Customized Medicines

Customized Medicines
Dr. Sonja O'Bryan, Pharm.D., ABAAHP Board Certified Health Practitioner Diplomate-American Academy of Anti-Aging Medicine: "Creative Medicines" for Hormones-Weight-Pain-Fatigue-Skin Diseases-Pediatrics-Autoimmune Disorders-Veterinary Needs. Using Complimentary, Integrative, Regenerative, Bio-Identical, and Lifestyle Medicine For Health and Healing.

Monday, June 25, 2012

So You've Been Told That Your Thyroid is "Normal"

Well, might want to ask some more questions.  In fact, even if you have been diagnosed with hypothyroidism, you will want to ask more questions.  There's a lot to this topic but I will try to encapsulate it the best way that I can so that you can direct your care better with your physician.

The thyroid gland secretes approximately one teaspoon of thyroid over an entire year, but it's becoming more and more obvious to me after my reading and research that that teaspoon is an absolute powerhouse in terms of metabolic control and disease prevention.   So let's highlight some things to help you understand better.  Today I will cover hypothyroidism.  NOT enough thyroid is basically what that means.

Signs and Symptoms of Hypothyroidism.  (pay attention here if you have been told things are normal yet struggle with these problems, okay?)

Brittle nails
Cold Hands and Feet
Cold intolerance
Difficulty swallowing
Elevated cholesterol
Eyelid swelling or swelling under the eyes (periorbital edema)
Hair loss
Hoarseness in your voice
Low blood pressure
Inability to concentrate
Menstrual irregularities
Muscle cramps/weakness
Slow heartbeat
Weight gain
Thinning of the eyebrows especially on the outer third portion (the "sign of Hertoghe") 

Diagnosing Hypothyroidism

Conventional:  The TSH value taken from a blood draw has been the gold standard for over 30 years.  The normal range from most laboratories is 0.5-4.5mIU/L. When TSH is above this range >4.5, a diagnosis of hypothyroidism is given.  I find it interesting that several decades ago the upper limit was 10.  So, that means that people were walking around with thyroid disease (according to today's ranges) and suffered unnecessarily.  Thankfully the range today is lower, but is it really low enough?  According to the thyroid guru Dr. David Brownstein, NO!!  It's not!!!  He uses a top number of 2 mIU/L as his laboratory guide in his patients.  That's 2 (t.w.o) and not 10 (t.e.n.)  Wow!  Huge difference from back in the day.  So, if you've had a TSH drawn in the past, you might want to revisit your records and see what the number was.

Listen to this from Dr. Brownsteins book, "Overcoming Thyroid Disorders" (second edition), a national best seller.

 "There are many physicians and organizations who believe the "normal" upper limit of the TSH range should be lowered from 4.5 to 3.  This may result in the doubling of the numbers of individuals diagnosed with hypothyroidism by blood tests from approx 13 million to 26 million."  Imagine what the numbers would be if we were still following 10 as the upper limit.  Yikes!!!

Holistic: Thyroid blood tests including TSH, T3 (active form), T4 (inactive form), Reverse T3, medical history of symptoms (remember those listed above), basal body temperature (should be between 97.8-98.2 degrees), and physical exam.

Those additional labs are important because if someone is low on T3 for instance, they will feel worn out and fatigued, depressed, and will appear to age rapidly.   Most physicians will make the diagnosis and put patients on Synthroid (T4).  But what if you are also low on T3?  Levothyroxine alone is going to do nothing for that and you will not feel much better.  ALL HAVE TO BE CHECKED.  Many thyroid experts use a combination of T3/T4 (Armour Thyroid) in their patients because they feel so much better.  There also is a diuretic component of Armour Thyroid which can really help alleviate swelling that is commonly found in hypothyroidism. I actually make special strengths for patients in our lab which are free of fillers, preservatives, etc.  My patients on these products do very well!!!

A study from the New England Journal of Medicine found that adding a small amount of T3 to patients already on Synthroid or levothyroxine (T4 only) significantly improved mood and brain function.

Factors that Cause an Inability to Convert T4 to T3 ( and BTW, some people are just poor converters)
1)Nutrient Deficiencies: chromium, copper, iodine, iron, selenium, zinc, Vitamin A, Vit B's
2)Meds: Beta blockers, Birth control pills, Estrogens (synthetics), Lithium, Dilantin, Steroids, Theophylline
3)Other factors: Aging, alcohol use, Lipoic Acid, Diabetes, Fluoride, Lead, Mercury, Obesity, Pesticides, Radiation, Stress, Surgery and Chronic Illness.

If you are on any of these medications or have any of these conditions, your thyroid may have gone ca-put a long time ago.  It has left you struggling with the symptom list that I highlighted earlier.

