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Adrenal Function - at the core of Hormone Balance

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

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

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

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

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

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

Last week I had a follow-up visit with a male patient in his early 40s who had come to see me for muscle aches and decreased muscle stamina with exercise. He was having soreness on a daily basis, particularly in his upper thighs.  Laboratory workup had revealed significant Vitamin D deficiency. He reported at his follow up visit that after only 3-5 days of high-dose Vitamin D supplementation, his muscle symptoms were noticeably improved.

He was surprised to hear that I see this quite frequently, both Vitamin D deficiency and other patients with similar symptoms of muscle aches that improve when Vitamin D intake is increased. My medical practice is in Northern Michigan, and Vitamin D deficiency is quite common. I have been checking Vitamin D levels routinely on my patients for many years, and I rarely find an "optimal" level, let alone a level that isn’t deficient!

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Why is your Vitamin D level important?

Did you know that Vitamin D is actually a fat-soluble hormone?  Your body produces Vitamin D in your skin when exposed to sunshine or ultraviolet light. Knowing that, it’s not surprising that north of the 45th parallel Vitamin D deficiency is quite common!

Vitamin D is necessary to absorb calcium, it helps to regulate the levels of calcium and phosphorus in the body, and together with these minerals works to maintain bone strength and integrity. The benefits of Vitamin D intake on bone health and reduction of osteoporosis is well documented by randomized controlled trials and evidence has also linked Vitamin D intake to reduced falls in the elderly.

A growing body of research suggests that Vitamin D intake may be linked to reduced risk of cancer (specifically breast, prostate and colon cancer), depression, autoimmune disease, and heart disease, although further studies are needed to verify these results.  Vitamin D deficiency has been linked to chronic muscle aches and pains, and (as described above) I have observed numerous patients with chronic diffuse muscle pain (especially in the thighs and forearms) get relief when restoring their Vitamin D levels to normal.

Do you know your Vitamin D level?

When testing your Vitamin D level, it is important to order the correct test. There are two tests for Vitamin D – 1,25(OH) Vitamin D or 25(OH) Vitamin D. 25(OH) Vitamin D is the best test as it is the best marker of overall Vitamin D status. 

A level below 30 ng/dl is considered deficient. In my practice we first look to raise levels above 30 into the “normal range”, and then look to get levels in the “optimal range” (those of you who are clients of mine know that this is a frequent topic of conversation, what is normal for one person may not be normal for another, and therefore when interpreting test results we strive for the optimal level for best health). Opinions vary as to “optimal” Vitamin D levels.  I strive to get levels to at least 48 ng/dl, as a comprehensive review of evidence from various studies found this level to be optimal for cancer prevention.

How do you raise your Vitamin D levels?

There are two types of Vitamin D: Vitamin D3 (cholecalciferol – which is the type of Vitamin D synthesized in your skin when exposed to sunlight), and Vitamin D2 (ergocalciferol – found in Vitamin D fortified foods and synthesized by plants).

Vitamin D3 is better utilized by the body than D2, and is the preferred source for supplementing. Vitamin D3 is found in eggs, organ meats, animal fat, cod liver oil, and fish.  It is also available in both liquid and capsule supplements.  If you are considering supplementing with Vitamin D speak with your physician about what dose is most appropriate for you.

Can I get too much Vitamin D?

Yes!  While Vitamin D toxicity is rare, it can happen if you over-supplement. Unlike many water-soluble vitamins, Vitamin D is fat-soluble and excess intake will store in your fatty tissues. Excess Vitamin D intake has also been linked to kidney stone formation.

For more information, or if you are interested in having your Vitamin D levels tested, contact our office at 231-638-5585 or This email address is being protected from spambots. You need JavaScript enabled to view it..

