What is Low Libido? Update: we have PT-141 troches!!
Low libido is a reduction in someone’s desire for sexual activity. It affects both men and women. It is not at all unusual for someone’s interest in sex to fluctuate over different periods of their life due to illness, sleep disruption, stress, medications, hormonal changes, and more- as I’ll describe throughout this article. Low sex drive in men or women becomes “a problem” when it affects a person’s sense of well-being, causes stress, or creates tension in their primary sexual relationship.
What causes low sex drive in men and women? Several lifestyle factors, hormonal shifts, and well, you-name-it. I’m going to break this down into a list of causes and then the fixes for men, women, and sometimes both men and women. Here’s how I’ll proceed.
Causes of Low Sex Drive in Women and Men
- Chronic Medical Conditions
- Medications
- Emotional and Psychological Factors
- Depression and Psychiatric Issues
- Excessive Exercise
- Poor or Inadequate Sleep
- Stress and associated high cortisol
- Fatigue
- Bedroom Boredom
Causes of Low Sex Drive in Women
- Oral contraceptives
- Menopause
- Pregnancy
- Gynecologic Conditions
Causes of Low Sex Drive in Men
- Low Testosterone
- Low Estrogen
- High Estrogen
Solutions for Men
Solutions for Women
Solutions for Low Libido for both Men and Women
What Causes Low Sex Drive in Men and Women?
Chronic conditions
High blood pressure: Over time, high blood pressure can affect how well blood can reach and then pass through small arteries, such as penile and clitoral tissue, causing sexual dysfunction and therefore impacting libido.
Heart disease: This can also lead to damaged blood vessels and decreased blood flow to the genitals, decreasing arousal or lubrication.
Diabetes: High blood sugar levels can cause both vascular and nerve damage. This can cause erectile dysfunction in men and decreased blood flow to the genitals in women. In addition, women with diabetes may experience more vaginal candida (yeast) and bladder infections. Both of these conditions can cause dyspareunia (painful intercourse) or, at a minimum, make sex uncomfortable.
Inflammatory bowel disease: Intestinal cramping and bouts of diarrhea are real mood killers for obvious reasons.
Pain: Any sort of pain will obviously nuke sexual desire.
Osteoarthritis: People with any notable degree of joint pain or stiffness might find it more difficult and therefore less enjoyable to participate in sexual activities.
Cancer: Treatments for cancer, including surgery, radiation, or chemotherapy, can lower libido. Of course, body image issues will also often play a role, especially for women with breast cancer and men with prostate cancer.
Obstructive sleep apnea: Research shows a direct correlation between untreated obstructive sleep apnea and symptoms of low libido in women and men.
Medications
If you actually listened to the “side effects portion” or TV ads or read through all the side effects of every single drug you ever put in your mouth, I guarantee you; you’d think more than twice. Fatigue, headache, nausea are mentioned constantly, and while “sexual dysfunction” might not be listed, do you think you’ll be “in the mood” if you have nausea from a pharmaceutical? Meanwhile, there are commonly used pharmaceuticals that specifically lead to a loss of libido. Here are some of the “big players.”
Antidepressants, oddly enough, are one of the main culprits. I say “oddly enough” because depression often causes a lack of sexual interest. So when you take a depressed person and give them antidepressants that make them even less interested in sex, you’re not doing them any favors. So here are the ones to watch for.
Serotonin and noradrenaline reuptake inhibitors (SNRIs) are the most popular category of antidepressants currently prescribed. Many of them will lower the sex drive in women and men. These drugs include venlafaxine (Effexor), desvenlafaxine (Pristiq), and duloxetine (Cymbalta).
Running a close second and prescribed more by primary care practitioners are the selective serotonin reuptake inhibitors (SSRIs). These drugs and even a couple of drugs noted above are also used for menopausal symptoms (groan). Popular drugs in this category include escitalopram (Lexapro), citalopram (Celexa), fluoxetine (Prozac, Sarafem), sertraline (Zoloft), fluvoxamine (Luvox), and paroxetine (Paxil).
Non-functional doctors use tricyclic antidepressants (TCAs) to treat depression, some types of anxiety, fibromyalgia, and certain types of chronic pain. Examples include desipramine (Norpramin), doxepin (Sinequan), amitriptyline (Elavil), amoxapine- clomipramine (Anafranil),nortriptyline (Pamelor), imipramine (Tofranil), protriptyline (Vivactil) and trimipramine (Surmontil).
To round out the list without naming every drug on the market, let me mention (while we’re on the subject of mental health) that some medications used in Schizophrenia will raise prolactin levels and therefore depress libido. Then there are the very commonly used medications finasteride and dutasteride used for prostate enlargement. Next, as I’ll get into more, oral contraceptives might be a problem. Finally, many medications that lower blood pressure also results in low libido. A prime example of a blood pressure medication used to lower blood pressure, calm tremors, and even decrease anxiety is a beta-blocker such as metoprolol.
Lastly, alcohol or recreational drug use can cause low sex drive in women and men. And, it’s a bit of a mixed bag when it comes to “weed,” which will be discussed later.
Emotional and psychological factors
Most people do not have a so-called “psychiatric diagnosis.” But that doesn’t mean none of us have “issues”- in fact, most of us do deal with emotional and psychological factors that can hinder our desire for sex. Let’s start with relationship problems. A lack of trust, poor communication, any form of abuse, or stresses from financial, parental, or child-related issues can lower sexual desire on the part of one or both sexual partners. In addition, mental health issues resulting from undiagnosed depression, anxiety, eating disorders, poor self-image, or even prior sexual abuse can diminish a person’s interest in sexual activity.
Depression, Anxiety and other Mental Health Issues
Sexual disorders are prevalent problems in patients who have been diagnosed with psychiatric disorders. As mentioned previously, medications such as antidepressants and antipsychotics will induce sexual dysfunction. A comprehensive review article looked at sexual disorders in psychiatric diseases such as bipolar disorder, schizophrenia, depression, obsessive-compulsive disorders, anxiety, and eating disorders.
Panic disorder and obsessive-compulsive disorder are both correlated with less frequent sexual contact. Decreased sexual desire and sexual aversion are strongly associated with all types of anxiety disorders. The diagnosis of bipolar disorder significantly increases the risk of sexual dysfunction. In the manic phase, there is an increase in libido associated with risky sexual behavior. Depressive phases of this disorder or frankly depressive disorders are associated with low libido and dissatisfaction with sexual activity. In patients with eating disorders, libido and the level of sexual activity decreases, and the level of sexual satisfaction decreases as well.
The prevalence of sexual dysfunction in patients with schizophrenia is quite high among both those treated and untreated. Women who have schizophrenia have anorgasmia, decreased libido, vaginal dryness, and therefore dyspareunia (painful intercourse). Men who have schizophrenia have a decreased sex drive, difficulty maintaining an erection, and delayed orgasm. The bottom line: if you are seeing a mental health professional, make sure to discuss your sexual needs with them.
Too much exercise
Lack of studies in females means just that: there is a lack of studies. However, it is well-documented in men that those who exercise at higher levels tend to have lower libidos. Thus, in men, higher levels of intense and greater durations of endurance training regularly are significantly associated with decreased libido scores.
Sleep deprivation
Most adults need 7 to 8 hours of good-quality sleep per night. Good quality means that the “sleeping hours” don’t include frequent arousals and are long enough for the individual to feel refreshed upon awakening. Yes, there are some (very rare) individuals who (genetically) require less than 7 to 8 hours of sleep each night. Lucky them. Most of us, when sleep-deprived, are simply pushing ourselves to sleep less. When we do this, we struggle to stay awake during the day, tend to have bouts of fatigue, and definitely suffer from a lower libido than if we were well-rested.
High cortisol
The hormone cortisol increases under stress-a good thing for your body in the short term. However, long-term high cortisol levels can lead to all sorts of physical problems. Physical problems, including immune system dysfunction, cognitive impairment, and much more, make this one of the most correctable and common functional medicine issues we see. High cortisol can also cause you to feel fatigued because the resultant decrease in mitochondrial ATP production interferes with regular sleep patterns. You can see where this is all going, right? Obviously, low libido is part of the end-game of this issue as well.
Fatigue
Fatigue can result from the two things discussed above: inadequate sleep and/or too much stress. Of course, many conditions interfere with sleep and many situations that may cause you to be stressed. If one of these issues is causing your fatigue, you need to address them before you regain your sex drive. If you have a “fatiguing illness,” that’s an entirely different story. I’ll explain.
Fatigue due to Mitochondrial Dysfunction
Mitochondria (the organelles of respiration throughout the body) produce energy in the form of ATP, which your body then uses for fuel. Your brain, muscles, and heart cells contain more mitochondria than other organs such as the lungs, kidney, or liver. When your mitochondria are working “full tilt,” your energy levels are high, your brain is focused, and your muscles and heart are at peak performance. The creation of new mitochondria (mitochondrial biogenesis) is required for optimal aging and health. As you would predict, mitochondrial dysfunction tanks your energy and contributes to numerous symptoms and diseases. So-what causes this problem?
Mitochondrial dysfunction, characterized by a loss of efficiency in the synthesis of ATP, is a hallmark of aging, and essentially, of just about all chronic diseases. Loss of mitochondrial function can cause fatigue and even other symptoms in just about every chronic disease you can imagine. Examples of fatiguing illnesses with mitochondrial dysfunction include all toxin-related illnesses such as mold mycotoxin illness, anything lumped into the “wastebasket” of chronic fatigue syndrome, fibromyalgia, and autoimmune diseases, for starters. As a “side note,” when I treat these diseases, I also “treat the sick mitochondria” so patients regain energy quickly.
Bedroom Boredom
We’re all adults here. I put this header here so you’ll think about this topic and perhaps even discuss it with your partner. You don’t need me telling you what this means. You know.
Low Sex Drive in Women
Causes of low libido in females can include anything that alters or interferes with the normal production of “female hormones” associated with libido, including estrogen, progesterone, testosterone, and possibly (but not probably) oxytocin. Let’s start by discussing the possible role of “the pill.”
Birth Control Pills
Common sense would tell you that when you interrupt normal hormonal functioning, you’d have sexual dysfunction. Not so fast! How about the psychological factors associated with knowing that sexual activity, using good oral contraceptives will generally not result in pregnancy? Do anxiety levels about pregnancy play a role? Studies have not examined that, but I suspect that it’s a factor. One very comprehensive study examined the libidos of women taking oral contraceptives in 30 studies. The results were basically “all over the place” as follows.
When used correctly, oral contraceptives (OC’s) provide very effective contraception and are widely used for “fertility control.” As I mentioned, a review paper looked at 30 studies to examine the correlation between OC’s and libido in women. In the uncontrolled, prospective studies ( 4), it was found that most women reported little change in libido during OC use. In the retrospective, uncontrolled studies (17), most women reported increased libido during OC use. In the prospective and cross-sectional controlled studies (4), women using OCs reported increased and decreased libido compared to non-OC users. The findings from randomized, placebo-controlled studies ( 5) were completely mixed. The takeaway here is that “I got Nuthin.” There is, however, good data on menopause.
Menopause
Most women experience a decrease in sex drive during menopause due to initially- drops in progesterone, then estrogen, and then testosterone. When a woman’s estrogen drops low enough, it not only suppresses her sex drive but also causes vaginal dryness and painful intercourse. In addition, a decreased production of testosterone has been linked in many studies to a decrease in female sex drive. Conversely, replacement of these hormones with bio-identical equivalents (BHRT) can often restore a woman’s normal libido.
Pregnancy
Hormonal changes that occur during and after pregnancy can affect a woman’s sex drive. These changes affect everyone differently. Some women may have an increased libido, while others might have little to no interest in having sex. Women’s hormones usually fluctuate during the postpartum months, which may affect sex drive during this time. Factors such as body image, breastfeeding, and fatigue all play a role in post-pregnancy sex drive.
Gynecological Issues
Medical conditions such as endometriosis, causing gastrointestinal cramping, pelvic cramping, or other symptoms can certainly dampen sex drive. In addition, post-menopausal women experience increased bladder infections due to the loss of lubrication of the bladder-also due to low estrogen levels. This type of burning pain, coupled with the other symptoms of bouts of cystitis certain dampen sex drive. In fact, any pelvic muscle problems or chronic pelvic pain will obviously result in low sex drive in women.
Causes of low libido in males
Low testosterone
Testosterone is the well-known sex hormone that males produce in their testicles. Testosterone is responsible for a range of male characteristics, including facial hair, muscle mass, libido, sperm production, erectile function, and bone mass. Low testosterone can be caused by trauma to the testicles, tumors, chemotherapy, and/or radiation for prostate or testicular cancers. In addition, anterior pituitary adenomas or toxins and pituitary damage due to traumatic brain injury can cause low testosterone in men. Furthermore, prior testosterone or anabolic steroid use can disrupt the testicular-pituitary axis, causing low T in later life. Lastly, any sort of chronic illness or heavy medications can lower testosterone levels as well.
Low estrogen
If a male has his testosterone replaced and is being treated too vigorously with aromatase-inhibitors, giving them virtually “no” estradiol levels, this can negatively impact male libido. In addition, occasionally, we find that a low progesterone level in a man will lower his libido and disrupt his sleep.
High Estrogen
On the other hand, testosterone which is endogenously produced but shuttled via the enzyme aromatase into estradiol as a conversion product, will impact libido when it gets too high. This is also found when testosterone is prescribed by inexperienced doctors who fail to check and then control estradiol levels.
Treatments-General advice for men and women
The treatment for low libido depends (obviously) on the cause of the problem. An easy example is if a doctor sees that a patient is taking a medication causing sex-related side effects. Another “no-brainer” would be to simply treat any underlying medical conditions that reduce someone’s sex drive.
Sometimes, it’s a matter of making the right “lifestyle changes” such as getting adequate sleep, exercising, cutting down on alcohol, eating a healthy diet, and losing weight. One easy caveat: the healthier you feel, the better your libido will be.
If there is a psychological barrier to sexual relations, talk therapy or sex therapy can be helpful. Therapy can help people improve their self-esteem, deal with previous trauma, and strengthen their relationship with their partner. In addition, research has found that cognitive-behavioral therapy can be beneficial for some women with low sex drive. Then, of course, we must fix the hormones.
Hormonal therapy for Women
Both estradiol and testosterone have been implicated as the steroid critical for modulating women’s sexual desire. Studies demonstrate that post-menopausal estrogen-only therapies produce increased sexual desire. Testosterone at supraphysiological, but not so much-physiological, levels- enhances the effectiveness of low-dose estrogen therapies at increasing women’s sexual desire, as demonstrated by most clinical studies.
Because effective therapies might require supraphysiological amounts of testosterone, it remains unclear in the literature whether testosterone contributes to the modulation of women’s sexual desire. Nevertheless, in countless reports of sexual satisfaction, women say that physiologic doses of testosterone help their sex drive.
Regarding the benefits of progesterone, it’s not safe to give estrogen without giving progesterone-anyway. However, in the years leading up to menopause, where progesterone levels are low: replacement alleviates symptoms of PMS which can arguably negate any sexual feelings a woman is having, and we don’t need a host of studies to prove this to me-and you? Next, let me dispel the myths about the magic of oxytocin.
Oxytocin for Women
Oxytocin has been the subject of countless articles, looking for evidence of sexual arousal with (mostly) intranasal preparations. While it can indeed increase the feeling of “bonding” with one’s sexual partner, there is no evidence that this hormone heightens sex drive in women. However, oxytocin gel can be useful for women (such as breast cancer patients) who cannot use hormone therapy with estrogen or testosterone. Here’s why.
Many postmenopausal women suffer from vulvovaginal atrophy, causing uncomfortable or downright painful intercourse. Several studies comparing lubricant jelly to oxytocin gel have been quite promising. Vaginal oxytocin gel appears to improves vaginal atrophy as well as all aspects of sexual function in postmenopausal women. Next- what happened to that “female libido pill” we heard about a couple of years ago?
Flibanserin for Women
Flibanserin (Addyi) is a famous pill that got a lot of press in 2019. It is a 5-hydroxytryptamine (5-HT1A) agonist and a 5-HT2A antagonist. It is approved by the FDA and is currently indicated for treating hypoactive sexual desire disorder in premenopausal women.
But here’s some data you might want to know before getting a prescription. In late 2019, a pooled analysis of three well-done clinical trials was published with the summary of results stating that 100 mg per day of flibanserin was “well-tolerated,” “improved sexual desire,” with results being consistent across different subgroups of women.
However, examination of various medical groups’ data revealed that treatment with flibanserin, on average, resulted in just one-half of an additional sexual encounter per month. In addition, there was a clinically significant increased risk of nausea, dizziness, somnolence, and fatigue. Needless to say, this drug, while still available, has fallen greatly in popularity and prescribing rate.
What are Healthy Habits?
Every time I write a “what’s new” type of article, I hope the reader is up to speed with the basics of a healthy lifestyle and has at least a foundation of healthy habits for eating, exercise, and sleep. These are the real basics when we discuss healthy habits. Everyone wants to live a life absent from disease and frailty, a new term coined as a “healthspan” rather than a mere lifespan. Let me share with you the Functional Medicine developments that have taken hold as dogma over the last couple of years, making the following issues the basis of how you will (hopefully) augment your healthy habits with Functional Medicine “tricks” for a healthspan lasting until you’re 120!
Here are the healthy habits we’ll cover:
- Healthy eating plans
- Intermittent Fasting and Timed Eating Intervals
- Exercise guidelines
- Sleep updates
- Microbiome health
- Mitochondrial health
- NAD enhancement
- How to keep your mood elevated and your cognition sharp
- CBD and Medical Marijuana
- Lighting and EMF’s
- Augmenting your hormones
- Controlling your cortisol
- Do we need to detox?
- Proper peptide usage
- More Emerging therapies
What should I eat to follow a healthy lifestyle?
When I discuss the very basics of healthy habits, I’m not talking about “not smoking” or “achieve and maintain a normal weight,” which I believe are “givens” to everyone reading this article. However, what exactly constitutes a healthy lifestyle eating plan is up for discussion. You all know, as an example, that the more processed a given “edible” is, the less healthy it is for you. Most of you know that sugar (and for some: salt) needs to be kept at a minimum. I hope you know that non-GMO is the way to go, as is organic, non-factory-farmed meat, wild-caught (not farmed) fish, and minimal to no “fast foods” are best unless the industry makes huge changes.
I have covered the concepts of oxidative stress ( basically the opposite of your levels of antioxidants), inflammation regarding your food choices. Notably, I’ll outline each diet plan as healthy choices to be low in inflammatory foods and, if done right, high in anti-oxidant foods. I’m not going to cover basic supplementation in this article but let me re-iterate that a good multi-vitamin, high in antioxidants, with an accompanying fish oil supplement twice daily is a basic recommendation. Vitamin D is another widely accepted basic supplement. And then, some supplements augment immune function, which can all be found here. Here are the diet plans getting the most “press.”
Plant-based Diet
Plant-based dietary patterns include a Mediterranean and Nordic diet pattern, the dietary approaches to stop hypertension (DASH), Portfolio diet, and vegetarian- or vegan-type diet patterns. Plant-based diets- especially when rich in high-quality plant foods such as whole grains, fruits, vegetables, and nuts, have been associated with a lower risk of type 2 diabetes mellitus and cardiovascular disease (CVD) and are recommended for both health and environmental benefits.
I am very much on board with the benefits to the environment, not to mention the abolition of factory farming. However, the association between changing to a plant-based diet and overall mortality remains unclear. Studies have not borne out any consistent associations between changes in plant-based diet indices and cancer mortality as a stark example. My only reservation to an entirely plant-based diet, as most are currently constructed, is that they are filled with lectins which we know cannot be tolerated by those with autoimmune disease, with the full jury being out on the rest of the population.
Keto Diet
Many of you are on the “keto kick” or want to eat a keto diet plan, but it’s not a good idea to eat this way “all the time” without a break. Why? Because long term, uninterrupted keto eating is thought to lead to a less diverse and therefore less healthy microbiome. Eating “keto” works for weight loss and diabetic control quite nicely. When you are eating a keto diet, it’s best to stop for the weekend every couple of weeks for the health of your gut. Long-term, when you are “keto-adapted,” you can go in and out of being ketotic at will. Now, this said, I’m not saying everyone should eat this way. However, if you have tried other ways to lose weight that have not been successful, this appears to be a great way to lose body fat, especially if it’s due to high leptin levels. A full explanation is found in the article referenced above.
Anti-inflammatory Diet
The healthiest diet (IMHO) is still a basic anti-inflammatory diet that excludes sugar and focuses on whole, organic foods. The latest twist in anti-inflammatory eating is avoiding lectins–especially gluten, most grains, beans, and all but high-fat dairy, preferably A2 dairy. As mentioned previously, all of the data isn’t complete regarding lectin restriction, but in my opinion, they are harmful to most.
AIP Diet
For those with leaky gut or any autoimmune disease, an autoimmune protocol diet is recommended. This AIP diet is also great for weight loss for those who can’t tolerate “going keto.”
The fashionable plant-based eating plan is actually how I used to eat (fully vegan) and what I try to maintain about two-thirds of the week with plant-based, AIP meals. However, with zero fish or eggs, I can’t get enough protein since grains and beans are off my list. If you haven’t tried it, nutritional yeast (I like Bragg’s) is a cheesy tasting topping that adds protein to veggie dishes, almond meal pasta, and more. Also, creative companies and Etsy bakers are making all sorts of tasty dishes with nut powders substituting for grains, making this diet much more palatable than it was 10 years ago.
