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Nutritional Endocrinology: The New Frontier in Health Care by Dr. Ritamarie Loscalzo www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Medical Disclaimer: The information in this presentation is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Ritamarie Loscalzo, drritamarie.com, and the experts who have contributed. We encourage you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. This presentation is provided for informational purposes only and no guarantees, promises, representations or warranties of any kind regarding specific or general benefits, have been or will be made by Dr. Ritamarie Loscalzo, her affiliates or their officers, principals, representatives, agents or employees. Dr. Ritamarie Loscalzo is not responsible for, and shall have no liability for any success or failure, acts and/or omissions, the appropriateness of the participant’s decisions, or the use of or reliance on this information. www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Disease Management vs True Health Care www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) From Health Crisis to Health Coach www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) What Do You Need to Help Them? Superior interview “Detective” skills: skills: Knowing Functional what to ask assessment tools Excellent listening Labs skills History taking In depth Physical evaluations understanding of Home tests “inner workings” A complete holistic of the body toolbox A system Love and understanding Tools and resources www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) What’s At The Heart Of Most Of These Tough Cases HORMONES www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) The Endocrine System www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Hormone Definition and Types Chemical messengers secreted by glands: Endocrine: into blood stream Exocrine: directly into target tissue www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Hormone Functions Messengers of life Control physiological and behavioral activities Digestion Metabolism Growth and repair Reproduction Mood Nutrient absorption Immune system Stress response Appetite Cardiovascular function Fluid balance Blood sugar www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Hormone Receptor in Cell Membrane www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Endocrinology is not a subspecialty. It is the Master Control Center! www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Nutritional Endocrinology www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) What Interacts With Hormones? Nutrients Foods Digestion www.DrRitamarie.com Stress Sleep Environment Other Hormones © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Nutritional Endocrinology Hierarchy of Interventions Food Lifestyle • • • • • Attitude Stress management Sleep Exercise Environment Herbs Isolated nutrients Bioidentical hormones – natural source www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) lab testin www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Understanding the Complex Web of Hormone Imbalances Connection between hormones and persistent symptoms in seemingly unrelated areas Relationships among nutrition, lifestyle, and endocrine imbalances www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Appetite & Digestion Stress Response Nervous System Blood Sugar Sleep Cardiovascular HORMONES Emotions Respiratory Reproduction Immune System Detoxification Metabolism www.DrRitamarie.com Growth & Repair © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Connection Between Hormones And Persistent Symptoms Fatigue and lethargy Weight gain / weight loss (yo-yo) Insomnia Depression, anxiety, and mood swings Skin lesions Anorexia Cold intolerance Hair loss Headache www.DrRitamarie.com Weakness Shortness of breath Brain fog Decreased libido insomnia Neuromuscular disturbances Impaired immune system High cholesterol Angina Cancer… © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Cortisol Adrenaline Pregnenalone ACTH DHEA Aldosterone GHRH CRH GnRH ADH Oxytocin Somatostatin TSH Reverse T3 TRH Thyroxine (T4) Triiodothyronine (T3) www.DrRitamarie.com CCK Secretin Gastrin Leptin Incretin Ghrelin © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Hormone