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Low Thyroid - Five Keys to Getting the Results You Are Looking For

Do you have (or suspect that you have) low thyroid function?

Are you tired of feeling sluggish and foggy only to be told that your thyroid tests “look normal”?

You are not alone! Thyroid health is one of the most common reasons why patients seek my care - and for good reason! Optimal thyroid function is an essential component of your health and well-being, as thyroid hormones play a major role in regulating many bodily functions, including

  • Metabolism
  • Weight
  • Energy
  • Mood
  • Temperature control
  • Bowel function
  • Cognitive function
  • Heart health
  • Skin integrity
  • Muscle development
  • Gingival health

Many conventional practitioners take a “one-size-fits-all” approach to low thyroid hormone, also called hypothyroidism. They rely on one laboratory value and prescribe one type of thyroid hormone for all patients, because that is how we are taught to approach hypothyroidism in medical school. While some patients are fine with this approach, others are not and find themselves continuing to experience symptoms without an adequate diagnosis or treatment plan.

If you have (or suspect that you have) low thyroid function, a practitioner skilled and experienced in a more comprehensive approach to hypothyroidism may help you to better understand why your thyroid hormones are low, and partner with you to create a customized treatment plan to restore energy, vitality, and well-being.

LOW THYROID - FIVE KEYS TO GETTING THE RESULTS YOU ARE LOOKING FOR

#1 - GET THE RIGHT TESTING AT THE RIGHT TIME
I can’t tell you how many patients I have encountered who have been told that their thyroid function is “normal“ based upon just one laboratory value - the TSH.

TSH = Thyroid Stimulating Hormone

TSH is made by your brain, not by your thyroid. Your brain makes TSH when it senses that your body needs more thyroid hormone. The TSH made by the brain sends a signal to the thyroid to make more thyroid hormone.
Patients are often confused when interpreting their TSH number because it is an “opposite” test. A high TSH value indicates low thyroid hormone in the body.

When thyroid hormone levels in your body are low, the brain makes more TSH to "turn on" your thyroid.

Getting a more accurate picture of your current thyroid health involves testing beyond the TSH and including:

  • thyroid hormone levels - Free T3, Free T4, and Reverse T3
  • Anti-thyroid antibodies

The time at which a hormone is tested will impact results. Thyroid hormones measured first thing in the morning will look different than those measured in the late afternoon. You should also have clear instructions on if and when to take your medication in relationship to your thyroid test. I generally hold thyroid medication for a first morning testing, and sometimes I have my patients take their morning medication and then test mid-afternoon for a different picture.

#2 - RECOGNIZE THE MANY FACTORS THAT CAN CONTRIBUTE TO THYROID HEALTH
If your thyroid function is not optimal, ask the question WHY? Do you have an auto-immune condition affecting your thyroid? Are there “missing ingredients” that your thyroid needs to properly function, or something interfering with your thyroid gland? There are many factors that contribute to thyroid health, including:

  • Nutrient deficiencies (such as iron, iodine, zinc and selenium)
  • Physical and emotional stress
  • Exposure to toxins (such as fluoride, pesticides, mercury)
  • Food sensitivities
  • Underlying infections and inflammation
  • Physical trauma
  • Certain medications or other medical conditions (such as celiac disease)

#3 - AIM FOR OPTIMAL HORMONE LEVELS, NOT “NORMAL RANGE” 
While “normal ranges” are provided for each laboratory test, these ranges can vary widely. To feel and look your best, the goal should be optimal hormone levels! Thyroid hormone testing is perhaps best examples of this. I can’t tell you how many patients I have met with who had been told their thyroid levels were “normal“ despite ongoing symptoms. After shifting the focus to target optimal levels, these patients are able to experience improved energy, vitality, and well-being.