Paleo Diet
I like this diet: it excludes the most potent nasty lectins; gluten, grains, beans, and dairy. However, I’m not too fond of the whopping amount of animal protein this diet not only allows but recommends. First, too much animal protein “jacks up” your omega-6 fatty acid load to make your omega 6:3 ratio way too high; into the “inflammatory zone.” Next, research shows we eat too much protein as it is. Protein helps build muscles, but it also stimulates the mTOR pathway too continuously, which might increase your risk of certain cancers. Lastly, with methane being a significant source of greenhouse gas, the amount of grain necessary to create beef (as well as chicken) is shocking. In my humble opinion, it is dangerous for the people on the planet to be consuming the amount of meat that Americans tend to consume; Paleo diet or no Paleo diet.
Modified Pescatarian Diet
My “vote” goes towards a Modified Pescatarian diet, which is anti-inflammatory and low in lectins. This diet is an anti-inflammatory diet that includes fish and a little bit of high-fat dairy; while recommending avoiding grains (other than sorghum), beans, and most dairy products. It’s fairly close to being an AIP diet plan.
I’ve heard about fasting, but it’s too hard!
Unless you have been sleeping underneath a giant pizza, you have heard about fasting, and no, it is not a “fad.” Numerous studies show that it is anti-inflammatory to the point where some forward-thinking trauma centers are “fasting” acute trauma victims. In addition, studies show it assists with weight loss and maintenance, metabolic syndromes, cardiac disease, brain health, and mitochondrial health. The different intermittent fasting schedules include time-restricted feeding (TRF), true intermittent fasting (IF), different caloric intakes for fasting, and fasting mimicry (which is relatively new and, to me-not proved.) I’ll focus here on what works and what’s absolutely “doable.”
Time-restricted eating is doable, meaning you can fit it into your daily lifestyle and not have to count calories or “go hungry.” However, let me interject here that most Americans are not used to “feeling hungry” for long; I would suggest that you tune in to how you feel when your GI tract doesn’t have to work hard all day. As a result, you might find that you have more energy and mental clarity.
What’s the perfect “eating schedule?” According to studies, a 16/8 schedule of timed eating is superior, but a 14/10 (so doable!) schedule is pretty darned good as well. You can have black coffee in the morning and then decide when your eight or 10-hour window of food consumption should be. Ideally (primarily for optimal glymphatic “cleaning” in the brain while you sleep), you should be food and beverage free four hours before you go to sleep. My personal eating window is noon-eight o’clock PM. As a final word, caloric restriction is indeed one of the healthy habits to cultivate, and you can accomplish pretty close to what you need by doing a one-day-per-week “low protein day” and use that same day to skip dinner. You’ll awaken feeling great-try it!
How little exercise can I do to be healthy and active?
Each type of exercise (cardio, HIIT, stretching, forms of yoga, and strength training) has a place in your fitness routine. However, current research shows cardiovascular benefits, weight maintenance benefits, brain, bone, muscle mass, and other benefits as follows.
You can take your dog for a brisk walk five days a week for 30 minutes and do two or three (six minutes minimum high intensity) HIIT routines, and cardio-wise, you’re “good to go.” Stretching routines can be as little as five minutes twice weekly, depending on your flexibility. Strength training can be seriously streamlined down to twice weekly, with a good one-set-per-body-part routine like this. Contrary to popular belief (and Fitbit marketers), you do not need to take 10,000 steps per day. Studies have shown no benefit comparing 2,000-4,000 steps to 10,000.
Do I really need 8 hours of sleep?
Other than the rare few people who have demonstrable genetics, along with others in their family showing that indeed they can “get by” on four or five hours of sleep per night, less than eight hours is woefully inadequate for proper bodily repair during the night. Studies have shown that a majority of Americans are not getting enough good quality sleep.
What’s new is using products such as liposomal GABA to stop brain-race and help both sleep initiation and re-sleeping problems. The use of melatonin seems to be somewhat controversial in the “mainstream” medical literature. However, in the Functional literature, it is well established as a sleep aid and an immune booster as well as a brain booster. Liposomal preparations are useful (combined with GABA preparations) for re-sleeping issues, especially in patients with posterior pituitary problems that cause low MSH, such as all patients with toxin exposures, including (mainly) those with mold and mycotoxin illness. For the severe insomniacs, which tend to include mold and mycotoxins patients, we have a very effective peptide called DSIP.
DSIP: (Trp‐‐‐Ala‐Gly‐Gly‐Asp‐Ala‐Ser‐‐‐Gly‐Glu)
Delta sleep-inducing peptide (DSIP) is quite remarkably effective when used for severe insomnia. Research findings in humans are yet sparse, but in several clinical studies, a few weeks of nightly administration of this peptide resulted in the resolution of previously intractable insomnia.
What’s new in microbiome health?
The human microbiome comprises 10–100 trillion symbiotic microbial cells with unique genes, principally from bacteria (and some yeast) in the gut. Our “bad” or unhealthy gut bacteria, of which we have up to ten times more than human cells, thrive on the things that create inflammation in our body, including sugar, refined carbs, unhealthy fats, and processed foods (to name the biggest offenders.)
These 100 trillion “bugs” send out chemical messages to the brain to influence our gut health, overall health, and mood. To have a healthy body and brain, you need a healthy gut. Breaches in the gut-brain barrier (from “leaky gut”) are responsible for all sorts of brain-related issues. I’m going to assume you are aware of the importance of gut protection, prebiotic fiber, and so on. A review of that information can be found in the previously cited immune health article.
What’s rather new data regarding microbiome health is the proof that a more diverse microbiome tends to lead to better health. The latest data regarding microbiome diversity is in the arenas of prebiotics (the fertilizer) and probiotics (the seeds).
Prebiotics
Prebiotic fiber comprises non-digestible carbohydrate compounds found in fibrous foods that assist in the growth of healthy bacteria in the gut. Foods, spices, and supplements high in polyphenols appear to promote gut diversity. Hazelnuts, berries, dark chocolate, cloves, red onions, and artichokes are good polyphenols sources. The ECGC in green tea supplements, as well as grape seed extract, are good polyphenol-rich supplements. Evidence is emerging in favor of using fructooligosaccharides as prebiotic supplement powder or in foods.
Onions, leeks, and scallion, as well as chicory, garlic, asparagus, unripe banana, artichoke, are great “gut foods.” They are all thought to assist gut health by producing healthy-gut-bug-food such as butyrate. Speaking of which, if you cook with either ghee or MCT oil, you’ll increase your gut butyrate production.
Probiotics
Regarding probiotics, we like to give a nice multi-strain mixture of the bifidobacterium and lactobacillus probiotics to our patients. However, long-term, especially for those with inflammatory bowel disease or even irritable bowel disease (or possibly “everyone”), sporulating probiotics are probably a better choice. The two types of sporulating probiotics being most closely studied are two in the bacillus species; bacillus subtilis and bacillus coagulans.
How do I help my mitochondria?
Mitochondria produce energy as adenosine triphosphate (ATP), which your body then uses as fuel. Some cells have more mitochondria than others. Your brain and heart cells are jam-packed with mitochondria, as are your muscles. You want your mitochondria working at full strength to keep your energy levels up, your brain sharp, and your heart and muscles at peak performance. The creation of new mitochondria is crucial for optimal and vibrant aging. As we age, we need to stimulate mitochondrial biogenesis with activities and supplements actively. There is great data for even “crazy-sounding” things such as IV and intra-rectal ozone!
This article should help make your life no less “livable” while you develop more healthy habits, so here are behaviors everyone should have as a part of their “mitochondrial health program.” Cold is your friend. If it’s winter where you live, go outside until you shiver once or twice a day. If you live in the tropics (as I do), when you take your hot shower, turn the water to cold at the end and stand under it for about one minute to produce a shiver. And if you really want to “get into it,” get a $99 ice vest online; it feels great to wear it for 20 minutes after a workout. Next, recall the section above on exercise, and be aware that it’s the HIIT that stimulates your mitochondria. Lastly, choose good supplements for your regimen so that your mitochondria are getting a daily workout from all angles. Here is one mitochondrial supplement we should all be taking, and yes, I am.
What’s all the buzz about NAD?
Nicotinamide adenine dinucleotide (NAD) is one of the most important chemicals in our bodies. It is necessary for over 500 enzymatic reactions, and it plays a vital role in regulating almost every major biological process. For example, healthspan-promoting activities, including caloric restriction, fasting, and exercise, increase NAD+ levels in our body. Research findings suggest that increased NAD+ levels help counteract the effects of a poor diet, promote mitochondrial health, improve several well-known markers of cardiovascular health, and slow the aging process in the body and the brain.
NAD+ (which can be given IV, sub-Q, and intra-nasally) and its related molecules, nicotinamide riboside, and nicotinamide mononucleotide have been put into popular nomenclature thanks to Dr. David Sinclair (Harvard researcher with a best selling book which touts his research findings). He discloses that he has a financial interest in some supplement companies, but that certainly doesn’t discount his discoveries.
A growing body of research from Dr. Sinclair’s lab plus multiple other labs suggests that exogenous sources of NAD+ precursors, so-called NAD+ “boosters” – nicotinamide riboside and nicotinamide mononucleotide – increase cellular levels of NAD+. The implications for health and cellular age “reversal” are just astounding. Moreover, it is more than proven in mouse studies.
I use doctors-only NAD+ products for my patients administered intra-nasally and via sub-q injection- these are the “strongest” and will activate stem cells the most efficiently. However, I also prescribe a gram per day of nicotinamide mononucleotide for energy-on-demand, mitochondrial support and to help treat mitochondrially-based diseases.
What’s new in brain health?
Recall that the brain is loaded with mitochondria, so do “take away” that any NAD boost is helping the brain. There has been more evidence linking poor sleep to dementia, so those of you not getting good, restful sleep should do something about it! In addition, the role of the glymphatic system of “nocturnal brain cleaning” has been elucidated even more over the last year. To emphasize again, leaving a good “window” between food or beverages and sleep onset is crucial for optimal glymphatic system function. And so is “good sleep.”
In the “brain supplements we know” department, we have learned that the optimal dose of daily oral resveratrol supplementation to boost BDNF is one gram per day. The evidence is now solid that those of us who avoid depression as we age fare better cognitively. This is an entire topic in itself, but for this article, let me discuss the peptide semax.
Heptapeptide Semax: (Met-Glu-His-Phe-Pro-Gly-Pro)
Semax is considered a nootropic peptide due to its ability to increase BDNF-brain-derived neurotrophic factor. It has also been shown to increase precursors to both dopaminergic and serotoninergic precursors, thus boosting mood. More definitive mood research is needed, but it’s looking terrific thus far. Next, a huge shout-out to the major BDNF-booster peptide called dihexa, given as an oral capsule in varying strengths. And then, there is the evolving data on VIP, a peptide given as an intra-nasal spray.
VIP:
Vasoactive intestinal peptide (VIP) is an important modulatory peptide throughout the CNS, acting as a neurotransmitter, neurotrophic or neuroprotective factor. In the hippocampus, a brain area implicated in learning and memory processes, VIP has a crucial role in controlling GABAnergic transmission, which appears to impact hippocampal-dependent cognition positively. It is currently used in patients with neurodegenerative diseases, including mild cognitive impairment and CIRS, but I anticipate we’ll be using it as another nootropic peptide soon.
Do I need CBD? Is marijuana use healthy?
For years, we have known that the endocannabinoid system has receptors all over the brain, nervous system, and immune system. It very well may be that everyone would benefit from some whole hemp-CBD1 and 2 receptor supplementation as we all age. The data appears to support its usefulness in boosting immune function and brain health, including treatment of TBI (traumatic brain injury.) Right now, we know that CBD1-whole hemp supplementation is useful for pain and sleep. We know that certain types of CBD are useful for some seizures, and other types are useful for anxiety.
Medical marijuana and, in fact, marijuana, in general, has become quite a political topic. While I favor decriminalization, I do not favor “blanket legalization,” and here is why. The “pot” that existed in the marketplace 30-40 years ago had multiples less THC than the recreational or medical marijuana contains now in 2021. The amount dispensed from all sources used by consumers most definitely does what mom told you pot did—it kills brain cells.
Anyway, yes, THC is indeed useful for some clinical applications such as chemotherapy-induced nausea. But, otherwise, it’s the CBD in medical marijuana supplying a therapeutic effect, with rare exceptions. I have looked at the ratios of THC and CBD in medical marijuana preparations and studied the recreational market. But, unfortunately, at this time, there is no “brain safe” marijuana out there that I see or that I have read about in the literature.
If formulations of marijuana can be cultivated to contain less THC and more CBD, they may be less harmful to our brains. I would also point out that the delivery route should not be in the form of smoking, either. If you are going to use “weed,” you should at least use an equivalent amount of CBD at the same time, in any form, to try to protect your brain. And I’d like this phenomenon to be studied more, of course.
Do I need blue blocker glasses? Are EMFs dangerous?
The state of the research is in serious flux, no pun intended. So if you want to look cool, go ahead, get those orange glasses, and wear them. Who knows when it will be proven that you have saved your eyes and your brain. Right now, my recommendation for you would be to dim your home’s lighting at sunset to lower your cortisol levels and re-enforce your brain’s circadian rhythm-something required for optimal health.
There is evidence that too much “blue light” (emitted from regular light bulbs and devices) after dark will possibly impact sleep quality and other bodily functions, including night vision. Therefore, in addition to dimming the lights, turn on a “blue blocker” app on your electronic devices. Also, consider getting a “red light” next to your bed if you sit up and read before turning in, as I do.
Some studies have linked excessive cellphone usage to a type of brain cancer, but nothing is conclusive. To err on the side of caution, use headphones or your speakerphone. The data on EMF exposure is similarly inconclusive, but again, it might be prudent for some people in some homes to turn off their routers at night. At the very least, make sure your devices are placed in “airplane mode” next to the bed.
A Word about Hormones
As you age, you become catabolic due to cortisol increase and testosterone and human growth hormone decrease. This phenomenon alone makes men and women lose muscle and gain body fat. That then leads to weight gain, diabetes, metabolic syndrome, osteoporosis, heart disease, and even certain cancers. Not to mention decreased physical activity, a decreased sex life, and overall reported life dissatisfaction. Therefore, I always suggest that everyone read about bioidentical hormone replacement to decide for themselves if they think it will enhance their life.
Cortisol
The only hormone that increases as we age-cortisol-increases under stress-a good thing for your body in the short term. However, long-term high cortisol levels can lead to immune system dysfunction, increased plaquing on your coronary arteries, decreased mitochondrial biogenesis, depressed cognitive function, and put you at higher risk for all-cause cancers. In addition, it can make you feel fatigued because the decrease in mitochondrial ATP production and high cortisol levels interfere with regular sleep patterns.
High cortisol can trigger sugar cravings. It can be the main “driver” of menopausal belly fat. If you are trying to build muscle, it does just the opposite as it again is catabolic. It not only can decrease muscle mass, but it also reduces bone mass and can slow your metabolic rate by reducing thyroid functioning. Finally, it can trigger leaky gut syndrome, which causes systemic inflammation and is one of the main root causes of all autoimmune diseases.
We, therefore, lower cortisol levels for people under constant stress and most individuals 55-65 years of age and older for the reasons mentioned above. I often re-set the adrenals with adrenal adaptogens and adrenal glandulars. Sometimes I use integratives such as a magnolia bark derivative. Sometimes I use aromatherapy or liposomal GABA. Often, I’ll turn to the intra-nasal peptide called Selank.
Heptapeptide Selank: (Thr-Lys-Pro-Arg-Pro-Gly-Pro)
Numerous clinical studies have shown that Selank has strong anti-anxiety as well as neuroprotective effects. In addition, the clinical effects of Selank are similar to those of anti-anxiety medications such as benzodiazepines, which enhance the activity of the GABA: the calming neurotransmitter. This similarity of effect is borne out in several clinical trials. In addition, there has been a documented similarity between the changes in the expression of 45 genes one hour after either GABA or Selank is given.
What about Detoxing?
Unfortunately, what may seem to be a “common sense thing” is just not studied in the general population. Yes, we know that most of us carry around a load of toxins, including plastics, BPC’s, and even some degree of heavy metals. However, we have no medical guidelines about detoxification other than for those who genetically cannot recognize biotoxins, those with MTHFR (methylation) defects, or those who may need something to augment their liver’s detoxification functioning during, say, chemotherapy. I will always recommend that you drink reverse osmosis water, shower in filtered water, and use non-chemical cleaning products. I discourage the use of “cleansing fasts” or the overuse of colonics as a detoxification method. The judicious use of activated charcoal blends on an intermittent basis seems reasonable, albeit not scientifically proven.
Any other peptides we should know about?
I prescribe a good deal of BPC-157 for gut issues and injuries. KPV is great for psoriasis, along with other integratives in our functional arsenal. CJC-Ipamorelin is just one anterior pituitary stimulant to increase HGH levels as a secretagogue but does seem to work the best. Sex lives will never be the same since the advent of kisspeptin and PT-141. The topicals we now have for hair growth (such as zinc thymulin) are simply amazing. Lastly, GHK-Cu in topical or injectable form works wonders for collagen and elastin stimulation and visible improvements to aging skin.
What’s new for our lifespan?
Cancer cures are just on the horizon, but as always, it’s best to take preventive measures and do all that you can to avoid getting cancer in the first place. Besides implementing the healthy lifestyle discussed in the previous paragraphs, high dose antioxidants, IV or liposomal vitamin C, and even low-dose naltrexone are gaining traction as standard functional medicine practices when someone is at high risk.
The research is ongoing and fascinating regarding our future ability to cure disease by repairing our genetic material. We use stem cells (mesenchymal, umbilical, and placental) for all sorts of regenerative purposes. Perhaps the most therapeutic cellular therapy will turn out to be what the stem cells secrete-packets of “young factors” called exosomes. Clinical trials are ongoing for neurodegenerative disease, autoimmune disease, and more with IV exosomes. Joint health is being addressed with injectable exosomes. Exosome therapy may even play a role in skin rejuvenation. A lot of preliminary data looks quite promising regarding the use of IV exosomes to treat illness and perhaps even, dare I say, reverse cellular aging. I’ll leave you with that thought. Remember, 120 is the new 60.
How to tell if you have a Hormonal Imbalance
A hormonal imbalance is having too much or too little of any of the myriad of hormones I’ll be discussing in this article. Out-of-whack hormone levels can cause just about any symptom imaginable. You can have weight gain or weight loss, hair loss, or excess hair growth. You can become lazy or anxious, sleep too much, or have insomnia! It’s no wonder people scratch their heads trying to self-diagnose. When you receive a diagnosis, you often don’t receive a full explanation, right? Bottom line: If you think you need hormone replacement therapy, seek a physician specializing in hormone replacement. To begin, let’s define “hormones.”
What are Hormones?
Hormones are the body’s “chemical messengers” that transport information from the brain to the “target glands,” The target glands secrete their hormones to affect their target cells.
Next, the cells send their messengers back to the brain to regulate how much message the brain needs to continue or not continue sending. Our bodies contain about 60 trillion cells that must communicate to carry out hormonally based functions. For hormones to be in balance, everything needs to work together, much like a symphony orchestra.
Hormones enter the cells through receptor sites. This can be thought of as akin to a key unlocking a door. Once inside, they flip the switches that control growth, development, and mental and physical functions throughout life.
As we age, the hormones that work to keep us healthy begin to decline. Hormonal balance is lost, causing unwanted symptoms, disorders, and even diseases. In other words, the hormonal symphony plays out of tune and out of cadence.
The A-Z of Where Hormones are Made
- Adrenals: Produces the hormones that control sex drive and the stress hormone cortisol, which controls salt and fluid in the body; aldosterone. DHEA is produced here too.
- Hypothalamus: Responsible for body temperature, hunger, moods, and the release of hormones from other glands. Controls thirst, sleep and is the “master supervisor” endocrine gland.
- Ovaries: Secrete estrogen, testosterone, and progesterone, the female sex hormones.
- Pituitary: The other “master control gland,” which controls other glands and makes the hormones that trigger growth. This is what happens in the anterior pituitary. The posterior pituitary produces ADH, controlling thirst and urination. It also provides pain-relieving endorphins.
- Pancreas: Produces the insulin that helps control blood sugar levels. Glucagon is secreted here too.
- Parathyroid: Controls the amount of calcium in the body.
- Pineal: Produces derivatives of melatonin, which affects sleep and more.
- Testes: Produces the male sex hormone, testosterone, and produces sperm, obviously in males.
- Thyroid: Produces hormones associated with metabolism.
- Thymus: Plays a role in the immune system’s function and the thymus’s maturity and is the primary source for immune “fighter” T-cells early in life.
I’ll cover each of these hormones in alphabetical order, preceded by some basics about hormone replacement therapy and followed by the questions you will be asking yourself about whether or not replacing your diminishing hormones is a good choice for you.
Correct Hormone Replacement Therapy
A little known but important fact about hormone replacement is there are two types of hormones available for hormone replacement therapy: Bioidentical hormones and synthetic hormones. This is extremely important because of the side effects. While some non-functional doctors will “argue” and even publish books touting their opinion that “only FDA approved” hormones-the synthetic ones-are the only ones that should be used, those same doctors are (correctly) touting the effectiveness of the non-FDA-approved mRNA COVID vaccines. It’s a matter of common sense that you, my reader, have or you wouldn’t be reading this article. Here’s why.
Bioidentical hormones are made from natural substances using a compounding process that results in an exact biological replica of the substance produced by our bodies. This is why they do not produce undesirable side effects when administered properly.
In contrast, synthetic hormones are synthesized from a variety of chemicals and, although these molecules resemble those produced by our bodies, they are not biologically identical replicas. As a result, their use can result in severe side effects, as evidenced by the warnings on the labels and research and clinical studies.
