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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. 
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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.

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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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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 Simple Steps to Prevent Summer Diet Sabotage

No matter where you live, the summer season can quickly turn into one big party! Tuesday night suddenly looks like Friday night, friends and family come out of the woodwork, and the picnics, BBQs and cocktails start becoming daily activities.

Suddenly, healthy eating becomes even more of a challenge.

Challenging, yes - but not impossible! Let me share with you the same advice I give my patients everyday - when it comes to food, don’t focus on what you shouldn’t be eating, instead focus on the foods that you need to eat at key points during the day to maintain energy, boost metabolism, and avoid over-indulging.

CONSIDER THESE THREE SIMPLE STEPS TO PREVENT SUMMER DIET SABOTAGE:

b2ap3_thumbnail_ProteinShakes.jpg1. Start your day with protein and fiber

Cereals, donuts, toast and bagels all cause a rapid rise in blood sugar (and insulin) that is followed by a blood sugar crash within hours. This can cause your energy level to plummet and can spark strong hunger and cravings. Starting your morning with protein and fiber promotes consistent energy by avoiding a blood sugar crash, boosts metabolism to promote weight loss and keep you full, often until lunchtime!

A protein shake/smoothie is an excellent way to start your summer days. Read more about reasons to start your day with a protein shake.


b2ap3_thumbnail_salad.jpg2. “Stack the Deck”
This is a concept that I frequently discuss with my patients. "Stacking the deck" simply refers to giving your body the food that it needs earlier in the day to promote stable mood and energy and reduced food cravings later in the day. If you know you have a party or event later in the evening, the last thing you want to do is starve yourself in anticipation! Not only will this increase cravings and decrease willpower, it can cause rapid mood swings. In addition, not eating during the day makes your body feel as though it is starving, which switches your metabolism to "fat-storing" mode instead of "fat-burning" mode.

3. Fill up on the good stuff first
Have you ever been to a Mexican restaurant? If you have, then you have probably gorged yourself on a basket of chips and salsa - filling yourself up before your meal even comes to the table!
Let's turn this scenario around. What if they brought out the basket of chips after you finished your meal? Would they still be as appealing? No way! Think of this as you plan your eating for your next party. Fill your plate with vegetables first. By filling up first with foods that are high in fiber and low in sugar, you will be less likely to over indulge in unhealthy choices without feeling deprived.

You can visit our online store to learn more about products we have available to help support you this summer, including my physician-formulated Balanced Vegan Protein Shake Mix, Appetite Support Formula, Starch Blocker, and Balanced Liver Support. 

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I'd love to hear your comments or questions. Feel free to message me directly at This email address is being protected from spambots. You need JavaScript enabled to view it..

Be Well!
Carin Nielsen, MD
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Guest Blog: Mindfulness

An Introduction to Mindfulness Practice
By CHRIS FRASZ, BS, MSW

Chris Frasz, BS, MSWMindfulness, an eastern meditation practice with a history of over 2,500 years, was established as a foundation for developing a clear and focused mind, allowing one to then analyze in depth various topics for self improvement.

With the gradual introduction of this practice to the west in the 60’s, interest has gradually built, supported by a great deal of research and empirical evidence, clearly showing many mental and physical benefits. Now, the practice of mindfulness is part of our culture, being incorporated extensively throughout the United States, from hospitals to businesses, from schools to professional athletic teams. Most recently, 60 Minutes aired a segment on mindfulness, touting both its efficacy and widespread use.

Mindfulness practitioners learn to better understand and regulate their thoughts, thus taking a more active role in improving their mental well-being. With developed stability and awareness, practitioner’s benefit by viewing and relating to their mental and physical states in a more objective and healthy manner. And, as the medical world builds empirical evidence relating to the connection of one’s mental and physical well-being, the mental growth and improvement has shown significant physical benefits, including:

  • Lower blood pressure
  • Lower heart rate
  • Increase in immune system
  • Stress reduction
  • Growth of grey matter in the brain (Psychiatry Research: Neuroimaging)

Within our upcoming course, Introduction to Mindfulness for Stress Reduction, we review the mindfulness practice in detail, giving participants various ways of engaging in the practice and the rationale behind why and how the practice is effective. Guided, in-class participation, combined with discussion and presentation, enables participants to learn and grow in a supportive and safe environment. Active engagement allows participants to build their own practice and create a foundation for future growth.


Chris Frasz received his B.S. from Michigan Technological University and his Masters Degree in Social Work from the University of Michigan, Ann Arbor. He has many years of experience teaching Mindfulness Meditation at a variety of levels, drawing on his exposure to various meditation techniques from both Western and Eastern meditation teachers, including Jon Kabat-Zinn, Kyabje Gehlek Rimpoche and others. His background in engineering, business, social work, and family life give him a unique perspective in understanding and working with the various stressors related to work, family, and life in general. If you are interested in learning more about the benefits of mindfulness and our Introduction to Mindfulness to Stress Reduction courses, 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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Quiz: Assess your Neurotransmitter Balance

In yesterday's blog I gave an overview of Neurotransmitters, brain chemicals that communicate information throughout our brain and body.  These “brain hormones” are essential for optimal mood, energy and weight!  Treating thousands of patients over the last ten years, I have learned that a proper balance of neurotransmitters is a key first step when embarking on a program toward lasting lifestyle change.  Take my short quiz to assess how neurotransmitter imbalance may be affecting your mood as well as your appetite and hunger patterns.  


Take my short quiz to assess your neurotransmitter balance.


CHOOSE 1-2 STATEMENTS FROM EACH GROUP BELOW THAT MOST APPLY TO YOU:
 
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A.  I consider myself a low-energy person
B.  I have trouble relaxing
C.  I am easily irritated, I can be quick to “snap"
D.  I am forgetful
 
2.
A.  I have trouble motivating to exercise
B.  I often feel "stressed out”
C.  I have poor self-esteem or poor body-image
D.  My memory is poor
 
3.
A.  I frequently seek out sugar/candy 
B.  I "binge", eating large amounts of food at one time
C.  I crave starchy carbohydrates, like pasta
D.  I crave fatty, fried foods like hamburgers and pizza
 
4.
A.  I consume caffeine throughout the day (coffee, soda)
B.  I am an emotional eater
C.  I have higher food cravings in the evening
D.  I prefer creamy deserts like cheesecake and ice cream
 
 
RESULTS:
 
- If you chose “A” for two or more of these statements, you may have low dopamine levels.  
 
Improving low dopamine levels:
  • ensure adequate intake of foods rich in tyrosine: including most animal products, green leafy veggies, avocado, vegetables, green tea, chocolate, coffee
  • supplement with L-tyrosine, the building block of dopamine, and/or ginkgo billoba*
  • exercise boosts dopamine levels
 
 
B - If you chose “B” for two or more of these statements, you may have low GABA levels.
 
