hormones demystified part 3 (revised) - welcome …...hormones demystified (revisited) – part 3:...

HormonesDemystified(Revisited)–Part3:Page1of22

Hormones Demystified Part 3 (Revised) I officially welcome you to webinar number three. This our deep dive clinical course on demystifying hormones. And as everyone's getting settled here, I do want to encourage you to go ahead and close competing interests, things that you might have been spending some time doing before we got started here, so that you can give yourself the benefit of the full attention on what you've chosen to prioritize today. And I do want to encourage you if you're joining us live here to make liberal use of the questions tab to get your questions answered. And of course, as always, you can use the Q&A board on the course page in your SAFM account in order to ask follow-up questions. We've been having some good discussion actually on topics related to this course.

All right. So, I think we are good to go, and I'm going to go ahead and get started. Again, this is part three of actually what is four webinars for this particular course to give us plenty of time to dive into all of the interconnectedness, and I'm going to start with just some very brief refresher concepts in order to get our juices flowing about hormones. And then we're going to pick up and continue our discussion about the classic and very, today unfortunately, common hormone imbalance that women wrestle with, PCOS. And then we're going to have some targeted discussion on the concept of phytoestrogens. I think there's quite a bit of confusion there, and I also think almost comical inconsistency in a lot of the popular health media about the notion of estrogen potentiating substances and why some of them are good and desirable and why some of them are perceived as negative. Then when we're going to spend the bulk of our session today talking about male hormone balance. And certainly, we've already started to talk about some of the interconnectedness of both androgens, or male hormones, and then estrogens, female hormones. And the same types of imbalances that can plague women and contribute to a lot of the classic dis-ease that we see in our patients and clients, you'll see there's an incredible commonality and true root causes in the types of dynamics that males struggle with as well. And then this will leave us to hone in on perimenopause and menopause and then hormone supplementation and testing in webinar number four, rather than trying to cram it all in here and not giving it the appropriate detail, so that you can clearly understand what's at play.

So, without further ado, just a few points around what we've covered so far. We talked about a tremendous amount of different types of hormonal interconnectedness, the role of hormones in the body, the hormone soup dance, which I hope is becoming a readily recallable phrase in your mind now because it's such a powerful way to describe hormones and hormone action to our patients and clients. But the fact that there are so many different hormones interacting with each other, not only in our blood but in our tissue. Different tissues have varying levels of receptors for different hormones. We can have genetic predispositions, not only for hormone synthesis but for the various levels of enzymes that are also well represented on this diagram that promote conversion of one hormone to a downstream metabolite. We've spoken of hormone clearance.


And I want to emphasize in particular, we're going to hone in on a few additional key concepts in today's material. A key concept, it certainly comes into play for men and women but it's going to be particularly relevant for our discussion today, is that different tissues express different levels of the enzymes that convert hormones. So, when we talk about the notion of, for example, testosterone being converted to dihydrotestosterone via the five alpha reductase pathway, and we've already spoken of this in the part two when we did an introduction to the androgen family. One of the reasons why men today can struggle so much with issues with prostate health, whether it's just annoying symptoms as often comes along with benign prostate hyperplasia where there can be urinary challenges and frustrations all the way through to the notion of prostate cancer, which is certainly the most common hormone mediated cancer in men. DHT, the enzyme that create DHT are much more prevalent in the prostate, and so when we think about hormone imbalances, they are often localized and can have a dramatic impact on one part of the body perhaps exclusively simply because of the relative ratio of enzymes in that body's tissue. Then of course there is the concept of receptors, and we spoke in webinar number two about the concept that by definition where there's no way to get an overt, accurate picture of hormones simply through lab work because whether we're measuring hormones in saliva or urine or blood ... even if we're getting at the true free component of hormones or even if we're measuring the metabolites in hormones, which gives us a really excellent insight into the hormones that the body has actually been utilizing. What we're not able to get a very clear picture of at all today given today's technology is the activity of hormone receptors. And in the same way that in the adrenal and thyroid course, we've spoken of the fact that what's measurable in the blood is not necessarily reflective of what's happening inside the cell at all. The same can be quite true in the world of sex hormones where our receptor sensitivity and the number of hormone receptors can have a dramatic impact on the actual level of hormone action.

