Download 9/11/08

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Nutr2 - Exam 3 (Final)
3/17/09
Endocrine Disorders
(part 2 – Insulin Resistance)
Increased obesity in the USA
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58 million overweight
40 million obese
3 million morbidly obese
80% people over 25 are overweight
78% don’t meet basic recommended activity level
25% are completely sedentary
Increased Diabetes
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76% increase in type II in 30-40 yrs old since 1990
90% diabetes is linked to high carb consumption
Diabetes alone represents 11% of US health care expenditure
Cost $98 billion in 1997(health care and lost wages)
In 2002, total cost went up to $132 bil.
Increased Nutrient Deficiencies
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Consumption of refined sugars causes severe deficiencies in nutrients that regulate blood sugars e.g. Bs and Mg, K
Excess sugar consumptions puts tremendous stress on the organs of blood sugar regulation: pancreas, liver, adrenals
One serving of sugar has been shown to decrease the immune response of certain white blood cells by 50% for over
8 hours
Sugar and CVD
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When 20 lbs. of sugar is consumed per year, there are 60 deaths per 100,000 due to CVD
When 150 lbs of sugar is consumed pre year, there are 300 deaths per 100,000 due to CVD
Increased dysfunctions associated with blood sugar dysregulation
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Hypoglycemia
CVD
Strokes
Diabetes
Oxidative stress
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Metabolic syndrome
Insulin resistance
Adrenal dysfunction
Pancreas dysfunction
Liver detox dysfunction
Insulin Resistance (IR)
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A state in which insulin receptors become unresponsive to the stimulation of insulin
– Defects in ligand/receptor binding
– Signal transduction
– Intercellular communication
– Polymorphism
– Found in 25-35% of population in westernized nations
– Major contributing factor to diabetes, CVD, sleep apnea, hormonal imbalance, obesity and certain kinds of
cancer
http://www.biblelife.org/rosedale.htm
Insulin Resistance
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Symptoms of Insulin Resistance
– Fatigue
– Cravings for sugar
– Unable to lose weight
– Constant hunger
– Fatigue after meals
– Migrating aches and pains
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Insulin Resistance
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Signs of IR:
– Elevated fasting or post-prandial glucose
– Elevated fasting or post-prandial insulin
– Elevated triglycerides
– Triglyceride : Cholesterol ratio > 1
– Low HDL
– Elevated uric acid
– Increased waist to hip ratio
– High blood pressure
– Central obesity
Insulin Resistance and CVD
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Blood pressure affected by the plasma levels of insulin in positive direct relationship.
Hyperinsulinemia may alter coagulation proteins involved in fibrinolysis
Plasminogen activator inhibitor 1 is elevated in hyperinsulinema
Insulin up-regulate HMG-CoA reductase
Impacts cholesterol ester transfer protein(CETP), lowers HDL levels
Increased BP, blood clot and cholesterol, lowers HDL
Am J Hypertens 1989;2:164-170
Metabolism 1993;42:945-949
Diabetes Metab Res 1991;7:139-153
Diabetes Care 1992;15:1258-1263
Circulation 1996;94(9):2057-2063
CETP = Cholesterol ester transfer protein
Insulin and Hormone Metabolism Disorders in Women
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Alters female hormone metabolism towards androgen dominance and estrogen dominance
4-10% women of reproductive age suffers from PCOS—leading cause of infertility
Symptoms of PCOS: hyperandrogenism, insulin resistance, chronic anovulation, irregular periods, infertility,
unexplained weight gain, fluid retention, fatigue, mood swings, acne, hair loss, unwanted hair growth, estrogen
proliferative cancers, acanthosis nigricans, increased risk of CVD and dyslipidemia
0best Gynecol Surv 2000;55:321-328
Contemporary Endocrinology: Insulin Resistance. Totowa NJ:Humana Press;1999:347-365
Fertil Steril 1992;85:3520-3525
J Clin Endocrinol Metab 2000;85:3520-3525
Am J Med 1995;98:27S-32S
IR and Androgen Dominance
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IR  androgen excess  IR
– Elevated testosterone, estrogen,
– Decreased sex-hormone binding globulin(SHBG)
– Increased androstenedione
– Increased DHEA, 17-hydroxy-progesterone and LH
Decreased SHBG causes overexposure of hormone to tissues
Euro J Endorinol 2000;143:383-388
J Clin Endocrinol Metab 1991;72:83-89
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IR and Sex Hormones
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IR leads to increase testosterone
Increase T blunt estrogen effect lead to anovulation
Anovulation reduces progesterone production
Reduced P lead to estrogen dominance
ED increases IR…
IR and Cortisol
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IR leads to increase cortisol and epinephrine
Cortisol suppresses insulin receptor…
3/18/09
IR, PCOS and Hyperinsulinemia
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Defects in the hypothalamus-pituitary feedback loop that sets up a pattern of elevated LH, anovulation and
menstrual irregularities (oligomenorrhea, anemorrhea, menorhagia)
The root of the problem is insulin resistance and adrenal disorder
Hormonal imbalance is only a symptom
-MSG stimulates appetite center, encouraging you to eat more
Conventional Treatments for Female Hormone Imbalance
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Oral contraceptives (OC) to suppress the pituitary feedback loop
Suppresses the production of ovarian androgen
Usually make worse the estrogen dominance problem by these synthetic estrogen
Chronic OC use may cause prolonged inhibition of the hypothalamus-pituitary-ovarian feedback loop—post-birth
control syndrome (inability to regain normal menstrual cycles)
Conventional Treatments
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GnRH analogue drugs (Lupron) to completely suppress all ovarian hormone production
Causing symptoms of hormone deficiency such as hot flashes, low libido, vaginal dryness
Exogenous synthetic hormone therapy is then Rx to treat deficiency symptoms
Glucocorticoid, prednisone, dexamethasone to suppress adrenal function
Increases risks and side effects
From Website: http://www.drugs.com/sfx/lupron-side-effects.html
Lupron
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most
COMMON side effects persist or become bothersome when using Lupron:
Breast tenderness; constipation; decreased sex drive; difficulty sleeping; hot flashes/sweating; impotence; infection (fever, chills, sore
throat); nausea or vomiting; pain; swelling; urination problems.
Seek medical attention right away if any of these SEVERE side effects occur when using Lupron:
Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blood in
urine; chest pain; dizziness or lightheadedness; fast or irregular heartbeat; increase in bone pain; severe drowsiness; severe headache;
swelling of the lungs; unusual or one-sided weakness; vision changes.
