Top 5 Hormones Affecting the Health of Your Skin

There are many important factors to healthy skin:  a diet rich in fruits and vegetables of many colors, good hydration, regular exercise.  There are some important factors to avoid as well including sun damage, smoking, sugar and processed foods.  

But did you know that there are also many hormonal issues that can affect skin health?

Estrogen has many important actions on the skin:  It retains moisture, to prevent dry skin (and dry hair and dry eyes and vaginal dryness…).   It maintains collagen and elasticity to prevent wrinkling.  It also helps to maintain the thickness of the skin.  There are more estrogen receptors in the skin of the face than on other parts of the body, so declining estrogen levels cause more obvious changes on facial skin.  

Estrogen replacement has been shown to increase skin thickness and elasticity, improve collagen content in the skin, and reduce fine lines and wrinkles.  Some women actually choose to apply their topical estrogen cream on their face to maximize skin benefits.  Even if estrogen is not applied to the skin, women often notice improvements in their skin, including that healthy glow, when their estrogen levels are restored.  

Testosterone can cause skin problems when it is too low OR too high! 

When testosterone levels are low in older men and women,  skin tends to become thinner, and wound healing is impaired.  Testosterone adds some oil to the skin, and this can be helpful in aging skin which tends to be dry.

On the other hand, excess testosterone or DHEA can cause excessively oily skin and acne breakouts, as well as excess hair growth.  

Progesterone has been found to help maintain skin thickness and elasticity, and helps to maintain scalp hair growth.  It also helps to reduce the negative effects of testosterone on the skin, so a lack of progesterone can exacerbate the effects of excess testosterone.

Hypothyroidism (low thyroid function) is often associated with skin dryness as a result of decreased sweating and reduced sebum production.  Many other factors may be seen with low thyroid:  pale skin color, dry bumps on the upper arms, puffiness around the eyes, scalp hair loss, loss of the outer third of the eyebrow,  dry and brittle hair.   

Cortisol is your main stress hormone.  Stress has been associated with skin problems such as acne breakouts.  Since cortisol regulates your immune system, stress can exacerbate rashes such as psoriasis and eczema, which are due to immune system problems.  There is actually a new area of study called psychodermatology looking at the links between skin health and emotional stressors. 

As you can see, there are many ways in which hormones affect your complexion.  If you want healthy, glowing skin then proper hormonal balance is important!

If you are having skin issues and feel that hormones may be part of the problem, please give us a call!  704-752-9346 or email us at questions@signaturewellness.org.  You can find more information at www.signaturewellness.org

10 Causes of Hair Loss in Women (and what to do about it!)

Thinning hair worrying you?  Lets do something about it. 

Are you dismayed by how much hair you see in the hairbrush and shower each day?  Hair loss can be extremely devastating for women, and it is not uncommon for women to be in tears in the office because of emotional distress from their hair loss.  While women do not typically lose all their hair, once the hair shedding is underway baldness feels like a very real possibility!  

Here are 8 reasons you may be losing your hair.

 1.  Thyroid problems 

Thyroid problems are a common cause of hair loss, and since thyroid problems are very common in women, we see this often.  Other symptoms associated with low thyroid function include:  fatigue, weight gain, constipation, feeling cold, depressed mood, anxiety, poor memory, low libido, dry skin, and dry/dull hair.  Standard thyroid blood tests often overlook subtle thyroid dysfunction, but even mild problems can be associated with distressing hair loss.  Many women who are being treated with standard thyroid hormone replacement continue to have symptoms despite treatment.  Fortunately, with a more comprehensive lab assessment and natural thyroid replacement, we can optimize thyroid function and achieve healthier, thicker hair.   An over-functioning thyroid gland can also cause hair loss, so good thyroid balance is important. 

2.  Stress

 Cortisol is your main stress hormone.  It is produced in your adrenal glands  to help you cope with emotional stressors, as well as physiologic stressors  (such as pain, allergies, insomnia, toxin exposures, etc). If cortisol levels  are abnormal, hair loss can result.  If you can reduce your stress, your hair  loss may diminish, but you made need some help.  It is possible to measure  your cortisol levels and while there are no prescription medicines to correct  this problem, there are lifestyle changes and nutritional supplements that  can help resolve the issue.