#4 - GET THE PRESCRIPTION THAT IS RIGHT FOR YOU
If prescription thyroid hormone therapy is needed, there are many options available. This allows treatment plans to be individualized for each patient. In addition to the industry standard synthetic T4 hormone (Synthroid/levothyroxine), there are various forms of natural porcine thyroid available containing both T4 and T3 hormone. Experienced practitioners can prescribe precise combinations of T4 and T3 prepared by compounding pharmacies, in both immediate and sustained-release forms.

#5 - PARTNER WITH YOUR PRACTITIONER IN THE DECISION MAKING PROCESS
To optimize thyroid function, the relationship between a patient and a practitioner needs to be viewed and treated as a partnership. Optimal thyroid function is a little different for each person, and patients should feel comfortable asking questions and expressing any symptoms or concerns. When prescribing thyroid hormone, I encourage patients to listen to their body for signs and symptoms that give us insight into thyroid health, such as body temperature, mood and energy, heart palpitations and more.



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including hormone imbalance and low thyroid.  During the COVID-19 pandemic, I continue to see both new and returning clients via our easy, secure, video-visit format. 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.

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HORMONE BALANCE - Four Steps to Optimize Hormone Testing

HORMONE BALANCE
Hormone Balance is one of the most common reasons patients seek my care, and for good reason! Hormones have profound effects on your mental, physical, and emotional health and well-being.

Hormones are chemical messengers made in cells throughout the body. These messengers are carried in your blood to the organs and tissues they affect. There are many types of hormones which influence nearly every bodily function.

HORMONES IMPACT:

  • Energy
  • Mood
  • Brain Function
  • Weight
  • Metabolism
  • Muscle Mass and Bone Health
  • Breast and Vaginal health
  • Menstrual cycles
  • Sleep cycles
  • Body Temperature
  • Skin Health

COULD YOU HAVE A HORMONE IMBALANCE? 
There are many symptoms and conditions associated with hormone imbalance, including:

  • Polycystic Ovarian Syndrome
  • Infertility
  • Mood Swings or Mood Disorders (depression, anxiety)
  • Poor Memory
  • Brain “Fog”
  • Poor Libido or Sexual Dysfunction
  • Poor Sleep
  • Acne and/or Aging Skin
  • Increased Appetite
  • Weight gain
  • Bone and/or Muscle Loss
  • PMS
  • Painful and/or Heavy Menstrual Periods

HORMONE TESTING
Hormone testing is an essential part of your journey toward hormone balance. Testing hormones can provide a more clear picture of your current hormone patterns and testing is invaluable to monitor hormone therapy and treatment protocols.

Testing hormones can be complicated, confusing, and at times expensive. Taking the right steps when testing hormones can ensure that you get the most useful and accurate information.


FOUR STEPS TO OPTIMIZE HORMONE TESTING


STEP ONE - FIND AN EXPERIENCED PRACTITIONER

Conventional practitioners often fall short when it comes to
hormone testing because they are not trained in how to appropriately order and interpret hormone tests (I certainly did not get this training in medical school). There are many types of hormones, and many types of tests. Working with a practitioner who is knowledgeable in how to order and interpret hormone testing is the first step in your journey toward hormone balance.


STEP TWO - CHOOSE THE RIGHT TEST
Hormones can be tested in blood, urine and saliva. When choosing the appropriate test many factors should be taken into consideration, including gender, age, and current symptoms. Many hormones are easy to test in blood, including estrogen, progesterone, testosterone, thyroid, insulin, cortisol, leptin and more. Urine testing can be used to measure hormone levels over a 24 hour period, and can also provide valuable information about hormone metabolism and bone loss. Saliva can be used to easily collect multiple samples over a day, week, or month, and is most often used to measure adrenal hormones and sex-steroid hormones such as estrogen, progesterone, and testosterone.


STEP THREE - TIMING IS EVERYTHING

For accurate and meaningful test results, the timing of hormone testing must be considered. Hormones can be tested on a specific day or time for a “snapshot” of that moment, or measured over the course of 24 hours or an entire menstrual cycle.

