Wellness

Medicines & Miracles

Your Hormone Health

The naked truth behind hormone science and how to safely rejuvenate mind, body and spirit

BY GLORIA HAKKARAINEN MD, FACOG, FASBP, FABAAM

The newest data on hormone research shows that hormone replacement therapy (HRT) actually benefits patients when dosing route and medication are properly chosen, and when doctors monitor patients closely. The big scare which had women going off hormone therapy started in 2001, with the preliminary results of the Women’s Health Initiative (WHI). The WHI study looked into the use of Premarin and Prempro in women who on average were already 17 years into menopause. It showed that Prempro (a mixture of pregnant purified horse mare’s urine and synthetic progestin, medroxyprogesterone acetate) after approximately five years of use, led to an extra eight cases of breast cancer per 10,000 users. The news media rushed in early to bring it to headlines and soon medical societies were advising physicians to minimize or discontinue use altogether.

Another study which showed similar discouraging results was the HERS trial (the Heart and Estrogen Progestin Replacement Study), which evaluated 2,763 postmenopausal women with known cardiovascular disease. Prempro was used again and did not demonstrate any significant improvement in future heart disease protection for this group of women. Based on these two trials, many women stopped taking their hormones and have suffered from unrelenting symptoms of menopause. Of course, many forms of HRT exist and the risk analysis was blindly extrapolated to all forms of hormone use, both bio-identical and synthetic, to make everything more confusing than ever. As more rational and in-depth analyses came to light, however, we were able to see that by 2005 the hormone story was beginning to change.

When renowned hormone experts analyzed the data more carefully, it was shown that many of the women in the WHI study were already at high risk of developing cardiovascular disease. These women were largely overweight to obese, many already had been placed on cholesterol controlling drugs, were using aspirin, and quite a few had high blood pressure. They were essentially past the ability of hormone therapy to make much of a direct impact on improving their heart attack risk. The studies did show however that the synthetic progestin use (MPA) acts very differently compared with natural progesterone, and that not all progestins are alike.

More scientists have re-analyzed over 25 years worth of good HRT studies, now giving a more comprehensive understanding of what judicious hormone use can do for patients. Clearly HRT has many beneficial effects on the body, including improving skin quality and integrity, eliminating wrinkles, boosting immune system function, relieving symptoms of muscle aches, improving the elasticity and collagen content of the pelvic tissues, keeping the brain sharp, preventing osteoporosis, fighting depression and much more! Modern day hormone analysis provides not only a look at estrogen stores in the body, but also at a host of other hormones including testosterone, progesterone, DHEA (dehydroepiandersterone), melatonin, cortisol and thyroid— to name a few.

The latest data from the North American Menopause Society (NAMS) shows that when women start to replace declining hormones earlier than what was done in the WHI study (late 40s and 50s), the aging effect of hormone depletion can actually be forestayed or reversed. Also the route of administration: oral, sub-lingual, sub-buccal, transdermal, transvaginal, gel, patch, cream or injection can be customized for patient convenience and efficacy. One may, for example, attempt to avoid oral routes of estrogen if possible, as these can elevate triglycerides (the amount of fat in the blood) and lead to an increased risk for a blood clot, or affect the gallbladder.

Let’s take a closer look at these hormones and how they work together in a magnificent balance that makes up the human body. I will also mention a word about estrogen metabolism and breast cancer risk, and how specialized testing can be used to help a patient assess their overall risk of the development of breast disease.

Hormones are very special chemical molecules that direct many fundamental and critically important processes in the body. They can act both on tissues a long distance away from their secretion site (endocrine), on neighboring tissues (paracrine) and on the individual cell itself that released it (autocrine). Each endocrine organ system makes a distinct hormone whose release is controlled by two areas in the brain: the anterior pituitary gland and the hypothalamus. There is a complex interplay between various hormones as the brain receives and senses the needs of the body. There is also a negative feedback loop that works to ensure that just enough of each hormone is made. Replacing just one hormone doesn’t make sense as we see declining levels of many hormones during menopause. Evaluating and studying the hormone profile across systems ensures that all critical areas are treated.