Improving GABA levels:
  • increase intake of shellfish, broccoli, brown rice, bananas
  • start a regular yoga practice
  • consider supplementation with l-theanine, taurine, glutamine, leucine, and/or inositol*
  • learn to meditate
 
 
C - If you chose “C” for two or more of these statements, you may have low serotonin levels.
 
Boosting serotonin levels:
  • ensure  adequate protein intake at key times during the day
  • supplement with 5-HTP, samE, and/or melatonin*
  • increase B-vitamins (especially B6) and magnesium*
  • stress management (elevated cortisol produced with stress breaks down serotonin)
  • heal your gut - 90% of your serotonin is produced in the gut
 
 
D - If you chose “D” for two or more of these statements, you may have low acetylcholine levels.
 
Improving acetylcholine levels:
  • increase intake of eggs, avocado, olives, nuts and seeds
  • increase Vitamin B5 intake*
  • consider supplements such as phosphytidyl serine or choline* 
 
*Each individual is different, and the pattern of neurotransmitter balance may be different for each person.  Nutritional supplements may interfere with each other, or with prescription medication.  Consult with your health care provider, or consider working with an Integrative Medicine Specialist, prior to starting nutritional supplements to treat a medical condition.



Carin Nielsen, MD Integrative MedicineLooking for a personalized approach to your healthcare? I 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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Get to know your Neurotransmitters - “brain hormones” essential for optimal mood, energy, and weight

Neurotransmitters
Balancing these “brain hormones” is essential for optimal mood, energy, and weight.


b2ap3_thumbnail_brain.jpgNeurotransmitters are brain chemicals that communicate information throughout our brain and body. Think of neurotransmitters as “brain hormones”. Proper balance of neurotransmitters is essential to regulate hunger, mood, cravings, energy, motivation, and self-image.

Neurotransmitters are synthesized in the body using amino acids, the building blocks of protein. These amino acids come from the digestion of protein in the foods that we eat. The synthesis of neurotransmitters also requires cofactors, various vitamins and minerals needed to make each type of neurotransmitter.


The four key neurotransmitters -
what they do and how their levels affect your mood, appetite and weight.



SEROTONIN 
What do you see when you look in the mirror?

b2ap3_thumbnail_serotonin.jpgSerotonin is perhaps the most important of all neurotransmitters in maintaining mood and well-being. The primary building block of serotonin is tryptophan, an amino acid found in large amounts in poultry. Tryptophan is converted to 5-HTP which is then converted to serotonin. Serotonin levels regulate:
  • self-image and confidence
  • mood stability
  • happiness/positive attitude
  • hunger and cravings
  • healthy sleep cycles
Low serotonin is associated with:
  • depression, anxiety, PMS and obsessive-compulsive disorder (OCD)
  • negative self-talk and self-image, poor self-esteem
  • sadness, tearfulness
  • short-tempered, an inability to “let things go”
Association of serotonin with hunger and weight:
  • serotonin is temporarily boosted after eating carbohydrates/sugar
  • those with low serotonin will often crave starches like pasta and bread
  • those with low serotonin will often have more hunger/cravings in the evening


DOPAMINE
Have you lost your “spark”?

Dopamine is another key neurotransmitter in mood and well-being. Dopamine is made from the amino acid tyrosine, which converts to L-DOPA, and then to Dopamine. Dopamine helps to regulate:b2ap3_thumbnail_dopamine.jpg
  • motivation
  • energy
  • focus
  • feelings of reward
  • Low dopamine levels may be associated with:
  • fatigue
  • low motivation
  • difficulty with focus/attention
The relationship of dopamine and food/drink:
  • those with low dopamine levels often have cravings throughout the day, especially sugar, candy, and chocolate
  • those with low dopamine levels also tend to seek out caffeine throughout the day

GABA
Are you able to relax?

b2ap3_thumbnail_GABA.jpgGABA is an inhibitory neurotransmitter that is needed to keep the brain from becoming overstimulated. It is our primary “relaxation” neurotransmitter. Low GABA levels are often associated with:
  • anxiety
  • an inability to relax
  • feeling chronically “stressed out"
  • Physical signs of low GABA may include:
  • recurrent headaches
  • heartburn
  • muscle tension
  • irritable bowel syndrome
How GABA levels may affect your eating patterns:
  • those low in GABA tend to be emotional eaters
  • those low in GABA are also more likely to binge eat, although not necessarily just starches

ACETYLCHOLINE  b2ap3_thumbnail_acetylcholine.jpg
Are you forgetful?

Acetylcholine is the neurotransmitter involved in the processing speed of the brain. Acetylcholine levels are associated with:
  • learning
  • memory
  • retention of information
  • low levels of acetylcholine are also seen with Alzheimer's disease.
Acetylcholine levels and food cravings:
  • those low in acetylcholine tend to crave fat, fried foods such as hamburgers and pizza
  • those low in acetylcholine may favor creamy desserts like cheesecake and ice cream

Are you relating to any of the above symptoms?  Many of my patients with neurotransmitter imbalance will relate to more than one of these categories.  Tomorrow I will offer a short quiz to test where your neurotransmitter imbalances may be, and discuss a variety of treatment options.  Stay tuned!

Carin Nielsen, MD Integrative MedicineLooking for a personalized approach to your healthcare? I 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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Highlights from the Annual Nutrition & Health Conference

Earlier this week I attended the 12th Annual Nutrition & Health Conference, presented by the Arizona Center for Integrative Medicine under the direction of Andrew Weil, MD (pictured with me below). Each year, this conference brings together a variety of experts to focus on the central role of nutrition in health and healing, and provide a scientific basis for the integration of nutrition and medicine into practice. It is a medical conference like no other! I was inspired not just by the depth of research presented, but also by the quality and character of both the faculty and the fellow attendees. This is an organization that truly “walks the walk”.

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MY CONFERENCE TOP FIVE HIGHLIGHTS:
 
Thin mice become obese when they receive a fecal transplant from obese mice.  
Without any other change (including no change in diet/exercise), simply transplanting stool from an obese mouse into a thin mouse causes weight gain.  Now you know why I am so obsessed about the role of your gut microflora in your health…
 
Environmental exposures are directly linked to childhood obesity, especially Bisphenol A (BPA). 
Once again, it is not just about calories, there is more to the story.  Chemical exposure contributes to obesity.  On a positive note, research has shown that when children have their diet changed to organic food, the measured levels of pesticides in their urine is substantially lowered in less than a week.
 
