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.

Saturday, July 27, 2013

The High Cost of 10 Years Without Hormones

I went on a rant (in another blog) about one ago.  WHY??? Because in 2002, women were told to get off their hormone replacement therapy because of a position statement surfacing out of the WHI study with skewed  evidence that hormones caused cancer and they were bad for women.  I read the study and saw the bullet holes all throughout it.  Even the highly esteemed Dr. Dobson made a plea to re-evaluate the evidence.  I have that document in my office to this day btw. Things just didn't match up.  Here's why. The women were much older in the study and well beyond the storms of the menopausal years, and they were not looking into cardiovascular, osteoporosis, general health, cognitive, and other needs, ..... just cancer.  That study was OVERTURNED 10 years later and it hit the national news.  Guess what???   They said, we relooked at this, and actually, hormones are good for women if there are not other contraindications or risks preventing their use in an individual.  They went back to the study and looked closer.   The study used SYNTHETIC hormones derived from horse URINE (Premarin) and not bio-identical therapies which match what the body normally produces.  Those types of hormones do have an increased risk of cancer  because they come from non-natural sources. Unless, of course, you consider horse urine to be natural.  Ick!!   I pitched a FIT FIT FIT around here.  My staff can tell you.  I said, WHAT ABOUT THE YEARS LOST for these women?  They have been without hormone therapy for 10 years because of this!!    I'm pretty passionate about what I do if you can't tell.   I've seen the benefits in hundreds of patients throughout the years.  And, I read like a madwoman to try to stay abreast of all that is happening in this growing niche of health and wellness.  I'm a bio-identical hormone user myself.  'nuf said!
......Well, this just OUT!  We are now seeing attention given to the evidence that this was bad advice for women.    This is now why women are seeking help in practitioners offices all across America and abroad to get help.  It's grown tremendously in the last 5 years especially.  Cardiovascular disease is the most prevalent risk for women (not cancer) and those women without hormone replacement therapy for all of those years are now statistics in this most current study.   At least ~20,000 are dead and perhaps as many as 90,000 due to heart disease as they look retrospectively at this decision.  Sad!
Philip M. Sarrel, Valentine Y. Njike, Valentina Vinante, and David L. Katz. (2013). The Mortality Toll of Estrogen Avoidance: An Analysis of Excess Deaths Among Hysterectomized Women Aged 50 to 59 Years. American Journal of Public Health. e-View Ahead of Print.    doi 10.2105/AJPH.2013.301295

Accepted on: Feb 18, 2013


The Mortality Toll of Estrogen Avoidance: An Analysis of Excess Deaths Among Hysterectomized Women Aged 50 to 59 Years

Philip M. Sarrel, MD, Valentine Y. Njike, MD, MPH, Valentina Vinante, MD, and David L. Katz, MD, MPH
At the time of the study, Philip M. Sarrel was with the Departments of Obstetrics and Gynecology and Psychiatry, Yale University School of Medicine, New Haven, CT. David L. Katz was with the Prevention Research Center, Yale University School of Public Health, Griffin Hospital, Derby, CT; and with the Department of Medicine, Yale University School of Medicine. Valentine Y. Njike was with the Prevention Research Center, Yale University School of Public Health. Valentina Vinante was with the Departemento di Sanita Pubblica, Universita di Firenze, Florence, Italy.
Correspondence should be sent to Philip M. Sarrel, MD, Emeritus Professor, Yale-Griffin Prevention Research Center, 130 Division St., Derby, CT 06418 (e-mail: ). Reprints can be ordered at by clicking the “Reprints” link.
P. M. Sarrel directed the literature search and assessment, and wrote the primary draft of the article. P. M. Sarrel and V. Y. Njike acquired the data. V. Y. Njike analyzed the data and developed the data tables. V. Vinante conducted the literature search. D. L. Katz developed the MTEA formula, reviewed and edited drafts of the article. All authors participated in data interpretation and critical article review.