3.  Menopause

Hormone changes associated with menopause (or peri-menopause) can also cause thinning hair (and thinning skin, and thinning bones….).  Restoring hormone levels with bio-identical hormone replacement can help improve the health of your hair (and skin, and bones!) . In a study of women receiving testosterone pellet therapy, 63% noted hair regrowth, and none of the women in the study reported an increase in hair loss after treatment with testosterone.  (Glaser et al, British Journal of Dermatology, 2012).

4.  Prescription medications

Many drugs can contribute to hair loss in women, including the use of birth control pills.  The American Hair Loss Assocation (AHLA) recommends that women consider using a low-androgen index birth control pills to avoid possible hairlsos, especially if they are genetically predisposed to hair loss.  Changing pills or choosing a non-hormonal birth control option may help to correct the problem.  .

5.  Pre-diabetes

Diabetes, or even pre-diabetes may be associated with hair loss.   A holistic approach to balancing blood sugar metabolism including lifestyle changes, nutritional supplements, and weight loss may have a positive impact on hair loss, as well as reducing the risks for some very serious longterm health issues.

6.  Nutritional deficiencies

While americans do not typically suffer with malnutrition, we tend to be nutritionally deficient due to poor quality food choices.  Even if you are trying hard to eat right, the food available at the grocery store may not have optimal vitamin and mineral content due to our modern farming practices.  If you have symptoms such as gas, bloating, indigestion, heartburn, constipation or diarrhea your ability to digest and absorb the nutrients in your food may be impaired.  Certain medications, such as ant-acids, can also impair your ability to digest nutrients.  Nutritional testing is available to determine whether this may be a problem for you.

One of the common nutrient deficiencies we see associated with hair loss is an iron deficiency.  The lab test that is most helpful is a ferritin level -  this is a marker of your iron stores, and if your level is below 80 it is possible that insufficient iron levels may be contributing to the problem

7.  Chronic disease

If you have any chronic disease, hair growth may be slowed to help redirect your body’s resources to other areas to help promote healing.  So hair loss may be a symptom of another problem going on in your body, such as an auto-immune disorder or chronic inflammatory condition.

8.   Androgenic Alopecia

This is the medical name for genetic hair loss (female pattern baldness)  This is hereditary and happens slowly over time (over a period of many years). Typically there is family history of baldness in male relatives and thinning hair in female relatives.  Women do not typically become completely bald.  Hair loss is first noticeable at areas of parts, and hair thinning progresses until the scalp becomes visible.  The hair loss occurs even with normal levels of hormones so treatment for hair loss, such as a PRP (platelet rich plasma) treatment,  is frequently required to restore hair growth.

9.  Alopecia Areata

This is a medical condition where the immune system attacks the hair follicles, causing patches of hair loss.   This is much less common, but more difficult to manage.  The hair may not grow back on its own and may require treatment to restore hair growth.  PRP has been effective in helping with this type of hair loss. 

10.  Physical stress  

If you have any kind of physical trauma, such as a severe illness, a serious injury or surgery, this can trigger increased hair shedding which is not usually seen until 3-6 months later.  The stressful event "shocks" the hair cycle temporarily, so less hair is shed around the time of the incident (you don't notice this!).  When the hair cycle starts up again, more hair is lost all at once (so you notice the shedding!).  The good news is that this is a self limited problem called "telogen effluvium", and the hair growing cycles will reset and go back to normal without treatment.

Healthy Hair Recommendations

Reduce stress.  Simplify your life if possible, and know that it is not always the AMOUNT of stress you are under that is the biggest factor, but how you ALLOW the stress to affect you that matters. 

Ensure hormonal balance – Take steps to restore hormone levels to optimal ranges.  Measuring your hormone levels and restoring normal hormone balance with natural, bio-identical hormone therapy can be life changing for women and affects far more benefits than simply improving the health of your hair. 

Improve nutrition and optimize digestive health to allow better absorption of nutrients.  Eat whole foods including fruits and vegetables, avoid processed food and especially sugar.  Ensure that you are not iron deficient, and consider being tested for a full panel of nutrients. 

Get regular moderate exercise – exercise increases blood flow to the scalp and improves your overall health.  Since your hair is a reflection of your overall health, your nutrition and fitness level are important to hair health.

Take biotin, a nutrient that can be helpful for hair and nails.  Our patients have found excellent results with RegeneMax Plus, which is a form of biotin with added silica (another nutrient important for hair).  This has worked better than standard biotin, and has quickly become one of our top selling supplements (people come back for more because they can see a difference!)