The time of day a hormone test is collected will impact results. For example, thyroid hormones measured first thing in the morning will look different than those measured in the late afternoon. Certain hormones, such as insulin and cortisol, are best measured in a fasting state first thing in the morning.

Finally, timing of testing in patients taking hormone therapy should be precise, and you should have clear instructions on if and when to take your medication in relationship to your hormone test. For example, thyroid medication is often held the morning of testing.


STEP FOUR - DON’T SETTLE FOR “ NORMAL RANGE”
There is no “one size fits all“ to interpreting hormone test results.
While “normal ranges” are provided for each test, these ranges can vary widely. To feel and look your best, the goal should be optimal hormone levels! One of the best examples of this is thyroid hormone. I can’t tell you how many patients I have met with who had been told their thyroid levels were “normal“ despite ongoing symptoms. After shifting the focus to optimal levels, these patients are able to experience improved energy, vitality, and well-being.

Optimal levels may vary from person to person. Each test result should be interpreted in light of the individual patient, their age and their symptoms or concerns. For example, the optimal estrogen level for a post menopausal woman on hormone therapy is often a lower level designed to provide enough hormone for bone health, not to restore the levels of a 20 year old.



Carin Nielsen, MD Integrative Medicine 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 balance. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. During the COVID-19 pandemic I continue to see both new and returning clients using our secure, easy video-visit format. 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.

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Female Hormone Testing 101

FEMALE HORMONE TESTING 101

Which test is right for you?


Achieving Hormone Balance in women starts with evaluating your hormone levels. While symptoms can often suggest hormonal patterns, I use laboratory data to confirm these patterns, and also to evaluate the safety and effectiveness of prescribed hormones, supplements and lifestyle recommendations.


WHICH HORMONES DO WE TEST?
The term “hormone balance” refers to the interaction and balance of a variety of hormones in the body, therefore when evaluating hormones we need to do so BY keeping all of these interactions in mind. While there are many hormones we are able to test, the hormones I most routinely test in my patients include:
  • Adrenal (stress hormones) - cortisol, DHEA-S
  • Sex-steroid hormones- estrogen, progesterone, testosterone, DHEA
  • Thyroid - TSH and free thyroid hormone levels
  • Other - insulin (think blood sugar regulation), pregnenolone (a hormone precursor often referred to as “the mother of all hormones”)
b2ap3_thumbnail_TESTTUBES.pngThere is no perfect hormone test for everyone.

Hormone levels can be measured in blood, urine or saliva. There are many factors taken into consideration when choosing which test is appropriate for each patient, including:
  • patient age
  • type of hormone(s) being measured
  • the number of samples needed to test
  • pre-, peri- or post-menopausal
  • whether the patient is currently on hormone therapy
  • cost of test

So which test is right for you?

Below I’ve broken down the pros and cons of each test and provided information on the tests I most often order in my practice.


HORMONE TESTING 101

BLOOD
Pros: Blood testing is simple and cost-effective (covered by most commercial insurance policies as well as Medicare and Medicaid).

I routinely use blood testing for thyroid hormones and fasting insulin regardless of age. Blood testing of DHEA and pregnenolone is useful for both baseline levels and to monitor when supplementing these hormone precursors. For sex-steroid hormones (estrogen, progesterone, testosterone), blood testing can be useful in the following situations:
  • Pre-menopause - an early-cycle draw (around day 5) can help evaluate for PCOS (polycystic ovarian syndrome).
  • Peri-menopause - a luteal phase draw (day 22-24) helps to evaluate PMS imbalances and estrogen: progesterone balance.
  • Post-menopause - blood hormone levels can be used to confirm menopause and also to monitor hormone levels while on hormone therapy.
Cons: Blood hormone testing gives us information on one moment in time. It is not practical to use blood for multiple-day specimens, or for several samples in one day. Blood measurements are also limited in their ability to provide information on hormone metabolites. Hormone metabolites give valuable insight info which “pathways” hormones take in your body, some of which are healthier than others, and can help stratify risk for hormone-related cancers.