Families Blood sugar balancing hormones Metabolic rate hormones Stress hormones Sleep hormones Sex hormones Digestion hormones Cardiovascular hormones Organ specific hormones www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Master Hormone Control www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) The Hypothalamus Controls: Temperature Hunger Glucose and insulin levels Aspects of parenting and attachment behaviors Thirst Moods www.DrRitamarie.com Energy and fatigue Sleep Circadian rhythms Blood pressure Heart rate Growth and repair Gut motility Sex drive © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Brain Hormones: Hypothalamus Hormone Produced by Actions Thyrotropin-releasing hormone (TRH) Parvocellular neurosecretory cells of the paraventricular nucleus Stimulate thyroid-stimulating hormone (TSH) release from anterior pituitary (primarily). Parvocellular neurosecretory cells of the paraventricular nucleus Stimulate prolactin release from anterior pituitary. Parvocellular neurosecretory cells of the paraventricular nucleus Stimulate adrenocorticotropic hormone (ACTH) release from anterior pituitary. Dopamine neurons of the arcuate nucleus Inhibit prolactin release from anterior pituitary. Neuroendocrine neurons of the arcuate nucleus Stimulate growth hormone (GH) release from anterior pituitary. Prolactin-releasing hormone (PRH) Corticotropin-releasing hormone (CRH) Dopamine aka Prolactin-inhibiting hormone (DA or PiH) Growth hormone-releasing hormone (GHRH) Gonadotropin-releasing hormone (GnRH) Somatostatin, aka growth hormoneinhibiting hormone (GHiH) Neuroendocrine cells of the preoptic area Neuroendocrine cells of the periventricular nucleus www.DrRitamarie.com Stimulate follicle-stimulating hormone (FSH) release from anterior pituitary. Stimulate luteinizing hormone (LH) release from anterior pituitary. Inhibit growth hormone (GH) release from anterior pituitary. Inhibit (moderately) thyroid-stimulating hormone (TSH) release from anterior pituitary. © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Additional Hypothalamus Jobs Nucleus Function/hormone released Medial preoptic nucleus Supraoptic nucleus Paraventricular nucleus GnRH Anterior hypothalamic nucleus Suprachiasmatic nucleus Lateral nucleus Dorsomedial hypothalamic nucleus Vasopressin (anti-diuretic hormone – ADH) Thyrotropin-releasing hormone (TRH) Corticotropin-releasing hormone (CRH) Oxytocin Somatostatin (growth hormone release inhibiting hormone – GIH) Thermoregulation Panting Sweating Thyrotropin (thyroid-stimulating hormone – TSH) inhibition Circadian rhythms Ventromedial nucleus Arcuate nucleus Lateral nucleus Mammillary nuclei Posterior nucleus www.DrRitamarie.com Thirst and hunger Blood pressure Heart rate GI stimulation Satiety Neuroendocrine control Growth hormone-releasing hormone (GHRH) Appetite and glucose regulation (triggered by leptin, insulin, and glucose) Dopamine Thirst and hunger Memory Increase blood pressure Pupillary dilation Shivering Vasopressin (ADH) © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Pituitary Gland www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Brain Hormones: Pituitary Hormone Thyroid Stimulating Hormone (TSH) Adrenocorticotropic Hormone (ACTH) Follicle-Stimulating Hormone (FSH) Produced by Actions Anterior lobe of pituitary Stimulates thyroid gland to produce T4. Anterior lobe of pituitary Stimulates adrenal glands to respond in times of stress. Anterior lobe of pituitary In women, stimulates the growth of ovarian follicles before the release of the egg at ovulation. It also increases estrogen production. In men, acts on the Sertoli cells of the testes to stimulate sperm production. In men, stimulates Leydig cells in the testes to produce testosterone. In women, stimulates ovarian follicles to produce estrogen, and causes the follicle to rupture and release a mature egg. Promotes lactation in response to the suckling of young after birth. (It’s inhibited by dopamine) Anterior lobe of pituitary Luteinizing Hormone (LH) Anterior lobe of pituitary Prolactin (PRL) Anterior lobe of pituitary Promotes growth in children and helps to maintain normal body structure and metabolism by promoting the deposition of protein and burning of fat. Anterior lobe of pituitary Bind to melanocytes to stimulate the production of melanin, a