Objectives. We examined the effect of estrogen avoidance on mortality rates among hysterectomized women aged 50 to 59 years.
Methods. We derived a formula to relate the excess mortality among hysterectomized women aged 50 to 59 years assigned to placebo in the Women’s Health Initiative randomized controlled trial to the entire population of comparable women in the United States, incorporating the decline in estrogen use observed between 2002 and 2011.
Results. Over a 10-year span, starting in 2002, a minimum of 18 601 and as many as 91 610 postmenopausal women died prematurely because of the avoidance of estrogen therapy (ET).
Conclusions. ET in younger postmenopausal women is associated with a decisive reduction in all-cause mortality, but estrogen use in this population is low and continuing to fall. Our data indicate an associated annual mortality toll in the thousands of women aged 50 to 59 years. Informed discussion between these women and their health care providers about the effects of ET is a matter of considerable urgency. (Am J Public Health. Published online ahead of print July 18, 2013: e1-e6. doi:10.2105/AJPH.2013.301295)

Thursday, July 25, 2013

Maybe It's Stress

If you have stress in your life, raise your hand.  ~I see those hands!!  Have you ever wondered how stress impacts your other hormones, your immune system, and the weird symptoms you think might possibly be related?   It's my aim to answer those questions today.  You can put your hand down now. (smile)

Here's what happens: When there is a stress signal sent through the sympathetic nervous system, a stimulus package is initiated in the hypothalamus and the pituitary gland releasing ACTH which then produces cortisol, and DHEA through the adrenal cortex.  This cascade is intended to provide anti-inflammatory help, and shuttle glucose to the brain, heart, lungs, and skeletal muscle. This is required by our body to help us make a quick getaway.  More energy is needed right? Have you ever heard of those amazing stories where people lift a car or tree off of someone?  That's stress on steroids.  Literally!!

Cortisol works with the liver to provide the glucose, but prevents fat breakdown elsewhere in the body to conserve energy stores.   That can be a major reason why someone is holding fat in their midsection.  Stress! Cortisol levels are usually their highest in the morning and decline throughout the day.  However in acute stress, there will be very high cortisol levels all throughout the day. If that goes on and one for a long season of time (stress, stress, stress,) then there will be a low cortisol in the morning.  Often people will complain that they are extremely tired, but wired.  They couldn't get sleep if they wanted to.  This person will literally be running on Cortisol empty and things will seem to be falling apart..... or in this fun comic strip, your stripes will feel like they are falling off.

DHEA is another prohormone that is forced into action with a stress response.  I have tons of patients who test their DHEA levels and they are low, low, low.  DHEA stimulates our immune system.  When there is not enough DHEA in our body, it's not a good thing.  I promise that you will feel the effects.  (I'm raising my own hand here.  I treated myself for some adrenal fatigue years ago) DHEA maintains tissue strength and repair, supports bone, is neuroprotective, and promotes a sense of well-being.  If you don't have enough, guess what you are going to feel like?  Crummy, blah, pitiful, fatigued, feeling sick, irritable, frumpy, and dumpy.  DHEA levels peak somewhere between 20-30 years old and after 40 the levels tend to decline markedly. Many studies provide evidence that low DHEA levels result in depression, forgetfulness, brain fog, lack of vitality, and poor immune status. 

Sometimes the body has to decide what to do because Cortisol and DHEA are derived from the same precursors.  The body says, should I produce one, or the other, or both? In normal circumstances, the body does a great job at providing both, and in good balance.  But, when we have a lot of stress in our lives, there is a preferential drive toward production of cortisol.  This is referred to as cortisol steal.  This person will have higher cortisol levels, and lower levels of DHEA and all the other hormones downstream. Long term cortisol production is associated with immune suppression, high blood sugar, insulin resistance, abdominal fat, high blood pressure, memory impairment, high cholesterol, and impaired thyroid function.  Not a good thing! This can only go on so long and then the adrenal glands take a vacation without giving you notice.  You are left to go about your stressful daily business without the hormones you need.  And the coffee pot and chocolate bars will become your best friends.

It is important not to make assumptions when a person may have hormonal imbalance. Fatigue and hot flashes might make you think of estrogen deficiency but there's so much more that has to be considered.  By testing the adrenals along with the sex hormones, I've seen over and over that the imbalance can rest on the premise of stress and cortisol steal.  The body will steal progesterone, and DHEA to get the steroid high that it needs.  If you don't address this contributor, the estrogen you might put on board for hot flashes will only benefit a person so much.  Then the other hormones needs to be balanced as well. If pregnenolone and progesterone are low because of the 'cortisol steal', then the other hormones will not be synthesized either.  It's a downhill snowball effect on your other hormones.   Test it and address it!