Conventional Treatments
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Androgen antagonists: ketoconazole, finasteride (side effects include cortisol production suppression, severe liver
toxicity)
Insulin sensitizing drug: metformen (lactic acidosis, malabsoption, B12 deficiency)
These should be the last resort instead of the first line therapy
Insulin and Hormone Metabolism Disorders in Men
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Hyperinsulinemia induces hypercortisolemia
Shifts progesterone conversion to cortisol
Progesterone protects the prostate
– Impacts nervous system function
– and has a role in osteoblast activity
Increases androstenedione and lowers DHEA—decrease vitality, weight gain and lowers testosterone level
Androstenedione has high affinity to testosterone receptors and acts as a testosterone antagonist at high levels
J Card Pharm 1997;30:523-527
FASEB 1992;9:1073-3074
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-this man is addicted to heroin
Insulin and Hormone Metabolism Disorders in Men
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IR increases body fat and aromatase activity
Aromatase converts testosterone into estrogen
Any patients that demonstrates aromatase upregulation need to be checked for adrenal and insulin resistance
problems
IR and Obesity
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Obesity due to impaired glucose transport, increase lipogenesis (fatigue and wt gain)
IR  hypercortosolemia  leptin resistance lead to lost of appetite control and inability to burn fat
Patient complaints of low energy, fatigue, hungry all the time, fat gain and not able to lose wt with exercise.
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IR And Liver Detox
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IR suppresses glucose-6-phosphate dehydrogenase (G6PD)  decrease hexose monophosphate shunt (HMS) 
decrease NADPH
NADPH is required for glutathione (GSH) production
Decreased GSH levels will compromise liver’s phase 1 and phase 2 detox pathways
IR And Cancer
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IR is associated with colorectal cancer and breast cancer
– J Natl Cancer Inst 1997;89:660-661
– Nutr Cancer 1997;27:316-320
IR And Essential Fatty Acid
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Low cellular insulin response inhibits the activity of the rate-limiting enzyme, delta-6-desaturase (D6D)
Lowers the conversion of linoleic and linolenic acid into GLA, EPA and DHA
Lowers D6D activity can alter the production of prostaglandins, eicosanoids and leukotrienes thus impact
intercellular communication
Decrease D6D will increase D5D activity and lead to increase arachidonic acid production and enhanced
inflammatory response
Prostaglandin Leukot Essent Fatty Acids 1997;57(4-5):379-385
Prog Lipid Res 1982;20:41-48
IR and Energy Metabolism
Decreases cellular uptake of glucose  decreased citric acid cycle pathway
Shift cells metabolism into an energy requiring lipogensis pathway
Produces an inflammatory state which will further short circuit the CAC and uncouple oxidative
phosphorylation pathways lead to lowered ATP production
• Alters EFA metabolism which inhibits lipolysis and beta-oxidation
http://www.sciencemag.org/cgi/content/full/300/5622/1140
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Conditions Associated with Hyperinsulinemia
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Acne
Addictions
Asthma
Cancer
Sweet cravings
Delay puberty
Mood disorders
Eating disorders
Weight gain
Heart burn and GI problems
Heart disease
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Hypercholesterolemia
High triglyceride
Infertility
Insomnia
Fatigue
Type II diabetes
Low estrogen
Estrogen dominance
Migraine headache
osteoporosis
Functions of Insulin and Glucagon
Insulin
Glucagon
Lowers elevated blood sugar
Raise low blood sugar
+ anabolism and energy storage
+ catabolism and release energy
Converts glucose and protein to fat
Concerts protein and fat to glucose
Store dietary fat
Converts dietary fat to ketone to use for energy
Remove blood fat into adipose tissue
Release fat from adipose for energy
Increase cholesterol production
Decrease cholesterol production
Stimulate the use of glucose as energy
Stimulate the use of fat for energy
Dr. Bernstein’s Diabetes Solution (considered the Bible for diabetes tx)
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Effects of Foods on Insulin and Glucagon
Food Group
Insulin
Glucagon
Carbohydrate
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No change
Protein
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Fat
No change
No change
Carb + fat
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No change
Protein + fat
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Hi Prot Lo Carb
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Hi Carb Lo Prot
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+
The Functional Approaches for MetS and Diabetes
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Improve insulin sensitivity
Reverse insulin resistance
Regulate liver gluconeogensis and glycogenolysis
Reduce postprandial hyperglycemia
Prevent systemic complications
Decrease or eliminate insulin use in T2DM
Decrease of eliminate oral hypoglycemic medications
Four Strategies
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Dietary modification
Supplementation with nutritional and botanical agents
Exercise
Lifestyle modification
Dietary Modifications For IR
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Reduce or eliminate all forms of simple and refined sugar from the diet
Eat whole and minimally processed foods
Eat plenty of organic produced protein as the main focus of the meal
Eat healthy fat liberally (traditional fats)
Eat only low glycemic carbohydrate, vegetables
Eat complex, unrefined carbohydrate
Eat mainly non-starchy vegetables.
Use only natural stevia as sweetener
Leptin diet
Nutritional Support for IR
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Vitamin E—men with lowest plasma levels of vitamin E had almost a 4 times greater incidences of getting T2DM.
Improve insulin sensitivity, lowers triglycerides and LDL, antioxidant that prevents oxidative complications
associated with diabetes, reduces CRP, glucose transport and anti-imflammatory.