When it comes to weight loss and reduction of hunger, it's not total daily protein intake, but rather adequate protein intake at key points during the day that matters. 
This was not news to me - but it was great to see the valid research backing up what I speak with my patients about daily!  For those patients in need of weight loss, food pairing with adequate protein at timed intervals during the day can be very effective in reducing hunger and preventing over-eating, especially curbing nighttime snacking.  
 
Mitochondria make up approximately 10% of your body weight.  
Don’t know what mitochondria are?  It’s time you learned.  Mitochondria are the “energy factories” in all of the cells of our body.  Certain cells have more mitochondria than others, such as heart cells, which need more mitochondria because they need more energy.  Healthy mitochondria are the key to healthy aging, and one of the best things you can do to keep your mitochondria healthy is to EXERCISE.
 
If an item displays a "USDA Certified Organic” label, it is non-GMO. 
I actually did not know this.  While there are separate labels for non-GMO, you do not have to look any further if you see this certified organic label.  No GMOs allowed.  That being said, as larger companies are buying up smaller organic companies, they are getting more seats on the government boards that set these definitions.  The number of allowed chemicals under the "USDA Certified Organic” label is changing yearly.  Something to keep an eye on...

If you have any questions about this conference or the topics above, please feel free to email me directly at This email address is being protected from spambots. You need JavaScript enabled to view it..

Be Well,

Carin Nielsen, MD
 


Carin Nielsen, MD Integrative MedicineLooking for a personalized approach to your healthcare? I 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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Meet LEPTIN, the hormone that turns off hunger in your brain.

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.


b2ap3_thumbnail_light-switch.pngLeptin 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.)
 


Carin Nielsen, MD Integrative MedicineI 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.

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Leaky Gut Explained

Leaky Gut = Inflammation, Food Sensitivities, Nutrient Deficiencies and Autoimmune Disease

b2ap3_thumbnail_GutHealing.jpgOur intestinal lining is a very important barrier. When working properly, the lining allows only certain small desirable substances (like nutrients) to pass through, while keeping out larger undesirable particles (like infections, allergens and toxins).

Think of your intestinal lining like a net with very small holes. If the net becomes damaged and the holes of the net become larger, then larger particles are able to pass through the net that ordinarily couldn’t. This damaged intestinal lining is what may lead to increased intestinal permeability, or “leaky gut”.

b2ap3_thumbnail_FineMeshStrainer.jpgIf the intestinal lining is damaged or compromised, undesirable substances such as bacteria, viruses, undigested food particles and toxic waste products can leak from the inside of your intestines through the damaged lining into your bloodstream. Once they get into your bloodstream, these particles are transported throughout your body and can trigger your immune system to react. The end result is inflammation in various parts of your body.


An unhealthy intestinal lining can be a major source of inflammation in your body.

The inflammation in your body caused by a damaged digestive lining can lead to a wide variety of symptoms, including:
  • Bloating and abdominal cramps 
  • Fatigue and “brain fog” 
  • Rashes, Eczema and Acne 
  • Food sensitivities 
  • Weight Gain 
  • Joint pain 
  • Headaches 
  • Depression and Mood Swings 
  • Chronic sinus infections 
  • Allergies 

When your intestinal lining is unhealthy, you are more likely to have food sensitivities.

When you have a leaky gut, certain foods that you eat are likely to make your symptoms worse. This is because large, undigested food particles entering the bloodstream trigger your immune system to react, promoting more inflammation and symptoms such as listed above.


An unhealthy intestinal lining can also lead to nutrient deficiencies.

With leaky gut not only is the intestinal lining more porous (bigger holes in the net) and less selective about what can get in, but normal absorption can also be affected. Intestinal villi are finger-like projections in the wall of the small intestine that are responsible for absorbing nutrients. When these villi become damaged, certain nutrients are not able to be properly absorbed, resulting in nutrient deficiencies. Common deficiencies seen include:
  • Iron 
  • Vitamin B12 
  • Magnesium 
  • Zinc 

An unhealthy intestinal lining over time can lead to autoimmune disorders.

There is a growing consensus that the immune system response triggered by leaky gut may be a primary cause of autoimmune disease. As discussed above, your immune system acts like your own personal army, ready for attack! When larger, undesirable particles get into the bloodstream, the immune system goes on “high alert”, increasing inflammation in preparation of fighting off invaders. The immune system then may begin to produce antibodies to attack and destroy these invaders. Problems result when this antibody response gets out of control, and begins to attack your own tissues. This is self-attack-self, the hallmark of autoimmune disease. This may trigger or worsen conditions such as:
  • Rheumatoid Arthritis 
  • Thyroid disorders 
  • Psoriasis 
  • Celiac disease 
Before you jump to potentially harmful prescription medication - get to the root of the problem! Healing an unhealthy intestinal lining is one of the most important steps in treating a variety of symptoms and conditions, including autoimmune disease.



Carin Nielsen, MD Integrative MedicineI use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many that are linked to an unhealthy digestive lining. Treating symptoms simply by prescribing medication as a “band-aid" 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.


  3526 Hits

Have you been tested for Chronic Inflammation?

b2ap3_thumbnail_fire.jpgIt is well established that chronic inflammation is a key factor in most chronic disease, yet many doctors overlook the one simple blood test that can assess your level of inflammation. Often without symptoms, chronic, low-level inflammation may be threatening your health right now without you even knowing it!



Inflammation - the Good and the Bad

Inflammation in your body has a purpose - to treat injury and illness. Without inflammation, wounds would not heal and simple infections could become deadly. The inflammation in your body that treats injury and illness comes from your immune system. Think of your immune system like your own personal army, ready for attack. If you become ill or injured, your immune system activates pathways of inflammation in your body for healing. You can see and feel this inflammation as swelling, pain, warmth and redness at an injury site or warmth from a developing fever. These symptoms are all signs that your immune system is doing it’s job! When your immune system is working properly, the inflammation is temporary, and the inflammatory pathways in your body are turned off as you heal.

b2ap3_thumbnail_injury.jpgWhile temporary, purposeful inflammation is healthy, too much inflammation in the body is not. When inflammation persists or serves no purpose, it damages the body and causes illness. In the brains of Alzheimer’s patients, inflammation destroys nerve cells. Inside arteries, smoldering inflammation damages the arterial lining and helps kick off atherosclerosis (plaque). Inside joints, inflammation eats away at cartilage causing painful arthritis.


