Bone Loss With Aging

Stats:
Over her lifetime, a typical woman will lose 42% of her spine and 58% of her femur.  In the U.S. an estimated 34 million people are at risk for developing bone loss, and 80% are women.  Fractures result in 800,000 emergency room visits, 2.5 million office visits, and 180,000 nursing home placements costing an estimated $14 billion.  20% of women die within the first month of their femoral fracture.  Sadly, most screenings for bone loss do not begin until age 65 when a significant amount of bone loss has already happened. 

Anti-Aging Bone Health
It is imperative that young women have regular menstrual cycles, adequate Vitamin D levels, and adequate calcium and protein during the ages of 15-25.  This is an important time of bone maturation, strength, and density.  I encourage young women to be on a supplement that contains Vitamin D, calcium, and multivitamins because this time in life is so important.

Biphosphonates
This class of medication was first developed for Pagets Disease in the 1960's. They were not intended for the treatment of osteoporosis, but in the 1990's we saw marketing for these agents come about to help with bone density loss. 

~Reversible side effects of this drug class: Kidney toxicity, join pain, muscle aches, fever, musculoskeletal pain, gastritis, low calcium (wow!!), eye complications, asthma (aspirin-sensitive), altered taste, and central nervous system side effects.

~Irreversible side effects with chronic use
Osteonecrosis of the jaw.  (Awful!!)  Have you ever wondered why dentists offices want to know if you are on Fosamax, Boniva, etc?  This is why.  Look up information about the mini-epidemic called "phossy jaw" related to factory workers with jaw necrosis after continuous exposure to phosphorous fumes. 

Spontaneous femoral fractures.  Even though some might consider this a rare side effect, when one considers that 190 million prescriptions are written worldwide for osteoporosis, this could translate into millions of men and women with the risk of potential fractures.

Hormones and Bone Health
Vitamin D is a steroid hormone and along with parathyroid hormone, and calcitonin, carefully control calcium metabolism. Limited sun exposure, skin pigmentation, and geography are well recognized causes for low Vitamin D.  I suggest 10-30 minutes (at least) in the sun each day.  It's a natural way to obtain Vitamin D.  In the winter months, it might be advisable to increase your Vitamin D supplement regimen due to less exposure to the sunshine.  D essentially drives calcium into the bone. It's important to have both in your vitamin regimen.

Sex Hormones
~Estrogen deficiency accelerates bone loss. 
~Progesterone deficiency is connected with reduced bone growth.  Women who have consistent low progesterone and those who do not have menstrual cycles are at risk.  It is important to supplement progesterone in young women especially who have PCOS (polycystic ovary syndrome).
~Androgens (DHEA and Testosterone) are important for bone health in both sexes.  Low free T is associated with increased hip fractures. DHEA levels directly correlate with bone mass. 
Plain and Simple: IT IS IMPORTANT TO ASSESS AND ADDRESS HORMONE DEFICIENCIES!!

Melatonin
Melatonin has positive effects on bone.  It directly stimulates osteoblasts (bone builders) and increases collagen production.  It also enhances sleep which indirectly raises growth hormone levels.

Vitamin K
Specifically K2-of the 3 forms of Vitamin K, this one is made by bacteria in the gut, ensures calcium is deposited in the bone and not into the arteries. 

Here's a good protocol to follow:
Vitamin D3: 2,000-5,000 units/day
Vitamin K2: 50-150mcg/day
Vitamin C: 1000-4000mg/day
B Complex Vitamin
Vitamin E: 200-800 units/day

Magnesium
This is one of the most common mineral deficiencies in adults.  High doses of calcium, without magnesium, can worsen magnesium deficiency. 

Potassium Citrate
Oral supplementation has shown an increase in bone density of postmenopausal women. 

Diet and Exercise
An alkaline diet rich in fresh fruits and vegetables, with limited protein and avoiding dairy, artificial sweeteners, and preservatives promotes an alkaline environment leading to improved bone health.

