Your Health and Your Staffs

Health: Impact on The School

System
Pamela W. Smith, M.D., MPH
Center For Healthy Living
313-884-3288
Copyright 2007

3 Tips To Be Healthy And

Stay Healthy

Tip #1
Limit your intake of aspartame

Side Effects of Aspartame

Dizziness
Visual impairment
Disorientation
Ear buzzing
Altered liver enzymes
Tunnel vision
Loss of equilibrium
Severe muscle aches

Side Effects of Aspartame (Cont.)

Numbness of extremities
Inflammation of the pancreas
Episodes of high blood pressure
Eye Hemorrhages (bleeding into eye)
Abdominal cramps
Hives
Memory loss
Headaches
ADD

Tip #2
Be hormonally sound
Andropause
Menopause

Symptoms of Andropause

Fatigue, tiredness, or loss of energy

Depression, low or negative mood
Irritability, anger, or bad temper
Anxiety or nervousness
Loss of memory or concentration
Loss of sex drive or libido
Loss of erections or problems during sex

Symptoms of Andropause (Cont.)

Backache, joint pains, or stiffness

Loss of fitness
Feeling over-stressed
Decrease in job performance
Decline in physical abilities
Bone loss
Elevated cholesterol
Elevated blood sugar

Functions of Testosterone
Sex hormone
Receptors all over a males body
Involved in the making of protein and
muscle formation
Helps manufacture bone
Improves oxygen uptake throughout the
body
Helps control blood sugar

Functions of Testosterone (Cont.)

Helps regulate cholesterol

Helps maintain a powerful immune system
Aids in mental concentration
Improves mood
Helps protect the brain against
Alzheimers disease

Stats
Half of healthy men between the ages of
50-70 years will have a testosterone level
below the lowest level seen in healthy
men who are 20-40 years of age.
Korenman, S., et al., Journ Clin Endocrinol
Met 1990; 71:963-69.

Estrogen Is A Problem
Elevated estrogen in males increases their
risk of prostate cancer and heart disease.

Causes of Estrogen Elevation in a

Male

Increased aromatase activity

Alteration in liver function
Zinc deficiency
Obesity
Overuse of alcohol
Ingestions of estrogen-containing food or
environmental estrogens
Drug-induced estrogen imbalance

Drugs That Can Elevate Estrogen

Levels
Pain/anti-inflammatory drugs:
acetaminophen, propoxephene, nonsteroidal anti-inflammatory drugs like
ibuprofin, aspirin
Antibiotics: sulfas, tetracyclines,
penicillins, cefazolins, erythromycins,
quinilones
Anti-fungal drugs: miconazole,
itraconazole, fluconazole, ketoconazole

Drugs That Can Elevate Estrogen

Levels (Cont.)
Antidepressants: fluoxitine, fluvoxamine,
paroxetine, sertraline
Anti-psychotic medication: thorazine,
haloperidol
Heart and blood pressure medicine:
propranolol, quinidine, amiodarone,
coumadin, methyldopa
Antacids: omeprazole, cimetidine

Drugs That Can Elevate Estrogen

Levels (Cont.)
Vitamins and nutrients: high-dose vitamin
E, general dietary deficiencies, grapefruit
Abusive substances: alcohol,
amphetamines, marijuana, cocaine
Cholesterol lowering medications: statins

Andropause
Testosterone replacement therapy for men
is safe and can provide significant
benefits.

Answers to Questions About

Testosterone Replacement
Prostate cancer is a contraindication for
testosterone replacement.
Incidence of prostate cancer is not
increased by testosterone replacement
No evidence that testosterone
replacement accelerates prostate
enlargement or prostate cancer
Testosterone does not cause prostate
cancer.

Treatment
Transdermal (on the skin)
More effective for erectile function
Transdermal 81% effective
Oral 51% effective
IM 53% effective
Jain, P., et al., Jour Urol 2000; 164(2):371-75.

Use compounding pharmacy

Less expensive than Androgel
Can titrate to the individual needs of the
patient

Menopause
Hormone response is as unique to each
person as their own fingerprints.
Hormone replacement should not be
considered without a thorough
understanding of how all of the bodys
hormones interact with each other.
References can be found in:
Smith, P. HRT: The Answers 2003.

