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Nutr2 - Exam 3 (Final) 3/17/09

Endocrine Disorders

(part 2 – Insulin Resistance)

Increased obesity in the USA

• 58 million overweight

• 40 million obese

• 3 million morbidly obese

• 80% people over 25 are overweight

• 78% don’t meet basic recommended activity level

• 25% are completely sedentary

Increased Diabetes

• 76% increase in type II in 30-40 yrs old since 1990

• 90% diabetes is linked to high carb consumption

• Diabetes alone represents 11% of US health care expenditure

• Cost $98 billion in 1997(health care and lost wages)

• In 2002, total cost went up to $132 bil.

Increased Nutrient Deficiencies

• Consumption of refined sugars causes severe deficiencies in nutrients that regulate blood sugars e.g. Bs and Mg, K

• Excess sugar consumptions puts tremendous stress on the organs of blood sugar regulation: pancreas, liver, adrenals

• One serving of sugar has been shown to decrease the immune response of certain white blood cells by 50% for over 8 hours

Sugar and CVD

• When 20 lbs. of sugar is consumed per year, there are 60 deaths per 100,000 due to CVD

• When 150 lbs of sugar is consumed pre year, there are 300 deaths per 100,000 due to CVD

Increased dysfunctions associated with blood sugar dysregulation

• Hypoglycemia

• CVD

• Strokes

• Diabetes

• Oxidative stress

Insulin Resistance (IR)

• A state in which insulin receptors become unresponsive to the stimulation of insulin

– Defects in ligand/receptor binding

– Signal transduction

– Intercellular communication

– Polymorphism

– Found in 25-35% of population in westernized nations

– Major contributing factor to diabetes, CVD, sleep apnea, hormonal imbalance, obesity and certain kinds of cancer



Insulin Resistance

• Symptoms of Insulin Resistance

– Fatigue

– Cravings for sugar

– Unable to lose weight

– Constant hunger

– Fatigue after meals

– Migrating aches and pains

Insulin Resistance

• Signs of IR:

– Elevated fasting or post-prandial glucose

– Elevated fasting or post-prandial insulin

– Elevated triglycerides

– Triglyceride : Cholesterol ratio > 1

– Low HDL

– Elevated uric acid

– Increased waist to hip ratio

– High blood pressure

– Central obesity

Insulin Resistance and CVD

• Blood pressure affected by the plasma levels of insulin in positive direct relationship.

• Hyperinsulinemia may alter coagulation proteins involved in fibrinolysis

• Plasminogen activator inhibitor 1 is elevated in hyperinsulinema

• Insulin up-regulate HMG-CoA reductase

• Impacts cholesterol ester transfer protein(CETP), lowers HDL levels

• Increased BP, blood clot and cholesterol, lowers HDL

Am J Hypertens 1989;2:164-170 Diabetes Care 1992;15:1258-1263

Metabolism 1993;42:945-949 Circulation 1996;94(9):2057-2063

Diabetes Metab Res 1991;7:139-153

[pic]

CETP = Cholesterol ester transfer protein

Insulin and Hormone Metabolism Disorders in Women

• Alters female hormone metabolism towards androgen dominance and estrogen dominance

• 4-10% women of reproductive age suffers from PCOS—leading cause of infertility

• Symptoms of PCOS: hyperandrogenism, insulin resistance, chronic anovulation, irregular periods, infertility, unexplained weight gain, fluid retention, fatigue, mood swings, acne, hair loss, unwanted hair growth, estrogen proliferative cancers, acanthosis nigricans, increased risk of CVD and dyslipidemia

0best Gynecol Surv 2000;55:321-328

Contemporary Endocrinology: Insulin Resistance. Totowa NJ:Humana Press;1999:347-365

Fertil Steril 1992;85:3520-3525

J Clin Endocrinol Metab 2000;85:3520-3525

Am J Med 1995;98:27S-32S

IR and Androgen Dominance

• IR ( androgen excess ( IR

– Elevated testosterone, estrogen,

– Decreased sex-hormone binding globulin(SHBG)

– Increased androstenedione

– Increased DHEA, 17-hydroxy-progesterone and LH

• Decreased SHBG causes overexposure of hormone to tissues

Euro J Endorinol 2000;143:383-388 J Clin Endocrinol Metab 1991;72:83-89

IR and Sex Hormones

• IR leads to increase testosterone

• Increase T blunt estrogen effect lead to anovulation

• Anovulation reduces progesterone production

• Reduced P lead to estrogen dominance

• ED increases IR…

IR and Cortisol

• IR leads to increase cortisol and epinephrine

• Cortisol suppresses insulin receptor…

3/18/09

IR, PCOS and Hyperinsulinemia

• Defects in the hypothalamus-pituitary feedback loop that sets up a pattern of elevated LH, anovulation and menstrual irregularities (oligomenorrhea, anemorrhea, menorhagia)

• The root of the problem is insulin resistance and adrenal disorder

• Hormonal imbalance is only a symptom

-MSG stimulates appetite center, encouraging you to eat more

Conventional Treatments for Female Hormone Imbalance

• Oral contraceptives (OC) to suppress the pituitary feedback loop

• Suppresses the production of ovarian androgen

• Usually make worse the estrogen dominance problem by these synthetic estrogen

• Chronic OC use may cause prolonged inhibition of the hypothalamus-pituitary-ovarian feedback loop—post-birth control syndrome (inability to regain normal menstrual cycles)

Conventional Treatments

• GnRH analogue drugs (Lupron) to completely suppress all ovarian hormone production

• Causing symptoms of hormone deficiency such as hot flashes, low libido, vaginal dryness

• Exogenous synthetic hormone therapy is then Rx to treat deficiency symptoms

• Glucocorticoid, prednisone, dexamethasone to suppress adrenal function

• Increases risks and side effects

From Website:

Lupron

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Lupron:

Breast tenderness; constipation; decreased sex drive; difficulty sleeping; hot flashes/sweating; impotence; infection (fever, chills, sore throat); nausea or vomiting; pain; swelling; urination problems.

Seek medical attention right away if any of these SEVERE side effects occur when using Lupron:

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blood in urine; chest pain; dizziness or lightheadedness; fast or irregular heartbeat; increase in bone pain; severe drowsiness; severe headache; swelling of the lungs; unusual or one-sided weakness; vision changes.

