Should you take aspirin to reduce your risk of heart disease?

We know that aspirin is anti-inflammatory and reduces blood clotting.  Inflammation and blood clots are important factors in causing a heart attack.  So it makes sense that taking an aspirin could help reduce the risk.

The problem is that studies have been mixed - some showed a benefit, and some showed not much, if any, benefit.  And there are risks.  Aspirin can cause gastrointestinal bleeding.  And the scary thing is, life threatening bleeds can happen out of the blue without any warning.  So you can actually die from taking an aspirin!  Of course the risk is very small, but there is much ongoing debate over whether the benefits outweigh the risks.

If you are at high risk for a heart attack (for example you have already had a heart attack and are trying to avoid another one), then the benefits clearly outweigh the risks. and you have likely been advised to take an aspirin by your doctor.

But what about people who don't have heart disease and are trying to avoid it in the first place?  The answer is not so clear.

There are many risk factors for heart disease.  Most people are familiar with the common ones: smoking, being obese, being sedentary, having diabetes, high cholesterol or high blood pressure.  But there are many, many more risk factors that should be considered as well.

Here are some other factors:

-level of inflammation in your body
-hormonal imbalances (in men and women)
-subclinical hypothyroidism
-chronic low grade infections
-environmental pollutants
-stress
-anxiety and depression
-lack of sleep
-lack of antioxidants
-Vit D level

Of course genes play a role as well.

If you have a heart attack when you are very young, say in your 30's, then genes are likely playing a large role.  As you get older, genes account for approximately 20% of your risk - environmental factors account for the rest!

There is no one "gene" for heart disease.  Your personal pattern of genes, and how they interact with your environment, determines your risk.

So back to the question of aspirin.....

We can now measure genes that tell us about your personal genetic blueprint.

A certain gene (called COMT) is important for regulating the amount of adrenaline and similar compounds in your body.  Too much adrenaline is associated with high blood pressure and rapid heart rate, which can increase your risk for heart disease.

If you have a certain version of this gene (which we can test for) then you are at risk for higher levels of adrenaline and therefore are at increased risk of heart disease.  In this case, taking an aspirin can decrease your risk.

But if you have another version of the gene, you likely have normal levels of adrenaline and no increased risk. Taking an aspirin with this gene type can actually INCREASE your risk of a heart attack! Taking Vitamin E could also increase your risk with this gene type.

While most women are scared of breast cancer, the fact remains that 1 out of 2 people is going to die of heart disease.  And most heart attacks are preventable.  It is important to understand YOUR personal genetic blueprint, optimize the lifestyle factors that are in your control, normalize hormone levels and reduce inflammation.

So should YOU take aspirin?

It isn't such a simple question, and the answer is certainly not going to come from large population studies where the statistics are analyzed.  Learning about your genes is an exciting new leap forward in medical science.

At Signature Wellness, we are pleased to be able to offer genomic testing, to be able to personalize your recommendations.

If you would like to have a closer look at your personal genetic risks for heart disease (so that we can modify them!) please contact the office for further information.    704-752-9346
www.signaturewellness.org  

Yours in Health

DrM

A hidden cause of weight gain that starts in your gut

Did you know that you have something called a microbiome?  You may not have heard about it, but it is a very important part of you.  In our digestive tract, we have trillions of microbes - in fact we have more bacterial DNA in our bodies than human DNA!  These microbes are called your "microbiome" and they play a very important role in your health, and in your weight.

A healthy microbiome has lots of different types of micro-organisms  - lots of diversity.   Overweight people tend to have different bacteria in their guts than lean people.

Things that can affect the types of organisms in a negative way include:

- antibiotic use
- birth control pills
- stress
- pain medications
- steroid pills like prednisone
- pesticide residues in our food

Poor quality foods (fried foods, trans fats, sugar, processed food and artificial sweeteners) tend to feed and promote the less desirable type of microbes in your gut.  These organisms affect the lining of your digestive tract, causing inflammation and promoting weight gain.

Some bacteria affect our digestive tract to increase the number of calories we extract from food. Evolutionarily this may have helped us survive in times of food scarcity, but in our modern times of readily available, high caloric foods it helps to promote weight gain.

The gut microbes can also cause food cravings.  Having excess amounts of yeast, in particular, causes sugar cravings, because yeast thrive on sugar and they literally highjack your brain so you feed it to them.  Weight gain is not just dependent on what you are eating, but what your gut bugs are eating!

