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.

Wednesday, February 25, 2015

Answering Common Questions

Ever since I went into menopause I feel like I’m living in a different body…and have a much harder time losing weight…is this the new normal?

Menopause is a new normal for women but it need not be a nightmare! The extent to which you are gaining weight and feeling like a stranger in a strange body, is very often tied to how far your hormones are out of whack. Shifting, declining hormones along with a slowing of metabolism are to be expected at menopause, but their effects are made worse by lack of sleep, chronic stress, and exposure to “hormone disrupting” toxins (pesticides, BPA, growth hormones in milk, etc.) in the environment. At the same time additional burden is placed on the adrenal glands as they take over hormone production from the ovaries at menopause. That can lead to tired adrenals that cannot keep up with demand, so this is prime time to start taking better care of ourselves with improved nutrition, sleep, and stress management. We know that cortisol rises when stress rises, triggering us to refuel by eating more. If stress stays high, blood sugars and insulin will stay high with continued overeating, and inevitably, weight gain. It bears mentioning that the belly fat we women love to hate happens to be the body’s favorite depot for storing energy reserves, which is why doctors often refer to belly fat as the body’s answer to stress.

I think I may be deficient in Vitamin D but I take a multivitamin every day…isn’t that enough?

If you are overweight you will want to make sure that you are not D-deficient, given what researchers are finding is a strong association with increased body fat and obesity onset. The so-called ‘sunshine vitamin’ is actually a ‘prohormone’ made in the body by the action of sunlight upon the skin. So those of us who live in the grayer, northern altitudes are typically low in D, but deficiency occurs even in sunny climates where you would least expect it, attributed to overuse of sunscreens and covering up against the D-enriching rays of the sun. As humans increasingly spend more time indoors in front of computers, and less time working or exercising outside when the sun is shining, the problem is taking on epidemic proportions. Sensible sun exposure, from15 minutes to a half hour a day can help boost D levels as nature intended.
To circle back to your question about supplementation, the amount of D3 contained in the average multivitamin may not be enough to raise D levels into the healthier ranges. If testing your D levels reveals a deficiency (30 ng/ml or below) talk to your provider about increasing your daily D intake. Supplementing between 2000 and 5000IUs of Vitamin D3 is generally suggested to bring levels into the optimal (50-80 ng/ml) range.

Could an imbalance in Estrogen/Progesterone cause low cortisol? I have low cortisol across the board.

This is certainly to be considered, particularly when there is too much estrogen relative to too little progesterone, an all too common imbalance known as estrogen dominance. This often shows up in the test results of women in menopause and perimenopause, when waning ovaries no longer make estrogen and progesterone in balanced proportions. This is also not atypical in younger women on birth control, with anovulatory (lack of ovulation), or erratic cycles.
Progesterone being high up in the hormonal cascade is also a precursor (source) of  primary adrenal hormones, so if it is in short supply, DHEA and cortisol, the key arbiters of adrenal health will also be down with some level of adrenal fatigue to follow. So your question is a good one: imbalances of estrogen and progesterone can and will negatively impact cortisol levels down the line. If you feel this is what’s going on with you consider testing your hormone levels to identify hidden imbalances and work with a provider to restore balance naturally.

If a patient is on birth control pills, can a saliva test be accurate?

Hormones levels tested while ‘under the influence’ of the pill will reflect its’ contraceptive effect and test at lower levels than would be the case in the absence of contraception. To get a true baseline level of hormones, it is suggested that birth control be suspended for four to six weeks before collecting hormone samples. Having said that, women who do test their hormones while taking contraceptives may use the results of testing to guide decision making about hormonal vs. non-hormonal birth control methods.

I am estrogen dominant, taking lots of supplements, I do bioidentical progesterone the last 2 weeks of my cycle; I’m perimenopausal, periods now 6 weeks apart, I have really high cortisol in the morning and in the evening, I do yoga, exercise and all the supplements -what else can I do? 