Conventional Treatments

• Androgen antagonists: ketoconazole, finasteride (side effects include cortisol production suppression, severe liver toxicity)

• Insulin sensitizing drug: metformen (lactic acidosis, malabsoption, B12 deficiency)

• These should be the last resort instead of the first line therapy

Insulin and Hormone Metabolism Disorders in Men

• Hyperinsulinemia induces hypercortisolemia

• Shifts progesterone conversion to cortisol

• Progesterone protects the prostate

– Impacts nervous system function

– and has a role in osteoblast activity

• Increases androstenedione and lowers DHEA—decrease vitality, weight gain and lowers testosterone level

• Androstenedione has high affinity to testosterone receptors and acts as a testosterone antagonist at high levels

J Card Pharm 1997;30:523-527

FASEB 1992;9:1073-3074

[pic]

-this man is addicted to heroin

Insulin and Hormone Metabolism Disorders in Men

• IR increases body fat and aromatase activity

• Aromatase converts testosterone into estrogen

• Any patients that demonstrates aromatase upregulation need to be checked for adrenal and insulin resistance problems

IR and Obesity

• Obesity due to impaired glucose transport, increase lipogenesis (fatigue and wt gain)

• IR ( hypercortosolemia ( leptin resistance lead to lost of appetite control and inability to burn fat

• Patient complaints of low energy, fatigue, hungry all the time, fat gain and not able to lose wt with exercise.

IR And Liver Detox

• IR suppresses glucose-6-phosphate dehydrogenase (G6PD) ( decrease hexose monophosphate shunt (HMS) ( decrease NADPH

• NADPH is required for glutathione (GSH) production

• Decreased GSH levels will compromise liver’s phase 1 and phase 2 detox pathways

IR And Cancer

• IR is associated with colorectal cancer and breast cancer

– J Natl Cancer Inst 1997;89:660-661

– Nutr Cancer 1997;27:316-320

IR And Essential Fatty Acid

• Low cellular insulin response inhibits the activity of the rate-limiting enzyme, delta-6-desaturase (D6D)

• Lowers the conversion of linoleic and linolenic acid into GLA, EPA and DHA

• Lowers D6D activity can alter the production of prostaglandins, eicosanoids and leukotrienes thus impact intercellular communication

• Decrease D6D will increase D5D activity and lead to increase arachidonic acid production and enhanced inflammatory response

Prostaglandin Leukot Essent Fatty Acids 1997;57(4-5):379-385

Prog Lipid Res 1982;20:41-48

IR and Energy Metabolism

• Decreases cellular uptake of glucose ( decreased citric acid cycle pathway

• Shift cells metabolism into an energy requiring lipogensis pathway

• Produces an inflammatory state which will further short circuit the CAC and uncouple oxidative phosphorylation pathways lead to lowered ATP production

• Alters EFA metabolism which inhibits lipolysis and beta-oxidation



Conditions Associated with Hyperinsulinemia

• Acne

• Addictions

• Asthma

• Cancer

• Sweet cravings

• Delay puberty

• Mood disorders

• Eating disorders

• Weight gain

• Heart burn and GI problems

• Heart disease

Functions of Insulin and Glucagon

|Insulin |Glucagon |

|Lowers elevated blood sugar |Raise low blood sugar |

|+ anabolism and energy storage |+ catabolism and release energy |

|Converts glucose and protein to fat |Concerts protein and fat to glucose |

|Store dietary fat |Converts dietary fat to ketone to use for energy |

|Remove blood fat into adipose tissue |Release fat from adipose for energy |

|Increase cholesterol production |Decrease cholesterol production |

|Stimulate the use of glucose as energy |Stimulate the use of fat for energy |

Dr. Bernstein’s Diabetes Solution (considered the Bible for diabetes tx)

Effects of Foods on Insulin and Glucagon

|Food Group |Insulin |Glucagon |

|Carbohydrate |+++++ |No change |

|Protein |++ |++ |

|Fat |No change |No change |

|Carb + fat |++++ |No change |

|Protein + fat |++ |++ |

|Hi Prot Lo Carb |++ |+ |

|Hi Carb Lo Prot |+++++++++++ |+ |

The Functional Approaches for MetS and Diabetes

• Improve insulin sensitivity

• Reverse insulin resistance

• Regulate liver gluconeogensis and glycogenolysis

• Reduce postprandial hyperglycemia

• Prevent systemic complications

• Decrease or eliminate insulin use in T2DM

• Decrease of eliminate oral hypoglycemic medications

Four Strategies

1. Dietary modification

2. Supplementation with nutritional and botanical agents

3. Exercise

4. Lifestyle modification

Dietary Modifications For IR

• Reduce or eliminate all forms of simple and refined sugar from the diet

• Eat whole and minimally processed foods

• Eat plenty of organic produced protein as the main focus of the meal

• Eat healthy fat liberally (traditional fats)

• Eat only low glycemic carbohydrate, vegetables

• Eat complex, unrefined carbohydrate

• Eat mainly non-starchy vegetables.

• Use only natural stevia as sweetener

• Leptin diet

Nutritional Support for IR

• Vitamin E—men with lowest plasma levels of vitamin E had almost a 4 times greater incidences of getting T2DM.

• Improve insulin sensitivity, lowers triglycerides and LDL, antioxidant that prevents oxidative complications associated with diabetes, reduces CRP, glucose transport and anti-imflammatory.

• 400-1200IU mix tocopherol with at least 200 IU gamma tocopherol

• Vitamin C— Found to be low in T2DM

• Glucose and ascorbic acid compete for the same transport pathway

• Vitamin C lowers serum glucose and CRP, inhibits glycation, prevents accumulation of sorbitol in retina, protects against oxidative stress

• 1000-3000 mg daily

• Gymnema sylvestre—reduces IR, decrease fasting blood glucose, enhance insulin action, may regenerate beta-cells

• Used for type I diabetes

• Chromium—depleted in refined carbohydrate diet, common deficient in US diet, co-factor in glucose tolerance factor which is important for insulin on receptor site and improve cellular glucose uptake, normalize post-prandial glucose and insulin levels, glycated Hgb, serum cholesterol

• Vanadium—insulin-like impact on receptor sites, improves function of glucose transport, improves intercellular transduction reactions, reduces IR

Nutritional Support for IR (cont)

• Alpha-Lipoic Acid—a sulfur-containing substance, improves insulin function by activating glucose transporters (GLUT1 and 4) which enhance glucose disposal and reset signaling response to insulin, powerful antioxidant, improves ATP production

• Magnesium—deficient in IR patients, optimizes insulin secretion, activate glucose transporter, improves insulin intercellular transcriptional response, 500 mg/day