We know that certain probiotics (the healthy kind of bacteria) and prebiotics (natural fiber that feeds the probiotics) can reduce inflammation and improve the makeup of the gut microbes.  For example, a bacteria called Akkermansia helps with weight loss and improves metabolic function. Oligofructose (a prebiotic) increases Akkermansia by 100 fold.   Oligofructose is found in foods like onion, artichoke, leek, and garlic.

A nutrition program that helps to balance gut microbes is an important part of a healthy weight loss program (and weight loss maintenance).    Once again we can demonstrate that "calories in and calories out" is only part of the overall equation for weight loss!

If you are looking for help with your weight, please let us know!  Our medical weight loss programs address the microbiome, as well as the other underlying causes of weight gain including hormone imbalance, hidden food sensitivities, inflammation, environmental toxins.  and blood sugar metabolism.

Yours in health,

DrM

Do you want to lose belly fat? 10 reasons you are not losing weight

For many years we have been told that weight loss is straight forward - eat less and exercise more.  Unfortunately it is just not that easy!  For some people, maintaining a healthy lifestyle is hard in our modern world.  Many of our patients are already eating a reasonably healthy diet, exercising somewhat regularly and yet STILL continue to struggle with their weight.  Clearly there are other factors at play.  Here are some factors that can interfere with weight loss success:

HORMONAL FACTORS:

As you may expect, there are quite a few hormones that affect your weight.

1.  Sex hormone imbalances.  Problems with estrogen, progesterone or testosterone may result in weight gain.  

2.  Stress hormones imbalances.  Cortisol and DHEA are made in our adrenal glands (along with adrenaline) and they regulate weight, especially around the waist.  

3.  Low thyroid function  Thyroid hormone regulates our metabolic rate, how many calories we burn and whether or not we are burning fat for fuel.  Low thyroid makes weight loss very unlikely.  An overactive thyroid gland is the only thyroid problem that can result in weight loss, but it also causes anxiety, heart palpitations, jitteriness and other problems.

4.  Insulin problems.  Insulin is the hormone that regulates blood sugar.  If insulin is not working properly it takes more and more insulin to maintain blood sugar in the normal range.  The problem is that insulin is a fat storing hormone.  The more insulin, the more belly fat.  

5.  Leptin problems.  Leptin is a hormone that controls appetite signals.  If Leptin is not working properly, your brain will always think that you are starving and will cause more hunger.  

As you can see, proper hormone balance is critical to losing weight and maintaining a healthy weight.  Lifestyle factors are also very important - quality of sleep, stress levels, physical activity, nutrient intake, healthy social connections.  Hormone imbalances can make it harder to maintain good lifestyle habits due to fatigue, insomnia, mood symptoms, poor stress tolerance, food cravings as well as directly affecting metabolism and whether you are burning or storing fat.

OTHER IMPORTANT UNDERLYING FACTORS:

These factors are often root causes of the hormone problems above.

6.  Food sensitivities.   It is very common to develop sensitivities to common foods.  A sensitivity causes low grade inflammation which promotes weight gain.  Changing nutrition to avoid the foods you are sensitive to can help with mood, energy, memory, joint pains, digestive symptoms, menstrual problems as well as weight gain.

7.  Toxins.  There are tens of thousands of chemicals that we are exposed to on a regular basis.  Many of these are “hormone disrupters” - meaning that they interfere with metabolic processes and hormonal  balance.  We know that people with higher levels of toxins tend to be more overweight and more likely to have diabetes, as well as many other hormonally related problems.  Avoidance of toxins and learning how to help optimize your natural detoxification pathways can be a very important step in weight loss.

8.  Dysbiosis.  This is a word that means there is an imbalance in your “micro biome” - the trillions of micro-organisms that live in your digestive tract.  If you have too many of the wrong bacteria and not enough of the good health-promoting bacteria (the probiotics) this is associated with weight gain.  In some cases the bacteria literally cause us to extract more calories from the same amount of food.

9. Candida.  Overgrowth of digestive yeast (candida) is another common problem that we see that promotes weight gain.  Candida causes sugar cravings that can be quite severe, making it much more difficult to avoid the sugary junk.  Candida also causes bloating, brain fog, fatigue, and hormonal imbalances

10.  Inflammation.  If there are too many inflammatory chemicals circulating in the blood stream, these directly cause problems with insulin and cortisol, resulting in weight gain.  Insulin and cortisol can contribute to more inflammation - so a cycle is created where all things being equal, your body wants to store more fat.  

Solutions are available!

As you can see, the "calories in vs calories out" equation is not the whole story.  A medical weight loss program that addresses ALL of these issues is much more likely to result in successful longterm weight loss.  If you have been struggling with your weight, please know that there are good options and that we can help!  Please click here for more information on our Optimal Wellness Program

Why is hormone pellet therapy so popular?

