Tag Archive for fatigue

18 Mar 2012
mood disorders

Hormones and mood– the first steps to feel better

Mood disorders are among the most common complaints I see in my anti-aging practice. The most common symptoms are anxiety and depression. However common associated symptoms are fatigue, insomnia, difficulty concentrating and memory problems.

One of the challenges I always face in treating a new patient is tackling numerous symptoms in just one hour. Sometimes the history alone can take half that time.

For that reason I advise my patients when I first meet them that the first visit will focus largely on hormone balancing. If mood problems are among their chief complaints I advise them that hormone balancing may result in dramatic improvements in their mood symptoms. I let my patients know which hormones are associated with nervousness and anxiety and which ones associated with sadness and depression so they can anticipate what they might experience with the initial course of treatment.

The following is a simple guide for patients to help them understand common associations between hormones and mood.

Nervousness and anxiety:

In women these symptoms are typically associated with low progesterone levels and/or excess estrogen (specifically estradiol). The best marker is the progesterone to estradiol ratio (Pg/E2). Optimal ratios are between 100-500 to one. I target 300:1as my goal.

Men, especially those who are obese, may have elevated estradiol as well because of excess conversion of testosterone to estradiol. This can contribute to anxiety(and further weight gain).

Low testosterone in both men and women can contribute greatly to anxiety. Many patients with low testosterone feel buffeted by stressors in their lives. They tend to be “reactive” rather than “proactive.”. Testosterone deficiency, when corrected, helps them feel more “in control” of their lives and better able to handle what challenges life throws at them.

Thyroid deficiency can cause not only anxiety but also panic attacks, trouble concentrating, decreased memory and slow speech. Thyroid excess can also cause anxiety and a racing heart and insomnia. Hence the reason for tight monitoring of thyroid levels to keep them in the mid to high normal range but not outside the range.

Overactive adrenals caused by chronic stressors generally will not cause anxiety per se, but they can cause irritability, cravings, confusion, fatigue, and insomnia. Adrenal fatigue can cause general emotional imbalances, fatigue, trouble concentrating, and insomnia.

DHEA deficiency can be associated with e inability to handle stress, trouble concentrating and insomnia.

Depression

Estrogen excess can be associated with depression. The annoying additional symptoms of weight gain, water retention, mood swings irritability, insomnia, swollen and/or tender breasts and headaches commonly associated with excess estrogen all serve to aggravate depression.

Progesterone deficiency (see earlier discussion of a low P/E2 ratio) can also cause depression as well as irritability.

Testosterone deficiency can also be associated with mild depression in men and women. However it can also do this if it is too high (as what might occur with too vigorous replacement, although this is a far less common cause of depression than too low.

Thyroid deficiency is a common cause of depression. Associated symptoms of constipation, headaches, water retention, memory and concentration problems, insomnia, fatigue, and reduced libido all tend to aggravate these symptoms of depression.

Cortisol deficiency, as what occurs in adrenal fatigue, generally won’t cause depression symptoms specifically but can certainly cause emotional disturbances, aggravated by associated blood sugar swings.

Finally, symptoms of deficiency of DHEA, one of the master adrenal hormones, can include depression, along with trouble concentrating and insomnia.

While deficiency of vitamin D, a hormone not a vitamin, is not typically associated with depression, I have seen patients who reported better mood when their levels were normalized.

So an initial anti-aging plan usually starts with hormonal balancing: first adrenals, then the sex hormones, and finally thyroid. I advise my patients to start with this approach for tackling their mood related symptoms, adjust dosages based on labs and clinical response and see how they do.

Many patients can stop at this point. They feel more on an even keel, able to cope with their daily stressors, and feel more optimistic about their current life and their future than before normalizing their hormones.

Hormones are not a panacea for mood problems. If symptoms persist we next pay attention to optimizing neurotransmitter levels. We have one option of a scientific approach, which can include direct measurement of urinary neurotransmitter levels, testing for cofactors deficiency, identifying markers of toxicity in the GI tract (including dietary stressors, intestinal and liver status), followed by corrective treatments. Or we can choose the other option of empirical (try it and see what happens) intervention with herbals, amino acids, cofactors like NAC to enhance nerve transmission, and other natural therapies to target symptoms by promoting boosting or calming of neurotransmitters based on our clinical experience. This is what is done by psychiatrists. In our specialty we look for corrective natural approaches first, or if the patient is already on psychotropic drugs, seek to eventually replace them if possible and the patient is willing. We never stop psychotropic drugs that are working until we feel the time is right, and then only with gentle tapering and the cooperation of the patients’ doctor(s).

It is critical to have knowledge of one’s hormone status if mood problems are present. This requires salivary or capillary blood testing for the adrenals and sex hormones and venous blood (regular blood draw)for the thyroid. Your fellowship trained ant-aging specialist is equipped to start you on the pathway to correction of hormone imbalances. This could be you solution to mood problems and the response can be rapid If the response is suboptimal then the neurotransmitters themselves can be nudged into normal balance with a creative,individualized plan. This process can be more lengthy, involving dietary changes, detoxification and correction of nutrient deficiencies. It requires close monitoring and good communication between doctor and patient.