Hormone replacement therapy often includes birth control pills to prevent pregnancy or synthetic menopause agents to help with the symptoms of menopause.  Anything other than bio-identical hormones can result in an increase of thyroxine binding globulin (TBG) which leads to a decrease in the amount of thyroid hormone that is available for the body to use.  The thyroid experts will only use bio-identical hormones which are customized to each an every individual patients needs.  That's what I do too.  According to Dr. Brownstein, patients thyroid function improves when they eliminate the synthetics and use bio-identicals.

Here's another one for you.  The relationship between infertility and hypothyroidism has been known for over 50 years.  Undiagnosed fertility problems can have thyroid disease at the core.  Get checked if you are trying to conceive a baby!!!  Physician colleagues at a recent conference that I attended shared story after story regarding patients who simply needed a comprehensive thyroid evaluation which later resulted in pregnancy.

In my experience of doing hormone replacement therapy for women, it's not uncommon for me to hear that a woman had a hysterectomy and took no supplementation of hormones.  Years later, wala, they end up with hypothyroidism.  They come to my office to see me and on their medication list I will find Synthroid or levothyroxine.  That's because when one gland system (ovaries in this case) are depleted of key hormones, then other glands try to compensate for the loss.  This ends up causing problems for the "overachieving" gland later on down the health road.  It's just the way the body works.  Getting hormones evaluated and into proper balance will help your body's system communicate better instead of short-circuiting.  Sooner....rather than later.... is the key here.

There's so much information surrounding good thyroid health.  I will cover more of this in the days and weeks to come but for now this is a lot to digest.  I certainly hope this helps you to realize that it's not all in your head when you are suspicious that something is out of whack internally.  I believe you!!!  Get this little POWERHOUSE gland checked out and let me know if I can help in my realm of expertise.

Remember: TSH of 2, T4, T3, Reverse T3, physical exam, medical history, and basal body temperature.  That's the place to start.  :)

To your good health,
Dr. Sonja

Thursday, June 14, 2012

Beware of Fables on Labels: Choosing a Great Vitamin

A very common question that I get is "Dr. Sonja, what vitamin do you recommend?"  In fact, that question came in as a text to my cell phone just this morning from a friend.  I love helping people feel better and look better so I thought I would answer it to the masses so that others may benefit from the information as well. Specifically, I'm going to tell you what I have used personally for over 11 years now.  Time flys!!!  It's easy to remember the beginning point of my healthy lifestyle transition because I got ON the weight loss wagon right after my youngest child (I'm a mother of 3) was born and I never fell OFF the wagon (so to speak). Yeah for me!  Really what happened was that this large woman kept jumping in front of me when I went to look in the mirror.  I finally had enough of her (smile) so I began to make her eat better, and forced her to exercise, and said goodbye to the bad habits she was influencing me to fall victim to.  I also started using a nutrional supplement program which I recommend to anyone wanting to lose weight and gain control of their health. 

Before I tell you the specific products that I use, I will give you an easy-to-understand  listing of some common nutrients and what to look for when you want to provide your body with key sources of energy, metabolic enhancers, and nutritional builders for overall health and longevity.  It would be a very long blog if I tried to put everything in here, but I will give you some concentrated information to help you in making your decision.  Beware: Not all vitamins are created equal and I don't want you to fall victim to Fables on Labels.  So here are some key ingredients to look for.  If you find a product with most of these things in it, I don't think you can go wrong in making it your choice. 

Alpha-Lipoic acid: antioxidant and energy production, eye health, and heart health.
L-Arabinose: decreases glucose by action on sucrose
L-Arginine: an amino acid helping with muscle maintenance, immune health, and blood flow
N-Acetylcysteine: an antioxidant, helpful in memory and in reducing homocysteine
Ashwagandha: Good for health and longevity, stress, and inflammation
Beta-carotene: a precursor of vitamin A which may prevent cancers
Beta-glucan: helps with cholesterol clearance
Bitter orange: metabolic enhancer, increases norepinephrine and epinephrine, promotes weight loss
Chromium: improved glucose control and improved lean muscle mass
Calcium caseinate: makes proteins pass more slowly through the gut enhancing satiety
Chaste tree extract (vitex agnus-castus): helps with hormone normalization.
Coleus extract (forskohlin). Highlighted on Dr. Oz show.  Increases lean muscle mass and burning fat
Cranberry juice powder: urinary deodorizer, mild diuretic
Dong quai extract: Urinary tract health and menopausal symptoms
Whey proteins: a protein source helping in weight loss management
Fructooligosaccharides (FOS): helps with digestion and intestinal function
GABA: energy and focus. 
Glucosamine: cartilage formation and repair
L-Glutamine: Helps with immune function and preservation of muscle mass.
Grape extract: contains polyphenols which induce endothelial vasodilation and promote heart health
Guar gum: used to reduce cholesterol (likely by its binding properties)
Hawthorn extract: increases blood flow and supports cardiac muscle health
5-hydroxytryptophan: mood and performance
Iodine: participates in thyroid hormone synthesis
Magnesium: Cardiovascular and muscle function
Magnolia extract: helps with anxiety
Melatonin: sleep
Milk Thistle: liver protection
Nettles extract: common in herbal products produced in Germany for inflammatory conditions
Omega Fatty acids: helpful with blood pressure, smooth muscle, and inflammation
Vitamin B-5 (pantothenic acid): breaks down carbohydrates
L-phenylalanine: an amino acid helping in mental energy and focus.
Resveratrol (also highlighted on Dr. Oz): a potent antioxidant. It's reported to slow aging
Silicon: a trace mineral which leads to collagen production
Teas:  please refer to another blog that I wrote on various teas.
Valerian: an herb known to calm and help with sleep
Vanadium: strong glucose lowering properties and common in weight training programs.