Exercise two times a week helps to maintain bones, and three times a week (or more) has been shown to increase bone.  Get out and exercise!

To your good bone health,
Dr. Sonja

Are You Tired of Being Tired?

Are you tired of being tired?  If you are like most Americans you will probably answer "yes" to this question. Stress and fatigue are the main reasons that people go to the doctor these days and they present themselves in the most unusual of ways.  Honestly, often symptoms of stress can look similar to hormone imbalance so getting to the root cause of the problem is key in making a patient feel better and gain some control back in their life.  A simple test can provide the clear answers to a "stress fracture" (play on words) instead of a hormone problem.  But before we get to that, here's some simple facts on the issue of stress and running around like crazy people all the time.  See how you measure up.....

First let's start off with the common causes of stress these days:
Anger/fear
Worry/anxiety
Depression
Guilt
Overwork/physical or mental strain
Excessive exercise
Sleep deprivation
Poor digestion
Chronic illness
Chronic severe allergies
Use of steroids
Insufficient sleep
Surgery/trauma
Death
Divorce
Injury
Inflammation
Infection/Injury
Chronic pain
Temperature extremes
Toxic exposure
Malabsorption
Hypoglycemia
Nutritional deficiencies
Jobs
Family issues
Alarms clocks/deadlines
Finances
and many others that you can add to the list

The Effects of prolonged stress:
Weakness
Unexplained hair loss
Nervousness
Lowered body temp
Weak muscle tone
Irritability
Depression
Difficulty with weight
Apprehension
Hypoglycemia
Inability to concentrate
Excessive hunger
Poor memory/confusion
Digestive dysfunction
Feelings of frustration
Osteoporosis
Auto-immune disease
Heart palpitations
Dizziness
Lowered resistance to infection and colds
Low blood pressure
Insomnia
Sweet/salt cravings
Headaches
Rheumatoid Arthritis
Weight gain
Inability to make decisions-Indecisiveness.
Respiratory illness/colds/bronchitis
Fatigue and reduced stamina



It's common to hear that people are worn out these days and just can't seem to get enough sleep.  "I'm dragging", "I'm asleep by 8 o'clock", or "I'm just tired of being tired." I hear these from men and women all the time.  In fact, I visited with a physician group today and in their assessment forms for patient referral they were delighted to see an evaluation area for stress and lifestyle influences.  Why? Because stress and lifestyles factor in to the equation of hormonal imbalance and it's important to include. 


Other reasons to test:
The "stress hormones" are important to evaluate because if a woman has low DHEA 'prior' to menopause, her chances for cancer are increased.  Conversely, if the levels are high 'after' menopause, her chances for cancer are increased.  It's important to know how your body is adapting to stress, the influence it has on you at your age, and ways to compliment your body's response to stress for health and longevity.  If your Cortisol is in the tank, then you're going to feel like you're in the tank as well. It's a fatigue indicator that can be evaluated.  Listen up! These same hormones, if out of balance, can cause a host of other problems as well.  The list goes from depression, to weight gain, to vaginal dryness, to poor blood sugar control, to immune problems, and on and on.  You better believe that I test my hormones and my adrenal EVERY year without fail.  It's key to an individuals peak performance.

So how do you test for stress? 
Call our office and we can explain the process to you.  It's very, very simple and affordable.  A testing kit can be mailed to your home and we can guide you on the best day and time to send your sample.  A common profile to assess key sex hormones and stress hormones typically costs less than $130.  If the kit comes from my office, I will be the one to read the results and connect with you personally. If you have great insurance and want to have your doctor do a lab evaluation, the same key hormones can be tested by blood.   I just met with a client who has great insurance and will head in to her doctors office to get tested soon. 

So, if you're tired of being tired, call us ASAP.  Our staff is ready to help and I personally can direct you on the best supplements for your lab profile and additional health problems.
 