Menopause
The normal age to go through menopause
ranges from 35 to 55.
Therefore, a woman may live one half of
her life without a menstrual cycle.
Cycling after the age of 55 increases a
womens risk of breast cancer.

Synthetic HRT
It is estimated that one-half of women quit
taking their synthetic hormone
replacement therapy after one year
because they are unable to tolerate the
side effects.
Synthetic hormones waste energy by
giving incomplete messages to cells which
then fail to produce a balanced hormonal
response.

Why Consider HRT

Relief of symptoms
Prevention of memory loss
Heart health
Bone production
Growth and repair

Hormones That Regulate

Growth and Repair

Insulin
Growth hormone
Testosterone
Estrogens
DHEA

Symptoms of Menopause

Hot flashes
Night sweats
Vaginal dryness
Anxiety
Mood swings
Irritability
Insomnia
Depression

Symptoms of Menopause
(Continued)

Loss of sexual interest

Hair growth on face
Painful intercourse
Panic attacks
Weird dreams
Urinary tract infections
Vaginal itching
Lower back pain
Bloating

Symptoms of Menopause
(Continued)

Flatulence
Indigestion
Osteoporosis
Aching ankles, knees, wrists, shoulders, heels
Hair loss
Frequent urination
Snoring
Sore breasts

Symptoms of Menopause
(Continued)

Palpitations
Varicose veins
Urinary leakage
Dizzy spells
Weight gain
Skin feeling crawly
Migraine headaches
Memory lapses

Estrogen

Estrogen
Estrogen has 400 functions in the body,
including the following:

Functions of Estrogen
Stimulates the production of choline
acetyltransferase, an enzyme which prevents
Alzheimers disease
Increases metabolic rate
Improves insulin sensitivity
Regulates body temperature
Helps prevent muscle damage
Helps maintain muscle
Improves sleep

Functions of Estrogen
(Continued)

Reduces risk of cataracts

Helps maintain the elasticity of arteries
Dilates small arteries
Increases blood flow
Inhibits platelet stickiness
Decreases the accumulation of plaque on
arteries
Enhances magnesium uptake and utilization
Maintains the amount of collagen in the skin

Functions of Estrogen
(Continued)

Decreases blood pressure

Decreases LDL and prevents its oxidation
Helps maintain memory
Increases reasoning and new ideas
Helps with fine motor skills
Increases the water content of skin and is
responsible for its thickness and softness
Enhances the production of nerve-growth factor

Functions of Estrogen
(Continued)
Increases HDL by 10 to 15%
Reduces the overall risk of heart disease by 40
to 50%
Decreases lipoprotein (a)
Acts as a natural calcium channel blocker to
keep arteries open
Enhances energy
Improves mood
Increases concentration
Maintains bone density

Functions of Estrogen
(Continued)

Increases sexual interest

Reduces homocysteine
Decreases wrinkles
Protects against macular degeneration
Decreases risk of colon cancer
Helps prevent tooth loss
Aids in the formation of neurotransmitters in the
brain such as serotonin which decreases
depression, irritability, anxiety, and pain
sensitivity

Symptoms of Estrogen Excess

Cervical dysplasia (abnormal pap smear)

Depression with anxiety or agitation
Increased risk of uterine cancer
Weight gain (abdomen, hips, thighs)
Water retention
Headaches
Poor sleep
Panic attacks
Swollen breasts

Symptoms of Estrogen Excess

(Continued)

Heavy periods
Increased risk of breast cancer
Increased risk of auto-immune diseases
Hypothyroidism
Fatigue
Irritability/mood swings
Uterine fibroids
Bloating

Causes of Excess Estrogen in

The Body

Taking too much estrogen

Impaired elimination of estrogen
Lack of exercise
Diet low in grains and fiber
Environmental estrogens
Elevation of 16-OH estrone

Synthetic Estrogen (Premarin)