400-1200IU mix tocopherol with at least 200 IU gamma tocopherol
Vitamin C— Found to be low in T2DM
Glucose and ascorbic acid compete for the same transport pathway
Vitamin C lowers serum glucose and CRP, inhibits glycation, prevents accumulation of sorbitol in retina, protects
against oxidative stress
1000-3000 mg daily
Gymnema sylvestre—reduces IR, decrease fasting blood glucose, enhance insulin action, may regenerate beta-cells
• Used for type I diabetes
Chromium—depleted in refined carbohydrate diet, common deficient in US diet, co-factor in glucose tolerance
factor which is important for insulin on receptor site and improve cellular glucose uptake, normalize post-prandial
glucose and insulin levels, glycated Hgb, serum cholesterol
Vanadium—insulin-like impact on receptor sites, improves function of glucose transport, improves intercellular
transduction reactions, reduces IR
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Nutritional Support for IR (cont)
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Alpha-Lipoic Acid—a sulfur-containing substance, improves insulin function by activating glucose transporters
(GLUT1 and 4) which enhance glucose disposal and reset signaling response to insulin, powerful antioxidant,
improves ATP production
Magnesium—deficient in IR patients, optimizes insulin secretion, activate glucose transporter, improves insulin
intercellular transcriptional response, 500 mg/day
Evening Primrose oil —hyperinsulinemia blocks D6D and reduce production of PgE1, EPO protect the insulin
receptors and reduce CRP, 900 mg/day
Biotin—improves insulin response to GTT, lowers post-prandial glucose levels, upregulate glucokinase (first step in
liver glucose utilization)
Zinc—protect beta-cells, increase insulin sensitivity, insulin metabolism, diabetics excrete zn
Inositol—ability to re-establish normal myoinositol levels in deficient neurons, helpful in diabetic neuropathy
Niacin—a component of GTF, potential to prevent the onset of type 1 diabetes, inhibits macrophage and
interleukin-1 mediated beta-cell damage, inhibits nitric oxide, has antioxidant function
L-Carnitine—enhance whole-body glucose uptake and increase gluconeogenesis, improves peripheral nerves and
vascular function, improves serum dyslipidemia in diabetics
Fiber supplement
• glucomannan (from Konjac root), slows sugar absorption for improve serum glucose control, 500-700
mg/100 calories in diet
• Fenugreek seeds, soluble fiber, 15 grams/meal reduces postprandial rise in blood sugar
Exercise
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Anaerobic strength training – increases insulin receptor sensitivity
Liftstyle Modification
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Stress reduction
Diet modification (reduce refined carbs)
Exercise
Reduces chemical exposure (including alcohol)
3/20/09
Functional Endocrinology and Nutrition
Part 3 - Detox, Thyroid
“Until you cleanse your organs, your vitamins and herbs will be useless and you won’t cure your illnesses”
-Dr. Richard Schulze (Medical Herbalist)
"Toxicology textbooks list the first symptoms of chronic poisoning as low energy, fatigue, muscle weakness, inability to
concentrate and intestinal complaints. These symptoms are virtually identical to those experienced by the chronically ill."
- Jeffrey Bland, Ph.D.
Toxins Interference
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Metabolism is the sum of catabolism and anabolism
The balance of metabolism is homeostasis which is health
The endocrine system directs metabolism
Every steps of the endocrine hormonal communication is vulnerable to toxins interference
Toxins: chemical, heavy metals, minerals imbalance, nutritional deficiency, metabolic wastes, emotional stress
Symptoms of Toxicity
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Furry coating on the tongue
Drowsiness after meals
Weight gain
Constipation - sticky stool
Tiredness upon waking in the morning
Halitosis (Bad breath)
Poor concentration
Mood changes
Acne / Boils
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Failing memory
Tiredness after minimal exertion
Joint pain and muscle ache
Poor appetite
Frequents colds and influenza
Low back pain - not traumatic
Depression
Candida infections
Irritable bowel
-if patient is fatigued, then don’t do a detox (need energy to detox)
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Gulf War Syndrome
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Recent government study finally admitted that chemical exposure are responsible for the multiple symptoms that the
veterans and their family are experiencing.
-http://www.gulfweb.org
Toxins, Toxins, Toxins
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It has been estimated that more than 36 million pounds of pesticide active ingredients are used annually in Nebraska.
Risk = Toxicity × Exposure
Toxicity is accumulative. That means they stored in the body over times. Increased exposure=increased risk.
The Environmental Protection Agency (EPA) currently recognizes more than four million chemical compounds.
More than 60,000 of these are produced commercially, with three new compounds introduced each day.
These are all chemicals not in existence 100 years ago.
Bioaccumulation
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An EPA biopsy study showed that 100% of people studied had dioxins, PCBs, dichlorobenzene, and xylene stored
in their bodies — some of the most potent causes of cancer known to us. These inescapable everyday chemicals
permeate every aspect of our lives.
A minute among over time and we cannot detoxify all of the many chemicals we inhale and digest every day, they
bioaccumulate in our tissues.
– Detox or Die, Sherry Rogers
Toxins Cause All Diseases
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Environmental toxins causing all diseases. Dr. Sherry Rogers describes the major health-destroying chemicals and
heavy metals, their sources, EPA studies, and how ubiquitous these substances are in our everyday environment.
Studies are cited showing that 95% of cancer, for instance, is caused by diet and environment.
Toxins in Cancer
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When cancerous breast tissue is compared with non-cancerous tissue from elsewhere in the same woman's body, the
concentration of toxic chemicals such as DDT and PCBs was "much increased in the malignant tissue
compared to the normal breast and adjacent adipose tissue.”
• Jerome B. Westin and Elihu Richter, "The Israeli Breast-Cancer Anomaly," in Devra Lee Davis
and David Hoel, editors, TRENDS IN CANCER MORTALITY IN INDUSTRIAL COUNTRIES
(New York: New York Academy of Sciences, 1990), pgs. 269-279.
Following public outcry, Israel banned these chemicals from being used on feed for dairy cows and cattle. Over the next ten years, the rate
of breast cancer deaths in Israel declined sharply, with a 30% drop in mortality for women under 44 years of age, and an 8% overall
decline. At the same time, all other known cancer risks--alcohol consumption, fat intake, lack of fruits and vegetables in the diet--increased
significantly. During this period, worldwide death rates from cancer increased by 4%. The only answer scientists could find to explain this
was the reduced level of environmental toxins.
It All Goes to Your Head
The most common organ affected by chemical exposure is the brain, leading to drowsiness, fatigue, exhaustion, sluggish
thinking, or a host of other symptoms
-Tired or Toxic, Sherry Rogers
• Detoxification is regarded highly in all traditional healing arts
Bowel Cleansing Program
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Before attempting a liver cleans, the bowel must be free of obstructions.