• Evening Primrose oil —hyperinsulinemia blocks D6D and reduce production of PgE1, EPO protect the insulin receptors and reduce CRP, 900 mg/day

• Biotin—improves insulin response to GTT, lowers post-prandial glucose levels, upregulate glucokinase (first step in liver glucose utilization)

• Zinc—protect beta-cells, increase insulin sensitivity, insulin metabolism, diabetics excrete zn

• Inositol—ability to re-establish normal myoinositol levels in deficient neurons, helpful in diabetic neuropathy

• Niacin—a component of GTF, potential to prevent the onset of type 1 diabetes, inhibits macrophage and interleukin-1 mediated beta-cell damage, inhibits nitric oxide, has antioxidant function

• L-Carnitine—enhance whole-body glucose uptake and increase gluconeogenesis, improves peripheral nerves and vascular function, improves serum dyslipidemia in diabetics

• Fiber supplement

• glucomannan (from Konjac root), slows sugar absorption for improve serum glucose control, 500-700 mg/100 calories in diet

• Fenugreek seeds, soluble fiber, 15 grams/meal reduces postprandial rise in blood sugar

Exercise

• Anaerobic strength training – increases insulin receptor sensitivity

Liftstyle Modification

• Stress reduction

• Diet modification (reduce refined carbs)

• Exercise

• Reduces chemical exposure (including alcohol)

3/20/09

Functional Endocrinology and Nutrition

Part 3 - Detox, Thyroid

“Until you cleanse your organs, your vitamins and herbs will be useless and you won’t cure your illnesses”

-Dr. Richard Schulze (Medical Herbalist)

"Toxicology textbooks list the first symptoms of chronic poisoning as low energy, fatigue, muscle weakness, inability to concentrate and intestinal complaints.  These symptoms are virtually identical to those experienced by the chronically ill." 

- Jeffrey Bland, Ph.D.

Toxins Interference

• Metabolism is the sum of catabolism and anabolism

• The balance of metabolism is homeostasis which is health

• The endocrine system directs metabolism

• Every steps of the endocrine hormonal communication is vulnerable to toxins interference

• Toxins: chemical, heavy metals, minerals imbalance, nutritional deficiency, metabolic wastes, emotional stress

Symptoms of Toxicity

• Furry coating on the tongue

• Drowsiness after meals

• Weight gain

• Constipation - sticky stool

• Tiredness upon waking in the morning

• Halitosis (Bad breath)

• Poor concentration

• Mood changes

• Acne / Boils

-if patient is fatigued, then don’t do a detox (need energy to detox)

Gulf War Syndrome

• Recent government study finally admitted that chemical exposure are responsible for the multiple symptoms that the veterans and their family are experiencing.

-

Toxins, Toxins, Toxins

• It has been estimated that more than 36 million pounds of pesticide active ingredients are used annually in Nebraska.

• Risk = Toxicity × Exposure

• Toxicity is accumulative. That means they stored in the body over times. Increased exposure=increased risk.

• The Environmental Protection Agency (EPA) currently recognizes more than four million chemical compounds. More than 60,000 of these are produced commercially, with three new compounds introduced each day.

• These are all chemicals not in existence 100 years ago.

Bioaccumulation

• An EPA biopsy study showed that 100% of people studied had dioxins, PCBs, dichlorobenzene, and xylene stored in their bodies — some of the most potent causes of cancer known to us. These inescapable everyday chemicals permeate every aspect of our lives.

• A minute among over time and we cannot detoxify all of the many chemicals we inhale and digest every day, they bioaccumulate in our tissues.

– Detox or Die, Sherry Rogers

Toxins Cause All Diseases

• Environmental toxins causing all diseases. Dr. Sherry Rogers describes the major health-destroying chemicals and heavy metals, their sources, EPA studies, and how ubiquitous these substances are in our everyday environment. Studies are cited showing that 95% of cancer, for instance, is caused by diet and environment.

Toxins in Cancer

• When cancerous breast tissue is compared with non-cancerous tissue from elsewhere in the same woman's body, the concentration of toxic chemicals such as DDT and PCBs was "much increased in the malignant tissue compared to the normal breast and adjacent adipose tissue.”

• Jerome B. Westin and Elihu Richter, "The Israeli Breast-Cancer Anomaly," in Devra Lee Davis and David Hoel, editors, TRENDS IN CANCER MORTALITY IN INDUSTRIAL COUNTRIES (New York: New York Academy of Sciences, 1990), pgs. 269-279.

Following public outcry, Israel banned these chemicals from being used on feed for dairy cows and cattle. Over the next ten years, the rate of breast cancer deaths in Israel declined sharply, with a 30% drop in mortality for women under 44 years of age, and an 8% overall decline. At the same time, all other known cancer risks--alcohol consumption, fat intake, lack of fruits and vegetables in the diet--increased significantly. During this period, worldwide death rates from cancer increased by 4%. The only answer scientists could find to explain this was the reduced level of environmental toxins.    

It All Goes to Your Head

The most common organ affected by chemical exposure is the brain, leading to drowsiness, fatigue, exhaustion, sluggish thinking, or a host of other symptoms

-Tired or Toxic, Sherry Rogers

• Detoxification is regarded highly in all traditional healing arts

Bowel Cleansing Program

• Before attempting a liver cleans, the bowel must be free of obstructions.

• Constipation allows time for toxins to reabsorbed into the body

• Pre-package bowel cleansing programs

• Increase dietary fibers and water

Hepatic Detoxification

• Especially important for the chronically ill

• Liver detox imbalance will make any endocrine problem patterns more difficult to evaluate and unresponsive to treatment

• Many times hormonal imbalance occurs as a result of compromised detox function

• Patients usually presents with contradicting symptoms, history of toxin overload and drugs exposure (HRT)

Hepatic Detoxification

• Symptoms of a compromised liver detox system:

– Neurological disorders

– Chemical sensitivity

– Adverse drug reactions

– Autoimmune problems

– Hormonal imbalance

– Blood sugar imbalance

– Fatigue

Hepatic Detoxification

• Defects in hormone detox can lead to many problems:

• Partially breakdown hormones can compete with non-metabolized active hormones at the receptor site and blocks their active functions

• Patient may present with symptoms of hormone imbalance but not supported by lab results, making recommendations for treatment difficult for the less experienced practitioners

• Phase 1 and phase 2 detoxification pathways

• Phase 1—oxidative/reduction reactions involves the cytochrome P-450 enzymes pathway

• Uses oxygen and NADH to add a reactive group such as a hydroxyl radical

• Either complete neutralize the compound or renders it more reactive to bind with the phase 2 conjugation moiety

• Intermediates of phase 1 detox is more reactive and much more toxic—free radicals

• Pathological Detoxifier

• Patients with very active phase 1 detox and very slow or inactive phase 2 detox enzymes

• Most chronically ill patients have this problem

• Increase glutathione is imperative, NAC

• Glutathione also involved with phase 2 detox

• Phase 2—conjugation of phase 1 intermediates

• Neutralized toxins or make them more water soluble in order to be excreted via urine, sweat or bile

• 6 main pathways: glutathione conjugation, glycine conjugation, methylation, sulfation, acetylation and glucuronidation

-beet root is a good methyl donor

-sulfur-containing compounds (like carnitine, taurine, methionine, N-acetyl-cystine) can increase production of glutathione

Liver Detox Profile

• Great Smokies Diagnostic Lab’s Comprehensive Detoxification Profile that include both phase 1 and phase 2 liver detoxification functions.