Estrone
Sodium equilin sulfate
Concomitant components
17 alpha-dihydroequilin
17 alpha-estradiol
17 beta-dihydroequilin

Natural Estrogens
E1 called estrone
E2 called estradiol
E3 called estriol

Estrone (E1)
Is the main estrogen the body makes
postmenopausally
High levels many researchers believe may
increase a womens risk of breast cancer

Estradiol (E2)

Increases HDL (good cholesterol)

Decreases LDL and total cholesterol
Decreases triglycerides
Helps maintain bone structure
Increases serotonin
Decreases fatigue
Works as an antioxidant
Helps maintain memory
Helps absorption of calcium, magnesium, zinc

Estriol (E3)
Considerable evidence exists to show that
it protects against breast cancer
Is used experimentally to treat breast
cancer with and without Tamoxifen
It does not have the bone, heart, or brain
protection of estradiol.

Estrogen Metabolism
After menopause, the metabolism of
estrogen can change. Consequently a
women may respond differently to
estrogen replacement.

Estrogen Metabolism
Two major competing pathways
2-OH estrone
16-OH estrone

Estrogen Metabolism
One minor pathway
4-OH estrone

2-OH Estrone
Good estrogen. It does not stimulate the
cell growth.
Blocks action of stronger estrogen
products that may be carcinogenic.

16-OH Estrone
Has significant strong estrogenic activity
and studies show it may be associated
with an increased risk of breast cancer.

4-OH Estrone
Studies show it may directly damage DNA
and cause mutations. Therefore, it is
proposed to enhance cancer
development.
Equine estrogens, such as Premarin,
increase metabolism into 4-OH estrones.

How Can You Raise 2-OH

Estrone?

Moderate exercise
Cruciferous vegetables
Flax
Soy
Kudzu
Indole-3-carbinol taken as a supplement. Daily
dose is 200 to 300 mg.
High protein diet
Omega-3-fatty acids
B6, B12, and folate

There are two other factors

that affect estrogen
metabolism

Obesity
Decreases 2-OH estrone and increases
16-OH estrone.

Xenoestrogens
There are 50 chemicals that imitate
estrogen that are toxic to your body.
Pesticides
Synthetic hormones fed to animals
Plastics
Cosmetics

Estrogen and the Brain

Increases blood flow

Increases glucose and oxygen to the neurons
Protects neurons
Increases neurotransmitters
Keeps the blood-brain barrier working
Increases sensitivity to nerve growth factor
Decreases neuronal generation of Alzheimers
beta amyloid peptides

Estrogen Replacement
Give transdermally (on the skin)

Estrogen Given By Mouth Can:

Increase blood pressure

Increase triglycerides
Increase estrone
Cause gallstones
Elevate liver enzymes
Decrease growth hormone
Increase carbohydrate cravings
Increase SHBG (decreases testosterone)
Interrupt tyrptophan metabolism and
consequently serotonin metabolism

SERMS
Tamoxifen (Nolvadex) and Evista
(Raloxifene)
Do not have the positive affects on the
brain as natural hormone replacement
does

Treatment
Compounded by a pharmacy
Dose is individualized
Physician can use any mix of biest (E2 and
E3).
Only method of obtaining E3

Progesterone

Symptoms of Progesterone
Loss

Anxiety
Depression
Irritability
Mood swings
Insomnia
Pain and inflammation
Osteoporosis
Decreased HDL
Excessive menstruation

Causes of Low Progesterone

Impaired production
Low LH
Increased prolactin production
Stress
Antidepressants
Excessive arginine consumption
Sugar
Saturated fat
Deficiency of vitamins A, B6, C, zinc
Decreased thyroid hormone

Synthetic Progesterone
Called progestins
Progestins do not reproduce the same
actions of natural progesterone

Side Effects of Progestins

Increases appetite
Weight gain
Fluid retention
Irritability
Depression
Headache
Decreases energy
Bloating
Breast tenderness
Decreases sexual interest

Side Effects of Progestins

(Continued)

Acne
Hair loss
Nausea
Insomnia
Interferes with the bodys own production of
progesterone
Does not help balance estrogen
Remains in the body longer
Can cause spasm of coronary arteries