Click HERE to read my previous blog on estrogen metabolite testing.


SALIVA
Pros: Saliva tests can be performed and shipped from anywhere, bypassing a trip to the laboratory. Saliva tests are convenient when multiple specimens are needed and can be kept in your freezer if testing over a month cycle.
I routinely use saliva hormone testing to test adrenal hormones. I also use saliva sex-steroid hormone testing in pre- or peri-menopause to look at cyclical trends and hormone fluctuations, testing anywhere from 5-28 day periods.

Cons: While Medicare covers saliva hormone testing, most commercial insurance companies do not. Saliva hormone testing does not provide hormone metabolite information. While saliva testing can be useful for adrenal and sex-steroid hormones, it is not used to measure thyroid hormones or insulin. Some patients have trouble producing enough saliva for testing, especially if they have chronic dry mouth or are on medications that reduce saliva production.

MY MOST ORDERED SALIVA HORMONE TESTS BY GENOVA DIAGNOSTICS:

URINE

Pros: Urine hormone testing can be done and shipped from home, bypassing a trip to the laboratory. One of the biggest benefits of urine hormone testing is the ability to get an abundance of information on hormone metabolites (see above and my prior blog). Hormone metabolites are especially useful in stratifying risk for hormone-related cancers and also in evaluating the efficacy and safety of hormone replacement therapy.

Cons: Most commercial insurance companies do not cover the cost of urine hormone testing. Some urine hormone tests in postmenopausal women require a 24-hour urine collection, which can be cumbersome for patients. While I use urine hormone testing to measure adrenal and sex-steroid hormones, I do not use urine to measure thyroid hormone or insulin.


b2ap3_thumbnail_DUTCHwheel.pngMY MOST ORDERED URINE HORMONE TEST BY GENOVA DIAGNOSTICS:
Complete Hormones (either 24-hour or first-morning urine, depending upon patient age)

MY NEW FAVORITE TEST BY PRECISION ANALYTICAL INC. COMBINES BOTH SALIVA AND URINE:
DUTCH Complete and DUTCH Plus testing




Carin Nielsen, MD Integrative Medicine 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.
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Three Reasons to Consider Estrogen Metabolite Testing

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Earlier this week, I introduced the concept of estrogen metabolites, which are formed when estrogens are metabolized through the liver.  Why do I care about estrogen metabolites?  Because certain types of estrogen metabolites are associated with a higher risk of Breast Cancer.  
 
Estrogen metabolite testing can give you an idea of which path estrogen is taking in your body.  
 
If you discover that estrogen is taking an “unhealthy path” in your body, you can take measures to correct this!

 
Three Reasons to Consider Estrogen Metabolite Testing
 

#1 - You are post-menopausal and considering hormone replacement therapy.
 
This is probably the most common reason I perform estrogen metabolite testing.  If unhealthy levels of “bad” estrogen metabolites are found on testing, this should be considered before adding hormone therapy to the mix, and may lead to:
  • consideration of non-hormonal alternatives or use of lower hormone doses
  • lifestyle measures to promote a healthier hormone balance
  • targeted supplementation to reduce risk
 
#2 - You are peri-menopausal and experiencing symptoms of hormone imbalance.
 
Symptoms of an “estrogen overload” pattern in peri-menopause (usually in the mid to late 40s)  include breast swelling and tenderness, weight gain, fluid retention, increased PMS, mood swings, and insomnia.  Identifying hormone imbalance during this time-period may help to direct therapies that alleviate symptoms and reduce breast cancer risk, and may include:
  • adding progesterone or herbal therapies to combat the potential dangers of elevated estrogen
  • focusing more intensely on lifestyle changes such as weight loss and alcohol reduction
  • dietary changes to limit animal fat and increase intake of cruciferous vegetables
 
#3 - You are at an elevated risk for breast cancer, or have a personal history of breast cancer, and you want to look for other potentially modifiable risk factors.
 