Phase 1 test: Mainly a saliva sample, collected after the ingestion of a measured amount of caffeine for phase 1I system

For phase 2: urine or blood sample is collected after the ingestion of aspirin and acetaminophen depends on the profile selected.

The report include caffeine clearance (phase 1), conjugates of 4 phase 2 pathways. Ratio of phase 1 and phase 2 and other information can be obtained depending on which profile tests selected.

3/24/09

Dietary And Lifestyle Support for Liver Detoxification

• Increase fruits and vegetable, cholesterol, whey protein (sulfur containing foods)

• Exercises

• Sauna—sweating and circulation

• Skin brushing

• Epsom salt bath

• Colonic

• Coffee enema

• Liver and gallbladder flush

• Fasting

[pic]

Nutritional and herbal Support For Detox Function

• Dandelion—improves liver and gallbladder function, promote bile production and secretion to the GB, contraction of GB

• Milk Thistle—increase bile solubility, reduces bile concentration, potent antioxidant protects against phase 1 free radical damages to the liver, prevent glutathione depletion, anti-inflammatory, inhibits PGE2 and leukotriene, promote liver cells regeneration

• Ginger—increase bile production (cholagogue), reduces hepatic cholesterol

• Lipotropic agents—Beet root and leaves (betaine HCl), taurine, vitamin C, lecithin (phosphatidylcholine)

• Centella Asiatica (gotu kola)—improves histological findings of liver cirrhosis, venous insufficiency, venous hypertension

• Panax Ginseng—improves liver function, reverse fatty liver in animal models, anti-hepatotoxic properties, promotes Kupffer cells, increases nRNA, rRNA and mRNA synthesis

• Multiple vitamins and minerals to insure nutritional co-enzymes and co-factors sufficiency

• B-complex, Mg, Zn, Mo, Se, K

Liver/Gallbladder Flush

• The purpose of this procedure is to assist your body in its efforts to maintain free-flowing bile and to help keep the gall bladder free of debris.

• First, natural forms of natural acids are used to “cut” the sludge or hardened bile to allow for it to be expelled from the gall bladder, through the bile duct, into the colon and out the body.

• Second, adequate amounts of magnesium are ingested which allows for relaxation of the smooth musculature, including relaxation and contraction of the bile duct.

• Third, a natural oil, e.g.., olive oil, or heavy cream is ingested to cause the gallbladder to contract, forcing the expulsion of the bile sludge out of the gall bladder into the bile duct.

• Finally, green tea and/or coffee enema may be used to stimulate the release of waste from the liver into the bile duct, which also increases the rate of bile released from the liver.

Liver/Gallbladder Flush

DAYS 1-5:

• Eat a normal breakfast (supplements)

• Ingest as much apple juice as you feel comfortable. Use organic apple juice (free of preservatives). Fresh is always best, then frozen, and lastly cooked, bottled apple juice.

• Add a total of 90 drops of ortho-phosphoric acid (Phosfood by Standard Process) to the apple juice each day. This is taken at once (or 45 drops twice or 30 drops three times a day)

• Alternative, pure apple cider vinegar may be used instead of the ortho-phosphoric acid

DAY 6

• Eat a normal breakfast (supplements)

• 2 hrs. after breakfast, dissolve 2 TBSP Epsom salt in 3 ounces of warm, pure water and drink it. Chase with a little citrus juice.

• If gall stones are present, take a coffee enema with ¼ cup Epsom salts dissolved in it.

• 5 hrs. after breakfast, dissolve 1 TBSP Epsom salt in 3 ounces of warm water, and drink it. Chase with citrus juice.

• 6-7 hrs. after breakfast, you have a choice:

- Fast, or

- Fruit and whipped cream salad (variety of fresh or frozen fruit of your choice and whipped cream).

Eat as much as desired

• At dinner time, drink one-half cup of extra virgin olive oil (unrefined) or other oil. If necessary, you may blend the oil with an equal amount of fresh squeezed orange, grapefruit or diluted lemon juice. Or alternate swallowing oil with juice. Should nausea be felt, it is due to the contraction of the gall bladder. Lay on your right side for at least 20 minutes.

• In the morning, drink 3 ounces of water with 1 TBSP Epsom salt dissolved in it, also if stones are present, take another coffee enema with ¼ cup of Epsom salt dissolved in it. Resume your normal diet.

• Can repeat flush in 2 weeks, if needed.

-if patient has gallstones, then take a lot of betaine HCl (and/or apples) before doing a gallbladder flush

Liver/Gallbladder Flush

Contraindications/cautions

• Stones are calcified and very large

• During pregnancy

• If liver disease is present

• The gallbladder in non-functional

• If patient is very obese

Fasting

• An integral part of many religions—Buddhism, Islam, Judaism and Christianity

• When the glucose store in body is depleted fat and carbohydrate stores are used for energy

• When protein stores begin to be depleted for energy (resulting in loss of muscle mass)—starving.