Side Effects of Progestins

(Continued)
Stops the protective affects estrogen has on the
heart
May make the symptoms of progesterone loss
worse
Increases LDL (bad cholesterol)
Decreases HDL (good cholesterol)
Protects only the uterus from cancer
Counteracts many of the positive effects of
estrogen on serotonin

Natural Progesterone Affects

Not Seen with Progestins

Helps balance estrogen

Leaves the body quickly
Improves sleep
Natural calming effect
Lowers high blood pressure
Helps the body use and eliminate fats
Lowers cholesterol

Natural Progesterone
(Continued)

May protect against breast cancer

Increases scalp hair
Helps balance fluids in the cells
Increases the beneficial effects of
estrogen on BV
Increases metabolic rate
Natural diuretic
Natural antidepressant

Estrogen/Progesterone
Ratio

Prolonged Use of Progesterone

Without Adequate Estrogen

Increases weight gain

Increases total cholesterol
Decreases HDL (good cholesterol)
Increases LDL (bad cholesterol)
Increase triglycerides
Causes depression
Causes fatigue
Decreases libido
Increases insulin resistance

Treatment
Compounded progesterone as a cream or
as a capsule
If you have insomnia as symptom then
choose progesterone by mouth which
affects the GABA receptors and has a nice
calming affect
Prometrium-- advantages and
disadvantages

Testosterone

Testosterone

Increases sexual interest

Increases sense of emotional well-being
Increases muscle mass and strength
Helps maintain memory
Helps skin from sagging
Decreases excess body fat
Helps maintain bone strength
Elevates norepinephrine in the brain (tricyclic
affectantidepressant effect)

Symptoms of Testosterone Loss

Muscle wasting
Weight gain
Fatigue
Low self-esteem
Decreased HDL (good cholesterol)
Dry, thin skin, with poor elasticity
Thinning and dry hair
Droopy eyelids
Sagging cheeks
Thin lips
Anxiety

Causes of Low Testosterone

Menopause
Childbirth
Chemotherapy
Adrenal stress or burnout
Endometriosis
Depression
Psychological trauma
Birth control pills
HMG-CoA-reductase inhibitors (statin drugs)

Symptoms of Increased
Testosterone

Anxiety
Depression
Fatigue
Hypoglycemia
Salt and sugar cravings
Agitation and anger
Facial hair
Acne
Insulin resistance
Weight gain
Hair loss or unwanted hair growth
Increased risk of heart disease

Treatment
Testosterone replacement by mouth or on the
skin
If used on the skin you must rotate sites.
In order for testosterone to work well, estradiol
must also be optimized.
Without enough estrogen, testosterone cannot
attach to brain receptors.
If testosterone is given alone it can increase
plaque formation (hardening of the arteries).
Elevated testosterone can be treated with saw
palmetto or metformin.

Adrenal Health
DHEA
Cortisol
Important for both men and women

DHEA
Is a hormone made by the adrenal glands.
A small amount is also made in the brain
and skin.
DHEA production declines with age
starting in the late twenties.
By the age of 70 the body may only make
of the amount of DHEA it made earlier.
DHEA makes estrogen, progesterone, and
testosterone in both women and men.

Functions of DHEA

Decreases cholesterol
Decreases formation of fatty deposits
Prevents blood clots
Increases bone growth
Promotes weight loss
Increases brain function

Functions of DHEA (Continued)

Increases sense of well being

Helps one deal with stress
Supports the immune system
Helps the body repair itself and maintain
tissues
Decreases allergic reactions

Low DHEA can be due to:

Menopause
Decreased production
Stress
Aging
Smoking (nicotine inhibits the production
of 11-beta-hydroxylase which is needed to
make DHEA)

Replacement of DHEA can:

Increase muscle strength and lean body mass

Activate immune function
Increase quality of life
Improve sleep
Increase feeling of wellness
Decrease joint soreness
Increase sensitivity of insulin
Decrease triglycerides
Stop the damaging effects of stress

Dosage
Women are more sensitive to the affects
of DHEA and need less DHEA than men.