Wow!  That's a lot of information to digest. (no pun intended).  At this point simply review the list and target the nutrient items that you feel would give you the most benefit in your physical need. 

I personally use a product line from Advocare. is the link. You can give them a call to find out how to get a discount and become a member if you wish.  That number above is my ID which might provide 20% off but don't quote me on that.  On their website you will find various products to target what you are looking for.  Trim, Well, Workouts, etc.  I found this company years ago and feel that their Medical Advisory Board is second to none. Their expertise is incorporated into their "blends" and nutrional systems and I feel that it saves me money in the end because I don't have to buy everything individually.  Also, when I read clinical nutrition articles I often see some of their names which justifies my opinion even more.  Please do your homework and see what you think.  Many professional athletes (and teams) use this product line as well.  Check their endorsers out too. Wow!

On the weight loss note....

Early on in my weight loss journey I used their package deals which came with shakes, drinks, vitamins, and everything.  If you are really serious about weight loss, that's a great place to start.  You buy the package deal and just stick to it like a prescription.  It works!  Currently, I don't have to be as aggressive with my supplements but want to maintain the level at which I am.   I now purchase about 6 things that fit my body's needs and have maintained less than 120 pounds for over 10 years.  A Doctorate degree in Pharmacology didn't hurt anything either.  :) We carried the product line here for several years but found that supply and demand was difficult to keep up with and just began pointing patients to the site for their favorite items.  I love the Spark.  I love the MNS supplement line (has tons of these ingredients).  I love the Catalyst.  Try it!  I think you'll like it.

I also recommend a product line called Cardiotabs.  We carry that line here in our store and our local physicians direct people over all the time.  This line was developed by a Cardiologist and the ingredients are also blended to promote cardio health and longevity.  The CardioTea is great.  The Omega and Vit D lines are great.  The cholesterol product Red Yeast Rice is great and comparable to prescription cholesterol lowering agents.  If you have this need, it's a great place to start.  I can answer your questions if you want to go that route. 

I sure hope this helps you.  Don't be afraid to send me your questions or interests beyond this post to my Facebook, email, or website.  I want you to have a healthy life and a long life.  That's my wish and goal for you!!  Get started!!! 

To your good health,
Dr. Sonja

Wednesday, June 6, 2012

Symptoms Can Be Deceiving

Symptoms can be deceiving when it comes to determining what the real problem might be for an individual.  Are you gaining weight and not eating?  Is your skin oily and are you getting adult acne?  Do you have unexplained anxiety? Growing hair in the wrong places? Not sleeping?  Tired yet wired? Let me just give you a run down of some common concerns that I hear in my office and tell you what the problem often can be related to.

Aches and Pains
Low Cortisol
Estrogen Dominance
Low Tesosterone

Acne and Oily Skin/Unwanted hair growth
High Testosterone

Estrogen Dominance
Too much caffeine
Diet pills
Deficiency of B vitamins
Chronic Stress

Cold Hands and Feet
Estrogen Dominance interfering with thyroid function
Low thyroid
Poor circulation due to excess sugar in the diet
Insulin resistance

Dry, Brittle Hair
Estrogen Dominance creating low thyroid function
Low Progesterone

Fat Gain
Low Cortisol
Estrogen Dominance
Lack of Sleep
Poor diet
Low DHEA (in fact Dr Oz highlighted this hormone on his show).  But don't just take any DHEA.  It's important to have a professional evaluate the other hormones to see which one is right. Truth!