It is well-established that chronic inflammation is the root cause of many chronic diseases, including:

  • Heart disease
  • Stroke
  • Obesity
  • Many cancers
  • Arthritis
  • Alzheimer's disease
  • Diabetes

Causes of chronic inflammation:

  • b2ap3_thumbnail_Donuts.jpgStress 
  • Lack of exercise 
  • Genetic predisposition
  • Elevated blood sugars
  • Excessive calorie consumption
  • Excessive body fat (fat cells release inflammatory signals in the body)
  • Exposure to toxins (cigarettes, pesticides, heavy metals, etc.)
  • Periodontal disease
  • Infection and Imbalance in the Digestive Tract
  • Inflammatory foods 


Testing for Inflammation

Knowing your level of underlying inflammation can be a key step in making changes to reduce the development of many chronic diseases and avoid age-related health decline.

hsCRP = high-sensitivity C-reactive protein

There are several tests that can be used to assess your level of inflammation, but the one test you need to start with is the high-sensitivity C-reactive protein, or hsCRP. C-reactive protein (CRP) is a substance produced by the liver that increases in the presence of inflammation in the body. Elevated levels indicate inflammation due to infection or tissue injury. The high-sensitivity type of this test can detect chronic inflammation even at very low levels.

Do you know your hsCRP value and what it means?

hsCRP value of 2.0 or greater is considered high risk

hsCRP value 1.0-1.9 is considered borderline risk

hsCRP value kess than 1.0 is desired


If you are interested in knowing your hsCRP value, you can order a hsCRP laboratory test directly through my website without an appointment!  Follow this link to avoid insurance hassles with affordable testing and get fast results!



Carin Nielsen, MD Integrative MedicineLooking for a personalized approach to your healthcare? I 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.


  3348 Hits

Three reasons to start your day with a Protein Shake

There are a number of reasons why starting your day with a protein shake or smoothie is a great idea.
Here are my top 3 reasons to get you thinking about what your breakfast has to offer!

1. It gives you energy and keeps you full.

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Sugary cereals and donuts and gluten-filled bagels cause a rapid rise in blood sugar (and insulin) that is followed by a blood sugar crash within hours. This can cause your energy level to plummet and can spark strong hunger and cravings.

Starting your morning with protein and fiber promotes consistent energy by avoiding a blood sugar crash, boosts metabolism to promote weight loss and keep you full, often until lunchtime! 


2. It's healthy and quick to make!

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Toss your ingredients in the blender and you have a healthy, delicious breakfast in minutes.

If you are really pressed for time, use a shaker bottle to mix your shake on the go.

 

3. It's an easy way to pack more greens and super foods into your day.

blender_bottle.jpgb2ap3_thumbnail_smoothiegreen.jpgA shake or smoothie is a great way to add extra servings of the foods your body needs to stay healthy and strong! You can add handfuls of greens such as spinach or kale. Blend in 1/2 cup of dark berries for added flavor and antioxidants. A tablespoon of ground flax seed can increase fiber and improve detoxification. Use up what is left in the fridge and pack the nutrients in!

I don't just encourage my patients to start their day with a breakfast rich in protein, fiber and micronutrients - I do so myself! Most mornings I begin my day with a nutrient-packed Vegan Protein Shake. While I always start with a high-quality protein-powder base, I customize the ingredients to match my needs each day. Here are a few of my favorite tips:

  • I like to make my smoothie with 1/2 water and 1/2 unsweetened coconut or almond milk. This keeps the sugars low but allows for a creamer texture and more full flavor.
  • If I know my day will be jam-packed with patients or meetings, I make a double batch in my blender and save a second shake for mid afternoon. This allows me to maintain consistent energy during they day, and by the time I get home I can make a nice dinner without feeling like I have to raid all of my cupboards!
  • I often freeze my greens, such as organic spinach and throw 1-2 large handfuls in my blender in the morning. This prevents my greens from spoiling and adds a nice texture to my shake (my mom likes to use Watercress).
  • For patients who are often constipated, I recommend 1-2 TBSP ground chia seed for added fiber and promotion of regular bowel movements.


b2ap3_thumbnail_ProteinShakePhoto.jpgClick here for more information on my physician-approved Balanced Vegan Protein Shake mix. It's 100% vegan, 100% non-GMO, packed with fiber and micronutrients, and is a great value!

I'd love to hear your comments or questions. Feel free to message me directly at This email address is being protected from spambots. You need JavaScript enabled to view it..


Yours in Health,

Carin Nielsen, MD

  4153 Hits

Food is Medicine

Meet Diane*

b2ap3_thumbnail_blog_foodismed_hands.jpgWhen we first met this past September, Diane was looking for both weight loss and an Integrative/Functional Medicine approach to her Rheumatoid Arthritis. She had been diagnosed with Rheumatoid Arthritis about 6 years earlier, and she had nodules and joint pain and stiffness in both her hands and her feet. Her pain had been worsening to the point where walking was very painful and she had become more sedentary. Her rheumatologist had recently recommended she move to an expensive intravenous/infusion medication to treat her joint pain pain and avoid further joint destruction. Diane was frightened by the thought of starting these infusions, worried about potential long-term side effects. She told me that she was in the process of scheduling her first infusion but felt was doing so while "kicking and screaming".

I asked Diane to postpone her first injection and give me two weeks to guide her to results both with weight loss and reduction of join pain. Diane agreed and started a Functional Medicine approach to her care, based on the concept of using Food as Medicine.
  • After 2 weeks Diane had lost 8 pounds and was pain free in her feet. Most of the pain was gone from her hands with the exception of some mild pain in her left wrist.
  • At 5 weeks she had lost over 12 pounds and had no pain with increased movement and activity.
How did Diane achieve such amazing results in such a short period of time? She did it by changing the information she was giving her cells, removing the foods that were promoting inflammation and activating her immune system to work against her. Diane did this simply by changing her diet through the use of a comprehensive elimination diet.

Food is Medicine

b2ap3_thumbnail_blog_jan2_salad.jpgOur bodies are made up of trillions of tiny cells. These cells work together to form all of our organs, our blood vessels, our nerves, our muscles and everything else that makes us, well us!

Each cell in your body contains your complete genetic code. Depending on where the cell is in the body, the cell will read a different part of the genetic code to do it's job (muscle cells read the muscle part of the code, skin cells read the part of the code that codes for skin, etc.).

Your cells will also activate different parts of the code depending upon the information that is presented to them.

Food is information

The food that you eat provides information to the cells of your body that tells the cells what to do! Food actually does this job as well if not better than prescription medication can! The type of food information presented to your cells can change the way the cells works by activating different parts of the cell's genetic code. For example, sugar activates the genes in our cells that promote the production of inflammation.

b2ap3_thumbnail_blog_jan6_cell.jpgIs this starting to make sense? The food that you eat can either activate or "quiet down" your immune system. And, like the example above, the food that you eat can activate pathways that increase inflammation, or activate other pathways from your genetic code that reduce inflammation.