Hormone loss is associated with many problems including heart disease, osteoporosis, memory loss, loss of muscle mass, lack of sex drive, mood changes, weight gain and aging skin. Bioidentical hormone replacement therapy has been show to have benefits such as improving mood, energy, sleep, memory, sexual function, muscle strength and body composition.

When I started my practice in 2007, I prescribed mainly topical bio-identical hormone creams. This approach allowed me to prescribe the appropriate mixture of hormones based on a patient's individual needs, and worked well in many people - but not all patients had optimal results. Currently, my most preferred way to replace hormones has become bio-identical hormone pellet therapy.  

Hormone pellets are smaller than a grain of rice and contain a natural plant source of estrogen and/or testosterone (based on a patient's needs). They are inserted under the skin of the buttock in a simple, painless office procedure. The pellets are gradually dissolved by the body, and a small, physiologic dose of hormone is released at a steady rate into the bloodstream.  

The pellets allow rapid resolution of hormone deficiency symptoms - sometimes within 48 hours!  The convenience is very popular - the pellets are inserted approximately once every 3-4 months and result in very consistent hormone levels and relief of symptoms.

Hormone pellet implants have consistently been shown to improve many common symptoms in men and women including:

- insomnia
- fatigue
- lack of libido
- hot flashes
- palpitations
- headaches (especially premenstrual or hormonal migraines)
- irritability
- depression
- anxiety
- memory loss
- incontinence
- aches and pains
- vaginal dryness

This treatment seems "new" but in fact hormone replacement by pellet implantation has been used with great success in the United States, Europe and Australia since 1938! Pellets deliver consistent, physiologic levels of hormones and avoid the fluctuations of hormone levels seen with other methods of delivery, like the topical creams.

Hormones delivered by pellet therapy bypass the liver, do not affect clotting factors and do not increase the risk of blood clots which is a risk with estrogen pills and synthetic progestin pills.

Pellet therapy has been shown to be superior to oral and topical hormone therapy with respect to relief of menopausal symptoms. This is why they have become the most popular method of bio-identical hormone replacement in my practice - women are finding better results! 

Hormone replacement with estrogen and testosterone pellets have been shown to be better than oral and topical hormones for bone health. The pellets not only prevent bone loss but have been shown in many studies to actually increase bone density.

Pellets do not have the same risk of breast cancer as synthetic hormone replacement pills.  In fact, studies show there may be a reduction in the incidence of breast cancer with pellet therapy. In a study on breast cancer survivors, hormone pellet implantation did not increase the risk of cancer recurrence or death as does estrogen in combination with synthetic progestins.

There are many options for bio-identical hormone replacement therapy including topical creams and patches, pills, vaginal creams, sublingual lozenges and pellet therapy. A thorough discussion of the options is important for each woman. Please click here if you are interested in learning more about bioidentical hormone replacement therapy.

Yours in health

Deborah Matthew MD

References:

Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale (MRS) Glaser R, York AE, Dimitrakakis C. Maturitas. 20011;68:355-361

Testosterone, delivered by subcutaneous pellet implant has been shown to improve hot flashes, heart discomfort, sleep problems, depressive mood, irritability, anxiety, physical fatigue, memory loss, migraine headaches, sexual problems, bladder problems (incontinence), vaginal dryness, joint and muscular discomfort in both pre-menopausal and post-menopausal patients without adverse drug events 

Moderate dosage estrogen–androgen therapy improves continuation rates in postmenopausal women: impact of the WHI reports Gambrell and Natrajan CLIMACTERIC 2006;9:224–233

Long-term studies with up to 30 years follow up, confirm the safety of testosterone therapy and absence of adverse drug events with the pellet implant.   No increase of breast cancer even after 20 years of hormone pellet therapy

Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women.  Savvas et al.  British Medical Journal 1988  Jul 30;297(6644): 331-333

Subcutaneous oestrogen is more effective than oral oestrogen in preventing osteoporosis, probably owing to the more physiological (premenopausal) serum oestradiol concentrations achieved.

Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrozole:  a prospective, observational study.  Glaser et al.  Maturitas 2013 Dec;76(4):342-9

Testosterone and/or testosterone+anastrozole, delivered subcutaneously as a pellet implant, reduced the incidence of breast cancer in pre and postmenopausal women.

The libido hormone - why women need testosterone too!

Ladies are you lacking motivation?  No energy?  Losing muscle mass?  Skin looking saggy?  Lost that lovin' feeling?

You could be deficient in testosterone!

We think of testosterone as the "male" hormone, but women have testosterone too and it is really important!  Testosterone acts like our "inner strength".  It gives us competitive drive, motivation, assertiveness, self esteem, decisiveness and confidence.  If testosterone levels decline, we notice a change in how we feel.