To your good health,
Dr. Sonja

An Up Close and Personal Testimonial

  This is one of those blogs that makes me smile.  Why?  It's about someone close and I love her story and know that you will too.  

It's great to see celebrities come forward with their treatments and recommendations, but I think there's greater importance when family and friends share their personal stories about the same things.  This is written by my sister-in-law Stacy about what hormone "balance" and testing did for her.  This is what I'm blessed to get to do everyday both professionally and personally.

Stacy Weaver O'Bryan Testimonial

" Unfortunately, for years I had suffered from endometriosis, fibroids, and a couple of other factors, which ended with me having a full hysterectomy at age 39. My hormones were already very out of whack, and, thinking back on things, my gyno NEVER questioned me about my moods, only my "plumbing" issues. FORTUNATELY, my sister-in-law is Dr. Sonja Pinnell O'Bryan!! After a casual yet in depth conversation about Bio-Identical Hormone Replacement Therapy, I decided to pursue treatment through Sonja. I had to talk to my gyno about using Bio-Identical Hormone Replacement Therapy, who wasn't familiar with it but was willing to work with Sonja to design my hormones. He now refers clients to her :) Wait, wait, back to ME! Since starting my Bio-Iden's, I have felt GREAT! My moods are mellow, I have energy, and I finally feel like myself. Also, I have found it easier to lose weight - actually 47 lbs! It seemed before that no matter what I did I couldn't lose weight. Once I started seeing my weight loss efforts were finally paying off, it was easier to change my eating lifestyle since I could see it was now beneficial! Dr. Sonja has been a blessing to work with, she is very concerned to help me be as normal as possible :) I have found it very important to communicate with Sonja about issues I may be having - it's amazing what hormones control. Many many many thanks to my sister-in-law, my friend, my medicine maker!!!" For more information on testing and treatment: drsonjaobryan@gmail.com

