Estradiol is the most biologically active hormone at the estrogen receptors.  That is why we want to test this hormone.  Using the more accurate test you can get a better understanding of where you are at. So use ultra-sensitive estradiol or mass spectrometry/liquid chromatography estradiol test. 

We also test for progesterone and both the estradiol test and the progesterone that we typically do are blood tests.  There are other tests which we will get into a little bit later but estradiol ultra sensitive estradiol and progesterone are really good tests.  The peak of the progesterone around cycle day 21 is known as the luteal phase.  The stated reference range at the lab for the luteal phase is pretty broad.  For progesterone it might be 2.0 all the way up to 23.  In the beginning in the beginning of the luteal phase around day 14, the progesterone is stating to increase but still quite low.  It will be highest around day 21.  At this time we are looking for the progesterone to be at the higher end of the reference range too.  That's why we check your levels at this time to see how high it gets.  The peak may vary a little bit by a few days from one person to the next.  

For estradiol the peak of estradiol is closer to ovulation around day 10 and a bit earlier than the progesterone.  When you are checking on day 21 the estradiol is already coming down.  That's why your reference ranges are going to look a little different.  So the range for progesterone that you're going for is  around 10-20 to on the blood test.  The  the range for estradiol is going to be on the lower third.  Since it is on it's way down it will be around one hundred to one hundred fifty.  A higher level of estrogen could mean that your body is making too much estradiol or it is not clearing it fast enough.  A common problem with low progesterone is it getting funneled into a different pathway to make cortisol or some other hormone. 

If you have one test that shows that there's a relative imbalance in estrogen and progesterone, usually it isn't conclusive.  If there is a clinical picture and  symptoms that suggest estrogen excess or progesterone deficiency, then we might give the test result more weight as well.  This is where clinical experience and having a doctor that does a lot of hormone testing can help.  Getting multiple checks of your hormones at this time of your cycle can be helpful when clinical experience is lacking.  This gives you more confidence that you're actually having a deficiency of progesterone or excess of estrogen.  There are cases where you may want to check these levels earlier in the cycle too, like at or near ovulation.  This is more true if there are symptoms around that time like cramping or or pain.  

Androgen Excess and Hormone Imbalance

There are other forms of hormone imbalance too like those that arises from excess androgens in PCOS.  Usually you can check these hormones when you check the others.  You would not want to check when you are menstruating because the production of these hormones is going to be lowest at this time.   These hormone levels may be much higher later on in the cycle.   Specifically the hormones that are important to look at and understand how they are funneling through the body are dhea, dhea sulfate, total and free testosterone, sometimes dihydrotestosterone and definitely hydroxy-progesterone.

Keep in mind not all insurances are going to pay for all these lab tests.  In this case it may make more sense to do a urine test.  These test provide a full hormone profile of all these hormones plus others. By looking at all these you can see which enzymes are up regulated and turned on and which ones are turned off based on the relative levels of the different hormones. 

For example, you may do a dhea level and it looks really low but your dhea sulfate is really high.  This suggests the enzyme between dhea and dhea sulfate is working relatively good and the the enzyme that breaks dhea sulfate into androstenedione is moving much slower.   This is where you get the clues to understand what you need to do to fix the imbalance or create balance. 

Another example is a higher than normal hydroxy-progesterone may indicate that one of your enzymes the 21-hydroxyl enzyme is working much faster which can lead to higher androstenedione and higher DHEA sulfate levels.  Both are precursors to testosterone.  Insulin resistance increases the activity of this enzyme and the three beta-hydroxysteroid dehydrogenase.   So insulin resistance is a key cause for many hormone imbalance issues especially high androgens. 

While cortisol and high DHEA oftentimes go together and also can be a cause for high androgens, it is possible for you to have high DHEA sulfate and normal cortisol though.   This simply suggests the high DHEA may not be linked to your high cortisol and stress.  I can understand this may be a lot of new information.  If you're not used to looking at biochemical pathways, it may be helpful for you to look at a steroidogenic pathway so you can see how one type of hormone funnels into the next and into the next. These steps are all controlled by enzymes.  Those enzymes can be up regulated or down regulated by certain physiological things that your body is going through.  An up regulation of insulin or certain food consumption, vitamin deficiencies etc can control these enzymes and pathways.  It is not a one-size-fits-all you do have to look at what your specific situation is.  Once you have the information on where the imbalance is, the next step is to look at how you can control those levels. 

That should give you a better understanding of how can i get my hormone levels checked for imbalance.   If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on checking and treating your hormone imbalance, click in the link below to get started. 

Are you feeling like you are retaining water? Maybe you are feeling a little swollen and asking the question, does TRT make you retain water or cause fluid retention?  In this video, we will look at this specific topic, the causes of fluid retention, and what you can do about it.  We will also look at how to track fluid retention so that you can really pin it down and get your fluid retention under control. 

If you want to understand the variables involved with TRT and fluid retention, keep reading. 

Does TRT Make You Retain Water?

Yes it does.  Testosterone replacement therapy also known as TRT can make you retain water if you are producing a lot of estradiol or estrogens in general.  The main estrogen that does this is estradiol.  Fluid retention can also occur with higher testosterone levels and corresponding increase in cortisol levels.   Both of these hormones can increase from testosterone replacement therapy.  However just because you are taking testosterone replacement therapy does not mean that you are going to have this issue. 

Both estrogen and cortisol (mainly estradiol but estrogens in general to a certain extent) increase the amount of sodium reabsorption in the kidneys.  When sodium is being excreted through your urine these hormones increase the reabsorption and prevent sodium from being excreted in your urine.   Water follows sodium.  The increased sodium and water retention in the kidneys causes the puffiness and fluid retention in your tissues.  So what can you do? 

First you have to find out if this is indeed your problem because it does not happen to everyone.  To do this, you want to check your estradiol levels from a few different angles .  This will ensure to you are actually capturing the real effect in your body.   You want to look at the estradiol on different days.  Which days depends on how often you are injecting.  You might want to do it on the third day after injecting, if you inject every seven days.  It also makes sense to check it the day after and the day before you inject.  You just want to get readings at different intervals.  You definitely don't want to only check at the end of the week.  This is when it's probably going to be lowest. 

The other thing to note is the type of test being used.  There are different tests for estradiol.   Some of them are less sensitive than others.  You want to use the most sensitive.  The most sensitive estradiol test uses mass spectrometry and liquid chromatography technology.   This test will capture the true nature of the issue.   You can also do a total estrogen test which will capture some of the other estrogens other than estradiol.   These can also contribute to the problem. 

In some cases increasing your testosterone levels can cause elevated cortisol.  So this is also important to test when you are wondering if TRT is making you retain water.  Testing for cortisol is pretty straightforward but it can change quickly too.  You want to make sure you get it earlier enough in the day, if you are doing a blood test.   You could also do a twenty four hour cortisol as well.  The twenty four hour will capture the whole day.  Usually when cortisol is high, it is high in the morning.  So the am cortisol capture most of the issues with cortisol.  There are also salivary cortisol tests which I don't use as much.   The twenty four hour cortisol or am cortisol earlier in the day are both options to capture the cortisol issue. 

Along with these test you may also want to track your electrolyte levels and your osmolality.  This can also give you hints about your sodium intake and retention in relation to cortisol, estradiol, and you testosterone dosing.  If  it is really high or higher than it was before, that tells you something about your fluid retention. 

That should answer the question, does TRT make you retain water or increase fluid retention.  If you have questions about the content or around fluid retention related to TRT drop it in the comment section below. 

If you want a customized plan on how to reduce your fluid retention, click in the link below to get started. 

Do you have itchy skin, red skin?  Do you want to know why do I have hives all of the sudden?  In this article we will look at this question.  We will also discuss what could be going on with your immune system, what some of the possible triggers could be and more importantly what you can do about it. 

If you want to know why you have hives suddenly, keep reading.

I want to help you understand why you might have hives all of the sudden.  There are many reasons why people develop hives.   In general it's going to be from the immune system.  It is an increased activity in specific aspects of the immune system known as the mast cells.  The number of mast cells and the activity of those mast cells are increased.  Mast cells are a particular type of white blood cell that produce a lot of histamine.  It is that histamine that creates the itching the redness burning and the stinging.  Similar to  if you get stung by a bee or or a mosquito.  The body is reacting to the venom or the activity of that sting.  The mast cells produce histamine that creates the itchiness and the burning there.  The question is why are your cells doing this suddenly? 

Why The Sudden Hives?

Typically there is some kind of trigger that create the hives.  That trigger could be a medication that you recently tried.  It could be something going on with your digestion like a a bug, a parasite, a virus, a food sensitivities or food allergies.  Keep in mind that these things can develop over time.  So you don't have to be doing something new for the food or medication to be a trigger.  That is because it takes multiple exposures for the mast cell activity to increase to the point where you have hives.  Anything that engages these immune cells can trigger the hives. 

Mast cells protect the body from things the body sees as foreign substances or as potentially dangerous to your body.  Finding the actual trigger can be tricky though because sometimes there are multiple triggers.   Additionally, even if you remove the triggers the residual immune activity can stay in your body for days to weeks.  Sometimes it's the overlap of these multiple allergenic exposures that creates the systemic kind of reaction and it shows up on your skin as a hive. 

The problem really is that certain aspects of your white blood cell lines are becoming overly active.  The environment they find themselves in, your body, is basically programming more of your white blood cells to turn into these mast cells.  There are several types of mast cells but one way to look at this is the differentiation between different types of white blood cells called T cells.  T cells differentiate into Th1 and Th2.  There are several other types of T cells including T regulatory cells.  These types of T cells regulate how much of the T cells turn into Th1 and Th2.   With excess allergies and hives there is an increase in the amount of Th2 cells.  When the environment inside your body is overly allergenic, you are going to get a shift and start making more of those mast cells.  That will cause your body to produce more histamine.  The histamine acts as a chemical signal to recruits more of those same histamine producing cells.  If you don't have enough of these regulatory cells or T regulatory cells, you will get an over abundance of the mast cells.   In a way it can become a feed-forward process.   What can you do about this?

What To Do About Sudden Hives

While you are investigating or trying to narrow down what the actual triggers are you can also put some efforts to recalibrate how your immune system is responding.  There are a few things you can do for this . Each case and situation is different but I will lay out a few ideas to help with the  T regulatory cells.  Vitamin D plays a strong role in helping the body produce enough of these T regulatory cells.  If you don't have enough vitamin D you want to make sure you get enough.  There is a wide reference range for vitamin D.  Clearly if you are under 20 ng/ml you need more.  If you are above 70 ng/ml you may be overdoing it.  You really have to check with your doctor and see what they think the best level of vitamin D is for you.  Here is an option for Vitamin D supplement. 

Another thing you can take that is very safe and also helps with this T regulatory function and calibration of the immune system is Astragalus.  Astragalus is an herb and typically you want to use the root or the bark.  Often times it comes in an alcohol extract. However, because alcohol has a lot of histamine in it, you probably don't want to use that.  Instead it is better to try and get an extract of the powder, a powdered extract of the Astragalus.  Something like this Astragalus root is good.  So those are two things you can do if you gat hives suddenly or stuck in a chronic loop of hives.  

That should give you a better understanding of why you have hives all of the sudden.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on resolving your hives, click in the link below to get started. 

How do you know if you have hemochromatosis?  Is there a blood test, a genetic test, what do you have to do to figure this out?  In this article we will  look at some of the blood testing, and genetic testing that confirm and tell you for sure whether or not you have hemochromatosis.  There are different scenarios where you may have high iron and blood levels suggesting hemochromatosis.  We are going to look at the specifics. 

If you want to know how you know when you have hemochromatosis, keep reading. 

What is Hemochromatosis?

We will look at some of the lab values that suggest you might have this but first a little bit on what hemochromatosis is.  Hemochromatosis is a genetic disorder of increased iron absorption.  There are certain signs, lab values and physically signs that one might see if they have this.  In later stages you might see manifestations of on the skin, for instance.  There are also a lot of different symptoms that one can have from this.  We are not going to get into all of the signs and symptoms in this video.  Instead we want to discuss  the lab tests and the genetic tests that suggest and confirm hemochromatosis.   

Typically people are asking this question when they have lab results that suggest you might have this (after a google search maybe?).  The results that come up in labs that may hint or suggest this are things like elevated red blood cells, elevated hemoglobin, elevated hematocrit, elevated serum iron, decreased total iron binding capacity, and elevated ferritin.   Of course there are a lot of things other than hemochromatosis that can cause these lab values to be elevated or decreased. 

We won't go into all of the different scenarios that can make things go up or down.  I do want to point out a few things though.  An elevation in red blood cells and hemoglobin is common when you are on testosterone replacement therapy.  This can occur in both males and females.  Of course,  ferritin can also go up in people with autoimmune issues or just really sick with a lot of inflammation.  Of all these tests, the one that raises the most suspicion for having hemochromatosis is the ferritin.  At least in the case that there is no increased inflammation or autoimmune issues.   

When ferritin above 300 in females you definitely should be suspicious maybe even a little bit lower.  When it's above five hundred for males you should be suspicious too.  It really depends on the age of the person and what's going on with them.   For example females are menstruating losing a lot of iron.  So if she has an ferritin that's above two hundred and fifty and she is still menstruating that is a red flag (especially if there is no inflammation).  For males, the diagnosis or alarm tends to come up a little bit earlier because they're not losing blood on a regular basis.   Still just having these elevated numbers does not tell us you have hemochromatosis you have to do more testing more investigation to discover this. 

Testing For Hemochromatosis 

Iron saturation or serum transfer saturation is the most sensitive and specific blood test that you can do for hemochromatosis.  When you do this test and it comes out positive, we have a high conviction that you have hemochromatosis.   What is a positive result?  This test shows a percentage and the result will be different for males and females.   When it's above forty to forty five or anything higher for males then that is highly predictive of hemochromatosis.  For females anything above thirty five to forty is also highly predictive of hemochromatosis .   

In some cases the other blood tests mentioned above may be normal but you still have a high transferrin saturation.  This just means you are catching it earlier on and you will get all the sings of hemochromatosis in the future (if not treated).  The transferrin is the transport protein for iron.   As the saturation on that protein increases, more of it gets transferred into storage which is the ferritin protein.   Ferritin levels then go up and increase as a result.  Of course, ferritin can go up for other reasons outside of saturation of the transferrin.   Ferritin serves as a way to safely hold iron and prevent the iron from causing free radical damage.  It's a safe way to store and release iron on an as needed basis.  Iron is toxic to cells when there's too much around.   If all the iron we needed was just freely floating around and all the transferrin carrier protein was fully saturated, your more likely for the oxidative damage to the cells. 

The protein called ferritin is a way to protect the body against this oxidative damage.  Once that iron starts building up higher and higher that suggests that you are absorbing too much or consuming too much.  Yes you could just be consuming too much when you have a high ferritin. 

What Cause Iron Levels To Be High?

When the percentage of transportation in that transferrin goes up, that's how you know you are getting some increased absorption.   This is the first sign that there is increased absorption of the iron, the hallmark of hemochromatosis. 

Genetic Testing For Hemochromatosis 

There is genetic testing for hemochromatosis as well.  This is also a very reliable way to understand whether or not you have hemochromatosis.  It's also a way to understand how efficient your body is at absorbing iron and what your risks are for getting iron overload issues.   The main alteration that creates hemochromatosis is a homozygous alteration in the C282Y gene.  When you have two copies, one from each parent, that is homozygous, you have and or will get hemochromatosis.  It also means that if you have a parent with hemochromatosis, it doesn't necessarily mean you're going to get it, because you do need two copies.   When you have a parent with hemochromatosis you will get one copy from that parent and that will increase your iron absorption.  However, it is not going to lead to iron overload.   Other factors have to come into play like other genetic alterations that also increase your iron absorption.   

Some of those you could just be heterozygous.   If you had a heterozygous alteration for the C282Y plus a heterozygous for the H63D gene, that may create a problem and may lead to hemochromatosis.  So it really just depends on all your genetics.  From a pure iron overload situation diet does play a role and whether or not you are a male or female does too.   With just one of the C282Y alterations that could potentially lead to an iron overload as well.  For the most part it's the C282Y that causes the increased iron absorption and hemochromatosis.   There are some other genetic combinations that creates this but this is the main one.   A secondary one would be the HFE H63D.  

If you do have problems with your blood work, family history, or genetics that suggests hemochromatosis, make sure you get tested for transferrin saturation.   This will tell you if your iron is possibly spilling into your tissues and causing damage.   If it is high or high normal you may want to get genetic testing as noted above or just follow the numbers more closely.   

That should give you a better understanding of how you know when you have hemochromatosis.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on your iron or other blood levels, click in the link below to get started. 

Are you wondering how common is B12 deficiency? Would you be surprised if I told you ten percent of the population has it? How about twenty percent?  In this article we look at studies that tell us about how common B12 deficiency is in different ages and populations.  We also look at how that changes over time, what some of the reasons are for B12 deficiency, and what you can do about it. 

If you want to know how common is B12 deficiency, keep reading. 

B12 Deficiency and Insufficiency Defined

B12 deficiency may be more common than you think but before we get into  how common it is, we want to look at some terms like B deficiency and B insufficiency.  To do this we will reference a study that looked at the levels of B12 in U.S. populations.  This was a study by the National Health and Nutritional Examination and it was a survey.  They defined B12 deficiency as a serum level of anything less than 148 pico moles per liter.  Most U.S labs will report serum B12 levels with the units picograms per milliliter.  In order to convert the pico moles per liter into picograms per milliliter, you have to multiply by 1.35 .  If we take 148 and multiply by 1.35, we get 195 picograms per milliliter.  So deficiency of vitamin B12, according to this study, would be defined as less than 195 picograms per milliliter.  200 pg/ml or less is close to what most labs will report it as deficiency in their reference ranges.   I would go a little further and say anything less than 200 pg/ml is deficiency.

In this study they defined an additional term called "marginal depletion.' They define marginal depletion of vitamin B12 as between 195 pg/ml and 298 pg/ml.  I still call this deficiency because I find that anything in 300pg/ml and even in 350 pg/ml will respond to B12 supplementation.  When they start taking B12 they feel better, less fatigue etc.  If you are on this lower end known as marginal depletion, which we can also describe as B12 insufficiency, it is worthwhile looking at some supplementation.  I would define sufficient B12 levels as above 500 pg/ml.  If you are at 500 pg/ml that doesn't always mean you have enough, but it does lead us down a different path.  I am giving you these parameters so you have a general idea of the difference between B12 deficiency and B12 sufficiency on paper.  We are usually looking at serum levels but this does not tell the whole story.  Without getting into too much detail, the serum test is just a starting place.  

How Common Is B12 Deficiency

The study looking to answer this question (from the serum B12 levels alone) was done by the national health and nutrition examination surveys.  This study was based out of the US as well and they found that as populations age deficiency rates go up.  This makes sense since stomach acid declines as we age.  Stomach acid is intrinsically tied with something called intrinsic factor.  Intrinsic factor is secreted when acid is secreted.   Acid levels generally go down with age as well.  With this decline in acid, intrinsic factor goes down as well.  Intrinsic factor is needed for B12 absorption.  Once secreted in the stomach, it binds to the B12.  The B12 travels further down into the small intestine it is absorbed in a specific area of the small intestine.  If there's not enough intrinsic factor, absorption does not occur.  Now with this information, it makes sense that as populations age, stomach acid goes down, intrinsic factor goes down, B12 absorption goes down. 

Back to the actual study findings. Nutrition Examination Survey was done on u.s populations between the years of 1999 and 2002.  What they found was deficiency rates were around 3 percent for those aged 20 to 39.  It was  four percent of those age 40 to 59.  It was six percent for  those 70 years or greater.  You can see it's gradually going higher and higher. 

When they changed the term and range to marginal depletion the rates increased a lot.   Those aged 20 to 59 had marginal depletion at a rate of fourteen to sixteen percent.  Those people age 60 or older had marginal depletion at a rate of twenty percent.  Clearly as age increases B12 deficiency becomes more common.  When we shift what we consider deficient just slightly, the rates of deficiency go up 2-3 fold. 

So back to the question, how common is B12 deficiency.  If you look at it from this perspective, about fifteen to twenty percent of the adult u.s population has B12 deficiency.  Keep in mind, this is based on a survey so it's not the most accurate way to answer this question.  I  wouldn't take it as gold but as a rough approximation.  A lot of people do have B12 deficiency.

If you are wondering if you have normal levels or adequate levels, you can check your serum B12 levels.  The lab reference range in your local lab may vary slightly on what it considers normal.  Typically it's going to be all the way up to a thousand on the high end.  Remember, just because you are within that range doesn't necessarily mean you have enough B12.  There are many ways to test and assess for B12 deficiency.  If you check your serum B12 levels and you are in the range of 400-500 pg/ml, this could still indicate inadequate or insufficient B12 levels.  I consider anything less than 500 pg/ml to be suspect of a B12 deficiency.  Part of that assessment includes doing other testing and looking at common B12 symptoms.  If you don't have any symptoms of B12 deficiency,  I would not be as worried about a lower serum B12 level. 

As this study indicates as, you age it is a good idea to monitor your B12 levels.  If you want to prevent the age related B12 deficiency problem, you can supplement with B12.  Here is a good B12 supplement option.  You can increase the actual amount that you are consuming every day.  You can do that through foods you can do that through supplements.   Sublingual form of B12 is going to be the best bet since you that does not require intrinsic factor.  Another thing you can do from a stomach digestive standpoint, is tonify your digestive cells.  You can do that by taking digestive bitters.  There are many different formulas for this. Here is one we have used Sweetish Bitters.

Anything that has a bitter taste when you consume it is a digestive bitter.  These actually helps your digestive tract secrete more acid and become more functionally active and produce more acid and intrinsic factor. 

That should give you a better understanding of how common is B12 deficiency.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to lower your DHEA levels, click in the link below to get started. 

In this article we will be look at what causes high estrogen levels in females.  We will look at some of the enzymes involved in estrogen production and some of the enzymes involved in estrogen breakdown. We will also look at how to help your body with high estrogen symptoms and actual high estrogen blood levels. 

So if you want to understand what causes high estrogen in females, keep reading. 

What Causes High Estrogen Levels In A Female?

High estrogen levels are caused by higher than normal production of estrogen or slowed or breakdown of estrogen.   We will look this hormone imbalance and the enzymes and biological functions involved in both production and breakdown of estrogens.   On the production side, we have the conversion of testosterone into estradiol and the conversion of androstenedione into estrone.   Both of these occur through an aromatase enzyme and the estrone can then be converted into estradiol as well.

The estradiol and estrone can then be broken down by a cytochrome enzyme called cytochrome 34A (Cyp 34A).  The resulting estrogens from that are then either bound to a sulfur molecule through sulfation, bound to a glucorate molecule through glucuronidation, or bound to a methyl group through the activity of the COMT enzyme.  If you have a high total estrogen estradiol or any high estrogen picture, it makes sense to enhance some of these detoxification pathways.  To enhance sulfation you can use something like N-acetyl-cysteine.  If you want to enhance glucuronidation you can use something like calcium D-glucarate.  If you want to enhance COMT activity, you can use any methyl donor.   Anything that up regulates SAMe production or actually SAMe plus magnesium.   You can also enhance the activity of the cytochrome p450 enzyme by eating lots of cruciferous vegetables or maybe even taking a supplement like DIM.   

High Estrogen or High Estrogen Activity

Another thing to look at is the overall activity of estrogen on the estrogen receptor in the tissues throughout the body.  During both reproductive and non-reproductive years estradiol is being produced through the conversion of DHEA-s to Androsteindione.  This is then aromatized into either estradiol or estrone (and eventually into the estradiol).  Estradiol is the most biologically active molecule.  One can argue that the high estradiol is from the increased aromatization or utilization of the aromatase enzyme.   What may be more important is the overall activity of that estradiol on the estrogen receptor.  The binding of estrogens to the receptors causes an estrogenic biological effect.  So perhaps more important than the amount of estrogen is the amount of unbound or free estradiol floating around in your body. 

In order to act in the body, all hormones need to be unbound so they can bind to the receptor.  Sex hormone binding globulin (SHBG) is the protein that carries estrogens (and all hormones) around in the body.  If you have lower SHBG you have more free estrogen floating around.  This allows it to bind to all of the estrogen receptors and creates more estrogen activity.  Typically high estradiol and high estrogens in general will cause the liver to up-regulate the amount of SHBG that is produced.   This modulates or balances out the estrogens.  However high insulin levels may actually drive down the SHBG production. This creates  a mismatch or a higher amount of unbound estradiol leading to higher estrogen activity in your bodies tissues.  If you have high estrogen symptoms or a clinical picture of high estrogen symptoms, one should also make sure you're looking at the insulin signaling.  High insulin levels and insulin resistance may trigger high free estradiol.  

That should give you a better understanding of what cause high estrogen levels in a female.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to lower your estrogen levels, click in the link below to get started. 

Can post infectious IBS be cured? In this article we are going to look at some of the strategies and tactics that I use to help people go from post-infectious IBS to 80-90 percent better.  Only about fifty percent of people with post-infectious IBS actually recover.  What we want to look at is some of the strategies that I have used to help people actually get better quicker and get to that ninety to one hundred percent better. 

So if you want to understand how to cure post infectious IBS, keep reading.   We are going to get into the details. 

Can Post Infectious IBS Be Cured ?

Yes it can.  In a previous article we looked at what is post-infectious IBS.  That article got a lot of interest and naturally got questions about wether or not post-infectious IBS can be cured.  This article will address this question  with the steps you can take to get to a point where your digestion is better.  I have helped many patients with IBS and with post infectious IBS get completely cured and no longer have symptoms at all.  In some cases they still have mild symptoms, but they are to a point where they are not worrying about it on a regular basis.  Before we jump into how to do this, a quick summary on what is post-infectious IBS. 

Post-infectious IBS is is a digestive condition resulting from your intestines getting inoculated with some intestinal bug.  This could be a bacteria, a fungus, a virus, or a parasite.  Any of those can do this and results in IBS-like symptoms.  Some people have diarrhea or loose stools and others have constipation or both with cramping bloating etc.  Usually these symtoms start after eating out or after you ate some bad leftover food or something like that.  The persistence of the symptoms after that event weeks and months later leads us to believe you have post-infectious IBS.   

Not all IBS is post-infectious but a lot of cases are from the post-infectious scenario.   The persistence of those symptoms occurs for three basic reasons.  The first is excess microbes that may still be present, months weeks or years later.  The second is general gastrointestinal inflammation.  The third is just an imbalance in the normal relative balance of the different microbes that are present in your digestive tract.  So what do you do about it?

Studies indicate that somewhere around fifty percent of all post-infectious IBS will recover and not need any specific treatment at all.  The time it takes for one person to heal versus another can vary from weeks to months.  Remember the other fifty percent recover without anything.  Those with anxiety and depression and mood disorders, seem to experience more problems more challenges recovering.  We want to look at how do we shorten the time it takes to recover and increase the chance that you fully recover and not have to deal with this.   In order to do this we need to understand what the actual problem is.  Which of the three issues mentioned above are occurring.  Is it dysbiosis or an imbalance?  Is it excess microbes?  Or is it just this persistent inflammation from the infection that was there before? 

Testing for Post Infectious IBS

We don't always have to know the specific thing that's going on in order to get some general strategies or help support and improve the things going on in the digestive tract.  There is a test to identify if you have post-infectious IBS too.  This can be helpful for people that are unsure if their symptoms are coming from a microbe.  For instance, if you are unsure if you have symptoms that have been there for a long time, and you can't pinpoint it to a specific event, this may be worthwhile checking.  It can still be  worthwhile doing it even if you do have that association, as certainty is key. 

The test is called "IBS smart" and it's measuring different antibodies to your intestinal tract. These antibodies increase from your immune system when you have post-infectious IBS.  The antibodies are called anti-vinculin and anti-cdtb.   Check that out if you're unsure of the source of your IBS. 

In order to shorten the time span from your current digestive issues to getting better from post-infectious IBS, we need to know what's going on (at least a general idea).  We said there's different bugs that one can get like bacteria viruses fungus parasites et cetera.  Which one you have or had is not always easy to tell without testing.  Testing is limited and when it is available it is not always accurate either.  However it's more common to get viruses or bacteria than it is any of the others but the others can occur too.  If you are in an area of the world where parasites are common, it might be worthwhile doing some parasite tests.   We are going to focus more on the bacterial side, since that is more common and what I have seen more of. 

The two things that we will look at for pathogenic bacteria are different clostridial species and Klebsiella species and overgrowth syndrome.  When there is pathogenic bacteria, they can be anywhere in the intestines but usually they are in the colon (large intestine).  There's no test or way to really differentiate where these issues are occurring unless you are doing a biopsy but where they are doesn't always matter either.  When testing for digestive issues this is mostly discovered through stool testing and different metabolomic testing.  When they are found it is assumed they live in the large intestine.  

Overgrowth syndromes on the other hand are going to be more in the small intestine.   These are typically the friendly bacteria that are now in the wrong place.  Because of this, they create a mess and a lot of fermentation that causes a lot of your IBS symptoms.   

When there is excess bacteria issues are occurring, it can be difficult to isolate through testing.  The tests can be expensive as well.  If you are not really getting better, it is important to utilize testing so treatment is more effective.  Some testing options include a stool test with a culture and sensitivity for different bacterial strains.  These test can also use PCR amplification to identify different bacteria through their DNA.  There are also Organic Acid Test which look for metabolites of different microbes like fungal, clostridial species and other harmful bacteria.  There is also the SIBO test itself.  As mentioned these tests don't always show when there is a problem.  This is where clinical experience and having a doctor that knows and understands GI problems is helpful.  The whole point of testing is to narrow in on what microbial problem is or is not present. 