Furthermore, in addition to avoiding the risk of side effects and thus being safe, bioidenticals have been shown by most clinical studies to be protective when administered properly. Meanwhile, the latest studies (many of which are listed in the references) refute prior claims that synthetic and bioidentical hormones are “the same.”
I did specify “when administered properly” because hormone replacement therapy is a complex and delicate balancing act that needs to be individually tailored to each patient, often requiring a combination of hormones in conjunction with other mitigating compounded medications. I cannot tell you how often I “clean up the mess” made by unqualified doctors prescribing hormones to patients who “want to save a buck.” Let’s explore whether or not your symptoms sound as if hormone issues cause them.
Do you have Hormone Imbalance Symptoms?
I receive new patient inquiries all of the time, with complaints listed such as decreased energy, sleep disruption, brain fog, and reduced libido. This is usually (at least partially) due to an imbalance (usually too little; not too much) of one or more hormones. However, to determine the problems, I have to “think through” every hormone and organ system—tying everything together like the symphony metaphor I used above. Rather than explain why you can’t self-diagnose your own hormonal imbalance issue or issues, below you’ll find a synopsis of hormone function. This will prepare you to ask the right questions when you see a specialist. As promised, I will go from A to Z, which means we’ll start with aldosterone.
What the heck is Aldosterone?
Most of you have never heard of this hormone, even though it plays an important role in cardiovascular health. The adrenal glands produce aldosterone. Aldosterone affects the body’s ability to regulate blood pressure. It signals the kidneys to increase or decrease the amount of sodium (salt) the body sends into the bloodstream or the amount of potassium excreted in the urine. Indirectly, aldosterone also helps maintain the blood’s pH and electrolyte levels.
Aldosterone is closely linked to two other hormones: renin and angiotensin—which is basically how your body uses the kidneys to regulate your blood pressure. When these three hormones are “out of whack,” your blood pressure can go up.
In addition, in severe adrenal “fatigue,” aldosterone levels can be reduced, causing worse fatigue as well as postural blood pressure changes, mimicking what is knows as POTS.
Anti-Diuretic Hormone (ADH)
The posterior pituitary gland secretes this hormone to work in conjunction with the kidneys, regulating what is called the osmolarity of your blood. Osmolarity is basically how much your blood and urine get concentrated as it passes through the kidneys. People with biotoxin illness (mold and mycotoxin illness and Lyme) often have low ADH issues, as do people with a history of head trauma. The symptoms are excessive thirst and urination—the same symptoms we associate with the onset of diabetes.
Calcitonin
Calcitonin is a hormone released by the C-cells in the thyroid gland. It opposes the action of the parathyroid hormone, which you’ll read about further down our list. Both hormones regulate the blood’s calcium and phosphate levels. While it can be used to treat severe osteoporosis, I choose to use the Parathyroid hormone instead. Calcitonin is also used to treat Paget’s disease of the bone.
Cortisol
You have heard about the fight or flight hormones cortisol and adrenaline, right? Cortisol increases under stress which is a good thing for your body in the short term. However, long-term high cortisol levels can lead to increased coronary plaquing, a depressed immune system with associated risks for an increased risk of cancer, and measurably impaired cognitive function, just for starters! In the intermediate term, high cortisol levels can zap your energy by interfering with mitochondrial function. It can make you feel fatigued, and it’s not just because high cortisol levels interfere with regular sleep patterns.
Cortisol causes symptoms I’ll call “annoyances” only because that is how individuals treat them. High cortisol can trigger sugar cravings. It can be the main “driver” of menopausal belly fat. If you are trying to build muscle, it does just the opposite: “catabolic.” It not only can decrease muscle mass, but it also reduces bone mass and can slow down your metabolic rate by interfering with thyroid function too. Lastly and disastrously, it can trigger leaky gut syndrome, a leading cause of systemic inflammation. This is the only hormone that actually (for the most part) increases as we age.
It is necessary to bring cortisol levels down for people under constant stress and most individuals over 55-65 years of age and older for all of the reasons mentioned above. I usually do this with a combination of adrenal adaptogens (containing ashwagandha, rhodiola, siberian ginseng, and astragalus) as well as an adrenal glandular preparation. Sometimes I use peptides, integratives, or liposomal GABA. There is even a role for some scientifically proven aromatherapy blends. This is the one “hormone arena” where people who read about HPA axis dysfunction (popularly termed adrenal fatigue) can generally self-diagnose much of the time. Please note that you need a medical workup if you self-diagnose and supplement and do not get better within a couple of months.
DHEA (Dehydroepiandrosterone)
I don’t know why this hormone gets a weird “rap”—for instance; it’s linked to anabolic steroids. This wonderful hormone is either not well known or is unfairly demonized, in my opinion. DHEA will amp up your immune system and help calm inflammation. Studies show “older Americans” with good DHEA levels have less depression than those with low levels. Lastly, it’s super important for bone thickness and the prevention of osteoporosis. You wouldn’t detect a DHEA hormone imbalance or deficiency symptomatically, which is why everyone needs key hormones checked as they age. Recent “brain studies” show that DHEA causes brain stem cell stimulation (to produce new neurons), another reason I insist all patients have this hormone normalized.
This hormone is safe to take unless you have a male who has had a “male cancer” or a female who has had “female cancer” or PCOS. DHEA metabolites might be a problem. But, you can safely take the 7-keto form of DHEA, which has the added benefit of being a bit of a metabolic stimulant.
Since when is Vitamin D a hormone?
Vitamin D is a pro-hormone the kidneys produce, which helps control blood calcium concentration and immune system function. The amount of Vitamin D made when sunlight hits the skin and is converted to the active substance called calcitriol by the kidneys is insufficient for most people. Recent studies reveal many cancers are linked to low vitamin D levels.
A low vitamin D level is also related to other issues such as heart disease, autoimmune disease, and even depression. This loosely translates into a minimum of 5000 IU’s per day of vitamin D, which should be consumed with vitamin K for optimal absorption. This is another lab test that should be checked (at least) annually. Recent guidelines recommend levels of 75-80 ng/dl as ideal. If you have an autoimmune disease, the literature strongly suggests higher vitamin D levels as optimal.
Estrogen
Estrogen is responsible for the development of “female pubertal changes.” Most women who contact me are interested in what to do when they have symptoms of estrogen deficiency due to menopause. But please take note that night sweats can be from estrogen deficiency, cortisol excess, mold toxin illness, or infectious diseases, meaning don’t just assume your “hot flashes” are due to estrogen deficiency.
If you have gained “the menopause 25,” it is due to an imbalance of several hormones, including estrogen deficiency. Losing the menopause weight without bioidentical hormone replacement is hard. Poorly done estrogen replacement (and yes, I have seen this) causes weight gain. Estrogen replacement, replacement of other hormones, and balancing cortisol levels make weight loss much easier. Estrogen counters most of the signs and symptoms women find bothersome about menopause.
However, that’s not the only reason to replace your missing estrogen. Estrogen helps your heart, bones, skin, and brain. I don’t know why “length of treatment” remains a controversial topic—likely because dangerous synthetic hormones have clouded the collective thinking on bioidenticals.
I would be remiss if I didn’t touch on two not-uncommon “female illnesses” which are now totally controllable with functional medicine treatment. PCOS (polycystic ovary syndrome) can cause metabolic issues, menstrual abnormalities, symptoms of high testosterone, and generalized inflammation. It can be well controlled, and if hormone replacement therapy is utilized, it is most efficacious if bioidenticals, not synthetics (such as “the pill”), are used for treatment. It is filed here under “estrogen” because often, estrogen levels are low, and cycles are anovulatory.
On the other hand, endometriosis tends to be a disorder associated with high, sometimes super-high estrogen-particularly estradiol levels. The endometrial tissue secretes estradiol, independent of ovarian estrogen secretion, and control of this disorder is also well done in functional medicine therapy, where estrogen levels are brought under control, and new endometrial tissue formation is blocked. Further discussion of these two disorders will be done elsewhere. Now, let’s move on to the pancreas.
Glucagon
This hormone is secreted by the pancreas and directly impacts the liver to control blood sugar levels. Glucagon prevents blood glucose levels from dropping to dangerously low levels. It does this first by stimulating the conversion of stored glycogen to glucose in the liver. It also keeps the liver from consuming glucose. This allows more glucose to enter the bloodstream when needed. Lastly, glucagon is essential for a process called gluconeogenesis: the production of glucose from amino acids.
HGH (Human Growth Hormone)
This is another hormone that gets “maligned”—likely due to its misuse in professional sports. HGH is necessary for many bodily functions. It helps heal injuries. Remember how quickly a sprained ankle healed when you were younger? That’s due to human growth hormone. An M.D-patient of mine had been to several well-known medical centers because he had such fragile skin. He bruised or bled with even a touch from someone else. When he contacted me, he had the lowest HGH markers I have ever seen. Therefore, he had incredibly fragile skin, and that was why he had the problem. Within three months of hormone replacement therapy, his symptoms vanished.
The FDA approves HGH for treating specific problems. The “side effects” are what have made this hormone notorious. It hastens the shedding of body fat and the development of lean muscle mass. It increases bone density and improves immune system function, according to most studies. Overall, it gives people a better sense of well-being. In clinical studies, it increases the dermis thickness—the layer of skin that contains the building blocks of skin called elastin and collagen. In fact, HGH users report they look younger.
Human growth hormone is not to be used in active or recent (within 5 years) cancer cases, as it causes existing tumors or remnant cells to grow. Despite the controversy over whether it does or does not cause cancer, no studies show that it (de novo) causes cancer. But, I need to emphasize this controlled substance should only be used under FDA guidelines. mTOR is one of the pathways stimulated by a marker of HGH called IGF1, and “too much MTor stimulation” might be related to adverse health outcomes. That’s why it’s always a good idea to counteract mTOR stimulation with good health practices such as exercise, intermittent fasting, and correct supplementation. When we stimulate the anterior pituitary to release more HGH by prescribing peptides, we see the same benefits as prescribing HGH for a fraction of the price. Now-back to the pancreas!
Insulin
The pancreas secretes insulin. People with type 1 diabetes have insufficient secretion. It’s an autoimmune disorder, and some cases are completely reversible. People with Type 2 diabetes have inadequate or unresponsive receptors for glucose uptake. Most individuals with Type 2 diabetes are overweight or obese. The entity most doctors call pre-diabetes is as having a fasting blood sugar of 99 ng/dL. What is normal blood sugar? Your fasting blood sugar should be 75-85 ng/dL, or you are “glycating” (stiffening) your body’s cells-all of them.
Insulin is responsible for getting blood sugar into all cells. By doing so, it increases muscle mass and fat storage. However, if insulin levels are too high, there is an increased risk of diabetes, heart disease, Alzheimer’s disease, and cancer. We use insulin as a biomarker for inflammation tied to most if not all disease states and aging in general. This is one hormone you want to keep at a nice, low level—around 2-3 uIU/ml. If applicable, you can get this level down with weight loss, curcumin, omega-3 fatty acids, green tea, and toxin removal. Now, I’d like to discuss a hormone most people think is simply “for sleep.”
Melatonin
Melatonin is one of the most underrated hormones. Most of us need supplementation by the time we’re 30 to have profound, restful, and restorative sleep. You can protect your natural melatonin secretion by maintaining a good circadian rhythm which includes blocking blue lighting as the sun sets. There are apps for tablets and phones you can set to dim your screen at sunset, and I suggest you do so. I recommend slightly higher doses of melatonin than you may be used for patients and families based on research that I find exciting. Here is just a sampling of “what else” melatonin can do for your health.
It reduces oxidative stress (free radical damage), thereby decreasing inflammation. Research shows it also helps block the process, which shortens telomeres, likely affecting genetic aging. It further reduces inflammation by reducing pro-inflammatory cytokines.
It augments immune function by increasing CD4 cells and also increases what is known as natural killer cells. Doing so helps us fight infections and was recently made a part of most good functional medicine COVID protocols.
Melatonin helps preserve brain mitochondria, slows age-related cognitive decline, and inhibits beta-amyloid formation in the brain. In addition, an exciting discovery is that we still have stem cells in our brains, even as adults. And guess what? Melatonin turns on these stem cells. Due to all of the brain-healthy effects, inexpensive but powerful melatonin makes it to my must-have hormones list for everyone.
Oxytocin
In women, oxytocin is responsible for signaling contractions of the womb during labor. The hormone stimulates the uterine muscles to contract, so labor begins. Because of this effect, synthetic oxytocin is sometimes used to induce a woman to start labor if she cannot begin naturally. Once the baby is born, oxytocin promotes lactation by moving the milk into the breast. When the baby sucks at the mother’s breast, oxytocin secretion causes the milk to release so the baby can feed.
At the same time, oxytocin releases into the brain to stimulate further oxytocin production. Once the baby stops feeding, the production of the hormone stops until the next feeding. Oxytocin function is less important for men, but it does appear to affect testosterone production in the testes.
Recent studies show oxytocin is an important hormone that controls some human behavior and social interaction. Oxytocin triggers the bond between a mother and an infant, and it may also play a role in recognition, sexual arousal, trust, and anxiety between partners and friends. It is released when we interact with a loved one, including our dogs; yes, our dogs. A 2017 study proves that you can bond your dog more to you and you- to your dog by staring into your dog’s eyes. And there is leftover oxytocin for you to use with your partner, family, and close friends!
Other fascinating research reveals that oxytocin hormone may affect addiction and stress levels. It also helps people overcome sugar habits with varying success. Recent studies show that it may be useful in pain management regimens as well.
Parathyroid Hormone
In the intestines, parathyroid hormone helps with vitamin D metabolism. This allows the body to absorb more of the calcium it digests from food. The hormone stops calcium release in the kidneys through the urine (stones!) while also increasing vitamin D production. This is one of the hormones where excessive amounts are more common than a deficiency when we are younger, but as with every other gland, the parathyroid glands can fail as we age. Anatomically, these four glands are found on the flip side of the thyroid gland, in the neck.
Pregnenolone
This is another hormone you might not have heard about, but if you’re anxious, you’ll certainly want to see if you’re deficient. It helps repair brain and nerve tissue, decreases anxiety, improves sleep quality, improves general well-being, and is probably brain-protective too. Self-medication with small amounts is generally fine.
Progesterone
Low progesterone complaints are often mistaken for psychological symptoms as all-too-many progesterone-deficient women are handed prescriptions for pharmaceuticals to treat anxiety and depression. Lack of progesterone causes PMDD symptoms, anxiety, irritability, depression, and more. Peri-menopausal sleep issues are generally the result of a dip in progesterone—the first female hormone “to go.”
Adding oral progesterone to the nightly regimen helps with sleep initiation and maintenance. I said “oral” because progesterone creams don’t pass the blood-brain barrier. Please check the referenced article for details on low progesterone symptoms and treatment.
Regarding the role of progesterone replacement in menopause, note that the menopausal weight gain referenced in an earlier section is partially due to the loss of progesterone.
Lastly, if you are on bioidentical estrogens, you must also be on progesterone, whether or not you have had a hysterectomy. You must protect not just your uterus but also your breasts from “unopposed estrogens.”
Testosterone
Testosterone is the most important of all male hormones. We know what happens in puberty, so we’ll skip that part. In adulthood, testosterone is a major energy hormone for men. It increases bone density and is responsible physically for libido and quite a bit of sexual function. The right amount (not too much) is good for cholesterol levels, improving cardiac health.
Bad publicity based on poorly done studies about testosterone supplementation causing heart disease has been completely debunked; testosterone doesn’t cause heart disease. If you take it in massive doses, who knows? But that shouldn’t happen. It also helps prevents prostate enlargement (if aromatization is controlled) and probably helps prevent prostate cancer. It is neuroprotective and decreases the incidence of Alzheimer’s disease in both men and women. Further, it increases muscle mass and bone density in men and women as well. The testosterone that is available on the black market requires self-diagnosis and trust that the substances are safe. Please consult a hormone specialist and don’t treat yourself for “low-T.”
A side note about testosterone is that if you are young, with a low testosterone level, that needs to be investigated, not just replaced. As an example, young men with CIRS will have low testosterone levels due to anterior pituitary involvement. HCG or Clomid is a much more appropriate choice for those patients to augment their testosterone levels while detoxing.
One last thing: if you are a woman who has had estrogen-receptor-positive breast cancer, you should not use testosterone replacement therapy for at least five years after you are done with treatment and considered to be in remission. The reason I’m bringing this up is that I’ve had to repair the damage caused by unqualified doctors who have placed women on testosterone supplementation, not realizing that some of it would be aromatizing to estradiol and then triggering a flare of their breast cancer.
Thyroid hormone
The active form of thyroid hormone (T3) is made from the inactive form (T4), which needs an enzyme (deiodinase) that requires quite a lot of minerals, so make sure you are on a good multi-vitamin-multi-mineral supplement. I often see labwork where the Free T4 is normal, but Free T3 is low, indicating decreased T4 to T3 conversion the majority of the time. Remember, T3 is the active form of thyroid hormone.
T3 increases energy, fat burning and helps control weight. It increases appetite and heart rate. Too little causes chilliness, a loss of the outer 1/3 of eyebrows, and a decreased morning basal temperature (below 97.3F). If you are looking to self-diagnose before having lab results, you can measure your morning temperature for a week. If it’s lower than 97.3, chances are you’re hypothyroid—no matter what your lab testing shows. Insist on the proper lab testing. Here’s what to ask for: TSH, FREE T3, FREE T4, reverse T3, TPO, and other thyroid auto-antibodies.
Why do Hormones Decline?
Hormonally and physically speaking, your body peaks around the age of 25. We often assume that things like a foggy memory, low libido, menopausal weight gain, hair loss, and wrinkles are simply a part of “getting older.” Worst of all, that’s what most doctors think too! But, we can relieve these symptoms with the use of bioidentical hormones.
However, before jumping into hormone replacement therapy, a good workup is necessary to rule out (or diagnose and treat) weight issues, inflammation, tumors, toxins, food allergies, head trauma, leaky gut, silent autoimmune disease, and excessive stress. A great form of natural hormone replacement is simply repairing the hormonal issue’s underlying cause (s). Once these problems are properly addressed, we can assess what truly needs to be replaced. Here are the basics.
In women, the symptoms of hormonal aging often first appear during early menopause (peri-menopause), when estrogen and progesterone levels begin to wane. Then they continue to decline throughout menopause. The hormone imbalance symptoms can begin as early as age 30.
Men usually experience a more gradual loss of hormones, mainly testosterone, which is called andropause. Unlike the sudden loss of estrogen that women face during menopause, the gradual loss of testosterone happens over time. It is often misdiagnosed or even dismissed as a “male mid-life crisis.” Both men and women usually experience weight gain, loss of energy, sleep disruption, and more during this time of life when (understandably!) most divorces occur.
Is Hormone Replacement Therapy Right for You?
In my opinion, most people benefit from melatonin replacement, and it’s “bad medicine” not to replace vitamin D. It’s a good idea to monitor DHEA-S, estrogen, progesterone, thyroid function, insulin, and testosterone levels once you hit age 30-35. If you need treatment, I hope that you’ll “go with” bioidentical hormone replacement therapy. I also hope you will find a well-trained specialist who doesn’t replace your primary care doctor but works with them. Please save this article to refer to in case you develop symptoms in the future.
Natural Ways to Lower Blood Pressure: Intro
If you are not currently among almost one-half of U.S. adults with high blood pressure, then the odds are that you might develop high blood pressure at some point in your life without some preventive measures. In this article, I’ll discuss all of the proven natural ways to lower blood pressure.
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure is called secondary (rather than primary) hypertension (HTN), with those underlying conditions spelled out in this article. All types of hypertension increase your risk for serious health problems, such as stroke, heart disease, ocular blood clots, kidney failure, and dementia. So, it’s clear you want to have normal blood pressure. Below you will find a blueprint for achieving your health goals naturally, which will cover the following:
- Eliminate the basic HTN risk factors
- Do the “right” type of exercise
- Eliminate two toxic types of foods right off the bat
- Address the major metabolic issues: blood sugar, insulin, and leptin
- Normalize your weight
- Balance your omega fatty acids
- Eliminate internal inflammation and oxidative stress
- Control your stress levels
- Fix your broken microbiome
- Banish toxins
- Increase nitric oxide
- Increase vitamin D
- Consider other foods, supplements, and integratives
The Basics of Treatment for Hypertension
Let’s first review risk factors you can easily control. For example, you can stop smoking, control alcohol consumption and, for those who are “salt-sensitive,” control your salt consumption. In addition, you can increase potassium-containing foods (such as bananas and raisins) and take a good magnesium supplement. Estimates show that 80% of Americans are magnesium deficient, and magnesium relaxes vascular smooth muscle; to directly lower blood pressure. In addition, your weight and the amount of exercise you do affect your blood pressure.
Exercise
It’s important to have an exercise regimen that will help to lower your insulin levels. Studies have traditionally shown that “cardio” or “aerobic” activities such as jogging and swimming tend to be the most beneficial for lowering blood pressure.
However, more recent studies reveal the good news that you don’t need a 30-60 minute workout to reap the insulin and blood-pressure-lowering benefits. Short, intense workouts such as high-intensity interval training (HIIT) are becoming more popular for both health and efficiency. It’s fairly easy to construct a HIIT regimen to do at home. You don’t need to do exact “timed intervals”; it’s just about getting short of breath, recovering, doing it again, and so on. If you have been exercising regularly, start “low and slow,” and if you haven’t exercised much since your “school years,” get medical clearance. Try doing burpees until you’re short of breath for 3 sets and work up to 6 sets, 2x per week. You can also do sprints on a track or in a pool. You can run in place, jump rope, or do jumping jacks.