Hormones and Weight: The Link

 This blog looks at one family of hormones, the steroid hormones, that have been closely linked with how your body manages to control your weight, and when “out of balance” may result in weight gain. This family of steroid hormones can be grouped into the sex-hormones and adrenal hormones. The sex hormones include the estrogens (estradiol, estrone, and estriol), progesterone, and testosterone. The adrenal hormones include DHEA and cortisol. 
Estrogen and testosterone
Estrogens are known as the female sex hormones and testosterone as the male sex hormone. While both estradiol and testosterone in fact have a wide variety of functions in both sexes, women in their youth have about ten times more estrogen than men, and men have about 10 times more testosterone than women. These stark differences in estrogen and testosterone levels in women and men define many of the characteristics that make men and women look and behave differently, including the way our body fat is distributed.
Women tend to have fat stores under the skin (subcutaneous fat), around the hips, and in the breasts. This results in the characteristic female curves that contribute to the characteristic hour-glass figure. When estrogen levels are high, excessive fat deposition occurs primarily around the hips and thighs leading to the typical pear-shaped body type, referred to as “gynoid obesity” or female type obesity.
Normally, healthy men have very little estrogen and subcutaneous fat. When they start gaining weight, it tends to be in the belly, in the intestinal space, and is known as “visceral fat” or “central weight gain”. This results in the characteristic apple-shaped body type, known as “android” (male type) obesity, when weight gain becomes excessive. However, this is also the type of fat that is the most metabolically active and therefore easiest to lose – men generally lose weight more easily than women for this reason. Visceral fat is very easily mobilized in response to adrenalin (the “fight or flight” hormone) and strenuous activity. Think of the hunter-gatherers from which we are descended – the males would store visceral fat preferentially when food was plentiful so that it could be easily used as fuel for the muscles when hunting for the next meal.
The picture is a little more complicated in postmenopausal women, when estrogen levels become very low while testosterone continues to be produced from the ovaries and adrenals. Normally estrogen rules over testosterone at the tissue/cellular level, but when estrogen levels drop at menopause and testosterone levels remain the same this estrogen/testosterone ratio shifts in favor of testosterone dominance. The presence of testosterone that is not counteracted by estrogen, a relative “androgen excess”, tends to promote the male type body fat distribution, and women who tend to gain weight during and after menopause often find that their waistline thickens and they become rather more apple-shaped than pear-shaped. The same effect is seen in women with polycystic ovarian syndrome (PCOS), who over-produce androgens. Studies of estrogen replacement therapy in postmenopausal women consistently show that this can prevent central weight gain, by maintaining a relatively higher level of estrogens than testosterone.
Fat tissue itself is an endocrine (hormone-producing) organ. It contains the enzyme aromatase, which converts testosterone to estradiol and androstenedione to estrone. In obese postmenopausal women, estrone can become the predominant circulating estrogen, rather than estradiol. Estrone is about ten times less potent than estradiol and its presence in the absence of estradiol is a hallmark of menopause.
DHEA
DHEA (dehydroepiandrosterone) is the precursor for the production of estrogens and testosterone in tissues where they are needed, and it therefore circulates in the body in significantly greater quantities than the other steroid hormones. Studies of DHEA supplementation have found no significant effect on body weight, but one of its natural metabolites, 7-keto DHEA, is known to increase the metabolic rate and has been found to help with weight loss.
Progesterone
Progesterone is well known for its ability to balance and optimize the effects of estrogens. With each monthly cycle, estradiol stimulates the proliferation of the breast epithelial cells and those of the reproductive tissues. Progesterone produced in the second half of the menstrual cycle then slows the estrogen-stimulated proliferation, allowing for tissue specialization and differentiation. For the same reason, progesterone is needed to balance estrogen replacement therapy to prevent excessive growth and proliferation of the uterine lining to reduce the risk of endometrial cancer. We know that synthetic progestins are also used for this purpose, but while they effectively suppress endometrial proliferation they have been found to have adverse effects in other areas, notably the cardiovascular system and the breast. Natural progesterone is without these adverse effects, and indeed has many beneficial effects in the body. But some women find that it can contribute to weight gain or bloating. Studies have found that women tend to have an increase in appetite and food intake in the latter half of the menstrual cycle, and during pregnancy, when progesterone levels are higher than usual. An encouragement to eat more in preparation for a pregnancy and during gestation would make sense physiologically, but we don’t need excessively elevated progesterone levels otherwise. Some forms of progesterone replacement therapy may lead to excessive progesterone levels that can increase the risk of insulin resistance, which will promote fat storage rather than utilization for energy. It is important to monitor progesterone levels, as with all hormones, during supplementation to ensure that levels are not out of physiological range and well balanced with estradiol and testosterone. Bloating or weight gain could mean you are using too much progesterone.
Cortisol
Cortisol is an adrenal hormone essential for blood glucose regulation, fat storage and utilization, and control of other body functions like the immune system.  Cortisol acts in synergy with many other hormones to help regulate their actions. Cortisol is released from the adrenal glands in response to stressors sensed by the brain. These stressors come in many different forms and include low glucose levels, emotional or physical stress, or invasion of the body by pathogens. Cortisol mobilizes glucose from the glycogen stores in the liver to be used as short-term energy for the muscle. While normal physiological levels of cortisol are essential to survival, excessive levels caused by chronic stressors shut down non-essential body functions, such as the immune system, and by suppressing the production of other hormones, such as sex hormones, growth hormone, and thyroid hormones. When stressors are present for extended periods the system goes awry and we develop a chronic stress condition and persistently elevated cortisol levels. When this happens, the effects of cortisol on blood sugar result in an increased appetite, particularly for carbohydrates (“stress eating”) and storage of more glucose as fat, especially in the visceral area, which has more cortisol receptors than other types of fat tissue. Stress-related weight gain can be treated by finding and reducing sources of stress, as well as relaxation techniques to reduce the harmful effects of stress on the body.
Conclusions
When you understand more about your body and how it is hormonally regulated, it is easier to see that hormones, when in balance, are friends rather than foes.  The entire endocrine system includes many more hormones than are mentioned above, which are involved in metabolic processes and other bodily functions that can affect our weight and our overall health. But even taking just the reproductive hormones and cortisol, and a little common sense, we can conclude that:

