What is the best way to keep your New Year’s resolution for better health?
Make it something easy and enjoyable that you actually want to do.

A key part of weight management, healthy blood pressure, hormone balance, and overall better health is stress reduction.

Exercise and acupuncture are both excellent ways to reduce stress. In a research article on acupuncture’s physiologic effects on the body, researchers in Stockholm Sweden stated “Both exercise and acupuncture . . . cause the release of endogenous opioids and oxytocin essential to the induction of functional changes in different organ systems. Beta-endorphin levels, important in pain control, . . . have been observed to rise in the brain tissue of animals after both acupuncture and strong exercise.”

The release of these ‘feel good’ substances helps us to feel less stress (and less pain). Evidence also shows that the elevated levels of endorphins and oxytocin after acupuncture can remain long after the acupuncture treatment has ended.

The exercise part of the equation is up to you, but monthly, bi-monthly, or even seasonal acupuncture treatments can do wonders for your health. And, if you have pain issues or a lack of energy, acupuncture can help with those too.

Resolving to improve your health could be the best choice you will ever make, but only if you actually follow through on it. Why not make it easy on yourself? A relaxing hour, or half hour, break in your day for an acupuncture treatment could make the difference.

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Regardless of your health history and physical background, almost anyone is a candidate for acupuncture. If you have an ailment, acupuncture can help relieve it. If you feel well, acupuncture can help you maintain wellness, boost immunity, and manage stress. At Integrative Medicine, practitioners provide acupuncture in collaboration with Dr. Nielsen’s recommendations. Patients very often see greater improvement in their condition when treated by both an MD and an acupuncturist. If you are interested in a consultation or appointment, contact our office at This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

Breast Cancer Risk

THE ROLE OF ESTROGEN METABOLITES 

Based on current estimates, 12.4 percent of women born in the United States today will develop breast cancer at some time during their lives. This means, if the current incidence rate stays the same, a woman born today has about a 1 in 8 chance of being diagnosed with breast cancer at some time during her life.

Hormone balance is one of the most common reasons women seek care in my office. As an Integrative and Functional Medicine physician, my role is to provide effective testing and assessment of hormone imbalance, and outline personalized recommendations to reduce my clients’ risks. I use estrogen metabolite testing to evaluate and assess Breast Cancer risk.



BREAST CANCER RISK FACTORS

When examining your potential risk for developing Breast Cancer, a variety of factors should be taken into consideration.
There are some risk factors for Breast Cancer that are out of your control, such as:

• genetic variants/gene mutations
• family history
• reproductive history
• high-dose radiation exposure to the chest

Other risk factors for Breast Cancer you have more control over and are modifiable:

• high endogenous estrogen (elevated levels of estrogen in the body)
• hormone therapy
• obesity
• alcohol consumption

Estrogen metabolites are additional factors that can be measured in your urine and considered when evaluating Breast Cancer risk. Estrogen metabolites are formed when estrogen is metabolized through your liver. This process is influenced by a combination of your genetics and environment. The type of estrogen metabolites that you produce in your body may have an impact on your Breast Cancer risk.

ESTROGEN METABOLITES 
Which path does estrogen take in your body?

• Estrogen metabolites are formed when estrogens are metabolized through your liver.
• There are different types of estrogen metabolites, and certain types may be associated with a higher risk of Breast Cancer.
• The types of estrogen metabolites that are produced in your body are impacted both through genetic and lifestyle factors.

Estrogen metabolites are formed when estrogens are processed through your liver.
All estrogen is metabolized in your body through pathways in your liver. It doesn't matter if the estrogen is made in your body (from your ovaries or through conversion in your fatty tissues) or if you are taking estrogen in from the outside (whether intentionally through hormone therapy or birth control pills or unintentionally through xenoestrogens in the environment). It all gets processed, or metabolized, in this way.


There are different types of estrogen metabolites, and certain types may be associated with a higher risk of Breast Cancer.
Think of estrogen being metabolized through the liver like it is traveling along a complicated map route. There are a number of factors that affect the route it takes, and different routes produce different estrogen metabolites.  The three key estrogen metabolites measured and their relative risk of Breast Cancer include:

Estrogen Metabolite                  Association with Breast Cancer Risk
2-hydroxyestrone (2-OHE1)                          lower risk
16 alpha-hydroxyestrone (16a-OHE1)            higher risk
4-hydroxyestrone (4-OHE1)                          highest risk


2-hydroxyestrone (2-OHE1) binds very weakly to target tissues, and has even been shown to have anti-estrogen properties. In contrast, 16 alpha-hydroxyestrone (16a-OHE1) is a powerful metabolite that stimulates target tissues. High levels of this potent metabolite are linked to increased risk and poorer prognosis in conditions linked to estrogen excess such as breast cancer and lupus. It is desirable to have a higher ratio of 2-OHE1 to 16a-OHE1 metabolites.

4-hydroxyestrone (4-OHE1) is considered a “bad” estrogen metabolite because it can easily convert to compounds that directly damage DNA, potentially increasing risk for initiation of Breast Cancer.



The types of estrogen metabolites that are produced in your body are impacted both through genetic and lifestyle factors.
If you have a genetic variant in one or more of these pathways, this can affect your ratio of estrogen metabolites and impact your risk of Breast Cancer.