Diet changes and precautions
Before I get into a more verbose discussion about non-inflammatory eating, I mention two food items we all used to think were healthy foods. Unfortunately, these so-called health foods have become poison for most people with existing high blood pressure, grains, and sugars (including fructose). Since many people still think grains and fruit juices are healthy choices, I want to emphasize they most certainly are not. Now, the science.
Addressing “Hypertension Pathophysiology”
Closely linked are the metabolic abnormalities of high blood sugar, high insulin levels, high leptin levels, and, therefore, insulin and leptin resistance at the receptor level.
Hypertension can be caused by cellular glycation (stiffening) from high blood sugar levels, so getting your blood sugar under control is a must. In addition, most people with hypertension have insulin receptors that don’t work efficiently, called insulin resistance. To compensate for this, your body produces more insulin. To lower insulin levels, you need to replace processed foods with real, whole foods. You also need to eliminate or dramatically reduce sugar and processed fructose (fruit) sugar and grains from your diet. Some studies show a closer correlation between fructose consumption and hypertension than even sodium! And then there’s leptin, another hormone that looms upward as you eat poorly and gain weight.
You can easily become leptin-resistant (with the attendant high leptin levels) by eating the same diet full of sugar (particularly fructose and grains once again.) Together, these foods will create the perfect environment for weight-packing bacteria to thrive in your GI tract; or microbiome. You then have your gut telling your metabolism to slow down and your high leptin levels telling you to keep eating and store more fat in your fat cells. It’s not a pretty picture, but it can be easily reversed. Other factors that play into the high leptin scenario include high cortisol levels (to be discussed) and other hormone imbalances. Often this trio shows up as belly fat. Lowering blood sugar, leptin, and insulin are partially achieved by simply losing weight which I’ll discuss next.
Normalize your Weight
I’ve talked about blood sugar, insulin, and leptin. To complete the discussion of the diet plan to normalize your weight for life, you must eat an anti-inflammatory diet. This can be a basic anti-inflammatory diet, a stricter autoimmune,no-lectin diet, or even a ketogenic diet plan. A paleo diet is effective, but you must be sure to compensate for the over-abundance of omega-6 fatty acids in meat. Here’s how you do just that.
Balancing the omega fats in your diet
Just about everyone needs to normalize their omega 6-to-3 fat ratio. Also, omega-3 fatty acids are vital for healthy blood pressure. Findings from a study of 2,000 healthy men and women between the ages of 25 and 41 showed that those with the highest serum levels of omega-3 also had the lowest blood pressure readings.
Both omega-3 and omega-6 fats are essential for your health, but most Americans consume too many omega-6 fatty acids in their diets and too few omega-3s. This is because we tend to eat more meat and milk and less omega-3 fish. Eating omega-3 fats is a great way to re-sensitize your insulin receptors if you are insulin resistant. It is also essential for normal, healthy blood pressure. Wild-caught salmon and sardines are both low-mercury and high omega-3 containing fish. However, it’s hard to consume enough to compensate for all of the omega-6s we eat, so I always recommend a good omega-3 supplement.
Inflammation and Oxidative Stress
Internal inflammation is associated with all disease states, including hypertension. Because approximately 70% of Americans are overweight, this alone is considered a major cause of reversible inflammation. In addition, eating the standard American diet (S.A.D.) described above will increase inflammation levels. Add in toxins such as heavy metals (mercury) and fluoride in drinking and showering water, and you’ve piled onto our national epidemic of inflammation. On the other hand, if you reduce your weight, clean up your diet, deal with toxins, stress and heal your probable leaky gut, then you will make a big “dent” in your inflammation problem and your blood pressure level, too.
Oxidative stress (defined as an over-abundance of free radicals which are not sufficiently quenched by antioxidants) worsens inflammation. But, this can be easily reversed with enough vegetables, fruits in moderation, and a high-antioxidant supplement.
Stress and Cortisol
There is a publicly accepted long-term myth that stress raises your blood pressure. It does short-term, and some so-called “experts” still say it doesn’t raise it or can’t raise it long term. However, sustained high cortisol will routinely cause leaky gut, disturbing the microbiome and potentially elevating blood pressure. So, based on current research, it’s now not a myth anymore! Let me explain the role of the microbiome.
Your Microbiome
Leaky gut is caused by everything from a poor diet to high “stress levels” to proton pump inhibitor antacid drugs such as Prilosec. It sometimes produces little to no symptoms, but it always causes internal inflammation, which you now know is associated with hypertension. In addition, leaky gut always produces unfavorable alterations in the composition of the GI microbiome. And this is yet another factor in the creation of the hypertensive state.
Doesn’t it seem that lately, you read that all aspects of your health are more and more related to the health of your gut? It turns out that an unhealthy gut microbiome with less “healthy bacteria” (a dysbiotic gut) will cause hypertension; via a different mechanism than through leaky gut and/or inflammation. It also seems that “hypertensive GI tracts” have fewer bacteria that produce (healthy) butyrate and acetate.
There are two easy ways to increase gut butyrate levels that help with weight loss, insulin resistance, leptin resistance, and blood pressure. One way is to take sporulating probiotics. The other is to supplement with MCT (medium-chain triglycerides) oil. I use MCT oil for cooking and suggest that “trick” rather than MCT supplements which often cause diarrhea.
Avoid toxins
Biotoxins such as mold mycotoxins and Lyme toxins and heavy metals such as lead and mercury can damage the microbiome via other mechanisms, including (most often) the sirtuin pathway, and raise blood pressure. So next, let’s talk about sirtuins.
Sirtuins are enzymes that are produced in decreased amounts in many metabolic disorders such as obesity and metabolic syndrome. SIRT1 (the most well-known and studied sirtuin) causes an increase in leptin sensitivity. It also increases adiponectin production. Both of these actions have both anti-obesity and, therefore, anti-hypertensive effects. The SIRT1 pathway is disordered in toxin-related disorders and many disorders of mitochondrial function. Therefore diseases such as Parkinson’s disease, Hashimoto’s thyroiditis, or Chronic fatigue syndrome are also associated with SIRT1 deficiency, with a built-in risk for metabolic syndrome, including hypertension.
The Role of Nitric Oxide
Nitric oxide (NO) protects the lining of blood vessels and vasodilates them as well. When arteries are damaged by inflammation, we see a decrease in nitric oxide near the smooth muscle linings of the blood vessels. In general, nitric oxide levels tend to decrease with age. To some degree, HIIT exercise enhances NO, but to make sure your levels are adequate, try foods or supplements. Below are some foods and supplements which raise NO levels.
Beetroot Juice
This juice is high in NO3, which converts to NO. An 8-ounce glass per day will lower your blood pressure (on average) by 8 mm Hg (systolic) and 4 mm Hg (diastolic), demonstrated in those with existing hypertension. I find this to be much more palatable when mixed with “juiced” carrots and spinach.
Examples of other vegetables high in NO3 include whole beets, arugula (the best!), celery, cabbage, leeks, scallions, radishes, kale, turnip tops, spinach, mustard greens, eggplant, carrots, and string beans.
Vitamin D
It’s a well-known medical fact that vitamin D deficiency is associated with arterial stiffness and subsequent hypertension. Still, a large study involving over 100,000 individuals has now demonstrated that low vitamin D levels can actually cause high blood pressure. To make the correlation even stronger, the highest vitamin D levels were shown to lower hypertension risk the most. High-D foods include the healthiest fish, wild sockeye salmon, and sardines, as well as eggs (only eat “pastured,” please). Most people are clinically deficient unless they take D3+K supplements, with most individuals requiring a minimum of 6000 IU’s per day.
Resveratrol
This multi-use supplement increases endothelial NO production, reduces vascular oxidative stress, and prevents smooth muscle proliferation, vascular remodeling, and arterial stiffness. In addition, resveratrol inhibits immune cell infiltration into the vascular wall and mitigates vascular inflammation. All these mechanisms contribute to the positive effects of resveratrol on vascular function and blood pressure.
L-arginine plus l-citrulline
A good NO-enhancing supplement will contain l-arginine and l-citrulline. Bodybuilders typically use these supplements for the increased “pump,” and some men use them to enhance erectile function. However, if taken often, they too will lower blood pressure by increasing nitric oxide.
The Role of the Oral Microbiome
The critical role of the oral microbiome in both our oral and systemic health is being elucidated more and more with each study that emerges. Elevations in plasma [NO2−] following dietary NO3− ingestion and the associated physiological responses are blunted by the use of antiseptic and antibacterial mouthwashes and even by toothpaste. This blunting is directly related to the diminution of healthy oral bacteria in the oral microbiome. Natural tooth powders are not as pleasant to use as commercial toothpaste products, but natural toothpaste seems to be an improvement from the highly processed supermarket brands. Mouthwash should be used sparingly, if at all.
Other Helpful Supplements
Vitamin E
Natural vitamin E (200 IU’s per day) has been shown to lower blood pressure. Natural vitamin E is always listed as the “d-” form (d-alpha-tocopherol, d-beta-tocopherol). Synthetic vitamin E is listed as “dl-” forms. Don’t take synthetic vitamin E, as it’s ineffective and might even cause harm.
Vitamin C
Studies (meaning a review of 29 studies done in 2012) indicate that 500 mg of vitamin C per day might help lower blood pressure. In 2020, another meta-analysis was done, focusing on 8 studies published between 1991 and 2018. Overall, 614 participants were included. The number of participants in the individual studies ranged from 12 to 480. Participants’ mean age ranged from 46 to 78 years. The duration of the intervention varied from 4 to 24 weeks. All participants had essential hypertension. The average SBP and DBP of the participants ranged from 143 to 173 mmHg and from 76 to 97 mmHg, respectively. The supplementary dose of VitC in the treatment group varied between 300 and 1000 mg/dL. The results? There was indeed a correlation between supplemental vitamin C and hypertensive control.
Why? At present, the main theory is that VitC increases intracellular concentrations of tetrahydrobiopterin, an endothelial nitric oxide synthase co-factor that promotes the production of nitric oxide, which is a potent vasodilator. However, there is also evidence that Vitamin C enhances the biological activity of nitric oxide.
Garlic
This can lower blood pressure by 10%, but only if you take it as a supplement. Although allicin is produced when raw garlic is crushed or chewed, much of it is destroyed during cooking. For about ten years, researchers have been aware the allicin made from alliin in garlic blocks the activity of angiotensin II—a substance that raises blood pressure. In addition, supplemental garlic elevates levels of nitric oxide.
Note, however, the health benefits of garlic supplements are due to ajoene, diithins, and allicin, not just due to allicin. So, shop carefully since ajoene and diithins are considerably more potent than “just allicin.”
Natto
Nattokinase enzymes have potent fibrinolytic (blood-clot-busting) activity, anti-atherosclerotic, lipid-lowering, antiplatelet (anti-platelet stickiness), and even neuroprotective effects.
In addition, with regards to the topic of this article, a well done double-blind, placebo-controlled, randomized study showed that supplementing with nattokinase for eight weeks resulted in a significant reduction of both diastolic and systolic blood pressure.
Nattokinase is an enzyme found in the food natto, which is a fermented soy product. Whether consumed as fermented soy or as a supplement, the natto enzyme has been used successfully for 25 years to treat hypertension and various circulatory issues in China and continues to be studied worldwide.
Odds and Ends
Ongoing research on peptides for weight control and metabolic issues will certainly yield some actionable results soon. Flavonoids such as green tea (EGCG) and pomegranate extract show promise for hypertension as well. Studies looking at herbs such as curcumin, ginger, and hawthorn extract are also quite encouraging. And what about hormones per se?
The idea that menopause or the associated estrogen decrease is associated with blood pressure increase is still under debate. The epidemiological challenge is the coincidence between menopause and aging and the evidence that both rising blood pressure and menopause have common determinants such as diet, body mass index, smoking, and even socio-economic class. In addition, there seems to be no correlation between testosterone levels in men and blood pressure levels. The bottom line, as always, is to eat healthfully, exercise correctly, and supplement smartly. For some, that might include nitric oxide supplementation.
How to Boost your Immune System
We suffered not just from sickness and loss; we have been shut in, shut down, and zoom-fatigued. Something that has emerged as almost a national obsession has been the urge for lots of self-care, including care that prevents infection. Such care now includes strategies to boost our immune system. We want not simply to mask up, but to also, well- “immune up!” Shall we?
Basic Lifestyle Strategies for Immune Health
Diet: I advise all patients to eat some form of an anti-inflammatory diet. To keep it super simple-eliminate highly processed foods, watch your sugar and starchy carbs consumption, and be careful with gut-damaging lectins. Foods that are highly processed or high in lectins such as gluten-containing grains, beans, nightshade vegetables, and low-fat dairy products lead to gut lining damage which means “leaky gut.” Eating this way then causes inflammation which is one of the root causes of all diseases. I’ll go into inflammation more in-depth in one of the following sections. See the first page of my website for a free, downloadable diet.
Immune-boosting foods include garlic, horseradish, and wasabi. Garlic is anti-viral, and while used as a supplement, I won’t explicitly cover its use in this article. It’s also essential to eat to support the health of your microbiome. Microbiome health equals far greater immune health; I’ll cover that in a separate section further on in the discussion. Dietary constituents with exceptionally high anti-inflammatory and antioxidant capacity include vitamin C, vitamin E, and phytochemicals such as carotenoids and polyphenols. Let that sentence serve as an introduction to the next topic, oxidative stress, followed by inflammation.
Oxidative stress
What is it? Oxidative stress is an imbalance between the production of free radicals (will explain) and the ability of your body to counteract or detoxify their harmful effects via neutralization by antioxidants. Oxidative stress is the condition in your body when it does not have enough antioxidants to neutralize free radicals. Just as an apple not coated with lemon (an antioxidant) turns brown when exposed to air, our cells can “rust” when we have oxidative stress- caused by unopposed free radicals.
Free radicals are unstable molecules that react with certain substances in your body to damage cells or create abnormal ones. Free radicals chemically react with cell components such as DNA, proteins, or lipids and steal their electrons to become stabilized. This process destabilizes the cell component molecules, seeking out and stealing an electron from yet another molecule, triggering a large chain of free radical reactions.
A proper diet can reverse this unhealthy but common condition. Eat five to twelve servings of organic fruits and vegetables daily or supplementing with a high-antioxidant multi-vitamin. I always measure patient’s levels of oxidative stress with a Raman spectroscopy unit. Other Functional doctors may use blood or urine testing. The bottom line: if you’re aware of this phenomenon, you can prevent it! Here’s what to watch out for and adjust your intake of antioxidants accordingly.
What Causes Free Radicals? Free radicals are simply a byproduct of energy consumption in our mitochondria, the factories that produce energy in each of our cells. When we exercise, we increase our respiratory and heart rate, creating more free radicals that need to be quenched by good levels of antioxidants. However, the free radicals that deplete our antioxidant supply are environmental and result from our lifestyles. Here are the big offenders.
Exposure to tobacco smoke: Imagine this-tobacco smoke contains more than 4,000 toxic chemicals that all can cause oxidative stress. One cigarette produces millions and millions of free radicals. How’s that for incentive to stop? We who use Raman Spec scanners have discussed the data, which shows that smokers score in the lowest range, equivalent to those with active cancer cases!
Consuming a “bad” diet: As referenced in the “diet section,” it’s essential to eat as if your health depends on it (because it does!). Eating too many calories, sugars, refined or starchy carbohydrates, processed and fast foods, and lectins do indeed cause oxidative stress and inflammation. Unhealthy foods force our mitochondria to work harder and release more “exhaust,” creating higher levels of free radicals burning toxic foods for energy. Speaking of diet, let’s look at two other popular lifestyle choices.
Excessive alcohol: Alcohol consumption increases your levels of inflammatory cytokines-inflammatory molecules linked to oxidative stress.
Eating charcoal-broiled foods: These foods-not just meats-contain polycyclic aromatic hydrocarbons, which contribute to oxidative stress. And yes, char-broiled meats are indeed carcinogenic. Now, let’s move onto some other lifestyle factors in oxidative stress levels.
Excessive psychological stress: The stress hormone cortisol increases inflammation, which further increases free radical production. It also causes a leaky gut, an asymptomatic cause of chronic inflammation, and the root cause of autoimmune disease.
Exercising too much: Exercise (which will be discussed in another section) is crucial for optimal health. However, too much of it can increase oxidative stress in our bodies. As a rule of thumb, more than 60 minutes per day is considered excessive. Therefore, all elite athletes need to supplement adequately.
Lack of sleep: Sleep deprivation increases oxidative stress through a complex series of chemical reactions. Yes, I’ll discuss sleep in more depth, too.
Exposure to air pollutants: Air pollution, industrial pollution, and even airborne allergens increase oxidative stress.
Chronic infections: Hidden (asymptomatic) infections will contribute to oxidative stress. One example is a biofilm secreting sinus organism called MARCoNS, found in people with mold and mycotoxin illness. Dental infections are another excellent example. If you have root canals, you will not feel apical abscesses-so get a panoramic X-ray annually.
Ionizing radiation and EMFs: Exposure to x-rays, excessive sun, radon, cellphones, hairdryers, airplanes, electric blankets, and heating pads can all contribute to oxidative stress.
Exposure to fungal toxins: Environmental molds (like those in basements and bathrooms) and internal fungi (such as those colonizing your gut in excess) can produce mycotoxins that increase oxidative stress.
Inadequate GI-tract detoxification: When the liver is overwhelmed with toxins from food (e.g., too much sugar) or the environment (e.g.:exposure to pesticides or toxic mold), it becomes inflamed and then produces more free radicals. And now that you know what causes this problem go ahead and fill your diet with antioxidant-rich food, smoothies, and supplements to combat it. Next, let’s look at OS’s evil twin: inflammation.
Inflammation
What exactly Is Inflammation?: Let me first explain “acute inflammation.” Think about what happens when you get a splinter in your finger. If you don’t remove the shard, the whole area turns red and gets a little puffy. That’s acute inflammation, and it’s a good thing, as it’s your body responding appropriately to a situation. It’s mostly your immune system rushing to the area to fight off any viruses or bacteria that might have gotten in. With a physical injury, if you leave the spot alone and don’t irritate it any further, the swelling will go down, and everything will go back to normal. The signs of acute inflammation: heat, redness, swelling, and pain will all dissipate.
However, if you keep stabbing yourself with fragments in the same spot, the re-injury would maintain the high levels of inflammation burning. That’s what is going on with chronic internal inflammation, but you can’t “feel the stabbing.” The inflammatory response is short and relatively precise. When it’s chronic, inflammation can be “silent,” can make you feel lethargic, or contribute to many other health problems. Here are the major causes of chronic inflammation.
Your weight: Inflammation risk is guaranteed if you are obese or even just overweight. Overweight and obese men and women have higher levels of inflammatory blood markers than men and women of the same age who are not obese or overweight. Inflammation drops when men and women lose weight, according to many clinical studies.
Unhealthy diets: I know you hear this repeatedly from me, but consider that it’s that important to eat a healthy diet. Common foods processed just like sugar and therefore considered”inflammatory” are sugary foods, high-processed carbohydrates, high-industrial fat, and seed oils, high-gluten, and all overly processed and fast foods, save the lone naked salad. I know this is the typical U.S. diet. Toxic foods are why our population is so inflamed! Further, this poor eating pattern also causes oxidative stress, which in turn worsens inflammation.
Insufficient omega-3 intake: Omega-3 fats are the precursors for anti-inflammatory eicosanoids, an integral part of the inflammatory response. Poor omega-3 status means inadequate production of anti-inflammatory eicosanoids and a lopsided anti-inflammatory reaction to normal stimuli. It’s easy to get good blood levels: eat omega-3-rich fish such as salmon or sardines and take good omega-3 fish oil supplements.
Excessive omega-6 intake: Omega-6 fats form the precursors for inflammatory eicosanoids, which are also an integral part of the inflammatory response. High omega-6 status (especially when combined with poor omega-3 status) means excessive production of inflammatory eicosanoids and a lopsided inflammatory response to normal stimuli. Cut down on your omega-6 intake by reducing your intake of meat.
Chronic stress: Life can be stressful, indeed. Everything all adds up, doesn’t it? Notably, if it becomes too much for you to handle, your body will have a physiological, inflammatory response to emotional stress. This physiological reaction includes a rise in cortisol, as mentioned earlier.
Lack of downtime: When you’re always on your phone or checking your social media accounts, you are not relaxing. When you hear a “ding” and rush to answer a text or email, you are always “on.” You may think you’re relaxing because your body is stationary, but you’re not relaxing-are you?
Lack of sleep: Poor sleep causes elevated blood inflammatory markers. Poor sleep is a chronic problem in the U.S. Either we go to bed too late, wake up too early, or use too many electronics late at night and disrupt the sleep quality we get. I’ll go more in-depth into the topic of sleep further on in this article.
Toxins cause Inflammation: Heavy metals, biotoxins such as mold and Lyme toxins, and more can cause chronic inflammation.
Lack of outdoor time: We all spend too much time cooped up in offices or, worse, in office cubicles, or even at home, doing zoom calls. We just plain don’t spend enough time in nature.
Your exercise and movement patterns: Insufficient exercise and even inadequate “movement” (more below) adds to inflammation.
Lack of movement: Most of us lead far too sedentary lives. A lack of activity causes systemic, low-grade inflammation. We don’t usually need to walk to get to our destinations. We take escalators and elevators. We sit for hours on end and then don’t make time for regular exercise. Suppose this is you-make time to move more. Get up on your feet for two to three minutes each hour you’re sitting. Better yet, do some burpees, jumping jacks, or push-ups.