Constipation allows time for toxins to reabsorbed into the body
Pre-package bowel cleansing programs
Increase dietary fibers and water
Hepatic Detoxification
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Especially important for the chronically ill
Liver detox imbalance will make any endocrine problem patterns more difficult to evaluate and unresponsive to
treatment
Many times hormonal imbalance occurs as a result of compromised detox function
Patients usually presents with contradicting symptoms, history of toxin overload and drugs exposure (HRT)
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Hepatic Detoxification
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Symptoms of a compromised liver detox system:
– Neurological disorders
– Chemical sensitivity
– Adverse drug reactions
– Autoimmune problems
– Hormonal imbalance
– Blood sugar imbalance
– Fatigue
Hepatic Detoxification
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Defects in hormone detox can lead to many problems:
Partially breakdown hormones can compete with non-metabolized active hormones at the receptor site and blocks
their active functions
• Patient may present with symptoms of hormone imbalance but not supported by lab results, making
recommendations for treatment difficult for the less experienced practitioners
• Phase 1 and phase 2 detoxification pathways
• Phase 1—oxidative/reduction reactions involves the cytochrome P-450 enzymes pathway
• Uses oxygen and NADH to add a reactive group such as a hydroxyl radical
• Either complete neutralize the compound or renders it more reactive to bind with the phase 2 conjugation moiety
• Intermediates of phase 1 detox is more reactive and much more toxic—free radicals
• Pathological Detoxifier
• Patients with very active phase 1 detox and very slow or inactive phase 2 detox enzymes
• Most chronically ill patients have this problem
• Increase glutathione is imperative, NAC
• Glutathione also involved with phase 2 detox
• Phase 2—conjugation of phase 1 intermediates
• Neutralized toxins or make them more water soluble in order to be excreted via urine, sweat or bile
• 6 main pathways: glutathione conjugation, glycine conjugation, methylation, sulfation, acetylation and
glucuronidation
-beet root is a good methyl donor
-sulfur-containing compounds (like carnitine, taurine, methionine, N-acetyl-cystine) can increase production of glutathione
Liver Detox Profile
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Great Smokies Diagnostic Lab’s Comprehensive Detoxification Profile that include both phase 1 and phase 2 liver
detoxification functions.
Phase 1 test: Mainly a saliva sample, collected after the ingestion of a measured amount of caffeine for phase 1I system
For phase 2: urine or blood sample is collected after the ingestion of aspirin and acetaminophen depends on the profile selected.
The report include caffeine clearance (phase 1), conjugates of 4 phase 2 pathways. Ratio of phase 1 and phase 2 and other information can
be obtained depending on which profile tests selected.
3/24/09
Dietary And Lifestyle Support for Liver Detoxification
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Increase fruits and vegetable, cholesterol, whey protein (sulfur containing foods)
Exercises
Sauna—sweating and circulation
Skin brushing
Epsom salt bath
Colonic
Coffee enema
Liver and gallbladder flush
Fasting
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Nutritional and herbal Support For Detox Function
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Dandelion—improves liver and gallbladder function, promote bile production and secretion to the GB, contraction
of GB
Milk Thistle—increase bile solubility, reduces bile concentration, potent antioxidant protects against phase 1 free
radical damages to the liver, prevent glutathione depletion, anti-inflammatory, inhibits PGE2 and leukotriene,
promote liver cells regeneration
Ginger—increase bile production (cholagogue), reduces hepatic cholesterol
Lipotropic agents—Beet root and leaves (betaine HCl), taurine, vitamin C, lecithin (phosphatidylcholine)
Centella Asiatica (gotu kola)—improves histological findings of liver cirrhosis, venous insufficiency, venous
hypertension
Panax Ginseng—improves liver function, reverse fatty liver in animal models, anti-hepatotoxic properties,
promotes Kupffer cells, increases nRNA, rRNA and mRNA synthesis
Multiple vitamins and minerals to insure nutritional co-enzymes and co-factors sufficiency
B-complex, Mg, Zn, Mo, Se, K
Liver/Gallbladder Flush
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The purpose of this procedure is to assist your body in its efforts to maintain free-flowing bile and to help keep the
gall bladder free of debris.
First, natural forms of natural acids are used to “cut” the sludge or hardened bile to allow for it to be expelled from
the gall bladder, through the bile duct, into the colon and out the body.
Second, adequate amounts of magnesium are ingested which allows for relaxation of the smooth musculature,
including relaxation and contraction of the bile duct.
Third, a natural oil, e.g.., olive oil, or heavy cream is ingested to cause the gallbladder to contract, forcing the
expulsion of the bile sludge out of the gall bladder into the bile duct.
Finally, green tea and/or coffee enema may be used to stimulate the release of waste from the liver into the bile duct,
which also increases the rate of bile released from the liver.
Liver/Gallbladder Flush
DAYS 1-5:
• Eat a normal breakfast (supplements)
• Ingest as much apple juice as you feel comfortable. Use organic apple juice (free of preservatives). Fresh is always
best, then frozen, and lastly cooked, bottled apple juice.
• Add a total of 90 drops of ortho-phosphoric acid (Phosfood by Standard Process) to the apple juice each day. This is
taken at once (or 45 drops twice or 30 drops three times a day)
• Alternative, pure apple cider vinegar may be used instead of the ortho-phosphoric acid
DAY 6
• Eat a normal breakfast (supplements)
• 2 hrs. after breakfast, dissolve 2 TBSP Epsom salt in 3 ounces of warm, pure water and drink it. Chase with a little
citrus juice.
• If gall stones are present, take a coffee enema with ¼ cup Epsom salts dissolved in it.
• 5 hrs. after breakfast, dissolve 1 TBSP Epsom salt in 3 ounces of warm water, and drink it. Chase with citrus juice.
• 6-7 hrs. after breakfast, you have a choice:
- Fast, or
- Fruit and whipped cream salad (variety of fresh or frozen fruit of your choice and whipped cream).
Eat as much as desired
• At dinner time, drink one-half cup of extra virgin olive oil (unrefined) or other oil. If necessary, you may blend the
oil with an equal amount of fresh squeezed orange, grapefruit or diluted lemon juice. Or alternate swallowing oil
with juice. Should nausea be felt, it is due to the contraction of the gall bladder. Lay on your right side for at least
20 minutes.
• In the morning, drink 3 ounces of water with 1 TBSP Epsom salt dissolved in it, also if stones are present, take
another coffee enema with ¼ cup of Epsom salt dissolved in it. Resume your normal diet.
• Can repeat flush in 2 weeks, if needed.
-if patient has gallstones, then take a lot of betaine HCl (and/or apples) before doing a gallbladder flush
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Liver/Gallbladder Flush
Contraindications/cautions
• Stones are calcified and very large
• During pregnancy
• If liver disease is present
• The gallbladder in non-functional
• If patient is very obese
Fasting
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An integral part of many religions—Buddhism, Islam, Judaism and Christianity
When the glucose store in body is depleted fat and carbohydrate stores are used for energy
When protein stores begin to be depleted for energy (resulting in loss of muscle mass)—starving.