• Autolysis—breaking down of fat stores in the body in order to produce energy

• Ketosis—depleted glycogen lead to the breaking down of stored fats and creates these ketone bodies

Fasting Benefits

• Detoxification--normal body process of eliminating or neutralizing toxins through the colon, liver, kidneys, lungs, lymph glands, and skin

• Enhance immunity--during a fast, energy is diverted away from the digestive system towards the metabolism and immune system

• Growth hormones are also released during fasting

• A slower metabolic rate, more efficient protein production, an improved immune system, and the increased production of hormones contributes to this long-term benefit of fasting

• Rejuvenation and extended life expectancy

• The only reliable evidence to extend the lifespan of a mammal is caloric restriction without malnutrition

Homotoxicology

• “The theory of disease developed by Dr. Hans-Heinrich Reckeweg (1905-1985), understands illness as the human body’s defense against toxic substances (homotoxins) that threaten to overwhelm the intercellular matrix. According to this therapeutic model, the type and severity of an illness are determined by the duration and intensity of toxin loading in relationship to the body’s inherent capacity for detoxification. «Clogging» of the matrix obstructs the movement of nutrients from blood vessels into cells, disrupting the body’s steady state and hindering important biological processes. The resulting disturbances, which eventually manifest as illness, are the body’s attempt to restore a state of biochemical balance. For Reckeweg, restoring this balance was the ultimate goal of all medical treatment.”

•

The Six Phase Table

• Subdivided into three blocks

• Each block has two phases

3/25/09

Fasting

• Juice Fast—3-7 days or more

• Water fast—3 day max, but natural hygienists promote prolong water fast as a way to heal serious illnesses.

• No food nor water—24 hours

• Brown rice fast—3-7 days

• Master Cleans (Water/lemon/lime/maple syrup/cayenne pepper)—3-21 days

• Raw food—7-21 days

• Fasting/detox programs—combining raw food or caloric restricting diet with herbal and nutritional supplements (7-21 days)

Fasting Precaution

• Wasting states

• Pregnancy and nursing

• Infants and children

• Medication

• Gallstone

• Physical activities—depends on the type of fasts

– None for water or abstinence of food (avoid physical activity with water fast)

– Light exercise for juice, lemon/lime/maple syrup fast

– 30-45 minutes moderate, raw food, weight loss fast

What to Expect During a Fast?

• Tired the first day or two

• Increase energy when ketosis established

• Increase urination

• Bowel movement will increase or decrease depends on types of fasts

• May experience euphoria on the third day onward

How to break a fast?

• Short fast, just resume normal eating

• Longer than three days, start with something light for dinner, gradually add back normal foods

• 21 days fast, normal raw veggies and fruits, add light protein for dinner, the first day, add more the next day to lunch, resume normal the third day at breakfast

• Continue on with a healthy dietary style

Thyroid Disorders

Most patients with functional thyroid problems do not have primary thyroid imbalances

[pic]

Low Thyroid S&S

• Fatigue

• Increase wt gain with low cal diet

• Morning headache wears off as day progresses

• Depression

• Constipation

• Hypersensitivity to cold weather

• Poor circulation and numbness in extremities

• Muscle cramps while at rest

• Chronic infections

• Loss of lateral third of eyebrow

Serum Thyroid Panel

• TSH—lab reference range: 0.5-5.5, functional range: 1.5-3.5

– Hypothyroid—above 3.5

– Hyperthyroid—below 1.5

• Free T4—can be altered by many drugs

• Free T3—active thyroid hormone, impacted by drugs

• Thyroid antibodies—auto-antibodies indicates autoimmune attack of thyroid

Malnutrition or Hypothyroid

• Symptoms are similar

• Insulin resistance is a major factor

– IR impair cellular utilization of macronutrients

– IR cause weight gain lead to the mistaken action of eating low fat and low protein diet

– Leads to malnutrition

– IR also cause under conversion of T4 to T3, a protective mechanism to slow down the effects of malnutrition

• Hypothyroidism is a malnutrition problem

Tyrosine and Iodine for Thyroid?

• Caution should be exercise when using tyrosine and iodine

• Use improperly can cause suppression of thyroid hormone production

• The relationships of tyrosine and iodine metabolism is more complicated then simply supplementing them without thorough understanding of the whole symptoms picture

• Tyrosine may be indicated for vegans

• Increase iodine can be used for hyperthyroidism

• Always support the adrenals first with thyroid problems, don’t treat the thyroid and ignore the adrenal which is usually the underlying cause of thyroid problems.

Nutrition And Herbs For the thyroid

• Procine thyroid glandular—Armour Thyroid, a prescription thyroid HRT, Apex Energetics and American Biologic produce desiccated thyroid glandular

• Withania (Ashwangandha)—stim both T3 and T4 production, support hepatic function, reduces oxidative stress, adaptogen activity that modulate cortisol release

• Vitamin A—influence thyroid hormone nuclear receptors transcription activation

• Vitamin D—immune modulation, suppresses autoimmune thyroiditis (Hashimoto)

• Selenium—co-factor for 5’deiodinase which convert T4 to T3 and degrades rT3

• Zinc—improves thyroid fxn, co-factor for 5’deiodinase, reduces thyroid antibodies

• Commiphora (Gugulipid)—stim. T3 production, reduce LDL, cholesterol and lipid peroxides

• Antiperoxidative compounds—lipid peroxidative and antioxidant enzymes systems play a profound role on the peripheral thyroid hormone conversion. Substances (alpha lipoic acid, N-acetyl cysteine, protein, B-complex) that support the synthesis of glutathione and decrease free-radical and oxidative stress (antioxidants, bioflavonoids, polyphenol, OPC) will improve thyroid hormone conversion and thyroid function

• Omega-3 EFA—imbalance of eicosanoids is linked to inflammatory reactions and thyroid disorders

-Iodoral supplement (~12mg iodine)

-excess iodine (10x the RDA) is not toxic for the body)

Thyroid HRT

• Desiccated Thyorid—generic or brand name desiccated pig thyroid (Armour Thyroid, Westroid, Naturethroid, Proloid)

• Cytomel—brand name for synthetic T3

• Levothroid—brand name for synthetic T4

• Levothyroxine—generic T4

• Levoxyl—brand name T4

• Synthroid—brand name synthetic T4 (most Rx drug in the US)

• Thyrolar—brand name fixed-ratio mix of synthetic T3 and T4

• Patients may respond well to natural thyroid replacement or synthetic ones

• If synthetic not working well, suggest to patient to consult with their MD to switch to natural replacement which may work better and vise versa.

• Synthetic usually to be taken on empty stomach, in the morning, avoid taking calcium along

• Natural thyroid med better be taken in 2 divided doses, after breakfast and dinner for optimal function according to Joseph Mercola, DO ()

What happens when you give thyroid hormones to a malnourished without re-feeding?

• Initially feels better

• Unravels the protective mechanism against rapid tissue breakdown

• Thyroid meds are stimulants

• Increases IR and accelerates muscles and protein reserves breakdown

• Health deteriorates rapidly

• Hormone replacement must be used with caution

Functional Endocrinology and Nutrition (on Final exam)

Part 4 - Female Hormonal Problems

“Because the family of glands is closely interrelated, it is difficult to hurt one member without injuring others.”