Poor recovery and Overtraining: On the other hand, some people move, but they exercise too much, with too little rest and recovery. Overtraining is a form of chronic inflammation. Not just elite athletes, but even casual 10K runners and others who train frequently can overtrain. This degree of over-exertion can cause inflammation, as well as elevated cortisol levels, and disrupted sleep. Now that I’ve gone through some ways not to exercise, why don’t I discuss how to exercise?
Exercise
Multiple studies in both humans and animals have demonstrated the profound impact exercise has on the immune system. There is an overwhelming consensus that regular bouts of short-lasting (30 to 45 minutes) moderate-intensity (e.g., brisk walking, vacuuming, dancing, doubles tennis, and “shooting hoops”) exercise is beneficial for proper immune function. This correlation has been demonstrated particularly well in older adults and people with chronic diseases.
Exercise is probably healthy for intestinal flora composition, so remember this when you read the section about the microbiome. Some investigations have shown that activity is associated with increased microbiome biodiversity with attendant beneficial metabolic functions. Gut microbiota (innately linked to all immune functioning) can, in turn, influence the pathophysiology of several distant organs, including the skeletal muscle. A gut-muscle axis may regulate muscle protein deposition and muscle function. This gut-muscle axis may involve maintaining skeletal muscle with aging and contribute to insulin sensitivity and blood sugar levels, which brings me to the next topic called glycation.
Glycation
Cellular glycation is the stiffening and aging of all cells. It occurs at fasting blood sugar levels somewhere in the range of 75-85 ng/dL. Research continues to lower the bar at which we set the definitions of glucose-intolerant, diabetes, and simply “cellular glycation.” I don’t think I need to mention that blood sugar levels increase with increased body mass.
Higher blood sugar levels are associated with immune system depression, increased risk of dementia, heart disease, cellular aging, and even cancer. Cancer is an immune-mediated and mitochondrial dysfunction disease that is largely preventable. Some studies demonstrate that certain cancers respond to treatment more effectively when blood sugar is lower, achievable via ketosis or medication. Studies also link better blood glucose control to better sleep. Here’s what you need to know about sleep.
Sleep
Sleep has powerful effects on immune functioning. Studies show that sleep loss can affect different parts of the immune system, leading to the development of a wide variety of disorders. Here are a few interesting studies to consider before giving you my recommendations for adequate, restful sleep.
Sleep loss is a risk factor for lessened immune response and infection. Restricting sleep to 4 hours per night for six days, followed by 12 hours of sleep per night for seven days, resulted in a greater than 50% decrease in antibody production to influenza vaccination than subjects who had regular sleep hours.
Restricting the time allowed for sleep to 4 hours for one night reduced natural killer (NK) cell activity to an average of 72%, compared with NK cell activity in participants who had a full night’s sleep. NK cells are essential for infection clearance; they also have a significant role in killing tumor cells. Reduced functioning of NK cells is associated with an approximate 1.6 times higher risk of dying from cancer.
In addition, restricting sleep to 4 hours for (again) just one night led to the generation of measurable inflammatory cytokines, which play an essential role in developing metabolic and cardiovascular disease. So, how much “good” sleep do you need?
How Much Sleep Do You Need? There is only a little individual variability in regards to how much sleep we all need. Most adults need 7 to 8 hours of good-quality sleep per night. What’s “good quality sleep?” Good quality means that the “sleeping episode” doesn’t include frequent arousals and is long enough for the individual to feel refreshed upon awakening. All wrist gadgets aside: most of us move correctly through the stages of sleep depth, including REM, and if we don’t, we don’t feel refreshed-plain and simple.
Researchers have identified genetic mutations in some people who naturally sleep six or fewer hours a day and appear healthy and functional. These people show less deterioration in performance when they are sleep-deprived under laboratory conditions. However, note that the percentage of the population with these gene mutations is minute. Most people who say they do not need much sleep are just pushing themselves to sleep less. As a consequence, they then struggle to stay awake and tend to function suboptimally during the daytime. They are putting themselves at risk for obesity and chronic illness.
Want to figure out your ideal sleeping time? The average sleep times across 5 to 7 relaxed days estimate your required sleep duration. Just record the length of time you sleep during a 7-10 day vacation, when you are awakening spontaneously, without an alarm, and go to bed when you are tired. During this time, remember to keep caffeine intake to no more than 2 cups of regular coffee a day (about 200 mg of caffeine). And speaking of a relaxing vacation, try to do an activity to reduce your stress levels daily at least a couple of times per day to mimic how you feel on holiday. Stress management is not simply to make you feel better; it’s a matter of your health.
Stress Management
Stress depresses the immune system. It does this via several different mechanisms. First, sustained high cortisol levels caused by stress cause gut hyper-permeability (i.e., “leaky gut”), which causes inflammation and subsequent disease. Cortisol also interferes with T-cell (a type of white cell) production and function, making your body more susceptible to pathogens. Stress is why you get more head colds when you are under pressure. Finally, cortisol kills brain cells (neurons), further interrupting the gut-brain axis crucial for proper immune function.
Manage your stress before it manages you. Incorporate movement and exercise into your day. Activity can be as simple as making sure you get up from your chair and walking around for a few minutes every couple of hours. Exercise should be something you will do, not something you’d like to envision yourself doing. Deep breathing and meditation are great habits to cultivate. If you don’t have the patience, you can activate the vagal (parasympathetic system) nerve by singing and even gargling. Some people also benefit from liposomal GABA supplements and peptides with anti-anxiety benefits. I touched on gut health, and now I’d like to go a little deeper into that topic with a discussion about the microbiome.
Microbiome Health
The human microbiome is between 10 and 100 trillion genetically unique (mostly) bacterial cells. The healthier your gut microbiome is, the better it is for your immune system, which is also (primarily) located in your gut. Unhealthy gut bacteria thrive on the things that create inflammation in our body, including refined carbs, sugar, unhealthy fats, and processed foods. Conversely, the healthy foods and activities discussed previously all contribute to microbiome health. To augment all of these healthy habits, we can add prebiotic fiber and probiotics into the mix. First of all, we need to eat good prebiotic foods as “fertilizers” for probiotics.
Prebiotic fiber: This is non-digestible carbohydrates found in fibrous foods that assist in the growth of healthy bacteria in the gut. White and even tastier-red onion, as well as asparagus, chicory, garlic, unripe banana, and artichoke-especially Jerusalem artichoke, are great “gut bug food.” They assist gut health primarily by helping healthy gut bacteria produce substances such as butyrate. Butyrate helps protect the gut lining and has anti-inflammatory properties in the gut. Now let’s seed this fertilizer.
Probiotics: High-quality kefir or yogurt (home-made) and fermented foods such as sauerkraut can supply a fair amount of good bacteria, but I generally supplement everyone to ensure they get enough probiotics to augment immune function. We see some good evidence that sporulating probiotics are more immune-supporting and microbiome-diversity-supporting than the strains of probiotics we used to recommend only recently.
Immune enhancement with hot and cold therapy
Heat shock proteins form in the body when you immerse your body in ice-cold water or a tub or sauna at 104 degrees F. They are great for your immune system and will enhance many positive immune modulation functions.
Cold therapy lowers cortisol levels when you do it on a repeated basis. I just reviewed why you want nice, controlled cortisol levels, and this is now another way to get them. As a reminder, bringing down your cortisol will not only help your gut lining stay intact, it will enhance the 70% of your immune system which resides in your gut. In addition, studies show that cold therapy improves anti-tumor white blood cell activity. Finally, NK (natural killer T cell) activity also gets a boost with cold therapy.
Various heat shock proteins induced by saunas (conventional and FIR) trigger positive effects in the immune system regarding infections, autoimmune disease, and even cancer therapy. Suffice it to say, for this article, that hot and cold treatments are fantastic for your immune health. Now, let’s discuss supplementation.
Supplements to boost the immune system
Multivitamin supplements
Over 10,000 vitamin companies are selling their multivitamins. You want to choose GMP, NSF certified, and high antioxidants, especially forms of vitamin A called carotenoids. Good MVI supplements also contain iodine and selenium, which are important for proper immune system function. The addition of polyphenols is an excellent “add” when you can find them, and they are suitable for the care and feeding of your microbiome. You need more vitamin C than you get via multivitamins: I’ll address that separately.
Vitamin D
You need vitamin D for a properly functioning immune system. We’ve more than learned that during this past year’s COVID crisis.
Vitamin D inhibits negative (harmful) immune pathways and promotes positive ones. It also positively impacts the composition of the microbiome and enforces the gut barrier. Clinical studies show low vitamin D levels are a risk factor for coronavirus infection. Previous studies correlate low levels of vitamin D with more “flu”; in general.
Vitamin D dosing: You want a level of 75-80 ng/dL which requires most Americans to take doses of 5000-10,000 IU per day.
Vitamin C and Zinc
Vitamin C concentrations in the blood plasma and white blood cells quickly decline during infections. Likewise, zinc deficiency impairs cellular mediators of innate immunity such as natural killer cell activity, phagocytosis of infectious organisms, and the generation of an oxidative burst.
Supplementation of vitamin C improves various components of our immune system: natural killer cell activity, migration of white blood cells (chemotaxis), the appropriate and proper proliferation of specific white cells called lymphocytes, and overall antimicrobial activity. Vitamin C contributes to the antioxidant status of cells, thereby protecting them against reactive oxygen species generated during the inflammatory response. Supplementation with zinc has shown similar benefits, which, in some studies, are augmented by the flavanoid-quercetin.
Therefore, both nutrients play important roles in immune function and help attenuate the risk of infection when taken as dietary supplements. They have reduced the risk, severity, and duration of many infectious diseases. When taking long-term zinc supplementation, make sure you are ingesting enough dietary or supplemental copper.
Zinc dosing: Ideal dosing is about 25-60 mg per day.
Vitamin C dosing: Liposomal preparations can be taken in doses up to 3 grams (usually 1 TBSP) per dose without GI distress for most people. Many clinical studies use 1.5 grams 4 times per day (6 grams total), but I generally recommend 1 TBSP 2x/day during “flu season,” including during this past COVID-year. Take regular buffered vitamin C as a 500 mg dose- just space that out accordingly.
Melatonin
Melatonin is a potent anti-inflammatory and anti-oxidant-not simply a sleep aid. The fact that it helps establish our circadian rhythm is an immune boost– right there. Many people find this surprising, but it’s accurate! When we are infected, It functions mainly to blunt our over-active inflammatory response, limiting tissue damage. It does much more, but for this article, I’ll state that it’s good for your immune system and will indeed help you sleep more soundly. There’s a good reason that the “expanded” use of melatonin won its scientists the 2017 Nobel Prize in “physiology or medicine.”
Melatonin dosing: Studies have the maximal efficacy at 10-20 mg per night.
Reishi mushroom extract
Many types of mushrooms contain polysaccharides called beta-glucans in their cell walls. Beta-glucans boost the immune system via several mechanisms. They enhance the action of macrophages (a type of white blood cell that kills foreign invaders), activate the “complement” component of the immune system, and boost natural killer (NK) cell function. There is an especially immune-boosting species of mushrooms called Ganoderma lucidum or reishi mushrooms. They are not especially tasty but are used to formulate potent immune-enhancing supplements.
Reishi dosing: Find a good brand that uses cracked reishi spores to make the powder put in capsules and take 1000 mg per day.
DHEA
The hormone DHEA is well known to impact adrenal function positively and, therefore, cortisol levels. It has verifiable anti-inflammatory properties and is most likely immune-supporting via several complex hormonal pathways.
DHEA dosing: Important note: Men with a history of prostate cancer and women with PCOS or a history of breast cancer must take the keto form of this hormone, if at all, since the keto form is not study-proven as an immune enhancer. Otherwise, men should take a daily dose of 50 mg; women-25 mg.
Nitric Oxide
Nitric oxide (NO) is bactericidal, which can act directly as an anti-microbial compound that can destroy bacteria. Certain families of immune cells called dendritic cells can produce NO, contributing to the resolution of both viral and bacterial infections. The non-proven inference is that higher NO levels contribute to a more rapid and efficient clearing of bacterial and viruses. It’s good for your vasculature and heart, indeed very well might be immune boosting, so because of all of this, it makes my list.
NO dosing: Look for a product with an equal amount of l-arginine and l-citrulline such that you take 1.5 grams of each 2x/day.
The Research Continues
Many organ systems function better by restoring male hormones and female hormones to youthful levels, and we know that human growth hormone is immune-boosting. We understand that the alpha-thymosin 1 peptide is so good at boosting the immune system (increased NK cell activity, increased antibody response to viruses, increased T cell function, and more) that the FDA pulled it off the market. Yes, that happens all the time with compounded products used successfully by Functional doctors. But studies are ongoing with other peptides.
There are other varieties of mushrooms (lion’s mane, for one) currently under investigation for immune enhancement. And finally, the most exciting research involves the use of stem cells and exosomes.
Get Rid of Bloating by Addressing the Root Cause
To get rid of bloating symptoms, you must identify the root cause. Depending on what is wrong, you’ll need to do “the basics” and then, typically, some other personalized steps. The gastroenterology literature compartmentalizes bloating into what they call “functional” (translation: they find no cause for it) and “non-functional” (translation: they can pinpoint a cause). Since Functional medicine prides itself on always finding and then addressing the root cause of symptoms, I’m not going to use this classification. What I’ll do, instead is go through some basic explanations, and then review the common causes and treatments for issues that cause bloating. You’ll learn not just how to reduce bloating but hopefully, how to get rid of bloating; either on your own, or with the help of a good functional medicine doctor.
- What is bloating?
- Can I “just” bloat?
- General happy gut hygiene
- Happy gut supplements
- Bloating due to Leaky Gut/Solution
- Bloating due to a Disordered Microbiome/Solution
- Bloating due to Insufficient stomach acid/Solution
- Bloating due to gut motility issues/Solution
- Bloating due to hypothyroidism/Solution
- Bloating due to SIBO/Solution
- Bloating due to SIFO/Solution
- Bloating due to carbohydrate intolerance/Solution
- Bloating due to food sensitivities/Solution
- Bloating due to Inflammatory Bowel Disease/Solution
- Bloating due to Celiac Disease/Solution
- Bloating due to Rapid weight loss or gain/Solution
- Bloating due to Irritable Bowel Disease
- Bloating due to Constipation/Solution
- Bloating due to Hormone Imbalance/Solution
- Bloating due to Chronic Stress/Solution
- Concluding comments
What is Bloating?
Bloating is caused by the physical sensation of having gas trapped in your belly. Put “more medically”-abdominal bloating is the subjective sensation of trapped gas, gassiness, or a feeling of pressure or being distended with or without obvious visible distension. It is decidedly not caused by fluid retention. You might have a bloated belly but have some fluid retention in other parts of your body (such as your feet and ankles) if you have a condition that’s causing both problems.
Patients also describe a sense of fullness or pressure, which can occur anywhere in the belly. We like to break it down into “above the belly button” (epigastric), belly button region, lower belly or diffuse so that we can analyze whether it’s an “upper belly” issue such as undiagnosed reflux, a small intestinal issue such as SIBO, or a lower bowel issue such as inflammatory bowel disease. All of these conditions will be covered in the “16 health issues” below.
Abdominal distension is the objective physical manifestation of an increase in abdominal girth. Male and female patients commonly describe how they look- “like I’m pregnant” when they have moderate to severe bloating with distension. Abdominal bloating and distension can occur independently, although they often occur together. Studies have reported that 50% of patients with “bothersome” bloating report abdominal distension. Remember when I said I wouldn’t talk about “functional bloating?” I’m going to break my rule this once: in so-called functional issues such as irritable bowel disorders patients are less likely to pair up bloating with visible distention than in decidedly non-functional disorders such as SIBO. Now that you know this, you can forgot I mentioned it.
Nearly all of us has experienced, at one time or another, a sensation of being bloated, gassy, or distended. For many people, these are merely annoying but transient sensations that occur after eating, resolve spontaneously, and do not lead to medical consultations. For others, however, abdominal bloating and distension are chronic, bothersome, and negatively affect their daily lives, whether they have a definitely treatable cause or a diagnosis of irritable bowel syndrome.
The occurrence of bloating with distension is significant, ranging from 15% to 30% in the general population, and is as high as 65%–90% in patients with irritable bowel syndrome (IBS). Women generally report higher rates of bloating than men, while patients with IBS with constipation predominance (rather than diarrhea predominance) have higher rates of bloating with distension. Seventy-five percent of patients with bloating (who do not have IBS) characterize their symptoms as moderate to severe, while 50% report that symptoms are so severe that they cause a reduction in daily activities.
To simplify the concept of bloating think of your gut as a digestion and bacteria factory. For some reason, you have inadequate protein, sugar and/or carbohydrate digestion which then causes foods to ferment. This can be caused by any of the medical issues I discuss below. You also have an imbalance in your gut bacteria or microbiome. This just “goes with the territory.”
Non-functional etiologies for abdominal bloating and distension that will not be discussed in this article include pancreatic insufficiency, diabetes, gastroparesis, Scleroderma, Chronic idiopathic pseudo-obstruction, Acute gastroenteritis, Gastric malignancy, Bowel malignancy, Ovarian malignancy, and ascites; an accumulation of fluid in the abdomen.
It is unusual but possible for any gastrointestinal bloating to actually represent fluid collecting inside your belly. This is not bloating. It is a potential medical emergency, and what you think is bloating, we call “fluid distension.” It could mean an infection such as hepatitis or even cancer. It could mean bowel obstruction from scars caused by prior surgery or adhesions from ongoing inflammatory bowel disorder. If you have sudden gastrointestinal distention, please see a doctor ASAP! Now let’s talk about the bloating that you came to read about. First, bloating by itself: can it happen with no other symptoms?
Does bloating occur by itself?
Yes it can. If so, it is typically due to SIBO, SIFO or food sensitivities which I’ll address shortly. Other than these three things, it’s very unusual for bloating to occur without gas (upper or lower), diarrhea, or constipation. Lower intestinal gas is the primary “second” symptom associated with bloating. Constipation is second and is often helped with proper “happy gut” measures.
How to have a happy gut=how to reduce bloating
Chewing is obviously the first step towards the digestive process. The enzyme (amylase) is released immediately from your parotid glands, and makes digestion much easier on your stomach. Sicca syndrome (dry mouth), aging or having even a minor reflux disease (heartburn: with or without symptoms) can interfere with this initial process and cause bloating. So, your first digestive “job” is to chew your food thoroughly. We’ll get into whether or not you’ll need digestive enzymes.
In addition to chewing your food thoroughly, eat enough soluble and insoluble fiber (25-30 grams per day) to keep your colon “moving along regularly.”
Both soluble and insoluble fiber help bulk up your stools and can be used as a food source for good bacteria in your large intestine. Soluble fiber draws water into your gut, which softens your stools and supports regular bowel movements. Examples of healthy high soluble fiber foods include broccoli, sweet potatoes, avocados and figs, to name a few of my favorite foods. Two great examples of insoluble fiber include nuts and cauliflower.
Hydrate well which just means drink enough water so that your urine is clear. Too much of any fiber without enough fluid-added at once will cause constipation. Add fiber slowly and make sure you add more water or fluids to your diet at the same time. The combination of hydration and fiber keeps the GI tract moving along the way it’s supposed to do.
Exercise regularly. Exercise also helps with the GI tract’s peristalsis which is it’s rhythmic propulsion forward.
Eat a healthy diet. Fast food and processed food causes an array of gut issues- from leaky gut to dysbiosis.
Happy gut supplements
Any time the GI tract is “stressed” (causing any symptoms), I advise patients to chew food more carefully, cook meat and veggies more thoroughly, and take digestive enzymes to decrease the GI tract’s workload. A good digestive enzyme will contain HCL or betaine, and enzymes made by the pancreas and gall bladder. If you’re a gardener you know that you get better results with good fertilizer and good seeds. Your gut fertilizer is prebiotic fiber. Prebiotics and natural prebiotic fiber are a great addition to anyone’s diet. Some examples of good prebiotic fiber food: onions, asparagus, Jerusalem artichokes and un-ripe bananas. Unless you are making your own A2-milk kefir or yogurt, it’s a good idea to take a sporulating probiotic daily. Other products are required for specific symptoms or issues and will be discussed in conjunction with their specific issue.
Bloating due to Leaky Gut
This extremely common condition is often caused by anti-inflammatory medications, antibiotics, stress (discussed later on in this article) or just “bad American food.” None of these things differentiate between “good” and “bad” bacteria when they are killing off organisms in your gut. Healing a leaky gut isn’t that hard. If you have one, you are likely not just uncomfortable, but you’re a set-up for autoimmune disease.
Getting you into remission from any autoimmune disease starts with fixing your leaky gut. Changing your diet to my A.I.P. diet plan is the first step in healing your gut and reducing your auto-antibody production. As you heal your gut over two months, your (probable) food sensitivities and, therefore, your bloating will diminish. If it doesn’t, it often means you have SIBO, which is not uncommon in those with leaky gut. We’ll discuss that in an upcoming section.
Solution: Use (under medical care) proper gut-healing peptides and (if needed), supplements for leaky gut such as l-glutamine and collagen powder. Vitamin D levels need to be normalized, and sporulating probiotics with their “fertilizer”-prebiotics, should be added when the symptoms start to subside. More about re-balancing your microbiome (the prebiotics and probiotics) coming up next.
Bloating due to a disordered microbiome
An imbalance in our microbiome is called dysbiosis. Dysbiosis an be caused by seemingly innocuous things from using too much mouthwash to stress to the use of hand sanitizers and consumption of OTC medications. When we carry around more pathogenic bacteria than we should, and also lack the proper diversity and number of protective bacteria we need, the microbiome is unbalanced, unhealthy, and will not serve our bodies well.