Autolysis—breaking down of fat stores in the body in order to produce energy
Ketosis—depleted glycogen lead to the breaking down of stored fats and creates these ketone bodies
Fasting Benefits
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Detoxification--normal body process of eliminating or neutralizing toxins through the colon, liver, kidneys, lungs,
lymph glands, and skin
Enhance immunity--during a fast, energy is diverted away from the digestive system towards the metabolism and
immune system
Growth hormones are also released during fasting
A slower metabolic rate, more efficient protein production, an improved immune system, and the increased
production of hormones contributes to this long-term benefit of fasting
Rejuvenation and extended life expectancy
The only reliable evidence to extend the lifespan of a mammal is caloric restriction without malnutrition
Homotoxicology
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“The theory of disease developed by Dr. Hans-Heinrich Reckeweg (1905-1985), understands illness as the human
body’s defense against toxic substances (homotoxins) that threaten to overwhelm the intercellular matrix. According
to this therapeutic model, the type and severity of an illness are determined by the duration and intensity of toxin
loading in relationship to the body’s inherent capacity for detoxification. «Clogging» of the matrix obstructs the
movement of nutrients from blood vessels into cells, disrupting the body’s steady state and hindering important
biological processes. The resulting disturbances, which eventually manifest as illness, are the body’s attempt to
restore a state of biochemical balance. For Reckeweg, restoring this balance was the ultimate goal of all medical
treatment.”
• http://www.heel.com/homotox/
The Six Phase Table
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Subdivided into three blocks
Each block has two phases
Humoral phases:
• Excretion
• Inflammation
Matrix phases:
• Deposition
• Impregnation
Cellular phases:
• Degeneration
• Dedifferentiatio
n
3/25/09
Fasting
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Juice Fast—3-7 days or more
Water fast—3 day max, but natural hygienists promote prolong water fast as a way to heal serious illnesses.
No food nor water—24 hours
Brown rice fast—3-7 days
Master Cleans (Water/lemon/lime/maple syrup/cayenne pepper)—3-21 days
Raw food—7-21 days
Fasting/detox programs—combining raw food or caloric restricting diet with herbal and nutritional supplements (721 days)
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Fasting Precaution
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Wasting states
Pregnancy and nursing
Infants and children
Medication
Gallstone
Physical activities—depends on the type of fasts
– None for water or abstinence of food (avoid physical activity with water fast)
– Light exercise for juice, lemon/lime/maple syrup fast
– 30-45 minutes moderate, raw food, weight loss fast
What to Expect During a Fast?
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Tired the first day or two
Increase energy when ketosis established
Increase urination
Bowel movement will increase or decrease depends on types of fasts
May experience euphoria on the third day onward
How to break a fast?
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Short fast, just resume normal eating
Longer than three days, start with something light for dinner, gradually add back normal foods
21 days fast, normal raw veggies and fruits, add light protein for dinner, the first day, add more the next day to
lunch, resume normal the third day at breakfast
Continue on with a healthy dietary style
Thyroid Disorders
Most patients with functional thyroid problems do not have primary thyroid imbalances
-insulin can inhibit proper
conversion of T4 to T3
-gut flora can convert T4 to T3
Low Thyroid S&S
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Fatigue
Increase wt gain with low cal diet
Morning headache wears off as day progresses
Depression
Constipation
Hypersensitivity to cold weather
Poor circulation and numbness in extremities
Muscle cramps while at rest
Chronic infections
Loss of lateral third of eyebrow
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Slow healing wounds
Required more sleep to function
Chronic digestive problems
Hypochlorhydria
Itchy dry skin
Dry brittle hair
Hair loss
Lower axillary temperature
Edema (myxedema)
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Serum Thyroid Panel
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TSH—lab reference range: 0.5-5.5, functional range: 1.5-3.5
– Hypothyroid—above 3.5
– Hyperthyroid—below 1.5
Free T4—can be altered by many drugs
Free T3—active thyroid hormone, impacted by drugs
Thyroid antibodies—auto-antibodies indicates autoimmune attack of thyroid
Malnutrition or Hypothyroid
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Symptoms are similar
Insulin resistance is a major factor
– IR impair cellular utilization of macronutrients
– IR cause weight gain lead to the mistaken action of eating low fat and low protein diet
– Leads to malnutrition
– IR also cause under conversion of T4 to T3, a protective mechanism to slow down the effects of
malnutrition
Hypothyroidism is a malnutrition problem
Tyrosine and Iodine for Thyroid?
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Caution should be exercise when using tyrosine and iodine
Use improperly can cause suppression of thyroid hormone production
The relationships of tyrosine and iodine metabolism is more complicated then simply supplementing them without
thorough understanding of the whole symptoms picture
Tyrosine may be indicated for vegans
Increase iodine can be used for hyperthyroidism
Always support the adrenals first with thyroid problems, don’t treat the thyroid and ignore the adrenal which is
usually the underlying cause of thyroid problems.
Nutrition And Herbs For the thyroid
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Procine thyroid glandular—Armour Thyroid, a prescription thyroid HRT, Apex Energetics and American
Biologic produce desiccated thyroid glandular
Withania (Ashwangandha)—stim both T3 and T4 production, support hepatic function, reduces oxidative stress,
adaptogen activity that modulate cortisol release
Vitamin A—influence thyroid hormone nuclear receptors transcription activation
Vitamin D—immune modulation, suppresses autoimmune thyroiditis (Hashimoto)
Selenium—co-factor for 5’deiodinase which convert T4 to T3 and degrades rT3
Zinc—improves thyroid fxn, co-factor for 5’deiodinase, reduces thyroid antibodies
Commiphora (Gugulipid)—stim. T3 production, reduce LDL, cholesterol and lipid peroxides
Antiperoxidative compounds—lipid peroxidative and antioxidant enzymes systems play a profound role on the
peripheral thyroid hormone conversion. Substances (alpha lipoic acid, N-acetyl cysteine, protein, B-complex) that
support the synthesis of glutathione and decrease free-radical and oxidative stress (antioxidants, bioflavonoids,
polyphenol, OPC) will improve thyroid hormone conversion and thyroid function
Omega-3 EFA—imbalance of eicosanoids is linked to inflammatory reactions and thyroid disorders
-Iodoral supplement (~12mg iodine)
-excess iodine (10x the RDA) is not toxic for the body)
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Thyroid HRT
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Desiccated Thyorid—generic or brand name desiccated pig thyroid (Armour Thyroid, Westroid, Naturethroid,
Proloid)
Cytomel—brand name for synthetic T3
Levothroid—brand name for synthetic T4
Levothyroxine—generic T4
Levoxyl—brand name T4
Synthroid—brand name synthetic T4 (most Rx drug in the US)
Thyrolar—brand name fixed-ratio mix of synthetic T3 and T4
Patients may respond well to natural thyroid replacement or synthetic ones
If synthetic not working well, suggest to patient to consult with their MD to switch to natural replacement which
may work better and vise versa.