1. We have changing reproductive hormone levels as we age. In our attempts to replenish hormone levels back to youthful levels, we sometimes upset the balance as we replace hormones to levels outside an ideal range, and we don’t recognize the effects this hormonal imbalance has on weight gain.
2. Weight gain itself affects hormone balance.
3. Our bodies have highly efficient stress responses, but the extreme, prolonged stresses of modern life have created an unhealthy hormonal imbalance (excessive cortisol) that has contributed to weight gain.

It is important not to ignore the elephant in the room, the highly palatable and refined foods that dominate the “Western” diet, which are clearly associated with the obesity epidemic. These are not the foods our ancestors ate.Our bodies have not adapted hormonally to the challenges of regulating fat stores when presented with these foods in excess.
Keeping our hormones in balance while maintaining a healthy diet, following an exercise program, and aiming for a stress-reduced lifestyle is key to optimal wellness and longevity.  (ZRT blog)


So what are you waiting for?  Give me a call and get your hormones tested?

Be Proactive: Common Hormone Symptoms in Five Age Groups

I'm revisiting a book this morning,  The 30 Day Hormone Plan, by Dr. Erika Schwartz, M.D. In it's pages, I came across something that I suppose every woman would enjoy knowing for herself.  After following many patients for a number of years, Dr. Schwartz realized that she could break down frequency of symptoms according to age ranges in five major groupings.  What if women could be more proactive with the hormonal shifts expected with the seasons of aging?  What if they could prevent or lessen the impact that hormonal imbalance can bring? Good idea right? Right!

Hopefully, you can use the guidelines for these age groupings to help you sift through your own symptoms:

Group 1: (ages 16-early 20's)
PMS
Bloating
Mood swings
Acne

Group 2 (ages mid-20's-mid-30's)
Bloating
Weight Gain
Postpartum Depression
PMS
Mood Swings
Fatigue

Group 3 (Ages 30's-early 40's)
Weight Gain
Bloating
PMS
Depression
Occasional loss of libido
Occasional night sweats
Irritability
Menstrual irregularity
Migraines
Fatigue

Group 4 (Ages 45-55)
Hot Flashes
Night Sweats
Fatigue
Insomnia
Loss of libido
Irritability
Mood Swings
Depression
Weight Gain
Bloating
Fatigue
Muscle and Joint Aches
Vaginal Dryness

Group 5 (Ages 55+)
Hot Flashes
Night Sweats
Fatigue
Insomnia
Weight Gain
Loss of Libido
Arthritis
Stiffness in Muscles and Joints
Chronic constipation
Bloating
Chronic illness (osteoporosis and heart disease)

So, how do things line up for you personally?  I can guide you on testing and anti-aging therapies to help you be proactive in the journey of hormonal change.  Give me a call today 417-231-4544

Live, Look, and Feel Better, Longer!
Dr. Sonja

Magnesium Deficiency Symptoms – Signs of Low Magnesium Levels | WorldHealth.net Anti-Aging Forum

Magnesium Deficiency Symptoms – Signs of Low Magnesium Levels | WorldHealth.net Anti-Aging Forum

The Owners Manual of Hormones and Aging

If there's one thing I've learned after serving professionally in the field of custom Anti-Aging Medicine and Bio-identical Hormone Replacement Therapy, it's that each person is genuinely unique.  The human body has provided centuries of research and discovery which, of course, continues on to this day and will for centuries to come.  I read continually to stay abreast of current trends, statistics, and studies to predict how things might shift in our medical "gold standard" approach and to personally educate myself to help others to understand better.  And, oh my, have I seen some shifting over the years.  This is good for you.  No, it's bad for you.  No, it's back to being good for you....  You know the drill.  It's bothersome to me that medicine has truly been a 'practice' in terms of writing prescriptions and suggesting therapies for what a clinician "thinks" it might be.