You might ask, why is it that certain foods negatively affect some people more than others? This is because we are all working off a different genetic code, or what I like to call our genetic "blueprint". This is also the reason why certain medications affect some people differently than others. Because we are all working off of a different "blueprint" (which makes us biochemically unique), we don't all respond to food in the same way. This concept is the basis for Nutrigenomics. a growing area of research that is focused on the effects of food on gene expression. We use the concepts of Nutrigenomics in my office every day when prescribing elimination diets for patients to treat various medical conditions.

The Elimination Diet
learning how foods affect your gene expression

In my office, we do not believe that there is one optimal diet that works best for everyone, because we know that based on our different genetic blueprints, we will all have different nutritional needs. We work with our patients to help them determine their own optimal diet for optimal health and vitality. An elimination diet can be an effective tool in doing so.

An elimination diet can allow you to determine how food is affecting your gene expression. More simply put, it allows you to figure out how different foods make you feel. By removing certain foods from your diet for a period of time, then re-introducing them, you can experience which foods are "working for you" and which are "working against you". Based on your symptoms or medical condition, the list of foods that will be recommended for you to remove may vary. Foods are generally removed for a period of at least 3 weeks, and then they are reintroduced one at a time, allowing 3-4 days before reintroducing another food in order to assess for delayed reactions in the body.

In Diane's case, her list of foods to remove from her diet included:
  • gluten
  • dairy
  • sugar
  • soy
  • corn
  • eggs
  • peanuts
  • nightshade vegetables
  • citrus fruits
You might look at this list and ask "well what could she eat then"? That's easy! We asked her to focus on:
  • lots of vegetables and fruits
  • clean, lean proteins
  • nuts and seeds
  • healthy fats
  • gluten-free, high-fiber starches and grains (like rice, quinoa, sweet potatoes and beans/lentils)

b2ap3_thumbnail_blog_foodismed_feet.jpgBecause Diane was also interested in weight loss, she limited her starches and grains to not more than 2 servings per day. She also utilized a vegan protein meal replacement in the morning for breakfast (meal replacement can be very helpful with the elimination diet because it takes some of the "work" out of meal preparation and provides essential amino acids).

We use elimination diets frequently in the treatment of autoimmune disease as well as a number of other conditions including irritable bowel syndrome, fatigue, brain fog, chronic headaches and weight gain.

At this point, Diane is 12 weeks into her journey. She is 15 pounds lighter. She no longer needs to consider the infusion therapy and she is still pain-free. We will be spending the next 12 weeks continuing her weight loss efforts, attempting some food reintroduction, and assessing for other underlying imbalances that may be contributing to her autoimmune disease such as the health of her digestive tract and the possibility of heavy metal toxicity. Stay tuned!

Yours in Health,
Carin Nielsen, MD

*while this represents a true story, the patient name has been changed to protect his/her identity and privacy

Carin Nielsen, MD Integrative MedicineI use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including autoimmune disorders like Rheumatoid Arthritis. Treating autoimmune 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.


  3611 Hits

UltraLite™ Dietary Ketosis Weight Loss Program

Turn on your body's fat-burning switch!

Meet Karen*, age 65

This past fall, Karen was looking to lose 10 pounds.
She lost even more than that in just 4 weeks with Ultra Lite™!

Integrative Medicine Weight Loss UltraLiteAt age 65, Karen was healthy and energetic. She took very little medication and had few concerns about her health. There was one thing that was nagging at her - her waistline. Since menopause, Karen had slowly put on about 10 pounds, and it wouldn't come off! Her Body Mass Index (BMI) was still considered in the "normal" range, but her clothes weren't fitting well and she just didn't' feel comfortable in her own body. With the Holidays approaching she was looking for a program that would produce results - fast!

Karen started the Ultra Lite™ to jump-start her weight loss. After one week she had lost 7.6 pounds, and after four weeks she was down 12.6 pounds. She lost 4.5 inches off her waist and 3.4 inches off her hips. Best of all, she felt full of energy!



What is Ultra Lite™?

Ultra Lite™ is a dietary ketosis weight loss program. It is designed to reduce hunger and cravings, increase mood and energy and maintain muscle mass while burning fat.  Ultra Lite™ is a great program for those who are motivated and ready for fast weight loss results or are looking to "jump-start" their weight loss/


How does Ultra Lite™ work?

The Ultra Lite™ program combines a balance of lean protein and limited high-quality carbohydrate to put your body into a mild state of dietary ketosis. This biochemically sets the body to burn your own fat as fuel for maximal fat loss. 


What is dietary ketosis?

The cells of your body typically use glucose, or blood sugar, as their primary source of fuel (I discussed this recently in my post about insulin resistance). When the amount of carbohydrates in your diet are restricted below a certain level, the cells of your body change their fuel!  They go from burning sugar for fuel to burning fat.  When you begin to burn fat as your primary fuel, your body produces ketone bodies which are circulated in your bloodstream.  The circulating ketone bodies have the benefit of reducing hunger and increasing energy and mental clarity.  You can measure the levels of ketone bodies in your urine to stay in maximal fat mode.  (Nationally known Functional Medicine neurologist Dr. David Pearlmutter makes an argument for lifelong dietary ketosis in his best-selling book "Grain Brain")


Is Ultra Lite™ a high-protein diet?

No! As a matter of fact, people will typically eat less protein than they normally do, but enough to not lose muscle mass (a key issue with weight loss is to protect your muscle mass; as muscle mass is your body's calorie burning engine).

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How is Karen doing?

Well, 2 weeks after transitioning out of dietary ketosis and into a normal, balanced diet, Karen was doing fantastic!  She had lost nearly 3 more pounds and her energy was still soaring high.

Are you interested in the Ultra Lite™ weight loss program? This is just one tool of many that I use with clients to customize weight loss and lifestyle change programs for their needs. Learn more about my approach to weight loss by visiting our website www.MyOptimalDiet.com.  

Yours in Health,

Carin Nielsen, MD

www.CarinNielsenMD.com

*while this represents a true story, the patient name has been changed to protect his/her identity and privacy.



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.
  6132 Hits

Your gut has everything to do with your health - Part Two

What causes problems with your gut... and what to do about it.

We have a recurring theme this month. It's about our cells and the information we present to them.

Integrative Medicine Leaky GutRemember, our bodies are made up of trillions of cells, and each cell contains a complete copy of our genetic blueprint, which makes us unique. Different parts of our blueprint will be activated in different cell types (muscle cells vs. skin cells).  The parts of the blueprint activated will also change depending upon the information presented to the cell. Food is information.  Many people do not realize that the information our food gives the cells in our body is as powerful, if not more so, than the information provided by prescription medicine.  Let's take this one step further - do you know how one medication may cause side effects in one person but not another?  That is because of our different genetic blueprints.  The same thing happens with the food that we eat.  Depending on our blueprint, the food that we eat will affect us differently.