If factors that are not in your control (such as family history and genetic patterns) have put you at a significant risk for breast cancer, or if you are a breast cancer survivor, you may be looking to identify every possible risk factor that can be avoided.  Estrogen metabolite testing can be used as part of this process to examine what path the estrogen is taking in your body.  The results may help you to lower your risk of breast and other estrogen-related cancers through:
  • considering prescription medication to reduce risk
  • reducing toxin exposure to prevent formation of harmful estrogen metabolites
  • providing methylation support to inactivate harmful metabolites, and/or antioxidant support to prevent DNA damage if needed

If you are interested in hormone testing or would like to learn more, send me an email!  This email address is being protected from spambots. You need JavaScript enabled to view it.
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Estrogen Metabolites - Which path does Estrogen take in your body?

Breast Cancer Risk

THE ROLE OF ESTROGEN METABOLITES 

b2ap3_thumbnail_breast-cancer-ribbon2.pngBased 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. 
b2ap3_thumbnail_complicated_map_route.jpg


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.

b2ap3_thumbnail_estrogen_metabolite2.jpg

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.

b2ap3_thumbnail_estrogen_metabolite.jpg



Carin Nielsen, MD Integrative Medicine 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.
 
 
 
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Could Insulin Resistance be causing your weight gain and fatigue?

Proper insulin and blood sugar balance can be a key factor in optimizing hormone balance and improving energy, mood and weight.

Integrative Medicine Insulin ResistanceBelly fat and low energy?

Is it getting more difficult to button your pants due to belly fat? Does your energy plummet at different times during the day, especially around 3pm? These are both clues that your body is not maintaining normal blood sugar levels. If insulin and blood sugar aren't working together properly not only will you see your waistline get larger, but you may also feel more tired or even depressed.

Insulin and Blood Sugar - the Basics

Integrative Medicine Insulin ResistanceOur body is made up of trillions of tiny cells. These cells work together to form all of our organs, our blood vessels, our nerves,muscles and everything else that makes us, well us!
In order for our bodies to work, our cells need energy.

This energy comes primarily in the form of blood glucose, also called blood sugar. Blood sugar cannot just enter into cells to provide energy - the blood sugar has to be carried into the cells - this is the job of insulin.

Insulin is a hormone that is made in the pancreas.
Your pancreas makes insulin in response to the normal increase in blood sugar that occurs after you eat.

The insulin binds to blood sugar in the bloodstream, and transports the blood sugar into your cells through an insulin receptor on the cell's surface. This provides the cells with the energy they need to stay alive and function optimally.

Think of insulin like a gas pump -
it gets the gas into the car for energy!

Insulin Resistance

When you have insulin resistance, your cells don't allow insulin to transport blood sugar into your cells so easily. It's like the nozzle of the gas pump no longer fits and your cells become "resistant" to the action of insulin. To compensate, your pancreas has to make more and more insulin to get enough fuel into your cells.


Integrative MedicineInsulin Resistance = Higher Insulin Levels = Higher Blood Sugar Levels = Low Energy

Why is insulin resistance a problem? For many reasons. Both high insulin and sugar levels contribute to inflammation in the body. Excess insulin also causes changes in energy levels, especially feeling tired after a meal, and increases hunger and sugar cravings. The higher blood sugar levels cause more of your blood sugar to be stored as fat, promoting weight gain, especially in your abdomen. When cells aren't getting the energy they need, your body doesn't operate efficiently, and you experience more fatigue, brain fog, and low stamina. Insulin resistance contributes to infertility, and if not corrected, insulin resistance is likely to turn into Type 2 Diabetes and elevated risk of heart and vascular disease.


Are you at risk for insulin resistance?