 

 

 

 

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TESTIMONIAL

Weight is never something women want to talk about but it is a common thread that ties us all together – namely our never ending struggle to lose weight and achieve a healthy lifestyle. Struggles with my weight have been consistent throughout my life. To make matters worse, I suffer from hypothyroidism and am now in my 40s – a lethal combination that accounts for an achingly slow metabolism. At the turn of my most recent birthday I knew that my life was spiraling out of balance and that something had to change. That’s when I sought the help of Dr. Nielsen. In addition to creating a customized weight loss plan that worked for me (I am a vegetarian), Dr. Nielsen addressed other issues that had plagued my ability to lose weight. She adjusted my thyroid, got me on a regular schedule of proteins that work for me and most significantly, took a comprehensive blood panel to make sure we weren’t missing anything. In four months, I lost more than 20 pounds. Even better, I no longer suffer from nightmares – nightly nightmares that have troubled me for years. I am sleeping better, my energy level is consistent throughout the day, I am losing weight and I am feeling better about myself. My journey is not done yet (I still want to lose 20 more pounds) but I know that I can do it thanks to Dr. Nielsen and the program she created specifically for me. I also know that I can trust her for guidance when I get frustrated and to celebrate my successes even if they are just one pound lost per week. I could not have gotten as far as I have without Dr. Nielsen’s support and expertise – something I will forever be grateful for. Thank you Dr. Nielsen for helping me find a weight loss program that works for me and for helping me find the balance I was so desperately seeking!
Marci, age 41
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The Healing Power of Acupuncture Never Ceases to Amaze Me


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Last week, I ran into a patient of mine as she was leaving the office after her third acupuncture treatment with Price DiGiulio, MS, LAc. I had recommended acupuncture a few weeks prior as an adjunctive treatment for her depression. She had been struggling with low motivation and energy, decreased appetite and weight loss as part of a mixed depression/grief reaction over the past year. Despite taking two anti-depressants she was not getting adequate relief of her symptoms.

Before speaking a word it was obvious that the acupuncture was working well for her. There was a brightness in her eyes and facial expression that was not there before.  She appeared more awake, alert and calm. When I asked her how her treatments were going she said “Very well, I’m feeling much better, but what really struck me is that after my last treatment I went home and was starving! I was so hungry I couldn’t get enough to eat. I can’t remember the last time I experienced hunger like that.”

My face turned into one big smile - this is the part where my job gets really cool. What this patient didn’t know is that Price and I had discussed her case prior to her last appointment (she had signed a release for us to do so). We compared our assessments and discussed her care plan – this is Integrative Medicine at it’s best.  I mentioned to Price that her weight loss and lack of appetite were becoming more concerning and were the symptoms that seemed the most difficult to treat with prescription medication. He said he would try specific points to stimulate her appetite. Obviously it worked.

How does acupuncture work?

This is how I explain Acupuncture to my patients:

Acupuncture is a form of Traditional Chinese Medicine. It is based on the concept of Qi (pronounced chee).  Qi is thought of as life energy flowing through the body along channels known as meridians. According to Traditional Chinese medical theory, illness arises when the flow of Qi in the meridians becomes unbalanced or blocked. Through acupuncture, specific points on the body are stimulated to “unblock” or balance the flow of Qi through the meridians.

Looking for a more scientific explanation? When needles are inserted (they are not inserted very deep), they stimulate nerve receptors that transmit impulses to the brain. Depending upon where the needles are inserted, different receptors and areas of the brain can be influenced. Choosing specific points can stimulate the release and balance of various chemicals, neurotransmitters and hormones from the brain that regulate various processes in the body, including digestion, mood, perception of pain, energy, well-being, sleep, inflammation and more.

It is thought that acupuncture works for the treatment of chronic pain by stimulating the area of the brain that releases endorphins, natural pain-killing hormones (I have read that endorphins are 200 times more potent than morphine). For treatment of depression, acupuncture is thought to stimulate the release of neurotransmitters that regulate serotonin (a major mood-affecting chemical). 

Acupuncture is prescribed in our office for a variety of symptoms and conditions. As a bonus - when your physician and acupuncturist are working together you are able to get the "best of both worlds".  To learn more about acupuncture or inquire about an appointment contact us at 231-638-5585 or visit our website http://www.carinnielsenmd.com/integrative-therapies/acupuncture.

 

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Mindfulness – Feel less stressed by reducing your “brain chatter”.

Today we finalized and published our fall Mindfulness class schedule and I am really excited about it.

What is Mindfulness?

Here is a textbook definition:  Mindfulness is the practice of paying attention to our thoughts and feelings purposely, in order to become more present within our own lives.

Need more clarification? Here is how I explain the concept of Mindfulness to my patients:  Mindfulness is a tool to create some distance between yourself and your “brain chatter”.