There are ways for physicians to avoid the side effects of high level dosing of any one hormone. Just as a cook uses various key ingredients of a recipe, where all elements are needed are to make the dish come together, so too the body regulates each hormone and they all support one another’s function. For example, thyroid function helps estrogen maintenance and vice versa. Some hormones, like cortisol (the hormone that is released in response to stress), actually increase with age. Abnormally high levels of cortisol can accumulate leading to elevated blood sugar levels and metabolic syndrome (pre-diabetes). The following list touches on some of the more critical hormones that exist in the body:

THE THREE SISTERS OF ESTROGEN

(E1) Estrone: mainly made by the adrenal glands; also made in fat, muscle and skin and can be converted from estradiol; normally considered an estrogen reservoir; the primary estrogen seen in menopause, normally represents between 10 to 20 percent of circulating estrogens prior to menopause; after menopause the major source can be from fat cells so obese women can have an elevated estrone to estradiol ratio; high levels can increase risk of endometrial and breast cancers; clearance routes and metabolites can affect breast disease risk

(E2) Estradiol: made by the ovaries; primary estrogen seen in young women; the strongest acting of all the estrogens (12 times stronger than estrone and 80 times that of estriol); most active biologically and the one reproduced by “Big Pharma” in most Rx formulations

(E3) Estriol: made by the ovaries; the weakest estrogen strength of all three kinds (approximately 1/80 that of estradiol); rises with pregnancy; thought to be protective/neutral to the breast; the majority component of BHRT (Bio-identical) therapy

THE A-B-Cs OF HORMONES

Adiponectin: exciting newcomer to hormone research and therapy; made by fat stores and acts as a satiety signal to the brain; also vital to clearing local inflammation to coronary blood vessels to reduce plaque formation thereby reducing heart disease risk; huge future target for obesity and new cardio protective meds of the future; low levels indicate disease risk.

Cortisol: made by the adrenal glands; principal hormone produced in response to acute or chronic stress; induces sugar stores to be broken down and can lead to pre-diabetes; increases with age and can lead to unwanted abdominal/truncal fat; most patients respond well to behavior modification and supplements that help support the adrenal glands; over demand to the system can lead to adrenal fatigue and insufficiency and “burn out” states can lead to apathy, extreme depression and inability to fight disease

Insulin: very important in regulation of blood sugar in the body; increased resistance to insulin in the body with aging leads to diabetes and metabolic syndrome (elevated blood pressure, triglycerides or fat in the blood stream and noted borderline high levels of blood sugar); controlled by many body regulating signals that ultimately determine overall health; fasting levels can be used to detect early onset disease

(IGF-1) Insulin Growth Factor -1: hormone made by the brain at night that travels to the liver and is converted to growth hormone; essential in many processes in the body; used for retaining of lean body muscle to burn off unwanted excess fat; immune system enhancer; generates new growth of bone muscle and tissues used to maintain the body; levels start declining at around 30 years of age and viewed by many anti-aging experts as a vital part of a comprehensive hormone assessment

Melatonin: hormone made by the pineal glands (mostly at night with sleep in a darkened room); responsible for the sleep and wake cycle; newest data shows that proper melatonin levels can lead to improved antioxidant levels and ability to ward off cancer (especially breast)

Progesterone: made by the ovaries and adrenal glands; has mood enhancing and anti-depressant effects; protects the uterine lining from overgrowth and cancer; usually made mid-cycle and is the first hormone that starts to decline with aging; can be used to treat PMS (pre-menstrual syndrome) and endometriosis; helps to normalize irregular cycles; used in fertility treatments to support early pregnancy

Testosterone: important hormone for women that exists at lower levels than in men; called the “hormone of desire” because of a known powerful effect to enhance libido or sex drive; assists with self-confidence and is an anti-depressant; also needed to maintain lean body mass to burn off fat which helps women retain their youthful figure; important also for energy and motivation; builds bones, muscles and ligaments to ward off osteoporosis

(TSH) Thyroid Stimulating Hormone: hormone secreted from the anterior pituitary of the brain that signals the thyroid gland to release thyroid hormone from the colloid gland in the neck; the thyroid hormone that is put forth is usually not that active and then is converted to T3 (Tri-iodo thyronine); responsible for the rate of most metabolic reactions in the body; women are much more prone to thyroid disease than men and sluggish thyroid function can lead to weight gain, fatigue and dry, flaky skin and constipation problems, poor self esteem and depression; some patients can make antibodies attacking their own thyroid gland with age, thyroid function testing can determine a patient’s current status, thyroid supports natural estrogen maintenance in the body. These hormones can be measured reliably in many ways, including the use of blood serum, saliva, bloodspot and urine testing. Each test the use of blood serum, saliva, bloodspot and urine testing. Each test has been designed to check a particular hormone system and you should speak with your doctor to see if you need further testing. Some tests, like thyroid hormone are done as a routine screening check, while others can be done at a specialist’s office such as estradiol at an infertility clinic or with your gynecologist. Most patients will need follow up testing of their levels once they start replenishment to ensure that levels are still safely in normal ranges and to avoid unwanted side effects of high level dosing. For example, too much estrogen can lead to breast tenderness, too much progesterone to abdominal bloating, and too much testosterone can cause acne or hair growth.