Estrogen Metabolite                                Genetic Pathway
2-hydroxyestrone (2-OHE1)                     CYP1A1
16 alpha-hydroxyestrone (16a-OHE1)       CYP3A4
4-hydroxyestrone (4-OHE1)                     CYP1B1


Diet and lifestyle patterns also affect which types of estrogen metabolites are produced in your body. Factors that are known to promote a healthier estrogen metabolite ratio and lower risk of Breast Cancer include:

• higher intake of cruciferous vegetables, lignans (flax seed) and whole soy
• reduction of body fat
• reduction of exposure to pesticides
• reduced intake of alcohol
• higher omega-3 fatty acid intake
• regular exercise

DETERMINING ESTROGEN'S PATH IN YOUR BODY.
In my office, I measure estrogen metabolites primarily through the urine (there is a report example below). In premenopausal women, this is done with a first-morning urine on day 21 of the menstrual cycle. In postmenopausal women, this is done with a 24-hour urine collection. The test can be repeated to follow-up targeted lifestyle therapies and supplement protocols.

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I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many that are linked to unhealthy hormone imbalance. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like estrogen metabolite testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

Are you constantly hungry? Always looking for a snack? Craving sweets? These are all signs that you may be resistant to the effects of Leptin, one of our key regulators of hunger and fat-burning.


Leptin is made by your fat cells to turn off hunger in your brain.

Leptin (from the Greek word “leptose" meaning “thin”) is a hormone produced by fat cells when you eat.  After being released by the fat cells, leptin travels to your brain where it binds to receptors that turn off your hunger.  Leptin tells the brain that you have enough energy stored, and that you don’t need to eat any more.


Leptin levels increase with high fat mass and overeating.

Leptin is produced by fat cells, so the more fat cells you have, the more leptin you make. Leptin production is stimulated when you eat, so the more you eat, the more leptin you make.


Chronically high levels of leptin lead to leptin resistance.

You become leptin resistant in the same way that you become insulin resistant. (You can read more about insulin resistance here)  When the leptin receptors in the brain are continuously bombarded by high amounts of the leptin hormone, they become resistant to it's actions.  


Leptin Resistance = Hunger + Increased Fat Storage

When you develop leptin resistance the brain doesn’t "see" the leptin and thinks you are starving.  This leads to increased hunger, and your body gets a signal to “hold on” to your fat - making weight loss more difficult!


How to reverse leptin resistance:

Research is ongoing, but there are few things we know for sure can improve your sensitivity to leptin, helping to reduce hunger/cravings and promoting weight loss.

• Reduce intake of simple carbohydrates, especially fructose - which is known to be a major culprit in leptin resistance.
• Get a good night sleep!  Poor sleep patterns and lack of sleep increase leptin resistance.
• Keep your stress levels in check.  Elevated stress levels worsen leptin resistance.  
• Correct insulin resistance! High levels of insulin also block the leptin receptor in the brain, causing a “double whammy” when it comes to hunger and weight loss. (Read more about insulin resistance.)

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I use an Integrative/Functional Medicine approach with my patients looking to lose weight. Assessing for hormone imbalance is a key first step in this process. I do not believe in the “calories-in, calories-out” philosophy of weight loss. Your body is not a bank account (deposit/withdraw), your body is a chemistry lab! My approach involves getting "under the surface" to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

Five ways our approach to healthcare can help you find your balance in the New Year.

#1 - Balance your Hormones and Neurotransmitters!

Looking for more stable mood and energy? Balanced hormones and neurotransmitters are the key! We can help you:

• Evaluate your Thyroid using the right tests, and look for optimal levels, not the "normal range"
• Examine the effects of stress on your Adrenals, which can be rebalanced with customized herbal blends
• Learn about both hormonal and non-hormonal options for peri-menopause and menopause
• Serotonin is a key factor in depression and anxiety, you can boost your levels by improving digestive health and providing key nutrients for serotonin production, not just with anti-depressants

Visit our website for more information about our approach to Emotional Health.

#2 - Figure out which Foods are working for you, and which are working against you.

Food sensitivities and intolerances are underlying factors in a number of chronic medical conditions, including:

• chronic headaches
• weight gain
• eczema/skin rashes
• asthma
• depression
• fatigue/low energy and "brain fog"
• autoimmune disease (such as rheumatoid arthritis and lupus)
• chronic sinus problems
• joint and muscle pain
• mood swings

We have the tools and experience to help you determine your optimal diet, including food sensitivity testing, customized elimination diets, and evaluation for "leaky gut".

#3 - Shed Pounds and Gain Energy with a Customized Diet Plan

We offer everything from a 10-day detox/cleanse to a 12-week weight loss and lifestyle change program to help you look and and feel your best. All programs are customized to your individual needs. No fad diets and no "one size fits all" program.

Visit our website for more information about our My Optimal Diet program.

#4 - Learn more about what is going on "under the surface" with Functional Laboratory Testing.

Assess the micronutrient status in your body. How well is your liver working? How balanced are the microorganisms in your gut? Our laboratory testing options go beyond "standard values". Examples include:

• micronutrient testing
• adrenal saliva testing
• screening for heavy metals
• advanced lipid testing
• food sensitivity testing
• hormone testing for men and women
• assessment of cellular energy production
• functional stool analysis

#5 - Customize your Nutritional Supplements to meet Your Needs

Every cell in our body contains a copy of our genetic code, or "blueprint". The nutrients we obtain from our food and vitamins/nutritional supplements will provide us with varying benefits, depending on our blueprint. Your genetics, your medical history, and your current state of health should all be taken into account when choosing nutritional supplements. Dr. Nielsen can provide you with sound evidence-based recommendations to meet your needs. Micronutrient testing is also available.

Visit our website for more information about Customized Vitamins/Supplements.


Yours in Health,

Carin Nielsen, MD
www.CarinNielsenMD.com

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The adrenal glands are walnut-sized glands that sit on top of your kidneys.  The main purpose of your adrenals is to enable your body to respond to stressfrom every possible source. This includes physical stress such as from injury or illness, as well as psychological or emotionsl stress.