Sounds like you are doing many things right, but if you still have depression, weight gain, and stress demands high enough to spike your cortisol levels morning and evening, look to your adrenal glands. These master stress responders need extra support especially during perimenopause when hormonal shifts and fluctuations trigger imbalances that can amplify stress demands upon the body.
Supplements like Vitamins C, B-complex, adaptogenic herbs, and natural progesterone, etc., when taken in the right amounts are essential adrenal supports, and the practice of yoga with its stretching and deep breathing is known to help lower stress hormones. All good, but if as you say your cortisol levels are still high, you may have to drill down a bit more and ask yourself how you are dealing with stress. If you’re overworked, overbooked, over-caffeinated, or feeling overwhelmed in general, it’s time to take stock of your stress, figure out where it’s coming from and how you can alleviate it at the source. That may be as simple as turning off your cellphone after 8pm and going to bed earlier, or as complicated as switching careers and walking away from the ‘dream job’ that drained you dry.
Lack of sleep by the way is one of the biggest contributors to cortisol imbalance, and a serious disruptor of appetite hormones, leading to sugar cravings and increased hunger. Getting by on just 5 or 6 hours a night will undermine your best efforts to stay healthy and balanced and a number of studies show that ‘short sleepers’ are more prone to weight gain. Aim for 7 to 8 hours a night at minimum, and “sleep in on the weekends whenever possible,” says Dr. James Wilson in his must read book: Adrenal Fatigue, The 21st Century Syndrome. 

Do you feel saliva over blood tests is better?

If you want to test active bioavailable hormone levels that correlate more closely to the symptoms you are experiencing, saliva can be a better way to go. That’s because this method (see also blood spot collection) captures the ‘free’ fraction of hormone that has left the blood stream to become active in the target tissues of the body; in contrast the standard blood test measures inactive hormones still bound by their carrier proteins in the blood stream. Saliva testing has another big advantage: collection is non-invasive, that is without needles, so all one has to do to collect hormone samples is spit into a tube – a painless change from the stress of a blood draw that can skew results.

My doctor did a blood test and said my hormones are fine and that I’m just depressed. Now I’m on Prozac, and gaining more weight!

I have a one-line response to your comment: Depression is NOT a Prozac deficiency. (see question above regarding blood tests.)

What is the "call to action?"  

In a nutshell; become aware of, and determine your own symptoms of hormone imbalance, test your hormone levels to identify imbalances that match up with the symptoms you are experiencing, and last but not least find a natural hormone friendly provider who will work with you to rebalance your hormones. A savvy practitioner will test not guess using hormone test results as a guide to individualizing treatment. After all, each of us has a unique body chemistry, so what works for one woman does not necessarily apply to her friend, sister or next-door neighbor.  Today’s more enlightened and effective approach to a woman’s hormonal health is bound to include lifestyle and dietary improvements, stress lowering techniques, key vitamins, minerals, herbs and/or bioidentical hormones as needed, to replenish and restore balance.

Article compliments of ZRT lab.

Thursday, February 5, 2015

Could Hormones Help Your Heart? Are Bio-Identicals Best?

Bioidentical (Natural) Hormones and Heart Disease

HOPKINS HEALTH WATCH QUESTIONS AND ANSWERS
crphormonesBioidentical Hormones, Used Wisely, May Reduce Heart Disease Risk in Women
Q: Thanks for the important info on C-reactive protein [Heart Disease, Crestor and C-Reactive Protein] in the last issue of your newsletter. Can  you tell me if bioidentical hormones affect CRP and other heart disease risk factors?
A: It’s long been known that conventional synthetic hormones (e.g. PremPro) tend to raise CRP levels, but thanks to outstanding research by Kenna Stephenson M.D. and her team at University of Texas Health Science Center in their year-long CHOICE study, we now know that women who use bioidentical (natural) hormones can significantly lower their CRP levels, by as much as 37%. This study also found that bioidentical hormones lowered blood pressure, and reduced fibrinogen and triglyceride levels. Stephenson recently presented the results of her year-long study to the American Heart Association 2008 Scientific Sessions.
It's important to know that, in the CHOICE study, the women's hormones were measured with a saliva test, and then bioidentical hormone creams were prescribed accordingly, in physiologic doses. A physiologic dose is one that approximates what the body would make when hormones are in balance. The women were retested at two months and doses were adjusted as needed. The typical progesterone dosage ranged from 20 to 40 mg daily.
A 2008 review of transdermal (creams or patches) bioidentical hormones in the prestigious European journal Maturitas, points to abundant evidence showing that progesterone lowers blood pressure, helps control insulin and glucose levels, improves cholesterol profiles, reduces heart disease risk factors associated with inflammation, helps prevent blood vessel spasm, does not increase the risk of stroke, protects the brain and the nervous system, and does not increase the risk of breast cancer. They conclude:
“HRT started at the menopausal transition and optimized through expert personalization (for example combining low doses of E2 [estradiol] given transdermally and micronized progesterone), will be cardioprotective and avoid an increased incidence of thromboembolic events as well as of breast cancer; it could eventually prevent to some extent the development of diabetes mellitus and possibly protect cognition.”
L’Hermite et al, “Could transdermal estradiol+progesterone be a safer postmenopausal HRT? A review,” Maturitas, Volume 60, Issue 3, Pages 185-201.