Estrogen metabolites, such as the hydroxy estrones, can also be assessed if one is worried about breast cancer risk on hormone use. The 2-OH estrone is considered to be the main safe estrogen clearance route in the body while the 4-OH and 16 alpha OH estrones, if not cleared appropriately, can lead to inappropriate tumor promotion of certain lines of breast cancer seen in laboratory studies. The 2/16 ratio of hydroxy estrones has been a widely used method to assess how a person clears their estrogen naturally from the body. Patients who don’t clear their estrogen as optimally as others may benefit from an estrogen clearance promotion diet/eating plan that includes key supplements such as indolyl methanes, sulforaphanes and antioxidants to ensure a good 2/16 ratio. This can easily be rechecked on repeat testing of estrogen metabolites after patients start on an estrogen detoxification and estrogen dominance clearance plan after about six months of care.

So don’t let fear lead you to discount the importance of checking your hormones. When done safely with a hormone specialist, you can enjoy the well known benefits of hormone therapy to rejuvenate your total mind, body and spirit. Many physicians are now savvy to checking these levels for their patients. Ask to make sure that the physician you visit is boarded with a concentration towards hormone analysis and treatment. Certain physician societies exist such as the American College of Obstetrics and Gynecology, American Academy of Anti-Aging Medicine (A4M), the International Hormone Society, the World Society of Anti- Aging Medicine, the American Academy of Clinical Endocrinologists, the Institute of Functional Medicine and more, that have rigorous standards that physicians follow to help to ensure proper testing and treatment protocols are followed. Remember the human body is a marvelous creation indeed, listen to it and take care of it and you will have a “harmonious” future together. v

Dr. Gloria Hakkarainen MD, FACOG, FASBP, FABAAM is an OB/GYN and also board certified in multiple disciplines. She specializes in wellness, weight loss and anti-aging, all with a focus on prevention. She practices at Palm Beach Weight & Wellness in West Palm Beach.

Reading References for those interested in finding out more; Dr Pam Smith,MD HRT: The Answers; Dr Winnifred Cutler, PhD , Hormones and Your Health; Suzanne Somers, Breakthrough, Eight Steps to Wellness

Beauty Sleep

Are you gettıng enough?

Restoring natural beauty is more than skin deep BY GLORIA HAKKARAINEN, MD, FACOG, FASBP, FABAAM

DOES THIS SOUND FAMILIAR? The alarm wakes you up at 5:45 AM. You have deliberately set it a little ahead because you want to snooze another 15 minutes. And yet despite getting barely five to six hours of goodsleep, you rise up to start another long day.

Did you know that without proper periods of rest your entire health is affected? With a society that runs 24/7, how does proper sleep make us more beautiful?

The human body is capable of achieving truly amazing feats. We require a period of restoration about every 12 to 16 hours (some folks every 10 hours or so). This involves the brain going through a series of different

bio-electrical rhythms during sleep in order to re-set and clear out the daily activities it has stored (creating new memory files, sorting out and weeding out of extraneous information).

The brain’s incredible ability to think and store information has been well studied using both diagnostic imaging (SPECT scan or MRI) and brainwave analysis EEG (electroencephalogram). The brain has a predictablerhythm that it follows when one is about to go to sleep, first we see an alpha wave frequency (8 to 13hz) and then it enters into a well studied cycle of brain waves that is crucial for proper well being, (delta waves 0.5 to 3.5hz, theta 3.5 to 8hz, and beta 13 to 30hz). A hertz (hz) is a cycle per second that is the measurement unit of brain activity on an EEG which can be examined in patients having a sleep study.

We need a proper synchronization of all these waves to enable the human mind to be its natural, beautiful, creative self. Beta waves are associated with ordinary waking consciousness and are seen when one isproducing logical, linear type thought. Alpha waves are very different and are commonly seen as one drifts off to sleep, bridging between the external and internal worlds. Deep sleep produces delta waves and thetawaves are associated with dreaming and creative innovative thinking. We can experience all of these states of consciousness throughout the day in mostly ordinary linear type patterns with bursts of extraordinaryinsight, creativity and emotional and/or mental clarity. These moments can appear briefly, in fleeting little groups of thought which are the “aha!” moments of the world.