skin pigment. Hypothalamus, stored and secreted by posterior lobe of pituitary Hypothalamus, stored and secreted by posterior lobe of pituitary Regulates the body's retention of water by acting to increase water reabsorption in the kidney's collecting ducts. Growth Hormone (GH) Alpha Melanocyte-Stimulating Hormone (α-MSH) Anti-diuretic Hormone aka Vasopressin (ADH) Oxytocin (OT) www.DrRitamarie.com Stimulates contraction of the uterus during childbirth and promotes the movement of milk into the breast. In men, stimulates sperm movement and production of testosterone by the testes. © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) HPATG Axis Imbalance: The Modern Epidemic Hypothalamus Pituitary Adrenal Thyroid Gonadal www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Chronic Stress: • Mental and emotional stress • Digestive stress • Inflammation, Infection • Food stress • Obesity • Blood sugar swings • Anemia • Immune system imbalance • Injuries • Toxic exposure • Sleep quality and quantity ANS Amygdala (-) TSH Acute Stress or Perceived Threat Medulla Digestion Thyroid Immune System Blood Sugar Inflammation cytokines: IL-1 beta, IL-6 and TNF-alpha www.DrRitamarie.com Cardiovascular respiratory HPAT Axis © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Adrenal Glands www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Adrenal Hormone Secretions Outer Zone (Cortex) Cortisol DHEA Aldosterone Inner Zone (Medulla) Catecholamines Adrenaline aka Epinephrine Noradrenaline aka Norepinephrine Androgens www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Stress Hormone Family Hormone Produced by Action Adrenaline (Epinephrine) Adrenal medulla Allows for fight/flight – increases heart rate, pulse, blood pressure Cortisol Stimulates glucose release from glycogen, amino acids, and fats; shunts energy to extremities for fight/flight Adrenal cortex Adrenal cortex Aldosterone Aids in retention of fluid and electrolytes – conserves sodium, secretes potassium Adrenal cortex Precursor to male and female hormones, muscle growth, and protein repair Norepinephrine Adrenal medulla Sympathetic response, sharpens focus, antagonizes insulin and stimulate gluconeogenesis Thyroxine (T4) Thyroid Increases metabolic rate, decreased function with high amounts of stress Anterior pituitary Enhances release of cortisol and fatty acids from adipose tissue DHEA ACTH (Adrenocorticotropic hormone) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Adrenal Hormone Pathways Cholesterol Vitamin B5 (Pantothenic Acid) Progesterone Pregnenolone 17-Hydroxy pregnenolone Deoxycortico sterone 17-Hydroxy progesterone DHEA Androsterone Corticosterone 11-Deoxycortisol Androstenedione Testosterone Aldosterone Cortisol Estrone Estradiol Estrone Cortisone Estriol www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Hormones In Charge of Metabolic Rate www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) How Thyroid Hormone Gets Stimulated www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Hypothalamus CRH Pituitary TSH Thyroid T4 5’ Deiodinase T3 www.DrRitamarie.com 5 Deiodinase rT3 © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Metabolic Rate Hormone Family Hormone Produced by Action Thyroxine (T4), Free T4 Thyroid Converts to T3 which stimulates oxygen uptake by cells Triiodothyronine (T3), Free T3 Thyroid Most profound effect on increasing metabolic rate Thyroid Stimulating Hormone (TSH) Anterior pituitary Stimulates release of T4 and T3 Thyrotropin Releasing Factor (TRH) Hypothalamus Stimulates release of TSH Reverse T3 Thyroid Inhibits T3 and decreases metabolic rate Insulin Pancreas – Islet cells Enhances uptake of glucose into cells and subsequent ATP Production Epinephrine (Adrenaline) Adrenal medulla Enhances metabolic rate and also insulin Cortisol Adrenal cortex Enhances release of stored sugar and supplies additional fuel to cells www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Types of Thyroid Dysfunction Hypothyroidism Hyperthyroidism Autoimmune thyroid conditions Graves’ disease Hashimoto’s thyroiditis Subclinical thyroid conditions Binding protein problems Conversion problems Thyroid receptor resistance Wilson’s temperature syndrome Cancer www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Effects of Thyroid Dysfunction on Glucose