Archive for October 30, 2011

30 Oct 2011
hormone replacement

Bioidentical hormones: Who should I see for these?

I just had the pleasure of speaking at a medical conference on bioidentical hormones sponsored by the International Hormone Society at the San Diego Harbor Marriott. My subject was testosterone deficiency and replacement, with an emphasis on testosterone pellet implantation.

I was struck by some of the questions the attending doctors asked me after the presentation. One included: “Why is it that some of my female patients still don’t have much libido despite being on testosterone?” I immediately knew that this dilemma related to elevated cortisol due to adrenal stress, among other causes, and I asked her how her patient’s adrenals were. She said she hadn’t checked them. I gently asked her what training she had in using bioidentical hormones. She said that she had attended only weekend seminars in the past. Rather than tell her how to work up and treat a woman with persistent low libido I told her she owed it to herself and her patients by taking at least one of the more than 10 available modules that are part of fellowship training given by the American Board of Anti-aging and Regenerative Medicine. The first module is 25 hours on hormones. I suggested starting with that,

After the flurry of questions from doctors practicing all over the country I thought about how many of the physicians in attendance actually had the knowledge base to prescribe bioidentical hormones in an optimal fashion. This means: maintaining adequate levels if each hormone, balancing hormones with others that interact with each other, addressing inflammation, immune status, diet, GI and liver health and optimally managing cancer and heart disease risk factors.

I immediately knew which 25 of the 300 doctors in attendance were able to claim to have this knowledge base. The BodyLogicMD doctors, who had completed fellowship training. I knew here were other fellowship trained physicians in the audience. But I also knew he majority of doctors were relative neophytes in this emerging branch of medicine

I earnestly hope that all physicians who wish to offer their patients bioidentical hormones take more advanced training leading to fellowship certification.

For now I encourage interested patients to seek out a doctor who has been fellowship trained. This will be listed on the physician’s web site.

Once in the doctor’a office for your initial visit you can expect to hear from your chosen physician about how your hormones are balanced, along with whether or not they are high or low Your initial testing will always include adrenal testing, using 4 saliva samples collected over the course of the day. It will always include measurements of the sex hormones and the free fractions of the thyroid hormones. The hormone vitamin D, (not a vitamin) will be measured Markers of inflammation will be examined. Heart disease and diabetes risk factor assessment will be done. After a thorough history and review of symptoms and goals for wellness is completed, a comprehensive treatment plan is then agreed upon and hormones and appropriate supplements are ordered. Followup labs and visits are scheduled. The doctor’s staff then reminds you when it is time to do the labs and be seen to optimize your compliance and ultimately your outcome.

If you are not getting this kind of personalized attention you deserve to. You can find board certified, fellowship trained bioidentical hormone doctors in your area by going to www.bodylogicmd.com

Dr. Stephen Center | No comments | Tags: , , , ,
16 Oct 2011
hormone replacement

Bioidentical hormones-why can’t I start them all at once?

Quite often new patients ask me: “After I am seen for my initial consultation, why can’t I start all of my hormones at the same time? I really want to feel better as soon as possible!”

The answer is “hormonal balance.”. Starting all needed hormones together or in the wrong order can result in vey annoying side effects. For example, if the adrenals are depleted and thyroid is started before adrenal support kicks in, one can have major stimulatory side effects like racing heart or palpitations. Starting testosterone before correcting adrenal weakness can greatly aggravate existing fatigue, sometimes leading to a drop in blood pressure, lightheadedness when standing, dry mouth and other symptoms.

The discerning patient looking for anti-aging medical care can always tell when their doctor has been fellowship trained, as are all BodyLogic MD physicians. The treatment plan will pay close attention to the relationship between the hormones that the patient is lacking, based on lab tests and correlated with symptoms. The doctor will then suggest a plan that introduces the needed hormones in the correct order. This way the benefits are free or annoying side effects. Optimal hormonal balance takes a little time but proceeding in a logical, methodical fashion is often best for the patient and leads to far less frantic phone calls or emails from my patients! I tell many patients that it took many years to get where they are now and it may take a few weeks or months to bring hormone balance back to normal. However it is well worth the effort. Patience, time and compliance are all key elements in achieving the best possible outcome.