Fibrocystic Breasts
Estrogen dominance (application of progesterone to the breast can clear this up)

Foggy Thinking
Low Estrogen
Low Testosterone
Estrogen Dominance
Low Blood Sugar

Heart Palpitations
Low Cortisol
Low Testosterone
Low Blood Pressure

Hot Flashes
Low Estrogen
Low Progesterone

Estrogen Dominance
Too much caffeine
Progestereone Deficiency
Excess Cortisol

Low Estrogen
Estrogen Dominance
High Testosterone
Excess Cortisol

Headaches (especially premenstrual)
Lack of Progesterone
Estrogen Dominance

Sexual Issues/Vaginal Dryness
Low Estrogen
Low Testosterone

These hormone imbalances can all be tested very easily with your doctor (serum) or from the convenience of your own home (saliva testing).  Determining the specific hormone levels and how they play a role in your symptoms as an individual provides the best approach and the best outcome in bettering your personal health.

To your good health,
Dr. Sonja

Tuesday, June 5, 2012

I trained with the best. Caught up with Dr. Morley. One of my favorite preceptors at the VA

Dr. John Morley: Geriatric researcher and physician, accidental humorist - St. Louis Beacon

Real Men have Real Man-o-pause

Did you know that men are not exempt from the downsizing of hormone levels as they age and androgen deficiency is often undiagnosed and untreated?  Remember from your biology lessons that androgens stimulate and control the development and maintenance of male characteristics and that the most well-known androgen is testosterone.  If you have been watching TV commercials, you will see low T highlighted everywhere.  Why? As men age, the production of testosterone goes down, down, down causing a once active and energetic man to become more sedentary and uninterested.  There are more and more men coming to my office to get tested for what they think might be problems with low Testosterone.  I know...I's not easy for "real men" to step out of their comfort zone and get things checked, but once the problem is identified and treated, they ALWAYS wish they had sought professional help sooner.  If you were wondering, but never thought to ask your provider, I've created a list of the common problems that men face as they age.  I promise you those guys that keep beating you in golf, who are now looking slim and trim, and bulking back up are probably coming in to pick up their 'low T' mojo.  Just sayin'

Symptoms of Andropause (the clinical term for male menopause) can include these things that become problematic and frustrating for many men as the production of testosterone begins to decline.

Symptoms of Andropause:
SLEEP disturbances
Decreased libido
Decreased stamina
Erectile Dysfunction
Prostate Problems
Decreased urine flow
Increased urinary urge
Lack of motivation and interest
Premature aging
Hot flashes
Night sweats
Mood swings
Abdominal Fat and weight gain
Decreased strength
Decreased mental sharpness
Elevated triglycerides
Bone loss
Memory lapses
Decreased exercise capacity
Decreased beard
Breast enlargement
IRRITABILITY and SNAPPY OUTBURSTS (highlighted b/c it's a common complaint)

Testosterone deficiency symptoms tend to come on gradually for men and they don't always know what hit them.  The testes produce nearly 95% of all male testosterone and at 40 years of age (or so) there is a decline in testosterone production which continues on throughout the later years of life.  By the mid to late "40 something" years, testosterone is down to about 40% from peak levels, A recent study by the World Health Organization which tested mens T levels at age 25 and THEN AGAIN at age 70 found that these men's T levels decreased by 90%.  Remember that's 45 years of data on the same guys.  That has a huge impact on men and the way that they feel.  How could it not?!?!

So what's the big deal by not doing anything? 
Well today there are numerous studies that are finding a link between disease and low Testosterone levels.  In one study, nearly 800  (EIGHT-HUNDRED!!!) men were evaluated with study results showing that there was a 33% greater risk of death (that's D-E-A-T-H, croaking, flatlining) for men with low T vs. those with normal T levels.  These men were more likely to have elevated inflammatory markers which lead to many diseases.  The men with low T were also more than 3 times more likely to have a waist circumference more than 40 inches, low HDL (good cholesterol), high triglycerides, and high blood pressure and blood sugar.  You can take your Lipitor and blood pressure medicine, but perhaps getting to the root of the problem is a better area of focus.  Fix the testosterone, fix the other problems.  And if you are on any of these other medicines, I need to guide you on the nutrients that they deplete from your system.  It's sad but true.  Be informed!!

And did you know that GUYS get osteoporosis too?  Roughly 1/3 of all hip fractures occur in men.  By about age 55, they face almost the SAME risk for osteoporosis as menopausal women.

In a study of male veterans, low serum T levels were shown to increase the risk of death in the next few years by 88%, according to a report in the Archives of Internal Medicine. That's compelling evidence if you ask me. 

If you have any of these symptoms, please get your T levels checked.  I have many patients who have been diagnosed with low T and found the answer and resolution to many of their health needs. The testing in simple and something you can do from your own home for the low cost of $60.   I am a STRONG supporter of saliva testing for testosterone imbalance.  I have plenty of studies to show that BLOOD does not always detect the levels well.  In other words, you may be told that everything is "NORMAL" and then test by saliva and realize that you are very low.  TRUTH!  Happens ALL the time.  I will work with your personal physician (for your) if you are suspicious that you are dealing with Andropause. Man-up guys and give me a call.

To your good health,
Dr. Sonja