When we talk about things that modulate hormone receptors, we tend to talk about agonists. That is things that attract and/or increase the binding affinity of a hormone to its receptor. So this is something that increases the activity of the hormone versus antagonists. These are things that tend to block or impair the binding of a hormone with its receptors, and this is the premise of a number of different medications. We've also added a little content into webinar number four about common considerations for various hormonal medications, which I think will be helpful to you. Substances can antagonize or agonize various hormone receptors, and we're going to be talking a little bit about this, right? The notion that there's an androgen receptor. This is where testosterone has its effect. Testosterone binds with the androgen receptor, and it's actually the binding of the hormone to its receptor that causes effects. The overt hormone on its own is not having what we think about as hormonal effects. In the case of the estrogen receptor, we've learned via research that there are both alpha and beta forms of the estrogen receptor and that they're really quite distinct, and this is going to come into place in some of our discussion today that it is the alpha receptor that is believed to be so dangerous and aggressive in terms of promoting cellular proliferation and that although beta receptors, estrogen receptors are involved in various forms of estrogen mediated cancer, that it's actually a countering or a calming action of the beta estrogen receptor that is actually countering cellular proliferation and helping to keep balance in overall estrogenic activity. And so again, the devil is in the detail, right? Rather than promoting confusion or overwhelm for you, part of what I want to convey by even just sharing some of the snippets of some of the greater complexity with you here is a keen understanding for the fact that we're not going to outsmart all of the body's processes. Taking us back once again to the notion that foundational lifestyle choices matter tremendously. Foundational lifestyle choices are helping to rebalance the body's own wisdom in orchestrating that complexity. Rather than trying to micromanage every little action that we take, every little food we eat, every little supplement we take, every little choice we make, trying to from the outside looking in micromanage the body's behavior. We're much better off normalizing our stress, being rested, having a wide complement of available nutrients, all toward the goal of helping the body to run itself more effectively.


When we think about the types of imbalance that we have talked about so far, we've been talking about imbalances for women in particular. The concept of estrogens are dominant, which can be because of higher overt estrogen or, more commonly, poor estrogen clearance or estrogen balance or the presence of strong xenoestrogen as well as low progesterone, perhaps secondary to PCOS, which usually comes along with androgen dominance, excessive levels of androgen in women and what that can promote in terms of failure to ovulate or insufficient ovulation. And then of course there's also the environment of truly just insufficient or suboptimal levels of hormones. We're going to talk in the fourth webinar about how progesterone synthesis in women begins to naturally decline in the perimenopausal years, typically five to 10 years before menopause. The overall experience of this milestone in life, this hormonal transition is often happening over a five to 10-year period. And as we were laughing about in one of the practitioner gatherings just this past weekend, we need to remember that perimenopause and menopause are not medical diagnoses, right? They're not medical problems. They are milestones of life, and very often people struggle with them and what they would label as a medical type of way simply because, again, there is an incompatibility between how the body is guiding us to thrive in the environment that we're in versus the choices that we may continually be making instead and the conflict at play there. We'll talk more about that in webinar four. In terms of imbalances for men, there's a notable overlap. As we've already discussed, men can also struggle with estrogen dominance, certainly secondary to xenoestrogenic types of substances that also are very much exacerbated by excessive aromatization of testosterone. Often secondary to insulin resistance, which is certainly an epidemic type of dynamic in our society today. We're going to talk more about that today as well as the notion of DHT dominant. That is the excessive conversion or metabolism of testosterone down the 5-alpha pathway as opposed to the 5-beta pathway that can end up creating an overload of DHT in the tissues where there are high levels of 5-alpha reductase that would therefore be vulnerable to that at all. We're going to talk a little bit about some of the snafus in some of the research looking at DHT. Of course, men also struggle from insufficient hormone, especially testosterone or free testosterone. We know that stress increases sex hormone binding globulin, which keeps testosterone bound and in circulation and therefore not available to have optimal cellular effect. And so whether it's the overall reduction in testosterone that can happen from, for example, excessive alcohol intake or the age related reduction in testosterone production, or a lot of men wrestle with what I call the stress mediated reduction in free testosterone. We're going to talk more about these today. But my hope is that as we're going class to class and we're reviewing these webinars at least one more time in between going onto the next one, that you're getting more and more comfortable with not only these types of imbalances and what is at play with them but getting more and more comfortable with just overall hormonal dynamics in the body.