Curing Post Infectious IBS

Once you know which microbe is present, you need to take an antimicrobial to reduce it's presence.  Sometimes we use prescriptions and sometimes we use herbs.  Both have the potential to make things worse if you don't get it right.  Because of this I will limit the discussion on those.  

In the case that you think you have cleared the microbial issue and there is lingering inflammation, then you will be looking at helping your body recover and resolve the digestive inflammation.  For this kind of issues you will basically be doing a trial of supportive nutrients, supportive herbs, probiotics and things like this.  These will help the body recover faster.  These are things like glutamine and slippery elm and usually found in formulas for leaky gut like GI Repair.  They are all going to help with the overall recovery process.  If you still have the bacteria or or microbes present in the intestines, it will be difficult for you to fully recover.  If you are adding in these things like probiotics and other things you may get worse.   Especially if they contain prebiotics.   Prebiotics and probiotic with prebiotics  can actually make things worse when you still have these bacterial problems present.   Check out this article on 

Why Most leaky Gut Cures Don't Work

Leaky gut cures can be really great and helpful.  There is a time and a place to use them.  If you still have bacteria or excess microbes in your intestine, they are probably not going to help a lot.  In some cases, it will make things worse.  Because of this potential, testing is oftentimes needed.   You should always consult your doctor when you're trying to get a better understanding of what's going on and get to one hundred percent.  Your doctor can help you make sure you are keeping the full picture in view.

Post-infectious IBS can be cured. I have helped many patients do it.  Sometimes you need more testing, sometimes you just need to use some supportive nutrients like the glutamine and general leaky gut cures.  

That should give you a better understanding of what could be going on with your body when you think you might have post infectious IBS.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to cure your post infectious IBS, click in the link below to get started. 

How does stress and anxiety affect erectile dysfunction.  In this article, we will look at some of the mechanisms involved with erectile dysfunction including stress, anxiety, and other physiological causes like nitric oxide.   We will look at how these things work together to create good erectile function and dysfunction. 

So If you are interested in the causes of erectile dysfunction, keep reading.

How Do Stress and Anxiety Affect Erectile Dysfunction

First we want to understand what is erectile dysfunction.  There are two main ways or manifestations of this issue.  Most people experience erectile dysfunction (ED) as inability to maintain an erection once one is achieved.  In some cases people can not get a full erection either.   This is also considered erectile dysfunction and typically a more severe situation.  The activity involved in this process is one that involves blood flow.  There's both psychological and physiological things that need to be appreciated with this process of erectile dysfunction.   

Stress and anxiety fundamentally change the activity in the nervous system shifting more to fight-or-flight activity.  With this shift several different things happen, most importantly a change in the blood flow.   During stress some areas of the body get more blood flow and some areas of the body get less blood flow.  This is congruent with the idea of fight-or-flight.  When we are in the classic fight-or-flight activity, the situation demands more blood flow to the muscles to engage in things like fighting or flighting.   So it makes sense that the blood flow is going to be pulled away from some areas and pushed more towards the muscles.   That extra blood may be needed for fight or flight activity.   

When you are under more stress and anxiety the same thing happens.  The nervous system will pull the blood away from the digestive tract, the genitalia, and other organs.  The body puts more  blood flow and circulation toward the muscles, for instance.   So psychological stress and anxiety directs nerves which then changes the blood flow in this manner.   This is how stress and anxiety affect erectile dysfunction. 

Another way to look at this is through the lens of the autonomic nervous system.  This contains the parasympathetic, rest and digest, and the sympathetic, which is fight or flight.   In order for males to get an erection, there has to be sufficient parasympathetic activity to produce and maintain that erection.  This is why it's common for erections to occur when they are sleeping as the body is in a more relaxed and calm state.  Since stress and anxiety can disrupt that parasympathetic activity thereby disrupting the blood flow, it can trigger erectile dysfunction.  When this happens the erectile dysfunction can create a psychological pattern as well.  The problem can get worse because you are worrying about if it's going to occur again.  This can almost become a self-fulfilling prophecy.   The more you worry about it, the more likely it is to occur because of the activity of the sympathetic nervous system on the genitalia areas.  Now that does not mean that everyone that has erectile dysfunction or ed has it due to psychological reasons or that your ED problem is all in your head.  It does mean though that there is a psychological component to erectile dysfunction that needs to be appreciated.  There is also a biochemical side to this as well. 

Biochemical Reasons for Erectile Dysfunction 

The biochemical process with erections mostly involves nitric oxide.  Nitric oxide is a potent vasodilator.  It dilates the arteries and allows for that blood to flow to the area, when it's not being restricted by the sympathetic activity. The problem with nitric oxide is the actual molecule of nitric oxide is used up very quickly and its presence is fleeting.   Many things can also interfere with nitric oxide production and utilization.  Because of the high interference,  most nitric oxide supplements are not very effective at increasing nitric oxide.  The molecule itself is used up very quickly and any increased production of nitric oxide is going to be short-lived. 

You will get more out of your efforts to improve erectile dysfunction  by maintaining healthy testosterone and androgen levels and improving blood sugar and antioxidant status.   These things will will encourage optimal nitric oxide oxide production and therefore blood flow to the genitalia.  This is because testosterone up regulates the production of nitric oxide.  Reducing blood sugar will also improve your body's overall antioxidant status.  When you have hyperglycemia, pre-diabetes, diabetes and the like, antioxidants are used to counter the oxidation from the high glucose.  

If you have normal blood sugar you can focus more on your overall antioxidant status through healthy lifestyle choices.  For instance, highly processed food products are likely o contain more free radicals and  reduce your nitric oxide production. 

That should give you a better understanding of how stress and anxiety affect erectile dysfunction.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to improve erectile function, click in the link below to get started. 

In this article, we will once again going to look at how do I lower DHEA levels.  Here we will focus more on the role of sex hormones and how they feedback to inhibit things which then raise DHEA levels.  We will look at the role of estrogen and testosterone to help you better understand what's going on in your body, get your DHEA levels down, and your overall hormone levels balanced. 

If you want to know what is driving your high DHEA levels, keep reading. 

Last time we we talked about the role of a specific enzyme,  3-beta-hydroxysteroid dehydrogenase on DHEA levels.  This time we're going to further that discussion but look at it from the hormonal feedback loops.  This is where different hormone levels feed back and affect the enzyme and ultimately influence your DHEA levels.  When referencing hormone levels, we are mainly talking about the activity of the hormones on the receptor sites.  The main two receptors that we want to discuss are the androgen and estrogen receptors.  Both a high amount of activity at the androgen receptor and the estrogen receptor will down regulates the enzyme 3-beta-hydroxysteroid dehydrogenase.  In doing so there is reduction in your bodies ability to convert DHEA-s into androstenedione and other androgens.  The reduction is more like a dimmer switch than a light switch.  So if you have a really high DHEA sulfate level, you should check your testosterone, estradiol, and other estrogens to gauge their relative abundance.  Higher levels in your blood means more binding to the estrogen receptor.  Estradiol is the main hormone that will activate the estrogen receptor but there are other types of estrogen too.  So in some cases it makes sense to looking at the total estrogens in one's body. 

For androgens the main one is testosterone but there are other metabolites of testosterone that may be worthwhile looking at as well.   If all these are high (including the estrogens), then you would want to focus on the clearance of these molecules.  You can do this by enhancing your detoxification systems.  It's important to keep in mind though, especially with estrogen(s) in females, what looks high at one point in your monthly cycle may look low at another point.  The highs and lows for estrogen vary based on the time of your cycle.  You wouldn't want to just look at the number and make a decision, you need to look and see what the numbers are relative to where you're at in your cycle.  For instance,  are you in ovulation, luteal, or follicular phase?  We will look at this in more detail in another article.  That article will look at female hormone lab testing and how to interpret these lab results.  In most cases this may require  expertise from a doctor that looks at hormone levels on a regular basis. 

If we decide that the overall levels are high that means we want to help your body eliminate some of these hormones (the estrogens and and testosterone).  How are these typically eliminated from the body? Testosterone gets converted into estrogen and dihydrotestosterone.  One approach then, is to focus on lowering estrogen levels.  There are two main pathways for your body to detoxify estrogens,  sulfation and glucuronidation.  If you are going to take this approach, you have to make sure you actually have high estradiol or estrogens.  You will want to check your levels multiple times depending on your clinical presentation (a lot of symptoms of high estrogen).  If everything lines up, one approach is to take something that helps enhance glucoronidation.  Glucuronidation is a process by which a glucurate molecule is put on estrogen (or other toxins) This helps the molecule get excreted from the body, through the urine and the end digestive tract.  Sulfation and many other detoxification pathways are collectively called conjugation.  The molecule gets pasted or connected on the toxin.  This helps the toxin get eliminated  from the body easier. 

So you can enhance glucuronidation by taking calcium D-glucorate and you can enhance sulfation by adding more cysteine to your system like N-acetylcysteine, for instance.  The relative dose and frequency of these depends on the clinical picture.  You can get a better understanding from a doctor that works with hormones to help you.  If your overall hormone levels are normal maybe you just have a high free testosterone or high normal testosterone and high free testosterone.  In this case the focus may be more on raising sex hormone binding globulin. 

In general sex hormone binding globulin goes down when the overall anabolic signal (like hormones), outweigh the catabolic signal.  Anabolic signals are things like testosterone, insulin, and insulin like growth factor. When you are overweight, oftentimes there is more insulin resistance and more insulin in your body.   If not now, there probably was at some point.  It does take time for that insulin to wash out and shift.  When your body is flooded with more of these anabolic signals, it means your sex hormone binding globulin will be lower.  Lower sex hormone binding globulin means more free testosterone.  The binding globulin basically binds up the different hormones so they can't bind to their corresponding receptor.  This activity then down regulates the activity of 3-beta-hydroxysteroid dehydrogenase.  So if you have high free testosterone but everything else looks normal, you want to raise your sex hormone binding globulin the best you can.  The main way you're going to do that is through reducing insulin. Another way to approach that is with estrogen.  Estrogen levels raise sex hormone binding globulin. 

Keep in mind these things are in a dynamic balance not static.  It's not a light switch. Instead all these molecules floating around binding to the receptors.  Depending on what else is going on in your body, you may have a minor relative excess or a minor relative deficiency.  These will not make much difference.   When the levels are over the top high, things start to shift and you see these abnormal levels in your blood like high DHEA sulfate levels. 

When you have high DHEA levels, you may have to stay after the plan and be really consistent and persistent in your efforts to get these signals to change.  You may not see the results of your efforts for two, three, or even four months.  As you keep after it there should be a steady improvement in your DHEA levels.   Keeping an eye on these other signals will help you understand whether or not you're getting better in a linear way and adjustments you need to make progress.  Also I wanted to note when you're looking at sex hormone binding globulin many things can alter these levels.  For instance, being in a fed or fasted state, hypothyroid,  can all affect SHGB.   With this in mind, it's important not to over interpret any one result.  Instead look for a consistent pattern.  This is how you know when you need to act. 

 Why SHBG Is Low In PCOS

Another thing to look at and understand is it's the overall stimulation to the androgen and estrogen receptors.  Remember these down regulate the 3-beta-hydroxysteroid dehydrogenase.  This will raise your DHEA-s.  Another thing to consider is the fact that dihydrotestosterone (DHT) is somewhere around ten times as strong as actual testosterone.   If you have a relatively normal testosterone you can still have a much higher dihydrotestosterone.   The conversion of testosterone into DHT occurs through an enzyme called alpha 5-reductase.  Sometimes women with PCOS and other related issues like high DHEA sulfate levels have low progesterone and theme of estrogen dominance.   Sometimes estrogen dominance comes from not enough progesterone other times it is an excess estrogen.  With decreased progesterone there is less regulation of alpha 5-reductase enzyme.  This can lead to more DHT and more stimulation of the androgen receptor.  More DHT means decreased 3 beta-hydroxysteroid dehydrogenase and higher amounts of DHEA.  These are basic endocrine feedback loops.  Hormones do have to be checked at specific times of mensural cycle to gage whether it is low or high.  When progesterone is low this it is something to consider as a therapy or a therapeutic avenue to get your DHEA levels balanced. 

Remember there are multiple layers of feedback going on with hormones. Any one feedback loop may be influencing your body's ability to convert the DHEA and DHEA-sulfate into other things more than another one.  Because of these layers it is important to consult with your doctor because you may be missing a piece of the puzzle. 

That should give you a better understanding of how to lower your DHEA levels.  This was part three in a four part series on how do I lower DHEA levels.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to lower your DHEA levels click in the link below to get started. 

Is it harmful to take antacids every day? Here we want to look at the risks and benefits of taking antacids every day.  Mostly we will look at what the potential problems are from taking daily antacids, like nutrient deficiencies and other problems lower down in the digestive tract. 

So if you want to know how taking daily antacids affect your body, keep reading.  

Benefits of Taking Antacids

First let's look at what antacids are and how they can be helpful to us.  Antacids are very important in preventing serious damage to the mucosa and cells lining the inside of esophagus and stomach.  They do come at a cost, however.  So what do we mean by antacid because there are several different types and mechanisms of reducing the acid production.   The simplest versions are things like Tums which contain bicarbonate.  These basically neutralize the acid that is coming out of the cells of the stomach. 

There are also things like histamine type 2 blockers.  Examples of these include things like ranitidine, famotadine, etc.  These work by blocking the histamine from binding to the parietal cells.  These are cells in the stomach. When the histamine binds here, it causes acid to be released from these cells.  With histamine type 2 blockers, the production of acid is blocked or reduced through binding to that receptor and inhibiting the histamine from binding.   These can reduce the production of acid by as much as seventy percent. 

There are also antacids called proton pump inhibitors which include prilosec and pantoprazole.  These directly inhibit the pumps that creates the acid.  These can inhibit acid production by more than ninety percent.  So there are three main types of antacids, the neutralization of the acid, the inhibition of the histamine which then reduces the acid, and then directly inhibiting the pump. 

The idea with taking antacids is that you are going to reduce the acid.  This allows the mucous membranes and cells in the esophagus in the stomach to take a break from all the acid production.  This can be helpful for short periods of time.  However in looking at what the potential harm or cost is, we also have to have to ask what is the purpose of the acid to begin with.  Why is the body producing the acid?

The Harm In Taking Antacids Every Day

The first thing that the the acid does is activate enzymes in the stomach. Once active these enzymes go on to do the bulk of the digestion and breakdown of the protein bonds in the stomach.  This is the first problem with taking antacids every day. There is less food breakdown in the stomach leading to decreased absorption of nutrients both in the stomach and further down.  Most of the food and nutrient absorption occurs lower down in the small intestines but some does occur in the stomach as well.   There is actually a lot more to the story. 

The same cells that are being inhibited by the proton pump inhibitors and the histamine blockers also produce something called intrinsic factor.  Intrinsic factor is needed to absorb vitamin B12 lower down in the digestive tract.  What happens is B12 is tangled in with the proteins that we eat like animal proteins.  When we consume the protein the acids and enzymes start to loosen up and break apart. Once this occurs the intrinsic factor can bind to the B12.  The small intestine is where it is actually absorbed by the body.  If we take antacids we inhibit the parietal cells from producing acid and inhibit the production of intrinsic factor. 

In addition when there is decreased acid in the stomach it changes what happens further down in the small intestine.  When there is less acid secreted in the stomach, there is less production of secretin.  This is a hormone that is produced in the small intestine in response to the acidic environment triggered by stomach contents.  Secretin causes the pancreas to produce bicarbonate and other pancreatic enzymes.   The bicarbonate neutralizes the stomach acid so that the enzymes produced by the pancreas can act in that environment.  The environment of the small intestine is a different ph than what is higher up in the stomach.   So the less secretin can change how the enzymes work.   

With less acid there is a decrease in the protein breakdown and free fatty acids.  This can trigger decrease production in CCK.   CCK, also known as Cholecystokinin, is another hormone that is produced in response to fatty acids and some amino acids  This hormone stimulates the pancreas to secrete lipase and protease.  Without it you have decreased breakdown of your food.  The other thing is CCK causes the gallbladder to contract and release bile. Bile is needed for emulsification of the fats that are in the small intestine.  Without bile, lipase cannot efficiently work on the fats because they are lumped together in one big ball. 

Is It Harmful to Take Antacids Every Day?

Yes it can be but the dose and duration of taking them does matter.  Short term uses like days to weeks, your body can recover from.  In some cases they are the only option to get your problem under control.  For instance, if there is severe erosion and other problems going on, some people may need to even take the antacids on a longer term.  However long-term chronic use will lead to B12, iron, and magnesium deficiency.  Chronic use can also increase your risk for bacterial overgrowth and other microbial imbalances lower down in the small intestine and potential even in the colon. 

So keep these things in mind if you are taking antacids or considering taking them.  If you are already on them,  you may want to look at your options for getting off them.  If it turns out you need to take them, be sure to periodically check if you have any vitamin or mineral deficiencies. 

Now you know what the risks and benefits are of taking antacids every day.  If you have questions about any of the content here, please ask in the comment section below.  If you need help getting off your antacids or managing your digestive issues, click on the link below to get started. 

Does testosterone replacement therapy increase blood pressure? In this article, we will look at some of the research behind blood pressure and testosterone replacement therapy.  I also will add some of my clinical experience on using testosterone replacement therapy and its effect on blood pressure.  

If you are interested in understanding how testosterone replacement therapy affects blood pressure, keep reading. 

Testosterone Replacement Therapy and Blood Pressure?

In my clinical experience and the research I looked at for this article, testosterone replacement therapy does not increase blood pressure.  It is very unlikely that TRT increases blood pressure.  It is much more likely that it decreases blood pressure.  We will look at the research studies that support this and my clinical experience. 

I have treated many patients for low testosterone and there are a few exceptions to this.  So we want to take a close look at those to make sure you avoid any high blood pressure situations.  Let's look at some of these studies first and then look at some of the exceptions with testosterone replacement therapy and the potential for increasing blood pressure. 

The first study was actually an observational study.  They followed men with testosterone deficiency over a five year period.  These men were taking testosterone therapeutically for their hypogonadism or testosterone deficiency.  This study also looked at other parameters too like blood sugar and cholesterol.  They found that there was a sustained reduction in the systolic and diastolic blood pressure gradual over time.  On average the systolic started at 153 and went down to 137.   Technically they started as hypertensive and then went into the normal range.  The 137 systolic blood pressure is still a little bit high but not as bad.  The same was true for the diastolic, it gradually came down over time.  So that seems to be a positive association of testosterone replacement therapy and blood pressure.  We can say for sure it is not increasing blood pressure. 

If anything maybe something else changed in their lifestyle or habits to improve blood pressure but clearly the testosterone didn't have a negative effect.  It was an observational study not randomized placebo-controlled or anything like that.  After the sustained reduction over the two years, they continued to follow them for three more years.  The blood pressure reduction maintained at that lower level for the remaining three years. 

Another study looked at arterial stiffness to assess this question.  The more stiff the arteries, the higher the blood pressure.  It was a small study but they did find that arterial stiffness improved with normalization of the deficient testosterone levels.  Then a final small study looked at the effect of testosterone on endothelial function.  This is similar to looking at the arterial stiffness but it was a different study.  In this study they assessed the endothelium in men before treatment, three months after treatment and then another assessment in three more months.   They found that testosterone either did not affect the endothelial function or actually improved it slightly.   

Taking all this information together, it does look like testosterone really does not have a negative effect of testosterone.  Add that with my clinical experience, I don't typically see changes in blood pressure in a negative way.   Doing a little research on this topic, it looks like it is not fully known as not enough studies have been done.   To be safe make sure you know if you do have a blood pressure issue and check it regularly after starting testosterone replacement therapy.   

Theoretical Causes of High Blood Pressure From TRT

There are some theoretical TRT causes of high blood pressure.  If these are not being monitored or addressed, you can potentially have a problem with higher blood pressure.   For instance, testosterone can increase blood pressure through increasing the amount of red blood cells that are produced.  This is known as secondary polycythemia.   In some people testosterone replacement therapy causes the red blood cell quantities to go up and the concentration overall in the blood to increase.  This thickens the blood, causing potentially more volume in the overall system, which can cause the pressure in that contained system to increase.  This is a theoretical concern.   I do monitor these things closely in my patients.  If it's happening then we have them take care of it through a blood donation.   

Testosterone can also increase estrogen.  If the estrogen gets too high, this can be a problem because estrogen actually causes our bodies to retain sodium.  We all know that sodium can increase blood pressure.   As your body retains more sodium it also retains more fluid.  Similar to increasing the volume with the red blood cell increase, the increased water increases the pressure in the artery.  These are two theoretical concerns which are easily adjusted for through close monitoring and taking appropriate action.

That should help answer the question does testosterone replacement therapy increase blood pressure.  If you have a specific question about anything related to testosterone blood pressure, drop it in the comment section below.

If you want a customized plan on how to lower your blood pressure while you are on testosterone, click in the link below to get started. 

Do you have questions about your DHEA levels?  Are you wondering how do I lower DHEA levels.  In this article we will go into more detail on things that can be done to lower your DHEA levels when they are high.  In the last article we talked about the impact of cortisol and stress on high DHEA. 

In this article, we look at the enzyme 3  beta-hydroxysteroid dehydrogenase (3 beta HSD), the things that influence this enzyme's function, and what you can do to get it to work better to lower your DHEA levels. 

If you are interested in understanding how to lower your DHEA-s levels, keep reading. 

How to Lower DHEA Levels 

This article will look at how to Iower DHEA-s levels via 3 beta-hydroxysteroid dehydrogenase.  The last article look at this through lowering cortisol and stress.   The enzyme 3 beta-hydroxysteroid dehydrogenase is responsible for breaking down DHEA sulfate into other hormones.   However, there are things that can affect it and cause it's activity to slow down.  We will look at the things that can affect its activity and how to work more efficiently. 

Before we jump into that, a quick reminder.  The approach to lowering DHEA levels will depend on your particular system and the reason it is high to begin with.  The body is a complex system with multiple layers of feedback inhibition.   Understanding your particular system takes patience, diligence, and testing.  It is also helpful to have help from someone with clinical experience.  Keep this mind when as you look at different systems because this article my not address all the variables.  Also we are referring to DHEA sulfate (DHEA-s) and this is different than DHEA when you get your blood tested. 

Three 3 beta-hydroxysteroid dehydrogenase is responsible for creating a lot of different hormones.  With regard to DHEA sulfate, it converts DHEA-s into andersteindione.  It can also make a lot of other hormones like turning pregnenalone into progesterone and andersteindione into testosterone.  This enzyme like many enzymes, requires a cofactor for it to work properly and efficiently.   Co-factors are things that encourage reactions to occur.  Similar to lighting a fire, you can light a fire a lot of different ways.  If you have some sort of helper or accelerant like gasoline it will light a lot easier and quicker. 

How to Lower DHEA Levels Insulin Resistance

NAD is the cofactor for three 3 beta-hydroxysteroid dehydrogenase.  Oftentimes people with metabolic disorders like diabetes and pre-diabetes or simple insulin resistance will have lower NAD levels.  It is a hallmark of insulin resistance.  If you have one of these issues, then you know you can work on this to help lower your DHEA levels.   When you have these issues the body has less NAD present and therefor less cofactor present. As a result, less of your DHEA is going to be converted into androstenedione and other downstream metabolites.  What do you do if you are in this situation?

You can focus on improving your blood sugar to start.   Remember though even if you have normal blood glucose levels or you don't think you have the insulin resistance, there are multiple ways that insulin resistance can present. There are also different ways to check for this.  Just because you don't have elevated fasting blood sugar or high hemoglobin A1C does not mean you don't have insulin resistance.  There are many different test and also different ways that the body will present insulin resistance.  If you've done the basic testing like fasting insulin and hemoglobin A1C, you probably want to go a little bit deeper to double check.  This way you can be sure that none of this is going on.  This is especially true if you have symptoms of insulin resistance like carrying extra weight or fatty liver.   Some tests to consider are two hour postprandial glucose, HDL to triglyceride ratio, fasting insulin etc.   All these are different ways to look for insulin resistance. 

Insulin resistance is a spectrum of disease progression with diabetes being the severe end and on the other side of the scale is mild insulin resistance As that insulin resistance gets worse you body needs more and more interventions to keep the blood sugar under control.  The classic scenario is high insulin, high blood sugar, high A1C, high triglycerides but not everyone present that way.   Sometimes you can have normal triglycerides and still have high insulin. Some cases may be very apparent other cases may not be. 

The main thing to do about this is to get better blood sugar control, lower your insulin, and create more metabolic flexibility.  This can be done by doing things like fasting and lowering your carbohydrate intake.  This will quickly improve your overall NAD / NADH ratio.  Sometimes people will say, " I'll just take an NAD supplement.   There is some evidence suggesting that form may work.  However if your overall metabolism is not where it should be, it's not really going to help that much.  It's like a drop in the bucket for yoru total NAD /NADH pool.  Plus the body is going to convert it into what it needs.  So if you are supplementing with NAD, you should also make sure your overall metabolism is where it should be. This will ensure you get the most benefit out of it. 

Affect of Some Foods On DHEA Levels

Another thing that can affect the enzyme activity is many of the constituents and soy products.   These can decrease the activity of 3 beta-hydroxysteroid dehydrogenase.  Collectively these constituents are referred to as soy isoflavones or phytoestrogens.  Enzyme function studies show that many of these isoflavones like genistein decrease this enzyme activity.   The more  soy that's in your diet the more likely it's going to lower the enzyme activity.   These studies were not actually done in live human subjects.  They were enzyme function studies done in test tube.  Still it's something to consider especially if you are on a plant-based diet and eating a lot of soy products.   

Again there are many layers of feedback inhibition to promote this enzyme to work the way it should.   There are also things that will inhibit it.   You have to take all the information into consideration including cortisol and stress, your unique body and circumstances, your lab values, and put it together with your symptoms.  With this you create the overall clinical picture.  It is best that you do this in conjunction with a doctor that can ask the right questions and and look at this from different angles to help you understand why your DHEA levels are elevated to begin with.   It is from this place you can proceed with the right treatment plan to lower your DHEA levels. 

That should give you a better understanding of what could be going on with your body when you have high DHEA levels.  This was part two in a three or four part series on how do I lower DHEA levels.  If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to lower your DHEA levels click in the link below to get started. 

Whether you are looking to prevent colds and flus, worried about COVID-19, or you just have a compromised immune system, many people ask this question.  What vitamins boost my immune system or what vitamins can it take to boost my immune system?  In this article will look at the role of certain vitamins and nutrients on the immune system.  We will also look at what the research and evidence says about taking those vitamins to boost the immune system.  We will also look at some of my personal favorite things that I (personally) use and recommend to patients for immune function.  

So if you are interested in understand what vitamins support the immune system, keep reading, we will discuss the details below.

Role of Vitamins In The Immune System

Some people are concerned about COVID-19 and others just don't want to be sick as much with seasonal cold and flu season.  At some point most people asks, what vitamins can I take to boost my immune system.  We want to look at what the science has to say about the role of vitamins and nutrients in the immune system.  The vitamins and nutrients we will look at include

• Vitamin E
• Zinc
• Omega 3- fatty acids
• Probiotics 
• Vitamin D

Before we jump into the details we should give a little general context about the role of vitamins and nutrients on the immune system.  There is certain level of vitamin nutrients and general nutrition that is needed for all cells to function at their optimal level.  Things like the RDA (recommended daily allowance) establish a minimum amount to prevent disease states from inadequate levels.  This would be like scurvy, berri berri, rickets and things like that.   However, just because you have enough to meet the RDA, does not always mean that your tissues and cells are in the optimal range for them to be functioning at their peak levels. 

For many vitamins we don't know what that "optimal level" is.  This is where we get into some of the controversy.  We also don't know the effect of pushing vitamins and nutrient levels well above adequate levels.  With that said we're going to look at what we do know what the research says about using these vitamins and supplements on boosting the immune system.  Some of this information is coming from a review article (see link) that goes into a lot of detail on the role of vitamins boosting immune function. 

Here is a quote from that research article.  "In all the bodily systems and tissues, appropriate supply of different types of nutrients is essential for maintaining cell homeostasis and performing respective function.  While the immune system is no exception, its specific defense functions determine what immune cells may be particularly sensitive to the status of certain nutrients and food components.  A primary task for nutritional immunology research is to identify which dietary factors and to define their optimal intake in terms of maintaining immunological balance and strengthening defense against pathogens."  Ok let's look at some of the details. 

Vitamin D Role in Boosting the Immune System

Vitamin D has been shown to have a protective effect against getting infections when adequate levels of vitamin D are maintained.  Adequate levels are defined as 20 ng/ml or above for 25 hydroxy vitamin D 3.  The effect of vitamin D on the immune system is clearly shows that it enhances the particular parts of the immune system called the innate immune system.  It has a stimulatory effect on the cells of the innate immune system.  These are cells like macrophages, neutrophils, and monocytes and they will proliferate and increase in number when incubated in the presence of vitamin D.  Vitamin D clearly has a stimulatory effect on immune cells and a protective effect against getting infections when it's maintained above what's considered adequate levels. 

The role of vitamin d and the adaptive immune function like the T cells and the B cells is less clear.  Like many vitamins taking above the adequate amount may not have much effect for the immune system.  My personal opinion on this is to maintain 25 hydroxy vitamin D around 45 ng/ml per ml. This is a safe range but anything above that may not be safe.   As the laboratory notations suggest anything above you are at increased risk for hypercalcemia (high calcium). 