Synthetic usually to be taken on empty stomach, in the morning, avoid taking calcium along
Natural thyroid med better be taken in 2 divided doses, after breakfast and dinner for optimal function according to
Joseph Mercola, DO (www.mercola.com)
What happens when you give thyroid hormones to a malnourished without re-feeding?
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Initially feels better
Unravels the protective mechanism against rapid tissue breakdown
Thyroid meds are stimulants
Increases IR and accelerates muscles and protein reserves breakdown
Health deteriorates rapidly
Hormone replacement must be used with caution
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Functional Endocrinology and Nutrition (on Final exam)
Part 4 - Female Hormonal Problems
“Because the family of glands is closely interrelated, it is difficult to hurt one member without injuring others.”
-Endocrine Handbook by Harrower
Female Hormonal Imbalance: Estrogen Dominance
The Female Cycle
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The female menstrual cycle is a complex interactions and orchestration of many hormonal messengers.
Endocrine disruptors are especially damaging to the female cycles because most of these chemicals are also estrogen
mimics.
Estrogen
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Estrogen's functions are primarily the growth and development of sex organs and other tissues related to
reproduction
Water retention
Fat storage
Maturation of the female adolescents
Stimulate endometrial growth during the first half of menstrual cycle.
Promote target cell proliferation
Develops progesterone receptors
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Estrogen (cont)
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Inhibits osteoclast activity and retard bone resorption
Over thirty different forms of estrogen have been described.
Produce by the ovaries in females
Can be converted from testosterone by aromatase in adipose tissues
The most common are:
• Estrone (E1)—10%
• Estradiol (E2)—10%
• Estriol (E3)—80%
Progesterone
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Progesterone is the other primary female hormone.
Balance the activities of estrogen.
Produced in the ovaries and the adrenal gland.
Precursor for both estrogen and testosterone, as well as cortisol.
Functions of Progesterone
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Target cell differentiation and maturation (to grow up and be )
Maintain the endometrium in pregnancy
New bone formation (stimulate osteoblasts)
Blood pressure regulation
Fat conversion and energy production
Sugar metabolism
Maintaining myelin
Regulating estrogen production
Increasing estrogen receptors sensitivity
Estrogen and Progesterone
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Estrogen has to be in balance with progesterone to function well in the body.
The excess or deficiency of either hormones will cause symptoms and disruption of the normal working of the
endocrine system.
Insulin, thyroid hormones and adrenal hormones (the major endocrine hormones) all exert influence.
Estrogen Dominance
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Anxiety, irritability, anger and agitation, mood swings
Cramps, heavy and prolong bleeding, clots
Breast tenderness
Water retention and weight gain
Fibrocystic breast
Sweet cravings
Foggy thinking
Allergies
Cervical dysplasia
Increased risk of cancers
Increased risk of autoimmune diseases
Back pain
Acne
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Uterine fibroids
Endometriosis
Irregular periods
Insulin resistance and unstable blood sugar
Lost of sex drive, infertility
Gall bladder problems
Insomnia
Osteoporosis
PCOS
Fat gain in hip and thigh areas
Causes of Estrogen Dominance
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Nutritional deficiency
Insulin resistance
Adrenal Stress--hypercortisolemia
Chronic inflammation
Excess of estrogen in comparison to Progesterone.
Estrogen disruptors or xenoestrogen—HRT and Oral Contraceptives
Other endocrine disruptors—thyroid disruptors
Digestive issues
Hepatic detoxification issues
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Endrogen Dominance
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Increased androgens (testosterone and DHEA) produce metabolic disorders in women
– Insulin resistance
– Central obesity
– T2DM
– CVD
– PCOS
– Poor glycemic control and poor health
Insulin Resistance
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Hyperinsulinemia upregulates 17,20-lyase, an anzyme produced in the theca cells
17,20-lyase increases androgen production by shifting away from estrogen production
Increased androgens in women promotes insulin resistance and the vicious cycle goes on and on…
Androgen dominance, estrogen dominance and insulin resistance promotes reproductive organs cancers in women
Xenostrogens
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DDT
DES
Dioxin
Drug version of HRT
Plastics
Pesticides
Cosmetic and skin care products
Perfume
Laundry products
Phytoestrogens
WHI Findings on HRT
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Findings from the Women's Health Initiative (WHI) studies showed that women using estrogen with or without
progestin may increase their chances of strokes and blood clots.
Using estrogen with progestin also increased a woman's chance of getting breast cancer and heart attacks, but using
estrogen alone did not.
For women with a uterus on hormone therapy, a combination of estrogen plus progestin is prescribed.
For women who have had a hysterectomy, hormone therapy consists of estrogen alone.
Using estrogen with or without progestin may increase the risk of dementia in women age 65 years or older.
Estrogen, with or without progestin, may decreased women's chances of developing osteoporosis. Estrogen with
progestin decreased the risk of colorectal cancer in women.
– FDA Press Release P04-94, September 29, 2004.
Risks and Benefit of HRT
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For some women, menopausal hormone therapy may increase their chances of getting blood clots, heart attacks,
strokes, breast cancer, and gall bladder disease. For a woman with a uterus, estrogen alone slightly increases her
chance of getting endometrial cancer (cancer of the uterine lining).
benefits of using hormones for menopause, HRT is the most effective FDA approved medicine for relief of hot
flashes, night sweats, and vaginal dryness. It may also reduce the chances of getting weak bones, a condition called
osteoporosis.
• FDA Press Release P04-94, September 29, 2004.
HRT and Heart Disease
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Women with or at high risk of coronary heart disease should not start HRT
Women without coronary heart disease might experience even greater net harm from HRT.
• Archives of Internal Medicine October 23, 2000;160:2897-2900
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HRT and Stroke
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An analysis of some 40,000 women involved in 28 clinical trials has discovered: Women who use HRT increase
their risk of stroke by 29 PERCENT and the likelihood of a fatal or disabling stroke by 56 PERCENT.