You may want to discuss testing for insulin resistance with your physician or booking an appointment in my office for a consultation if you have one or more of the following:
  • you struggle with weight gain, especially in your abdomen
  • you experience energy "slumps" after eating, especially mid-afternoon
  • you have a family history of Type 2 Diabetes
  • you have a personal history of gestational diabetes (diabetes in pregnancy)
  • your diet is high in "fast carbs" like sugar and white flour
  • you experience chronic stress
  • you have dark patches of skin on the back of your neck, elbows, knees, or armpits
  • you have a lot of skin tags, especially around your neck and armpits

Can insulin resistance be reversed?

YES - insulin resistance can be reversed! As a matter of fact, we help walk people through this process frequently in my office. Insulin levels can be normalized fairly quickly if the problem is caught early enough and the right action is taken. Treating insulin resistance makes weight loss easier, improves energy and mood, and reduces hunger and sugar cravings. The mainstays of treating insulin resistance in my office involves the following:
  • Changing the types of foods in your diet. Removing "fast carbs" like sugar and white flour, and incorporating more "slow carbs" that are high in fiber and micronutrients
  • Learning how to read a food label to look for hidden sugars, fiber content, and more.
  • Stress management to avoid cortisol and blood sugar spikes
  • Supportive supplementation to correct underlying deficiencies, reduce inflammation, and make your cells more responsive to insulin
  • Prescription medication is sometimes used in advanced cases as one part of the treatment plan
Are you or a loved one interested in testing and treatment of insulin resistance? Feel free to send an email my way, or contact our office to schedule an appointment, This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

Yours in Health,

Carin Nielsen, MD
www.CarinNielsenMD.com



Carin Nielsen, MD Integrative MedicineI use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms and chronic disease simply by prescribing medication doesn't 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" 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.
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Adrenal Function - at the core of Hormone Balance

Hormone balance is a common theme in my office.  Today it was a theme of nearly every patient!  Often, patients present to me complaining of fatigue, weight gain, depressed mood, and low stamina, questioning whether an imbalance in hormones is the cause.  They often ask about their thyroid.  Some are interested in Bio-identical Hormone Replacement therapy.  While thyroid hormone and estrogen balance are important factors to consider - it might surprise you to learn that my first step in evaluating hormone balance is always the adrenal glands.
 
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.
 b2ap3_thumbnail_adrenals.jpg
In medical school, I learned about the adrenal glands by studying Addison's disease. This is an uncommon disorder, often autoimmune, in which the adrenals lose their ability to function. Those affected by Addison's disease require lifelong daily medication for survival.
 
Now, I discuss more subtle changes adrenal function with patients every day.  Even more mild changes and adrenal function can have a significant impact on vitality, energy and quality-of-life.  
 
In addition to regulating sodium and potassium balance in the body,  the adrenal glands create and secrete hormones in response to stress.  When something startles you, adrenaline is released, which creates a "fight or flight" response. You feel suddenly super-charged and ready for quick response.  Cortisol, one of the primary hormones secreted by the adrenals, is important to maintain blood pressure and blood sugar. When you experience injury or inflammation, elevated cortisol secretion protects the body by supplying adequate levels of blood glucose and maintaining blood pressure for healing.
 
If the adrenals are exposed to chronic inflammation, such as that from chronic illness, poor diet, or prolonged emotional stress, they can have a prolonged output of cortisol and adrenaline. This can cause anxiety, irritability, chronically elevated blood pressure and blood sugars, elevated heart disease risk, increased fat production (especially abdominal fat), and weight gain
 
Over time, over-active adrenal glands can become exhausted and under-active.  If this happens, you may experience symptoms such as fatigue (especially in the morning), feeling rundown or overwhelmed, craving salty and sweet food, low stamina, difficulties recovering from illness or injury, low blood pressure, or "brain fog".  Adrenal exhaustion may also be associated with the development of auto-immune disease or illness.
 