In the colon, there are trillions of healthy (and unhealthy) bacteria which compete for space. When the number of “bad bacteria” outweigh the “good bacteria”, the imbalance can lead to abdominal bloating and gas.
We obviously require a higher ratio of gut-friendly microbes to outnumber the harmful ones in order to stay symptom-free and optimally healthy. Unfortunately, due to multiples of bad habits, most people’s microbiomes are filled with billions of potentially dangerous bacteria, viruses, and other pathogens.
Solution: It’s all about the fertilizer and the seeds: the prebiotic fiber and the probiotics. First, a quick note about yogurt. The only healthy yogurt is made from A2 dairy, using live cultures. Even then, we all recommend that you avoid dairy-based yogurt until your gut heals. Therefore, at least initially, your probiotics should be from capsules so you’re in charge of the dosing.
If your gut microbiome is unbalanced with “bad bugs” in the majority, you need to use prebiotic fiber to feed a lot of good bacteria (and-if there is no mycotoxin illness- a little “good yeast”) to overtake the bad bacteria. You want to consume about 50 to 100 billion probiotic CFU’s per day. Some of the literature suggests that a mixture (in your main probiotic) of Bifidobacterium species and Lactobacillus species is necessary. Also, add in some friendly yeast called Saccharomyces boulardii. However, the latest research supports the use of sporulating probiotics for most conditions, especially for the treatment of Crohn’s disease and ulcerative colitis. No matter what we’re treating, there are strong suggestions that the sporulating probiotics will result in a more diverse (and therefore more healthy) microbiome. Here’s what to look for.
Find a probiotic that contains a few strains of the bacillus species, which are all delivered to the gut as spores which then encapsulate beneficial bacterial strains. Look for b. subtilis, b.coagulans and b.clausii, as they have been studied and documented as beneficial. If the amount of CFU’s found in one of these probiotics (rarely) gives you diarrhea, simply open and empty 1/2 of a capsule out before taking it.
Bloating Due To insufficient stomach acid
Although it seems totally counter-intuitive, reflux-or heartburn- is the result of insufficient stomach acid. It is indeed sometimes caused by the H. pylori bacterium, but a short course of antibiotics and proton-pump inhibitor medication (or the natural alternatives if you’re my patient) are indicated solely in these documented cases. The bloating for this one condition tends to be around or above the belly-button.
Here’s the problem with PPI medications like Nexxium or Prilosec. They were intended for short-term use but instead, are either prescribed or bought over-the-counter and used for years. When you do this, it alters your microbiome, suppresses your immune system and may even increase your risk of heart disease. As for your gut heath, it’s awful for that, too.
Note this is not how the PPI drug was intended to be used–ever! In the instances where people take over-the-counter PPI medications for their heartburn symptoms, the low stomach acid impedes the digestive process, making those individuals a total set-up for leaky gut!
Solution: To correctly treat run-of-the-mill heartburn, you need digestive enzymes containing pancreatic enzymes and bile acids. If that isn’t enough to quiet down your symptoms, add betaine (HCl) capsules; taken 15 minutes before meals. If your heartburn persists, you should be breath-tested for H. pylori. If you still have bloating (especially below your belly-button), you have lower gut issues. You might have developed leaky gut and/or food sensitivities, for instance. It’s time to seek Functional integrative care.
Bloating due to gut motility issues
In cases of leaky gut, with or without SIBO, as the gut lining becomes destroyed, some segments of the small and large intestine will propulse “out of sync” causing intestinal cramping and, often, constipation; sometimes, diarrhea as well. This can be easily addressed, but before we jump to the solution, let re-visit the concept of fiber a bit.
I’ve mentioned the need for fiber above but honestly, aren’t most people aware that they need to eat adequate amounts of dietary fiber for optimal gut health? To review: fiber is a non-digestible carbohydrate which you can find mainly in plant foods such as fruits, vegetables, legumes and whole grains. In addition, fiber helps maintain a healthy microbiome and supports healthy bowel movements (via motility and bulk) to decrease the risk of diverticulosis and colon cancer. The recommended amount of fiber is a minimum of 25 grams per day for women and 38 grams per day for men. This doesn’t even include the prebiotic fiber or “fertilizer” we’ve discussed previously. And yes, if you cannot manage to eat your prebiotic fiber it’s just fine to take powder-fiber supplement mixes which contain things such as inulin, citrus pectin, prune powder, and psyllium husk.
So, if you are experiencing cramping, constipation and some diarrhea while your leaky gut (let’s say) is healing, here’s what you need to do.
Solution: In this case, we usually recommend products to either bulk up the stool (e.g.: modified citrus pectin), and/or a fiber blend as noted above. We can also improve GI transit at the smooth muscle level with 5-HTP supplementation if constipation is the primary issue. While we wait for the 5-HTP to “kick in” we use non-stimulant and osmotic products to draw water into the colon and relieve constipation: trifala and magnesium hydroxide.
Bloating due to hypothyroidism
Since gut motility decreases when someone is hypothyroid, due to sluggish, slower or weaker smooth muscle gut contractions, constipation is a common symptom of Grave’s and Hashimoto’s disease. The resulting constipation, due to decreased gut motility is due to a decrease in FreeT3 which acts directly on the gut’s smooth muscle layer. This decrease in Free T3 can be due to T4 to T3 conversion issues but is often due to an unchecked increase in rT3 which is clogging up T3 receptors, rendering a patient “effectively” hypothyroid. This occurs quite often when someone has developed constipation which leads to leaky gut and then leads to SIBO-something we’ll discuss in the next section. It’s estimated that a minimum of 50% of those with Hashimoto’s thyroiditis have untreated SIBO. SIBO symptoms are often confused with those of other GI disorders and will be reviewed thoroughly in the next topic. Meanwhile….
Solution: Make sure you have all of the right thyroid hormones and auto-antibodies checked, including a reverse T3. Correct the hypothyroid state, and augment gut motility (methods above) as needed. Check for, and treat SIBO as discussed below.
Bloating due to SIBO
SIBO (small intestinal bacterial overgrowth) is an increased number and/or abnormal type of bacteria growing in the small intestine section called the jejunum, a part of the bowel that is supposed to be sterile. For years, a culture of the small bowel was the way we diagnosed SIBO based on the presence of ≥1 × 105 bacteria (colony-forming units (CFU)) per cubic centimeter of jejunal aspiration. However, this definition is now under a great deal of scrutiny, and current thinking is that “normal” rarely exceeds 1 × 103cfu/ml. Furthermore, the idea that someone needs to see a Gastroenterologist and have a procedure called an endoscopy is rapidly falling out of favor in Functional medicine.
SIBO It is associated with anything that disrupts intestinal mucous, the microbiome and happens to be a quite common, undiagnosed cause of chronic constipation. It is a frequent result of chemotherapy, is (naturally) associated with leaky gut and with mycotoxin illness. As just mentioned above, it’s quite common in people who are hypothyroid.
The most common symptoms of SIBO are bloating and flatulence; particularly right after eating. Other symptoms include abdominal discomfort, constipation with interspersed bouts of diarrhea. It can be labelled as irritable bowel disease due to the alternating diarrhea and constipation. Multiple food intolerances are relatively common.
Solution: Diagnosis. First- get the right diagnosis! As mentioned above, the endoscopic procedure of bacterial sampling and quantification has fallen out of favor due to the variability of data regarding diagnostic parameters, patient discomfort, and inherent procedure risk. Breath tests are now routinely used as an alternative to direct aspiration because they are noninvasive and considerably less expensive. The most commonly used breath test is the hydrogen breath test.
The lactulose hydrogen breath test (LHBT) is the most widely used hydrogen breath test. After the oral administration of 10 grams of lactulose, we take breath samples at 15-minute intervals for 3 hours. There is a catch: there are a huge number of false negatives- up to 60%! Because breath tests are not very sensitive or specific, many Functional doctors will treat a patient if they exhibit symptoms and have underlying reasons for them.
Treatment includes antibiotics that are not absorbed by the gut (specifically Rifaximin) or with natural (herbal) substances. Herbal therapies are at least as effective as rifaximin for resolution of SIBO in head-to-head clinical trials. Herbals also appear to be as effective as triple antibiotic therapy for SIBO therapy for rifaximin non-responders. Some effective herbals (which should be given under medical supervision) include berberine, oregano oil, barberry, garlic, olive leaf extract, goldenseal, wormwood, Oregon grape, garlic, caprylic acid and pau d’arco.
As a last comment, in addition to the sporulating probiotics, often your bloating and gas will respond almost immediately to 10 billion units of L. plantarium daily.
Bloating due to yeast overgrowth-SIFO
Yeast overgrowth often occurs at the same time as SIBO. It occurs in the same scenarios as described for SIBO, and especially for those in moldy homes.
Solution: If you’re living in a toxic home, that needs to be cleaned up, or the SIFO just won’t get better. It is also very important that you exclude all sugars from your diet as this is what feeds the yeast. The medication nystatin is used by some doctors to kill intestinal yeast infections. Natural yeast-killers include oregano oil, olive leaf and caprylic acid.
Bloating due to Carbohydrate Intolerance
Lactose, fructose, and other carbohydrates intolerance means that you cannot digest certain carbohydrates due to a lack of one or more intestinal enzymes. Symptoms include diarrhea, bloating with abdominal distention, and flatulence. The most common carbohydrate intolerance is lactose intolerance. This occurs when the enzyme that is required to digest lactose (the sugar found in milk and various dairy products) is not readily produced in the body, leading to symptoms as minimal as mild cramping or as much as just described.
Solution: For lactose intolerance, the diagnosis is “clinical”-meaning-take away dairy products and the symptoms cease. For other hard-to-pin-down carbohydrate intolerances, a more accurate version of the hydrogen breath test is used. Treatment is simply-removal of the causative disaccharide from the diet. Or in the case of lactose intolerance, consumption of less-lactose-containing A2 dairy products in combination with the enzyme lactase, taken with the A2 dairy meals can be quite effective.
Bloating Due To Food Sensitivities
Food sensitivities are not the same thing as food allergies. If you have an IgE-mediated food allergy, you have an immediate and quite unpleasant reaction such as a rash or hives and/or throat tightening. We’re not discussing these issues, due to, for example: peanuts.
The foods which cause most food sensitivities are (in this approximate order) gluten, dairy, eggs, corn, soy, shellfish, peanuts, citrus, lectins (namely beans) and nightshade vegetables (tomatoes, eggplant, white potatoes and peppers.) Food sensitivities most often develop in conjunction with other issues such as leaky gut, SIBO, chronic constipation, mold exposure and so on. If you are indeed sensitive, eating any of these foods can contribute to inflammation and even autoimmune responses such as skin rashes, migraine headaches, weakened immunity and even worsen or trigger the onset of autoimmune diseases.
Let’s discuss a few important specifics. Sometimes GI symptoms are caused by mild gluten sensitivity. This probably has to do with the fact that almost all U.S. wheat is GMO and is added to many products as a thickener. Estimates show that a minimum of 30% of the U.S. population has some variant of gluten sensitivity. Try removing it from your diet-if it’s the problem, your symptoms will resolve.
A last word about beans. We joke about flatulence being caused by beans. This is simply a matter of your digestive enzymes being overwhelmed or a true sensitivity to the lectins in the beans. An example of a high-lectin bean is the kidney bean, with lentils being fairly low in lectins.
Note there are sophisticated tests (Doctor’s Data labs, etc.) that can detect specific food sensitivities if you have eliminated the “frequent offenders,” fixed your gut, and other issues to be discussed below. However, most people find that removing the above foods and then slowly reintroducing them will pinpoint the foods you need to avoid. This doesn’t account for FODMAPS foods (to be discussed).
Solution: The vast majority of people find that their food sensitivities start reversing in concert with the reversal of their GI symptoms. You can try doing an Elimination and re-intro diet if you still have food intolerances. If you’d like more specific data, the lab “Doctor’s Data” does the most accurate food sensitivity blood testing. I have not found that Cyrex labs (who seem to be popular with the public- perhaps due to social media advertising) to be all that predictive.
Bloating due to Inflammatory Bowel Disease
If you have an inflammatory bowel disorder, you started out with a leaky gut, didn’t have treatment and it then produced more symptoms and finally evolved into Crohn’s disease or Ulcerative colitis. Leaky gut can indeed be asymptomatic, and you might shrug off some post-meal bloating as due to something you ate. Inflammatory bowel disease symptoms such as explosive diarrhea or rectal bleeding can come, seemingly, out of nowhere. To get the plethora of symptoms under control, and your disease in remission is not only possible, but something that we Functional doctors who “treat a lot of guts”- do all the time. When I discuss solutions, for this topic, getting into remission is not something you can do “on your own.”
Solution: You’ll need to start out with a strict AIP diet and make sure there are no environmental factors (e.g. mold) contributing to your problem. Next, you need your leaky gut healed, and if you’ve had bloating and constipation, SIBO and SIFO will need to be evaluated and addressed. We now use peptides and LDN to treat IBD, so find a good Functional doctor who can do this for you. You’ll need good prebiotic fiber with sporulating probiotics. It might even be a good idea to suppress TNF-alpha and IL-6 with supplements. Some patient also benefit from a low-FODMAP diet: please refer to the IBS section below for more details on this.
Bloating due to Celiac disease
If you feel that gluten is causing severe symptoms such as cramping, bloating and explosive diarrhea, you might have Celiac disease, which is not the same as gluten intolerance. Individuals with Celiac disease are considered to have an autoimmune disease, with detectable antibodies on lab testing.
Solution: Blood testing for Celiac disease and then elimination of all gluten from the diet. The website Celiac-dot-com is quite helpful.
Bloating due to Weight loss or gain
Rapid weight loss or (much more commonly) weight gain are associated with abdominal bloating. How common is this? In one study, recent “COVID weight gain” occurred coincidentally with new onset bloating in 25% of the study participants. Why? A possible mechanism may involve an abnormal feedback mechanism from the abdominal adipose tissue which helps modulate the brain–gut axis.
Solution: You probably know that I’m going to recommend that you slowly achieve your ideal weight and try to “stay there.” If you have cravings or binges, a little tweaking of your brain chemicals is done with intra-nasal peptides or integratives which are precursors to “happy brain chemicals.”
Bloating due to Irritable Bowel Syndrome
IBS (Irritable bowel syndrome) affects 7–15% of the U.S. population. Many people with a diagnosis of Irritable bowel syndrome have a treatable disorder. For instance, diarrheal-type IBS is often a problem called bile-acid malabsorption (BAM). Leaky gut, as you’ve read, causes bloating, constipation and diarrhea; often similar to IBS. You might have a chronic parasite infection if you are a world traveler or live near and recreate in a fresh-water lake.
Constipation-dominant IBS is quite often undiagnosed SIBO. In fact, some studies show that up to 80% of those diagnosed with IBS have SIBO!
Solution: If you do indeed have IBS, the #1 currently effective treatment is a low-FODMAP diet. Eliminating high-FODMAPS from your diet will help with symptoms; specifically bloating. The FODMAPS acronym stands for Fermentable Oligo, Di- and Monosaccharides and Polyols sensitivity. Foods containing glucose, fructose, polyols, and lactose can all cause symptoms for everyone with IBS and some people with IBD.
The mechanism of action of low-FODMAP diets is probably a reduction in small intestinal absorption of osmotically active polyols, resulting in diminished intestinal water content and beneficial effects on colonic fermentation and subsequent gas production. Other treatments include stool bulking agents such as modified citrus pectin, good prebiotics and probiotics, and if needed; anti-spasmodic medications. A few clinical trials show some benefit from biofeedback and even meditation.
Bloating due to Constipation and Outflow Obstruction
Functional (meaning perceived with nothing in particular being diagnosed) abdominal bloating and distension may be related to constipation and to functional outflow obstruction. Now, this being said, I’ll bet you that most cases of “functional” constipation are just cases of diagnoses not being made. At any rate, retained stool in the rectum can cause impaired gas evacuation and slowing of intestinal transit.
Solution:
Yes, there have been positive clinical trials with drugs for constipation-type IBS, but since I don’t like the drugs one bit, I’m not going to name them. What I always go back to is “what is the root cause” of the slow transit. Let’s talk more about serotonin than we did in the gut motility section. Serotonin is the happy brain chemical that you probably think is made in the brain. However, in both men and women, about 90% is made in the GI tract!
When your GI tract is not making enough serotonin, not only are you anxious and a little depressed, you have less GI motility and therefore constipation. You can have low GI motility due to a lack of serotonin, be constipated and not feel depressed or anxious as a FYI. Slowly adding some 5-HTP to your evening supplements will increase your gut motility, as mentioned previously. And you can also add trifala and magnesium hydroxide if needed, too. Please don’t get into the habit of taking stimulant laxatives, as this can cause permanent neurological damage to the propulsion in your gut.
Bloating Due to Hormone Imbalance
Bloating is a common sign of low progesterone. During the luteal phase of your menstrual cycle (after ovulation), both water and sodium retention increase with low levels of progesterone and high levels of estrogen. This occurs because the estrogen lowers the “osmotic threshold” for which water being reabsorbed in the body. When estrogen levels are high, this threshold is lowered and therefore less water is excreted through urine. This then causes the body to retain water and creates the sensation of bloating. Since this type of bloating, unlike “GI bloating” is indeed due to fluid retention, it’s different but often perceived as the same thing.
Low progesterone symptoms include the sensation of lower abdominal bloating. The bloating symptoms are usually accompanied by other low-progesterone (cyclical) symptoms such as irritability, sleep disruption and a little brain fog. If you have low progesterone due to perimenopause or early menopausal symptoms, your symptoms are less cyclic and you might, then blame your GI tract. Be on the lookout for this mistake.
Since progesterone helps gut motility via serotonin increases, low levels will generally cause some constipation. Men can also suffer from low progesterone symptoms, in addition to low testosterone issues, by the way.
Can chronic low progesterone lead to SIBO? Or leaky gut? Interesting questions which haven’t been studied but I would say a definitive “yes.”
Solution: Treatment is simple. Bioidentical hormone replacement with progesterone will clear up the bloating and constipation. Sometimes a little 5HTP is needed as well. A temporary measure is to use pregnenolone (non-prescription) which partially breaks down to progesterone. Progesterone creams sold over-the-counter are absolutely ineffective.
Bloating Due to Chronic Stress
If you “feel stressed” a good part of your workday, chances are good that you have a high fasting cortisol level. High cortisol levels can easily cause the breakdown of your GI lining. It slows down both GI motility and the entire process of digestion. As a result, some people experience “heartburn” while others have no symptoms whatsoever. Blood flow subsequently decreases to all of the digestive organs. This then adds insult to injury and results in a higher concentration of toxic metabolites which then whittle away at your gut lining. You can see that if the cortisol alone doesn’t give you leaky gut, the entire shutdown sure will. And if this isn’t enough, there’s actually more to this story. Simply being stressed out can lead to leaky gut, then to constipation, then to SIBO and food sensitivities.
Solution: Stress-management techniques are a must but it’s hard to find the time to do them if you’re already over-worked and over-stressed, right? If you can’t find the time for yoga, meditation or deep breathing exercises, try intermittent parasympathetic activation via your vocal cords. Do this by gargling salt water or even singing. You can get your cortisol down with adrenal adaptogens, as well. Do this not just for your gut, but for your brain, and arteries and more!
Final thoughts
If you have a little bloating once in a while, you can probably clean up your diet and your microbiome and maybe even identify an offending food or two, and voila, you’ll be fine. If you have been “abusing your gut” with processed foods, toxins, pharmaceuticals or stress, you’ll need functional medical help to get it all repaired and get rid of not just your bloating, but your other GI symptoms. GI symptoms are painful and bothersome. Don’t put up with them, now that you have some answers.
Mitochondria are the key to energy and health -Important update: I can now get NAD+ troches for you!
Before I dive right into a discussion about mitochondria, I’d like to ask you why you are reading this article? If you are looking for improved health and longevity, this article will give you lots of actionable information. However, if you have been feeling ill, with fatigue being a prominent component of whatever is wrong, you need Functional Medical care. You can’t “fix fatiguing illness” yourself. That’s all I’m going to say about that; now I’ll get into the topic you came for: how to boost and why to boost your mitochondrial function. Mitochondria are involved in many vital processes in human cells, including energy production, fatty-acid oxidation, and the Tricarboxylic Acid (TCA) cycle, calcium signaling, apoptosis (cellular death), and heat production. However to simplify things let’s talk about energy and longevity which is what their function translates to for practical purposes. And to help this occur, we can review the health practices, along with the best supplements to improve mitochondrial function.
- Why do we want well-functioning mitochondria?
- What happens when mitochondria malfunction?
- What about mitochondrial function and aging in general?
- Mitochondria boosting health practices
- Mitochondrial specific exercise
- CoQ10
- Alpha lipoic acid
- PQQ
- L-carnitine
- D-ribose
- Phospholipids
- NAD
- Miscellaneous supplements
- Final words
But before we begin, I’d like to give every one of my readers “patient access” to my Designs-For-Health account so that if you want to purchase supplements, you’ll receive a 15-25% discount from their Amazon price. Here is their website: https://www.designsforhealth.com/ and then my practitioner code is: kimcrawford, allowing you to create a un and pw for your own account. You’re welcome! If you want to try just one supplement, this one is probably your best bet. In addition, mitochondria reproduce and put out more of their “good stuff” when you lower sympathetic nervous system activity. Here’s the best and easiest way to do VNS to accomplish that goal quickly. Feel free to use and share my patient code: DrKim25 for a $25 discount on the best thing you’ll buy this year.
Mitochondria: Why do we care?