And From a Livestrong Article

Relationship Between Estrogen and Cholesterol

Physicians at the Mayo Clinic state that declining estrogen levels during menopause and peri-menopause can lead to an increase in LDL cholesterol, commonly called "bad" cholesterol. This increase in the bad cholesterol and concurrent decrease in HDL cholesterol, or the "good" cholesterol, increases the risk of heart disease. Estrogen appears to have a protective effect on the vasculature of the body against diseases. Estrogen stimulates the release of nitric oxide and decreases the contraction of smooth muscle cells. This relationship appears to reduce the risk of high blood pressure and high cholesterol levels while estrogen levels remain high during a woman's childbearing years.

Tuesday, February 3, 2015

Hormone Testing At-A-Glance

http://youtu.be/KURpZSXA7u8


Often I'm asked how to go about testing for hormonal imbalance.  It's so simple and affordable and such a life changer for those struggling to make it through their days.  And if you can't make it through your days, how will you ever make it through your years?  Simply click on the link above to find out more about the testing kit that I can provide conveniently by shipping it to your home address. The same kit is used for both women and men and a simple call to our staff can help you determine which testing panel is best for you and your symptoms. 

So is Hormonal Imbalance Affecting You? 

Infertility
Loss of pregnancy
Erectile Dysfunction
Irritability
Anxiety
Night sweats
Incontinence
Fibroids
Sexual dysfunction
Insomnia
Fatigue
Difficulty losing weight or gaining unexplained weight
PMS
Vaginal Dryness
Yeast Infections
Continual infections and immunity issues
Palpitations
Migraines
Memory concerns
Lack of focus
Loss of stamina
Loss of muscle mass




It's exciting to have helped so many  and extra exciting to see so many getting the help that they need in these areas.  Don't put this off another day.  Your "normal" is probably not "optimal" if you're having any of these symptoms. Give me a call and I can help you get started towards a "NEW and IMPROVED YOU"!!  Yay!!!

To your good hormone health,
Dr. Sonja

Thursday, January 22, 2015

Depression, Anxiety, Fatigue, Insomnia, Headaches...Which Medication Is Best?

Our nervous system is a master controller of so many things when it comes to health, wellness, vitality, coping, and so on.  Within the brain and nervous system exists chemicals called neurotransmitters which control so many life sustaining functions such as sleep, breathing, digestion, energy, and immunity to help us out when our body is in need. But what if something goes haywire or a traumatic life event occurs which causes our system to short circuit? The answer is that symptoms such as anxiety, headaches, poor sleep, fatigue, and depression can result. Anti-depressant and anti-anxiety remedies can be helpful to a person, but often trial and error processes take place in trying to find the right medication or therapy for a person and their symptoms. This can delay benefit and improvement and sometimes cause unwanted side effects. 

Did you know that neurotransmitter testing exists? I am a provider of a testing kit that you can do affordably and conveniently from your own home. 

Let me highlight some of the neurotransmitters and their associated symptoms. You can certainly do some reading on each of them individually as it would be difficult to cover their details in a short blog such as this.  Here's a listing of some of the BIG symptoms (connected to neurotransmitters) that people struggle with:

Poor Sleep: Serotonin, Taurine, GABA, Glutamate, Histamine, Phenylalanine(PEA), Norepinephrine (NE), and Epinephrine (EPI)

Fatigue: Glutamate, Histamine, NE, and Epi

Anxiety: Taurine, GABA, Glycine, Glutamate, PEA, NE, Epi

Depression: Serotonin, Glycine, Glutamate, PEA, and NE

Attention Deficit: PEA, Dopamine, and NE

Excessive Energy: Taurine, GABA, NE, and Epi

Cravings: Serotonin, Glutamate, and Dopamine

Intestinal Complaints: Serotonin

Poor Cognitive Performance: Glutamine, PEA, and Dopamine

Weight Management: Serotonin and Epi

Excess Stress: Serotonin, Glycine, NE, and Epi

Headaches: Serotonin and Histamine

Immunity: Serotonin, Glycine, Glutamate, Histamine, and NE


A profile test to determine deficiencies of one (and often more) of these neurotransmitters can help in matching up a correct therapy for a person.  Who knew this option existed right?  It does, and let me tell you that it's been very critical to some of the patient needs that I have had the opportunity to take part in with caring physicians who want to discover more about the symptoms their patients are describing.  Various anti-depressants exist and their neurotransmitter connections vary from class to class. Knowing which one to pick as a better match to a person's deficiencies is certainly the best approach to take in my opinion. It's a win-win!   That's simply GOOD MEDICINE!