Some people suffer from lack of proper sleep and consequently do not have normal cycles through these brainwave patterns, as evidenced in a sleep study. They are not able to achieve their best, whether at work or athome, and cannot even enjoy the simplest activities of human existence. Our bodies need that time to restore themselves and if deprived chronically of this restorative phase, daily activities can become downrightdangerous (think about airline pilots and staff that are not allowed to work more than a pre-determined schedule). Improper sleep wave patterns can be corrected by first having a sleep study done and then rectifying the missing brainwave activity by using various sound tracks that have been specifically produced to induce the missing brainwaves to return. Some of these tracks help a person better access their creative selves,sparking new spontaneous thinking. The “inner core genius” can now show itself.

Many celebrities and “genius” scientists share a common trait; spending a significant amount of their brainwave activity in the desired theta block (3.5 to 8hz) during sleep that helps them come up with new creativejuices during the day. One wellknown sleep researcher, Dr. Jeffrey Thompson, has designed this type of audio therapy for many high level executives at Fortune 500 companies in order to boost problem-thinkingpowers. Now it is simply good mind/sleep therapy that should be available to everyone, including you.

Improper sleep can also be seen in a myriad of different diseases that patients suffer with everyday. These people never realize that half the battle is getting enough rest. They will never completely heal unless the bodygets a chance to literally perform thousands of tasks during sleep. The list is vast and seemingly endless but I am going to try to point out a few of the more common ones.

Obstructive sleep apnea (OSA) is on the rise and is a condition where patients may suffer with a partial obstruction of their airways during sleep causing a transient hypoxia where the tissues are not receiving enoughoxygenation. A simple sleep study can usually pick up the diagnosis and patients can be given a CPAP (continuous positive airway pressure device) machine that they can use while sleeping, ensuring adequateoxygenation to the body. Various CPAP devices are available and some have smaller and lighter masks that fit around the face and are more comfortable than before. People who have even a mild apnea can be at increased risk for serious heart disease. OSA patients can suffer with daytime sleepiness and problems staying alert which can affect their ability to perform their work.

OSA is increasing among Americans because we have an ongoing obesity crisis in this country. The fatty tissues can accumulate around the airway and compress the trachea or windpipe affecting our ability tobreathe. So losing excess weight if you are overweight or obese is an important step in correcting this life-threatening problem. If you or your partner are suffering with daytime drowsiness and are overweight, a sleep study may be very helpful.

Patients that suffer with Fibromyalgia (a chronic pain syndrome) often have very disturbed sleep cycles. Even when they may be spending up to 10 hours in bed, they may not feel well because they can have periods of”automatic arousal” during sleep time. These frequent interruptions can mean that these patients are never able to get to their more restorative states where essential hormones are produced-the growth hormonebeing one important example.

It’s interesting that, growth hormone, one of the most important hormones in the adult body, and often touted as an “anti-aging” hormone in lay literature, is mostly produced late at night. Muscles need it for healing andrepair and most tissues have a receptor-binding site for it. Important brain signals such as neurotransmitters cannot be replenished without it. Hence, a lot of the wear and tear stresses of the day never get properlytaken care of, causing patients to develop over sensitiveness where even the smallest stress becomes overwhelming and causes pain. Better sleep means less pain and it is recommended that these people take their sleep seriously if they want to improve their health. Testing for nighttime neurotransmitter imbalance can often indicate where deficient levels need to be adjusted. Specific supplementation can often do the job.

Sleep deprivation itself has been studied as an independent risk factor in the development of obesity. There has been a growing body of research that demonstrates that adults and children in general who don’t getenough time asleep tend to weigh more than those who get enough sleep. The Nurse’s Health Study involved 60,000 women that were followed for 16 years. Those women, who all started out at a healthy weight, were asked about their behaviors. The nurses that got five hours or less had a roughly 15 percent chance of becoming obese compared to the women that got seven hours/per night. Why did this occur? Were sleep-deprivedindividuals too tired to exercise? Did they have less growth hormone? There is a mounting body of evidence that shows lack of proper sleep time can affect the body’s response to Leptin, a hormone made in our naturalfat stores that tells the body that we’re full and to essentially stop eating. Lack of responsiveness to Leptin has been shown in obese individuals who don’t get a lot of snooze time and may contribute to a vicious cycleultimately leading to the development of OSA and other disorders.