Vitamin E Role in Boosting the Immune System

Vitamin E is mostly known for its fat soluble antioxidant function.  It works as an antioxidant in fat soluble tissues  sitting just inside the cell membranes.  Here it works to protective against free radical oxidation and inflammation.  As for it's effect on the immune system, it seems to work by enhancing the natural killer T cell function and enhancing the signals between the T cells and other adaptive immune cells.   

Clinically it has been shown to reduce the rate of infections overall when given at a dose of 200 ius and above.   However other studies tried to replicate this, but did not find the same positive effect of giving vitamin E.  One possible reason for this is that there are different types of vitamin E subunits. If the study participants were given only one specific subunit, it could have negativity impacted the overall vitamin E (subunit) balance.  This follow-up studies may not have given a balanced subunit of vitamin E and the original did. Not sure .   When you take vitamin E for any reason, you want to make sure you are taking a mixture of all the vitamin E subunits also known as mixed tocopherols and tocotrienols. 

Zinc Role in Boosting the Immune System

Zinc has been noted for its many effects on the immune system both the adaptive and the innate immune cell function.  Zinc deficiency clearly creates an increased risk for infections both bacterial and viral infections. However, when adding zinc in the place of adequate zinc levels, the result on immune function is not as clear.

Several studies have found that supplemental zinc does reduce respiratory tract infections.  Just as zinc deficiency can decrease immune function taking too much zinc can also impair your immune function.  Short bursts of low dose and moderate zinc intake is safe for most people.  If you plan on taking zinc on a regular basis, you should have blood tests done to determine how much zinc you have.  Zinc can become toxic and it can also deplete some of your other trace minerals as it competes with the other trace minerals for absorption.   So you have to be careful about that. 

Probiotic Role in Boosting the Immune System

Intake of probiotics have a direct effect on the mucosal cells in the digestive tract and the immune cells in and around the digestive tract.   Most of our immune system is located around the digestive tract.   When you take probiotics, they have an effect on the local digestive mucosal cells which then transfers that effect onto the immune cells.  Most of those immune cells are in these conglomerates called pyres patches.  Probiotics have these local effects but studies show they also have a more systemic effect as well. 

Here's a quote from the article noted above.  "Several studies have indicated that probiotics could induce pro-inflammatory cytokines (cytokines meaning inflammation) to facilitate an immune response against viral or bacterial infections.  They also induce anti-inflammatory cytokines that can mitigate excessive inflammatory reactions and lead to a more balanced immune response."  This statement encompasses the gist of how probiotics and a lot of natural substances work. 

Probiotics have also been shown to enhance vaccination response.  They have also been shown to help people be more resistant against infections in the gastrointestinal tract and respiratory tract.  They also help decrease allergies.  With all these benefits many people want to know, which probiotics should I take. Which probiotic, which brand is best for me? 

This a difficult thing to answer for a few reasons.  For one everyone's microbiome is slightly different. So what's optimal for you may not be optimal for me and the next person.  Because there's so much uniqueness among everyone determining what's optimal is difficult.  Also we don't yet know what an optimal microbiome looks like.  We can see general patterns but that's about it.  That's why lactobacillus and bifida strains are used and tend to be beneficial across the board.  There's also spore forming probiotics There are benefits and and potential downsides to each of these.  However the main point of this article is to point out that probiotics are helpful in modulating immune response.  When you do have an infection, they can actually help fight off infections.  Especially when that infection is in the gastrointestinal tract and upper respiratory tract.  If you stick with a lactobacillus or even bifido strains those are going to be generally more beneficial for most people.  Sometimes probiotics have prebiotics and those can be harmful for some. Don't just assume all probiotic are going to be good for you.  They are generally harmless but some of your symptoms could get worse. The bottom line is probiotics are beneficial but be cognizant of your symptoms and health issues that may come up when you start a new probiotic.   

Really the benefit of probiotics comes down to optimal digestive tract function. This is very helpful for fighting against infections and having optimal immune response.  If you are someone that is challenged digestively or you don't even know what optimal digestion is, that a look at that first.  If you do have digestive issues, it is best you sort through why you have that issue first.  It could be food related, it could be IBS or some other chronic digestive issue like Crohn's or ulcerative colitis.  There are many things that could be going on with your digestive tract.   It's important to find out what that is so you can effectively treat that.  Probiotics are not the answer to everything but they can be helpful. 

Omega 3 Role in Boosting the Immune System

Omega- fatty acids are also very helpful for the immune system as they are for many aspects of our body.  They can modulate, which means balance, the adaptive and innate immune system and across our entire body's inflammation.  They do this by changing the raw material available for the immune cell signaling.   When we talk about inflammation in the body, we're mostly talking about an increased activity of the immune system.   That could be the innate immune system or the adaptive immune system.  When you have a relatively low levels of omega- fatty acids, you may have a increased overall immune signal because you don't have as much of the omega- fatty acids.  This is because when there are things like damage to the cell membrane, omega- fatty acids turn into signals that are anti-inflammatory .  When other types of fatty acids break down, like arachidonic acid, which is a fatty acid found in a lot of animal sources, they turn into pro-inflammatory signals.  Everyone needs some pro-inflammatory signals in order to have an adequate response to pathogens and overall immune response.  Really what we're talking about here is having a balanced response.   You don't want to have your immune system to be overly excited but you don't want to want it to be deficient in its response.   Because most people are low in omega- fatty acids, supplementation can help in modulating or balancing out the overall inflammation and immune response

What Vitamins Boosts Your Immune System?

When someone asked me the question, what vitamins boost your immune system; my question back to them is, what's going on with their health?  Why would they need a "boosted immune system?" Of course, some people are perfectly healthy as far as they know  and that can will be addressed below.  The main things that I look at when trying to improve immune system is digestive issues.  If you have any digestive issues and you are looking to boost your immune system with supplements, vitamins, and herbs, pause. 

Take a look at what's going on with your digestive tract on a day-to-day basis first.  How are your bowel movements? Do you have gas and bloating? This will probably get you a lot more improvement in your overall immune function and ability to fight things.  More than just taking a supplement that says "immune boosting." If your digestion is fine, there is a more direct way to answer this question.   We like mushroom extracts.  These have a general immune boosting effect.  We use these personally and for patients for general immune support.  We also look at vitamin D and some of the things noted in this article. 

Both animal and human studies have given promising findings suggesting a benefit of things like vitamin D, omega- fatty acids for chronic inflammatory conditions like autoimmune disorders.  Things like vitamin D vitamin E, zinc, and even probiotic have been shown to be protective against infections.   The discrepancy in some of the research leaves a little to be desired in terms of further research needed.  Some of this is due to the  many different layers of the immune system.  This creates a challenge in tracking the exact changes that occur when supplements are given.  There is also a lack of funding for these types of endeavors.  Both the complexities in the nutritional immunology sphere and  lack of funding. 

Even though there's not clear consensus that these things are going to help, they are very safe as long as you are getting regular lab checks and being followed by a doctor.  

if you do have questions about what vitamins boost your immune system,  drop them in the comments section below. If you want a customized vitamin and nutrient plan to boost your immune function, click on the link below to get started. 

In this article we look at how stress and anxiety can affect the digestive system.  Specifically we will look at how the nervous system is integrated with the digestive system and how problems here, can lead to problems in the digestive tract.  These problems can lead to digestive disorders. 

If you are interested in understanding the connection between stress and the digestive system, keep reading. 

The Nervous and Digestive System Connection

To understand how stress and anxiety affect the digestive system you need some background on the nervous system and how it is connected to the digestive process.   The nervous system is a critical aspect of digestion.  Because our emotions and brains are  connected to the nervous system, they play an important role in digestive system problems and disorders.  The digestive tract has a unique and separate nervous system allowing it to be synchronized and respond to the local environment of the digestive tract.  For instance, it can respond to the presence of food or inflammation.  This specialized digestive system is called the enteric nervous system.  While it is totally separate from the rest of the body, it does receive input from the autonomic nervous system which contains two parts. 

The autonomic nervous system contains a parasympathetic and a sympathetic branch.  You can think of think of these two tracks of the autonomic nervous system like yin and yang,  because they do opposite things.  The parasympathetic nervous system is often referred to as "rest and digest" and the sympathetic nervous system is thought of as "fight or flight." You can easily see from this reference that their actions are going to be different and opposite.  As it relates to stress, the parasympathetic activity is always on in the background especially when you are resting, sleeping, and relaxing.  More of the energy is shifted to the sympathetic nervous system when you are worried, exercising, and generally more active.  With these activities come higher stress to the body as well as shunting some of the energy of the body in a different directions.   When we have more stress the parasympathetic is still activity. However it is drowned out by the overwhelming sympathetic nervous activity. 

The Affect of Stress and Anxiety on The Digestive System

So how does stress and anxiety affect the digestive system?  With more stress and more anxiety, you have a lot more sympathetic fight or flight activity.  This drowns out the parasympathetic activity leading to poor incomplete digestion.  So the question about the effect of stress and anxiety on digestion is really about what the parasympathetic nervous system does in the digestive tract. 

The parasympathetic nervous system encourages the natural synchronized process of digestion when food is introduced.  It also increases blood flow to the digestive tract.  This allows the vessels to take fuel to the muscles there.  The parasympathetic nervous system is also involved with production of salivary juices and digestive enzymes.  It also triggers the gastrocolic reflex where the acid in the stomach triggers emptying of the the bowels.  It gently stimulates release to make more room for more food coming in. 

This normal digestive process and parasympathetic activity is also involved with hormone production like gastrin.  Gastrin stimulates parietal cells and chief cells in the stomach to produce acid and enzymes that help with the digestive process.  If there is not enough acid, due to stress, then the next step in the process in the small intestine will be compromised.   With more stress many things in the digestive tract don't work completely like less of the mucosal mucus production in the stomach.  This is why stress and high anxiety are a common trigger and cause for ulcers. 

Having treated many people with anxiety and stress, digestive issues are often intermingled and correlated with one another.   Of course, this is not always the case.  It is hard to tell which came first because they can seem to trigger one another.  It is like the chicken and egg story. 

In my experience more often the digestive problems are triggering the anxiety.  A lot of things going on in the digestive tract can lead to systemic issues that can trigger anxiety and mental health issues.   Still anxiety can trigger digestive problems too.  Sometimes it happens in a feed forward way so you really never know which one is the original trigger. 

This should give you a better understanding of how stress and anxiety affect the digestive system.  If you have other questions about this particular topic, please drop it in the comments section below.  If you need a customized plan to help your digestion, click on the link below to get started. 

In this article we will answer the question can I take testosterone and DHEA together.  We will mostly discuss the use of DHEA but most of the information does apply to pregnenolone as well. These two hormones have separate effects on the body.  We don't look at pregnanalone in much depth but most of the effects of DHEA-s overlap with pregnanalone. 

We will mostly look at some of the benefits of DHEA and why one would consider taking it in conjunction with testosterone.  We also consider why you might not want to take DHEA.   

If you are interested in understanding wether or no you can take testosterone and DHEA together, keep reading.

Can I Take Testosterone and DHEA Together?

So can you take testosterone and DHEA together? The short answer to this question is yes you can.  However, what we want to do first is answer some general questions about DHEA like:

• Why someone would take DHEA and testosterone together in the first place?
• Why would you would take DHEA in general?
• What are you going to get out of taking DHEA?
• What are the potential side effects of taking DHEA and testosterone together?

There are two two general reasons why people would take DHEA and maybe a third as well for females. The two main reasons across the board are for increased testosterone production and adrenal support. 

For adrenals the idea is that by supplying more DHEA the adrenal glands do not have to produce as much on their own.  DHEA then gets converted into testosterone through two enzymes as long as those enzymes are working properly.  DHEA turns into androstenedione which then can then turn into testosterone.   

From a pure symptom standpoint DHEA does seem to have some independent effects on libido (especially for females).  However it is hard to separate this away from the increase in testosterone that comes from taking DHEA.  If you are having libido issues, you may want to take DHEA for that reason independent of adrenal and testosterone support.  These are the two two main reasons for taking DHEA.

Taking Testosterone and DHEA Together

When you are on testosterone replacement therapy DHEA will help supply extra precursor for internal testosterone production.  Your body does make DHEA on it's own and taking testosterone does not affect DHEA production.  So if you are on testosterone replacement therapy and taking DHEA to support your overall androgen and testosterone production, it may not be doing much.  The theory is by taking more DHEA as a precursor it will keep internal testosterone production going.  The main enzyme that regulates testosterone production from DHEA sulfate is three beta hydroxysteroid dehydrogenase.  If that enzyme is not working or slowed down for some reason, then you are not going to get much conversion of DHEA sulfate into androstenedione (which then goes on to make testosterone). 

One of the things that regulates the that enzyme is the binding of hormones like testosterone and dihydrotestosterone to the androgen receptor.  When these hormones are more bound to the receptor, the signal is to down regulate the three beta hydroxysteroid dehydrogenase enzyme.  Keep in mind the exact regulation of this enzyme is not fully understood. and there is some tissue specific differences for this enzyme as well.

So if you have high to moderate levels of testosterone already your DHEA may not get converted into testosterone.  The other thing is that DHEA has alternative pathways that it can go down.  It can get turned into progesterone and estrogen as well.  These conversions are regulated by that same enzyme and it is important to note that DHEA has other fates. 

Outside of supporting testosterone levels DHEA does seem to have an independent effect outside of testosterone.  It can help with energy levels and have effects in the brain in terms of libido.  So it helps with overall energy, drive, ambition and libido.  These may be independent of testosterone but it is hard to know for sure. 

Coming back to the question, "Can I Take Testosterone and DHEA Together?" Of course you can but the question is why.  If your energy libido and everything are already really good, it may not be worthwhile to add this. Testosterone and dihydrotestosterone are providing the bulk of the anabolic and androgenic effects. 

You could make the argument that providing extra DHEA will support androstenedione and other pre and post-testosterone hormones.  There is a good argument for that.  However from a symptom and clinical standpoint, you should ask what benefit is this providing?  That's the way I look at it and I don't think it provides much benefit if you are taking it with testosterone replacement. 

The other thing to consider is look at your actual DHEA sulfate levels.  There is a pretty broad range of DHEA sulfate levels.  The levels also vary with age and gender.  Generally we can say the range is about 90-500 mg/dl in a male from age 30 to 50.  As you get older the ranges are going to come down a little bit maybe around 400 mg/dl (on high end).  If your DHEA-s levels are below 250, you may want to add this to your regimen and see how much benefit it gives.  If it's not below 250, I would not expect it to add much benefit.  One person may notice more than the next depending on where their levels are staring from. 

So that should give you a better understanding of taking testosterone and DHEA together.  If you have questions about tis topic, leave it in the comment section below.  If you need help with your testosterone replacement therapy, click on the link below to get started.  

What does it mean if you test positive for Epstein-Barr? This is a common question when reviewing lab results with patients. Patients see that their results show positive next to some of their results.  Naturally, they want to know what that means.  In this article we will look at a lab test example and all the different meanings behind positive Epstein-Barr tests results. We will specifically look at things like viral capsid, nuclear antigen, early antigen d, both the IgG and the IgM.  All this will help you better understand if you currently have a problem you need to deal with or if it is simply a positive result from a past infection. 

So if you are interested in understanding Epstein Barr, keep reading.

The video above gives you a visual of one of the tests we use called the Epstein-Barr virus panel.  It shows the reference ranges and different antibodies tested.  In this case, the person was positive for all of the antibodies shown.  There are three different antibodies that the test shows, two IgG and one IgM.  The three are viral capsid IgG, viral capsid IgM, and nuclear antigen IgG.  So lets look at what it means when you have a positive Epstein-Barr virus test.

Anytime there is a positive IgM, it means you have had a recent exposure.  This pattern suggest a recent Epstein-Barr virus (EBV) infection and you are still fighting it off.   Sometimes when people have been infected many years (or even 6 mo) ago you expect to see this negative.  If the virus is being reactivated, this one can turn positive again.  Typically though, it's going to stay negative even if it becomes reactivated.  The IgG is more indicative of a reactivation of an Epstein-Barr virus.  When you have an EBV test that shows a positive result for viral capsid IgG, it could go either way.  It could mean that it's just a past infection and it's dormant.   It could also mean that it's currently a reactivation of a previous dormant Epstein-Barr virus.  We will talk about how to decipher this further in the article.  First I wanted to talk about the nuclear antigen IgG antibody.   Anytime this one is positive by itself, it means that there is a past infection.   The viral capsid antibody can go away after the initial infection whereas the nuclear antigen will always be positive once you have been exposed to EBV.  Because of this we know positive nuclear antigen IgG means past infection. 

Now what do you do about a positive viral capsid antibody?  Let's say both of the viral capsid IgG is positive but the nuclear antigen IgG is negative.  This could be a past infection.  If the IgM viral capsid is negative, it is likely a reactivation. 

If both the viral capsid IgG and nuclear antigen IgG are positive, it is suggested of a past infection or a current reactivation.  This means  you want to do some more deeper testing.   Below we will look at another antibody test that can evaluate this question more thoroughly.  In addition, you can also do the PCR viral load test to quantify how much virus is present. 

Testing Positive for Epstein Barr with Early Antigen D

The above video also shows another sample result of this early antigen D test.  This test helps us differentiate when someone has a reactivation of the Epstein-Barr virus.  We wouldn't look at this one to see if someone has a recent acute infection, however.  It is more to look and see if they have a reoccurrence or a reemergence of a previous EBV infection.  We call this reactivated or or latent EBV.  This can be helpful because when this test result is high, it does suggest reactivation more so than positive viral capsid IgG. 

The reason being when someone has fought off the Epstein-Barr virus and it becomes dormant, the early antigen d antibody should no longer present in their system.  The result would read less than 9 (whatever the positive threshold is on your labs reference range).  So when it is positive, it makes us think you still have lingering amounts of this early antigen d from the virus replicating.  When it's high we know it's because reemergence of the virus.  We know this because eighty percent of the people will be negative many months after they've been exposed.  When you have a positive Epstein-Barr early antigen d IgG and it's well above the reference range, it further increases your suspicion for a reemergence.  So this is how we would look at and interpret a positive Epstein-Barr test. 

With both a positive early antigen D and positive for viral capsid IgG, you should have more suspicion that this person may have reactivation.  As mentioned above you can just follow these test with a PCR test to quantify the amount of virus that's there.   The PCR test can be especially helpful when your are not getting expected results from your treatments.  Also you always want to correlate these tests back to the person's symptoms.  For instance, if you are not really having symptoms, you may not even bother with testing in too much depth.  Usually you are going to screen for this when you are having symptoms like fatigue. 

So that should give you a little better understanding of how to look at a positive Epstein bar test and what the test might mean with different antibody results.  If you have a follow-up question on any of the content on this article, please ask it in the comment section.  If you want a customized plan on treating your Epstein Barr, click on the link below to get started. 

Many people are asking me, how do I lower DHEA levels? This is a first in multiple articles on how to go about lowering DHEA levels.  We will talk about specific tactics you can do to lower your DHEA levels in each article.  Many times high DHEA levels are a sign that you have other things going on.  If you haven't been checked out for PCOS and things like this, you should be evaluated further for this. 

If you want to know how to lower your DHEA level, keep reading. 

Approach to Lower DHEA Levels

The approach to lower your DHEA levels will vary based on the reason that it is high to begin with.  Your body is a complex system of overlapping layers of feedback inhibition.  By feedback inhibition we mean one thing causes something which then feeds back to inhibit the same thing that caused it. Understanding your particular system takes patience lots of testing and clinical experience.   With that in mind we will narrow the focus and I will  explain how I would approach lowering DHEA.   Also note that when DHEA I am referring to DHEA sulfate (DHEA-s). 

Overall the idea here is that there's either too much DHEA-s coming in or not enough coming out.   Either one can offset the flux of DHEA leading to higher DHEA levels.  In this article, we are going to look at the different things that are known to influence that which is coming in.  Other videos will look at the things that influence what goes out.  One important note about high DHEA levels is that congenital adrenal hyperplasia, which is a genetic disorder, often presents with elevated DHEA-s levels.  With this condition the enzyme that breaks down DHEA and turns it into androsteindione is defective.  This enzyme is referred to as 3 beta-hydroxysteroid dehydrogenase.  There are some other (non congenital adrenal hyperplasia)  things that can go on with this enzyme that leads to elevated DHEA levels.  So depending on how high your levels are, you may need to look into seeing an endocrinologist.  This is a good idea in general to see what they have to say. 

Lower DHEA Levels Via Cortisol

The first thing that we want to talk about is the amount of DHEA that's coming in and where it comes from.  One of the things that influences this is stress.  You may have suspected this or heard this and here we are going to go into more detail on how this occurs and what you can do about it.  Each time cortisol is produced DHEA is also produced.  This is because in the brain there's a hormone called ACTH which stimulates the adrenal glands.  At the same time it stimulates cortisol, it also stimulates DHEA production. Those two hormones are almost coupled together.  You can't have one without the other.  So the more stress you present with, the more DHEA-s production you're going to get.  So the first step in figuring out if this is something that's relevant to your situation is to check your cortisol levels.  You already know your DHEA-s is high but why is it high?  If your cortisol levels are elevated this suggests it could be at least part or one of the causes. 

Now one cortisol test is not going to tell you definitively that that's the cause.  However if you have multiple samples that are showing you are above the normal or close to the normal upper end of the reference range, this does suggest it is the cause.  There are different ways to check cortisol too.  There is morning am cortisol.  There is random serum cortisol and there is 24 hour urine tests.  There are also salivary tests, but I don't use these very much so I won't comment much on them. 

If your cortisol is in the upper range, that does suggest this is a contributing factor. You should check multiple times because cortisol can be quite variable and can change from day to day depending on what's going on, what you've eaten etc.  Serum cortisol levels for most labs around 16 or higher would be in the upper range with 20 mg/dl being high.  So now that you have a high test, what are we going to do about it?

Lower DHEA-s By Lowering Cortisol 

Keep in mind,  if your cortisol is high based on testing that's one thing.  If you don't know your cortisol is high, these suggestions may actually hinder your progress.  Don't go off of a feeling of stress and assume you have high cortisol.  You should check to know and also check with your doctor to make sure none of these things are going to interfere with anything.  Generally these things are very safe though. 

The first one to mention that can lower cortisol mention is Ashwagandha.   Ashwagandha is in a category of herbs called adrenal adaptogens.  There's multiple herbs that are in this category but Ashwagandha seems to be quite favorable.  People respond well to it and do not have problems with it.  Adaptogenic herbs work by balancing out the activity that they work on.  In this case it is the adrenal glands and cortisol. These herbs as a group help balance out cortisol activity. 

When cortisol binds to the receptors it has a certain response at those receptors.  Ashwagandha can modulate that response.  It can block if there is lots of cortisol around by blocking that cortisol from binding.   Therefore you have less of that response.  It can also stimulate a mild cortisol response if you have low cortisol.   That's called an adaptogen response and Ashwagandha is a good adaptogen.  When you have high cortisol it can really help but  I think of it as more on the mild side . There are multiple other herbs that can be used that are similar to Ashwagandha. 

Another thing that I will mention is zinc levels.  Zinc deficiency is often associated with high cortisol levels.  That does not mean that that zinc deficiency causes high cortisol.  However there is an association.  So you may want to consider checking your zinc levels if your cortisol is high.  Correcting that may help dampen that response as well.  Holy basil is also an herb that can be used to lower cortisol and it has a stronger effect on dampening the cortisol levels as compared to Ashwagandha. 

Lastly just a couple general notes on cortisol levels.  These levels are going to fluctuate based on blood sugar.  When your blood sugar levels are really low, your cortisol levels are going to go up.  Cortisol will mobilize the stored glucose called glycogen.  If you're someone that's eating a lot of refined carbohydrates and sugary things your body is overall metabolically inflexible.  A high carb diet, specifically more of the simple carbs will create a lot of up and down swing in your blood sugar.  With the swings in your blood sugar, your cortisol is going to be also going up and down as well.  Other Chronic health issues can cause higher cortisol levels too depending on where you're at in the state of chronic health.  For instance, depression is often associated with high cortisol. 

It's also important to look at general self-care.  What is your support system? How do you de-stress from work or life?  Do you have a sense of community and support? These things are important in how you interpret the events and "the happenings" day to day.  The things that are going on in your life cause your brain to be more stressed and trigger more that ACTH production leading to this higher DHEA and cortisol. 

So these are all things to keep in mind if you want to lower your DHEA by lowering cortisol.  If you have questions about any of the content in the video, please ask in the comment section below. If you want a customized plan on lowering your DHEA levels, click on the link below to get started. 

In this article we will address the question of how long for TRT to work.  Many of my patients ask similar questions about how long it is going to take before they see the benefits of testosterone injections or topical testosterone.  The answer really depends on a few different things.  I will say right out of the gate that initially it is going to take about three weeks before you notice the benefits.  However, you may not get the full benefits for almost three months.  In between that time there are a few different things that you want to make sure are optimized and a few different things that can accelerate the benefits.  That's what most of this article is going to be about. 

So if this interests you keep reading, we are going to get into the details. 

How Long For TRT To Work

Many people starting testosterone replacement therapy wonder how long for their TRT will start to work.  On average I expect people to feel some improvements in about three weeks.   For some it can take longer up to three to six months.  In the case you start feeling better early on, you may not get the full benefits until several months down the road.  Firsts let's look at  what symptom improvements  you are expecting to see on TRT or testosterone replacement therapy. 

Benefit Timeline of TRT

The main benefits I expect to see when someone has low testosterone and they start testosterone replacement therapy are  increased energy, drive, and mood.  Along with this you will also typically see improvements in erectile dysfunction and libido.  The benefit that most people notice first is with energy mood and drive.  How long it takes depends on:

• If your dose is correct.
• If your estrogen levels are not going up.
• What's happening with your androgen receptors. 

These three things are important but I also wanted to point out that most of us think a little bit is good, so more is even better.  That's not always the case for testosterone replacement therapy.  The reason it is not in this case, is tied in with the downstream hormone metabolites of testosterone and other hormones.  If you're on a high dose of testosterone and your levels are really high,  your enzymes will be saturated.  These are enzymes like alpha five reductase and aromatase.  The alpha reductase turns testosterone into dihydrotestosterone (DHT) and the aromatase makes estrogen or estradiol. The more testosterone in your system the more DHT and estradiol.  These can cause some side effects. 

The Role of Estradiol 

In the case of estradiol, it can diminish the positive effects of the testosterone.  So if you're getting a lot of estrogen production with the increased testosterone, it may negate some of the benefits.  Sometimes you just decrease the dose testosterone and things even out.  Most people know that high estrogen negates some of the benefits of their testosterone replacement therapy.   What they sometimes forget is that, you have to check the levels at different times.  You have to make sure you check it mid week and several months into the treatment.  Once you get the estradiol optimized, you will see more of the benefits.  A high estradiol will delay the time it takes you to see benefits.  That doesn't necessarily mean you have to discount the total time and start back from square one.  Once optimized it may take an additional 3 weeks after the estradiol is normalized. 

The Role of Your Dose

The other thing to look at when we're trying to understand how long this might take for you to realize the full benefits, is your actual dose of testosterone.   The benefits of testosterone replacement therapy are all tied in with the androgenic and anabolic effects of testosterone.  One of the metabolites of testosterone is DHT which has stronger androgenic effects.  Testosterone replacement therapy can lead to higher levels of DHT.  If it gets too high, this can lead to more irritability and anxiety.   The outcome will really depend on how active your enzymes are.   Regardless of your enzymes, higher levels of testosterone will lead to higher DHT levels.  If you are taking it for mood reasons, pay attention to your mood in relation to your dose.  Generally it helps with mood and positive outlook but it can make things worse too. 

If your testosterone levels are still low after you check it six weeks later, your tissues may not be getting fully saturated with those androgens.  In this case, it will take longer than you expect to get to the full benefits.   Typically it's going to take about two to threes months to get the full benefits if everything is optimized. 

Another thing that is important is the number of androgen receptors.  The main two hormones are testosterone  and dihydrotestosterone.   The dihydrotestosterone binds to the androgen receptor stronger than the regular testosterone.  As you're saturating your tissues with more androgens from the testosterone replacement therapy that saturation has the effect on the cells and the tissues.  However, if you don't have very many androgen receptors then you have less tissue saturation.  You can enhance the saturation and shorten the duration of time we expect to see benefits when you have more androgen receptors.   These receptors increase with more resistance exercise and to a lesser extent exercise in general.  The exercise likely creates more androgen receptors in all of your tissues, but it is specifically documented in muscles. 

The last thing i wanted to note is about cortisol levels.  Very high testosterone levels can cause high cortisol.  When your testosterone levels are low you may notice difficulty sleeping and waking up sluggish.  When your testosterone levels get too high the high cortisol can interfere with your sleep.  If you are having more issues with sleep when you start the testosterone that may be a problem.

If you have checked off all these boxes and you are not noticing the benefits of testosterone replacement therapy maybe there's another problem going on.  That doesn't necessarily mean you don't need the testosterone at all.  If your levels started off  low it may be just a piece of the puzzle.  You may feel ten or thirty percent better but you're still not quite where you think you should.  In this case, there's probably another thing going on there you haven't figured out yet.  If all the hormone levels are optimized, you know you have to look at other possibilities to what could be going wrong.

That should answer the question, how long for trt to work.  If you have specific questions about testosterone replacement therapy and how long it might take to work, ask in the comment section below.  If you want a customized plan on optimizing your testosterone replacement therapy, click on the link below to get started. 

To know if Epstein-Barr is active in your body, there are several tests you can to do to answer this question.  These test look at different Epstein-Barr virus (EBV) antibodies your body makes when exposed to EBV. Understanding and interpreting the test results can be a little tricky, so I will go into some detail on this topic. 