Dr. Stephen Center | No comments | Tags: , , ,
10 Oct 2011
Pain

Exercises to prevent chronic neck and back pain

A chiropractor friend of mine, Skip George, taught me many years ago that we spend much of our lives in flexion. What this means is that our waist is bent forwards, our shoulders are rolled forwards, and our head is forward. If we do the exercise discussed in the previous blog with our back against the wall, what gives us relief of the muscle tension or spasm that comes on quickly as we struggle to hold this position? Easy! Bending at the waist, letting our shoulders droop forwards and letting our head drop forwards This feels good because it gives the weak extensors (the muscles that bring our neck, shoulders, hips and back in a backwards direction) a vacation. It also feels good because it permits the overly tight flexors (the muscles that bring our spine and hips forwards) to return to a shortened position, like a spring returning to a rest position.

So the quick and simple DAILY postural correction routine should start with a few simple exercises designed to do 2 things: stretch the flexors and strengthen the extensors of the neck, shoulders, back and hips.

Here is what I do — you can add many more or even get a “Theraball,” inflated to the proper size for your height (it say this on the box!). The Theraball (beach ball sized) comes with great exercises and helps with balance. With all of these excesses be sure not to hold your breath (yoga will teach you that!) Also, don’t overstretch! (true for all stretching)to the point of pain or spasm.

1. Stand in a doorway. Rest your bent elbows against the inside of the doorframe (or your arms if you are short). With the head held upright gently lean forwards until you feel tension in your armpits/shoulders. Hold is for 5 seconds, return to the starting position, and then repeat 5-10 times.

2. In the same doorway reach up to the lintel (the top of the doorframe). With the elbows straight stretch forwards gently as described above and follow the same time and repetitions. Keep the head facing forwards, not downwards for both of these stretches.

2. Lie prone on the floor with a towel under your face and place your palms flat on the carpet. Then slide your hands fowards 1-2 feet depending on how flexible you are. Then extend your arms, raising your chest upwards but still keeping your bellybutton on the ground. Your head and neck should either be in line with your upper back or gently tilted backwards–don’t overdo it or you will have some discomfort. Hold this position for 10 seconds, then return to the starting position. Repeat 3 times. In yoga the common name for this stretch is “Cobra.”

3. Start in the same position as #2. Bring your arms along you side while resting your chin on the towel. Slowly raise your arms off the ground a few inches. At the same time raise your legs(keep the knees straight) and the chest off the ground as much as you can. Hold this for a few seconds the return to the prone position. Repeat this up to 20 times (I try to hold each position for 2-3 seconds at least). This position is sometimes called “Superman.”.

4. Get into a position where you are kneeling on one knee while the other foot is flat on the ground in front or you with that knee bent 90 degrees. This is similar to the yoga position “kneeling warrior” (you can find that in Google Images). Do a pelvic tilt (like you are thrusting your groin forwards). Raise the hand overhead on the side where the knee is on the ground. Slowly stretch it to the opposite side, keeping it in line with tour body while tilting your spine in the same direction as you arm. After you reach your limit return to the starting position and repeat this 7 times. Then switch sides. This exercise, when done properly, stretches the hip flexors.

5. Finally give your hamstrings a good stretch (avoid this exercise if it causes an sciatica or back pain–there are modifications that would be better for you). Get a rolled towel (lengthwise), lie on your back, and bend one knee so the foot is flat on the ground. Bend the other knee so you can loop the towel around your forefoot. While maintaining tension in the towel so it doesn’t slip, slide your hands to both ends of the towel and then slowly pull the leg upwards while straightening out the knee fully. Keep your head relaxed on the ground or on a pillow. Don’t be surprised if you can only raise it @60 degrees. Hold this for 15 seconds, relax and repeat 3 times. Then switch sides. Done properly (and twice daily) you can improve from 60 degrees to nearly 90 degrees in 4-6 week. I did. Boy did it help my back!