So, we've been discussing all throughout some of the most common things that can quote, unquote go wrong with hormone balance, and keeping in mind that these are examples of things that for the most part we are doing. So, we are choosing in our everyday lifestyle environment, and what we see is perhaps a maladaptation between the body's response to our choices versus how we would like the body to be responding. As we discuss many times, and this is a powerful thing to explain to your patients and clients, sometimes there's nothing wrong with the body, right? The body is doing exactly what it was programmed to do. It's just we are looking for a different type of response. We would like to be able to live one way and have the body respond as though we were living a different way, and this goes back to the prototypical example that we talked about in the first couple of webinars. Indeed, many of our patients and clients are wrestling with multiple of these particular choices or dynamics that in aggregate, can have pretty dramatic impacts on our hormone balance and therefore cause the downstream dis-ease dynamics that we so often see. We've been talking about the hormone soup dance, and some of the interconnectedness of hormones. In webinar number two, we started diving in particular into this particular cluster of hormone imbalance, the sort of quadruple whammy of higher insulin levels, often in response to both stress and higher dietary intake, refined carbohydrates combined with number two, a higher testosterone level as


the higher insulin promotes higher ovarian production of testosterone, which promotes lack of ovulation. So of course, we end up with a insufficient level or a low level of progesterone, which is factor number three, and then that of course can create some estrogen dominance. Irrespective of whether the overt level of estrogen is high or even if there's even a strong presence of xenoestrogen, there may or may not be. We know that strong xenoestrogen exposure can be a big exacerbating factor for PCOS, but it certainly is not always involved. This is just a good example of the fact that seldom is a single hormone all on its own involved in what is at play in the dis-ease that our patients and clients are feeling. I want to just drill down for a moment on the imbalance of PCOS just as a gentle reminder, and then we're going to move into talking about some overt remedies for relief in PCOS. And we discussed in the second webinar the fact that not only is this dynamic prevalent. It is increasingly prevalent in younger women, and again perhaps not a surprise that we are seeing younger and younger issues. Research actually shows that high toxic exposure, which can create genetic issues, can create cellular integrity issues, can actually be the starting point for downstream hormone disfunction. Some really interesting research that looks at even high levels of toxic exposure or even high levels of, for example, xenoestrogen exposure in utero and what that can cause. Obviously as a woman is developing as a fetus in the womb, she is growing her eggs, and the health of those eggs long-term, both just from an overall cellular wellness perspective but also in terms of fertility, is going to be highly affected by the environment in utero.

I just spoke about the hormonal quadruple whammy, if you will, but I think there's some interesting catch-22s in the environment here where we spoke last time that often medications here whether it is oral contraceptive pills, the classic birth control pill that is prescribed to try and normalize hormone function or the spironolactone, the classic diuretic that is prescribed for this type of dynamic, trying to triage the impact. But unfortunately, neither of these remedies is really fully addressing the root cause at all, and in that sense the dis-ease dynamic would be very likely to simply resume itself with cessation of the meds. And of course, both of those medications bring along possible side effects, which in some cases can be traumatic. I think that one of the things we need to keep in mind is that because hormones are messengers in the body, we need to remember that sustained hormone impairment is not just about the symptomatic dis-ease that people might feel, not to take away from that. There can be a lot of suffering from that. We need to remember that the rest of the body is responding to the imbalance of hormones, and for a short period of time, that may not be an issue at all. But over time with sustained hormone imbalance, we see increases in risk of all sorts of other types of disfunction. We know that it certainly sustained elevated levels of insulin and estrogen dominance together can definitely increase the risk of various cardio-metabolic impairments and issues. Over the next few slides, I'm going to talk about some other interconnectedness that might surprise you. PCOS in adult women is also associated with perhaps a nearly 10 eggs increase in the presence of sleep apnea, and I think this will be of interest to some of you. Yes, like you, Nina, who are passionate about sleep apnea. And this is actually attributed to the higher levels of testosterone, and the links that I've given you down here below, you may find really fascinating. There's a really interesting consistency in research at higher incidence of sleep apnea in, for example, men who are using exogenous hormone supplementation. Of course, sleep apnea's very stressful to the body and definitely increase the overall activation of the sympathetic nervous system, and over time that can also have cardio-metabolic implications. On both of these links.

I really want to encourage you to take advantage of the hyperlinks that I put in the footer of all of the slide decks. Obviously, there's no intention that you would be able to read or copy these from live presentation, but one of the reasons we give you a PDF file of the slide decks is so that you can not only review the slides and make notes on them if you wish. But you can click on all the hyperlinks and follow up with additional research. It's not uncommon for me to read five or six books and review several hundred clinical research references to try and cull and curate for you a very small subset of them that I think is particularly relevant and interesting to our particular discussion and to our level of teaching. I do want to encourage you to


take advantage of those because they have been very particularly selected. Often a lot of the concepts I talk about, there are dozens and dozens of studies that reinforce the point or explore the point, but I have indeed tried to pull for you very specific ones to save you time and get some efficiency in your study.