Symptoms of DHEA Excess

Fatigue
Anger
Depression
Deepening of voice
Insomnia
Mood changes
Weight gain
Facial hair
Acne
Sugar cravings
Restless sleep
Irritability

Cortisol
Is the only hormone in the body that
increase with age.
Is made by the adrenal glands.

Functions of Cortisol

Balances blood sugar

Weight control
Immune system response
Bone turnover rate
Stress reaction
Sleep
Protein synthesis

Functions of Cortisol
(Continued)

Mood and thoughts

Influences testosterone/estrogen ratio
Influences DHEA/insulin ratio
Affects pituitary/thyroid/adrenal system

What Elevates Cortisol

Stress
Depression
High progestin intake

Consequences of Elevated
Cortisol

Decreased immune system

Increased osteoporosis risk
Fatigue
Irritability
Sugar cravings
Shakiness between meals
Confusion

Consequences of Elevated
Cortisol (Continued)

Low energy
Night sweats
Binge eating
Increased blood pressure
Increased cholesterol
Increased triglycerides
Increased blood sugar

Consequences of Elevated
Cortisol (Continued)

Increased insulin/insulin resistance

Increased infections
Thin skin
Easy bruising
Muscle weakness
Weight gain
Sleep disturbances

Abnormal Cortisol Levels Are

Associated With

Menopause
CFS
Fibromyalgia
Depression
Impotence
Anorexia nervosa

Abnormal Cortisol Levels Are

Associated With (Continued)

Panic disorders
PMS
Infertility
Sleep disorders
Osteoporosis
Heart disease

Adrenal Burnout
Cortisol and DHEA levels decline

Symptoms of Adrenal Burnout

Fatigue
Low blood pressure
Sensitivity to light
Insomnia
Digestive problems
Emotional imbalances
Hypoglycemia
Decreased sexual interest

Hormones Are A Web

If cortisol is increased, it decreases the making
of progesterone and its activity.
Cortisol competes with progesterone for
common receptors.
When cortisol is elevated, thyroid hormone is
more bound and less active.
Decreased estradiol in a women is a stressor to
her body (causes decline in function of NE,
serotonin, dopamine, and acetylcholine).

Pregnenolone
Precursor to DHEA, estrogen,
progesterone, and testosterone.
Decreases with age.
At age 75, most people have a 65%
decline compared to age 35.

Functions of Pregnenolone
Regulates the balance between excitation and
inhibition in the nervous system.
Increases resistance to stress.
Improves energy both physically and mentally
Enhances nerve transmission and memory.
Reduces pain and inflammation.
Blocks the production of acid-forming
compounds.

Pregnenolone Used in
Treatment Of

Arthritis
Depression
Memory loss
Fatigue
Moodiness

Elevated Pregnenolone Can

Cause
Acne
Drowsiness

Measurement of Hormones
Blood
Saliva
Urine

Tip #3
Be nutritionally sound
EPA/DHA (fish oil)

EPA/DHA
Decreases inflammation
Inflammation is the cause or contributing
cause of 80-90% of chronic disease

Inflammation
Inflammation and CV systemheart disease
Inflammation and the nervous system
Alzheimers disease, Parkinsons disease
Inflammation and the immune systemarthritis
Inflammation and the gutIBS, Crohns colitis
Inflammation and lung diseaseCOPD, asthma

Inflammation (Cont,)
Inflammation and the kidneys
glomerulonephritis
Inflammation and the hepato-bilary system
inflammatory liver disease
Inflammation and the endocrine system
diabetes (type II)
Inflammation and the reproductive system
prostatitis, cystitis
Inflammation and the musculoskeletal system
fibromyalgia, arthritis

Summary
Your health and the health of your staff
impacts the school system.
In medicine today we have the knowledge
to individualize care. Protocols will go by
the way side.
It is a new era in medicine which looks at
the cause of the problem, as opposite to
treating only the symptoms.

Summary (Cont.)
This new field of medicine is called antiaging and functional medicine. It looks at
the function of the body to keep you and
your staff healthy. There is now a two year
fellowship training program in this field and
board certification.