We will look at how testing can differentiate EBV that is a current active infection, a reactivated or latent infection, or dormant past infection.  There are different antibodies tests and levels of positivity for each of the tests. 

If you are interested in learning more about Epstein-Barr antibody tests, keep reading. 

How Do You Know If Epstein-Barr Is Active. 

Epstein-Barr is also known as EBV and is a virus in the human herpes virus family.  It is responsible for Mono or Mononucleosis.  Mononucleosis occurs when there's an initial acute infection with EBV or the Epstein-Barr virus.  You will know you have active Epstein-Barr, if you've been diagnosed with Mono recently.   Once a person recovers from this virus, it is always going to live in your body.  This is true of all herpes viruses.  These people can go on to get a resurgence of symptoms months or even years later.  This is called latent or reactivation of Epstein-Barr virus.   When you have a latent or reactivation of Epstein-Barr virus sometimes it is also referred to as active Epstein-Barr Virus as well.   Really it should be referred to as reactivated. 

In addition, some people initially contract Epstein-Barr Virus and they never really get sick with classic Mono. symptoms.  Some don't have any symptoms.  In these cases they were just exposed and their immune system fought it off.  However, even if you were exposed without full-blown Mono. or other symptoms, you can still get latent, reactivation of Epstein-Barr later on.

Testing to Know If Epstein-Barr Is Active

Like Mono the symptoms associated with active or reactivation of Epstein-Barr Virus are most commonly fatigue.   Since fatigue can have many different causes, it's important to test and see how likely your fatigue is coming from the EBV.  Understanding the testing can be a little tricky.  With testing though we can distinguish between initial active Epstein-Barr virus that would be commonly associated with Mono, reactivation, or dormant Epstein-Barr.  The challenging part of testing is distinguishing a reactivation versus a dormant infection. 

So to know ifEpstein-Barr is active requires a deeper understanding of antibodies and how your immune system makes these antibodies.  So let's look at some of that.  

The initial infection is straightforward to detect and look at.  However we need a little bit more understanding of how your immune system makes antibodies.  When your immune system sees the Epstein-Barr Virus proteins, it is able to recognize that those proteins are foreign and different than self.  It starts to make antibodies against them.  These initial antibodies are going to be in the IgM category.  For EBV these IgM antibodies will fade fairly quickly after the initial infection.  As they fade they are replaced by a different type of antibody called IgG antibody. 

So you will know if epsilon bar virus is active when you check your blood and you see these antibodies.  If you have any of the IgM antibodies then you have an active infection.  Some people have IgM antibodies for longer than we would typically expect.  Most people will not have the IgM antibodies after about four months or so.  However, IgM antibodies can persist for much longer.  

What Specific Antibodies Tell Us About Active Epstein-Barr

We want to mostly understand the distinction between the active EBV in terms of reactivation versus the dormant EBV like a past infection.  So this brings us to the IgG antibodies.  Both the IgM and the IgG antibodies are made specifically to the proteins of the virus.  Your immune system sees the proteins and makes specific antibodies to those proteins.  Those antibodies can be labeled based on what their specificity is.  There is one called the 'viral capsid antibody.'  There is one called the 'nuclear antigen antibody 'and there is also one known as the 'early antigen d antibody.'   These are all different antibodies that your immune system makes to fight the Epstein-Barr virus. 

We already know that if you have any of the IgM antibodies active, you have active EBV.  When you have IgM antibodies, you probably should be treated for it.  Especially if it seems like it matches a lot of your symptoms.  Because the antibodies are active at different times in the course of the virus infection, looking at each of these will help us understand how likely you have a dormant Epstein-Barr virus or reactivation of Epstein-Barr virus.  For this tests we are looking specifically at the IgG antibodies.   

The viral capsid antibodies also abbreviated as VCA IgG, are antibodies against the viral capsid.  These typically appear at the time of onset of clinical symptoms of your acute infection.  So when the IgM is positive, you will also have the IgG viral capsid positive.   The IgM viral capsid antibodies appear close to the same time as viral capsid IgG.  The VCA IgM will disappear within a few weeks, while the VCA IgG persists for several months or even years.  Children and adults with primary infection are not always positive for the viral capsid IgM.  Once positive, the IgG VCA antibody typically remains positive for life.  If I am looking at your lab test results and see VCA IgG positive test, it may be more reflective of a past infection.  It really depends what other antibodies are positive. There are other (non-antibody) ways to confirm if it is from past or current infection though (see below). 

The next antibody we want to look at is the Epstein-Barr nuclear antigen antibodies.  The EBV nuclear antigen IgG antibody is usually undetectable on the initial infection.  This is going to be a less reliable one to look at initially.  It will show up positive after a few weeks or months.  However, once it is present, it typically will be there for life.  Therefore if you only see this one positive in your antibody blood test results, it reflects a past infection. 

The last one to look at is the early antigen D antibody.  There are a few these.  Early antigen can have the D and an R version.  Clinically we test for mostly the D version.  Although this antibody is not always present, the early antigen D IgG increases during the first three to four weeks of infection.  It is usually no longer detectable three to four months after the initial infection.  In approximately eighty percent of the patients, it will no longer be detectable after the acute infection.  This is important because if we see it positive then it is a stronger indicator that there is a reactivation going on.  Contrast this with the nuclear antigen IgG. This is always an indicator of past infection and viral capsid IgG is usually and indicator of past infection.  In some cases the early antigen D IgG can still be detected years after the primary infection in healthy people.  Studies find that approximately twenty percent of healthy subjects have previously been infected with EBV, do have positive early antigen D IgG antibody.  High levels of this antibody is considered anything above 25-30. 

Some people can have a positive even though they feel healthy and have no like fatigue or other symptoms.  The relative level of the early antigen D IgG antibody, may give us a clue about considering a true reactivation.  For instance, higher levels of early antigen d are seen in cases of reactivation of the Epstein-Barr virus in immunocompromised patients.  Ultimately what it comes down to  to validate any confusion about the test is do a PCR test. This test  will quantify how much virus is actually in your system.  It is looking for the RNA of the virus and identify approximately how much virus is in your system.  Supporting reference for serological Epstein-Barr testing. 

So if you have a positive early antigen D IgG or a positive viral capsid IgG and you are unsure about positive, then you can do a PCR test.  The PCR test will show if it's actually present in your system. 

Now you should know how to tell if you have active Epstein-Barr virus.  If you have more questions about this topic, please ask in the comment section.  If you need help managing your Epstein- Barr infection, click on the link below to get started. 

Can B12 deficiency cause balance problems? Can it cause issues like dizziness or what's known as ataxia?  Yes B12 is important for a lot of different neurological functions.  It's important specifically in the nervous system for myelin sheath production which allows for nerve impulses to be conducted through out the nervous system.  In this article we will look at a specific case report of B12 deficiency that caused some of these symptoms.  We will also look at the findings on MRI and physical exam and how B12 deficiency was responsible for those findings. 

 If you are interested in learning more about the role of B12 deficiency and balance, keep reading. 

B12 Deficiency And The Nerves

Yes b12 deficiency can cause balance issues because of its role in the nervous system.  B12 is a vital nutrient critical for many functions.  It is needed for the production of red blood cells but B12 is needed for production of any cell.  B12 is also a critical nutrient for gastrointestinal function and the absorption of nutrients.  It also plays a role in neurological and psychiatric aspects of our body.  Therefore when there is a B12 deficiency, it can cause problems in any of these areas.  When it comes to balance, of course, B12 deficiency is involved because of its role in the nervous system.

Of all the possibilities of where B12 deficiency shows up, many times the initial presenting symptom is neurological in nature.  When you are deficient in B12 for long enough the body doesn't have enough B12 to go around for all of these different functions in the body.  This is when symptoms start to manifest.  When it comes to the nerves and nervous system, B12 is needed for the production of myelin sheath.  Myelin sheath is like an outer coating of the nerve that allows for proper conduction of the nerve impulses.  You can think of it like a wire with an outer plastic coating.  If there is no plastic coating, you might get more short circuits.  Similarly if you have B12 deficiency this can lead to a decrease in the nerve conduction, weird sensations, or sensations that are out of place.  The myelin allows for conduction of signals from any part of your body to the spinal cord to your brain and vice versa.  So the odd sensations can happen in your legs and your arms or even more centrally in the spinal cord itself.  Let's look at some case examples so we can better understand how B12 deficiency balance problems might manifest. 

Case Study of B12 Deficiency and Balance Problems

The information on this case of B12 deficiency and balance problems is coming from a case report that was published and you can find here.  This case report describes five different neurological manifestations of B12 deficiency.  In all five cases the laboratory, imaging, and clinical history were compatible with the diagnosis of cobalamin deficiency.  As a side note, cobalamin is another way to say B12.  So B12 deficiency and cobalamin deficiency are synonymous.  In all five cases the B12 deficiency symptoms resolved with administration of B12 injections.  Now let's look at some specific cases related to B12 deficiency and balance problems. 

Two of the patients in this case report presented with what the authors describe as posterior-lateral cord syndrome causing gait ataxia.  One of the two had a more acute case with sensory gait ataxia.  First let's look at what is ataxia. 

Ataxia is an impairment in coordination.  This impairment can happen for many reasons like a lack of proper impulses from the brain to the hand.  Imagine if you are not be able to hold a cup because you can't quite feel it.  In this case the nerves that transmit the feelings when you touch it aren't getting transmitted up to the brain.  This is similar to what can happen with B12 deficiency.  So let's look closer at one of these cases to better understand how B12 deficiency causes coordination and balance problems. 

This case is an eighteen year old patient with difficulty walking.  The authors  describe a slippage of foot wearing without knowledge. The patient's shoes are slipping off without her  recognizing it.  Her physical exam also shows that the patient has impaired joint position in the lower limbs.  So she didn't know the positioning of her joints in space.  She had nothing neurological wrong in the upper limbs.  She also had positive Romberg sign.  The Romberg test is used to evaluate the causes of motor coordination loss also known as ataxia.

The Romberg test is performed by simply closing your eyes while in a standing position.  The observer looks to see if you have a loss of balance or start to sway.  If you have normal proprioception, you won't have any dizziness.  Proprioception is the signal from the brain to the joints and from the joints back up to the brain.  If this proprioception signal is uninterrupted you will have dizziness or imbalance when you close your eyes.  She did have dizziness.  When this patient had an MRI it showed she had posterior lateral syndrome.  What does that mean? This occurs when there's an interruption in the sensory signal coming from the brain back to the muscle.  In her case, the lack of B12 contributed to the loss of myelin sheath in the spinal nerves that transmit this signal.  This demyelination can be seen on the MRI visually because the myelin contributes to the bulk or mass of the nerves.  Demyelination  from B12 deficiency can occur anywhere but it tends to manifest itself in the posterior cord region.  This is a specific area in the spinal cord where spinal nerves that transmit signals about sensation to the brain.  This problem can manifest as lack of sensation really anywhere in the body. 

Resolving Balance Problems From B12 Deficiency

In this case parenteral or injection of cobalamin was given in the form of  one thousand micrograms of B12 called cyanocobalamin.  I typically don't recommend this kind of B12.  However if you really need it and you are really low in cobalamin the cyanocobalamin will work.  Typically I would advocate for hydroxy or methyl cobalamin. She received the B12 injections intramuscular daily for the first seven days.  Then she received them weekly for four weeks.  After this she went to once monthly.  She was also advised to eat a diet that was a little more rich in B12.  She showed marked improvements in the first few days of treatment.  At the one month follow-up she was completely relieved of these signs and symptoms. 

From my own clinical experience treating patients with B12 deficiency, balance problems are some of the initial presenting symptoms of deficiency.  Some people describe it as dizziness.  Other times they describe it as just feeling like a bit out of it when they're walking or moving.  Or they almost feel like they are going to run into the wall or something like that.  It can present itself in a lot of different ways.  I have seen several cases of B12 deficiency causing dizziness that resolved after their B12 levels were repleted.

That should explain how B12 deficiency can cause balance problems and how to resolve it.  If you have questions or comments about anything noted here, please drop it in the comment section below.  If you need help managing B12 deficiency or other vitamin nutrition related problems, click n the link below to get started. 

 In this article we are going to look at what causes iron deficiency anemia from the standpoint of what anaemia is.  We will look at what some of the causes are and what triggers a lack of iron in the body. 

If your are interested to learn more about iron deficiency anemia, keep reading, we are going to discuss the details. 

Cause Of Iron Deficiency Anemia

Basically iron deficiency anemia is caused by a lack of iron in the body, which is straight forward.  The anemia, though, is a result of a lack of iron sufficient enough to make the hemoglobin.  When there is not enough hemoglobin, for long enough the body will stop making the red blood cells.  You can think of iron deficiency anemia as the end stage in iron deficiency.  The longer your body goes with low iron, the more impact on red blood cells and hemoglobin.  It is also possible for you to be low an iron and not have iron deficiency anemia.  Many people get confused and use anemia interchangeably with iron deficiency.  Just because you're low in iron doesn't mean you have anemia.  The anemia comes when you have really low iron and your body can't make hemoglobin and then it can't make red blood cells. 

Usually the anemia occurs after a long standing iron deficiency.  All this may be obvious about iron as the cause for iron deficiency anemia.  However, you maybe wondering what is driving the iron deficiency to begin with. 

Causes of Iron Deficiency

There are two main drivers for the iron deficiency.  One is loss of iron and the other is not enough intake.  Within each of these there are a few different causes or problems to consider as well.  First let's look at loss of iron.  Anytime you are bleeding you are losing some of your iron in the form of hemoglobin which is in your red blood cells.  When you bleed you loose red blood cells and the hemoglobin inside.  Some common reasons for this in males comes from the digestive tract bleeding, such as an ulcer, hemorrhoids,  or other the bleeding in the digestive tract.  I have also seen  donating blood be a cause of iron deficiency.  When you donate blood they are strict cut-offs for eligibility to donate blood.  They will not allow you to donate blood if you're already anemic, for instance.  What can happen though is after you donate blood, you become anemic, or just iron deficient.  The measurement they use for donation eligibility is hemoglobin. You can have enough hemoglobin and be low to low normal on your stored iron (ferritin). So you may not low enough to be ineligible but on the edge.  Then you donate which drops you into low. If you're not consuming enough iron in your diet or had a diet change it may take a while for your iron levels to normalize. This problem does not come up commonly but most iron deficiency does not present in males either. 

Of course, for females their menstrual cycle is commonly the cause for iron deficiency.  Sometimes it's deficiency without the anemia and other times it's both.  This is also why women are more common to have anemia then men.  They losing blood every month and the heavier the menstrual cycle the more common that will be.  However,  just because a woman has a heavy menstrual cycle doesn't mean she's necessarily going to have iron deficiency anemia.  It really depends on the second factor that we're going to look at which is lack of intake. 

There are two factors that cause for a lack of intake, poor absorption and poor consumption of iron rich foods.  When you have poor absorption it can occur for genetic reasons.  In your digestive tract there are the receptors for bringing iron into your body.  These may be genetically altered leading to less iron absorption.  Also some people  have chronic digestive problems that impair your ability to absorb the iron into the body.  Any chronic inflammation in the digestive tract can interfere with absorption.  If you pair this up with regular iron loss or low consumption of iron rich foods, eventually this leads to anemia. 

The iron-rich foods are foods that are rich in blood.  These are all going to be your animal proteins.  The blood in animals similar to our own blood have hemoglobin.  That hemoglobin is rich in iron. So consuming foods like beef, chicken, turkey, pork etc will provide iron in your diet.  It is possible to get some iron from plants.  However these don't contain nearly the same amount of bioavailable iron as animal protein.  Once you have iron deficiency anemia it will be pretty hard for you to rebuild your iron without consuming animal proteins.  If you are vegan or vegetarian you can get it from an iron supplement. Here is the iron that we like to use 

There are of course other causes for iron deficiency anemia but these are the most common that I see.  This should give you a better understanding of what causes iron deficiency anemia.  If you have a question about iron iron deficiency, please ask it in the comment section below.   If you want a customized plan on how to manage your iron deficiency, click on the link below to get started. 

What is Mast Cell Activation Syndrome?  In this article we will look at:

• What is it?
• What parts of the immune system are involved?
• How does it start?

We will break down Mast Cell Activation Syndrome so that you can understand what some of the driving forces are behind it. 

If you are interested in understanding mass cell activation syndrome, keep reading.  

What Mast Cell Activation Is

Mass cell activation syndrome is part of a broader category of health problems that is caused by mast cells.  It has a lot of overlap with histamine intolerance (see link above). These mast cells are types of immune cells that contain high concentrations of  granules.  Within the granules are different types of immune chemicals, histamine, and others.  These mast cells are typically located within your mucous membranes inside the mouth, inside the lungs, inside the throat etc. They sit inside the mucous membranes behind the part that you can feel and touch, the outside world. They're also commonly within connective tissue areas as well. 

Their main function is to alert other immune cells to the presence of toxins, allergens, or microbes.  With Mast Cell Activation Syndrome there is an increased activation of these mast cells.  When mast cells are activated, they release their granules out into the surrounding tissue space, spreading the signal of the presence of toxins, allergens or microbes.  These chemical messengers signal to other immune cells that they need to be on alert and to protect themselves and surrounding tissues against a potential threat.

The Role Of Histamine In Mast Cell Activation

One common chemicals in the granules is histamine.  Histamine is a chemical that causes much of the allergenic symptoms that people feel.  When you have Mast Cell Activation Syndrome a lot of times these people will have a lot of histamine like reactions. These reactions can vary widely itchy skin, eczema, IBS, cardiovascular, anxiety, and asthma. Sometimes people have these reactions in multiple areas.  When they are in multiple areas we group them together too into something called atopic syndrome.  Even though it has a different name the key reaction still comes from histamine and mast cells.  So you have to ask, what is triggering the mast cells in these people?  Why are so many of the mast cells activated and triggered to release the granules? 

The trigger(s) all have a common theme. That is, when any protein is seen by the mast cells as a foreign substance, it binds to antibodies on the mast cell surface.  These proteins are called antigens.  Any protein the immune system sees as a foreign invader is and antigen.  The first time the immune system sees it, it is not necessarily going to do anything.   It takes multiple exposures before the immune system recognizes it.  Once recognized as an antigen, the immune system will turn that into a piece of information and cause the B cells in the immune system to make antibodies.  Usually the first time there won't be any antibodies.  It really comes down to the immune system recognition of the foreign substance that creates the cascade of antibody production.  After antibodies are present, exposure to the antigen will cause the mast cells will spill their granules. 

The exact reason why one person becomes allergic to ragweed and another person does not, still isn't fully understood.  We know it takes multiple exposures for the immune system to start producing those antibodies.  Once the B cells of the immune system start to produce these antibodies, the mast cells get triggered from that same antigen. 

The video above shows this process as an image.  The first time the allergy prone person runs across the allergen such as ragweed they may not make any antibodies.  Once they do, then they sit on the cell surface of the mast cells.  The second time the person gets the ragweed in their system,  the granules spill out.  This is when the symptoms start.  With Mast Cell Activation Syndrome, this process is happening more frequently because the mast cells are hyper-responsive and more sensitive to all types of antigens.  With Mast Cell Activation more things trigger degranulation and less of a trigger is needed for degranulation.  This results in a chronic allergy symptoms.  The symptoms typically wax and wane in severity based on the total load of exposure to triggers (antigens). 

The exact triggers are hard to say as they can be different for different people.  Compounded on this is the symptoms are not always the same from one day to the next.  

Symptoms of Mast Cell Activation Syndrome

The symptom picture typically looks like a theme of what was described above as atopic syndrome.  There can be rashes, runny nose, chronic sinusitis, post nasal drip, asthma, irritable bowel syndrome, interstitial cystitis, and mod alteration.  These symptoms don't have to be severe just chronic in nature.  The rash, for instance, can simply be itchy skin, burning in the throat, etc.  Burning in the throat can be a symptom of high histamine in the lining of the esophagus.  The mast cells are getting triggered in that area.   So the symptoms of Mast Cell Activation Syndrome can present themselves in a lot of different tissues in the body but typically the symptoms are red itchy classic allergy symptoms in the target tissue.

That should help you understand "what is Mast Cell Activation Syndrome".  If you have questions about anything in the article, please ask in the comment section below.  For a customized plan on how to treat Mast Cell Activation Syndrome, click on the link below to get started. 

Are you wondering what hormones cause irregular periods? In this short article we're going to talk about the different categories and specific hormones that cause irregular periods.

If this interest you, keep reading. We are going to discuss the details.  

The Hormones Involved with Irregular Periods

So what hormones are involved with irregular periods? There are three groups of hormones that I think about with this question. They are:

1. Female sex hormones
2. Cortisol
3. Thyroid

The main group of hormones that affect a women's periods are the female sex hormone.  In a similar article "Can Hormone Imbalance Cause Irregular Mensuration?", I go into much more detail on why these hormones do this. 

Female Sex Hormones

Estrogen, progesterone and the relative balance between these is the most important thing to look at.  Sometimes if you have high testosterone it can throw off this balance leading to higher amounts of estrogen.  So both a high estrogen with normal progesterone or normal estrogen and a low progesterone can cause the issue.  Both of those can lead to irregular periods or menstruation.  High testosterone can do that too.  For instance, when females are getting supplementation with testosterone, either pellets or injections, it can cause irregular periods. Testosterone itself does not do this but testosterone turns into estrogen.  So the testosterone can lead to high estrogen and more frequent menstruation. 

This problem with hormones causing irregular periods occurs because of estrogen and progesterone effect on the uterine lining. Estrogen causes the uterine lining to thicken and grow. Progesterone provides blood and nourishment to the uterine lining. If there is not enough progesterone the uterine lining does not get nourished and begins to shed.  This naturally occurs when the egg is not fertilized and this is a period.  With low progesterone the shedding occurs earlier than expected and so does your period. 

Two Other Hormones that Cause Irregular Periods. 

Problems with the thyroid that cause irregular periods and usually occur from hypothyroid.  However, both hypothyroid and hyperthyroid can do this.  So we have to keep both in mind. 

The last hormone that can lead to irregular periods is cortisol. If you are under high periods of stress, this can reduce or stop your hormone levels all together.  As a result it can stop ovulation from occurring.  In these cases you will see a longer duration and even skipping a cycle or two during that period of high stress. 

So that should answer the question what hormones cause irregular periods.  If you have questions about the contents of the article, please ask in the comment section below. To get a customized plan to help regulate your periods, click on the link below to get started. 

In this article we want to answer the question, what does a high DHEA sulfate in a female mean?  This can come up on labs in a lot of females with PCOS. This leaves many with PCOS asking what does this mean and what can I do.  High DHEA-s is not necessarily dangerous in and of itself but it can help us understand what could be going on in your body and more importantly why.  There are additional lab studies to look at and we will discuss those as well.  We will look at  the things that stimulate DHEA sulfate (DHEA-s) to be produced and also how it is being broken down.  With this information we can triangulate what could be going on in your body to produce this level, especially if it's very consistently like that. 

So if this interests you, keep reading. We are going to discuss the details. 

High DHEA Sulfate In A Female Meaning 

When this shows up on your lab values you might ask what does this tell me, what is going on in your body, and should I be worried?

Hormones work in a feedback loops and each one a has separate (but in some cases intermingled) feedback loops.   As such, we can look at each hormone as a separate system.  DHEA is no different in this way.  So we want to look at how the substance is being produced and entering into the system.  We also want to look at how the the substance is being eliminated from the system.  The main source of the DHEA is from the adrenal glands.  It is the innermost part of the adrenal glands that produce the DHEA.  The stimulus for the DHEA to be produced mainly that comes from a hormone called ACTH.  The ACTH it comes from the pituitary gland and it stimulates the adrenal glands mostly to produce glucocorticoids.  The ACTH is being stimulated when there's a fight or flight response, like when you are in a car accident or someone is chasing you.  This causes more ACTH production which stimulates the adrenal glands to produce cortisol.  Along with that, the innermost part of the adrenal glands are going to be stimulated and you get increased production of DHEA.   

Is Stress and Cortisol Causing High DHEA-s?

Outside of the fight or flight response there is always some background production of the ACTH and therefore cortisol and DHEA.  So what we want to look at is, what is above normal and what is above this baseline.   This can be a cause for increased DHEA.  We can evaluate this by looking at cortisol levels. 

When we look at cortisol levels there are a few different ways to do that.  The morning or AM cortisol is a good option.  However when that is seemingly not reflective of what going on, you can also do a twenty four hour cortisol to evaluate this.   So a spot check in your am cortisol levels may show normal.   When you look at the total load over a twenty four hour period,  it may show above normal levels.  Those are two ways that we typically use but there is also salivary cortisol, but we don't use that one as much.   So the question when you have high DHEA sulfate is, do you also have high cortisol? 

When you measure your cortisol you might want to do it several times and look at different angles, if it's not correlating with the high DHEA -s.  The cortisol and high stress I know for sure can cause elevated DHEA-s levels .  What happens if you actually don't have high cortisol after several tests and everything looks normal?  Then we want to look at what could be going on with the breakdown of your DHEA sulfate. 

Why Low SHBG In PCOS?

High DHEA-s From Insulin Resistance

DHEA sulfate is turned into androstenedione and then testosterone. There are some alternative pathways for DHEA-s.   It could be turned into estrogen as well.  All DHEA-s breakdown pathways are dependent on one enzyme.   That enzyme is called 3 beta-hydroxysteroid dehydrogenase.  This enzyme makes the conversion fairly readily, however it is dependent on a few different things.  If there is a high amount of androgen receptor and estrogen receptor activity, then this enzyme can be down regulated.  So if you have high testosterone or high estrogen,  you may get a down regulation in this enzyme.  This results in raising the DHEA sulfate or not allowing it to be converted through its normal path.  The other thing that regulates 3 beta-hydroxysteroid dehydrogenase is the cofactor NAD.   

Your body is always trying to keep a relatively higher amount of NAD to NADH.  When the ratio flips and you have more NADH, it slows down the overall metabolism.  Low NAD is common  in people with diabetes.  Your body is always in flux but people with insulin resistance and diabetes typically have low NAD.   Those with PCOS often have insulin resistance, sometimes pre-diabetes, and diabetes.  So if you have PCOS and insulin resistance, this is potentially a reason for DHEA sulfate being high in some women.  This could be a signal that you have poor breakdown or poor conversion of your DHEA sulfate into the requisite other hormones. 

In this case, we would expect to possibly see a lower testosterone level too but it could go either way.   If it seems like more of the issue is with NAD, you would should look closely at insulin and diabetes markers.  The part about low NAD is a little bit of theory. NAD is the cofactor. However, it is not clear how low NAD would have to be in order to slow the enzyme down.  We do know that there is low NAD with insulin resistance.  With this the ratio between NAD to NADH is low.  This is partially why they don't breakdown carbohydrates as efficiently.  Similarly in PCOS the NAD is low.   Because cofactors are needed for enzymes to work, lower NAD cofactor for the 3 beta-hydroxysteroid dehydrogenase means high DHEA-s. 

The last thing to mention about this is you have to make sure you're looking at the DHEA sulfate.  You can also measure regular DHEA without the sulfate.  It's a different molecule and there would be different reasons for that to be elevated.  DHEA is converted into DHEA sulfate via a different enzyme and there could be problems with that enzyme as well. 

That should give you a better understanding of what a high DHEA-s in women means and what could be going on in your body to cause this.  If you have a specific question or follow-up question about this drop it in the comment section. For helping discovering the cause of your high DHEA-s, other hormonal imbalance, and managing your PCOS, click on the link below to get started.

https://academic.oup.com/edrv/article/26/4/525/2355189

Does vitamin D help the immune system?  Yes it does and in this article we will look at some of the research papers on Vitamin D and its role in helping prevent against infections.  We will also look at how it helps your overall immune health. 

So if you are interested in understanding how vitamin D can help you, keep reading. 

Vitamin D And The Immune System

Vitamin D does seem to have a promoting or boosting effect on the immune system.  It helps the body respond to active infections like viruses, bacteria, and fungus.  It also helps with modulating and balancing the immune system in those people with inflammation and autoimmunity.  Below we will get into a lot more details on how this works.  First a little immune system background. 

There are two different aspects of our immune system one is called the innate immune system and the other is the adaptive immune system.  The innate immune system is a group of cells that initially will detect pathogens and other problematic proteins that our bodies might come in contact with.  This part of the immune system is considered the first line of defense.  This group of cells consist of things like macrophages and monocytes.  These cells will basically engulf any dangerous substance or actual pathogen.  When they engulf the substance they digest it and present pieces of that pathogen or protein.  The cells put the protein on their surface to communicate with the other parts of the immune system what that cell has encountered.  This is called presenting the antigen or antigen presenting.  Vitamin D  enhances this function in macrophages and other innate immune cells. 

In summary, it enhance in the ability of the cells to find and actually engulf any pathogens or potentially problematic thing they see. The net result is enhanced detection and removal of bacteria, viruses, fungi, and other potentially harmful substances. Here is a link to an article describing Vitamin D's role in immune function in more detail. 

The Role of Vitamin D on Adaptive Immune Function

The adaptive immune system is responsible for producing antibodies and different lines of T lymphocytes.  Vitamin D's role in the adaptive immune system is less clear than it is in the innate immune system. This is partially because there are more layers to the adaptive immune system making it herder to study.  Overall vitamin D does seem to have a modulating effect on the various arms of the adaptive immune system. 

The adaptive immune system consists of things like the B cells which produce antibodies.  It also involves the T cells which find, isolate, and kill specific pathogens that are identified by antibodies.  Within the T cells there are different cell lines that can be differentiated.  All T cells start the same, as a basic T cell.  Based on what the immune system is seeing, like immune chemicals, the T cells will differentiate into a different lines of T cells.  The role of Vitamin D is to provide some balance or modulation to the T cell line development. 