Hopefully you realize after reading this that living on stress is not the best.  I understand that we can't excuse ourselves from our stressful jobs, family needs, and life events, but we can manage our physical "self" to help us weather the storms of life much better.  It's important to get to a professional that can identify the root cause of the fatigue, hot flashes, irritability, poor sleep, poor healing, poor immunity, and so on.  Each person is unique in their daily activities, stress levels, age, and adaptability to the juggling act of life.  Knowing what your levels are and how to treat them appropriately is significant in your efforts to live happy and healthy.  In the majority of those suffering with this, it's just a simple and manageable regimen that needs to be implemented.  Core supplements and vitamins are essential and beneficial in combatting this along with custom therapies to restore the lacking hormones.  ~That's years of experience talking here.

Call my office and I can tell you how to get tested in a convenient and affordable way.

To your good health,
Dr. Sonja

Wednesday, July 24, 2013

The Future of Medicine Now

The realm of integrative, complimentary, restorative, and anti-aging medicine is growing at an unprecedented rate.  It's exciting, because for years and years, I trudged along building a foundation for something that I knew would come. Attending conferences, joining webinars, teaching programs to community groups and churches, going back to the classroom myself with the American Academy of Anti-Aging Medicine, and talking to physicians was the norm for so long.  It wasn't easy almost 2 decades ago when The time is here!!  Now, the calls are coming in to us with questions on how we might provide unique solutions to individuals needs.  I'm grateful for that and look forward to additional growth in the future.  It's coming! 

There are things I've learned over the course of my professional career and some transitions that are taking place.   I encourage you to add you thoughts and comments about the view on "modern medicine".  Here's my two cents:

~People want NATURAL when possible. 

~People are seeking options that used to be considered "alternative".  Now we're finding that they should have been included all along.

~Hormonal imbalance affects everything from menstrual cycles, fertility, mood, vitality, heart health, bone strength, cognitive function, sexuality, rapid aging, weight management, sleep and the list could go on and on.  And except for menstrual cycles, that's a statement for both men and women.  We are seeing more and more attention being drawn to this in the media and in health articles.

~"Normal" ranges aren't always in sync with a patients symptoms.  For 30 years we had a "normal TSH range" for thyroid that has now been adjusted ~6 points lower.  That means that for decades, people were being told they were 'normal'.  They would be on therapy by today's tightened ranges.  Sad!  Medical oopsie that cannot be reversed.  We can't afford these kind of oo-boo's.   It really makes people wonder what the word "normal" really means, and if it can be trusted.

~Often nutraceuticals (vitamins, herbs, and supplements) can be used to treat/prevent common things.  If you are NOT on certain nutritionals (omega's, Vitamin D, core vitamins ), you are more prone to disease.  The studies prove it's true.

~Band-aid medicine is NOT the best answer.  It just covers up the problem.  What is the underlying reason?  That's what people want to know. 

~People can't afford to go to the doctor and are looking for other avenues and options to treat their problems or better yet, to prevent or minimize them from happening. I design custom regimens tailored to family disease and inherited risks.  If you are in your 20s, 30s, 40s, it's absolutely necessary for you to get started in prevention.  That's Anti-Aging medicine at it's best. If you are doing nothing, me ASAP.

~ Customized medicine is often much less expensive than the pharmaceutical approach.  It's not just for the celebrities in Hollywood.   We have hundreds of women and men on Bio-identical Hormone Replacement Therapy and we've had some of them for many years.  Why is that?  They feel better and want to maintain their health and longevity as much as possible.

~Bio-identical Hormones are the best approach in treating imbalances and can change the "issues" men and women are having.  If you have never heard this term, please do some reading.  If you've never heard about Adrenal Fatigue, do some reading.  Please, please.