-Endocrine Handbook by Harrower

Female Hormonal Imbalance: Estrogen Dominance

The Female Cycle

• The female menstrual cycle is a complex interactions and orchestration of many hormonal messengers.

• Endocrine disruptors are especially damaging to the female cycles because most of these chemicals are also estrogen mimics.

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Estrogen

• Estrogen's functions are primarily the growth and development of sex organs and other tissues related to reproduction

• Water retention

• Fat storage

• Maturation of the female adolescents

• Stimulate endometrial growth during the first half of menstrual cycle.

• Promote target cell proliferation

• Develops progesterone receptors

Estrogen (cont)

• Inhibits osteoclast activity and retard bone resorption

• Over thirty different forms of estrogen have been described.

• Produce by the ovaries in females

• Can be converted from testosterone by aromatase in adipose tissues

• The most common are:

• Estrone (E1)—10%

• Estradiol (E2)—10%

• Estriol (E3)—80%

Progesterone

• Progesterone is the other primary female hormone.

• Balance the activities of estrogen.

• Produced in the ovaries and the adrenal gland.

• Precursor for both estrogen and testosterone, as well as cortisol.

Functions of Progesterone

• Target cell differentiation and maturation (to grow up and be )

• Maintain the endometrium in pregnancy

• New bone formation (stimulate osteoblasts)

• Blood pressure regulation

• Fat conversion and energy production

• Sugar metabolism

• Maintaining myelin

• Regulating estrogen production

• Increasing estrogen receptors sensitivity

Estrogen and Progesterone

• Estrogen has to be in balance with progesterone to function well in the body.

• The excess or deficiency of either hormones will cause symptoms and disruption of the normal working of the endocrine system.

• Insulin, thyroid hormones and adrenal hormones (the major endocrine hormones) all exert influence.

Estrogen Dominance

• Anxiety, irritability, anger and agitation, mood swings

• Cramps, heavy and prolong bleeding, clots

• Breast tenderness

• Water retention and weight gain

• Fibrocystic breast

• Sweet cravings

• Foggy thinking

• Allergies

• Cervical dysplasia

• Increased risk of cancers

• Increased risk of autoimmune diseases

• Back pain

• Acne

Causes of Estrogen Dominance

• Nutritional deficiency

• Insulin resistance

• Adrenal Stress--hypercortisolemia

• Chronic inflammation

• Excess of estrogen in comparison to Progesterone.

• Estrogen disruptors or xenoestrogen—HRT and Oral Contraceptives

• Other endocrine disruptors—thyroid disruptors

• Digestive issues

• Hepatic detoxification issues

Endrogen Dominance

• Increased androgens (testosterone and DHEA) produce metabolic disorders in women

– Insulin resistance

– Central obesity

– T2DM

– CVD

– PCOS

– Poor glycemic control and poor health

Insulin Resistance

• Hyperinsulinemia upregulates 17,20-lyase, an anzyme produced in the theca cells

• 17,20-lyase increases androgen production by shifting away from estrogen production

• Increased androgens in women promotes insulin resistance and the vicious cycle goes on and on…

• Androgen dominance, estrogen dominance and insulin resistance promotes reproductive organs cancers in women

Xenostrogens

• DDT

• DES

• Dioxin

• Drug version of HRT

• Plastics

• Pesticides

• Cosmetic and skin care products

• Perfume

• Laundry products

• Phytoestrogens

WHI Findings on HRT

• Findings from the Women's Health Initiative (WHI) studies showed that women using estrogen with or without progestin may increase their chances of strokes and blood clots.

• Using estrogen with progestin also increased a woman's chance of getting breast cancer and heart attacks, but using estrogen alone did not.

• For women with a uterus on hormone therapy, a combination of estrogen plus progestin is prescribed.

• For women who have had a hysterectomy, hormone therapy consists of estrogen alone.

• Using estrogen with or without progestin may increase the risk of dementia in women age 65 years or older.

• Estrogen, with or without progestin, may decreased women's chances of developing osteoporosis. Estrogen with progestin decreased the risk of colorectal cancer in women.

– FDA Press Release P04-94, September 29, 2004.

Risks and Benefit of HRT

• For some women, menopausal hormone therapy may increase their chances of getting blood clots, heart attacks, strokes, breast cancer, and gall bladder disease. For a woman with a uterus, estrogen alone slightly increases her chance of getting endometrial cancer (cancer of the uterine lining).

• benefits of using hormones for menopause, HRT is the most effective FDA approved medicine for relief of hot flashes, night sweats, and vaginal dryness. It may also reduce the chances of getting weak bones, a condition called osteoporosis.

• FDA Press Release P04-94, September 29, 2004.

HRT and Heart Disease

• Women with or at high risk of coronary heart disease should not start HRT

• Women without coronary heart disease might experience even greater net harm from HRT.

• Archives of Internal Medicine October 23, 2000;160:2897-2900

HRT and Stroke

• An analysis of some 40,000 women involved in 28 clinical trials has discovered: Women who use HRT increase their risk of stroke by 29 PERCENT and the likelihood of a fatal or disabling stroke by 56 PERCENT.

• The effect is seen in ischaemic strokes, caused by blockages of blood flow to the brain, not in the less common form of hemorrhagic stroke.

• The University of Nottingham research team recommended patients with a high risk of stroke should stop taking HRT unless there is a strong medical reason not to do so.

• BMJ, January 7, 2005

Three Major Problems

1. Soy

2. Trans Fatty acids

3. Refined Carbohydrate

Soy Alert

• “Deleterious effects include endocrine disruption, thyroid suppression, immune system suppression, suppression of sperm production, DNA breakage and increased incidence of leukemia, breast cancer, colon cancer, infertility, growth problems and subtle changes in sexually dimorphic behaviors.”

•

Soy Isoflavone

China (1990 survey) 3 mg/day

Japan (1996 survey) 10 mg/day

Japan (1998 survey) 25 mg/day

Japan (2000 survey) 28 mg/day

In Japanese subjects receiving adequate iodine, causing thyroid suppression after 3months 35 mg/day

In American women, causing hormonal changes after 1 month 45 mg/day=0.75 mg/kg*

In American women, causing changes presaging breast cancer after 14 days 45 mg/day

FDA recommended amount 24 mg/day

AdvantaSoyTMClearTM 30-50 mg/ 100 g serving

In children on soy formula 38 mg/day=6.25 mg/kg*

*assumed 60 kg for adult, 6 kg for infants

Source:

Trans Fatty Acid

• Unnatural

• Disrupt cell membrane

• Disrupt cell receptors

• Disrupt essential fatty acid metabolism

• Disrupt hormone productions

Refined Carbohydrate

• Carbohydrate intake increases insulin

• Insulin encourages fat gain

• Fat tissues increase estrogen

• Estrogen also promote fat gain

• Estrogen also induces insulin resistance

• Insulin resistance cause carbohydrate cravings…..