To your good brain health,
Dr. Sonja

Thursday, December 18, 2014

Sneezing and Leaking: The Hormonal Link

Stress incontinence is the most common cause of incontinence in women who are in the reproductive years or early postmenopausal years. It is defined as urine leakage due to abrupt increases in abdominal pressure caused by such things as exertion, sneezing, coughing, laughing, bending, or lifting.  Stress incontinence is often a result of childbirth or thinning of the estrogen dependent lining of the outer urethra.  Symptoms similar to having a urinary tract infection could be described with this condition even though a urine culture does not test positive for bacterial organisms. Patients who are overweight will often have more bouts with stress incontinence because of the amount of pressure above the urinary system and weight reduction is important in the wellness plan for urinary tract health.

Muscle strength training exercises.
Kegel exercises can have a role in improvement of incontinence. To perform kegel exercises, patients are instructed to specifically contract the pelvic muscles instead of the abdominal, thigh, or buttock muscles with a 10 second contraction followed by a 10 second relaxation method.  It is typically recommended as a repetition process of 10 to 15 times.  Although helpful, most people will forget to do the process or slack off after a certain period of time.  So just for good measure and since you're reading this blog, go ahead and do your Kegels today! (smile)

~Could hormones affect incontinence? Absolutely!!!
Interestingly, and unknown to many women, is that hormones can play a significant role in the urinary health of a female. A decrease in ovarian estrogen production can result in noticeable changes to the vaginal, urethral, and bladder tissue. This often presents as urinary frequency and urgency of urination.  In addition, it's estimated that 1 in 2 women will have an atrophy condition of the vaginal tissue with aging.  This can cause a burning sensation, difficulty and pain with sexual intercourse, and reoccurring urinary tract infections if not addressed.   If you are suffering with any of these problems, then make sure to have your hormone levels checked.  Treatment with a low dose hormone replacement therapy can have a great impact on symptom improvement and the health and integrity of the uro-gynecological tissues.

We provide at-home testing kits that can be used to evaluate your hormone status.  If you having been suffering with incontinence in silence, or if you are having other problems highlighted in this blog, then please reach out and let me help you get things back on track.  You'll be happy that you did and the simple, convenient, and affordable process might just save you some embarrassment with your next sneeze or cough.

To your good health,
Dr. Sonja

Wednesday, December 3, 2014

The Link: Economic Decline and Fertility Rates

Fact Sheet: The Decline in U.S. Fertility

by Mark Mather

(July 2012) In the United States and other developed countries, fertility tends to drop during periods of economic decline. U.S. fertility rates fell to low levels during the Great Depression (1930s), around the time of the 1970s "oil shock," and since the onset of the recent recession in 2007 (see Figure 1). The U.S. total fertility rate (TFR) stood at 2.0 births per woman in 2009, but preliminary data from the National Center for Health Statistics show that the TFR dropped to 1.9 in 2010—well below the replacement level of 2.1.1 A similar decline—or leveling off—of fertility rates has been reported in Ireland, Italy, Spain, Sweden, and several other European countries.

Figure 1
The U.S. Fertility Rate Has Fallen During Periods of Economic Decline

* Estimated by PRB.
Source: National Center for Health Statistics

This recent fertility decline may be just a short-term response to high unemployment rates, or it may signal a longer-term drop in lifetime fertility. Most recessions have had relatively minor effects on fertility rates—often lasting two to five years. Recessions generally affect the timing of fertility but not the overall number of children that women will have in their lifetimes.2 Longer-term trends in fertility are determined by broader societal factors, including trends in marriage; economic development; cultural norms; and women’s education, employment, and access to contraception. Although fertility rates bottomed out during the Great Depression, the birth rate had been declining throughout the 1920s—a period of rapid economic growth—as more couples used birth control to limit family size.3
The U.S. fertility rate is edging closer to TFRs in Europe, where many countries are grappling with very low birth rates (averaging 1.6 children per woman) and potential labor shortages.

Fertility Rates Converge for Different Racial/Ethnic Groups

Fertility rates in the United States have fallen since 1990 among all major racial/ethnic groups (see Figure 2). The Latina fertility rate dropped sharply in recent decades, from 3.0 births per woman in 1990 to 2.4 births per woman in 2010; and for black women from 2.5 to 2.0. Fertility rates among white and Asian women have also dropped, but at a slower pace, resulting in similar fertility rates among different racial and ethnic groups.