Recently, I wrote about the gastrointestinal (GI) tract, or gut, and the huge role it plays in our immune system, nervous system, mood and more. I explained how a properly-functioning digestive system works, and also what can go wrong and cause gut imbalance and "leaky gut" - leaking food particles and proteins into your bloodstream that the cells of your immune system don't recognize, activating inflammatory pathways which can lead to many medical problems, including autoimmune disease, eczema, fatigue and more. Today we'll explore the causes behind "leaky gut" and how to repair and rebalance your GI tract.

Causes of "Leaky Gut"

There are many factors that can contribute to your GI tract becoming out of balance, including:
  • Chronic stress and use of over-the-counter pain medications, antacids or PPIs (proton pump inhibitors like Prilosec or Nexium) reduce your stomach acid. Other medications can reduce saliva production.
  • If your gallbladder has been removed you lack the "control switch" on your bile salts. 
  • High intake of sugar, alcohol or genetically modified (GMO) food can break down the protective mucus barrier that lines your intestines.
  • Loss of "good bacteria" from low fiber intake and use of antibiotics may impair digestion and breakdown of food particles and increase growth of "bad bacteria", which along with toxins and irritants can attack and break down both the mucus barrier and the intestinal wall.

Healing your leaky gut.

Identifying and healing your core gut imbalances is one of the most important first steps you can take to promote health and well-being. Originally pioneered by naturopathic physicians, the "4Rs" program of gut repair is used routinely by Functional Medicine physicians to restore health and balance to the GI tract.

The "4Rs" Program

REMOVE - Get rid of what might be irritating your system! Start an elimination diet to remove commonly offending foods. Consider testing for food sensitivities with IgG antibody testing. Identify any abnormal bacteria, yeast or parasites with functional stool testing (I use the "GI Effects" test from Genova Diagnostics) and take appropriate measures to remove them!

REPLACE - Replace any missing factors needed for proper digestion. Working with a functional medicine practitioner can be useful to identify which enzymes or acids are missing. Betaine HCL can be used to replace low stomach acid, digestive enzymes can replace low pancreatic enzymes, and bile salts can be added if needed. The idea is not to remove acid, but rather to support your digestion with the acids and enzymes it needs, giving your gut less work to do!

REINOCULATE - Add back "good bacteria" with a high-quality probiotic blend and promote growth of good bacteria by increasing your intake of fiber and fermented foods.

REPAIR - Promote healing of the GI tract lining by supplying needed nutrients, such as zinc, antioxidants, fish oil, and glutamine.

In my experience, patients generally see positive results in as little as 10 days of this process, with less pain, bloating and stiffness, clear skin, improved energy and mental clarity.


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.
  5099 Hits

Your gut has everything to do with your health - Part One

The Functional Medicine TreeMy traditional family practice has evolved into an Integrative/Functional Medicine practice, and my approach to health and healing has changed in many ways. Digestive health and wellness is one of the biggest changes.

Every day, I sit across the table from my clients and talk about the gut. The "gut" we speak of is referring to the gastrointestinal (GI) tract, which is a long tube that starts at your mouth and ends "where the poop comes out" (I have twin 10-year-old sons, so in my house we have many terms for this area).

As a Functional Medicine physician, I often look to the gut first when encountering any chronic medical condition. Why? Because your gut has everything to do with your health. I'm not just talking about symptoms like abdominal pain, bloating or abnormal bowel movements - there are many more symptoms and conditions that occur outside of your gut, yet may be closely linked to GI tract imbalance, 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

Read more about Functional Medicine


Why is the gut so important?

Integrative Medicine GI TractYour GI tract contains the first line of defense in your body. 70% of your immune system lies in your gut! Every day, when you eat, drink and breathe, you bring various toxins and infectious "bugs" into your body through your mouth and nose. Your gut provides one of the most important and difficult balancing acts of your immune system, seeking out and destroying these foreign invaders (toxins, viruses, bacteria) while ensuring that proper nutrition and micronutrients can be absorbed and assimilated from the foods that you eat.


Your gut is a key factor in regulating your emotional health and nervous system. There is an enormous amount of communication that occurs between your GI tract and your nervous system (which consists of your nerves and brain). The connection between your gut and your nervous system is so strong that scientists have referred to your gut as your "second brain"! Your gut balance can directly affect your mood - 95% of your serotonin (a key neurotransmitter involved in depression and mood) is in your GI tract, and serotonin regulation is a key factor in depression, anxiety, and other mood disorders.

"Leaky Gut"
How GI tract imbalance can affect your entire body

If you used the term "leaky gut" with me 10 years ago, I may have looked at you like you were crazy! As a matter of fact, if you use this term with many of my traditional Western medicine colleagues, they will probably do the same. That is because this is a concept that is not familiar to traditional Western medicine. This is part of Functional Medicine, which involves "getting under the surface" to determine the underlying cause of your symptoms, rather than just treating your symptoms with a medication.

Let me describe "leaky gut" to you the way I described it to my patients in the office. 

A healthy, properly functioning GI tract looks something like this: 
  • Saliva and chewing break the food in your mouth
  • Stomach acid breaks down food particles further, while muscles and nerves work together to keep everything "moving forward" in your intestines.
  • Digestive enzymes and bile salts (from your pancreas and liver) break down your proteins, fats, and starches.
  • Food particles then enter the small intestine. The small intestine has a very important job! 

This is where all of the nutrients and proteins in the food that you eat are absorbed into your bloodstream, while at the same time preventing toxins and infections from being absorbed. In order for everything to work as it should in the small intestine, several things need to be in working order:
  • First, the small intestine has a thick mucus lining that provides protection against toxins, infections, and other irritants.
  • Second, the small intestine contains adequate amounts of "good bacteria". These bacteria work to digest your food and also maintain a balance that prevents overgrowth of "bad bacteria" or other infections.
  • Third, the wall of the small intestine is tight and strong. This wall is what separates the food particles from your bloodstream. If the wall of your small intestine remains healthy and intact, only well-digested small food particles and proteins are let through into your bloodstream. 
So, when everything is functioning properly, your food is digested well, infections and irritants are kept from getting out of control, and small nutrient particles and proteins are entered into your bloodstream where they can find and enter your cells to provide them the nutrition and energy they need.

What happens when the gut becomes leaky?

Integrative Medicine Leaky GutIf your food is not broken down properly, the size and structure of the nutrient particles and proteins presented in your small intestine may be larger and shaped differently. If the integrity of your small intestinal wall is compromised, these larger, different nutrient particles and proteins may be let into your bloodstream.