Consider PRP (platelet rich plasma) treatments.  PRP is appropriate for most woman concerned about hair thinning.  By the time the hair thinning is visible, approximately 50% of the hairs have been lost.  Most women are well aware far sooner – their pony tail is thinner, their part becomes wider and they can see the hair shedding.  PRP treatments will have the best effects on hair follicles that still have some function.  This innovative procedure has been featured on  ABC news (Oct 2015).  http://abcnews.go.com/GMA/video/treatment-millions-people-suffering-hair-loss-34336528

For best results, it is important to address your hair loss BEFORE it is in the advanced stages  So starting sooner rather than later (as a preventive measure) is perfectly reasonable.

If you would like more information or need help to correct your hair loss issues, please contact the office at 704-752-9346 or email us at questions@signaturewellness.org.  More information is available at www.signaturewellness.org.  

Deborah Matthew MD

Could you be in perimenopause?

Before you go through menopause, there is a period of time (up to 10 years!) where things start to change. The changes can be subtle or not so subtle. We call this phase of life "perimenopause", and it can be one of the most difficult transitions in a women’s life. Sadly, some women are told to tough it out and that it will pass. And often women are told that they are too young to be in perimenopause.

Addressing the hormonal symptoms of perimenopause can dramatically improve quality of life for many women. Lets talk about what is going on.

While estrogen levels start to decline around the time of menopause (average age of menopause is 52), progesterone levels start to decline much earlier.  In fact a your progesterone production may decline by as much as 80% between age 30 and 40.  This is one of the reasons that women in their forties have a harder time getting pregnant.

Progesterone is produced in two main places in your body. It is produced in the ovaries and in the adrenal glands. The majority of progesterone is produced in the ovaries after ovulation.  It helps to prepare the uterine lining in case of a pregnancy and is very important throughout pregnancy (it is “pro-gestational”).  

When a woman is in the second half of her monthly cycle, she is producing between 20 and 25 mg of progesterone a day. During pregnancy, production of progesterone spikes to between 300 and 400 mg per day.

When progesterone levels start to decline because of age, and symptoms of hormone imbalance become noticeable, we call this “perimenopause”.  

Progesterone deficiency is the most common hormonal problem we see in peri-menopausal women, but younger women can have this problem as well.  Because progesterone levels naturally vary over the menstrual cycle, the symptoms vary as well.  

Typically the week after a period is a “good” week; you are eating your broccoli, exercising regularly, and cleaning out your closets.  Then as you get closer to your period,  symptoms get worse and worse including irritability, anxiousness, and interrupted sleep.   You may feel more negative, critical, impatient, and easily frustrated - and this can affect how you behave towards your family and co-workers!

In fact, this variation in symptoms is a big clue that hormones are the problem.  If your mood symptoms or insomnia are exactly the same on every day in your cycle, it is less likely that hormones are the cause.

Progesterone has mainly been studied for its effects on the uterus but it turns out that progesterone has far more roles to play.  Women have progesterone receptors on cells in all parts of our bodies, and surprisingly the cells with the most progesterone receptors are our brain cells.  Anyone who has experienced PMS symptoms with mood swings and irritability may not be surprised after all!  

Research is showing that progesterone has important neurological effects.   It acts as a natural anti-anxiety compound, helps with sleep and is calming - sort of like nature’s version of valium or a glass of red wine.

Here is a checklist of symptoms that you may experience if you progesterone levels are declining:

Insomnia (especially wakening in the night)

Night sweats

Anxiety

Irritability

Mood swings

Weight gain

Increased PMS

Pre-menstrual headaches

Heavier periods

Shorter cycles (periods coming less than 28 days apart)

If this sounds like you, please know that there is help! You can feel like YOU again.

You can find more information at our website www.signaturewellness.org or contact the office at 704-752-9346

Yours in health

DrM

How to have younger looking skin

You know the basics for promoting healthy skin.  A “whole foods” diet (as opposed to processed foods), rich in a variety of colorful fresh fruits and vegetables is the basis of overall health, and skin health is no exception.   Staying hydrated is important.   Exercise improves blood flow to the skin, and helps maintain skin health.  

Avoiding sun damage is critical.  Some sun exposure is important to make sure you are getting vitamin D (which is also good for skin health!), but sun damage can be prevented by wearing a hat and a non-toxic sunscreen.