Figure 2
Fertility Rates for Latinas and Black Women Are Approaching Those of White and Asian Women.

* Preliminary data.
Source: National Center for Health Statistics.

Relatively high unemployment rates among African Americans and Latinos may have played a role in the recent fertility decline—especially among those with less education and lower incomes.4 But increasing college attendance, especially among women, is another potential factor. Education affects the timing of marriages and first births, typically delaying both. Thus, the U.S. fertility rate may drop further if the share of women attending and completing college continues to increase. Among 18-to-24-year-olds, more women than men are enrolled in college in every racial and ethnic group.5
A prolonged decline in African American and Latina fertility rates will affect the future racial and ethnic composition of the United States. The Census Bureau recently reported that over half of all U.S. infants are racial/ethnic minorities.6 The U.S. population is currently projected to reach "majority-minority" status (the point at which less than half of the population is non-Hispanic white) in 2042. For several decades, immigration has been the driving force behind rapid racial/ethnic change in the United States, but a sustained drop in fertility rates could slow the pace of growth of the country’s minority population.

Young Adults in U.S. Postpone Childbirth

The decline in U.S. fertility has been driven primarily by a trend among young adults to postpone having children. Forty years ago, birth rates among women in their 20s were significantly higher than those of women in their 30s. In 1970, there were 168 births per 1,000 women ages 20 to 24, compared with 73 births per 1,000 women ages 30 to 34. However, this gap has steadily narrowed over time. By 2009—for the first time in U.S. history—birth rates among women ages 30 to 34 (97.5 births per 1,000 women) exceeded those for women ages 20 to 24 (96 births per 1,000 women). In 2010, the birth rate among teens dropped to 34 births per 1,000 girls ages 15 to 19—the lowest level ever recorded in the United States.
This recent drop in births among young adults could be linked to the recession. In Europe, high rates of unemployment and low levels of economic security are strongly associated with declines in fertility among young adults.7 The economic downturn may have had a similar effect on young adults' fertility in the United States.
However, longer-term fertility trends may depend on future trends in women's employment and earnings relative to men.8 Women outnumber men in college and make up a growing share of the labor force. The recession hit male-dominated jobs the hardest, contributing to a growing share of women who now outearn their husbands.9 As more women become primary breadwinners, fertility decisions are more likely to hinge on women’s earnings than they did in previous decades. A growing reliance on women’s employment and earnings could further dampen U.S. fertility rates in the coming decades.

Mark Mather is associate vice president of Domestic Programs at PRB.

References

  1. The total fertility rate estimates the number of births a woman is expected to have during her lifetime based on current age-specific fertility rates. Replacement level fertility is the level of fertility at which a couple has only enough children to replace themselves, or about 2.1 children per couple.
  2. Tomáš Sobotka, Vegard Skirbekk, and Dimiter Philipov, "Economic Recession and Fertility in the Developed World," Population and Development Review 37, no. 2 (2011).
  3. U.S. Centers for Disease Control and Prevention, "Achievements in Public Health, 1900-1999: Family Planning," accessed on June 26, 2012.
  4. Gretchen Livingston, "In a Down Economy, Fewer Births," accessed on June 7, 2012.
  5. Linda A. Jacobsen and Mark Mather, "A Post-Recession Update on U.S. Social and Economic Trends," Population Bulletin Update (December 2011).
  6. U.S. Census Bureau, "Most Children Younger Than Age 1 Are Minorities," accessed on June 7, 2012.
  7. Wolfgang Lutz, Vegard Skirbekk, and Maria Rita Testa, "The Low Fertility Trap Hypothesis," in Vienna Yearbook of Population Research, ed. Dimiter Philipov, Aart Liefbroer, and Francesco Billari (Vienna: Vienna Institute of Demography, 2006); Lisa Bell et al., "Failure to Launch: Cross-National Trends in the Transition to Economic Independence," Luxembourg Income Study Working Paper Series 456; and Christian Schmitt, "Gender-Specific Effects of Unemployment on Family Formation: A Cross-National Perspective," SOEP 127 (2008).
  8. Diane J. Macunovich, "Using Economics to Explain U.S. Fertility Trends," in "What Drives U.S. Population Growth?" Mary M. Kent and Mark Mather, Population Bulletin 57, no. 4 (2002).
  9. Richard Fry and D’Vera Cohn, "New Economics of Marriage: The Rise of Wives," accessed on June 7, 2012.