So how do we ensure that we do get a proper night’s rest? Let me offer some simple tips for a night to dream for: Have a small meal or snack at least three hours out from naptime. Limit alcohol and nighttime caffeine.

Heavy, fatty meals need at least a four hour interval to be processed well prior to entering into sleep mode. Make sure that your bedroom is a true oasis in the chaos of your life. Try to keep the activities of the rest of

the house out of your inner sanctum. Make sure that it is absolutely quiet or use a relaxing brain wave tape or other vibrational energy soundtracks to spark your creative inner self. Ensure that you make proper

melatonin by darkening the room and padding your bed against interruptive sounds. Limit news or stimulating thoughts when settling down for sleep. A warm cup of tea with chamomile or a hot cup of milk to release

tryptophan can be helpful. A warm soothing bath, hot shower or sauna is also a wonderful adjunct that can produce good restorative sleep patterns. Meditation or yoga at the end of a long day can actually be sleep

enhancing if the mind is allowed to drift without any intrusive thoughts from the day.

Even the delicate area around the eye can be affected with dark circles without proper rest, so make sure that you have a good eye cream as well. If you sleep on your back you’re less likely to develop new facial

wrinkles. But try thinking peaceful thoughts so you won’t frown to begin with, and get going on your sleep and make sure that your body has plenty of time to make itself beautiful for the next day beyond. Sweet
dreams.

Dr. Gloria Hakkarainen MD, FACOG, FASBP, FABAAM is an OB/GYN and also board certified in multiple disciplines. She specializes in wellness, weight loss and anti-aging, all with a focus on prevention. She

practices at Palm Beach Weight & Wellness Center in West Palm Beach.

Understanding Stress

THE EFFECTS OF STRESS ON YOUR ADRENALS AND YOUR BODY

Does the world seem to move at a faster pace than ever before? Perhaps you feel a little tired from the holidays, or it seems that you can’t regain your normal energy no matter what you do or how many doctors you visit? If any of this seems to describe your current state, ask yourself—when was the last time I really felt relaxed and well? Unfortunately, Americans have been suffering with a human energy crisis for decades. We have set up a society than runs 24/7 with big business, that holds important breakfast meetings starting at 7 am, gyms that are open round-the-clock and fast food restaurants for even faster people.

We live in a time where even our youth are going at a non-stop pace. It is not uncommon for some kids to attend as many as three after school activities on a given day. In fact, sobering statistics from pediatric obesity experts state that this will be the first time in history that our children will not outlive us. They are doomed to chronic diseases such as diabetes, heart attacks and strokes at an early age, unless we do something now to drastically change the disease trend of the country. But where do all these problems that we and our kids have stem from? Naturally it starts with us, the parents. Many patients are wandering around suffering from adrenal fatigue, burn out, and are stressed to the max. Elevated cortisol levels will literally kill us unless we learn to take initiative now. Excess cortisol production from chronic stress leads to an easy extra 10 to 15 lbs of stubborn belly fat that you can’t get rid of. Let’s look into how anti-aging physicians evaluate adrenal function and learn what we can do to restore that lost “mojo.” The adrenal glands that control our reactions to stress and help us with the toils of daily living are located in a very special place on top of the kidneys. The adrenals are a key player in hormone control throughout the body and their state of health directly influences our well being. These very small crescent-shaped glands can secrete their hormones directly into our circulation.

They produce many hormones including cortisone (in response to stress), hydrocortisone, testosterone, estrogen, DHEA (dehydro epiandersterone), progesterone and aldosterone—to name a few. Over many years, the adrenal glands can cope up to a certain point and then they will start to fatigue. Soon after, they will be unable to keep up with the ongoing stresses presented and will slowly but surely fail. This is also known as the “stressed and wired” phase which progresses to “stressed and tired.” When this occurs the person is at extremely high risk of facing both a personal and professional collapse. Many patients report drastic changes in their ability to handle the busy daily stresses. A simple add-on task seems to be insurmountable, they lose their interest in things that normally would give them pleasure (anhedonia) and they are unable to find the energy to get up in the morning, despite obvious needs to get the kids to school or go to work to pay the rent. Often partners initially try to put up with these problems and then eventually give up as patients are unable to rouse themselves out of their extreme state of fatigue and distress.