Did you know that hormonal balance is also important to skin health?  A medical study found that women with the lowest estrogen levels looked 8 years older than their actual age, and women with higher estrogen levels looked 8 years younger than their age (that is a 16 year differential!).  Estrogen helps maintain collagen production in your skin, which helps minimize fine lines and wrinkles, and it helps your skin remain hydrated.  You may notice that your skin “glows” when you are hormonally balanced.

Significant changes occur in your skin during menopause, including thinner skin, increased wrinkling, skin dryness, and loss of elasticity and firmness of your skin.    Skin thickness has been found to decrease by 1.5% per year after menopause, and collagen content can be reduced by as much as 30% within 5 years of menopause.  These skin changes appear to be more closely related to length of time that you have been estrogen deficiency than to your actual chronological age.  (In other words, the longer you have been without estrogen, the older you look!)

Hormone replacement has been shown in a number of studies to help improve hydration of the skin, maintain skin thickness and elasticity, improve blood flow to the skin and increase collagen production. 

In one study, estrogen replacement resulted in a measurable increase in skin thickness after only 2 weeks of applying topical estrogen.  Another study found that skin thickness was increased by 30% after 12 months of estrogen therapy.

A large study showed reduced wrinkling in postmenopausal women on estrogen replacement.    Another study of women on hormone replacement found less wrinkles in the estrogen treated group compared with women on no hormones.  

Estrogen has also been shown to speed up wound healing and offer some protection against photoaging (sun damage).  

Estrogen is good for your heart, your bones, your brain and also your skin!

Apart from maintaining your hormone balance, there are a number of aesthetic treatments that can help you to look as young as you feel!  

SkinPen treatments are ideal if you want to treat fine wrinkles, acne scars,   or sun damage.  A small device contains tiny surgical-grade needles that produces microscopic punctures in your skin.  This stimulates the production of collagen and elastin which give your skin a more youthful appearance. It mimics what a laser treatment does, but without the discomfort or downtime. 

And have you heard about PRP (platelet rich plasma) to rejuvenate the skin?  PRP is obtained from your own blood - it is the fraction of your blood which contains growth factors.  It is injected into your skin, where it activates your own stem cells to stimulate growth of collagen, blood vessels and nerve fibers.  We are harnessing your own innate healing potential to create younger looking skin! 

If you are interested in learning more about how to have younger looking skin,  please visit our website at www.signaturewellness.org.  Or you may contact us at questions@signaturewellness.org, or call at 704-752-9346.   

Yours in health, 

DrM

How to reduce your risk for breast (or prostate) cancer

Are you worried about breast cancer?  (Or prostate cancer?) You certainly, aren’t alone!  This is the number one concern I hear about when I am talking to patients about hormone balance.  Many men are not aware that their estrogen level can affect their risk for prostate cancer (high estrogen levels may increase the risk).   

Estrogens are essential for health and well being in both women and men. Estrogen plays a role in mood, energy, memory, sleep and sexual function.   Estrogen is important for bone health, brain health, heart health, breast health and prostate health.  

Every day, the body has to clear today’s estrogen to make way for tomorrow’s estrogen.  This is true whether you are making your own estrogen or whether you are taking estrogen replacement (synthetic or bio-identical).  If you are not clearing the estrogen properly, levels can climb and lead to symptoms.  Another factor to consider is HOW your body is clearing the estrogen.

Some estrogen metabolites (or “breakdown” products) have been shown to be harmful and increase risk for breast cancer in women, and prostate cancer in men.  On the other hand, some estrogen metabolites are protective, and associated with a REDUCED risk of breast cancer.  Wouldn’t you like to know which ones you are making?

The levels of the various metabolites can be measured, and we can use this information to help assess breast cancer (and prostate cancer) risks.  The good news is that armed with this information, there are many steps we can take to CHANGE the risks.  

How does it work?

There are 2 main estrogens we need to consider here.  Estrone,  also called E1, is the predominant postmenopausal estrogen.  Estradiol, also called E2, is the predominant pre-menopausal estrogen and the one that we replace in estrogen replacement therapy.   Men also have these estrogens, and estrogen levels tend to increase in men with age.

In “Phase One” of detoxication of estrogen, the liver metabolizes these estrogens into 3 different possible metabolites:

2-hydroxyestrogen (2-OH) is breast protective, so we want the most of your estrogen to go down this pathway.