The effect is seen in ischaemic strokes, caused by blockages of blood flow to the brain, not in the less common form
of hemorrhagic stroke.
The University of Nottingham research team recommended patients with a high risk of stroke should stop taking
HRT unless there is a strong medical reason not to do so.
• BMJ, January 7, 2005
Three Major Problems
1.
2.
3.
Soy
Trans Fatty acids
Refined Carbohydrate
Soy Alert
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“Deleterious effects include endocrine disruption, thyroid suppression, immune system suppression, suppression of
sperm production, DNA breakage and increased incidence of leukemia, breast cancer, colon cancer, infertility,
growth problems and subtle changes in sexually dimorphic behaviors.”
• http://www.westonaprice.org/soy/dangersisoflavones.html
Soy Isoflavone
China (1990 survey)
3 mg/day
Japan (1996 survey)
10 mg/day
Japan (1998 survey)
25 mg/day
Japan (2000 survey)
28 mg/day
In Japanese subjects receiving adequate iodine, causing thyroid suppression after 3months
35 mg/day
In American women, causing hormonal changes after 1 month
45 mg/day=0.75 mg/kg*
In American women, causing changes presaging breast cancer after 14 days
45 mg/day
FDA recommended amount
24 mg/day
AdvantaSoyTMClearTM
30-50 mg/ 100 g serving
In children on soy formula
38 mg/day=6.25 mg/kg*
*assumed 60 kg for adult, 6 kg for infants
Source: www.westonaprice.org
Trans Fatty Acid
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Unnatural
Disrupt cell membrane
Disrupt cell receptors
Disrupt essential fatty acid metabolism
Disrupt hormone productions
Refined Carbohydrate
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Carbohydrate intake increases insulin
Insulin encourages fat gain
Fat tissues increase estrogen
Estrogen also promote fat gain
Estrogen also induces insulin resistance
Insulin resistance cause carbohydrate cravings…..
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2 / 4 /16 Estrogen Metabolites
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To understand all the complex interactions involved is nearly impossible!
But we can rely on the body to clear it all up once we find the causes and solutions are available.
Tests and Evaluation
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Hair Analysis
Saliva hormone tests
History
Lifestyle assessment
Questionnaires: endocrine assessment, metabolic typing, emotional, behaviors, symptoms survey
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Solutions
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Clean up the environment
Clean up the diet, rely on whole foods
Clean up the body, detoxify liver, GI tract
Exercise and dietary modification
Hormone modulating herbs and supplements
Bio-identical hormones (must be tested first and monitor regularly)
Stress management
Balance blood sugar
Agricultural and food processing reform
Hormone Modulating Herbs
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Black cohosh
Blue cohosh
Licorice
Chaste tree
Wild yam
Dong Qui
Red clover
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Raspberry leaves
Ginseng
Tribulus
Gymnema
White peony
Shepherd’s Purse
Hormone Modulating Herbs
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Black Cohosh—modulates estrogen effects in the body, improves estrogen deficiency symptoms, decreases hot
flashes, increase pelvic blood flow, reduce spasms, reduce depression
Dong Quai—has “selective estrogen receptor modulator” properties, 1/400th the activity of true estrogen on cells,
useful in both estrogen deficiency and excess conditions, hemotonic, analgesic, anti-inflammatory, anti-allergenic,
cardiocprotective, mild laxative, increase vaginal secretion
Chaste Berry (Vitex Angus-Castus)—optimizing impact in luteal phase function, increases progesterone levels
and LH, decreases FSH, modulates prolectin associated with hyperprolactinemia induced by corpus luteum
insufficiency, reduces PMS symptoms, improve fertility and optimizing luteal phase funcition
Sheperd’s Purse (Capsella busa-pastoris)—increase uterine tone, hemostatic properties, helpful in dysmenorrhea
associated with progesterone deficiency, help shedding of uterine lining (excessively thickened due to estrogen
dominance), also helpful in treating hemorrhoids and diarrhea
Chem Pharm Bull 1992;40(4):954-946
Chinese Herbal Medicine Materia Medica, Bensky D, et al
The complete Botanical Prescriber, Sherman JA.
Acta Pahrmacol et Toxical 1983;52:246-253
Nutrients For Hormone Balance
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Calcium
Magnesium
Zinc
Vitamine E
Vitamin B complex
– B6
– Pentothenic acid
Vitamin C
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Vitamin D
Cod liver oil
Evening primrose oil
Gamma linolenic acid
Wheat germ oil
Glandular extracts
Nutrients For Hormone Balance
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Pyridoxal-5-phosphate—reduces tissue hypersensitivity to estrogen, modulate hormone receptor complex and the
binding of this complex to DNA, deficiency of B6 lead to exaggerated symptoms of estrogen excess with normal or
slightly increased estrogen levels
Magnesium—essential for hepatic Phase II detoxification of estrogens, co-factor for Catechol-O-methyltransferase
(COMT) which converts estrogen metabolites from phase I into water-soluble metabolites, up-regulates glucuronyl
transferase which helps detoxify estrogens
Vitamin B12—essential support for phase II, methylation pathway
Indole-3-Carbinal(I3C)—natural compound found in cruciferous vegetables, shifts the 2/16 ratio in favor of 2-OH
estrone which is not carcinogenic.