This routine will take you 5-7 minutes. No excuses. Saying you have “no time” is a cop-out. People who say that really mean: “it is not a priority for me”. I hope you now see that it should be.

There are many neck stretches and back/hip stretches that can be added if you have time. If you sit a lot during the day it would be great to do this routine before AND after work. Do these and other exercises you find on-line or in books and consider joining a yoga class See a good practitioner if these exercises are not enough.

Remember, anti-aging is not only about using bioidentical hormones. It is also about getting older while standing tall, proud and free of pain. My 80 year old upright patients are justifiably proud of their youthful posture. If you want to reduce your need for medical care and drugs, get the most out of life, and be an upright, pain free 80 or even 90 year old one day, you just have to do a little daily w-o-r-k! Your body will thank you!

Dr. Stephen Center | One comment | Tags: , , ,
10 Oct 2011
Pain

Relief for chronic neck and back pain–part 1, your posture

One of the most common complaints I seen in my anti-aging practice is chronic neck and back pain. Typically patients who complain of these symptoms tell me that they spend much of the day sitting, especially sitting in front of the computer. When I ask them about their posture most people tell me they slouch a bit and their shoulders and neck tend to be a bit forward while they’re typing.

When I examine the typical neck or back pain patient I notice two things. First, their lower back lacks a normal “lordosis,” which is to say that instead of having a gentle C shape, with the concave side facing backwards, they lack this curvature and instead have straightening of their lumbar spine with a backwards tilt. This is referred to as a “swayback.” When I examine their upper back and neck I notice that they have a forward curvature, what is referred to as a cervicothoracic kiphosis. A more extreme example of this is seen in elderly patients, especially women, who can become so bent forward that they are unable to raise up their head to look straight ahead, are at high risk of falling and need a walker.

One way of telling if you’re developing this type of problem is by standing with your back to a wall and your heels against the molding at the bottom of the wall. Bring your shoulders back so that they are touching the wall and then bring your head backwards so it is against the wall (without tilting your head upwards). You may need to ask someone if your head is tilted backwards or looking straight ahead. Then you should be able to comfortably hold this position for at least 10 seconds. The few people I see who can do this easily are those who do yoga regularly or do some other form of daily stretching. Almost everybody has difficulty. The degree of difficulty indicates the severity of the postural imbalance.

What we need is a quick, painless daily routine that can help straighten out our neck and back and help prevent pain and spasm from returning.

Stay tuned!

Dr. Stephen Center | No comments | Tags: , , ,
07 Oct 2011
hormone replacement

Bioidentical versus non-bioidentical (bio-similar) hormones

Many men and women seeking hormone replacement therapy from anti-aging doctors like myself ask about the safety of the hormones that we prescribe.

The reason for this concern, often mentioned to them by their family doctors, is that the Women’s Health Initiative, the Nurses Study and other studies show that “hormones” were “dangerous,” because they slightly increased cancer and other disease risks.

These studies were done using the drug Prempro, a combination Premarin and Provera. Premarin is bio-similar to the human hormone estrone. Provera is biosimilar to the human hormone progesterone. Neither is bioidentical. Premarin is made from the horse hormones equilin and equilenin. These two compounds differ slightly but significantly from the human estrogen called estrone. These differences, and the way it is processed by the human liver, result in the body receiving a foreign chemical that is different from what the ovaries used to make. These differences cause it to have a unwanted stimulatory effect on the metabolism of these compounds. This can actually increase the possibility of DNA damage within the nuclei of our cells which can contribute to cancer. The same thing was true with Provera, which was shown in a separate arm of the WHI study to have even more negative effects on cancer then Premarin. Provera is a progestin, which is not the same as progesterone. Many if not most traditionally trained MDs are confused about the differences of progestins versus progesterone. This is why you might hear the statement from magazines, newspapers or your physicians that “hormones” are dangerous. To be accurate, what they should be saying is that Provera or Prempro are potentially dangerous. But this is not what patients hear, adding to their confusion.