16-hydroxyestrogen (16-OH) is bone protective (reduces the risk of osteoporosis) but is not breast protective.  We used to think that the ratio of 2 to 16 hydroxyestrogen (or the “2 to 16 ratio”) was a good predictor of breast cancer risk, but the current research does not support this.

4-hydroxyestrogen (4-OH) is the metabolite that you really don’t want.  This one has been associated with an increase in the risk for breast cancer.   This is also the one that breast cancer cells release into the bloodstream, so an increased level of 4-OH is concerning.  This is a newer test, and was not available in the past.   If the level of 4-OH is too high, we can help correct this with cruciferous vegetables (like broccoli, cauliflower,  kale, brussels sprouts), ground flax seed and fish oil.  We can also use a nutritional supplement called DIM.

In “Phase Two” of estrogen detoxification, the metabolites are altered further:

2-methoxyestrogen (2-Me) and 4-methoxyestrogen (4-Me) are made when 2-OH and 4-OH estrogens are “methylated” into methoxyestrogens.  This is a biochemical event where a “methyl” molecule is attached to the estrogen.  Even if estrogen has been converted into the “bad”  4-OH, once it is “methylated”  into 4-Me,  it becomes harmless.  Some people have a genetic variation resulting in reduced ability to methylate, and this leaves more 4-OH.  If the level of 4-OH is too high, we can help reduce it with supplements such as folate, B12 and SAMe which help methylation.

If the 4-OH is not methylated, it can be “oxidized” to a quinone-estrogen which can damage DNA and cause cancer.  But here too, we can intervene to prevent this!  Anti-oxidants, including glutathione (an important anti-oxidant produced in your liver), protect the 4-OH from being oxidized into a quinone-estrogen.  We can help clear the 4-OH safely by increasing your levels of glutathione.  This can be done by eating foods such as garlic, onions and beets, and with a supplement called N-acetylcysteine (NAC).  

Where should you start?

Previously we could only test for 2 and 16 estrogen metabolites, which didn’t give us the whole picture.  Now we can also measure for the 4 estrogen metabolites, which allows us to map out your personal estrogen metabolism  pattern.  We can also test for genetic variations that may be pushing your estrogen metabolism in the undesirable direction, as well as test for levels of anti-oxidants such as glutathione which help to clear the “bad” estrogen metabolites.   With this information we are able to make recommendations to alter your pattern so you make more of the protective estrogen 

metabolites and less of the harmful ones.  Then we can repeat the test to make sure we got it right! 

There are many other factors that are important for reducing cancer risk, including maintaining a healthy weight, eating a whole foods diet rich in fruits and vegetables of many colors, getting regular exercise, coping with stress in a healthy way, avoiding environmental toxins and making sure your estrogen is balanced with progesterone.  

Knowing your estrogen metabolism pattern, and optimizing it, is an example of how emerging medical science can help guide our nutritional recommendations to help you reduce your risk for hormone sensitive cancers.  The test is not covered by health insurance, and the cost is $200 or less, depending on the lab.  I recommend this test be done at least once in all patients.  If it is abnormal, we can talk about further testing for the gene variants, so we can compensate for any genetic weaknesses.  

If you are interested in being evaluated for your estrogen metabolism pattern, please contact the office for more information, 704-752-9346 or email us at questions@signaturewellness.org.   You can find more information at www.signaturewellness.org

Yours in health,

DrM

Is Estrogen Replacement Safe?

In July 2002, the well publicized Women's Health Initiative (WHI) study suggested increased rates of heart disease, strokes and breast cancer in women on hormone replacement therapy.  Naturally women and their doctors were fearful of the risks, and in the next 10 years hormone replacement use dropped by 79 percent.  Newer studies are showing that warning women off hormones was a mistake.  We know that estrogen and other sex hormones are vital for many functions in a woman's body.  

A study done by doctors at Yale and published in the American Journal of Public Heath, Sept 2013, evaluated the result of this widespread reduction in hormone use.  According to their calculations, estrogen AVOIDANCE may have led to as many as 90,000 preventable deaths.  The study found that estrogen therapy (ET) was actually associated with a REDUCTION in deaths from heart attacks and breast cancer.   According to the authors:  “Estrogen therapy in younger postmenopausal women is associated with a decisive reduction in all-cause mortality” 

A new study supports this.  Almost half a million women in Finland were followed over 15 years, and the results show that the longer the women were on estrogen replacement, the lower their risks for heart disease and strokes.  In fact, all cause mortality (meaning death from ANY cause, including breast cancer) was reduced by up to 30%.