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2 / 4 /16 Estrogen Metabolites

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To understand all the complex interactions involved is nearly impossible!

But we can rely on the body to clear it all up once we find the causes and solutions are available.

Tests and Evaluation

• Hair Analysis

• Saliva hormone tests

• History

• Lifestyle assessment

• Questionnaires: endocrine assessment, metabolic typing, emotional, behaviors, symptoms survey

Solutions

• Clean up the environment

• Clean up the diet, rely on whole foods

• Clean up the body, detoxify liver, GI tract

• Exercise and dietary modification

• Hormone modulating herbs and supplements

• Bio-identical hormones (must be tested first and monitor regularly)

• Stress management

• Balance blood sugar

• Agricultural and food processing reform

Hormone Modulating Herbs

• Black cohosh

• Blue cohosh

• Licorice

• Chaste tree

• Wild yam

• Dong Qui

• Red clover

Hormone Modulating Herbs

• Black Cohosh—modulates estrogen effects in the body, improves estrogen deficiency symptoms, decreases hot flashes, increase pelvic blood flow, reduce spasms, reduce depression

• Dong Quai—has “selective estrogen receptor modulator” properties, 1/400th the activity of true estrogen on cells, useful in both estrogen deficiency and excess conditions, hemotonic, analgesic, anti-inflammatory, anti-allergenic, cardiocprotective, mild laxative, increase vaginal secretion

• Chaste Berry (Vitex Angus-Castus)—optimizing impact in luteal phase function, increases progesterone levels and LH, decreases FSH, modulates prolectin associated with hyperprolactinemia induced by corpus luteum insufficiency, reduces PMS symptoms, improve fertility and optimizing luteal phase funcition

• Sheperd’s Purse (Capsella busa-pastoris)—increase uterine tone, hemostatic properties, helpful in dysmenorrhea associated with progesterone deficiency, help shedding of uterine lining (excessively thickened due to estrogen dominance), also helpful in treating hemorrhoids and diarrhea

Chem Pharm Bull 1992;40(4):954-946

Chinese Herbal Medicine Materia Medica, Bensky D, et al

The complete Botanical Prescriber, Sherman JA.

Acta Pahrmacol et Toxical 1983;52:246-253

Nutrients For Hormone Balance

• Calcium

• Magnesium

• Zinc

• Vitamine E

• Vitamin B complex

– B6

– Pentothenic acid

• Vitamin C

Nutrients For Hormone Balance

• Pyridoxal-5-phosphate—reduces tissue hypersensitivity to estrogen, modulate hormone receptor complex and the binding of this complex to DNA, deficiency of B6 lead to exaggerated symptoms of estrogen excess with normal or slightly increased estrogen levels

• Magnesium—essential for hepatic Phase II detoxification of estrogens, co-factor for Catechol-O-methyltransferase (COMT) which converts estrogen metabolites from phase I into water-soluble metabolites, up-regulates glucuronyl transferase which helps detoxify estrogens

• Vitamin B12—essential support for phase II, methylation pathway

• Indole-3-Carbinal(I3C)—natural compound found in cruciferous vegetables, shifts the 2/16 ratio in favor of 2-OH estrone which is not carcinogenic.

• Diindolylmethane(DIM)—More active then I3C, but less stable

Principles for Health

1. Optimize GI fxn: digestion and absorption

2. Support liver detoxification

3. Support lymphatic function—skin brushing, rebounding, walking, dancing

4. Proper breathing to increase blood O2

5. Promote adrenal health by managing stress and reducing adrenal stimulants

6. Maintain normal glycemic control

7. Whole, real, organic, locally-grown food diet

8. Pure drinking water

9. Proper exercises—aerobic and anaerobic

10. Avoid fake fats

11. Avoid all artificial sweeteners

Functional Endocrinology and Nutrition

Part 5 - Male Hormonal Problems

Male Hormonal Disorders

Andropause—decline in testosterone production in males

Andropause

• A gradual decline in men’s ability to maintain an androgen dominant state

• Production of testosterone decline

• Emerging health problem in developed nations

• Due to increased exposure of xenoestrogens, exotoxins in the environment, stress, EFA and nutritional deficiencies, and impaired hepatic detox function

• A product of chemical, physical and environment factors—industrialization

• Primary, secondary and functional

• Functional is the most common cause

• The ratios between testosterone and other hormones changed, the most common between testosterone and estrogen

• Normal T:E should be 50:1

• Estrogen dominant syndrome in men

• Can be found in men of all ages from late 20’s to the aged

• Typically presents a middle-age man with gradual decline in sex drive, strength, energy and enthusiasm for life, inactive, physical and mental fatigue for no apparent reason, depressed, pessimistic, difficult to get along, deteriorating family and social relationships, erectile dysfunction





S/S of Andropause

• Typically identified with low testosterone levels

• Obesity

• Increased waist-to-hip ratio

• Insulin resistance

• Hyperglyceridemia

• Hyperlipidemia and hypercholesterolemia

• Low HDL

• Low LDL

• Increased fibrinogen levels

• Increased lipoprotein B

• Venous congestion

Testosterone Functions

• Cardiovascular—heart has more testosterone receptors than any other muscles in the human body, statin lowers cholesterol has been shown to reduce testosterone

• Energy and hemopoesis—as T decline, so does RBC count, reduced O2 leads to lowered ATP production

• Bone density—testosterone and progesterone stimulates osteoblasts activity

• Prostate health—testosterone is not responsible for prostate hyperplasia, both DHT and estrogen induce prostate hypertrophy

• Sex drive—testosterone promotes libido in both sexes

• Moods—testosterone promotes a man’s sense of well-being and mood

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Causes of Male Hormone Imbalance Problems

• Andropause—overall reduction of T

• Adrenal stress disorders—increased cortisol and estrogen dominance

• Prostate hypertrophy—lowered progesterone

• Gastrointestinal disorders

• Hepatic detoxification problems—most common reason for low DHT

• Nutritional deficiency—EFA, vitamins and minerals

• Statin drugs and corticosteriods

• Insulin resistance

Insulin Resistance

• As levels of T wane in men, glycemic control goes out of control

• Reduced T and increases in cortisol lead to insulin resistance, central obesity and metabolic disorders