With autoimmune disease the balance in T cells is shifted and so are the immune chemicals. This is responsible for the increased inflammation.  Vitamin D can dampen that effect through its effect on other another type of T cell called a T regulatory cell.  Vitamin D enhances these T regulatory cells.  Overall the consensus on vitamin D's role in the adaptive immune response is not as clear.  However it does seem to nullify any excessive inflammation and autoimmune activity that might be going on. 

The Role Of Vitamin D In Infections

An interesting thing to note about the role of vitamin d in helping the immune system, is its role on respiratory tract infections.  There are multiple studies over the years that have looked at this.  A review study looked at the role of vitamin d and preventing or reducing respiratory tract infections in general. 

"It appears that vitamin D may represent a novel and safe indication for preventing respiratory tract infections. In addition daily or weekly doses seem to more to be more efficient than pulse therapy. Individuals with lower levels of vitamin D may benefit more from the supplementation."

They're saying pulse therapy would be like giving a really large dose one or two times versus daily doses or even weekly doses.  Similarly it is better to keep your vitamin d levels within range consistent over time versus always chasing it.  It also makes sense that those with the lowest levels of vitamin D benefit most from supplementation. 

So this leads to the question, what are the therapeutic benefits of vitamin D supplementation, on the immune system, when vitamin D levels are already sufficient?  The data on that is is lacking at this point. 

There does seem to be a benefit in taking vitamin D for immune support in different scenarios like:

• When you are actually low.
• Sort term when you are sick.
• When your body has more inflammation.

As far as the inflammation side, vitamin D is going to get converted and used up quicker.  As a result,  you may need to supplement with vitamin D.  The inflammation is more in reference to having a blood test showing high inflammation.  If you feel a joint pain or something, that doesn't necessarily mean you have inflammation.  Typically if you have autoimmune disease you will have high inflammation. 

The point is you should verify if you have inflammation with a blood test.  Similarly you should be carful with vitamin D supplementation because too much can be harmful.   You can check your vitamin D status.  Once you check and you are low in vitamin D, it is very safe to supplement with.  It appears from multiple research studies and both in humans and test tube studies,  that vitamin D has a positive affect on different immune cells.  Vitamin d has a beneficial effect in preventing cold flus and overall helping the immune system be more balanced. 

That should give you a better understanding of the role of vitamin D in your immune system and health.  If you have any questions on the contents of the article, please ask in the comment section.  If you need help navigating your vitamin D levels, or optimizing your immune health, click on the link below to get started. 

Many people believe that they need to take HCG when they are on TRT ( testosterone replacement therapy).  That's not necessarily true.  In this article, we will look at the different scenarios when you should be thinking about taking HCG if you are on testosterone replacement therapy.  We will also look at when it isn't necessary.

If this interest you keep reading we are going to discuss the details. 

So the answer to question "Do you have to take HCG on TRT" is no. You don't have to take HCG when you're taking TRT or testosterone replacement therapy.  However in some cases it can be a necessary part of your treatment.  In answering this question you have to understand what HCG does for your body.  This understanding will help you know when you do and don't need to take HCG.  So let's look at what HCG does.  

Using HCG With TRT

HCG stands for human chorionic gonadotropin.  Males don't produce very much HCG naturally.  There are small amounts of HCG produced in the pituitary gland in both males and females, however.  HCG is mostly known for its effects during pregnancy.  It also can be administered to help promote fertility for both males and females.  When you are on TRT or testosterone replacement therapy many males will take HCG because it helps keep the testes active in producing both testosterone and spermatozoa. 

Testosterone and sperm production are regulated by the pituitary hormones, luteinizing hormone (LH) and follicle stimulating hormone (FSH).  The pituitary produces these hormones when it detects a low level of circulating testosterone.  When you are taking TRT your levels of circulating testosterone are high.  The pituitary detects that and produces less of the hormones (LH and FSH) that stimulate the testes to produce testosterone.  Because of this your testes are going to produce less testosterone and less sperm.  If you take HCG, it mimics the effect of LH and to a lesser extent FSH.  This turns the production of testosterone and sperm back on. 

Benefits Of HCG on TRT

The signaling involved with this is dose-dependent.  For instance, if you are on a relatively low dose of testosterone replacement therapy, it may be low enough and not interfering with the LH and FSH production.  Equally important, if you are on a low enough dose of HCG it may not be high enough to re-stimulate the production of the spermatozoa and the testosterone.  So you do have to take all that into consideration when you are looking at dosing.  Testing your hormone levels will always give you a clearer understanding of what's going on.  If you are asking this question, you should have the conversation with your physician as well.  So do you have to take HCG on TRT? The answer really depends on your goals. 

If your goal is to have a baby and get pregnant, then you probably should be considering HCG or some other gonadotropins stimulant like Clomid.  You may want to first do a semen analysis because not everyone is going to need to take HCG.  I have had plenty of male patients that get pregnant when they are on testosterone replacement. If you are concerned about it, you may want to do a semen analysis while you're on the testosterone.  If it is low, then you would certainly want to start something.  If it's normal then you may want to try without taking it at all. 

Reasons You Don't Need HCG on TRT

If you are not interested in the fertility aspect of HCG and not considering getting pregnant, then HCG is not as important for you.  It does help your body maintain the testosterone abundance and production.  HCG is short-lived though, only lasting about 48 hrs.  As soon as it wears off the testes are going to start down regulating production again.  The other thing to keep in mind is when you stop testosterone, your body will start to produce FSH and LH again. 

As a result your testosterone typically does return to the previous level before you started your TRT.  This has been my experience in treating many patients on testosterone therapy.  Those that decide to stop and check their testosterone levels weeks or months later, typically return to their previous levels. 

So on the question, "Do you needs to be on HCG when on TRT?", it really depends on your goals.  If you have more questions about using HCG on TRT, ask in the comment section below.  To get a customized plan for your testosterone replacement therapy, click on the link below to get started. 

Does estrogen cause fluid retention? Yes estrogen definitely does cause water retention.  In both males and females there are other hormones and systems the body uses to balance out estrogens affect on fluids and water retention.  In this article we will look at the specific role of estrogen on fluid retention and fluid balance.  

If this interests you keep reading, we are going to get into the details. 

Your Bodies Fluid Regulation Mechanisms

Before we can dive into the how estrogen causes fluid retention, we need to understand the body's fluid regulating mechanisms and the other hormones involved in counterbalancing estrogens affect.

Most of your body's water is inside the cells, or intracellularly.  That leaves about five percent, on average, for the body to regulate the overall fluid balance.  There are several difference mechanisms and systems the body uses to regulate this fluid.  One of the main ones being the kidneys.  The kidneys use an intricate system to regulate fluid and electrolyte balance.  That system in the kidneys is in turn regulated and controlled by different hormones.  While estrogen is involved it is not one of the main hormones that regulate fluid balance.  Estrogens do affect the kidneys fluid balancing systems though.  Let's first look at some of the other hormones involved with the kidney's fluid regulatory system.

The main hormone responsible for fluid balance inside the body via the kidneys is aldosterone.  It is a mineral corticoid hormone and there are several mineral corticoid hormones.   As a group these hormones cause increased sodium retention in the kidneys.  With that increased sodium retention there is increased water retention, as water tends to follow sodium.  Where there are high concentrations of sodium, the water will balance out that high concentration of sodium by flooding to that area.  As a result, when there is more aldosterone there will be more water retention. 

The Role of Estrogen on Fluid Retention

So aldosterone causes fluid retention and it just so happens that estrogen increases the production of a substance that is needed for aldosterone production.  In addition, studies looking at women on long-term hormone therapy do find a relative increase in fluid retention through this sodium retention effect in the kidneys .  From these studies it seems that the estrogens effect on fluid retention is mediated through the kidneys.  This occurs either through its effect on aldosterone or it may have an a direct effect on the kidneys, similar to aldosterone. 

Now contrast this with progesterone. Progesterone acts to antagonize or block the effects of aldosterone and other mineral corticoid hormones from binding to the kidneys.  This leads to less sodium retention and a corresponding decrease in water retention.  Only "bioidentical" progesterone has that effect.  However not all forms of progesterone have that effect.  For instance, other synthetic type of progesterones known as progestins do not.  Progestins don't have the counter balance effect on sodium retention and mineral corticoids.  So for females on hormone replacement therapy or birth control, this could be the reason you have so much fluid retention.  Birth control pills contain progestins and not progesterone.  For females that are postmenopausal they may not be taking any progesterone or they may be taking progestins.   In some cases, women just take estrogen in the form of estradiol.  This can lead to a relative increase in sodium retention leading to a puffy feeling and weight gain.  This usually doesn't happen all at once.  It happens over a long-term, maybe after you're on it for several months or more. 

Even if you are on biodentical progesterone it may not be enough to counterbalance the amount of estrogens.  In this case it is just a relative imbalance and the amount of progesterone and estrogen in your formula. 

Estrogen Affect on Fluid Retention In Males

Males too can have this problem because  testosterone turns into estrogen.  One of the metabolites of testosterone is estrogen, specifically estradiol. This occurs through a process called aromatization.  Some men have more of this enzyme activity than others.  If you have a lot of aromatization your testosterone turns into more estrogen. This estrogen is causes more sodium and fluid retention in the kidneys. 

Males don't typically get progesterone supplementation.  They could in some cases but it's not as common as for females.  Giving a small dose of progesterone would be one way to counterbalance the increased fluid retention in males.  More commonly, however, we would work on the relative excess of estrogen by decreasing the aromatization. 

Other Hormones Involved with Fluid Retention. 

Another consideration in this fluid retention situation is whether or not there is increased cortisol.  Cortisol is a mineral corticoid and it has the same effect as aldosterone except not as strong.  So it does cause more fluid retention.  The other thing to note is that when you are on hormone replacement therapy and your levels are high to high normal, this can elevate your cortisol levels.  This too will lead to increased fluid retention.  Here is a link to an article that looks at some of these points and how estrogens cause fluid retention. 

This should answer the question, "Does Estrogen Cause Fluid Retention." If you have follow up question on this topic, please ask it in the comment section below.  If you need help with fluid retention or want a customized plan for your hormone imbalance, click on the link below to get started. 

Yes Milk Thistle can help with blood sugar.  We will discuss some of the mechanisms of how it works and the clinical trials that have been done on milk thistle.  This should help you better understand how you might use milk thistle to lower your blood sugar.  

If you're interested in the effects of milk thistle on blood sugar keep reading we're going to discuss the details.

Is TSH affected by stress? Yes it is.  In this article, we will look at the role of stress on TSH (Thyroid Stimulating Hormone), thyroid function, and what happens in with your body with stress.  We will look at how stress can cause both high and low TSH and what each scenario means.

If you're interested in stress and TSH, keep reading we're going to get into the details. 

Two Ways TSH Is Affected By Stress

There really are two different ways that stress affects TSH.  As a point of reference, the information provided is based on my clinical experience treating patients with hypothyroid and subclinical hypothyroidism and some cases of hyperthyroid.  It is also based on my medical school training and some additional cursory research to see if there are any research papers documenting how TSH is affected by stress.  For the most part, this information is well-established and there is little debate about how stress affects TSH. 

TSH also known as thyroid stimulating hormone is affected by stress through the role of cortisol.  Cortisol is the main stress hormone that's secreted in the body when we are under higher stress levels.  There are two main ways that cortisol has this effect on TSH. One is through the brain in the hypothalamic-pituitary-access.  The other is through reverse T3. 

Stress and The Hypothalamic-Pituitary-Access

What is the hypothalamic pituitary access? The hypothalamus is one of the central places where a lot of hormones are controlled from. Because it is the central place, it has to take input from other parts of the brain and body too.  Stress is one of them and can have a down regulatory aspect on some of the hormones that come out of the hypothalamus.   The hypothalamus is a gland in the brain that secretes hormones that then tell the pituitary to secrete hormones.  If there is a down regulation at the hypothalamus, there will also be a down regulation at the pituitary.  TSH is the hormone that comes from the pituitary and it tells the thyroid to make more thyroid hormone, specifically T4.  So if you have a down regulation in the hypothalamus then you will also have a down regulation and decrease in the TSH.  T4 which is produced from the thyroid then feeds back to the pituitary which senses if it has enough thyroid hormone.   The feedback from the T4 plus the input from the hypothalamus regulate the production of TSH. 

When you are under a lot of stress your TSH can go down but stress does not always lower TSH. Let's look at the role of stress on reverse T3. 

Stress, TSH, and Reverse T3

Reverse T3 increases in response to periods of stress and what the body perceives as high stress like inflammation.  Reverse T3 is basically a storage compartment for T4.  It takes some of this thyroid hormone out of circulation so it can not be used.  This is a common lab finding in people that report higher stress.  So basically when we're looking at how stress affects TSH it can do two things.  Stress can reduce thyroid output through its activity on the hypothalamus and down regulation of TSH.  The other side is when cortisol is more prevalent in the blood there is increased production of reverse T3.  With more reverse T3 there is decreased availability of the T4 hormone.  So what is the net effect of all this stress on the TSH?

With high reverse T3 oftentimes we see a corresponding higher TSH.  That doesn't always happen but it does make physiological sense too.  There is less T4 around because it's being put into this reverse T3. With this then you have less feedback to the pituitary.  The pituitary sees less of the T4 so the pituitary produce more TSH. The net effect is a rise in TSH.  If you don't check the reverse T3 you may think the person needs more thyroid hormone because high TSH is in a hypothyroid state.  When this happens we need to keep in mind that there is a reason the body is converting T4 into reverse T3. 

We also have the opposite effect with stress in the brain as there is a hypothalamic down-regulation to the pituitary.  So in that sense you see a decrease in the TSH.  When the stress is coming into the body, how long it's there, the degree of stress, etc all play a role in what we will see with the TSH.   There is not a definitive answer with what always happens with TSH and stress.  The two studies that I found actually came to separate different conclusions.  You can find those here:

• Increase TSH with increased cortisol
• Stress and Thyroid Hormone Regulation (rats)

In my clinical experience, using reverse T3 (and cortisol) is very helpful to understand what needs to be done.  You can really start to hone in on what the true TSH number and true thyroid function is.  This is regardless of what stress is doing to the brain.  In addition, you also have to look at the free t3 and free t4.   Put it all together and you can get a pretty clear picture of the thyroid activity and what's going on in the body.

For instance, if you have a high TSH and a high reverse T3, we can say the reason that that TSH is high is from the T4 being stored as reverse T3. 

That should give you a better understanding of the affect of stress on TSH.  If you have questions on the specific of this article, please ask in the comment section.  If you want help with how to interpret your thyroid numbers, click on the link below to get started. 

Are you wondering what insulin resistance does to the body?  If you recently got a diagnosis of insulin resistance or you think you might have insulin resistance, this is a good question to ask.  In this article we will look at two of the key ways that insulin resistance affects the body and some of the negative impacts of insulin resistance. 

If you're curious how insulin resistance affects the body and what it does to negatively affect your health keep reading we're going to get into the details

The two Main Things Insulin Resistance Does To The Body

When I think about what insulin resistance does to the body I put it into two buckets.  There is the effect of glucose on the body and the effect of insulin on the body.  In simple terms we can say glucose mainly negatively affects the micro-vessels of the body.  The vessel that deliver blood to the nerves and the eyes and other parts of the body.  These are the areas where you start to see complications from high blood sugar and diabetes.  For instance, a common complication of diabetes is peripheral neuropathy and diabetic retinopathy. 

With the insulin there's also the effect on the macro vessels like the larger arteries of the heart and all the large peripheral arteries that go into the legs etc so those are kind of two broad ways to look at it but it's much more nuanced than that there's more broader effects of glucose and broader effects of insulin outside of these two simple areas.  so let's look at the effect of glucose and a little more depth so we can kind of understand how it's affecting the body as a whole. 

What Insulin Resistance Does to the Micro-vessels of the Body

So when glucose interacts with the proteins of the body a reaction occurs causing the glucose to bind to those proteins.  This reaction, referred to as glycation occurs without a catalyst or enzyme.   The simple interaction of those two molecules, the amino acid and a sugar (glucose molecule) causes glycation.  With higher glucose levels in your blood the more glycation that will occur to the proteins of your body.  Glycation actually damages those proteins making them more stiff less responsive.   You can think of this like the hardening of the arteries that occurs with cardiovascular disease.  Glycation is partially responsible for cardiovascular disease.   The glycation reaction is also known as the maillard reaction. 

Chefs know this maillard reaction because they use it in some of their cooking processes.  For instance, when they expose meats and proteins to sugar, this reaction cooks the meat.  Of course, there has to be enough heat and time for this to actually cook the proteins.  When you cook the outside of a steak, the browning will occur much easier when you use a sugar or carbohydrate on the steak.  That same is true with cooking bread.  Before you start cooking the bread, you can put a little bit of egg on outside.  the egg will make it more brown as you cook it in the oven.  Even without the egg it will still brown though.   Think about how pliable and responsive that bread starts out,  white, fluffy and soft.  After cooking, it is brown and stiff and even crispy.  That same kind of thing is happening in the body with the maillard and glycation reaction. 

So when you have insulin resistance your tissues are not accepting the glucose quickly enough.  The insulin has to go up and during that time the glucose is higher and interacting with the proteins of your body.  In particular the glycation seems to be more pronounced in the micro vessels of the body.   These are the vessels that deliver blood to the nerves and eyes.  Over time damage to the proteins of these vessels reduces blood flow to the nerves and eyes.  Sometimes this is the first sign that tells people that have a blood sugar issue.  It is not uncommon for patients to come into our office initially with symptoms of visual disturbance and nerve pain.  When we check their blood sugar and see it is high it becomes apparent why they have these symptoms. 

To these patients it often seems like this happens all the sudden when in fact the glycation has been occurring for many years.  The point being that the micro vessels are oftentimes the first part of the diabetes process that shows up as a symptom.  Diabetics retinopathy occurs from glycation in the eyes and peripheral neuropathy is from glycation in the peripheral nerves. 

If you keep your glucose under control  those things won't happen but it's something that's pretty common.  One test we use to look for blood sugar problems is called hemoglobin a1c. This is a measurement tool to identify when you have high blood sugar.  This test is measuring the amount of glycation to the hemoglobin molecule.  The hemoglobin molecules get cooked by the extra glucose.  The test approximates what the blood sugar level is down to a fairly precise number.  This test is an estimate but it's pretty accurate in identifying what your blood sugar has been for the previous three months.  The test measures a percentage of hemoglobin molecules that have been glycated and from this we can predict how high your blood sugar has been. 

What Is Insulin Resistance

What Insulin Resistance Does to the Macro-vessels of the Body

Now let's look at insulin in a little more depth and see how it affecting the tissues of the body.  Insulin is a growth and storage signal to the tissues of the body.  Insulin must increase when there is higher glucose in the body or in the blood.  The higher glucose occurs when the body's storage tissues become maxed out and unable to accept more glucose.  With increased insulin the cells and tissues are forced into accepting it.  This causes them expand and grow.  This is particularly important or pronounced in the visceral area of the body.  This is the area around your organs in the abdominal cavity.   This is where insulin is most sensitive and it causes these  visceral tissue and visceral fat in particular to grow and expand. 

In a similar way, the higher insulin causes the larger arteries of the body  to grow and expand.  As the insulin is going up it affects the abdominal tissue but that insulin is penetrating everywhere in the body.  The large vessels like the arteries carry the insulin and it causes the walls expand narrowing the lumen.  In addition the higher glucose causes some glycation to occur making the vessels less pliable and harder. So with higher insulin you get thickening of arteries and hardening of the arteries. 

Over time that creates a very problematic situation especially when it comes to your heart.  These are the vessels that supply the blood to the heart.  If the lumen of the artery gets too thin because insulin growth signal, the blood flow is diminished.  The deliver the nutrients and oxygen to the heart goes down and weakens it.  This process leads to heart attacks and similar problems in other areas of the body.  In answering the question what does insulin resistance do to the body, we put it into these two categories  micro-vessels and macro-vessels because these are very well documented.  However the effects of glycation and insulin occur all over the body and other areas as well.  Anywhere there is higher insulin there is a growth signal and anywhere you have this higher glucose there is higher chance of protein cooking (glycation).

So this is what insulin resistance does to the body. If you have further questions about the affect of insulin resistance on the body, leave it in the comment section below. If you need help managing your insulin resistance, click on the link to get started. 

Can hormonal imbalance cause irregular menstruation? Yes it can. 

Maybe you are asking this question because you are having regular menstruation yourself or you just want to know how hormones are involved. We will address both as well as what you can do and think about when you have irregular menstruation.  

We will look at common causes of hormone imbalance that lead to irregular menstruation both chronic and more transient causes. 

If you are interested in this keep reading we're going to discuss the details. 

Hormones and Process of Regular Menstruation

Yes hormonal imbalance can cause irregular menstruation and there are several different hormones and scenarios involved.   Before we look at those, let's look at the specific hormones and what is involved with normal menstruation.  This way it will be easier to understand what's going on when there's an abnormality.

Typically menstruation occurs every 28 days.  The regularity at which this occurs is what we're referring to with irregular menstruation.  So if you have a menstrual cycle every 28 days or every four weeks that would typically be considered regular.  If it varies outside five days outside 4 weeks, this points toward more abnormal or irregularity in menses.  For instance, if you are expecting your menses and it doesn't come for five or six more days after that or it comes five or six days before, your cycle is irregular.  Put another way, if you have a cycle every three weeks or every five weeks or six weeks, this is irregular menstruation.  When this occurs on an ongoing basis a hormone imbalance is typically the cause.  There's a few different groups of hormones involved with this most commonly. 

Hormones Causing Irregular Menstruation

The hormones involved with regulating the menstruation and the regularity at which it comes are the relative balance of estrogen and progesterone.  When the body is not producing these in a balanced way, you can get some mensural irregularity.  Sometimes the irregular menstruation can occur just one or two cycles. We would call this a transient irregular menstruation.  When it last much longer like six months or more, this is chronic.  Let's first look at the transient types of hormonal imbalance that leads to irregular menstruation. 

There are three common transient causes of hormonal imbalance that lead to transient irregular menstruation.  These are common causes that I see in my practice.  First and probably most common is stress.  When stress levels are high cortisol levels rise.  If cortisol is high enough it can disrupt the hormone signaling in the brain.  Your brain, specifically your pituitary gland secretes hormones that stimulate the ovaries to produce hormones. With high cortisol, this normal signaling may get disrupted and lead to either a missed cycle or a shortened cycle.   The irregular menstruation from high stress and cortisol is usually short lived.  It may persists for a cycle or two after the stressor has gone away as well.  Typically this type of irregular menses will be on the shorter side.   

Another transient hormone reason for irregular menstruation is birth control.  When you are starting a new birth control sometimes it will create a little imbalance leading to a missed cycles, shortened or lengthened cycle or two.  Usually this corrects itself within two or three months. 

The third transient hormonal cause for irregular menstruation is extreme weight loss.  Some cases of losing a lot of weight especially if it is fat loss, can trigger a hormone disruption.  Women need to have a certain amount of body fat in order to maintain regular menstrual cycle.  A body fat percentage at or below around 20% is where  problems can start to arise.  The exact body fat trigger is going to be different for each female.   Once they get around the 20% mark or below,  they might start seeing some disruption in regular cycling.   There's good reason for this too.  The body as a whole is getting signals from, caloric intake, exercise, metabolic rate, etc.  It is taking the sum of these signals to understand if it's able to put the investment into having a baby.  From the machinery of the body this is a very large investment in terms of calories.   If she does not enough reserved fat in the body, there may be enough stored fat to carry the baby all the way to term.  When the percentage of fat drops below a certain amount, menstruation starts to get disrupted and may stop altogether. 

In summary, the three transient reasons for hormones leading to irregular menstruation  are:

• Stress
• Starting a new birth control 
• Extreme weight loss 
  

Chronic Hormone Cause of Irregular Menstruation

The more chronic hormone imbalance cause of irregular menstruation is perimenopause.   All women go through perimenopause but not all have symptoms and irregular menstruation.   The root word peri means next to and menopause meaning pausing of menstruation.  So then perimneopause is the time next to the pause in menstruation.   While some women don't have change in their cycles before menopause, others do.  It is common reason for women to seek help.  The cycle disruption typically starts about two to three years before actual menopause.  So you can think of this in women around the age 45.  

Some women start perimenopause earlier around forty.  Early on in perimenopause before the menstruation stops there can be a drop in progesterone.  That decrease in progesterone causes the uterine lining to shed earlier.  Because of that there is not as much progesterone to keep the estrogen in check.  As a result, the uterus has more endometrial thickening.  Sometimes it can also lead to fibroids.  So one of the things you want to think about if you are in this age demographic is progesterone and estrogen balance.  Because that could be one of the causes for increased flow and increased number of cycles. 

Sometimes in perimneopause the cycles start to come every three weeks  and it seems like you are always having the cycle.  That happens because there is breakthrough bleeding.   In this case you are not actually ovulating every time you are bleeding.  Instead it is just that the uterine lining keeps shedding because there is not enough progesterone around to prevent that from happening.  Later on, as you get closer and closer to menopause, you may stop menstruating altogether so you have a cycle like every other month or every two months.  Usually that is closer to actual menopause where you will see that happening. 

Another kind of chronic cause for irregular menstruation that is related to hormones imbalance is fibroids.  This has a similar cause related to estrogen dominance and perimenopause.  A lot of times fibroids are more commonly found in a woman that are premenopausal.  Both the perimenopause and the fibroids share this link with estrogen dominance. 

So this is a third reason, estrogen dominance outside of being premenopausal or having fibroids that can lead to irregular menstruation. With these there is a relative abundance of estrogen in comparison to the progesterone.  So there can either be a lack of progesterone or an excess of estrogen depending on the situation.  You may have both or one or the other. Estrogen dominance can happen in menopause or can happen much earlier even women in their 20s and teens can have this.

Hormone Imbalance in Younger Women

Hypothyroid and Irregular Menstruation

Another chronic cause of hormonal imbalance that triggers irregular menstruation is hypothyroid.  This is one that's not really associated with female hormones but is associated with thyroid hormones.  The more research that looks at this the more clear the association seems to be.   The exact mechanism of why this occurs isn't really clear.   It seems that the more severe the hypothyroid is the more severe the irregular menstruation.  there does seem to be an association with hypothyroid.  So if you are having irregular Menstruation, you should have your thyroid levels checked.  Correcting this might fix the problem depending on what your situation is.  More minor cases of hypothyroid may not do a whole lot. 

Lastly there is pregnancy.  With pregnancy obviously menstruation stops.  It is chronic because it lasts nine plus months.  Of course, pregnancy is associated with hormones and shutting off normal ovulation.  When the hormones come back there can be irregularity initially as well.  

That should give you a better idea of how hormone imbalance can cause irregular menstruation.  If you have a follow up question about the contents of the article, please ask it in the comment section below. To get a customized plan on hormone imbalance and  irregular menstruation. 

What does it mean to be insulin resistant? Maybe you ran some labs and found you have insulin resistance or told by your doctor that you have insulin resistance. In this article we will explain what is insulin resistant.  We will also look at a simple model you can use to help you better understand it.  This model will help you understand what's going on inside your body when you have insulin resistant occurring.

If you want to better understand what insulin resistance is keep reading we are going to discuss the details.

What It Means To Be Insulin Resistant?

One way to think about insulin resistance is it is a process by which your body is no longer accepting the same amount of glucose or carbohydrates into the tissues with the same amount of insulin that it previously did.  You can also think about it as your body becoming less and less efficient at being able to take up and store macronutrients in general. Macronutrients meaning protein carbohydrates and fat. More specific to insulin resistance is the carbohydrates.  So let's look at what happens with insulin and glucose (carbohydrates) in normal situations when there is no insulin resistance.   This way we can better understand the situation with insulin resistance. 

Insulin and Blood sugar Response 

First we want to look at what is insulin.  Insulin is a hormone that's produced by the pancreas in response to higher than normal blood glucose levels.  The blood glucose is basically a small carbohydrate that is floating around in your blood.  When the pancreas detects higher than normal (about 60-100mg/dl) amounts, it produces more insulin.  The insulin then will help to open up channels or doorways into the tissues and cells so that this glucose can be taken up.   That glucose or carbohydrate is important because it's a main source of energy. Your body uses it and turns it into a form of energy called ATP.  There are other forms of energy the body uses to create ATP.  However, for the purpose of this article we're just going to focus on the effect of carbohydrates or glucose on this process.   

So back to the glucose story. Glucose is used to help your body make ATP.  Instead of turning all of the food you eat into energy right away, the body needs to store some of it away.  This allows your body to have energy consistently on demand when it needs it.  For instance, it can mobilize some of this stored energy when you have to run away from someone chasing you or you need to sprint.  On the other hand when you're sleeping you may not need as much energy.  So the body has this process by which it can store energy and use energy based on demand.  As for storage, your body only has so much space to store this energy.  Some people have more storage than others and that's why we have different size people.  As the space gets used up and full, the efficiency at storing these macronutrients and carbohydrates goes down. That process is at play with insulin resistance.  As the efficiency goes down over time you body gets more and more insulin resistant.  One thing that happens with more insulin resistance is that your insulin levels in the blood go up.  This happens because your body needs more insulin to open up those channels or gates. 

Insulin Resistance and Storage of Glucose

Storage of the carbohydrates is critical to insulin resistance so let look closer at how this storage process works.  The first storage compartment that is filled up after eating is the liver.  This is also the first one that gets depleted as well.   When you are going about your daily activities exercising etc the stored glucose which is referred to as glycogen in your liver gets tapped in to.