This morning I consulted with a young woman who had gone through a hysterectomy in her late 20's.  Now in her 30's and about 6 years beyond the surgery, she is having significant symptoms.  Her personal physician wants to prescribe an anti-depressant to control her hot flashes, but she feels there is more to her condition.  Through discussions, she is also experiencing weight gain, irritability, low libido, vaginal dryness, and more. Modern advancements have provided the tools and testing mechanisms to truly find out what the problem is, so why not use them? One such advancement is the use of saliva, urine, blood spot, and serum testing to determine hormonal, neurotransmitter, and adrenal imbalances.  NASA has used these 'discoveries' to determine if an astronaut is fit to travel to outer space and back.  I know we all can't fly to the moon, but for each of us it's like taking a car to the Auto Shop and having a diagnostic evaluation done.  Our vehicle to health is our body and keeping it in tip-top condition is important.  You own your body and it won't get you where you want to go, and as far as you could go, if things aren't running at optimum.

Here's some tips that you might find in your Hormone Health Owner's Manual:

Tip #1
Estrogen is like the gas pedal and there are 3 unique kinds: Estriol, Estradiol, and Estrone.  Your age, lifestyle, social history, toxin exposure, medical history, weight status, stress level, etc. can all play-in to estrogen levels.  Though Estradiol comprises around 10-20% of your levels, it alone controls 80% of the activity in your body.  If you're low, you're going to feel it.  Rapid aging, dryness,  mental fog, irritability, fatigue, and more can be related to your gas pedal malfunctioning.

Tip #2
Progesterone is the brake pedal.  It is known to calm things down a bit, keep estrogen in check, and help with sleep, bone health, and emotions.  This hormone is most often connected to PMS, infertility, fibrocystic breasts, and absent or sporadic menstrual cycles.

Tip #3
Take control of your stress.  Where there is stress (emotional, physical, mental), there is inflammation! Cortisol is the stress stabilizer and secreted to help regulate inflammation and serve as a messenger to the brain telling it the status of the conditions below.

Tip #4
Support your Adrenals.  After menopause (natural or surgical) the adrenals take the lead in hormone production.  What used to be controlled more-so by the ovaries in women and testes in men, has now become the assumed responsibility of the Adrenal Glands.  Our modern lifestyles, diet, and environment are requiring Pit Stops to assure better care of our body.  If the adrenals are taxed, so will be the person.  Adrenal Fatigue is REAL.  If you have it, you'll feel it.

Tip #5
Incorporate Nutraceuticals into your care plan.  If you're not doing a core nutrition regimen then START!
B-Complex, Magnesium, Omega Fish Oils, L-Theanine found in green tea, antioxidants, Glucosamine, Calcium, Vitamin D, etc.   Proper hormone metabolism is dependent on having the proper nutrient in the proper amount to make things function in the body better.

Tip #6
Get a hormone and adrenal assessment and stop pretending that your symptoms do not exist.  If someone tells you it's "normal" to feel a certain way, beware!! If you do not feel your normal self, then it's time for a diagnostic check-up.  Did you know that you can have a good assessment done for just $130?

Tip #7
Go to a provider that will listen.  If things don't quite seem to add up in your own mind, it might be time to consider an alternate view or opinion.  The information is out there, so do your own homework and follow your heart.

You should personally own your health.  Have you checked your owners manual to see if things are running as smoothly as possible?  I do hope so, but if not, I can provide information and an at-home testing kit to help you in these areas of your health.



To your good health,
Dr. Sonja