• Declining T may be the primary driving factor for IR, MetS and CVD in men

Diabetes 1996;45:1605-160

Benign Prostatic Hyperplasia

• Voiding problems such as decreased caliber of urine stream, hesitancy, intermittency, staining, incomplete emptying and urine retention

• Storage problems such as urgency, frequency, nocturia, dysuria, urge incontinence

• These may also relate to bladder tone, especially in older men

• The Lancet 2003;361(9366):1359-1367

BPH Pathogenesis

Two theories:

1. Mechanical components or the hormone dependent hyperplasia

• Androgen hypothesis

• Estrogen hypothesis

2. Dynamic component or alpha-adrenergic tone

• Modern Phytotherapist 2003;7(2):22-28

Androgen Hypothesis

• Prostate function and growth are androgen dependent

• In the prostate, T is converted to DHT by 5-alpha reductase

• DHT is the active intracellular androgen which binds with the nuclear androgen receptor. This complex then bind to a specific DNA sequence, initiating mRNA production, protein synthesis, cell growth

• Modern Phytotherapist 2003;7(2):22-28

Estrogen Hypothesis

• Estrogen originate from T and androstenedione via the action of aromatase

• Observation from experiment showed that administration of estrogen could induce BPH

• As men age, endocrine environment becomes more estrogen dominant with a dramatic increase in estrogen compare to T

• It has been shown that estrogen, mediated by sex hormone binding globulin (SHBG), participates with androgen in setting the pace of prostate growth

• SHBG has been shown to increases with age and can act like an additional androgen receptor

• It is suggested that E binds to SHBG in the cell membrane, IGF-1 is synthesized leading to proliferation of prostate epithelial cells

• Further addition to the proliferating stimulation by androgens

• Modern Phytotherapist 2003;7(2):22-28

Dynamic Component

• Urethral obstruction—prostatism

• Alpha-adrenergic (sympathetic) fibers innervate the smooth muscle of the prostatic urethra and bladder neck

• Contraction of this smooth muscle can lead to BPH symptoms

• Alpha-adrenergic blocker such as prozosin hydrochloride are usually prescribed to alleviate prostatism symptoms

• Sympathetic dominance caused by stress may contribute to neurogenic inflammation and BPH symptoms

• Modern Phytotherapist 2003;7(2):22-28

Herbal Support for Andropause

• Tribulus terrestris—supports sexual dysfunction for both sexes, improves spermatogensis, increase sertoli cells LH and T in males

• Lepidium meyenii (Maca)—enhances fertility in both sexes, increase spermatogensis, and hormones, aphrodisiac, adaptogenic

• Chrysin—passion fruit flower extract, inhibits aromatase activity, thus prevents the conversion of T into Estrogens, antioxidant, anti-inflammatory, anti-histamine, anti-viral, anti-cancer

• Panax Ginseng—increases T production, promotes spermatogensis, libido

• Saw Palmetto (Seronoa repens)—reduce 5-alpha reductase activity and lowered DHT which stimulates prostate cell to proliferate, reduce symptoms of BPH

• Cautions: overdoes can reduce T production

• Pygeum Africanum—reduced benign prostate hypertrophy (BPH) similar to Saw palmetto

• Cerniltion—inhibits growth of prostate cells, reduces BPH and related symptoms: urinary urgency, dysuria, nocturia, incomplete voiding and dribbling

• Stinging Nettle (urtica dioca)—intercepts DHT and receptor binding, reduces BPH

Nutritional Support for Male Hormone Disorders

• Zinc—improves male fertility and T concentration, down-regulates 5-alpha reductase and reduces DHT, inhibits prolactin levels

• Amino Acids (glycine, glutamic acid, alanine)—influences neurotransmitters activity of the bladder and relieve BPH symptoms

Summary of Functional Endocrinology

• Complex interactions of endocrine glands to each other, to the environment, internal and external stressors

• Interactions of major hormones: cortisol, insulin, thyroxin, and adrenalin

• Interactions of major hormones with minor hormones: estrogens, progesterone, testosterone,

• Look for the root cause of problems

• Support whole body health by addressing the 3Ts: Trauma, toxins and thoughts

• Don’t miss digestive, liver detox and adrenal stress issues

• Focus on using dietary and lifestyle changes, wholesome foods, whole food based supplements (priority), individual nutrients for short term corrective action, essential fatty acids, anti-oxidants, botanicals

• Chiropractic care and nutritional counseling form a solid foundation for a wellness care program

Resources

• Seminar: Dr. Datis Kharrazian—Functional endocrinology, Functional Blood Chemistry

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• Vitamin D

• Cod liver oil

• Evening primrose oil

• Gamma linolenic acid

• Wheat germ oil

• Glandular extracts

• Raspberry leaves

• Ginseng

• Tribulus

• Gymnema

• White peony

• Shepherd’s Purse

• Uterine fibroids

• Endometriosis

• Irregular periods

• Insulin resistance and unstable blood sugar

• Lost of sex drive, infertility

• Gall bladder problems

• Insomnia

• Osteoporosis

• PCOS

• Fat gain in hip and thigh areas

• Slow healing wounds

• Required more sleep to function

• Chronic digestive problems

• Hypochlorhydria

• Itchy dry skin

• Dry brittle hair

• Hair loss

• Lower axillary temperature

• Edema (myxedema)

Humoral phases:

• Excretion

• Inflammation

Cellular phases:

• Degeneration

• Dedifferentiation

Matrix phases:

• Deposition

• Impregnation

-insulin can inhibit proper conversion of T4 to T3

-gut flora can convert T4 to T3

• Mental fatigue and poor concentration

• Depression

• Lost of initiative

• Myalgia

• Decrease in

• morning erection

• Fullness in erection

• Libido

• Physical stamina

• Visual acuity

• Failing memory

• Tiredness after minimal exertion

• Joint pain and muscle ache

• Poor appetite

• Frequents colds and influenza

• Low back pain - not traumatic

• Depression

• Candida infections

• Irritable bowel

• Hypercholesterolemia

• High triglyceride

• Infertility

• Insomnia

• Fatigue

• Type II diabetes

• Low estrogen

• Estrogen dominance

• Migraine headache

• osteoporosis

• Metabolic syndrome

• Insulin resistance

• Adrenal dysfunction

• Pancreas dysfunction

• Liver detox dysfunction

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