There is no need to suffer with symptoms of menopause due to fear of side effects of hormone replacement. Your individual risks are related to many factors including your age, whether you are using bio-identical or synthetic hormones and the delivery method of the hormones (for examples pills vs topical estrogen).  Please ask us about your personal risks and the potential benefits, including improved memory, energy, mood, sleep and even younger looking skin.   Click here for more information.

Why is estrogen important for women?

Lets talk about the benefits of estrogen.  It has literally hundreds of roles in a woman's body!

Estrogen helps to protect your heart.  When you are premenopausal, your risk of a heart attack is significantly less than a man’s risk.  But after menopause, when estrogen levels drop, the risks become equal.   

It also helps to keep your tissues hydrated.  Without estrogen you can become dry:  dry eyes, dry mouth, dry skin, dry hair, dry vagina……

Bone health also depends on hormones, and estrogen in particular helps to prevent bone loss.  While this may not be something you are particularly worried about right now, it should be!  If you have a broken hip because of osteoporosis, there is a good chance that you will end up in assisted living. Preventing bone loss now is very important for your future mobility and independence.  

Something you may be very concerned about right now is how old you look!  Estrogen affects skin health - it helps to provide hydration and blood flow to keep that youthful glow to your skin,  and it maintains collagen to provide elasticity, which helps to minimize fine lines and wrinkles.  You may notice your skin aging rapidly as you go through the menopause.  One research study found that women with higher estrogen levels looked on average 8 years YOUNGER than women with low estrogen levels! 

Arguably the most important role of estrogen is on brain health.  Estrogen is energizing to the brain, so if estrogen levels are low you may feel more tired.  It is also important for quality of sleep, and obviously you have to be able to sleep to have good energy!

Estrogen is a natural anti-depressant in women.  It is needed to activate serotonin receptors in your brain, and serotonin is the natural brain chemical responsible for peace and joy, so obviously you want that!  If your estrogen levels are low, you may feel more flat, anxious or unmotivated.   You may be prescribed an anti-depressant medication to try to boost serotonin levels (like Prozac, Celexa, or Zoloft for example), but if you can normalize your estrogen levels,  your mood may improve without the need for medication.

There is a very important relationship between estrogen and memory.   If your estrogen level drops you may find yourself forgetting names, why you walked into the room or where you left the car keys.  It can be alarming and you may even worry that you are experiencing the early stages of Alzheimers!  Fortunately in many cases your memory can improve significantly with restoration of normal estrogen levels.  

Did you know that the average woman gains 20 pounds as she goes through menopause?  Estrogen deficiency can cause you to pack on the pounds, even if you haven't changed your diet or exercise. Of course, if you are tired, unmotivated and not sleeping well you may be finding it more difficulty to maintain healthy lifestyle habits!

As you can see, estrogen is very important for how you feel, how you look and how you will age. 

If you are interested in learning more about estrogen and whether estrogen replacement may be a good idea for you, click here.  If you are interested in scheduling an appointment to talk with us about your personal situation, please call 704-752-9346.  

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. 
   

Women with low estrogen look older

A study published in the medical journal The Lancet found that women with low estrogen look significantly older than women the same age with more optimal levels of estrogen

Low estrogen levels are associated with loss of collagen and moisture content of skin, which leads to increased facial wrinkling.

In this study, independent reviewers estimated the ages of 100 women. The women’s estimated age was then compared to their real age and their estrogen level
. The women in the study were between 35-55 years of age. The reviewers estimated the women with low estrogen to be significantly older than their age and those with more optimal estrogen levels to be much younger than their age.
 The women with the lowest level of estrogen looked 8 years older than their age and those with the most optimal levels looked 8 years younger than their age (a 16 year differential).


According to the authors, “The age of women with low estradiol serum concentrations was systematically overestimated; with increasing serum estrogen levels the reverse was the case. Women with high estrogen concentrations looked younger, women with low estradiol concentrations older than they really were. The discrepancy between estimated and real age could be as high as 8 years in either direction [16 year differential]. These data suggest that serum estrogen concentrations have a pronounced impact on the estimation of age.”


Lancet. 1999 Jul 17;354(9174):224.
Oestrogen and age estimations of perimenopausal women.
Wildt L, Sir-Petermann T.