HOW DID WE GET THIS WAY?
Unfortunately, we often don’t learn to say no until it is too late and end up paying heavily with unforeseen consequences. The hormonal balance in the body is responsible for so many important factors that determine energy production, so it’s amazing that we function as well as we do for such long periods until we notice that something is off. People learn to ignore the warning signs that their adrenals are suffering, and continue to push themselves with little pep talks, chiding themselves for not having the energy that they used to. They may keep themselves going by eating chocolate, drinking teas and coffees. Patients of this type often have almost little to no free time and feel chronically tired and stressed. In the end, they may start having psychosomatic complaints that are vague and difficult for doctors to pinpoint such as chronic fatigue and fibromyalgia. Often patients will note uncharacteristic, sudden temper outbursts for which they later feel remorseful while energy levels deteriorate as they feel more and more despondent that they cannot get through the day. Tranquilizers and other anti-depressants are often prescribed with initial benefit, but no further relief. Pain killers and alcohol are temporary boosters and downers that eventually are of little benefit.

Left unrecognized, adrenal burn out can be brought on by long hours spent at work, especially on the grave yard shift, which will affect a patient’s melatonin production. Melatonin is another natural hormone made in the body at night during sound sleep once the pineal gland in the brain senses that it is dark outside (almost pitch black is best). Melatonin functions to regulate the circadian rhythm or sleep/wake cycle and you start producing it about 20 minutes into deep sleep. Unhindered rest at night is critical for proper production of Melatonin, which acts as a powerful antioxidant in the body. Many health experts have shown melatonin to be a potent protector against cancer and possibly the onset of Alzheimer’s disease. Worldwide travelers have often taken advantage of melatonin, using up to 20mg (be sure to consult with your physician) to overcome the effects of jet lag after a long flight. It helps them find good energy and relieve the toils of fatigue and loss of good sleep during the travel process. Melatonin administration can also help the production of cortisol by increasing the DHEA sulfate/cortisol ratio after six months of treatment. This can be a wonderful way to support low adrenal reserve.

THE IMPORTANCE OF GOOD ADRENAL FUNCTION
Simply put, good adrenal function is vital to health. The adrenals are the body’s sensors of stress. When they believe that the person is actively undergoing some sort of important stress, they directly influence adrenaline production (epinephrine release) for that famous “fight vs. flight” response. There are many incredible stories that people have told about super human strength and hero-like feats during a fire, a hurricane, etc. where loved ones were saved due to the powerful hormone surge that occurs. The elevated cortisol that is secreted also creates an immediate supply of glucose (sugar) for consumption by muscle and brain tissues to cope with the stress. Under longstanding conditions, however, this can become a set up for the development of diabetes. One other important side to all of this, is to realize that without proper adrenal function in place, virtually all the other sex hormones such as testosterone, estrogen and progesterone are greatly affected. This can influence the patient’s ability to get pregnant naturally, and also affect the success of fertility treatments and can later bring on a more intense and abrupt menopause, with greater tendencies for dreaded hot flashes and night sweats. Males can experience potency issues, have low libido and show signs of erectile dysfunction. All hormones work together in a “symphony in the body” according to Dr. Pam Smith, executive director of the American Academy of Anti-Aging Medicine’s Fellowship Program (A4M). Low adrenal reserve will require higher dosing of hormone replacement to achieve appropriate effects in the body. It is always more prudent to give the lowest doses needed to achieve clinical improvement to decrease risks of the side effects and problems seen with high hormone dosing.

ARE YOUR ADRENALS ON THE WANE? Traditionally blood serum testing at precisely 8 am was used as a screening for patients at risk. Newer testing modalities include four-point salivary testing for both cortisol and melatonin, which can be done conveniently at home rather than at the medical lab. Results usually take a few weeks to come back. It is very important to make sure that full blown Addison’s disease or insufficiency is also ruled out. If a person succumbs easily to allergies and infections, feels constantly drained and exhausted and experiences low blood pressures and sugars, then they may warrant a more intensive evaluation. Both the thyroid gland and the adrenals need proper evaluation. Addison’s may need vigorous treatment. Levels of hydrocortisone, aldosterone, epinephrine and ACTH can be measured in blood, plasma and urine. An ACTH challenge test can also be done to distinguish between other diseases such as Cushing’s Syndrome, which is caused by an adrenal tumor. Also a high potency steroid suppression test can be administered which temporarily shuts down overactive adrenal activity. Specialized diagnostic scanning with abdominal X-rays, MRI, CT scan, arteriography and radionuclide testing and IVP tests can be performed to help determine if a patient has an adrenal calcification, tumor, atrophy or other growths of the glands.