First, let’s discuss the “energy part.” Mitochondria produce Adenosine Triphosphate (ATP). In the cell, the energy in the form of ATP is produced in two ways: in the cytosol as a product of glycolysis and in the mitochondria as a product of oxidative phosphorylation. The substrates, in the form of fatty acids and pyruvate, are oxidized via fatty acid β-oxidation and the TCA cycle, respectively. The Nicotinamide Adenine Dinucleotide (NADH) and flavin adenine dinucleotide (FADH2) produced by these reactions are used by the electron transport chain to generate ATP. Just remember from this complex discussion of energy production that you need ATP and you need NAD+/NADH to make that ATP, so you feel as if you have enough energy.
Proper mitochondrial functioning is crucial for every nucleated cell in a body. A number of diseases are characterized by dysfunction of muscular or neural systems or metabolic reactions. All these diseases and pathophysiological conditions are developed against a specific genetic background, together with environmental factors.
Mitochondria produce energy as ATP (adenosine triphosphate), which your body then uses to fuel your daily activities. Some cells have more mitochondria than others. Your brain, muscles, and heart cells are full of mitochondria. Putting diseases and aging to the side: you want your mitochondria working at full strength to keep your energy levels up, your brain sharp, and your muscles and heart at their peak performance. The creation of new mitochondria (mitochondrial biogenesis) is needed for optimal aging, which we now call our healthspan. Not to be repetitive, but always remember this is mandatory to keep your energy levels at a peak. It’s also a part of what’s needed to protect you from oxidative stress. As you would predict, mitochondrial dysfunction tanks your energy and contributes to numerous physical ailments.
Mitochondrial Dysfunction and Disease
Mitochondrial dysfunction, characterized by a loss of efficiency in the synthesis of ATP, is a characteristic of aging and, essentially, of all chronic diseases. Loss of function in mitochondria can result in excess fatigue and even other symptoms in just about every chronic disease you can imagine. These conditions include neurodegenerative diseases, such as Alzheimer’s disease and Parkinson’s disease, and Amyotrophic Lateral Sclerosis.
Metabolic syndrome, heart disease, and diabetes are all associated with mitochondrial dysfunction. Metabolic syndrome is a group of conditions that combine hypertension, hyperglycemia, abdominal obesity, and abnormal cholesterol or triglyceride levels. Metabolic syndrome greatly increases the risk of cardiovascular disease, stroke, and Type two diabetes. There are numerous reports mentioning mitochondrial dysfunction and lower oxidative capacity in patients with Type two diabetes compared with healthy individuals.
The cardiovascular system strongly depends on mitochondrial function. Cardiomyocytes (heart cells) have very high mitochondrial content in order to produce the necessary ATP, and mitochondrial dysfunction inevitably leads to the development of cardiovascular diseases.
There is now increasing evidence of mitochondrial dysfunction in Alzheimer’s Disease, Parkinson’s Disease, Huntington’s disease, and Amyotrophic lateral sclerosis. Even some psychiatric conditions, such as autism spectrum disorders, schizophrenia, and bipolar mood disorders, are included.
In addition, mitochondrial dysfunction plays a significant role in the inflammatory response in acute human pathologies. Systemic Inflammatory Response Syndrome (SIRS) is a pathological state with a systemic immune reaction to severe damage, including ischemia, acute pancreatitis, trauma, and sepsis.
Autoimmune diseases such as rheumatoid arthritis, Crohn’s disease, and systemic lupus erythematosus are all characterized by mitochondrial failure. Of course, truly fatiguing illnesses, such as CIRS (mycotoxin and mold illness and Chronic Lyme), Chronic fatigue syndrome, fibromyalgia, and Gulf War Syndrome have mitochondrial near-failure as a prominent component. Lastly, as you might predict, cancer and chronic infections round out the list of disorders. If you have any one of these disorders, you will need to improve your mitochondrial health and function in order to recover.
Mitochondria and Aging
A number of age-related processes (e.g., “normal aging of the brain”) are associated with mitochondrial dysfunction, so most of the popular aging theories take this into account. The mitochondrial theory of aging posits that the accumulation of damage to mitochondria DNA promotes the process of cellular aging of both humans and animals. The theory claims that there is a vicious cycle involving the accumulation of damage in mitochondrial DNA, which then leads to more oxidative damage due to defects in the mitochondrial respiratory chain. Let’s say that this theory is true. What, then can we do to save our precious mitochondria and therefore slow the aging in our cells and help prevent diseases?
Mitochondrial health practices
Eating an anti-inflammatory diet is one of the easiest ways to improve mitochondrial function. Polyphenol-rich foods such as blueberries, red and purple foods (e.g. raspberries and purple cabbage), and many fresh green foods are high in healthy mitochondrial-boosting polyphenols. Using intermittent fasting methods such as timed eating and intermittently “going keto” are also mitochondrial boosters.
Heat shock proteins produced by extreme cold or extreme heat are great for your mitochondria. Cold exposure is an easy way to give your mitochondria a boost. Studies have demonstrated benefits with “ice jackets”, facial submersion, and ice baths. Even cryotherapy tanks! And “ice swimming.” Based on what I personally find tolerable and affordable, you can get enough of a boost by doing the following. At the end of your daily hot shower, just turn the temperature to cold for 30 seconds. It is mostly quite invigorating!
Far-infrared saunas are another way to generate heat shock proteins. An FIR is a great investment in your health, as it is also a great way to do a bit of a detox.
Meditation and yoga also boost your mitochondrial output.
Ten minutes of direct sunlight is great for a burst of mitochondrial activity. Conversely, most data suggest that fluorescent lighting puts a damper on ATP production and mitochondrial biogenesis. The data is rather murky when it comes to EMFs, blue-blocking glasses, and so on, but it’s something to watch, as there seems to be some correlation between better health and less high-level EMF exposure, as well as less blue light exposure.
Exercising For Mitochondrial Health
Many types of exercise are mitochondria-healthy. Walking is great. Running is great. Weight training is great. Yet, the very best type of exercise for your mitochondria is high-intensity interval training. This doesn’t need to be complicated, but do get medical clearance if this is a new activity for you. Do you know how to do a burpee? Do burpees until you’re short of breath. Then catch your breath and do it again. Repeat this a total of 6 times if you can, less if you can’t.
You can do HIIT outside, too of course. If you have access to a track, great! If not, use a treadmill if you’re inside or run in your neighborhood if you’re outside. Sprint one lap. Or half of a lap. Whatever gets you short of breath. Then, walk until you catch your breath and you can even lie down on your back for faster autonomic neurological adaptation for up to 90 seconds if you need that long to catch your breath. I do this in our lap pool and it’s far more fun than simply “swimming laps” to me.
Now, let’s discuss the best supplements to improve mitochondrial function.
The best supplements to improve mitochondrial function
I see people perk right up within (literally) 24 hours of proper mitochondrial supplementation. If someone has a chronic and/or fatiguing illness or are just suffering from age-related mitochondrial failure, supplementation absolutely works. It sure beats energy drinks which end up causing adrenal issues and potentiating energy problems.
Here are the mitochondrial supplements that have been studied and proven effective.
Co-Q 10
CoQ10 is an essential electron carrier in the mitochondrial respiratory chain. In other (more complex) words, CoQ10 passes electrons between NADH-ubiquinone oxidoreductase, succinate-ubiquinone oxidoreductase, or succinate-cytochrome C oxidoreductase. You can now just forget you read that and rub your eyes. Basically, CoQ10 can be found in both oxidized (ubiquinone) and reduced (ubiquinol) forms, and the conversion between these oxidized and reduced states allows it to act as a cofactor of enzymatic reactions via the transfer of electrons.
CoQ10 is a critical part of the mitochondrial oxidative phosphorylation system. Over ten well-done studies show that supplementation with this vitamin-like antioxidant compound in individuals with reduced CoQ10 levels results in increased energy production and reduced fatigue. The most dramatic results are in those individuals with degenerative diseases. Here are some examples.
In studies using Alzheimer’s disease models, CoQ10 administration significantly delays brain atrophy and characteristic β-amyloid plaquing. In a 4 month clinical study on around 100 Alzheimer’s patients who took an oral mixture of vitamins E, C, CoQ10, and α-lipoic acid, the group receiving supplementation showed significant reductions in oxidative stress markers and subsequent DNA damage.
Individuals with Parkinson’s disease tend to show increased levels of oxidized (and by definition: damaged) CoQ10. They also have significant increases in markers of oxidative stress and damage in their brains, which is partially reversible with CoQ10 administration.
One last important clinical note: recall that the heart is filled with mitochondria which are partially powered by CoQ10. If you are taking a statin drug, please be aware that they deplete your body of CoQ10, so supplementation is a must.
Alpha-lipoic acid
ALA is a potent fat and water-soluble antioxidant vitamin. It is also a metal chelator (helping to remove iron, copper, mercury, and other heavy metals). It is also a fairly decent anti-inflammatory supplement. Clinically, α-lipoic acid has been used mostly to help treat complications associated with diabetes such as neuropathies and vascular (blood vessel) complications. It also improves cognitive (brain) and mitochondrial function, adding to the evidence linking oxidative damage to mitochondria and cognition. The use of α-lipoic acid for chronic fatigue syndrome (CFIDS) has not yet been studied in controlled clinical trials. However, it is widely used in “fatigue regimens” (200-600 mg) as a way to both support mitochondrial function and reduce oxidative stress.
Despite its various potentials, the therapeutic efficacy of ALA is reduced due to its “pharmacokinetic profile”. Data shows that ALA has a short half-life and bioavailability (only about 30%) due to degradation in the liver and chemical instability in the stomach. The R isomer of ALA (R-lipoic acid) shows better pharmacokinetic parameters, including increased bioavailability as compared to the S isomer, ALA. Translated: just use R lipoic acid or a double dose of alpha lipoic acid for approximately the same results.
PQQ
Pyrroloquinoline quinone (PQQ) is contained in fruits and vegetables such as kiwi fruit and green peppers. It has received a lot of research attention in the past several years. PQQ can reduce reactive oxygen species (ROS) levels and improve the apoptosis (death) of tumor cells. PQQ protects tissues by regulating the redox (electron transfer) reaction. Moreover, PQQ protects overall tissue function by improving the mitochondrial function of the liver, neurons, and other important tissues. It can also reduce atrophy in mouse skeletal muscles.
PQQ decreases oxidative stress (production of ROS) and inflammation which, by definition, will protect mitochondria. It also increases mitochondrial biogenesis, which is the formation of new, young-acting mitochondria. It is neuroprotective, too. Here’s how. Recall that you have read about GABA versus glutamate or inhibitory (relaxing) versus excitatory (too stimulating) neurotransmitter activity. We want more GABA than glutamate, plain and simple. Too much glutamate damages brain cells. PQQ protects neurons by preventing the long-term over-activation of the glutamate (NMDA) receptors, which results in toxic excitotoxicity of neurons. This over-stimulation of brain cells is associated with many neurodegenerative diseases and seizure disorders.
Recall again that you have the largest concentration of mitochondria in your brain, heart, and skeletal muscles. The brain “wins” pound for pound by a little edge, which is why you feel tired after using your brain all day. With this in mind, remember that when we protect the brain, we’re protecting brain mitochondria. PQQ protects the brain (to a certain extent) against neurotoxicity induced by mercury and other potent toxins such as mold mycotoxins. Lastly, it too helps to prevent the accumulation of amyloid tau and beta proteins associated with Parkinson’s and Alzheimer’s diseases.
Acetyl-l-carnitine
Acetyl-l-carnitine is a naturally occurring fatty acid transporting amino acids. L-carnitine supplementation has long been studied and then used in many mitochondrial dysfunction disorders. These disorders are also characterized by low concentrations of serum l-carnitine levels such as heart disease, diabetes, kidney disease, and overwhelming infections.
An important cellular longevity function of l-carnitine has been to increase the rate of mitochondrial oxidative phosphorylation (ATP production) that declines with age. A study where old rats were fed acetyl-l-carnitine resulted in the reversal of age-related decreases in l-carnitine levels, an increase in fatty acid metabolism, and an increase in mitochondrial activity. Acetyl-l-carnitine also reverses the age-related decline in muscle mitochondria.
Clinical studies show that L-carnitine supplementation may also be useful in alleviating fatigue symptoms in hypothyroid patients, especially in those younger than 50 years and those who have hypothyroidism after thyroidectomy for thyroid cancer. Note: L-carnitine is the nomenclature used for many clinical studies, but due to l-carnitine’s ability to increase TMAO, experts suggest that all human supplementation be done with acetyl-l-carnitine.
D-ribose
We know that D-ribose has documented positive mitochondrial effects for those who are genetically d-ribose deficient. It’s a popular bodybuilding supplement which “hardcore” bodybuilders credit as being helpful with their muscular fatigue. Studies have looked at neurodegenerative diseases such as Multiple Sclerosis and ALS with promising results. Due to these studies, I decided to use it in a protocol on a dog named Charlie. Charlie is a very beloved and smart standard poodle, belonging to a favorite patient of mine. The patient (another M.D.) contacted me, quite distraught that his dog had received the diagnosis of degenerative myelopathy or “doggie ALS” as I found upon doing some research. Charlie, it seemed, couldn’t get himself up off the floor. The same mitochondrial problem has been identified in both dogs and humans. So, I got to work on Charlie’s protocol.
I calculated doses of supplements based on Charlie’s 48-pound weight. I recommended a mitochondria-boosting ketogenic diet. Then I added ALA, ALC, CoQ10, PQQ, and NAD (discussed below), as well as some d-ribose powder. I had my patient add some antioxidant powder to Charlie’s food, too. “Why not” I thought. My patient said that 24 hours after Charlie started his regimen, he was noticeably stronger, up and walking, and even playing! The patient’s Veterinarian was astounded and has gone on to use my protocol on other dogs. Now, let’s give an honorable mention to another concoction.
Phospholipids
Mixtures of probiotic, phospholipid, and antioxidant preparations have shown some clinical promise in fatiguing illness. This mixture is made using antioxidant powders, probiotics, and phosphatidylserine. The bulk of the studies have been with patients who have fibromyalgia and/or chronic fatigue syndrome (CFIDS).
NAD
NAD is now the big news, thanks largely to the research by Dr. David Sinclair and his best-selling book, “Lifespan.” Recall the mentions throughout this article about the conversion of NAD+ to NADH, and vice versa, as essential reactions in creating ATP. Recall that ATP is cranked out by mitochondria, and gives cells (and you) energy. Therefore NAD and its substrates are crucial for cellular energy, mitochondrial biogenesis and it turns out; cellular longevity. All that remains to be seen, is proof positive that one “form” of NAD is superior to another. Here are some of the data.
Oral NADH supplementation can reduce symptoms in patients with chronic fatigue. One study on patients with chronic fatigue syndrome treated participants with micro-encapsulated, oral NADH or a placebo for a month’s time. 8 of 26 study participants (about 1/3) responded positively with increased well-being and energy levels to the NADH compared with 2 of 26 (8%) in the placebo group.
This supplement also shows promise for neurodegenerative disorders such as Parkinson’s and Alzheimer’s diseases. The increase in measured NADPH levels correlates with a marker for aging: an increase in telomere length.
NAD will stimulate the SIRT1 pathway which is notably dysfunctional in those with metabolic syndrome, diabetes, and more. When you stimulate the SIRT1 pathway, you lower leptin levels, making it again possible to lose weight, improve blood sugar, cholesterol, and triglyceride levels, and in fact, all aspects of metabolic syndrome.
Taken orally, NMN (nicotinamide mononucleotide) is rapidly absorbed and converted to NAD+. In numerous studies, supplementation with NMN increases NAD+ biosynthesis, suppresses age-related fatty tissue inflammation, enhances insulin secretion and its action, improves overall mitochondrial function, and in the brain, it improves mitochondrial as well as neuronal function. In animal studies, it extends lifespan. In fact, NMN given to mice does quite a bit. Before I discuss NMN, let me give a shoutout to nicotinamide riboside- also converted to NAD+. As well as NMN? We don’t know, and the research continues. Meanwhile, we have a lot of data from mice studies.
Orally administered NMN is rapidly converted to NAD+ in mice. NMN has been shown to enhance energy metabolism and physical activity, suppress age-associated weight gain, improve insulin sensitivity and even improve ocular function. It improves mitochondrial metabolism and prevents age-related negative changes in gene expression. In mice bred to be obese or diabetic, NMN improved both the action and secretion of insulin.
NMN also protects the mouse heart from ischemia and/or reperfusion injury. It restores skeletal muscle mass in aging mice. Of special interest to those of us who treat many patients with brain issues, it has been shown to slow cognitive decline in a mouse model of Alzheimer’s disease, by improving the survival of neurons, improving energy metabolism, and reducing oxidative stress. It may also help maintain the integrity of the blood-brain barrier.
NMN also probably suppresses the increase in systemic inflammation associated with aging based on the studies which show that it lowers adipose tissue inflammation associated with age. In fact, surprisingly enough, older mice appear to be more responsive to NMN, in comparison with younger mice.
Some studies appear to suggest an increase in blood vessel formation called angiogenesis with artificially increased NAD levels for prolonged periods of time. This is why, despite the fact that I use a lot of NMN and intra-nasal NAD in my clinical practice, I have patients take intermittent breaks from it, and will do so until more data is available on this phenomenon.
Additional supplements with much promise
Studies are increasingly showing that mitochondrial illnesses are fueled by oxidative stress; implicating the use of antioxidants such as natural vitamin E and NAC (the precursor to glutathione) as well as glutathione as additional treatment considerations. We know that the sirtuin pathways are boosted by resveratrol and ECGC-green tea extract; implying mitochondrial benefit. Branched-chain amino acids, vitamin D, and creatine are all pro-mitochondrial health supplements as well, despite being poorly studied for this particular issue. Finally, there is emerging data for mitochondrial health with berberine, magnesium threonate, selenium, and even immune-boosting melatonin. B vitamins are likely involved as well. It appears that the more useful a supplement has been proven to be (vitamin D as a prime example), the less it is studied for other, more complete benefits.
Final words
In any good health regimen, you want to eat an anti-inflammatory diet and take a few supplements. It makes sense to take vitamin D and high antioxidant power supplements for many reasons, including mitochondrial health. At this juncture, if you are healthy and have specific goals in mind, you might choose, let’s say, some acetyl-n-carnitine if you are lifting weights, or some PQQ if you have a family history of neurodegenerative disease. And currently, if you have metabolic syndrome, SIRT pathway issues, or fatiguing illness, it seems prudent and helpful to take NMN and/or NAD intra-nasal spray. Yes, IV NAD is beneficial, but I am “not a fan” of this current craze of “drip bars” and feel that consumers are being, quite frankly, ripped off by this trend when alternative routes of administration can be utilized. Finally, if you’d like my opinion on what would be good for you, just ask me.
Introduction to Inflammatory Bowel Disease
The etiology of Inflammatory bowel disease (ulcerative colitis and Crohn’s disease) is complex, with genetic predisposition, an altered microbiome, environmental factors and a weakened epithelial (“gut”) barrier function triggering a chronic immune response in the mucosal layer. These two disorders of chronic intestinal inflammation affect approximately three million people worldwide. U.C. therapy and Crohn’s disease treatment starts with a good understanding of the disease process itself.
Currently, allopathic (versus functional medicine) Crohn’s disease treatment, for example- starts off with with brain and gut damaging corticosteroids and 5-aminosalicylic acid products, adds “immunomodulators” (Azathioprine, 6-mercaptopurine, methotrexate), and eventually, “biological agents” which are “TNF-alpha inhibitors” (infliximab, adalimumab, certolizumab, and golimumab). The story is just about the same for Ulcerative colitis. Just. too. toxic. for. words.
Not one of these drugs are curative, and their long-term use often causes severe side effects including cancer. Around 30% of patients with inflammatory bowel disease (IBD) are refractory to current IBD drugs or relapse over time. As a result, patient surveys show that almost 40% of Crohn’s and U.C. patients use alternative therapies to complement their conventional medical care. The first thing I now do with new patients is to get them using a VNS device to bring down inflammation quickly. Here is the only device that works, is not too pricey, and kicks in immediately. When you purchase yours, feel free to use and share my discount code for $25 off: DrKim25.
Furthermore, because we Functional docs (in conjunction with happy, cooperative patients) obtain such stellar symptomatic control with our IBD patients, many of them will switch entirely to Functional care, stay symptom-free, and experience far less invasive colonoscopies, since a fecal calprotectin level is a great way to monitor all disease activity. U.C. and Crohn’s disease treatment is fairly easy in the “functional world”, and it is helpful to know what it is that you can do to prevent disease occurrence or, at least, lessen your symptoms.
First, I’ll explain the five major factors that you can control regarding what causes inflammatory bowel disease to occur and to flare: the “root cause.”. Then, I’ll review the following list of items that will help you get into and more importantly-remain in remission:
- Change your diet to an autoimmune eating plan
- Be careful when it comes to consuming pharmaceuticals.
- Heal your gut lining
- Manage your stress (cortisol).
- Clear up toxins (if needed).
- Take herbals to clear up toxic bacteria and/or yeast.
- Get your hormones balanced.
- Re-balance gut motility (often needed).
- Eat prebiotic probiotics foods and choose probiotic supplements.
- Use peptides
- Use low-dose naltrexone
- Consider lowering TNF-alpha with supplements-it can’t hurt!
The Root Cause of Crohn’s Disease and Ulcerative Colitis
Traditional medicine teaches us that risk factors officially implicated with ulcerative colitis and Crohn’s disease include low fiber-high carbohydrate diets, smoking, altered microbiomes and gut permeability as well as medications such as non-steroidal anti-inflammatory drugs. Each of these things will cause leaky gut, so what you’ll read next will not contradict these conventions. Leaky gut is the root cause of all autoimmune disease, including ulcerative colitis and Crohn’s disease. Here are the reasons you are more likely than not to have some degree of gut hyper-permeability syndrome AKA “leaky gut.”