Testosterone also affects everything to do with sex including interest, lubrication, and ability to become aroused.

I see testosterone deficiency in women starting at age 35-40,  long before menopause.  Sometimes this is due to use of birth control pills, or high stress levels, and often it is just due to the aging process - by age 40 our testosterone levels may be reduced by half.

Restoring testosterone can help with quality of sleep, energy, mood, strength and endurance, skin tone, muscle tone and shape, and can have marked improvements on sexual function.

Other things that can improve with testosterone restoration are PMS symptoms, menstrual migraines, aches and pain, hot flashes, incontinence, vaginal dryness, palpitations and bone density. Testosterone is very important in improving bone strength to prevent fractures.

There are even some reports that suggest testosterone may help to reduce the risk of breast cancer.

Testosterone is available as a topical cream, a sublingual troche (dissoved under the tongue) or as a pellet (which is implanted under the skin).  The pellets are by far the most popular in my practice and have the best symptomatic benefit.  They have been used in the United States since 1938 and have a long track record of safety and effectiveness.

The risks of testosterone replacement are mainly nuisance symptoms like excess hair growth or some pimples, as opposed to serious risks, and these problems go away if the dose is reduced or testosterone is discontinued.  Women who already have these problems are the most likely to experience these side effects.

Testosterone replacement can have a very large impact on a women's life, her marriage, her work performance, and overall wellbeing.  It has been very satisfying to be able to help women get back to feeling like themselves again.

If you would like more info about testosterone replacement and whether it may be right for you, please click here.

Yours in health

Deborah Matthew MD

0. Reference:  Glaser R, York AE, Dimitrakakis C. Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale (MRS). Maturitas. 20011;68:355-361. 
   

Have you heard about the new non-surgical treatment for incontinence?

Do you have incontinence?  Don't want to have surgery?  There's a new option!

Incontinence, or the leakage of urine, is very common in women, and I see women complaining of this problem every day.   In some studies, up to 50% of women suffer with incontinence!  This can be an embarrassing problem, and can also lead to hygiene issues.  Aging tissues and childbirth are two common causes of incontinence.

In the past, we did not have very good treatments.   If symptoms were reasonably mild, women could wear a pad "just in case".  If more severe, surgery could be done.  The surgical procedures available require inserting a mesh or sling (foreign materials) into the body to help support the tissues, and come with some risks.  This is not really a good option unless the symptoms are pretty severe.

Bioidentical hormone replacement therapy can also help with incontinence.  Hormones are very important to help keep tissues healthy, including the tissues of the urinary tract.  In some cases, incontinence can be greatly improved or even resolved with use of hormone replacement, and I see this regularly in my practice.

But in some women, bioidentical hormones do not completely resolve the problem.  We now have a new solution that is so exciting because it is simple and very effective.

What if I told you that you could treat your incontinence in 20 minutes, with near zero risk and no down time?  Sounds too good to be true, but a new treatment, called the O-Shot, can do just that.

The O-Shot is a medical procedure performed by specially trained doctors using Platelet Rich Plasma (PRP),  the fraction of the blood that contains growth factors.  PRP has been used to help professional athletes heal from orthopedic injuries by injecting it into joints. It has been used to help improve wound healing in surgical patients by injecting it into the incision site.  Over the past 10 years it has been used in hundreds of thousands of procedures around the world in various parts of the body with no reports of any serious complications.  Now we can use PRP to help women with incontinence.

Here's how it works.  We draw blood from your arm, and prepare the blood in a special centrifuge to extract the PRP (which contains the growth factors).  Then the PRP is injected into the vaginal wall and clitoris near the urethra.  Topical numbing cream  is used and the needle is very tiny so you feel little to no discomfort.  The growth factors stimulate stem cells in the area to regenerate tissues - including blood vessels, collagen and nerve fibers.

It takes approximately 20 minutes to draw your blood and prepare the PRP, and the injection takes approximately 5 minutes.  Once the procedure is over, you can resume regular activities with no down time. The tissue regeneration typically starts after 3 weeks and full effects will be noted in 3 months  There are no reported serious side effects, and while results will vary, initial reports indicate that most women have significant improvement if not resolution of their symptoms.  We are really excited about the results that we are achieving.  

The O-Shot has an added benefits for some women.   Many women note improvement in sexual function, including increased lubrication, sensation, and often a reduction in pain (for women who have discomfort during intercourse).

If you are interested in learning more about the O-Shot please contact us at 704-752-9346, or visit the website www.signaturewellness.org.