Testing adrenal function can be done through blood or saliva.  My test of choice is a saliva test that tests adrenal hormones at four points throughout the day.  It is done at home and shipped directly to the lab company.  I receive results in about 10 days.  This information can then be used to direct therapy to balance adrenal function.  A combination of nutraceuticals, herbs and/or prescription medication can be used to restore under-active adrenal function or calm over-active adrenals.
 
In addition to adrenal testing and therapy, we offer Mindfulness training (both group and individual) to help control and change response and reaction to stress.  Learning how to better manage and respond to stress is essential to maintain healthy adrenal function and hormone balance.
b2ap3_thumbnail_HormoneBalance-b.jpg 
 
If you or someone you love is experiencing any of the symptoms above, or if you would like more information, contact our office at This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
 
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Is your pink ribbon BPA-free?

October is Breast Cancer Awareness Month, and like most of you, I have many patients, friends and loved ones who have been affected by Breast Cancer.  It's hard to imagine in this day and age that there is someone out there who hasn't been affected by Breast Cancer.  According to the National Institutes of Health, it is estimated that about one out of every eight women born today will be diagnosed with breast cancer at some time during her life.

Breast Cancer advocacy groups have done a remarkable job of increasing Breast Cancer awareness, educating the public on risk factors, raising money for research and encouraging screening for early detection (and therefore higher cure rates).  It is really fantastic to see Breast Cancer research support at such a national level, especially in October when the nation is practically painted in pink ribbons.
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But in my opinion, there is one risk factor that we just aren't talking about enough - and that is the link between environmental exposures and development of Breast Cancer.

Endocrine Disrupting Chemicals, or EDCs, are chemicals that can mimic or disrupt our natural hormone balance.  There is a growing body of scientific research that exposure to environmental chemicals containing EDCs is associated with developing Breast Cancer, as well as early puberty, endometriosis, male and female infertility, and prostate cancer.  Many of the most harmful EDCs are xenoestrogens - compounds that can mimic the effect of estrogen in the body.  Excess estrogen is everywhere!  Dangerous amounts of both natural and synthetic estrogens are being found in our public water supply.  Male fish containing female sex organs are popping up in our nation's rivers.  Girls in general are starting their first menstrual period several years earlier than they were twenty years ago (early onset of first menstrual period is a known risk factor for breast cancer), and those with higher levels of exposure to common household chemicals have been found to have their first menstrual period even earlier (seven months earlier than girls with lower exposures).  

EDCs are all around you!  They are in your jeans (2/3 of jeans made in China, your mattress, your canned goods, your upholstery, and your PLASTIC!  They are in your perfume, your lotion, your shampoo and your cosmetics.
 
In honor of Breast Cancer Awareness Month, I encourage you to educate yourself on Endocrine Disrupters and examine your home and environment to reduce exposure (I know I will).  There are a number of simple things individuals, families, and communities can do reduce exposure to environmental chemicals that could pose risk for breast cancer:
    • Avoid plastic water bottles and Styrofoam containers;
    • Never microwave food in plastic or Styrofoam; 
    • Eat fresh or frozen foods, not canned, unless can is lined with BPA-free plastic;
    • Go fragrance free in both personal care products and household cleaning products;
    • Remove plastic bags and air out garments that have been dry-cleaned before either wearing them or putting them in closets or drawers;
    • Choose products that have detailed ingredient labels and don't contain known EDCs (e.g., parabens, phthalates, BPA). Contact companies for information if you have concerns about their ingredients;
    • Minimize the use of pesticides and herbicides, especially when using them for mainly cosmetic landscaping purposes, to avoid personal exposure and especially for young children in your neighborhood.
    • Seek out reputable information to help you make safer choices and decrease your exposure to environmental risks, such as The Environmental Working Group

I offer advanced laboratory testing in my office to assess for toxic exposure, as well as relative levels of "good" and "bad" estrogens.
Want to learn more?  This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585
 
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