Liver glycogen is storage spot number one. After eating this storage area gets replenished first.  Once that is filled up the body moves to store more glucose in the muscles.   After that any remaining glucose gets turned into a triglyceride and is stored in fat deposits as fat.  So as the liver glycogen gets filled up and the more often it's full, the muscles also become full.  If you don't exercise the muscle glycogen does not get used up.  The decreased storage capacity overall makes the body less and less efficient at taking glucose out of the blood and putting it into the storage compartments.  As a result the blood glucose go up because it can't get out of the blood as quickly as it otherwise could. 

In the beginning maybe when you are younger  you can say you had plenty of storage space.  The glucose quickly went into these storage compartments . Over time as they became fuller it can't get out and get into these storage compartments.  As that process evolves more and more, a higher glucose is detected by the pancreas.  The higher glucose levels detected by the pancreas, results in more insulin production.  The insulin then will literally open up more doorways or open the glucose gates wider. This allows more glucose to get jammed into that space. Over time the muscles and tissues that store this blood sugar become less and less efficient because they are so full.  As a result most of it gets stored in the fatty tissues.  Insulin then has to go up even further.  This reciprocal process is referred to as insulin resistance. 

Natural Treatments for Diabetes

To be clear there is a lot more nuance to insulin resistance than what I outlined.  However this model works well in predicting what you can do about it and why it seems to happen.  So you may be asking why is my storage compartments getting filled up? Or why am I not processing through some of this stored energy and other energy sources and in an efficient manner? Why now, ten years ago this wasn't happening? 

This process tends to gradually build up over time.  There are several other reasons why your cells and tissues become less efficient.  One reason has to do with how the mitochondria are working.  Mitochondria are the considered the powerhouses or energy factories of the cell.  You have probably seen cartoon pictures of these.  The mitochondria are able to sense and detecting signals from the environment.  One such signal cause the mitochondria to slow down their activity (processing energy).  We don't really know all the details of why this happens but it does seem like a crucial part is this insulin resistance process.  One idea is that the increased storage itself acts like a signal to slow down the processing of the glucose through the mitochondria.  This explains why the critical step for reversing insulin resistance is decreasing insulin.  To do this we need to reverse the excess storage of these macronutrients.  By doing so you make the body more efficient at processing what you do consume on a daily basis.

Hopefully that helped answer the question what is insulin resistance and gives you a working model to approach this in your own health.  If you have questions about this, please ask in the comment section.  If you want help managing and improving your insulin resistance click on the link below to get started. 

Are you wondering if you can permanently cure eczema without using medications? Maybe you are using a topical steroid or maybe you are just suffering with eczema all the time and you don't want to use medications.  Whichever your situation, this article will discuss some of the things that I use to help people permanently cure their eczema without using medications.  We will look at some dietary things and non-medication treatment ideas. 

If this interests you keep reading, we are going to discuss the details. 

Looking at The Gut to Permanently Cure Eczema

The short answer to this question is yes, you can cure eczema without medications.  The next logical question you probably ask is how do you do this, what does it take, etc?  I have personally helped many people permanently cure their eczema without using medications and without the eczema coming back.  The approach (discussed below) is to treat the gut and create more optimal digestion.  For those of you who already know you have digestive issues, you may want to scroll down to the "Treating the Gut" section.  

If you don't think you have digestive issues or you are unsure, I recommend taking a closer look at what this means.  Many, if not most times, those people with eczema and skin issues do have digestive problems.  The digestive issues are not always overt or super obvious.   However, if you pay attention, you will start to see that there are patterns in your digestion and skin disruptions.  This has been been my experience in treating and helping numerous patients with eczema.   As they start to pay closer attention, their skin issues or eruptions correlate with their digestion. 

Skin cells and tissue can take several weeks or even months for them to fully turn over and have new cells.  This is the point where you can actually see a change and improvement in the skin. This is why you cannot really track things from one meal or one day to the next.  However, if you stay consistent with what you are doing, you will start to see the changes over time, weeks or months. 

Gut Problem Or Not?

With regard to identifying digestive issues, you want to start with understanding what is normal and what is abnormal.  For that you want to look at frequency and consistency of your bowel movements.  For frequency, one to two bowel movements per day is considered normal.  Any less than that would be abnormal and more than that would be abnormal too. Three per day might still be okay. 

For consistency we are looking for how well formed the stool is.  For instance does it break up and dissolve? Is it really hard and pebble like?  If yes, these would be abnormal. It should look like a tree that was recently cut down with nice consistent form to it. Contrast this with a tree that's been decaying in the woods for three to four years.  That breaking up look is abnormal. 

The other thing is to look at how often is it normal versus the abnormal?  Is it ninety percent of the time normal?  If so, then maybe you don't have an issue.  If it's 50 percent of the time, then that sounds like an issue. So do you have the normal consistency and are you going regularly the way you should.  If not then you should look at what could be going on with your digestion. 

If you found that you actually do not have any digestive system issues, as far as you can tell, you may want to dig into that even further.  There are cases of eczema that are not related to digestive issues like contact dermatitis and others.  To be sure you don't have digestive issues it makes sense to do some more in depth testing.  This way you can rule it out for sure.  To do this you will like need to consult with a doctor that has some experience in speciality lab tests for digestive problem. Now let's look at what to actually do about eczema in a sense of treating the gut. 

Treating The Gut to Permanently Cure Eczema

In a previous post "Is Eczema A Sign Of Something More Serious", we discussed how the immune cells of the innate immune system are being activated by food particles and microbial toxins.  We reviewed how this occurs  from leaky gut and inflammation in the digestive tract.  It is with this in mind that the first thing you want to do is to treat this problem by calming down the activation of the innate immune system.  It is the over-activation and stimulation to those immune cells that starts this problem. The microbial toxins and/or food particles get distributed throughout the body via the lymphatic tissue.  This shows up on the skin further inflaming the local immune system sitting underneath your skin surface.   So that's a general overview of the problem but let's put this into some categories so you can look at how to approach it. 

When you have eczema and other skin issues, but eczema specifically, there's little doubt that you do have leaky gut.  This should be treated but I believe it is important to recognize that each person is going to need a little different approach.  Currently, there is no one-size-fits-all treatment approach for eczema and digestive issues.  A lot of people do have leaky gut and there's a lot of suggestions and supplements on how to treat leaky gut.  Most of these suggestions are good but they don't fix the problem.  Allow me to explain. 

You want to make sure you are sequencing the treatments in a logical and systematic order, paying attention to symptoms, progress, and labs.  The supplements and treatments you use have to be adjusted as you progress through your treatment.  So to say "take these 5 supplements for leaky gut", can be misleading.  You don't need to use them all at the same time.  It is like being given 10 exercises for shoulder rehab and starting them all at the same time.  You would not do that because some of those exercise will make it worse in the beginning and others won't be helpful as your shoulder gets stronger.  The same can be said for leaky gut. 

For more on leaky gut, check out

Why Most Leaky Gut Cures Don't Work.

So a good first step is to calm down the inflammation that triggered the leaky gut.  The most common reason for the inflammation is microbial toxins. These toxins are in abundance when you have bacterial overgrowth, fungal overgrowth, and other forms of dysbiosis or imbalance in your microbiome.  Food sensitivities and allergies along with histamine excess are also culprits.  These are the three important things to be paying attention to when you have eczema. 

Treatment for microbial or fungal overgrowth many times will make the eczema get a lot worse initially.   This happens because many of the microbial toxins are getting released into your body as you are killing them. Specifically it is the bacterial cell walls and debris that gets into your body and triggers your immune system.  So you have to approach the microbial issues with the awareness that things may get worse before they get better.  Because of that, a lot of times it makes more sense to approach the dietary aspect of this first before going in with antimicrobials. 

What dietary things can you do to help permanently cure your eczema or reduce some of the flare-ups.  A lot of times people will do an elimination diet or AIP (autoimmune protocol) type of diet. Both of these diets remove many of the common food triggers. These foods can trigger the innate immune system or the immune system in general. There is a lot of overlap between those two types of diets.  You can read more about foods and their affect on the immune system here. 

One reason these diets work is because they reduce the food particles that are pro-inflammatory.  They also reduce the amount of microbial growth and therefore reduce the microbial toxins that are released into your body.  There are specific diets that focus on reducing microbial toxins like a low FODMAP diet.  All of these diets can start to reduce the skin irritation before you take anti-microbials.

Sometimes just eliminating gluten can make a big difference in reducing eczema.  For others it may completely go away with elimination of dairy products or eliminating gluten, for instance.  This is great if it's the only thing you need to do.  While this alone may seem to cure or reduce the eczema, remember that there may be microbial imbalance occurring as well.  Be sure to go back and address this if symptoms return or are persistent.  This is especially true for those that need to eliminate five or ten different foods. This suggests more of a microbial issues.  So if you do this and then you are still having skin issues and eczema, you need to look closer at your digestion.  Generally this means there is some aspect you are missing.  Maybe you do have to go back in treat the microbial overgrowth.  Also, after your skin is calmed down (getting little or no flare ups), then make sure to treat the leaky gut.  

It's also important to note that this process is not always a clean progression from removing the foods to treating leaky gut to complete recovery.  So you have to pay attention to how often you are getting flare-ups.  Are your symptoms getting better in a linear fashion?  If they are not going completely away most of the time, this is also a sign you are missing something.  This is when it may be helpful to do some speciality lab testing to determine where the problem actually is occurring.  Whether it's a blood test, a stool test or some leaky gut test, you need a way to assess what's going on with the cells of the digestive tract. 

Most of the problems with eczema are coming from the gut.  Assessing and re-evaluating where the problem is coming from as your treatment progress can be challenging.  This is where speciality labs and carful tracking come into play.  I hope this gives you a better idea of hot to permanently cure eczema without medications and some of the approaches we take for skin issues.  If you have questions about any of the content discussed, please ask in the comment section below.

For a customized plan for your eczema or skin issues, click on the link below to get started. 

Do you have questions about your MTHFR gene mutation? Maybe you are reading that some information about MTHFR are myths and you are confused.  I find there are a lot of questions and confusion about MTHFR gene mutations.  Specifically about what supplements you should be taking.  Like, should you take glutathione, vitamin B12, or something else when you have MTHFR gene alterations?

In this article, we will help you understand what some of the myths and what some of the truths are about MTHFR gene mutation.  We will look at how to get more concrete personalized understanding and what is needed for balance when you have this gene mutation. 

If this interest you keep reading, we are going to get into the details. 

MTHFR Gene Mutation Myth #1

The first MTHFR myth is; if you have MTHFR gene mutation, you have to do something about it.  For instance, you have to take a supplement or do something to rebalance the effects of the gene alteration.  The truth of this really depends on which part of the gene is altered.  So I want to go into that a little more detail to make sure you understand this point.  Just because you have a report that says you have MTHFR, does not necessarily mean it will impact your health in a significant way. 

There are two spots along that MTHFR gene that tend to alter the outcome of the protein that is made from that gene.  The gene is made up of a double helix and cross connections between base pairs.  You can think of the cross connections like the rungs of the ladder.  These rungs are where the double helix fit together by electromagnetic bonding.  These are the nucleotide base pairs represented by  A's T's C's and G's and they fit together electromagnetically.  One of the pairs can be changed and replaced with a different one.  For instance, an 'A' can be replaced with a 'T'. The configuration for any gene that is most optimal and common is called the wild type. 

The MTHFR gene is made up of over twenty thousand of these base pairs.  So twenty thousand of these double helix base pair connections long.  One side of the pair comes from mom and the other side from dad.  Along this twenty thousand there are two spots that are correlated with changing the protein outcome.  At each spot, you can have one change or two changes.  So both base pairs can be flipped or replace or just one of them can be.  Without getting into too much nuance here, the spots that are most significant are A1298C and the C677T. 

The A1298C spot is less associated with a significant change in the protein outcome.  The C677T spot has more significant impact on the protein outcome. Because you get one from mom and one from dad, there are a few different combinations that you can have.  One change at the spot A1298C is not very significant, but two here can be.  On the other hand, if you have one at the C6 77T spot, this also can be significant.  Each case should be taken into a larger context of your health and labs.  Those with two of this C6 77T will definitely be significant. 

The bottom line is you can have different combinations of MTHFR.  Depending on what you have, this may not be a very big problem for you.  So if you have an MTHFR gene mutation that doesn't mean you have to take some supplement or do something to fix it.  Get the details of your genetics and health and let that drive your decisions on what to take and do.  

MTHFR Gene Mutation Myth #2

Another MTHFR myth that I want to bring up is; if you have MTHFR gene alteration, then you your health is compromised in some way.  Of course, this is a similar trend to the first one but wanted to separate this from the points made above.  Your health is a expression of your genetics and the environment.  It is a living thing.  It's not static but genes and genetics are static.   You can turn genes on and turn genes off but we are looking at your MTHFR gene status.  This is not going to change over time but what does change is your phenotypic expression, aka your health. 

So to start you want to ask is your health compromised in some way? What's currently going on within your body.  Are you having any symptoms MTHFR gene alterations like problems with depression, mood alterations or even any fatigue.  You also want to look at any physical signs that tell us that there's a problem. 

If you don't have have any of these problems, it doesn't necessarily mean you don't do anything about it (if you have C6 77T homozygous).  It does mean that you may not need to do as much as you originally thought.  Just because you have an MTHFR gene alteration does not mean your health is somehow compromised.  It does mean this particular part of you biochemistry is susceptible to being compromised.  As a result, you have to be more aware of it. You can think of it in a similar way to a family history of heart disease. With this you may want to watch your cholesterol a little closer or your blood pressure closer. Similarly, when you know that you have the MTHFR gene alteration what you do will depend both on what your current health issues are and which alteration you have.  It is combination of those two things that informs us what we do about it. 

MTHFR Gene Mutation Myth #3

MTHFR myth number 3 brings in the concept of methylation.  The myth is, if you have MTHFR gene alteration, you don't methylate.  This would be more accurate (and not a myth) if we simply say you don't methylate well.  Again it really depends on which MTHFR gene alteration you actually have.  In some cases it can be true that your methylation process is impaired but most are not.  What does methylation mean though?  

The process of methylation is a biochemical process of adding a methyl group on to another molecule.  A methyl group  is a carbon with three hydrogen's.  You can think of the utility of this process as helping the body make molecules more active or less active. This methylation process occurs (in some parts) through utilization of the MTHFR enzyme and methylfolate.   However, there are alternative pathways that can allow methylation without using the MTHFR enzyme and methylfolate. 

You can consume molecules with methyl donors in our food in the form of methionine, for instance. Methionine is an amino acid that is has methyl groups on it already.  This can be used in your body to create SAMe.  SAMe is the major methyl donor for the methylation process.  There are also alternative ways to create and recycle methionine without using the MTHFR and the methionine synthase enzymes. 

The main point is, if you have MTHFR gene mutation there are other ways your body can methylate and support methylation in general. It could mean that some of your methyltransferase enzymes are slowed down or compromised. The MTHFR enzyme itself doesn't turn those off. It creates methylfolate which allows for SAMe to be made efficiently.  So with less methylfolate, there is  a slow down in the production of SAMe. As a result the enzymes that depends on SAMe are slowed.  Especially when you have a more significant MTHFR gene alteration

In summary, we know it is inaccurate to say, I have MTHFR gene mutation, I don't methylate well.  This is not out right false but it is misleading. It can be true in some instances but most of the time there are alternative ways that your body can perform this function.  It really depends on your gene state, your overall health, and what your diet is. 

MTHFR Gene Mutation Myth #4

The fourth MTHFR myth that I want to discuss is your need for taking methylfolate when you have MTHFR gene alterations.  Many people think if they have an MTHFR alteration, they have to take methylfolate.  At face value this is false.  Just like some the other points discussed above, it will really depend on which gene alteration you have, and your current health situation.  Not everyone has to take methylfolate.  Many of my patients that have MTHFR gene alterations do not take it.  In some instances, it's just not relevant for them.  The relevance is determined by how you respond to methylfolate supplementation and if you have other chronic health issues. 

In these cases you may have to use alternative nutrients to support and balance out the methylation status in your body.  This can be measured through labs.  Homocysteine is one such lab that can be used to determine whether or not you need more methyl donors.  Sometimes we also use a more advanced tests like the SAM/SAH. The main point is that our health status together with your MTHFR gene status determine whether or not you need to take methylfolate. 

The other thing is there are other gene alterations that cause you to need other nutrients to balance out the methylfolate when you take it.  This is true for those with COMT, transulfuration, and detoxifcation SNPs.  In summary you should look at the actual gene mutation you have, current labs, your current health status and  other gene alterations or SNPs.  All these together will determine your response to and need for methylfolate. 

MTHFR Gene Mutation Myth #5

The fifth myth is that MTHFR gene mutation doesn't matter so you shouldn't worry about it.  Some say to forget about it and don't even think about it.  This is certainly a myth because there are plenty of health-related consequences from having MTHFR gene alteration. Now that does not mean that everyone that has a slight alteration or even a major alteration will have compromised health because of this.  I recommend raising your awareness to some of the possible symptoms that can come up when you do have it.  Here are some things to keep in mind.  Having an MTHFR alteration can lead to:

• Increased risk of clotting disorders and  cardiovascular related issues. 
• Increased incidence of mental health issues 
• Neurological problems like neuropathy

The most common that we see are related to mental health and  fatigue.  There is plenty of research to support these claims.  Here is a link to a recent review article that brings together multiple studies looking at health consequences of MTHFR and it's different variations.

In summary when you have MTHFR it can mean that your health is compromised in some ways.  However, you really have to pay attention to specific health issues and be aware that these things can come up. 

Lastly if you have MTHFR gene mutation does that mean you need to take more b12? There is no reason you need more B12 just because you have MTHFR.  However, there are genetic issues with B12 recycling as well.  When it comes to MTHFR it's really methylfolate (other methyl donors) or riboflavin that is going to help.  In some cases, if you are supplementing with methylfolate and doing things for MTHFR you may need b12 too.  You wouldn't just take B12 because you have MTHFR 

In a similar vein, sometimes people get lists of things to take because they have MTHFR.  For instance, you need to take glutathione and cysteine, liver support, and probiotics and different things like this.  We can make a case for why you might need a dozen or even more supplements. 

Instead think about customization and understanding how your body responds to these different nutrients. Think about and explore how your blood markers change and how you feel when you make these changes.  Just because you have MTHFR does not mean you need to take a huge list of supplements.   You may only need to take the methylfolate but it may only need to be consumed on an irregular basis. Other times people do have to take four or five or even more different supplements temporarily. This can change over time too as your body changes and you come into more balance with all your nutrients.

I hope this gives you a better understanding of the MTHFR gene mutation myths that exist.  It should give you a more concrete and actionable way of approaching MTHFR gene mutations.  If you have questions about any the content in this article, please ask in the comment section. To get a customized nutrition, genetic, or health plan, click on the link below to get started. 

Is eczema a sign of something more serious? Does it mean that you have an autoimmune disease or have inflammation? Does it mean you're eating the wrong foods or that there is something wrong with your liver?

In this article we will address these questions and get into some of the details on what eczema is a sign of in your body.  We will also look at what some of the research says about this question, how eczema is typically treated and some of the things that I think about when treating eczema holistically.

If this interests you, keep reading we are going to discuss the details

Is eczema a sign of something more serious (link to Is Eczema Linked To Gut Health)?  What is going on with eczema is it telling you that something is off in your diet?  Yes eczema is a sign of something more serious, specifically it tends to be more of an issue with gut health.  What we find is that with eczema there is a shift and your body's overall immune system and inflammatory balance . We will discuss what that means in more detail but first we need to understand what is meant by eczema. 

What is Eczema?

Eczema is also known as dermatitis where the derma refers to skin and itis inflammation.  So eczema is inflammation of the skin.  Often times it presents like dry itchy red scales on the skin not to be confused with something like psoriasis.  Psoriasis is a thick white scaly patch but eczema has less of the scale.  We don't want to focus too much on the diagnostic differences.  Eczema is almost always itchy and red.  Sometimes it can form blisters and over time may get more scales and become thicker.  What we want to look at and understand in this article is what this itching and skin inflammation is telling us?  What is triggering this inflammation and is that trigger a sign of something deeper in your body. 

The Deeper Issue With Eczema 

Studies have found significant changes in the intestines of patients with atopic dermatitis and eczema compared to their peers.   One of these changes is a change in the metabolites of the gut flora.  The microbes in your intestines and the things they produce through their normal course of living, play a very active role in priming the immune system. This process can explain how and why we respond to certain foods the way we do.  For example, if your gut flora have a relatively larger amount of pathogen microbes compared to the good or commensal microbes, the immune system will be primed to have more of an inflammatory response. That response is from the microbes themselves and their byproducts.  These are all cues to the immune system. 

Let me back up and say a little bit on pathogenic microbes versus commensal or good bacteria.  We often talk about that in a very generalized way and that is because currently our knowledge is limited in this area.  I can give you a little bit of terminology and explanation that will further your understanding. 

In your digestive tract there is suppose to be a relative balance between what we call the Firmicutes and the Bacterioides.  In general your body should have more of the Firmicutes than the Bacteriodies.  Part of the reason for this is because the Firmicutes group have microbes like lactobacillus and Bifidobacterium.  These types of bacteria don't have lipopolysaccharide and tend to not produce as much of the toxic things that inflame the immune system.  These toxins trigger the macrophages and other types of cells in the innate immune system to respond in an aggressive manner towards the bacterium.  So when there are more of the Bateriodies (which have LPS) or even just decline and the Firmicutes, it starts to prime the immune system away from the Th1 response and toward Th2. 

In the immune system the Th stands for T helper and these are lines of white blood cells that help the body prepare and respond to problems in and appropriate manner.  Depending on what the immune cells see will determine which type of T helper cells are produced.  This particular scenario we are describing creates more of the Th2.  So how does this relate to eczema? 

With eczema there is this relative shift in the bacterial flora.  Many studies (see link) have found that eczema patients have less of the Firmicutes and more of the Bactericides.  This leads to less production of small chain fatty acids, because the Firmicutes produce more these.  The short chain fatty acids act like a barrier and add another layer of protection against things getting into the into the body through the intestines.  This shift also creates more inflammation because of the byproducts that are present in the in these bacteria. You get things like the LPS which stands for a lipopolysaccharide and other products that trigger the immune system to respond in a way. 

If this is always going on you will always have inflammation in your intestines. This triggers a reciprocal reaction that tends to repeat itself over and over again.  This will continue until the balance of microbes is reset.    

Let me give you a mental illustration to help you picture this better.  The lumen of the digestive tract where food is passing through and being absorbed is made up of cells.  These cells are connected and the connections can open and close.  They are linked by protein.  When you have a lot of inflammation, these proteins tend to degenerate over time.  Then these cell to cell connections are just open and more food, bacteria, toxins etc. can travel inside and further trigger the immune system.  It creates a cascading effect of more of the helper cells to more of the Th2 response and less of the Th1. 

Just on the outside of the intestinal lumen inside your body, there is a kind-of open space. Just below this or deeper inside is your gut associated lymphoid tissue (GALT).  This tissue and channel is  responsible for signals and toxins (in this case) getting transferred to the rest of the body.  This lymph tissue is oftentimes where the T helper cells are sitting and also where the shift to more of the Th2 occurs.  That shift and corresponding signals are then carried all over the body through via the lymph and blood.  This is how the same types of cells can be activated in the gut and skin at the same time. 

Those signals are then passed along locally to the skin tissue as well.  The actual lymph tissue is carrying along those undigested food particles and the LPS and other toxins.

To summarize it is the leaky gut in atopic dermatitis and eczema patients that propels the skin inflammation by enabling the penetration of toxins, poorly digested food particles and microbes into this systemic circulation.  As these toxins and signals reaches the skin the Th2 response is initiated locally in the skin causing more tissue damage. This further propels that same type of reaction locally in the skin.

You might be asking yourself why have I not heard this before, why did my doctor tell me about this?  Most doctors are interested in helping you with the acute reaction.  They are going to prescribe a topical anti-inflammatory type of medication (corticosteroid).  This will suppress the immune response locally on your skin.  This is fine especially if you have an acute type of reaction like an allergic type of atopic dermatitis.  However, chronic uses of these steroids will lead to problems systemically.  For instance the steroid is shutting off that immune response locally which is why it helps the symptoms go away.  Your skin feels better but when your body's trying to fight something off systemically, it is weaker. 

You have these signals coming from your digestive tract going all over your body.  When you are on the steroid you don't see the signs on your skin.  The signals are still there and this systemic reaction is going on in your immune system.  You can think of this like a military trying to fight multiple battle fronts at the same time.  It can be done but it is harder.  It is harder for your immune system too.  As a result you have a relatively weaker response to cancer infections, etc.  Theoretically that's going to lower your ability to fight those off. 

Some of the steroids depending on how strong they are can cause other issues – like bone loss.  It really depends on how much you are using and how long you are using it.   If you read the package insert on the stronger steroid medications, you will see this.  You might be asking, where can I learn more about this.  This link has a lot of nice pictures and that give you a better understanding of how all this process looks and works. 

Also watch out for my next video on eczema where we will discuss how you can permanently cure eczema without medications.  More detail on how you would actually go about this with strategies and specific things you can do to get rid of the eczema without using medications.  That should answer the question is eczema a sign of something more serious going on in my body. 

If you have questions about this article, please ask it in the comment section below. If you want a customized plan for you skin or eczema, click on the link below to get started. 

Are you wondering what causes iron levels to be high?  Maybe you were told you have high iron and you don't really know what that means.  There are different ways to measure iron.  So in addition to discussing what causes high iron we want to look at the various test that can look at iron levels. 

If you are curious about the causes of high iron and some of the things you should be thinking about when this comes up in your health, keep reading we are gonna get into the details.

What causes too much iron or iron levels to be high? First let's define a little bit more on what we mean by iron levels.  There are a few different tests that can refer to iron and iron levels.  One way we can measure iron is through a serum iron test.  This is the kind of iron that is free floating (bound to transferrin) around in your blood.  While it is bound, it's more free and ready to be used.  We also have another form of iron referred to as stored iron. This test is called ferritin.  

Then there is one other way that is more of a surrogate marker for iron.  This is hemoglobin.  Hemoglobin is not actually iron but it contains iron.  Hemoglobin is a molecule that helps your body transport oxygen and in order to make hemoglobin, your body will require iron.  So iron is a core part of that hemoglobin. Because of this hemoglobin makes up the bulk of the iron in your body.  Often times when people refer to your iron levels, they are referring to  hemoglobin.  The terms, iron and hemoglobin are sometimes used interchangeably. 

They are not the same and should not be used interchangeably.  While the levels of hemoglobin, serum iron and ferritin often correlate, the don't always.  For instance, it is possible to have a normal hemoglobin and high ferritin.  It is also possible to have high hemoglobin and low ferritin. So let's look at what cause iron level to be high in more detail. 

What Is Too Much Iron?

For this article, we will exclude hemoglobin from the conversation of too much iron.  What we will include and are specifically referring to is high serum iron and high ferritin.  In particular, we want to look at the ferritin.  It is important to note that normal ferritin levels differ for males and females.  The ferritin reference range for females starts at about eleven and goes up to two hundred and thirty.  The reference range for males starts at about twenty five and goes up to about five hundred.  Males have a very broad reference range for ferritin. 

When we talk about high iron levels there are two ways to think about this.  There is extremely high iron like 30% above the normal range and then there is something above what is considered an optimal range.  We will discuss both of these.  For a female a ferritin well above two hundred, let's say two hundred to three hundred is very high.  Something in the high one hundreds and low two hundreds would be suboptimal.  There are a few things you should be thinking about when you have these levels.  We will discuss it below. 

For a male if they have a ferritin that's well above five hundred, like six hundred to seven hundred, this is extremely high.  Even when their ferritin is in the three hundred to four hundred range, this is suboptimal and on the high range.  Now let's look at what might be causing these high iron levels.

What Causes High Iron Levels?

One of the things that can cause high iron levels is called hemochromatosis.  Hemochromatosis is the disease state caused by high iron.  It occurs due to a genetic abnormality if increased  iron absorption through the digestive tract.  When that happens your body tends to accumulate more iron.  For females this problem tends to not show up early in life, if they are having normal menstrual cycles.  It still can happen, but it is more common after they go through the menopause or stop mensuration.  Women can still have the genetics of hemochromatosis but because they have menses their iron levels do not get high. 

For this reason it is more common for men to get hemochromatosis diagnosis.  In men this can show up in their mid twenties or late thirties.  It does take a while for the iron to build up.  Anything over four hundred is considered problematic . These higher levels usually occur when you have hemochromatosis.  Sometimes this will not show up right away.  So if you are still pretty young you have to keep checking your ferritin periodically over the years. Since it is genetic, you may have a family member with this as well. 

When the high numbers show up depends on several different things, like your specific genetics, your diet, etc.  For instance, there are several different gene alterations that will cause iron to absorb at increased rates.  If you are doing any kind of blood donations this will mitigate the risk for both males and females . However you should not just rush out and start doing blood donations (more on this below).  Your diet will also play a big role too. 

For dietary sources of iron only certain foods are going to be a significant source of iron. The main source of iron in our diets is called heme iron.  The heme iron is coming from hemoglobin in the blood of animals.  If you are eating animal products, you are getting some iron from this.  If you are not eating animal products, then you might be getting a little bit of iron.  The potential for any dietary source of iron to raise your ferritin or serum iron will depend on how well you absorb it.  With plant sources, it is unlikely you will get high iron because there is not a lot of iron in these.