The other meaning of the world bioidentical is how the hormones are delivered to the body. In general, with the exception of oral progesterone which is very safe, bioidentical hormones are delivered through the skin or mucous membranes or even implanted in the body. By avoiding processing by the stomach and later the liver, hormones delivered by a cream or gel or implant can enter the bloodstream directly and travel to the target areas where they are needed before they are altered chemically by the liver. This is exactly what happens when the ovaries and the testes release hormones-they enter the bloodstream directly and travel throughout the body before they reach the liver. In this way the cells of the body receive the hormone unchanged from what is applied to the skin or elsewhere. This is very important and further renders these hormones much safer then oral forms.

Anti-aging physicians educate their patients to understand the difference between bioidentical and biosimilar hormones. By doing this they understand that some of the negative studies on commercial hormones are not applicable to the safe and beneficial bioidentical hormones are we prescribe to them (and take ourselves)! We also can provide to our patients published clinical studies documenting the safety of bioidentical hormones.

Dr. Stephen Center | 3 comments | Tags:
03 Oct 2011
Adrenal Fatigue

Why am I tired?

Why am I so tired? This question is asked of me by many if not most new patients.  Quite a few of them have already seen their regular doctors and have failed to get a satisfactory answer.

When I meet these patients the easiest way to answer their questions is to look at what causes us to be tired. We are tired because our brain or body is unable to provide the energy we need. The brain produces dopamine which actually boots the amplitude of our brain waves. Along with energy, dopamine gives us the motivation to accomplish our daily tasks and plan for new ones. The brain also produces melatonin, which helps us achieve a deep and restorative sleep. The adrenals produce our adrenalins, which give us mental and physical energy, ideally produced when we need it (daytime) and not when we don’t (bedtime). Our liver produces glucose, which, when added to what we extract from our diet, provides fuel to our cells. Our cells produce ATP which drives our metabolism, and protein.

Instead of seeking out a cause of fatigue, patients will often look for stimulants like caffeine. They may see their doctor who will attempt to assign a name for the fatigue, either by diagnosing a disease (sometimes one is found), or, in the absence of a proven diagnosis, calling it “depression” or chronic fatigue syndrome. A drug is prescribed and one hopes for the best. If the drug helps, the duration of its use may become indefinite.

Anti-aging physicians approach a tired patient the way an electrician approaches a power outage. Rather than sticking a penny in the fuse box as a quick temporary fix, the electrician assesses the circuits and whatever fix is needed is done. Specialists trained in anti-aging and functional medicine often start with hormone corrections, especially the adrenals, thyroid, testosterone and melatonin. We can optimize sleep in a variety of natural ways if that is contributing to daytime fatigue. Next we can assess and optimize blood sugar regulation, especially when fatigue seems to be worse a few hours after meals. We can evaluate the diet to see if it is adequate to provide energy. We can determine if toxicity is present in the liver or elsewhere, as this can greatly sap energy, or see if there is a hidden infection or inflammation in the body that is contributing to fatigue. We can test and correct brain imbalances with special tests and start a natural corrective plan to boost dopamine and other energy related neurotransmitters. We also can use specific supplements that enhance cellular and brain energy in most people without adverse reactions.

At BodyLogicMD of San Diego and other BLMD practices around the country, every tired patient is approached like a power outage in our house. Rather than cursing the darkness and being content with merely lighting a candle, we seek out the cause or causes of the “outage” and endeavor to fix it. This can take days, weeks or months to accomplish, but the outcome is well worth it. Once the energy is back to target the goal is to prevent what caused the fatigue from recurring in the future.

Dr. Stephen Center | 2 comments | Tags: , , ,
 

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