Environmental contaminants and toxins
Direct gastrointestinal toxins we consume or absorb such as the methylmercury in canned tuna fish, the excessive use of plastics for food storage and even the fluoride in unfiltered water- can all damage our gut lining and disturb our microbiome. We even accumulate toxins via skincare products, and from non-filtered showerhead water. We breathe polluted air if we are in or near a city or a factory. We don’t think of “bad air” as a gut issue, but it is. If we’re in a dusty house, even if we don’t have dust mite allergies, dust mites have been demonstrated to cause leaky gut.
Lastly, another problem we don’t generally associate with gut health is mold. The reason I mention this outright is because 25% of us cannot (genetically) clear mold toxins so they not only damage our gut, they are responsible for a host of symptoms and long-term medical problems. If you have or had mold in your home (50% of structures in the U.S. fall into this category), you likely have mycotoxins in your HVAC that you’re breathing in and out of your lungs which may or may not ultimately damage your gut and may or may not cause ulcerative colitis or Crohn’s disease.
Depending on how well your detoxification systems both recognize and clear certain toxins, your toxin loads can build up to damaging levels. Something to keep in mind is the gut-brain barrier. Once the gut barrier is breached, so is the gut-brain barrier which then typically adds brain fog and things like concentration and mood issues to your “gut issue.” Now, let cover the most common way for Americans to wreak havoc on their guts: food.
Food
The food you eat can absolutely cause leaky gut. People who consume the “standard American diet” (SAD) with it’s high-processed and fast foods as well as it’s high-sugar content are putting their guts (and therefore their total health) at risk. As you are likely aware, gut-damaging GMO foods are now dominating the soy, wheat, and corn markets. GMO-gluten used all too ubiquitously in our food supply is increasingly being blamed for non-celiac gluten sensitivity and leaky gut. It’s estimated that 25-75% of Americans have some type of food sensitivity. The most frequent offenders are (in this order) wheat, dairy, eggs, and corn.
Consuming gluten, artificial sweeteners, GMO foods, dyes and additives so non-food-like that they are now dubbed appropriately “franken-foods” as well as the massive amount of sugar (including HFCS and other hidden sugars) in our typical diet results in leaky gut. Add in non-sprouted grains and lectins (found-for example-in beans and nightshade vegetables), fruit juice and excessive caffeine and alcohol, and it’s a wonder we all don’t have leaky guts.
Actually those of you eating a standard inflammatory American diet likely do have a degree of leaky gut. Enough to trigger you to the other side of U.C. or Crohn’s disease? Do you really want to find out the hard way? And if you are someone who has I.B.D. and just “eat what you want” while taking a potentially harmful biologic drug-would you be willing to alter your eating style for improved health and a promise for a better chance for remission? What about your over-the-counter drugs habits? You can certainly alter those, can’t you? Sure you can! You, first, however need to know what is potentially problematic.
Pharmaceuticals
Americans pop OTC painkillers as if they’re candy. T.V. commercials feature actors who are pleased with themselves that they take just one non-steroidal anti-inflammatory gut irritant in the morning; and not again, until the end of the day! Your gut lining can be interrupted by everything from Aleve and Ibuprofen to Vioxx or even Tylenol. The majority of people who take OTC pain relievers daily have some degree of leaky gut.
Another category of awful-for-the gut drugs is antibiotics. I hate to bash my own profession, but am always amazed at the amount of antibiotics my new patients tell me they were given for dubious bacterial infections. Antibiotics not only cause leaky gut, they also upset the good to bad ratio of bacteria in the GI microbiome. We now also have proton pump inhibitors sold over the counter; thus sky-rocketing their use. These drugs were never designed for more than short-term use. Many people use these PPI’s (Nexium, Prevacid or Protonix, ) for chronic heartburn and slowly etch away the lining of their GI tract.
Synthetic hormone medications such as birth control pills or cortisone-containing steroids (e.g.: prednisone or a Medrol dose-pack) can propagate the growth of excess candida (yeast), which also often damages the gut lining.
Hormonal imbalances can also cause chronic constipation such as low progesterone levels and low thyroid hormone levels. Indeed, this can readily lead to small intestinal bowel overgrowth (SIBO) as can many types of cancer chemotherapy agents. SIBO disrupts the gastrointestinal balance dysbiosis), often causing gas, bloating and eventually, leaky gut.
Chronic Stress
If you constantly “feel stressed”, chances are very good that you have a high cortisol level. High cortisol-apart from everything else we’re discussing-can cause the breakdown of your GI lining. It does this by slowing down both GI motility (peristalsis) and the process of digestion. When this happens, some people experience reflux, or “heartburn” while others have absolutely no symptoms. Blood flow then decreases to all of the digestive organs. This results in a higher concentration of toxic metabolites which then whittle away at your gut lining.
Gut Dysbiosis
Dysbiosis of the gut means that your GI microbiome (gut-bacterial-environment) is out of balance. A properly balanced GI microbiome is absolutely crucial for optimal GI function, immune function, and brain function. Yeast (candida) can invade the lining of the intestinal wall to cause SIFO; small intestinal fungal overgrowth. Toxic E. Coli species are common culprits in SIBO (small intestinal bacterial overgrowth) issues. Other organisms such as giardia (a parasite) and Helicobacter pylori (responsible for ulcers and cases of severe heartburn) can also chip away at the intestinal lining. Deserving of a mention in this section are three things that can lead to lower gut motility and therefore SIBO and SIFO: hypothyroidism, low progesterone levels and low serotonin levels. Lastly, toxins are increasingly found as a cause of leaky gut.
Toxins
This topic is worth re-visiting. Although the amount of plastics (as an example) we consume is escalating, what is getting a lot of attention as definite gut-busters are mold toxins called mycotoxins. Since 50% of the buildings in the U.S. are estimated to have water damage-a set up to mold growth; with the increasing climate events, we are seeing more and more water damaged buildings and more mold (especially toxic mold) growth.
We know that approximately 25% of the population is genetically unable to recognize and clear mold toxins, leaving them vulnerable to all sorts of medical problems including fatigue, brain fog and leaky gut. Now that we’ve discussed what causes leaky gut which can then lead to ulcerative colitis or Crohn’s disease, let’s talk about how we treat these two conditions with the best Functional Medicine has to offer.
Treat Underlying Gut Issues as an Integral Part of your Ulcerative Colitis and Crohn’s Disease Treatment
Change your Diet
It’s necessary to eliminate foods from your diet that can directly cause leaky gut. Initially, this is typically a huge lifestyle modification that is structured as such so that treatment doesn’t miss any offending foods. Over time leaky gut can precipitate as host of IGG-mediated food sensitivities which can cause a plethora of symptoms. It is much simpler to start with a basic diet and then reintroduce certain foods (e.g.: eggs) when you have your symptoms under control.
If you are eating a standard American diet, you’ll notice that the modifications you need to make will cause you to shed some pounds, have more energy, and in general, you’ll feel better. The first thing to do is to clean out your pantry and make yourself a list of “allowed foods.”
The best diet to follow is an AIP (auto-immune protocol) diet which restricts the “usual gut offenders” such as gluten, dairy, eggs, corn, sugar, processed foods, fast foods, citrus, nightshade vegetables, legumes, grains, as well as alcohol and caffeine. Yes, just like the Paleo diet! It also restricts high FODMAP foods if they cause GI distress, which for most patients, is necessary. You cannot blame your gastrointestinal symptoms on specific foods if you eat this way for the two months it takes to heal a leaky gut. Yes-this diet is restrictive, but it will help to get you well and in two months, you can reintroduce some food items.
The Crohn’s and U.C. Diet Plan
What Do You Eliminate?
- Processed foods
- Legumes, such as beans, lentils, and peanuts.
- Grains.
- Dairy products.
- Seed oils, such as vegetable and canola oil.
- Nightshade vegetables, such as eggplant, potatoes, tomatoes, peppers, and okra.
- Fast foods.
- Refined sugars.
- Eggs.
- Soy.
- Nuts and seeds.
- Herbs from seeds, like coriander, cumin, and nutmeg.
- Coffee.
- Chocolate.
- Dried fruits.
- Food additives, like gums and emulsifiers.
- Caffeinated teas: herbals are fine.
- Spices made from nightshades, like chili powder, paprika, cayenne, chipotle, red pepper.
- Alternative sweeteners such as xylitol and mannitol with stevia being OK in small amounts.
- Alcohol.
After eliminating all potentially allergenic foods, the remaining basics are:
- Meat, fish, shellfish, mollusks and poultry.
- Low-sugar; small quantity fruits (berries only at first) and all vegetables, except for the nightshades.
- Fruit oils (avocado, coconut, olive, MCT, palm) and animal fats such as ghee.
- Bone broth (or gelatin/collagen).
- Tea-Herbal is best, but some mildly caffeinated brands (loose, organic; not teabag) might be fine.
- Vinegar: Restrict to apple cider initially.
Follow this eating plan (along with whatever else your Functional M.D. prescribes) until the “explosive diarrhea” wanes. For most people, this occurs within 3-4 weeks. At that time, you can add in a small cup of brewed coffee with a splash of additive free coconut or almond milk. Coconut milk is not included at first because it is a high FODMAP food in more than tiny amounts. Reintroducing food is quite personalized, so I can’t advise you what to add back from this list-if ever-or when.
Pharmaceuticals
We’ve reviewed what not to take- so what do you use instead? Instead of NSAIDS for pain, use tylenol. Better still, if your GI tract is healed, use fish oil and curcumin- proven in clinical studies to out-perform even the priciest NSAIDS. For heartburn, try one white Rolaid or TUMS. Better yet: find good digestive enzymes. Herbals can often be substituted for antibiotics and anti-fungals, but you will need guidance for those. Hopefully, this article will make you aware of what you’re taking, and the effect it has on your gut.
Heal your Gut
Getting you to remission and being asymptomatic from U.C. or Crohn’s disease starts with fixing your leaky gut. Changing your diet is the first step in healing your gut. Use (under medical care) proper gut-healing peptides ( discussed below) and (if needed), supplements for leaky gut such as l-glutamine and collagen powder. Vitamin D levels need to be normalized, and sporulating probiotics should be added when the symptoms start to subside so that they don’t “leak back” into the bloodstream. At this time, you’ll also add prebiotic fibrous carbohydrates (such as a half of an unripe banana) to your diet. More about re-balancing your microbiome (the prebiotics and probiotics) coming up soon. But first, let’s talk about what’s plaguing most of us: stress.
Control Stress to Lower Cortisol
Stress is honestly just terrible for your health. We innately know this- but do you know the physiology of why this is? We know cortisol is a direct neurotoxin; likely being a risk factor for Alzheimer’s disease. We know it adds fat to the belly. When we’re talking about U.C., Crohn’s disease or any autoimmune disease for that matter, we’re looking at the direct effect high cortisol has on the gut. As previously mentioned, sustained high cortisol can be the sole reason for having a leaky gut. As a “not-so-fun-fact”-this is the probable reason so many “hardcore” bodybuilders (who all have high cortisol levels) have leaky gut.
Adrenal (herbal) adaptogens, glandulars, liposomal GABA and certain types of aromatherapy are proven to lower cortisol levels. Stress-busting techniques such as “vagal breathing,” meditation, and yoga are great relaxation practices. Finally, just activating your hypoglossal and therefore your vagal nerve to tone down your sympathetic nervous system will help. Simply sing, or even gargle!
Clear out Toxins
Common toxins that routinely cause leaky gut are the mycotoxins, the dust mites that usually are not numerous enough to be an issue unless there is actively growing mold, (AKA dust mite food) and lastly-heavy metals such as mercury. How do you know if mold is making you sick? If you have gut issues, fatigue and a foggy brain, with a history of mold exposure, there’s your answer. Dust mites? Not nearly as guilty– but in the line-up. Heavy metals? This depends on your environmental history and more. As does “toxicity” in general. Let me explain.
Toxins play more of a critical role if you have “faulty genetics” including glitches in your detoxification pathways. Having a few mercury amalgam fillings isn’t usually “enough” to cause leaky gut. We generally say “having eight or more fillings” is a problem that needs to be addressed after we get the general health of the patient under better control. However, be careful with your diet as a steady diet of canned tuna-fish or tuna sushi is actually enough to cause methylmercury build-up with effects on the gut and other organs.
Clear up Infections
If you have a history of vaginal yeast infections, you can cross-over infect your gut, especially if you have some sort of gut motility issue as mentioned earlier-things such as thyroid issues, low progesterone or low serotonin. Many cases of small-intestinal-bacterial-overgrowth (SIBO) occurs when colonic bacteria “backwash” into the usually sterile jejunum. The most common yeast (SIFO) and SIBO symptoms are gas, bloating and constipation. Also, be aware of Helicobacter infections, and parasites. When in doubt, breath test, and treat. Sometimes symptoms are just so obvious that we simply treat- especially since Functional doctors tend not to treat SIBO with antibiotics, nor do we treat SIFO with anti-fungals.
Balance your Hormones
Both female hormones and male hormones need to be balanced for optimal gut motility, necessary to prevent “backwash” and infections. The gut “works better,” and the microbiome stays more in balance when your hormones are in balance. A full discussion of this is beyond the scope of this article. Be aware, however that during menopause, the decrease in estrogen causes a rise in cortisol, something we just discussed. Also be aware that adequate progesterone is necessary, as is adequate thyroid hormone for optimal gut motility. Gut motility depends on a healed gut which includes a healed smooth muscle propulsive layer.
Re-balance Gut Motility
As the gut lining becomes destroyed, some segments of the small and large intestine (depending on where the involvement of the disease is) get destroyed and therefore “out of sync.” As the gut heals, we sometimes need to use products to bulk up the stool and therefore improve the transport of “contents” such as modified citrus pectin or a multi-fiber blend. Sometimes we need to also improve GI transit at the smooth muscle level (by utilizing the serotonin precursor 5-HTP for example.) As mentioned, hormones need to be normalized as well. It’s strange to realize that diseases which produce “explosive” diarrhea can actually cause bloating and constipation while healing occurs, but indeed, this can happen. Now, let’s discuss what needs to happen to your microbiome.
Re-Balance your Microbiome
By definition, when you have leaky gut, you have more “bad bacteria” than “good bacteria” populating your GI tract. Use prebiotic fiber to feed the good bacteria and (if you are not in a “mold situation”) a little bit of “good yeast” to re-create a healthy gut microbiome. State of the art care is to add a friendly yeast called Saccharomyces boulardii (by prescription: Florastor). Regarding prebiotic fiber, start with asparagus, Jerusalem artichokes, red onions and naturally fermented (not pickled) foods such as sauerkraut. If you like un-ripe bananas, they make great prebiotic fiber.
When your gut lining is coming together-usually the 2 to 3 week mark, add probiotics. Do not purchase or even make your own yogurt; you can’t have dairy yet, remember? Historically, we have recommended 50 to 100 billion probiotic CFU’s per day. A mixture (in your main probiotic) of Lactobacillus species and Bifidobacterium species is probably fine, but there is increasingly more evidence supporting the use of sporulating probiotics for an even better microbiome. A generic product, VSL3, has yielded some positive remission studies, as have the probiotic strains Lactobacillus casei and Lactobacillus rhamnosus.
The most current research supports the use of sporulating (soil-based) probiotics to create a more diverse and therefore more healthy microbiome. These sporulating probiotics are so potent, you need to be careful not to “overdose”, or you can experience cramping and diarrhea. Start as low as 5 billion and increasing to as many as 25 billion CFU’s daily (best done under a doctor’s supervision). These probiotics are species of Bacillus with b. subtilis and b. coagulans being the most studied. Finally, if you see your diarrhea disappear but still have gas and bloating studies are promising for using 10 billion CFU’s of Lactobacillus plantarum. If that doesn’t work, consider the SIBO/SIFO angle if you haven’t done so already. Next, let’s discuss what has revolutionized the treatment of Crohn’s disease and ulcerative colitis: peptides and LDN. First, let’s discuss peptides.
Peptides
Peptides are short strings of amino acids, typically composed of 2–50 amino acids. The peptides used in functional medicine are derived from human secretions and therefore bioidentical; meaning no side effects such as what we see with pharmaceuticals. There are many peptides being used for many functions in functional and integrative medicine, but three in particular which are used in various forms, combinations and doses for ulcerative colitis and Crohn’s disease treatment.
BPC-157
The pentadecapeptide Gly-Glu-Pro-Pro-Pro-Gly-Lys-Pro-Ala-Asp-Asp-Ala-Gly-Leu-Val, M.W. 1419, named BPC 157 has been demonstrated to counteract peritonitis and heal intestinal lesions-especially colitis lesions.
Gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, M.W. 1419 as above) is stable in human gastric juice, now found to be effective both in the upper and lower GI tract, and remarkably free of side effects. BPC 157 has been demonstrated to be an efficient therapy of inflammatory bowel disease. It has been shown to interact with the nitric oxide protective system, providing endothelium protection and counteracting severe complications of advanced and poorly controlled inflammatory bowel disease.
GHK-Cu
The human peptide GHK-Cu (glycyl-l-histidyl-l-lysine) has multiple biological actions, all of which appear to be positive. It stimulates blood vessel and nerve outgrowth, increases collagen, elastin, and glycosaminoglycan synthesis and supports the function of dermal fibroblasts. GHK’s ability to improve tissue repair has been demonstrated for skin, lung connective tissue, bone, liver, and stomach lining. It has been extrapolated to have reparative effects on the lining of the entire gut.
KPV
α-Melanocyte-stimulating hormone (α-MSH) is a cleavage product of a melanocortin that has protective and anti-inflammatory effects. Its anti-inflammatory activity has been shown to be mediated by three N-terminal amino acids: lysine-proline-valine (KPV). The KPV peptide alone has been found to exert an even stronger anti-inflammatory effect than the whole α-MSH peptide.
KPV has been demonstrated to attenuate the inflammatory responses of colonic epithelial and immune cells and reduce the incidence of colitis upon oral administration. KPV exerts its anti-inflammatory function inside cells, where it inactivates inflammatory pathways by a decrease in pro-inflammatory cytokine expression. Very importantly, unlike the drugs currently used for U.C. therapy and Crohn’s disease treatment, KPV is a naturally derived tripeptide without any notable side effects. And now to what many of us consider the “game changer” for all autoimmune disorders: low dose naltrexone.
Low Dose Naltrexone
Close to a third of patients with inflammatory bowel disease are resistant to all currently available pharmaceuticals, or they relapse over time. Investigators have turned their eyes to studying the effects of “LDN” on the gut epithelial barrier in treatment resistant patients with ulcerative colitis and Crohn’s disease.
One study utilized low dose naltrexone for 47 patients who were followed prospectively for 12 weeks. Where available, endoscopic data including tissue biopsies were collected. The effect of LDN on wound healing and tissue biopsies from endoscopic procedures were evaluated. The results? Spectacular in my book. Low dose naltrexone resulted in “significant clinical improvement” in 75%, and complete remission in 25% of patients.
Another clinical study involves close to 600 inflammatory bowel patients. Among the 250 or so patients who became persistent LDN takers, there were reductions in the number of users of all previously consumed drugs (down by 12%), intestinal anti-inflammatory agents (down by 17%), other immunosuppressants (down by a whopping 29%), intestinal corticosteroids (also markedly decreased by 32%), and aminosalicylates (decreased by 17%). Of importance: this study did not manipulate diet or use any other gut-healing agents. Not even any probiotics!
The most recent clinical study assessing LDN in IBD involved 28 patients affected by Crohn’s disease and 19 by ulcerative colitis. Patients with an intractable (meaning basically untreatable by conventional methods) active phase of IBD received a daily dose of LDN in addition to standard treatment. Follow-up lasted for approximately 3 months and 35 patients (75%!) responded to therapy with a decrease in disease activity which lasted for at least a month. Six patients achieved full clinical remission, including five of them having a complete endoscopic remission.
Just imagine if the above patients had been put on my autoimmune diet, given peptides, vitamin D, sporulating probiotics with good prebiotics- along with their LDN? And just imagine that we could add in some supplements? What, then would the response rate be? Let’s finish up with some possibly helpful supplements.
Supplements and more for TNF-alpha Reduction
“Conventional medicine” offers Crohn’s and U.C. patients “biologics,” which come with an array of potentially fatal side effects. I’m not saying they don’t work, and I also don’t suggest that you stop anything “cold-turkey.” We know that these drugs all lower a laboratory biomarker called TNF-alpha. Disease activity appears to correlate with the level of this marker. We don’t yet know if reducing this marker will reduce disease activity in humans. However we know that TNF-alpha is likely a toxic lab value that we’d probably prefer to get as low as possible, no matter what. If that’s the case, then the following “in vitro” information is relevant.
We know that nutritional ketosis will inhibit TNF-alpha. Resveratrol, curcumin, melatonin, PQQ and vitamin D will also all inhibit TNF-alpha. We understand that some activities (ice baths, FIR saunas, and even cold showers, and baths) will suppress TNF-alpha, and have other beneficial physiologic effects. So, as a last thought on these things, why not?
Finally, this article contains a great deal of information that can inform you- the patient and can also inform your doctor. It is not information that is intended to diagnose or treat patients who have inflammatory bowel disease. As with all procedures and “meds” used in the practice of medicine, the dose, timing, mixture, and monitoring of symptoms and laboratory tests is crucial to obtain optimal results. Not to mention the cooperation between the patient and an experienced, board-certified Functional doctor.