So far we talked about two main causes of high iron, high dietary consumption of high iron foods and hemochromatosis genetic alterations that favor iron absorption.  You don't have to have a diagnosis of hemochromatosis for this to be a cause of high iron. Some people only have minor genetics that favor this.  The diagnosis of hemochromatosis is done by a hematologist or blood specialist and they do this after looking at really high ferritin and transferrin.  If these are both high usually they will do genetic test to confirm the genetics for increased iron absorption. There are different combinations you can have to get that diagnosis.  Some are more common than others.

The last reason that people can have high ferritin has to do with inflammation.  This phenomena is called an anemia of chronic disease.  In this case, the overall iron levels are not high.  What shows up is high is the ferritin.  What happens is your red blood cells actually come down and you become anemic.   When there is really high inflammation in your body, your body will sequester or store and shunt all of your iron into into ferritin.  So if you have a high ferritin and you don't know why, it's a very important that know this before you start donating blood.  You have to make sure that your hemoglobin is normal and also that you don't have inflammation because that could be a cause for high ferritin.  

Sometimes high iron alone can cause inflammation.  This means there are a few finer points that you need understand about iron.  As a result this is something you should be doing in conjunction with your doctor.  In summary the three main causes of high iron are:

• High iron foods
• Hemochromatosis or genetics favoring that
• Anemia of chronic disease, chronic inflammation, or chronic infections

That should give you a better understanding of what causes iron levels to be high and maybe some things to discuss with your doctor on what the best steps will be.  If you have questions about anything resented here, please ask in the comment section below. To get a customized plan on your blood tests or high iron levels, click on the link below to get started. 

Is eczema linked to gut health?

Spoiler, eczema is linked to gut health.  The focus of the article will be to look more in depth on what some of the research has to say about this question and what the mechanisms are behind it.

What is the common link between gut and skin?  How could it be that something so far apart are linked? I will also share a little bit of my clinical experience treating people with eczema and other skin issues and how that has turned out. 

So if this is something an interest you keep reading, we are going to get into the details. 

In my clinical experience eczema is linked to gut health. I will share  some of my experiences with patients having eczema and treating them through focusing and on problems that they have with their digestion.  I also want to give a little color on some of the newer research that is looking at this question and attempting to understand not only is it linked but how it's linked. 

We know from a very basic standpoint that the way the two are linked is through the immune system.  We will look at a research paper below that illustrates this with a little more detail.  First we need to understand more about what the immune system is. 

Often times we talk about the immune system as if it's one thing.  It is common to say, let's increase your immune system to to help your body fight off a cold or a flu. Sometimes we also say, let's suppress your immune system because you have autoimmune disease or you have allergies etc.  The thing is your immune system actually has a lot of different layers to it.  When it comes to eczema, we want to be more specific when we are talking about the immune system.  So when we say increase or suppress your immune system, we really need to define which aspect or which layer of your immune system we are talking about. We can break it down into its component parts or categories and look at different aspects of the immune system.  This will allow us to better understand how eczema is linked to gut health via immune system. 

Eczema Gut And Immune Health Link

In a very broad sense we can break the immune system down into two different categories.  We have the innate immune system which is a very nonspecific aspect of the immune system.  Then we also have the acquired or adaptive immune system.  We will discuss the second one later.  First we'll talk a little bit about the innate immune system. 

Once a microbe or toxin is ingested into the body, usually this occurs from food or breathing it in, that microbe has to get past that physical barrier.  So if you take in a bacteria from food poisoning or something like that, the bacteria on that will try to enter your body and live in your body. The first thing is it has to do is get past the acid and enzymes in your digestive tract.  Then that microbe has to get past that physical barrier.  This physical barrier is the most basic aspect of the innate immune system.  

In addition to that, there are also specific white blood cells that are engaged in this nonspecific innate immune response.  These types of white blood cells are usually positioned in very close proximity to that physical barrier.  They are oftentimes close to the lungs close to the digestive tract, or anywhere the body is in contact with the outside world.  So if that first physical barrier breaks down, now you have that backup white blood cell that's going to start to isolate these pathogens, toxins, or whatever the threat is.  We mentioned that these white blood cells are in places like in respiratory tract, digestive tract. They are also positioned in skin layer which is relevant to our question about eczema.  Ultimately we are going to see eczema is related to gut health but I wanted to give you sort a primer on the role that the immune system plays.  In the end it will be more clear how it's all connected. 

The response of the white blood cells to recognizing when something gets through the physical barrier requires them to identify self from non-self.  The cells of the innate immune system do this through a protein and receptors mechanism. The receptors sit on the outside membrane of the immune cells.  These particular receptors are nonspecific receptors.  The proteins that trigger these receptors are found on pathogens.   All pathogens have proteins on their surface that match these non-specific receptors.  This allows the cells in the innate immune to recognize this microbe as foreign.

So there are little things jutting out on the pathogen that are common to many pathogens.  These allow the white blood cells in this nonspecific immune response or innate immune response to recognize those.  The cells will try to isolate and engulf those pathogens to prevent them from spreading any further. 

In a similar way, when there is damage to your tissues, there are proteins inside the tissues that are also exposed.  They are only exposed when there is tissue damage.  These will also bind to the white blood cells and trigger those white blood cells to go to the area.  so Both pathogens and tissues damaged by pathogens or for any other reason that can tigger this innate immune response. That is the basic innate or nonspecific immune system responses throughout the body.  So now that we talked about the innate immune system, we should briefly discuss this other type of the immune system called the adaptive immune system. 

The adaptive immune system involves other types of white blood cells called lymphocytes.  These cells come from the bone marrow and they are able to recognize previous infectious agents through a specialized process of making immunoglobulins.  There are several different types of immunoglobulins. We won't get into that now but it is through this process that these types of white blood cells called lymphocytes are able to have memory. This is why it's called the adaptive immune response.  So how does all this immune stuff relate to eczema?

How Eczema is Linked to Gut Health

If you look at a biopsy of an eczema lesions you will see an increased amounts of these innate immune cells, like macrophages and mast cells in the lesions.  Similarly, in patients with IBS (Irritable Bowel Syndrome) many studies have found an increase in these same types of immune cells surrounding the digestive tract.  If you look in the area just below where your internal small intestinal lining is, you will see increased amount of mast cells macrophages etc.  This is the common link between the two, the immune system.  Both eczema an IBS have this similarity where there is increased activation of these innate immune cells. 

A recent study looked to see if there was a correlation between the two with actual patience and their symptoms.  While the study was small (Link to study IBS and Eczema), they did find some interesting data. The researchers found "that IBS was more common in the atopic dermatitis group (atopic dermatitis is the same as eczema)." They also found things like "abnormal stool form, abdominal distention, a feeling of incomplete evacuation, and straining with bowel movements in those with atopic dermatitis patients."  Keep in mind this was one very small study.  While there may be others out there, it does give some legitimacy to this skin gut axis. 

Of coarse it is one thing to see to see a research paper and find things that correlate in a research setting.  It's another thing to see this connection in actual clinical practice with patients.  I have seen this numerous times in many of my patients.  Problems in and on the skin, specifically eczema but other skin issues too, are directly related to digestive and gut health. 

Case Study of Eczema Linked to Gut Health

This has not just happened one or two times, but numerous times. I am not the only one either, this was talked to me in my naturopathic medical school and continues to be something that I find very helpful for my patients over and over again. 

The question remains, what is causing all these cells of the innate immune system to be over activated and in increased quantities in the eczema lesions and in the gut?  We mentioned above that one of the things that triggers these cells are the proteins that sit on top of pathogens, like different types of bacteria, and environmental proteins.  Both of these along with tissues damage in general can stimulate or trigger this process to begin. 

So treating the gut and things related to gut health often improves eczema and many different skin issues.  Watch out for the next video on eczema.  We will discuss in more depth some of the mechanisms of eczema and gut health.  The title is "Is eczema a sign of something more serious?" This will go into more detail on what's what is going on in the body to trigger this process and what you can do about it.

If you have questions about anything discussed here you can ask it in the comment section below. To get a customized plan on your skin and gut health, click on the link below to get started. 

Why would my sex hormone-binding globulin be high? Maybe you are asking this question about your sex hormone-binding globulin being elevated and what you can do about it?  Both males and females can have this elevation leading to various hormone imbalance symptoms.  Regardless of gender, I will discuss some of the driving forces behind sex hormone binding globulin secretion and production in your body. 

If this is something that interests you keep reading, we are going to get into the details. 

What Is Sex Hormone Binding Globulin?

First I wanted to explain briefly what sex hormone binding globulin (SHBG) is.  This is a protein produced in the liver and there are different signals from the body that will make you produce more or less of this hormone.  Its main function is to carry other hormones throughout your body so that they don't immediately bind to receptors in the local tissues it was secreted from .  This allows the hormones to be more evenly distributed throughout your body.  Mainly the sex hormone binding globulin binds things like estrogens and testosterone. 

There are various types of estrogen that it binds to.  There is E1, E2, E3 and there are different metabolites of those as well.  All are carried by SHBG.  The same thing is true for testosterone.  There is dihydrotestosterone and other metabolites of testosterone that the sex hormone binding globulin binds and distributes. 

Estrogens Cause SHBG to Be High

The thing that is most notable and commonly referenced as raising SHBG is estrogen.  We know it does this for several reasons.  Females have more sex hormone binding globulin than males.  We also know that birth control can be used to to raise sex hormone binding globulin.  For instance, in women with PCOS, they will sometimes be given birth control and that will raise their SHBG. This is not an absolute solutions for them but it can help.  We also know women on birth control often have a lower free testosterone.  That being caused by the same phenomenon.   

For both males and females you have total testosterone which includes the amount that is bound to SHBG and unbound or free.  Only a small part of your total testosterone is free and available or bioavailable.  A bigger chunk of that is being bound up by the sex hormone binding globulin.  So when you have an issue with low testosterone symptoms part of the issue can be you have even a smaller fraction that is free or bioavailable. 

Estrogen comes in a lot of different forms and abnormalities can arise in males when they have more fat mass than muscle mass.  The fat cells, or adipocytes, actually make some estrogen through aromatization.  Aromatization is simply and enzyme reaction that turns testosterone into estrogen.  This is the only place males get estrogen and it is a natural process for this to occur.  When there is more fat cells these enzymes basically take a higher amount of the testosterone and turn it into estrogen.  As a result, that estrogen gets circulated back up to the liver causing the liver to make more of this SHBG. 

There is also the issue with xenoestrogens or environmental estrogens. These are things like plastics and other man made compounds that have a similar biochemical structure to estrogen. Because of the similar structure they can stimulate estrogen receptors in a similar way that the actual estrogens do.  I did not look at any actual research but this is common sited as another form of estrogen.  For now we will say it can theoretical stimulate the receptors in the liver to produce more SHBG. 

Things like soy products or soy isoflavones are also weak estrogen known as phytoestrogens.  It has very week estrogen effects.  Contrary to popular believe it can actually help with some of the high estrogen effects.  It does this by blocking the stronger estrogen from binding to the estrogen receptors.  If someone has low estrogen, these could also bind to the estrogen sites in the liver and cause increase in SHBG.  For the most part, the things with soy and estrogen can be overblown.  However, if you have a high SHBG and consuming a lot of soy, it may be something to look at closely. 

Viruses Cause SHBG to Be High?

Another thing that can raise sex hormone-binding globulin is viral hepatitis.  This is pretty well documented and clear-cut.  Other forms of hepatitis like NASH (non steatohepatitis) are not as clear cut.  Some studies have found an increase where others have not.  It is a little bit hard to tease out the effect of hepatitis (inflammation in the liver) and the effect of insulin.  Insulin resistance is common with NASH.  We know that insulin will drive down SHBG.  What is not clear is if it is the inflammation in the liver that raises the SHBG.  We do know that viral hepatitis causes increases in sex hormone binding globulin.  So is it the virus itself or the inflammation in the liver.  If it is the virus, there maybe other instances from other viruses and infections that can also raise sex hormone binding globulin.  I do not have any research to support this theory however. 

There are some other things to consider like medications. There is a medication used to treat psoriasis that is known to raise SHBG.  The medication targets an immune chemical messenger called TNF alpha. The medication lowers TNF alpha which is a marker of inflammation marker. So it lowers inflammation through that mechanism. This medication actually raises SHBG.  That doesn't mean everything that lowers inflammation will raise SHBG however.  Taken together with the viral information this suggest that there is some effects of different immune chemicals on SHBG.  You can read more about the causes of high SHBG and the link between SHBG and inflammation at the link above. 

Dietary and Hormone Causes of Elevated SHBG

Putting yourself in caloric restriction and reduced protein (often vegan and vegetarian) diets will raise your sex hormone binding globulin.  This may be more of an indirect route because of the effect on insulin.  We know that insulin is a stimulus to lower your sex hormone binding globulin.  Insulin goes up in response to things like eating a diet high in carbohydrates and protein.  So if you are eating less of these, insulin goes down and SHBG goes up.  There is also insulin like growth factor which is more of a growth hormone signal.  Lower amounts of this will also raise sex hormone binding globulin.  So if you are someone that is doing a lot of fasting or trying to lose weight and restricting calories, this may be why you have elevated sex hormone binding globulin. 

Something else to pay attention to is the timing of testing and what you are doing around the test as this may also influence your numbers.  For instance, if you are doing a 12 hr fasting test you may have a much higher SHBG because you will have lower insulin at this time.  To get a true sense you might want to test for SHBG in both fasted and non-fasted state. 

Thyroid hormone like thyroxine or t4 is also known to raise sex hormone binding globulin.  So if you are on thyroid medication, this would be something to look at depending on how important it is to get your sex hormone binding globulin down.  Some doctors are more aggressive and dose thyroid hormone high.  Your thyroid medication dose may be something to consider depending on how you are dosing it. 

The other thing to mention is that low free testosterone is a common reason this comes up to begin with.  Most people that are looking at how to decrease their sex hormone binding globulin are males with low free testosterone.  Wether you are male or female testosterone and other hormones are not just bound by sex hormone binding globulin.  There are other hormones  binding proteins that bind up hormones like albumin So if you have a low free testosterone and a normal total testosterone part of your issue may be related to albumin as well as sexual binding globulin.

This should answer the question, why would my sex hormone binding globulin be high and give you some ideas on what you can do about it.   If you have questions about anything in this article, ask it in the comment below.  If you want a customized plan, on how to lower your sex hormone binding globulin and hormonal imbalance, click on the link be low to get started. 

How do you test for MTHFR mutation? In this article we will discuss the different ways to do this. There are a few different methodologies to go about testing for MTHFR mutation with different pros and cons to consider for each of them. 

Maybe a more important question is why would you want to test for this to begin with. There may be certain lab values that are off or symptoms that are off.  So we will also discuss some of the things that make me think someone might have MTHFR mutation, in terms of lab values, clinical history and symptoms. 

If this interest you, keep reading we are going to get into the details.

Why Would You Test For MTHFR Mutation?

There are three basic ways that I would categorize testing for MTHFR mutations and all these are valid ways to do it.  I utilize all of them but some may be a little bit more reliable and some may come with some privacy concerns.  Depending on your preferences these may steer you in one direction or another. We will get into that in a second, but first why would you test for MTHFR to begin with?

It's always nice to know more information about your health but there are a few different health circumstances where I will encourage people to test for MTHFR mutation.  When these circumstances are present you should.  Wether or not everyone needs to know their MTHFR status is debatable.  I personally don't think it is necessarily for everyone.  If it is inexpensive and easily accessible for you, then it is probably worthwhile.  If you're having certain health issues then it probably is a good idea. What health issues?

The lab values that make me think there may be an MTHFR problem or MTHFR mutation is unexplained elevated MCV.  MCV refers to Mean Corpuscular Volume .  Since a corpuscle is a red blood cell, it refers to the size of the red blood cell.  It basically tells us about the relative size or volume of the cells.  When that number is always high, the reason could be MTHFR alteration.  Other methylation problem could cause the MCV to be elevated too.  B12 deficiency can also cause elevated MVC. So these two things need to be considered as the driving force for elevated MCV.  Since b12 deficiency is more common, most people treat this first.  It is also possible for someone to have a relative folate deficiency – but that's pretty uncommon in this day and age.  So if it's not b12 most there could be an issue with MTHFR enzyme. 

The other lab value or factor that makes me think about an MTHFR mutation is homocysteine.  Unexplained and consistently elevated homocysteine also suggests the same two factors (B12 deficiency or MTHFR mutation).  So those are two tests to look at and see if this could be a problem for you. They're not absolute but can give you a general idea.   You can have a normal MCV and a normal homocysteine and still have a significant problem with your methylfolate status in your body either from a deficiency or an MTHFR mutation.  This is a less common but it still can happen.

Symptom that that can be present with an MTHFR mutation are numerous, but only a few make me think you might have this genetic alteration.  The most commonly documented is mental health issues like anxiety and depression.  Specifically when there's a lack of response from conventional antidepressants and conventional treatments.  This is not suggesting that these are the only way to to treat anxiety and depression. There are many other ways. However, when you've been treated with antidepressants and you don't respond, it could be from a lack of this methylfolate.

Methylfolate is needed to produce some of your neurotransmitters to begin with.  When antidepressants are having their effect they may have less of a pool of neurotransmitters to work on.  Therefore, they may produce a reduced response.  So if you are someone that is not responding to antidepressants there's an increased correlation with MTHFR mutation.  Similarly I would put fatigue in that category.  Often times depression can manifest as fatigue.  So depression, anxiety, fatigue and some unexplained neurological symptoms all create more interest in MTHFR mutation. 

Learn More About MTHFR Mutation

How Do You Test For MTHFR Mutation?

• Genetic Genie
• MTHFRdoctors.com
• MTHFRsupport.com

Genetic genie is free (with the option to give a donation), so that is a bonus.  It does tell you about your MTHFR status.  If you are looking for a lot of other SNPs, you may be disappointed. It does give some but it is more limited than MTHFRdoctors.com and MTHFRsupport.com.  These different third party sites will have different SNPs that they check for.   If you have a newer kit from 23andme.com, they only have a few SNPs anyway.  Any kit purchased after early 2018 or late 2017 will have much less genetic health information on it (in terms of SNPs).  Prior to that the kits provide more information about different SNPs.  Currently, they do still provide you with your MTHFR status regardless.   So if you have a later dated one, it makes less sense to pay more for the expanded third party site because they don't have as much anyways.  So that covers the indirect ways to test for MTHFR mutation. 

The above mentioned ways are less accurate than some of the direct methodologies. With the direct testing the lab is specifically looking for this gene alteration. I don't have the specifics on why these are more accurate,  I just know there is some question about the accuracy.  The direct testing can be done through Quest labs or Labcorp and most major laboratory facilities.  These are probably a little bit more expensive than if you just test for MTHFR using a kit like from mthfrdoctors.com (mentioned above). 

Lastly is the direct comprehensive methodology. This offers more expanded types of genetic information.  This testing gives you your MTHFR and a bunch of other genetic information (SNPs). This and similar test are usually around $200-300.  As far as I know, you can not get access to these directly without a healthcare provider.  The only way I know of is to go through a doctor or a healthcare provider that has an account

Using the more direct methods there is more privacy because they have to follow HIPPA rules.  With 23andme I know they allow for third parties to anonymously harvest data for research.   They are not looking at individual information but looking for trends in the population that can be exploited.  With Lab Corp and Quest, the health privacy acts are in place.  The same privacy is in place for other vendors that do direct genetic testing. 

That should give you a better understanding of how to go about testing for MTHFR mutation and why you would think about testing for it.  If you need help testing or treating your MTHFR mutation, click on the link below.  For questions on the article content, please leave it in the comment section below. 

Why is SHBG low in PCOS?  What are the underlying factors that influence sex hormone-binding globulin in females and males? What could be driving this process over the short term and over the long term?  These are some of the questions we will answer in this article. 

If you're curious why sex hormone binding globulin is low in PCOS, keep reading we're going to get into the details. 

So why is sex hormone binding globulin low in women with PCOS?  First, let's define some terminology like sex hormone binding globulin and PCOS.  PCOS stands for polycystic ovarian syndrome.  PCOS is more of a syndrome than it is a disease state or concrete diagnosis.  We say this because it's more of a combination of several different characteristics or patterns, rather than a clear-cut physiology that everyone fits into.  Of course, there are some commonalities and distinct things about PCOS that other people don't have. Some of those things are:

• Weight gain and insulin resistance
• Decrease fertility and hormonal imbalances that make conception difficult.  (in more severe cases, there is a lack of ovulation)
• Androgenization, where females start taking on more male characteristics with a corresponding high testosterone (more specifically high free testosterone)
• Multiple ovarian cysts and other hormonal imbalances.

Not all women have all aspects of these signs and symptoms, however.  What seems to be most common among all women that get this diagnosis is ovarian cysts and insulin resistance. 

What is sex hormone binding globulin? It is often abbreviated as SHBG and basically what it does is carry hormones around in the body.  Specifically it carries estrogen and testosterone around.   When I say estrogen it's all estrogens, E1, E2, E3 and their hydroxy and methyl derivatives.  For testosterone it carries dihydrotestosterone and the other derivative forms of testosterone as well. 

Insulin and Why SHBG Is Low In PCOS

What happens with PCOS is androgenization and part of what's driving that is a decrease in sex hormone binding globulin.  The low SHBG happens through to two distinct mechanisms.  Before we get into that first let me explain a little more about the sex hormone binding globulin story.  Females generally have more sex hormone binding globulin because sex hormone binding globulin is increased in the liver from estrogen.  The liver produces this protein and it goes up when there's more estrogen floating around.  So estrogen works as a signal to make more sex hormone binding globulin.

The protein actually goes down in the presence of insulin.  We said in PCOS there is insulin resistance which means higher levels of insulin.  Because of this, the insulin drives down the SHGB.  Typically females have lots of this SHBG but because of the insulin resistance their sex hormone binding globulin goes down.  As a result there is less this floating around and binding up the hormones.  When this happens, the levels of free testosterone go up. 

What is free testosterone? With testosterone our bodies have total testosterone and then bioavailable testosterone.  Usually a fraction of the total testosterone is the bioavailable or unbound testosterone.  This bioavailable testosterone (aka free testosterone) means it is not bound to any other proteins.  Specifically sex hormone binding globulin is the protein that binds up most of the testosterone and the other hormones.  The SHBG works like a buffer. 

Again why is sex hormone binding globulin low in someone with PCOS?  Most of the time women with PCOS are producing more insulin because of insulin resistance.  In the presence of the same carbohydrate load or same macronutrient load, they need more insulin to get those nutrients into the tissues.  Insulin has an opposite reaction to sex hormone binding globulin production. When insulin goes up, sex hormone binding globulin goes down.  As a result of that, free testosterone goes up.  That increased free testosterone cause the androgenization.  So that is how that relationship goes and also how this issue seems to start. For some additional details check this article, on insulin and SHBG.

Role of Estrogen in Low SHBG and PCOS

In women with PCOS, there is also this issue with estrogen too.  Some women with PCOS have an-ovulation meaning they don't ovulate anymore or ovulation is limited.  This causes lower estrogen output.  As a result that lower estrogen also has an influence on SHBG.  With low estrogen, the SHBG will be lower compared to her female counterparts. 

Here is my theory on how PCOS starts and progresses.  At the beginning stages of PCOS there is insulin resistance, with this over time there is increased free testosterone and androgenization.  Next comes problems with the ovarian tissues and an-ovulation.  

We see the negative effect of high glucose and high insulin on other organs and other tissues.  For instance, glucose damages nerves, vessels, kidneys and the eyes.  So it would not come as a big surprise that the glucose (or insulin) is having a negative impact on parts of the ovarian tissue.  Over time there is decrease hormone output and response to other hormone signals.  In the later stage there is lack of ovulation.  This is a linear explanation of why SHBG is low in PCOS and how it is linked with high insulin and low estrogen.   However, while all these aspects are present PCOS may not progress in this linear fashion.  In fact some women with PCOS have high estrogen.  This is a working theory with some supporting research like this one, insulin activity on the ovary. 

Clinically we do see some or all these things reversed by treating the insulin resistance aspect of it.  Because the sex hormone binding globulin has a lot of different things that can influence it, you may not see a linear increase in your SHBG.  As long as you're treating the insulin resistance, you will see an improvement and the trend should get better over time. 

Hopefully that answers a question why is SHBG low in PCOS.  If you have any questions about your SHBG or PCOS, please ask them in the comment section.  To get help with your hormonal imbalance, PCOS or high SHBG, click on the link below to get started.  

Are you interested in doing the ketogenic diet but you heard about some of the bad things that you could happen like ketoacidosis, high cholesterol,  gaining weight and things like that? Some of the things you heard may be more of a ketogenic diet myth.  Like most myths there can be an element of truth in them.  So in this article we will look at some myths about ketogenic diet and separate the myths from truth.

If you are interested in the truth keep reading we are going to get into the details.

First let me list out the five myths about the ketogenic diet, then we will talk about each one in a little more detail. 

1. The ketogenic diet will cause ketoacidosis.
2. The ketogenic diet will make you gain weight.
3. Eating all that fat with the ketogenic diet will make you fat or gain weight.
4. The ketogenic diet will raise your cholesterol and have a negative effect on your heart.
5. The ketogenic diet is healthy for everyone regardless of your blood work and other health parameters.

Ketogenic Diet Will Cause Ketoacidosis

The idea that the ketogenic diet will cause ketoacidosis is a myth for most of us but it can occur for someone with Diabetes.  Specifically, it's type 1 Diabetes where this can occur. If you have Type 2 Diabetes, there are some scenarios where ketoacidosis can occur, but it is rare.

The main thing that creates ketoacidosis is when the body is not getting enough nutrients, specifically glucose, into the tissues.  As a result the body will be mobilizing all stored glucose and calories to keep the glucose and energy up.  At first the body can use the stored glucose called glycogen to raise the glucose.  This eventually runs out since there is no insulin (with type 1 Diabetes) to cause the cells to bring in and store more glucose.  Once the glycogen runs out, the body will mobilize massive amounts fat and protein.  The fat is used for fuel and the protein is turned into glucose through gluconeogenesis. The glucose is used for specific organs that require some glucose like the brain, kidneys, etc.  The massive amounts of fats are turned into massive amounts of ketones which create an acidic imbalance known as metabolic acidosis. 

The physiology that causes this acidosis state is almost always in the presence of Type 1 Diabetes.  There are some scenarios where it can happen with type 2 Diabetes as well but that's pretty rare.  To be safe you want to gradually make your dietary changes from high carb to moderate carb to lower carb diet.  If you make this change over weeks to months there is very little chance ketoacidosis will occur.  If you have type 1 diabetes the scenario may change a bit any you need to have closer monitoring from a doctor. 

If you your labs show you don't have  blood sugar or diabetic state, then you don't have to worry about ketoacidosis when starting a ketogenic diet.  

Ketogenic Diet Will Cause You to Gain Weight?

The second myth about the ketogenic diet is it will make you fat.  This can happen if you are not following the diet the way it was intended.  However, generally speaking eating fat is not going to make you fat.When you consume fats some are turned into ketones for fuel and most are stored in the body as fat.  However, when you don't consume much carbohydrates or protein and you do consume lots of fats, less of the fat is stored and most is turned into ketones to be used as fuel. 

So what is meant by not doing the ketogenic diet properly?  This means eating a lot of carbohydrates in conjunction with the fats.  Sometimes people will do "cheat days", and this can lead to a continuation of eating too many carbs on non-cheat days.   This will lead to weight gain.  In addition, eating too much protein can also be a problem and lead to weight gain. 

The other thing is you should be looking at your calories.  In some instances you can just change your macronutrient profile (carbs protein and fat percentages) to a low carb or ketogenic diet and you don't have to pay attention to your calories.  However, if you do that for a long time and you are not actually losing weight you may end up gaining weight.  So at some point you do have to pay attention to your calories too. 

When you consume a high carbohydrate high protein diet your body will produce a lot of insulin.  That insulin is making your body swell because insulin is a pro-inflammatory molecule.  More significantly though, insulin signals your bodies tissue to grow.  Insulin is an anabolic substance like a steroid in some ways.  Unlike steroids it causes fat and other soft tissues to grow.  So when you have a very high insulin your body tends to expand and gain weight.  For instance, a person eating the same calories in the presence of high insulin will gain weight.  Where the person with low or normal insulin will have stable weight or loose weight. 

Just by changing that one hormone through diet changes, you tend to shrink.  It really depends what you are doing now and what your insulin level is.  So generally speaking eating more fat will not make you fat because of the insulin issue. 

Ketogenic Diet Will Cause High Cholesterol?

Will the ketogenic diet raise your cholesterol?  This myth about the ketogenic diet can be true but it's not for everyone.  The thing is if you have high glucose, high triglycerides and high cholesterol, this pattern is often driven by a diet high in carbohydrates.  By lowering the carbohydrates you will see a decline in your LDL cholesterol and LDL particle number. 

Read More About LDL Cholesterol Testing

Most people that I recommend doing the ketogenic diet will see a reduction in their cholesterol because they have the pattern described above.  However, if you start the ketogenic diet and you have normal insulin and normal glucose, there is a chance that it will raise your LDL cholesterol (or LDL-p).  If you are getting a higher LDL particle number from the ketogenic diet then it's probably not a good idea to continue it. 

There are different things you can do to work around this problem.  In the long run though, if you have higher LDL particle number, then you really should not continue this diet.  Most of the time doing ketogenic type diet will improve your overall metabolism and cholesterol.  If you get the opposite reaction, it is not a good idea.  The reason this happens to some people and not others is not well understood.  In some cases there may be genetic reasons and in some cases unknown reasons.  Regardless you have to check the numbers and if they're getting skewed in the wrong direction stop and re-evaluate. 