As we have discussed before, food is information! The food you eat provides information that interacts with the genetic code that resides in each and every cell in your body. By changing the structure and size of these food particles and proteins, you are changing the information presented to your cells, which may activate pathways that promote inflammation.

The cells of your body's immune system are particularly sensitive to this. High inflammatory foods, such as sugar, along with increased "bad bacteria" or toxins in the gut may send a signal to your immune system to be "on alert" for problems. This is followed by the altered food particles and proteins entering the blood stream, causing your immune system to feel under attack! The cells of the immune system activate pathways that increase inflammation. Depending upon your genetic code (or "blueprint", as I like to call it), certain cells may be affected more than others. That is why leaky gut may present with a rash in one person, fatigue and headaches in another, and autoimmune disorders like rheumatoid arthritis in yet another person. Your genetic blueprint determines your susceptibilities.

Common signs of "leaky gut" include:

  • rashes/eczema
  • headaches
  • fatigue and "brain fog"
  • muscle and joint pain
  • weight gain and water retention
The good news - identifying and healing your core gut imbalances is one of the most important first steps you can take to promote health and well-being. We've covered the basics of digestive health and where problems can arise, stay tuned to learn more about the causes of "leaky gut" and what to do about it!

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.
 
 
 
  3602 Hits

12 Weeks = Amazing Results

Recently I wrote about Insulin Resistance, a common disorder I see in my practice. This post highlights my recent experience with Beverly*, who lost nearly 30 pounds and dramatically increased her energy in just 12 weeks - simply by identifying where her imbalances were and making a few simple changes that improved her insulin sensitivity.


Meet Beverly*, Age 60

When Bev first sat across the table from me this past August, she said "I feel off balance". She couldn't pin-point it, but something just didn't feel right. She felt more and more fatigue, especially mid-afternoon when she had her energy "slumps". She was gaining weight steadily and was feeling "old".

During our discussion I learned more about Bev. She had her thyroid removed a few years ago due to a large goiter. While her temperature fluctuations and heart palpitations had improved, her energy levels had not. She had also described high levels of stress during the past few years. She had made progress with her stress management but in general felt "worn down".

Bev's medication list included thyroid replacement, and two medications for high blood pressure. On examining her I noted that her weight gain was primarily around her abdomen. I also noted an elevated heart rate and increased reflexes.

We then obtained some data with a blood draw, and Bev's laboratory results confirmed my suspicions. Now remember - I am a Functional Medicine physician - so I often order labs that other doctors may not order. I also interpret the lab results differently, looking for patterns and clues that relate to the individual and their symptoms, and desiring "optimal" results, not "normal" results. Bev's blood sugars were normal, but she had significantly elevated morning insulin (normal less than 10, hers was greater than 50. While her thyroid tests were "within normal range", they showed her thyroid was functioning on the high-end of normal, which explained her elevated heart rate and hyper-reflexes.

Now it was time to get to work. Bev had insulin resistance! This had likely been creeping up over many years, and was made worse the past 3 years by elevated cortisol as a result of the stress she had been experiencing. To make matters worse, one of the two blood pressure medications she was on was known to worsen insulin resistance. My Functional/Integrative approach to Bev's care was simple and straightforward, focusing on:
  1. Correcting her underlying hormone imbalance
  2. Removing the foods that were working against her by limiting the refined carbohydrates and sugar from her diet
  3. Using targeted supplementation to treat her insulin resistance


Hormone balance

While getting to work on treating her insulin resistance, we also had to balance Bev's thyroid. I lowered her dose of thyroid medication and within a week she felt a difference. Her heart rate came down and she began to feel more "at ease". This is an important point because so many women want to add more thyroid medication - but more isn't always better! An overactive thyroid can also contribute to fatigue. It's all about balance!


Removing offending foods

I presented Bev with a meal plan that included real, clean food. Her plan involved 2 prepared meals, two meal replacement shakes, and healthy snack options. Her two prepared meals each included lean, clean protein, lots of vegetables and healthy fat. We limited her starches and grains and had her choose from gluten-free, high-fiber varieties. The timing of her meals was also important! She was not to go more than 3-4 hours without eating (to balance her blood sugars). We used meal replacement to provide adequate protein and help her with meal structure (meal replacement can often help take some of the "work" out of diet change.

Targeted supplementation

Bev's supplementation recommendations were designed to help correct her insulin resistance, and included chromium, ALA, Fish Oil and PGX.

Chromium - helps insulin to do it's job! Chromium helps insulin transport blood sugar into cells more efficiently, providing cells with much-needed energy.

Alpha-lipoic Acid (ALA) - enhances the insulin receptor on the cell's surface, allowing insulin to enter the cells more easily (there is actually a direct binding site for ALA on the insulin receptor). ALA also acts as an antioxidant, reducing cell damage.

Fish Oil - contains two key substances - EPA and DHA - which help form and strengthen cell membranes, keeps them from getting stiff. This improves cellular communication and helps insulin receptors work properly.

PGX - a novel fiber blend, PGX is taken with a glass of water about 15-20 minutes prior to meals. The flavorless granules can also be sprinkled over food or taken as capsules. The PGX fiber expands into a gelatinous "blob" in your stomach. This helps you to:
  • feel full after eating less food
  • release any glucose from your meal into your blood stream more slowly
  • reduce insulin and blood sugar spikes
  • reduce hunger and sugar cravings.



Within 2 weeks Bev had lost over 7 pounds and reported less brain fog and more consistent energy.
At the end of 12 weeks she had lost 29.6 pounds, 5.5 inches off her waist, and 3 inches off her hips!

She felt great and was no longer getting a dip in her energy levels in the middle of the day. Repeat blood testing showed that her fasting insulin level was cut by more than half. She was completely off one blood pressure medication (the one that was making her insulin resistance worse) and was down to a fraction of a dose of her other blood pressure medication. She had lost so much weight that we had to lower her thyroid dose even further!

The best part? She kept saying over and over "I really just can't wrap my head around it, this has been so easy". The changes Bev made were simple and straightforward. She continued to live her life and did not have to remove herself from society in order to make the necessary changes (she even traveled, ate at restaurants and hosted parties). In just 12 weeks, Bev not only changed her life, she created a plan for lasting change.

Yours in Health,

Carin Nielsen, MD
www.CarinNielsenMD.com

*while this represents a true story, the patient name has been changed to protect his/her identity and privacy

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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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.
  5120 Hits

New Year - New You!

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

Integrative Medicine Petoskey Balance Hormones

#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".