So, let's talk a little bit more about the detail of PCOS interconnectedness and also intervention. Now, of course it goes without saying that diets and stress are right here number one and two at the top of the list here in terms of the hormone cascade and insulin's role in exacerbating the downstream disfunction in sex hormones. Now, we have an entire deep dive clinical course here at SAFM called Reversing Diabetes, which goes into immense depth and step by step guidance around reversing insulin resistance and the various scenarios of supporting that depending on whether it's at the early stages when there's been no perturbation of blood sugar at all, the moderate stages where blood sugar turns to run low because insulin is so high, and then the latter stages where blood sugar tends to be much higher because insulin has dropped. And it's no longer able to keep blood sugar at an optimal place perhaps because of regulatory mechanisms in the body, perhaps because of pancreatic disfunction, or perhaps because of an autoimmune dynamic. There are various root causes there. I do want to mention that certainly just the general low glycemic diet, there's evidence in the research that all sorts of different types of low glycemic diets work. It doesn't have to be a paleo diet. It certainly doesn't have to be a ketogenic diet. People's bodies are different, but what I have seen work over and over again is that increasing vegetable intake and ensuring ample protein while getting rid of the highest glycemic foods. And so I would include within that all overt sweeteners except for maybe very small uses of stevia, but I think we have to be careful with stevia because it can keep people addicted to the flavor of sweetened things. For juices, not whole fruits. I think there are a lot of practitioners that are afraid of whole fruit, and I think we need to remember that fruit is fantastically loaded with nutrients and phytochemicals that are wonderfully supportive for enzyme pathways in the body. So absolutely wanting to support fruit intake, especially with appropriate skin are left on for supported prebiotic fiber. But very often I find taking grains out of the diet entirely, and in some cases because there's a cross reactivity with gluten and in some cases because grains are just dense carbohydrates. And people are consuming too much, and it just creates too much of an overall carbohydrate load for a person's unique body. And of course, the intervention here for reversing PCOS is intended to be therapeutic, right? It's not about this has to become a woman's long-term permanent diet. We need to remember that there's a difference between a person's baseline diet when they come to our practice. There's a therapeutic diet of some kind that may be necessary for a period of time to simply promote reversal in healing of what has been dysfunctional, and very often that will be different than the maintenance diet that people intuitively feel helps them to thrive after the dis-ease that they've been wrestling with has actually been addressed.

So, these are the principles that I have found to be most important from a dietary perspective, and then stress really can't be ... From a dietary perspective, and then stress really can't be, I think, overstated here, keeping in mind that completely separate from diet that increases in stress hormones, promote increases in body fat, promote increases in blood sugar, and therefore by definition are going to promote higher protective secretions of insulin from the pancreas. We also know that in general increased sympathetic activation, right? That's sympathetic dominance that we've spoken of before that also involves adrenaline. Increases ovarian testosterone secretion, and that's in using pathways that are completely separate from ACTH stimulation like happens in the adrenal. Just an interesting aside here that I think you might be fascinated by, this is why beta blocker drugs, yes, a hypertension drug, right? An adrenaline blocking, right? Beta adrenergic receptors that these medications block have been shown to reduce ovarian cysts. It's a fascinating point of interconnectedness, and in the same way that people are shocked to learn that ... Why would spironolactone be used for a sex hormone dynamic when it is a diuretic that we think of as being a hypertension drug? Of course, we need to remember that medications can have multiple, multiple modes of action that might be surprising. And of course, we discussed that spironolactone is blocking


androgen promoting enzymes, and in this case, the beta blocker drugs by virtue of blocking the actual cellular effects of adrenaline is therefore reducing promotion of ... Excuse me. Production of testosterone in the ovaries. And this is also a great example of adage we talk of immensely in our getting pregnant and staying pregnant course around fertility is that stress impairs fertility very overtly, very actively. And this makes sense from a reproduction perspective. Nature generally is not going to choose to favor reproduction in a highly stressful environment, whether that's stress because of lack of nutrients, lack of sleep and healing, whatever might feel threatening in the environment. Nature is naturally going to prefer to reproduce in a parasympathetic dominant environment.