The many successes I have had in my career with helping patients feel better with hormones and adjunctive treatements continue to enhance my enthusiasm for this approach to managing anxiety and depression. If these problems plague you I encourage you to seek our a doctor with the proper training and experience to help you feel your best.

Dr. Stephen Center | One comment | Tags: , , , , , , , , , , ,
06 Nov 2011
hormone replacement

Estrogen: a hormone that serves many needs

It is quite common for female patients of mine to question me concerning the need for estrogen as part of their bioidentical hormone regimen This is especially true if they don’t have symptoms such as hot flashes and night sweats. In fact most physicians will only recommend estrogen to woman who have severe symptoms like these, and they still do it reluctantly, fearing it may cause breast cancer (i have addressed why this fear is unfounded based on many clinical studies in my previous postings).

So I thought I would list some of the 200 roles estrogen plays in a woman’s body, as well as a more comprehensive list of symptoms of deficiency

Estrogen:

Decreases total cholesterol, triglycerides and bad cholesterol (LDL)
Increases good cholesterol (HDL)
Increases growth hormone
Helps maintain your bones
Improves (sustains) sleep
Decreases fatigue
Works as an antioxidant
Maintains memory

Decreased estrogen symptoms in women include:

Thinner skin
More wrinkles/Aging skin
Decrease in breast size
Stress incontinence
Oily skin
Acne
Decreased sex drive
Decreased dexterity
Increased insulin resistance/possible diabetes
Vaginal dryness
Decreased memory
Osteoporosis
Urinary tract infections
Increased cholesterol
Increases blood flow to the brain
Improves the function of neurons (brain cells)

I hope these lists are helpful to you when it comes time to make a decision about whether or not estrogen is for you. Any fellowship trained, board certified anti-aging physician will not only consider estrogen (in the form of Biest cream or gel, typically) along with proper balancing with other important hormones like progesterone, testosterone, thyroid and cortisol.

Good health to you!

Dr. Stephen Center | No 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: , , ,
09 Aug 2011
Depression

Treating depression as a correctable symptom rather than as a drug dependent disease

A recent CDC release reports that antidepressant drug use has skyrocketed in the last 10 years. Is depression some kind of epidemic? They also found that a sizable percentage of patients treated with these types of drugs did not actually have a diagnosis of depression. Quite often they were given the drug prescription for off-label use for symptoms of fatigue, job stress, insomnia and other conditions. Presumably the decision to use an antidepressant meant that the condition was not due to a treatable disease, so prescribing drugs to stimulate or suppress neurotransmitters in the brain would ideally provide patients with more relief of symptoms than adverse reactions.

Physicians who are thoroughly trained via board certification and specialized fellowship training in anti-aging and integrated medicine approach the symptoms of depression entirely differently. We take note and advocate learning better coping methods with job, financial, marital, parental and other stressors. We also review dietary factors and look for metabolic imbalances that can affect the major neurotransmitters associated with depression, such as serotonin, dopamine, and norepinephrine.

Among the many tools we use for reducing and eliminating depression symptoms, besides optimizing diet, detoxifying the intestines and liver, and using specific amino acids and herbs to help regulate imbalanced neurotransmitters, are bioidentical hormone replacement therapy (BHRT). Correctable hormonal causes of depression symptoms include inadequate adrenal regulation (often referred to as “adrenal fatigue”), progesterone deficiency in women, testosterone deficiency in both sexes, and estradiol deficiency. Depression may be associated with suboptimal thyroid status (often a failure to convert the less active thyroid hormone, T4, to the far more active thyroid hormone,T3).

The message of this blog is that all of these hormone deficiencies and metabolic imbalances can be improved with sensible treatment. If any one or a group of these conditions are improved, depression symptoms can abate, often completely and long term. Every month, in anti-aging and integrated medicine practices, patients are successful tapering off drugs they may be on for depression symptoms as their underlying deficiencies and imbalances are progressively corrected.
Results of these treatments can be seen in days to weeks.

Similar approaches are successful for treating fatigue, loss of stamina, insomnia and hundreds of other common complaints. The treatment plans are usually supported by clinical or experimental research augmented by the practitioner’s personal experience (there is no substitute for intuition).

So if an physician advises drug therapy for depression symptoms, think carefully, as there is no better advocate for your welfare than yourself. If the condition is severe and treatment is urgently needed, sometime antidepressants can be essential temporarily. Psychiatrists are best equipped to prescribe drugs in these situations. But if you are like most patients with less serious depression symptoms, you owe it to yourself to seek out medical care that addresses underlying reasons for your mood problems. Anti-aging and integrated medicine physicians have a vast toolbox to manage depression and other mood disorders. Our goal is to provide symptom relief, like drugs, but heal the body and brain at the same time, unlike drugs.

Be well!

Stephen A. Center, MD
BodyLogicMD of San Diego
Board certified and fellowship trained in Aging and Regenerative Medicine

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

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