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There will always be stress. Often in life it seems we finish dealing with one stressor, and there is another waiting around the corner. We can't change that. What we can change is our reaction to stress. We don't have control over the presence of stress in our lives, what we do have control over is our response.

When you start to think of stress in these terms, the concept of stress itself becomes external. You can put a little distance between yourself and the stress. By doing so, the effects of stress are less likely to "take over" your mind and body.

If you feel chronically “stressed”, it is likely that you have a good amount of what I like to call “brain chatter”. As a Type-A busy working mom, I am very familiar with this concept.  “Brain chatter” is all of that stuff that is spinning around in your brain.  It is the to-do lists, the thoughts about what happened at dinner last night, about where the kids need to be picked up later, about your worries about your job, about that kitchen faucet that still needs to be fixed, and everything else.  It is all of those thoughts that are spinning around in your brain while you go about your day.

With a brain so full of chatter – it’s difficult to concentrate on anything else.  You go about your day almost on “auto pilot”. You could get yourself ready in the morning, eat breakfast, and drive to work and yet be totally unaware of your actions because you are so distracted by your “brain chatter”.  If that chatter is full of worries and negativity, it can cause you to be irritable and snap at others for no apparent reason. You react quickly, perhaps in a negative way, because you are not focused and present within moment, your brain is focusing instead on negative chatter. The chatter escalates and spreads throughout your body, causing you the physical symptoms of stress (muscle tension, headaches, and heart palpitations to name a few).

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It is called Mindfulness practice for a reason. You can read about the concept all day long, but it is putting it into action that gives you results. It isn't easy! It takes time to retrain your brain to become more aware and less reactive. With patients I often use the analogy of running a marathon. You wouldn't just wake up one day and run a marathon. You would spend months, oftentimes up to a year, to train. It is similar when training your brain. When learning Mindfulness meditation, you start with a few minutes here and there, and gradually work your way up to longer meditations.

S.T.O.P. 

"STOP" is a quick and easy way to start incorporating Mindfulness into your daily routine as a means of reducing the effects of stress. It takes about 30 seconds. I often do this routine in between seeing patients.

S = Stop what you are doing

T = Take a deep breath.  A " belly breath", Relax your abdominal muscles and breathe deep as though you are filling your belly with air.

O = Observe. How is your body feeling? Where are your thoughts right now? If your mind is spinning with "brain chatter", acknowledge this chatter and then set it aside. Put a little bit of space in between you and your "brain chatter"

P = Proceed. Go on about your day with a mind that is slightly more clear and a body that is slightly more relaxed.

Have I sparked your interest? I’ll discuss the science and research of Mindfulness in future posts, but if you are interested in getting started this fall we will offer everything from one-night workshops to a six-week course to teach the principles and practices of Mindfulness.

Chris Frasz, MSW

Back by popular demand, we will be offering our six-week introductory course "An Introduction to Mindfulness for Stress Reduction". This course is facilitated by Chris Frasz, MSW who has facilitated several courses for us in the past and gets many rave reviews and requests for additional classes. Chris recently completed a week-long Mindfulness intensive under the direction of Jon Kabat –Zinn, the founding and executive director of the Center for Mindfulness in Medicine, Healthcare, and Society at the University of Massachusetts Medical School. Learn more about this class and Chris Frasz by clicking here, www.carinnielsenmd.com/stress-reduction.

Kelly Daunter, PsyD, LLPIn addition to the six-week introductory course, clinical psychologist Dr. Kelly Daunter will be offering three one-night Mindfulness Workshops - Mindful Eating, Mindful Parenting, and Mindfulness for Stress Reduction During the Holidays. These workshops are a great way to “get your feet wet” and see what Mindfulness Practice is all about, while applying the concept to everyday life stressors. If you’ve ever mindlessly ate a bag of potato chips, snapped at your kids and regretted it, or felt run-down by Holiday stress, one of these workshops might be for you!  www.carinnielsenmd.com/events

Workshops will be held at Integrative Medicine | Carin Nielsen, MD in Downtown Petoskey. Space is limited and advanced registration is required. Please contact us to reserve your spot (231) 638-5585 or This email address is being protected from spambots. You need JavaScript enabled to view it.

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