Diindolylmethane(DIM)—More active then I3C, but less stable
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Principles for Health
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Optimize GI fxn: digestion and absorption
Support liver detoxification
Support lymphatic function—skin brushing, rebounding, walking, dancing
Proper breathing to increase blood O2
Promote adrenal health by managing stress and reducing adrenal stimulants
Maintain normal glycemic control
Whole, real, organic, locally-grown food diet
Pure drinking water
Proper exercises—aerobic and anaerobic
Avoid fake fats
Avoid all artificial sweeteners
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Functional Endocrinology and Nutrition
Part 5 - Male Hormonal Problems
Male Hormonal Disorders
Andropause—decline in testosterone production in males
Andropause
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A gradual decline in men’s ability to maintain an androgen dominant state
Production of testosterone decline
Emerging health problem in developed nations
Due to increased exposure of xenoestrogens, exotoxins in the environment, stress, EFA and nutritional deficiencies,
and impaired hepatic detox function
A product of chemical, physical and environment factors—industrialization
Primary, secondary and functional
Functional is the most common cause
The ratios between testosterone and other hormones changed, the most common between testosterone and estrogen
Normal T:E should be 50:1
Estrogen dominant syndrome in men
Can be found in men of all ages from late 20’s to the aged
Typically presents a middle-age man with gradual decline in sex drive, strength, energy and enthusiasm for life,
inactive, physical and mental fatigue for no apparent reason, depressed, pessimistic, difficult to get along,
deteriorating family and social relationships, erectile dysfunction
http://www.andropause.com/
http://health.discovery.com/centers/mens/articles/andropause.html
S/S of Andropause
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Typically identified with low testosterone levels
Obesity
Increased waist-to-hip ratio
Insulin resistance
Hyperglyceridemia
Hyperlipidemia and hypercholesterolemia
Low HDL
Low LDL
Increased fibrinogen levels
Increased lipoprotein B
Venous congestion
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Mental fatigue and poor concentration
Depression
Lost of initiative
Myalgia
Decrease in
• morning erection
• Fullness in erection
• Libido
• Physical stamina
• Visual acuity
Testosterone Functions
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Cardiovascular—heart has more testosterone receptors than any other muscles in the human body, statin lowers
cholesterol has been shown to reduce testosterone
Energy and hemopoesis—as T decline, so does RBC count, reduced O2 leads to lowered ATP production
Bone density—testosterone and progesterone stimulates osteoblasts activity
Prostate health—testosterone is not responsible for prostate hyperplasia, both DHT and estrogen induce prostate
hypertrophy
Sex drive—testosterone promotes libido in both sexes
Moods—testosterone promotes a man’s sense of well-being and mood
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Causes of Male Hormone Imbalance Problems
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Andropause—overall reduction of T
Adrenal stress disorders—increased cortisol and estrogen dominance
Prostate hypertrophy—lowered progesterone
Gastrointestinal disorders
Hepatic detoxification problems—most common reason for low DHT
Nutritional deficiency—EFA, vitamins and minerals
Statin drugs and corticosteriods
Insulin resistance
Insulin Resistance
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As levels of T wane in men, glycemic control goes out of control
Reduced T and increases in cortisol lead to insulin resistance, central obesity and metabolic disorders
Declining T may be the primary driving factor for IR, MetS and CVD in men
Diabetes 1996;45:1605-160
Benign Prostatic Hyperplasia
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Voiding problems such as decreased caliber of urine stream, hesitancy, intermittency, staining, incomplete emptying
and urine retention
Storage problems such as urgency, frequency, nocturia, dysuria, urge incontinence
These may also relate to bladder tone, especially in older men
• The Lancet 2003;361(9366):1359-1367
BPH Pathogenesis
Two theories:
1. Mechanical components or the hormone dependent hyperplasia
• Androgen hypothesis
• Estrogen hypothesis
2. Dynamic component or alpha-adrenergic tone
• Modern Phytotherapist 2003;7(2):22-28
Androgen Hypothesis
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Prostate function and growth are androgen dependent
In the prostate, T is converted to DHT by 5-alpha reductase
DHT is the active intracellular androgen which binds with the nuclear androgen receptor. This complex then bind to
a specific DNA sequence, initiating mRNA production, protein synthesis, cell growth
• Modern Phytotherapist 2003;7(2):22-28
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Estrogen Hypothesis
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Estrogen originate from T and androstenedione via the action of aromatase
Observation from experiment showed that administration of estrogen could induce BPH
As men age, endocrine environment becomes more estrogen dominant with a dramatic increase in estrogen compare
to T
It has been shown that estrogen, mediated by sex hormone binding globulin (SHBG), participates with androgen in
setting the pace of prostate growth
SHBG has been shown to increases with age and can act like an additional androgen receptor
It is suggested that E binds to SHBG in the cell membrane, IGF-1 is synthesized leading to proliferation of prostate
epithelial cells
Further addition to the proliferating stimulation by androgens
• Modern Phytotherapist 2003;7(2):22-28
Dynamic Component
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Urethral obstruction—prostatism
Alpha-adrenergic (sympathetic) fibers innervate the smooth muscle of the prostatic urethra and bladder neck
Contraction of this smooth muscle can lead to BPH symptoms
Alpha-adrenergic blocker such as prozosin hydrochloride are usually prescribed to alleviate prostatism symptoms
Sympathetic dominance caused by stress may contribute to neurogenic inflammation and BPH symptoms
• Modern Phytotherapist 2003;7(2):22-28
Herbal Support for Andropause
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Tribulus terrestris—supports sexual dysfunction for both sexes, improves spermatogensis, increase sertoli cells LH
and T in males
Lepidium meyenii (Maca)—enhances fertility in both sexes, increase spermatogensis, and hormones, aphrodisiac,
adaptogenic
Chrysin—passion fruit flower extract, inhibits aromatase activity, thus prevents the conversion of T into Estrogens,
antioxidant, anti-inflammatory, anti-histamine, anti-viral, anti-cancer
Panax Ginseng—increases T production, promotes spermatogensis, libido
Saw Palmetto (Seronoa repens)—reduce 5-alpha reductase activity and lowered DHT which stimulates prostate
cell to proliferate, reduce symptoms of BPH
• Cautions: overdoes can reduce T production
Pygeum Africanum—reduced benign prostate hypertrophy (BPH) similar to Saw palmetto
Cerniltion—inhibits growth of prostate cells, reduces BPH and related symptoms: urinary urgency, dysuria,
nocturia, incomplete voiding and dribbling
Stinging Nettle (urtica dioca)—intercepts DHT and receptor binding, reduces BPH
Nutritional Support for Male Hormone Disorders
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Zinc—improves male fertility and T concentration, down-regulates 5-alpha reductase and reduces DHT, inhibits
prolactin levels
Amino Acids (glycine, glutamic acid, alanine)—influences neurotransmitters activity of the bladder and relieve
BPH symptoms
Summary of Functional Endocrinology
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Complex interactions of endocrine glands to each other, to the environment, internal and external stressors
Interactions of major hormones: cortisol, insulin, thyroxin, and adrenalin
Interactions of major hormones with minor hormones: estrogens, progesterone, testosterone,
Look for the root cause of problems
Support whole body health by addressing the 3Ts: Trauma, toxins and thoughts
Don’t miss digestive, liver detox and adrenal stress issues
Focus on using dietary and lifestyle changes, wholesome foods, whole food based supplements (priority), individual
nutrients for short term corrective action, essential fatty acids, anti-oxidants, botanicals
Chiropractic care and nutritional counseling form a solid foundation for a wellness care program
Resources
•
Seminar: Dr. Datis Kharrazian—Functional endocrinology, Functional Blood Chemistry
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