Metabolism Decreased rate of glucose uptake by cells Decreased rate of glucose absorption in the gut Slower response of insulin to elevated blood sugar Slower clearance of insulin from the blood www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Normal Blood Sugar Management Involves pancreas, liver and adrenals When blood sugar gets too high – insulin When blood sugar gets too low – glucagon Affected by stress Affected by diet Affected by genetics www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Blood Sugar Hormone Family Hormone Produced by Action Insulin Pancreas – Beta cells Stimulates glucose uptake into cells and reduces blood glucose Glucagon Pancreas – Alpha cells Stimulates glucose release from glycogen and synthesis from amino acids and fats Somatostatin Stomach, intestine, and pancreas Suppresses glucagon and insulin, gastric hormones, GH, TSH, and prolactin Growth Hormone Anterior pituitary Antagonizes insulin Epinephrine (Adrenaline) Adrenal medulla Enhances glucose release from glycogen and fat Cortisol Adrenal cortex Antagonizes insulin and stimulate gluconeogenesis and increases glucose Thyroxine (T4) Thyroid Enhances release of glucose from glycogen and absorption of sugars from intestine ACTH Anterior pituitary Enhances release of cortisol and fatty acids from adipose tissue Incretin Small intestine Increases insulin even before glucose enters bloodstream www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Early Detection of Insulin Resistance (Dysglycemia) Home glucose monitoring Hemoglobin A1C Stealth lab analysis techniques Waist to hip ratio > or equal to 0.8 in a female or equal to 1 in a male or waist > 35 inches Symptom survey www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Connections Between the Gut and Brain Vagus nerve Neurotransmitters: dopamine, serotonin, GABA Leaky gut Microbiome: Lactobacillus helveticus, Bifidobacterium longum Allergens Inflammation Mood, memory, and focus www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Appetite and Digestion Hormones Hormone Produced by Action Leptin Fat cells Signals satiety Ghrelin Stomach lining Signals hunger Gastrin Stomach Production of stomach acid Cholecystokinin (CCK) Small intestine Production of pancreatic juices and emptying of gall bladder Secretin Duodenum Stimulates bicarbonate production by pancreas, bile production by liver, and pepsin by stomach Peptide YY Mainly ileum and colon, but a little in other parts of GI tract Inhibits gastric motility, increases water and electrolyte absorption in colon, may suppress pancreatic secretion, increases efficiency of digestion Incretins: GIP: Gastric Inhibitory Peptide and GLP: Glucagon-Like Peptide Small intestine Increases insulin, inhibits glucagon release, slows rate of absorption of nutrients by reducing gastric emptying Somatostatin Stomach, intestine, pancreas Inhibits gastrin, CCK, secretin, GIP and also growth hormone, TSH, glucagon and insulin Dopamine Brain and GI mucosa Reduces motility and protects mucosa Serotonin Brain and GI mucosa Inhibits gastric acid and stimulates mucus www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) The Vagus Nerve Main Functions • Heart rate • Breathing – acetylcholine, blocked by mercury • Digestion Overactivity • Drop in blood pressure and heart rate • Vasovagal syncope Underactivity • • • • • www.DrRitamarie.com Gastroparesis Difficulty swallowing Decreased enzyme production Loss of gag reflex Voice changes © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Reproductive Hormone Family Hormone Produced by Action Pregnenolone Adrenal cortex Precursor to all sex hormones Progesterone Ovaries, Adrenal cortex Promotes sleep, maintains uterine lining, corpus luteum pregnancy, strengthens bones, protects estrogen Estrogen Ovaries, Adrenal cortex Female traits, proliferation of breasts, ovulation Testosterone Gonads, Adrenal cortex Male traits, sex drive FSH Anterior pituitary Follicle maturation in females, sperm maturation in males LH Anterior pituitary Triggers ovulation in females, testosterone in males GnRH Hypothalamus Stimulates anterior pituitary production of LH and FSH Thyroid Thyroid Involved in egg maturation Cortisol Adrenal cortex Chronic excess cortisol depletes sex hormone precursors HCG Placenta Maintains pregnancy Prolactin Anterior pituitary