SUPPORT &TREATMENT
Treatments of adrenal fatigue can start with high-potency natural supplements. The first goal, of course, is to remove any harmful stressors from a patient’s immediate environment. Serious consideration to lifestyle changes are tantamount
to restoring good health, including trying to limit consumption of processed foods and chemical additives. Excess alcohol and tobacco are to be avoided because these substances can harm the already overtaxed adrenal glands.

Below is a simple list to support adrenal function from Life Extension’s Disease Treatment and Prevention with a few added favorites of my own:

• Ashwaganda 75mg
• Vitamin C 3 grams daily
• DHEA 50mg daily
• L-theanine 100 to 400mg daily
• Pantothenic Acid (vitamin B5) 1500mg daily
• Melatonin 300ug to 6 mg at bedtime, daily
• Phosphatidylserine 300mg daily
• Licorice (Glycerrhiza glabra) 1000mg or less daily
• Relora (Magnolia Officinalis) 125 mg

Adrenal Extracts in high potency supplements, OraAdren, AdrenAll (take ½ hour prior to bedtime to assist with sleep) Intravenous Infusion with Vitamin C, B’s and Magnesium These are but a few of many items that can be used for adrenal support. Occasionally patients will need true cortisol replacement, in which case I use a dosing schedule that follows the pattern of the body, usually somewhere between 2.5 to 7 mg four times a day, as described by the great pioneer in the field, Dr. William Jeffries. (Dosing needs to be individualized as with any other medication.) Investigation for gluten sensitivity in the diet can also be another useful adjunctive along with thyroid support. I also like to use a specially designed herbal tea to be taken at noon, for patients that aren’t fond of swallowing a lot of pills. It works well, is pleasant tasting, and makes patients perform the most important task of all, learning to take a small break away from a grueling day’s work. Taking away trigger foods with empty simple refined carbs can also be very helpful along with the addition of healthy fat to the diet, which promotes good energy. Often timing of meals can help patients avoid sugar spiking, which can worsen energy highs and lows.

Adjunctive care with massage therapy, bio-energetic medicine techniques with acupuncture and stretch therapy, cranio-sacral therapy, yoga and meditation can all be excellent non-medical remedies that are often soul-relieving and effective when combined with the other suggestions already mentioned. One of my favorite natural remedies is to have an activity that helps you get away mentally from the stresses of the day (think soul soothing—playing music, painting, spiritual or inspirational reading, poetry or quiet activities such as walking on the beach, relaxing on a boat hearing the waves or taking a stroll in a verdant green garden). Ensuring that these simple activities, even as little as 10 to 15 minutes a day, make it into the daily schedule can be all you need in order to get through the grind of life. So, be sure to take the time to stop and smell the roses, not only is it the green thing to do but it is also the adrenal thing, too.

Dr. Gloria Hakkarainen, MD, FACOG, FASBP, FABAAM is an OB/GYN and also board certified in multiple disciplines. She specializes in wellness, weight loss, and anti-aging, all with a focus on prevention. She practices at Palm Beach Weight & Wellness Centers in West Palm Beach.

Living Well

Whether you’re making small changes for yourself, your home or the environment, we are all trying to take a closer look at how we live. There has never been a better time for change and these tips and tricks are sure to help you live better in 2009. Thomas Fuller, the great historian, once said “We never know the worth of water ‘til the well is dry.” Instead of losing sight of what we have, let’s make changes now. We will all reap the benefits later.