~Anti-depressants, Anti-anxiety medicines, pain medicines, and sleeping pills are prescribed as the magic cocktail for aging when other options need to be investigated.  Sadly, they have done a poor job at mitigating these conditions for the long haul.

~Diet and Lifestyle awareness is trending.  We all know we could do better.  Some choose to, some not so much, but overall I think there's an increased awareness.  (Maybe I'm just looking with a glass-half-full mentality??)

~Our modern day foods are saturated with pesticides, chemicals, preservatives, artificial sweeteners and hormones but the truly organic versions are way more expensive, so people can't afford to buy them.  Bringing those prices down is an economic benefit to healthcare costs in the end.  Reward farmers who want to provide quality and not quantity.  Reward consumers who want to eat better. Healthy should not only be for the wealthy.  Can I get an amen?

~People need more time with their doctor for their needs to be fully expressed.  The average time is about 7 minutes.  Sad! I hope you don't forget to remember (smile) what you're supposed to talk about in that short of a time period with your physician or practitioner.  Have you ever left the office saying, "Crud, I forgot to ask about that!"?  Of course you have.  When I wrote my hormone handbook, I included a section at the back of each chapter to allow personal notes as a reminder to discuss those issues with the doctor.  It has worked well for women. 

~We will see a growing number of physicians abandoning the corporate practice world to provide specialty care and to truly build relationships with their patients.  Its already happening and I can give you specific names.  High five to them!!

~There's something to this autism and ADHD  thing with children.  I don't have the answer, but I believe there's a need for funding in research and programs to evaluate every possible cause. (vaccines, food, maternity care, etc.). Integrative Medicine has done a great job in leading the way for possible reasons and interventions to help.  Parents of these children are heroes and sheroes!!

~People are starting to talk more openly and seek answers.  A referral is the highest compliment to me and I'm always thankful when a friend refers a friend.  Tell your story and your success and cheer each other on. 

~Statistics are now showing that half of Americans are headed for obesity.  That number is higher than ever.  There will be a tremendous burden to our healthcare system and to each of our pocket books if we don't turn this cat around.

~Pain management is a huge issue and prescription pain pills are known to cause problems with hormonal imbalance, gastrointestinal motility, respiratory function, and mental clarity.  We are providing a greater amount of customized pain therapies for those patients needing control of pain.  Physicians are now being educated about topical pain management more than ever before. 

~Customized therapy is not always a first thought with people.  But, you need to know it IS an option and the last thought should sometimes be your first thought.  Call us and we can offer options and bill your prescription insurance. 

~People are seeking physicians who are in tune with this niche of medicine.  The textbooks of 50 years ago are good, but we've come a long way baby and we now know so much more.  That's called progress and some providers just aren't willing to change. Thankfully, I work with some of the best and brightest this country has to offer and who take time to update their intellectual data bank.  They're out there, you just have to find them.

Okay, enough for today.  I would absolutely LOVE to hear your perspective on this note.  This is a compilation of what people are talking about in my world.  Comment away!

To your good health,
Dr. Sonja

Friday, July 5, 2013

Fibromyalgia: Haven't Got Time For The Pain!

I've been at this for just a little while, and I will have to admit that I cringe almost every time that I see the diagnosis of Fibromyalgia on a patient's profile.  Muscle pain, weakness, extreme fatigue, morning stiffness, depression, insomnia, (and more) are often the self-reported symptoms that a person explains as I do consultations in my office.  The frustration and the reason I cringe is that "it" (Fibro) has kind of a big question mark ? over it.   Unlike just taking someone's blood pressure, cholesterol, or blood sugar and seeing that it's unusually high, I think most doctors would tell you that Fibromyalgia is a bit more complicated to piece together as the culprit for the way a person is feeling and existing.  It's typically a real struggle for a patient to go about their normal activities of daily living.  Some (~most) try to be "troopers" and grin and bear it, but if they could speak candidly, I promise they would tell you that they hurt and ache significantly. 

Here's a little image I pulled from the National Institutes of Health site showing the facts about Fibromyalgia. 

Fibromyalgia is a common burden in our society with an estimated 7-10 million people being affected and happening (typically) between 29-37 years old as a median age of onset. And did you know that, nine out of 10 of those with Fibromyalgia are women?  Yes, 90% are women. Just stop and think about the implications of those statistics on families, careers, and activities.   WOW!  These young people really haven't got time for the pain!