Integrative Medicine Weight Loss Petoskey

#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

b2ap3_thumbnail_blog_jan2_vitamins.jpg

#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



b2ap3_thumbnail_blog_carin3.jpg
I 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.
  3756 Hits

Functional Medicine may be just what you are looking for

I am a Functional Medicine physician. I use Functional Medicine every day to optimize the health and well-being of my clients, yet many of my clients aren't familiar with the term "Functional Medicine". It's time to change that!

Functional Medicine practitioners promote wellness by focusing on the fundamental underlying factors that influence every patient’s experience of health and disease. 

Modern Western medicine does a really good job with medical emergencies. If you've sustained an injury, suffered a heart attack or stroke, or have a serious infection, modern medicine has the tools, technology and ongoing research to take care of your immediate need.

In my opinion, modern Western medicine falls short with it's current approach to chronic disease. With the emphasis on technology and promotion of pharmaceutical therapies, modern Western medicine has lost "the basics". The system is so focused on pills to treat your symptoms that it no longer asks the most basic question:


Funtional Medicine Carin Nielsen MD
"What are the root causes of your symptoms?"

Functional Medicine asks this question and more.
  • What is going on under the surface?
  • What happened "upstream" to cause this "downstream" effect?
  • Where is the underlying imbalance?

Functional Medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among each patient's genetic, environmental, and lifestyle factors that can influence their long-term health and development of chronic disease.  Functional Medicine recognizes that the factors underlying disease are unique from person to person, and that optimal health and well-being can only be achieved by examining the person as a whole, rather than just treating a symptom.


Functional Medicine is Integrative Medicine

Functional Medicine integrates traditional Western medical practices with what are sometimes considered “alternative” or “complementary” therapies. The focus is not on diagnoses/labels but on prevention, wellness and balance. Some of the tools I use every day in my office include:
  • personalized nutrition, diet, and exercise recommendations
  • state-of-the art laboratory testing and other diagnostic techniques
  • prescription medication and/or botanical medicines
  • evidence-based supplements and therapeutic diets
  • detoxification programs
  • stress-management techniques 

Do you feel your healthcare needs are not being met?  Do you have unanswered questions?  Are you looking for healthcare that involves more than a prescription pad?  Are you looking for tools to help you achieve optimal health and well-being?


Functional Medicine may be just what you are looking for.

For more information please visit my website www.CarinNielsenMD.com or send me an email at This email address is being protected from spambots. You need JavaScript enabled to view it.. You can also learn more by visiting the Institute for Functional Medicine's website https://www.functionalmedicine.org.

Carin Nielsen, MD



b2ap3_thumbnail_blog_carin3.jpg
I 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.
  4773 Hits

Importance of LIfestyle Change is Buried under Statin Drugs in New Cholesterol-Lowering Guidelines

It has been a busy week in the medical press with opinions abound on the new guidelines published Tuesday by two of the nation’s leading heart organizations. The American Heart Association and  The American College of Cardiology.  The first new such guidelines in a decade, they serve to outline specific clinical strategies for the lowering of blood cholesterol to lower the risk of heart attack and stroke.

It is widely accepted that the new guidelines represent a dramatic shift from the current accepted "norm" of cholesterol treatment, and that adherence to these guidelines will double the number of adult Americans who are prescribed a statin medication (such as Lipitor, Crestor or Zocor) to lower cholesterol.  This is expected to increase the number of U.S. adults on statin drugs to approximately 1/3.  In addition, those taking statin drugs to lower cholesterol will no longer be monitored to reach specific target levels of LDL cholesterol, but rather simply taking a recommended dose of the medication is considered sufficient.

The new guidelines divide people needing statin treatment into two broad risk categories:
 
HIGH RISK - those with diabetes or very high levels of LDL cholesterol or those who have had a previous heart attack.  These patients are recommended to be prescribed high-dose statins regardless of other risk factors or cholesterol levels.  
 
LOW RISK -  Those not considered high risk (everyone else) should be considered for a statin if they have a calculated 10 year risk of a heart attack or stroke of at least 7.5 percent.  Doctors are advised to use a new risk calculator that factors age, sex, race, blood pressure, diabetes and total cholesterol to calculate risk.
 
So what's my take?  While the new guidelines do address lifestyle changes in the prevention and treatment of heart attach and stroke, the message is lacking, and difficult to find, buried underneath the message to focus on increased statin drug therapy.
 
Dr. Stephen Devries, an Integrative Cardiologist with the Gaples Institute for Integrative Cardiology at Northwestern University offered insightful "pros and cons" of the new guidelines in a blog post earlier this week.  To summarize:
 
Pros
 -The guidelines do a good job of clearly defining the 4 highest risk groups most likely to benefit from statins and should be helpful in addressing the current under treatment of high-risk populations - those with known vascular disease, middle age diabetics, people with exceptionally high LDL, and those with multiple risk factors. 
 
Cons
-The guidelines give a comprehensive overview of the benefits of long-term use of statins in high-risk people, but not the risks!  As I see quite commonly in my office, significant side-effects are common, especially muscle pain - experienced by up to 10% of those on statins-and more common with high doses.  In 2012, the Food and Drug Administration updated labeling on statins to include warnings about the potential for muscle weakness, confusion and memory loss, and elevated risk of developing Type 2 diabetes.
-Another concern is that recommending long term high dose statins for vascular disease regardless of cholesterol levels may reduce the incentive for patients to make lifestyle changes.  The new guidelines call for using the same high dose of statin regardless of changes in diet, exercise, or weight. Dr. Devries makes an excellent point that an accompanying guideline on Lifestyle Management to Reduce Cardiovascular Risk”  emphasizes improving cholesterol and blood pressure, rather than focusing on diet changes to impact overall risk to heart health. There’s an important difference. For example, a  Mediterranean diet in the Lyon study succeeded in reducing the risk of a serious heart problem by 72%, yet didn’t change cholesterol at all.
 
The bottom line.
According to the World Health Organization, 80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors.  These new guidelines offer new tools to calculate risk of both heart attack and stroke, and offer specific, evidence-based drug treatment protocols for those at the highest risk.  Companion guidelines on modifying lifestyle and treatment of overweight and obesity in adults are a step in the right direction, but their message is lost behind the strong emphasis on statin drug therapy.

While I am not opposed to statin therapy in high-risk populations, I will not allow the message of lifestyle modification to be lost with my clients.  My approach involves digging deeper with specialized testing to evaluate risk, "thinking outside the box" to treat all risk factors, and treating each client with a personalized approach.  If you want to learn more about your risk, or how these guidelines affect you or someone you love, consider an Integrative Medicine consultation.  www.CarinNielsenMD.com.
 
  3720 Hits

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