When it does occur, the spike in LDL-p is coming from the saturated fat in ketogenic diet.  So you can still do a low carb diet and get your fats from non-saturated sources. 

Ketogenic Diet Is Good For Everyone

The fourth myth is that the ketogenic diet is good for everyone.  I already pointed out a few instances where the ketogenic diet might not be the best for your health.  There are also some things surrounding thyroid and digestion and adrenal issues that you want to be more cautious around.  In these cases potentially not do a ketogenic diet.  If you are having a hormonal issue with your cortisol and thyroid you probably wouldn't want to do ketogenic diet right out the gate. 

Reasons Not To DO Ketogenic Diet (coming soon)

In these cases making a gradual shift in some of your macronutrients might be more appropriate for you.  So there are some scenarios where you wouldn't necessarily want to do the ketogenic diet. 

Ketogenic Diet Will Never Make you Gain Weight?

The fifth myth to discuss has to do with weight again.  Just like some people are convinced that everyone will gain weight on the ketogenic diet, others get the erroneous idea that you can't gain weight on this diet.  That's simply not true.  If you eat too many calories you will gain weight.  It seems that some people no matter how much they eat have trouble gaining weight and they tend to have lower insulin levels.  In the case that you have a metabolic profile and producing a lot of insulin, eating more caloires will make you gain weight rapidly.  

To avoid this be sure to calculate your calories and macronutrients appropriately for you age, weight, gender etc.

Learn To Calculate Macros for Keto

Also be cognizant of the amount of protein, the amount of carbs and lastly the amount of fat.  Calories carbs and protein are all important for weight loss with any diet. They are particularly important when following the ketogenic diet. 

If you have question about the content above, ask it in the comments below. For a customized weight loss or health plan tailored to your body, click on the link below to get started. 

In this article we will answer the question can testosterone shots cause ED or erectile dysfunction?  We will also talk a little bit more about how testosterone can actually help or enhance erectile function.  If you are using testosterone shots, there are a few instances where this can actually worsen erectile function and you should be aware of those potential problems. 

If this is something that interests you keep reading, we are going to discuss the details.

Testosterone Shots Can Cause ED

Can testosterone cause ED? Is this possible? I think this question is interesting because a lot of people assume that more testosterone will make their erections more pronounced and improve their erectile function.  For the most part, this is true.  When your testosterone is low and you bring it up into a normal range, almost always there will be more erectile function.  However there are some distinct physiological areas that can actually get worse. 

In a previous article, we talked about how some people can get a paradoxical effect from taking testosterone. For instance, generally it will help with anxiety, help with mood, and it can even help with your ability to stay calm.  In some subsets of people it you can have the reverse effect. 

Can Testosterone Cause Anger and Anxiety?

In these cases, the person thinks they are in the optimal range but really the dose of testosterone is just slightly too much for their system. The testosterone is causing more anxiety and more irritability.  This generally has to do with the two issues estrogen and cortisol. 

How Testosterone Shots Cause ED Through Cortisol

With regard to erectile dysfunction the main thing that allows for the penis to get erect has to do with blood flow.  In medical school we learn two things 'point and shoot.'  The point part is related to parasympathetic activity and the shoot part as related to sympathetic activity.  These refer to two parts of the nervous system that control our state of relaxation and excitement. The parasympathetic activity is related to rest and digest.  This activity is associated with relaxation, calming and blood flow and dilation of the arteries.  If you are not able to get or maintain an erection, this could be that you have too much anxiety, worry, and cortisol.  Cortisol definitely can have a stress provoking  activity. It puts you closer to that stress threshold. Another way to think about it is the time to irritability or anxiety is smaller.  So there is a thinner layer between when you feel calm and when you feel agitation, anxiousness or worry.

When your testosterone is up at the high end, some will produce more cortisol.  With higher cortisol some people can get this erectile dysfunction effect, with an inability to maintain or initiate an erection.  You can see this too with the psychological stress and worry about the performance. There are definitely some psychological things that make the problem worse.  The idea here is too much testosterone can cause elevated cortisol which can be an issue.  

How Testosterone Shots Cause ED Through Estrogen

The second way testosterone shots can cause ED is through estrogen.  If you think your testosterone shots are causing ED, make sure you are checking your estrogen in the middle of your weekly cycle. For instance, if you do your injection on a Monday and you check your estrogen the following Monday you will not see the peak estrogen level.  To ensure you see the peak you want to make sure you check your estrogen 3-5 days after the injection.  If you are doing multiple injections per week then it is not as important.  Regardless you do want to try and catch the peak, if you are having ongoing erectile dysfunction and possibly from your testosterone shot.

The other thing to think about is higher doses of testosterone means higher levels of estrogen.  Sometimes people will not be able to see the estrogen as easily if they are using a standard estradiol test.  If you want to ensure you are measuring the whole true estradiol levels, test the ultra-sensitive estradiol.  This test uses a more accurate technology called mass spectrometry and liquid chromatography.  This will give you a clearer understanding of what your actual conversion of testosterone to estradiol is. Of course, the more estradiol you have the more counteracting of your free testosterone. The testosterone is what has the ability to produce more nitric oxide and dilate the arteries.  The arteries are what bring more blood flow to the penis to cause the erection.  If you have higher estradiol counter acting your testosterone, you are not getting the most benefit out of your testosterone shots. The same is true with other forms of testosterone replacement causing ED.  

Hopefully that gives you a better understanding of how testosterone shots can cause ED or erectile dysfunction.  If you have questions about the content here, leave it in the comments below. If you want a customized plant for your testosterone replacement or erectile dysfunction, click on the link below to get started. 

Who should not do a ketogenic diet? This is the question we will discuss in this article. The way I think about this question is to break it into four different sets of possible health problems.  People with problems in these four areas may not want to do the ketogenic diet for reasons we will discuss below.  At a minimum, people with problems in these areas should watch more closely if they are doing or considering doing a ketogenic diet.  There are a few labs and health parameters to follow and ensure these health issues are not occurring.  

If you are interested in this, keep reading we are going to discuss the details. 

Four Groups Who Should Not Do A Ketogenic Diet

So who should not do the ketogenic diet or who should be more cautious when they are starting a ketogenic diet? The four kind of health issues or categories that should cause a little caution with this diet are:

• high cholesterol
• digestive issues
• adrenal issues
• hypothyroid or thyroid issues

We will dive into each of these in a little more detail so you have some context and understanding of what to look for if you decide to do the ketogenic diet.

Learn How To Calculate Your Macro's For Ketogenic Diet

Those With Digestive Issues Should Not Do Ketogenic Diet

If you have problems with your digestive tract, in particular constipation and low amounts of the good bacteria, the ketogenic diet may make things worse.  This does not always happen but is common if you are not paying attention.  Now, I say this but it can also make things better too.  So let me give you some further details.

When you have low amounts of good bacteria, a high fiber diet is going to promote the growth of these microbes.  Fiber is main source of food for these bacteria.  When we talk about good bacteria and the microbiome we are referring to the bacteria in the large intestine. This is where most of the bacteria should be.  They feed off of the leftover fiber material that is not absorbed in the small intestine.  Lower carb and ketogenic diets generally are going to have less fiber in them.  To ensure this does not happen to you focus on eating a lot of vegetables like Brussels sprouts, cauliflower, broccoli and the like. These vegetables are low in net carbs but also high in fiber, so they work well for ketogenic and low carb diets. 

It is not necessary for people eating a ketogenic diet to eat a low fiber diet. So my first recommendation if you are going to do ketogenic diet and you have constipation or low good bacteria be sure you have plenty of the good fiber sources or high vegetable sources in your diet. 

I also mentioned that a ketogenic diet could actually make your digestion better.  This often occurs when you have bacterial overgrowth.   Sometimes people have too much bacteria in their small intestine which is higher up or before your large intestine.  This is known as SIBO or small intestinal bacterial overgrowth. You can read more about SIBO here. 

Even if you have an excess of bacteria or pathogenic microbes in your large intestine, limiting the amount of carbohydrates, could make your symptoms better.  You just want to pay attention and not be doing this long term.  Mainly because the good bacteria in your large intestine need a wide variety of fiber sources to thrive and do well over time. 

Those With Adrenal Issues Should Not Do Ketogenic Diet

The second category of people that should not do the ketogenic diet are those with adrenal and cortisol problems. When you are doing ketogenic diet, at least initially, your body is going through low blood sugar states off and on.  When you initially start doing the ketogenic diet you will have lower blood sugar at times.  This is partially what is responsible for the "keto-flu."  When this lower blood sugar state occurs, cortisol will be released from your adrenal glands to increase your blood sugar.  One of the jobs of cortisol is to mobilize the stored glucose in your cells known as glycogen.  When you have low blood sugar the glycogen gets mobilized to keep your blood sugar at a normal rate.  If you drop too low, it could cause a major issue for your brain, your kidneys, and other parts of your body.  Our body always need to keep a certain amount of glucose in the blood or it can be detrimental to these organs. 

If you are someone dealing with an ongoing stressful situation or chronic anxiety, the high cortisol from the ketogenic diet can make this worse . Over time the diet could actually improve your cortisol because your blood sugar will not be bouncing back and forth all the time (as it does on moderate to high carb diets).  Keep this in mind if you have a more fragile cortisol or adrenal issues.  Instead you should ease into the diet slowly.

Those With High Cholesterol Should Not do Ketogenic Diet

The third group who should not do the ketogenic diet are those with high cholesterol.  There are some cases or subsets of the population that really do not do well with high saturated fat.  This probably doesn't come as a surprise to most of us who have been following the best diets to lower cholesterol. Typically these diets focus on lowering saturated fats. However not everyone will lower their cholesterol by lowering their saturated fats. 

Most of the macronutrients seen in diets today are higher carbohydrates and sugar. These diets cause high insulin, high liver enzymes, high triglycerides, and high LDL cholesterol.  This kind of pattern is the pattern that the ketogenic diet will actually help.  Most of the time when these people consume a more ketogenic diet, they will see an improvement in their LDL cholesterol.

More on Cholesterol Testing

If you have a normal blood sugar and you have high cholesterol, there is less chance that your cholesterol will improve on the ketogenic diet.  To know for sure you should always test your levels.  Make sure you are not assuming that it is ok because you never had a cholesterol problem and you think you are "eating healthy." 

If you are just assuming it's gonna be better just because you are eating less carbohydrates it's not always the case.  Even for people that do you have the high triglycerides and high blood sugar, there is still a chance that things will get worse.  Keep that in mind and make sure you are checking your numbers when you are three months to six months into it.  If  your cholesterol goes up when start the ketogenic diet and it stays up, it probably will not go down.  There are some tweaks you can do to kower it while maintaining this diet.  Primarily you have to decrease the saturated fat in your diet.  In my experience that's the only way to get the numbers down or back into a normal range.

High LDL cholesterol (or LDL particle number) is the one cause that we know of that progresses cardiovascular disease (this and inflammation). Cardiovascular disease is the number one cause of death in the United States.  With that being said, high cholesterol is something that is very controllable through diet and other things. So don't overlook this if you are doing ketogenic diet. 

Those With Hypothyroidism Should Not do Ketogenic Diet

The last group that should not do ketogenic diet is those that have thyroid issues,  specifically hypothyroid.  I did post a separate video on this topic,  "Can You Do Ketogenic Diet If You Have Hypothyroid" (coming soon).  This article goes into more detail. The main point is if you have hypothyroid you should use a little more caution. The reason is the conversion rate between your T4 to T3 thyroid hormone can be slowed. Your T3 thyroid hormone is the more metabolically and energetically stimulating part of the thyroid hormone.  If you have lower conversion rate into this hormone, then you might have more hypothyroid symptoms.  It will not be a problem for everyone but it is something to watch out for.  You can follow both through thyroid lab testing and monitoring any low thyroid symptoms. 

This should give you a better idea of who should not do the ketogenic diet and who should be a little more cautious when they're thinking about doing the ketogenic diet.  If you have questions about anything in the article leave a comment below.  For a customized diet or health plan, click on the link below to get started. 

In this article we mainly will discuss how much iodine is too much.  To get a clear picture of this we want to look at specific iodine questions like:

• How much is too much?
• How much is too little?
• Testing to do to figure out if you have too much iodine?
• What problems can occur to your thyroid and your health in general from not enough or too much?

If this interests you, keep reading we're gonna discuss the details.

Why Iodine Is Important

We are going to discuss how much iodine is too much below, but first I want to give you a little background on iodine. Like why iodine is important and why this question is important to begin with.  Iodine is an essential trace mineral that is important mainly for it's importance with thyroid function.  When thyroid hormone is being produced one of the main components is iodine. 

A large portion of the population was deficient in iodine in the early 1900s.  and that caused thyroid problems. To solve this problem the government introduced iodine into the salt.  It is now known as iodized salt.  For the most part, this solution resolved most of the iodine deficiency in the United States.   

More recently in the last 20 years or so more and more people are using natural salt like sea salt and Himalayan salt.  These by and large do not have iodine in them not nearly to the degree that iodized salt does. 

So if you are someone living in an area where there is low iodine in the soil, the foods will also be low in iodine.  These people need to be more conscious of getting iodine from salt. Salt is not the only place we get iodine, however it is also in many seafoods.  If you eat prepared foods on a regular basis most place use iodized salt to season with.  So you are also getting iodine here.  Iodine can also be found in cheese and some vegetables. 

The RDA for iodine is around 50 micrograms per day and our bodies cycle through about one hundred micrograms per day.  So you really don't need to consume a whole lot of iodine on a day-to-day basis.  However your total body load, the total amount of iodine in your body is around 15 to 20 milligrams. This total body load will vary depending on your size.  When you are deficient depending on how long you've been deficient, it will take your tissues and body a while to get your total levels back to 15 to 20 milligrams. 

It may take months or even a year of supplementing with small amounts to get that level up because you don't want to do too much all at once.  Your body and in particular your thyroid can be pretty sensitive to the amount iodine you're consuming.  Too much iodine can disrupt the thyroid function just like too little can also disrupt the thyroid function.  If you don't get it right you have increased chance of Hashimoto's Thyroiditis, higher rate of hyperthyroidism and also low thyroid or hypothyroid. 

How To Cure Thyroid Disease

So we want to look at and sort out each one of these three different scenarios:

• autoimmune
• low thyroid
• high thyroid

Ultimately we want to answer how you can safely take your iodine without causing more problems to your thyroid or body. 

Research on How Much Iodine is Too Much

So in trying to figure out how much iodine is too much or how much you need, we want to look at some research looking at what happens when you take too much or don't get it quite right.  If you are already significantly  deficient and you start taking a moderate to higher doses of iodine it could cause problems.  Specifically it can shift your body into thyrotoxicosis which is a severe hyperthyroid state.   In this situation the person will have palpitations, anxiety, sweating, can't sleep, etc.  It is a very uncomfortable state. 

Another scenario is with autoimmune thyroid issues or Hashimoto's.  Some people have very mildly elevated thyroid autoantibodies and may not even know they have it. 

Read More on Hashimoto's Thyroiditis

If they start taking iodine and it can worsen or exacerbate this problem.  Sometimes people have antibodies but they are within the normal range and have a genetic susceptibility to Hashimoto's.  For these people, taking iodine can induce Hashimoto's or increase the amount of antibodies that are being produced.  So this begs the question, how much is too much?  

There's a study done in the American Journal of Clinical Nutrition that looked to see what a moderate to high dose of iodine would do in people that have normal thyroid function.  The study was done in healthy Chinese population and they were randomly assigned to receive different doses of iodine.  They received 400 micrograms and up.  The result showed that people getting the 400 micrograms started to see a decrease in thyroid function.  Not all of the people did but about 5% of the participants that did get the iodine started to get a decline in the thyroid function.  As that dose went up the amount of people that saw a decline in thyroid function also went up.  The decline in thyroid function reached 50% at the 2 milligram dose.  Usually  the upper recommended dose for iodine is around eleven hundred micrograms . This is what's usually thought of as the upper limit.  As this study illustrates you don't even need this much to potentially cause a problem.

To me it highlights the idea that you really want to know what your iodine levels are before you start taking it.  Also to a certain extent you want to know what your antibody levels are.  

Testing How Much Iodine is Too Much

With all the above in mind, most people that take iodine will be fine without causing long-lasting permanent problems, but it can.  The simplest way to approach this is to get your iodine level checked before you start taking even small amounts.  It's a good idea. 

If your levels are normal, you could still take a small amount of iodine but you probably want to be more cautious.  The standard test for iodine is called a serum plasma iodine test.  It is done through a simple blood test that most labs can perform.  The cash price is expensive so if you have insurance you probably want to use that.  If your levels do come out low that means generally it is safe for you to take iodine.  However depending on how low it is will dependent on your dose.  You also have to consider how long your level has been low to understand how long you should continue taking it.  You could simply run the test again periodically as well.  Let's look at a few hypotheticals. 

If your level is below 35 micrograms per liter,  you want to start with a lower dose. It is probably best for everyone to start with the lower dose but these people specifically should start with a lower dose and titrate up.  The reason is when you are low to being with you can trigger thyrotoxicosis (hyperthyroidism).  You can go up to around that 1000 or 1100 micrograms but slowly over a four to six-week period. 

Regardless of dose, you want to make sure you are re-checking your levels every four to six weeks.  If you are lower then when you started (and this can happen), you probably need a higher dose.  In other cases your levels may come out much higher.  In this case you need a lower dose.  Each time you check your levels you should avoiding the iodine for up to three days before you do the test.  This will ensure that the dose that you took that day and subsequent days is not still in your system.  This ensures you are looking at what the total body levels are.  Eventually you don't want to be supplementing with the iodine every day . You are also trying to find that dose that is not going to increase your levels too much to negatively affect your thyroid function normal.  

That should give you a deeper understanding of how much iodine is too much, how much is too little and how to supplement with iodine when  you want to optimize a low thyroid function with iodine.  Again iodine can cause problems if you get too much so make sure you're not overdoing it.  If you have questions about your iodine supplementation submit a comment below.   If you would like a customized plan on iodine and thyroid support, click on the link below for a free consultation to get started. 

Do you have hypothyroidism? Are you wondering if you can do the ketogenic diet when you have hypothyroidism? 

The short answer to this question is you can.  The more long nuanced answer is the subject of this blog post.  We will discuss: 

• What labs to do if you have this concern.
• What things to consider if you are looking at this diet and have hypothyroid. 
• What some of the research has to say about this question.
  

So if you want to know the details keep reading we will get into the details. 

Can You do a Ketogenic Diet If You Have Hypothyroid?

The thing with the ketogenic diet and hypothyroid is that there is a theory or hypothesis that this diet will slow the conversion of your T4 into T3.  To that you might say, why is that important? 

Well T3 is the active form of your thyroid hormone.  T4 is the main thyroid hormone that your thyroid gland makes.  The T4 hormone does not really do a whole lot in terms of thyroid activity in your cells and tissues. However it is converted in the peripheral tissue, your cells and tissues all over your body, into T3.  These levels of T4 and T3 can be measured in your blood.  The theory is that following a ketogenic diet will cause less of this conversion into the active form of the thyroid hormone. 

By the way, this T3 hormone is also responsible for the thermogenic and metabolic effects of your thyroid hormone.  So if you are making less of this then potentially you will to be less metabolically active.  Most of the people doing the ketogenic diet are doing so to lose weight, not everybody but most. 

Read More on the Health Benefits of The Ketogenic Diet

In that sense then maybe thyroid effects are negating some of that weight loss effect of ketogenic diet by reducing the conversion of your T4 to T3.  Let's take a little deeper dive into this and look at what some other research actually says about it. 

Research on Ketogenic Diet and Hypothyroid

One study looked at children that were put on a ketogenic diet to prevent seizures.  These were epileptic children that medications were not working for to lower or prevent their seizures.  Over the course of about one year the researchers found those on this diet had a statistically significant increase in the diagnosis of hypothyroidism.  Specifically, about 17% of the children they followed were diagnosed with hypothyroidism.

Another smaller study looked at the same demographic and they found a trend towards decreased thyroid function.  This study was over two years but they did not find a statistically significant increase in actual hypothyroidism. With that said, there was a small trend toward decreased thyroid function. 

A few studies in adults looked at the same question.  These did show a decrease in some of the thyroid measurements like a decline in some of the thyroid measurements.  Specifically they saw a decrease in the conversion of T4 to T3.  The actual T3 measurement was lower but there was no change in the T4 measurement.  They didn't show any statistically significant change or impairment in things like metabolism or the overall thyroid function.  There was also no increase in thyroid symptoms.  So it wasn't clear overall that people were getting hypothyroidism. It was clear that there was a decrease in the overall T3.

So what could be going on here is a possible increase in cortisol.  When doing ketogenic diets your glucose levels are lower and cortisol is secreted  to increase release of stored glucose.  This is what cortisol does.  This increased cortisol could be taking some of the T4 and putting it into what is called reverse T3.  That reverse T3 is no longer accessible to get converted into the T3.  It's also possible that the body could just be more efficient and so there's less conversion going on because less T3 is needed.  Those are two possible scenarios that could be going on when you are doing a ketogenic diet.  So now you might be asking what does this mean for me?  Can I do the ketogenic diet if I have hypothyroidism? 

Bottom Line With Ketogenic Diet and Hypothyroid

You can do the ketogenic diet when you have hypothyroid.  You should be aware that the conversion of T4 to T3 could go down.  As such, if you do have hypothyroidism you should be a little more cautious in doing a ketogenic diet.  You may want to get these tests done before you are already on the ketogenic diet.  You should be measuring T4 and T3 and compare after you are on the diet and make sure it doesn't go too low.  Usually when we measure this it is the free T3 .  You can and should also measure the reverse T3 and look at cortisol.

If you are doing ketogenic diet and you have low thyroid function you should be measuring these tests before and after starting.  If you are not having a whole lot of symptoms of low thyroid like weight gain, feeling cold,  hair loss, fatigue, etc then maybe you don't have to worry about it as much.

These are some things to think about when you are doing ketogenic diet or considering ketogenic diet and you have hypothyroidism.  If you have questions this content or about your thyroid function after starting a ketogenic diet leave it in the comments below. 

Click on the link below, if you want a customized plan for your thyroid, hormone, or and health in general. 

Are you looking for a way to fix your irritable bowel syndrome and improve your digestion? This article will look at three different ways to approach this for those that are new to this diagnosis, and those that have a more chronic case of IBS.  The article is broken down into the following three sections:

• Simple approach
• Strategic approach
• Traditional approach

The first thing to think about when you are trying to fix your Irritable Bowel Syndrome or improve your digestion is that not all cases are the same.  With IBS there are different variations of it and these variations have different causes.  IBS is not just one thing.  For instance, there is IBS-C and IBS-D. These differentiate the people that have more constipation type and more diarrhea type.  However, even within these categories there are different variations and causes.  Despite this, we often think about, discuss, and treat it as one thing.  To some extent it does have similar causes but they're not always exactly the same.  So before we can look at the different things that are impacting your iBS and how to improve digestion, we want to ask what is IBS to begin with.  Then we will look at the different variations and causes. 

IBS is the term given to people that have significant digestive distress and all other natural causes have been ruled out.  IBS stands for Irritable Bowel Syndrome.  It is a syndrome because basically it's a bunch of symptoms but there's no known specific pathology that applies to all cases of IBS.  Typically people with this diagnosis have seen a traditional Gastroenterologist.  These doctors work to rule out that you do not have Ulcerative Colitis, Crohn's Disease, GERD, Celiac's Disease, Cholecystitis, some other gallbladder issue, or major digestive problem.   So all the known or solid diagnoses that have clear treatment paths in traditional gastroenterology get looked at and ruled out first.  Once these are ruled out, you are left with the diagnosis  of IBS.  Even though, as we said IBS is not all the same for everyone.  

Traditional Way to Approach IBS

Traditional doctors usually do a good job at pin-pointing one of these other diagnoses and when your don't have these you get labeled with having IBS. 

With this in mind it is not a bad idea to explore traditional digestive diagnostics to see if you have one of these other things.  So, the first way to approach curing your IBS, is to get a traditional GI doctor evaluation. You can also go to your primary care doctor and rule some of these things out.  If you do have these other digestive problems (mentioned above) and not IBS, there are alternative ways to treat these too. 

If you end up with the diagnosis of IBS, it is best to approach it with more curiosity than the common conventional medicine approach.  This conventional approach is changing to include more modern testing for IBS, however.  Depending on the doctor that you see they may include some of the approaches listed below. 

Simple Way to Fix Your IBS

Now let's say you have ruled out all these other organic or underlying pathologies (listed above) that may be causing your digestive problems.  What do you do next?

I break this into two categories simple and strategic.  Depending on how long you have had the digestive problem or what you have tried you may decide to do a simple approach or a more strategic one.

Usually if it's a newer diagnosis or you haven't tried a whole lot of things you might want to try the simple approach.  This approach does not require a whole lot of guidance.  Whereas the strategic may be for somebody that has more chronic digestive problem and already tried a few things already. Let's first take the simple approach.

This approach focuses on foods that might be contributing to your digestive problems.  Foods like dairy gluten and others can have a negative impact on your digestive system and even cause IBS like symptoms.  I like to break the foods that do this into three main categories: 

• Food sensitives
• High Histamine
• High FODMAP's

So these are three categories of foods you can avoid to see it improves your digestion.  These are diet experiments that you can do to see how these foods are impacting your digestion.  Keep in mind, there is some overlap between the categories.  You certainly would not want to eliminate all three of these at once but it may be an experimental thing that you may find beneficial.  Let's look at each in a little more detail. 

Learn More About IBS Triggers

Food sensitivities

Many people have heard of the Autoimmune Protocol Diet (or AIP). This diet focuses on removing all the common food sensitives.  It is considered a hypoallergenic diet as it removes a lot of the food culprits that typically cause inflammation and GI distress.  Other people may know this diet as the elimination diet etc.  You can also perform a blood test for food sensitivities.

High Histamine

High histamine foods are another category and these do have some overlap with the autoimmune protocol list of foods. Some of them are high histamine food but not all of them are.  With high histamine foods there's no consensus on which foods are always high.  As a result this can be a little bit tricky to figure out at first.  High histamine foods are typically more of problem for people that also have moderate to severe allergies,  in addition to having digestive symptoms.

High FODMAP's

FODMAP stands for Fermentable Oligo-Di-Monosaccharides And Polyols.  An easy way to think about this diet is that these foods are highly fermentable carbohydrates. There is a lot of information on high FODMAP foods, so it is pretty easy to research. The only thing is there are a lot of foods in that category.  So you generally want to look and see how am I responding to these. 

Remember that foods that trigger your IBS symptoms may be a signal that something deeper is going on with your microbiome.  This is specifically true with high FODMAP foods.  It could be a signal that you actually have bacterial overgrowth or some microbial imbalance.  If this is the case you probably want to take care of that rather than just eliminating the foods.  The reason is the diet itself is not really getting at the underlying cause.  With that being said, if you do find benefit from removing these, it may be a temporary and partial solution.  At some point you would want to get some support from a doctor to actually test and treat you for the SIBO or whatever microbial imbalance is present. 

Fix Your IBS Strategically

The third way to fix your Irritable Bowel Syndrome is strategic.  To make sure you are not missing anything, I recommend testing for microbiome issues first.  The other testing to consider are food sensitivities, leaky gut, sampling of your microbiome, pathogenic microbes, SIBO, and candida. 

You don't need to do all these at once but you want to think about them strategically (see specifics below).  Once you've done these tests and you have some positives test results, the treatment is usually pretty straightforward.  How you sequence the treatments together is not always obvious, however.  Testing does help clarify what's going on and what you should do in a basic sense.  It doesn't always give 100% clarity into what's going on with your body now and what happens when you start the treatment.  Because these test are often expensive to do, most people will not be running these test every 3 months or even 6 months.  So how do you know what to do when you are not getting the desired results?

Be Strategic

Here are some general rules to follow.  Start by treating or ruling out that you don't have anything seriously compromising to your body.  These include microbial infections or imbalances.  You want to look and see if you have any of those first.  You might want to do the SIBO test, look for Candida antibodies in your blood, or do some other stool test to look for pathogenic or potentially pathogenic microbes. 

If those are present then obviously you will treat those.  When you are treating those how do you know when the bugs are gone or the imbalance is fixed?  Some people get worsening of symptoms during the treatment course.  This is a sign you should likely pause the treatment temporarily but it typically tells you that this is a significant problem for you body. 

What you are looking for through the treatment is either a dramatic improvement in your symptoms, like fifty or seventy-five percent or flare-ups or worsening of your symptoms.  When there are flare-ups you want to back off and support the underlying digestive function. 

Sometimes depending on where those flare-ups are occurring, the rest of the body's cellular function needs support as well.  The amount and duration of treatment pressure to apply is not a one size fits all.  Similarly the amount of cellular support you give to the person at any given time needs to be specific for them.  You can base this off of symptoms, genetics, or test results. 

Once the microbial issues have been ruled out or eliminated, then we would move on to things like genetics or other food related issues.  So these are some strategic ways to approach finding the cause of your IBS and improving your digestion.  

Hopefully that gives you some better clarity on how to fix or cure your irritable bowel syndrome.  Do have questions about any of the content here or something that's going on with your IBS?  Ask it in the comment section below.  If you want help figuring out a strategy to fix your Irritable Bowel Syndrome, click on the link below to get started. 

In a previous post we looked at 2 common Physiological Causes of Anxiety.  That article looks specifically at the role of hormones and biogenic amines on anxiety.  Here we will at the role of digestion, nutrition, and addictive substances as physiological causes for anxiety.

Digestive Problems Can Be a Physiological Cause of Anxiety