Fibromyalgia was probably described in the 17th century as "muscular rheumatism", but didn't really get as much attention in medical circles as we have today, or get it's name "Fibromyalgia" until the mid-1970's.     Perhaps this is mostly because the most distressing symptom, pain, cannot accurately be measured or quantified.  Although one can't put an objective measuring stick on the pain level,  he/she can recognize other characteristics and contributors to Fibromyalgia that may help for the long haul in wellness and health.  After reading this blog, I hope you will realize that there may be underlying reasons for the pain which need to be investigated and addressed.  Treating symptoms with band-aid medicines doesn't really help with the root cause and often ends up with poly-pharmacy situations with one medicine counteracting another.  Truth!

The most common symptoms of fibromyalgia are muscle pain, typically in the shoulder or upper arm, and often accompanied by sleep disturbances.  Early morning awakenings, feeling tired and unrefreshed, as well as mood and cognitive disturbances are reported.  Trigger points related to erythrocytes and skin blood flow have been studied and patients getting injections of lidocaine and glucose to those pain points often report reduced pain.

Muscle biopsies in those with longstanding Fibro have a common finding of Type II fiber atrophy (google for info).   Patients also typically have hormonal imbalance with elevated values of ACTH, FSH, and cortisol, but lowered levels of thyroid hormones and estrogen.  I have many patients with Fibro who seek help with hormonal and thyroid problems because it helps in reducing their pain.  Most patients with Fibro also complain of insomnia and sleep difficulties.  Melatonin may be altered, but backing up into the metabolic system even more, most patients are found to have lowered serum serotonin and tryptophan which are essential in forming melatonin. Without the precursors, the active can't be formed appropriately.  Also, I'm sure you're making the connection to lowered serotonin and depression as well.  Lowered serotonin typically results in lowered mood, poor sleep, fatigue, and the general blah's.  Are you seeing the links?   Sometimes natural therapies can be added to a vitamin and supplement regimen to help compliment the serotonin levels, which then boosts the melatonin levels, which also helps with sleep, which also helps with.... see what I mean?

I've also mentioned in other blogs a treatment that I customize for combatting pain and inflammation at the cellular level.  That's treating things at the root cause right there.  Low dose naltrexone is currently being used in clinical studies, but is also available through sources and professionals like me.  Why wait?  Check out for more information about this effective and upcoming treatment agent for this and a host of other conditions, including autoimmune disease and cancer. 

Here's another critical link that we are aware of today in modern medicine.  In patients with Fibromyalgia, there is often an infectious root.   You mean this might be related to an infection process??? Yes! Infection!   Mycoplasma, viral (Hepatitis), bacterial (Chlamydia), and fungal (candida, Cryptococcus, asperigillus) infections are found as single, double, and triple infections, in some cases with incidence of up to 80% at times.  You may have been exposed to these things, didn't know it, and never made the connection to your pain. If you suffer from Fibromyalgia, have you ever had an infectious disease work-up? ...... No?  Then get with your doctor ASAP!  Not just a general, "do I have an infection panel?", but get a very specific panel to test for infections that we now know are linked to Fibromyalgia disease.  An anti-microbial protocol (antibiotics/probiotics/vitamins) might be your answer to helping to eliminate the pain and discomfort of Fibromyalgia.  Get to a doctor that knows what to look for on the infectious disease side of the Fibromyalgia diagnosis.  The evidence is speaking for itself and I encourage you to do your own homework on infections as a cause. 

Certain nutritional supplements are a MUST in helping to support a healthy GI tract, in boosting immunity,  and in bolstering the body system as a whole for improved well being.  And remember, hormonal imbalance, low brain transmitters, and poor adrenal function can all affect Fibromyalgia symptoms and severity.  Call me on those!   I'm always ready to do things to help you in the areas that I have training and experience with and I can point to you even more resources on integrative and effective approaches that I customize in our lab for patients.  I have a network of great physicians that I can recommend for those wanting more answers to their Fibromyalgia needs. 

To your good health,
Dr. Sonja