Lactation Oxytocin Posterior pituitary Milk letdown, uterine contraction, bonding www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Male/Female Hormones/Stress Interaction Cholesterol Vitamin B5 (Pantothenic Acid) Progesterone Pregnenolone 17-Hydroxy pregnenolone Deoxycortico sterone 17-Hydroxy progesterone DHEA Androsterone Corticosterone 11-Deoxycortisol Androstenedione Testosterone Aldosterone Cortisol Estrone Estradiol Estrone Cortisone Estriol www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Estrogen Metabolism Dangerous Metabolite Dangerous Metabolite Protective Estrogen Protective Metabolite Quotient: E3/ (E1 + E2) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Sleep Hormone Family Hormone Produced by Action Melatonin Pineal Promotes deep sleep, immune support Growth Hormone Anterior pituitary Promotes growth and repair and fat burning Cortisol Adrenal cortex High levels at night disrupt sleep Leptin Fat cells Peaks in middle of night to promote fat burning Progesterone Ovaries, Adrenal cortex Promotes sleep Estrogen Ovaries, Adrenal cortex Improves quality of sleep Testosterone Gonads, Adrenal cortex Lack of sleep lowers it Insulin Pancreas Disrupts growth hormone and sleep pattern Glucagon Pancreas Keeps blood sugar steady while sleeping www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Organ Specific Hormone Family Hormone Produced by Action Erythropoietin Kidney Stimulates red blood cell production Thymosin Thymus Stimulates glucose release from glycogen and synthesis from amino acids and fats Parathyroid hormone Parathyroid gland Increases blood calcium, decreases calcium in bones Calcitonin Thyroid Decreases blood calcium, increases calcium in bones Antidiuretic hormone Posterior pituitary Retention of fluid Natriuretic peptide Heart-blood vessels Induces release of sodium in urine Angiotensin Liver Vasoconstriction, release of aldosterone Brain natriuretic peptide Heart Thrombopoietin Liver, kidney, striated muscle, bone marrow www.DrRitamarie.com Reduces blood pressure Produces platelets © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Nutritional Endocrinology Assessment Tools Asking the right questions Symptom surveys Home testing Physical exam Blood chemistry Genetics Functional assessments Adrenal Stress Index Fatty Acids Amino Acids Organic Acids Minerals Steroid Hormone Panels www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Order Matters! Digestive stress Inflammation Food stress Obesity Injuries Toxic exposure Sleep quality and quantity Eating too close to bedtime Infection Heal and Optimize Digestion www.DrRitamarie.com Transform Stress Balance Blood Sugar Repair and Recharge Adrenal Calm Balance Serenity Clarity Joy Love Peace Success Protect and Heal Thyroid © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Hormone Balancing Hierarchy www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Foods That Disrupt Hormones Hydrogenated and oxidized fats Processed high glycemic foods: flour, sugar, grains Charred meat: heterocyclic amines promote ER alpha Chemical-laden foods Foods in cans and plastic Gluten Dairy Caffeine Excess alcohol www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Foods That Support Hormones Greens Brassicas Sea vegetables Omega-3 fats Coconut oil Cumin Pomegranate Lignans: flax, sesame and pumpkin seeds, soybeans, broccoli, beans, and some berries Isoflavones: soybeans, clover, kudzu, mung beans, alfalfa sprouts, black cohosh, and chickpeas www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) How to Be Unstoppable in Your Health Care Practice Impeccable Self-Care www.DrRitamarie.com Clinical Mastery Effective Business and Marketing © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE) Step-By-Step to Phenomenal Results Values and goals: connect to what matters most Ask the right questions to assess where they are now, what brought them here, and what’s getting in the way Labs and exams to determine the current state of health and identify imbalances Order of correction protocols needs to be decided in advance Restore balance with diet, lifestyle, and supplementation Reassess and adjust at regular intervals to make sure you are on the right track www.DrRitamarie.com © Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, Institute of Nutritional Endocrinology (INE)