1. Don’t drain your wallet dry. Find a faucet mount, such a Brita® or PUR, and buy reusable containers to fill up. Many brands offer tasty flavor options, too. If 10,000 people gave up bottled water and opted for a faucet mount, in five years they’d save a collective $1,300,000. That’s quite a cash flow.
2. The idea of driving to the gym to run on a machine can seem ironic. Get green with your workout by taking it outside. “Green Gyms,” gaining popularity in the UK, have harnessed workout power for something better. For example, planting trees, laying hedges and building walls for the community can actually burn hundreds of calories more than running. And when you’re all done with those trusty, old sneakers, Nike’s shoe recycling program, Reuse-A-Shoe, will turn them into Nike Grind, a material used for sports surfaces and playgrounds. Find out more at Nikereuseashoe.com.
3. Paper or Plastic? Just say no to both. While you use a shopping bag for an hour, it takes a lifetime to decompose. Try bringing your own bag when grocery shopping. With all of the stylish new options out there, it’s easy being “green.” For an ultra-chic option, we suggest Anya Hindmarch’s “I’m not a plastic bag.” Find it at Whole Foods stores statewide.
4. Replace one meal a week with a meatless entrée. While many love a good filet mignon, our meat-based diet actually contributes to world hunger and deforestation. Take baby steps. Eating a greener diet would cut over 50 percent of the U.S. consumption of oil and water, not to mention the good effects it would have on our health. Visit Seeveggiesdifferently.com to learn how delicious and easy it is!
5. Fresh, organic foods are the best for our health. However, their high price tags often leave them lingering on the shelves. Pick and choose certain foods to buy in the organic section, as it has been proven that some items contain more pesticides and contaminants than others. When tested, some 16 contaminants were found in leading baby food brands according to the National Academy of Sciences. Baby foods, along with apples, grains, milk and strawberries are highly contaminated by pesticides, so pick them up in the organic section.
6. If you think vampire power means the spellbinding power of a white-fanged caped man, think again. Commonplace appliances in your home can “suck” energy and drain funds from your wallet, even when switched off. Try unplugging your appliances when not using them. Collectively, we could save $3 billion a year, that’s $200 per household!
7. Cleaning products are a cocktail of poisons that we use in our home. While people with young children are more aware of their dangers, we all should be. Save money and worry by making your own “green” cleaning supplies. Stock up on a few safe ingredients such as soap, vinegar, baking soda, borax, lemon juice and a coarse scrubbing sponge. With a little elbow grease, vinegar and water makes an excellent glass cleaner,while baking soda and cornstarch can deodorize carpets in a snap.
8. Incorporate the five “superfoods” into your diet and you will be off to a healthy start. Walnuts are a great source of plant protein, so try eating a handful a day. Flax seeds have been shown to have anti-cancer properties and are packed with fiber. Add Pomegranate into your daily diet, as it is loaded with anti-oxidants and lowers cholesterol. Eat two servings of salmon a week, to get lean protein and omega 3 fatty acids. Lastly, dark greens like asparagus and collard greens are high in fiber and low in calories.
9. We all have received unwanted catalogs and papers in the mail. Before you throw them away, request to be removed from the list.Think before you print. In a single year, the average U.S. worker uses 10,000 sheets of paper. If you get an important e-mail, save don’t print. Also, spread the word about bamboo and organic cotton papers now available. Your office may pick up on the trend.
10. Walk it off! Contrary to popular belief, how many minutes you walk is not as important as your distance and speed. Remember to increase your distance before working on your speed. Note: a person of about 180 lbs. should burn approximately 100 calories per mile.
11. One light bulb per house. That’s how many light bulbs it will take to change the world. According to Energy Star, if every one of 110 million American households purchased just one Compact Fluorescent Lightbulb (CFL), and put it in place of their regular 60-watt bulb, the energy saved would be enough to power a city of 1.5 million people. This frosted, ice-cream cone shaped marvel is one of the best-kept secrets, and your local home goods store is charging around $3 for them. This sounds like a pretty bright idea to us.
12. Be an eco-hostess. There are many choices when it comes to entertaining and gift giving. Order gorgeous organic flowers from Organicbouquet.com, and serve your guests organic and fair-trade coffee, from Purevidacoffee.com. For those with a sweet tooth, satisfy your stomach and conscience with delectable organic goodies, available at Theochocolate.com.
13. Join an environmental group. There are hundreds of great organizations around the country waiting to recruit people. Find one that focuses on something you are particularly dedicated to, and pitch in! Plus, it’s a great way to meet people in your community. Visit the North American Association for Environmental Education (NAAEE)’s Web site to find ways to get involved in your area!
14. Getting there is half the fun. Travel the right way, with eco-travel. There are many sites, for example Itsagreenworld.com, that help you plan environmentally friendly travel accommodations. Whether you choose to visit an inviting and informal trailside Eco-lodge in France or an organic olive farm in Greece, you will be a mean, “green” traveling machine.
15. Mother earth knows best. Think of raising your children as a way of raising consciousness about the earth. Buy toys that are naturally safe, thoughtfully produced and just as fun as mainstream brands. Look for items that are made from sustainable, renewable materials like bamboo and rubberwood. Your little one will be an earth angel in no time.