Now something that might surprise you is the interconnected role here of hypothyroidism. There is a very high coincidence in research, and you've probably seen this in your own practices. Well, of women who have a hypothyroid state, which may be clinical or sub-clinical, and then polycystic ovaries. And when you think about the action of the HPATG axis, this is going to make sense. So increased levels in the brain, right? So, in the hypothalamus and then in the pituitary producing TRH, which increase TSH. That re-stimulating hormone coming from the brain, but it also increases prolactin, which inhibits ovulation. This is a great example of how hypothyroidism is not just having an impact on cells metabolism in terms of basic cellular metabolism and ATP synthesis, but across that also highly regulated HPATG axis, the hypothyroid state in telling the pituitary to stimulate the thyroid for needing more support. It's also informing the body perhaps that it's not the best environment in which to reproduce. So it's an interesting point of interconnection. Part of the downstream ratio of hormones that shifts is also an increase in follicle-stimulating hormone as the body tries to continue to promote ovulation, and we end up at the skewing of SSH to LH. For those of you who are perhaps a little unfamiliar with prolactin, this is also a hormone that is produced, and when women are breastfeeding, this is part of what promotes higher lactation and actually suppresses levels of estrogen and progesterone. Again, part of nature's survival mechanism would be to discourage pregnancy until the weening of the newborn is assured, until the safety of the newborn is assured. And that doesn't it's impossible. There's plenty of women who can vouch for that, but there is a natural shifting of the hormones in order to try and prioritize the activities that would promote survival of the species. Obviously, this is not necessarily clinically relevant in your practice, but I'm explaining some of this to you ... why we see certain points of interconnectedness and why indeed we have to think about the hormone soup dance, right? We can't just talk about sex hormones even, much less estrogen on its own. We have to be looking at hormones in aggregate. We also know that in a higher insulin state in PCOS, women tend to increase their percentage of body fat irrespective of weight, which increases estrogen because we know that adipose tissue is endocrine tissue that is actually producing estrogen. And we also know coming on the other side, kinda coming back around that excess estrogen can impair thyroid function overtly by increasing the levels of thyroxine-binding globulin, TBG. This is what makes the difference between bound thyroid hormone and free thyroid hormone, right? So the difference between total T4, for example, and free T4 is about binding globulin. There are for all hormones there's more than one binding globulin that can actually lock up the hormone, but for each hormone, there's a dominant one. And certainly, for thyroid hormone, it's TBG. Related to that, just adding a little more geekiness to the discussion, there's an interesting theory that one of the primary mechanisms via which metformin might actually help, at least from a triage perspective with PCOS. It's not just via reducing insulin resistance but also via reducing TSH. Reducing elevated TSH, right? It's a normalizing sort of approach. I've given you as you can see, a whole slew of references here to read more up on this. And again, I think talking about some of this biochemical interconnectedness is also toward the goal of helping you to, again, not just know but really understand this stuff. There is no better way to increase your practice in working with complex patients and clients than to really know your stuff. Even just listening to the past five or 10 minutes about this interconnectedness of hypothyroidism and playing it over and over and over again can make a dramatic boost in your comfort in helping some of your hypothyroid patients and clients understand what else might be at play in their body. I'm sure a number


of people are going to come to your practice using metformin because that's what they've been prescribed, and as always, we need to be on the lookout even if you're not the prescribing physician. Even if you're not even dealing with or it's not even appropriate for you to really discuss medication dosages with the people you serve. I believe strongly that it's within all of our scopes to simply educate people about the facts, about medication, and there are a number of drugs that have been well demonstrated in clinical study to deplete certain nutrients by their natural, or their normal rather, mechanism of action. And vitamin B12 can be readily depleted with the ongoing use of metformin, and of course this could be exacerbated even in people who aren't consuming a lot of B12, such as those eating a vegan diet or in people who have, for example, low stomach acid ... Excuse me. hypochlorhydria that might impair the uptake of vitamin B12 due to suboptimal levels of intrinsic factor.

There are a couple of great questions here. The effect from my understanding on the research, and I definitely had a lot of fun geeking out on this, the use of metformin cannot actually hide a hypothyroid use. What it can actually do is normalize an inappropriately elevated TSH, so it's a normalizing effect. And yes, there's a great comment here of the interconnectedness of the body. If you think about ... of ongoing stress, especially strong stress promotes more of an androgen dominant, sympathetic dominant type of thing. If we think about male hormones and go slay the tiger and defend the family, exactly, it makes sense that all of that is interconnected in terms of orchestrating a response. It's appropriate for our environment. And if someone is about to do harm to your child, then it's really wonderful that the body can orchestrate a strong hormonal response that helps us to protect ourselves and our family. We get into trouble when we're living that way on an ongoing basis where, again, it's not so much an acute or life-threatening stress. But we have a crazy stressful job where there's a lot of demands, and there's a lot of controlling masculine energy or conflict in that environment. I do believe absolutely that there's a strong mind-body connection that can be exacerbating that for sure.

These are some foundational things to think about, and now this goes first because if you want the highest impact, we've got to go upstream. We've got to address the root causes, but as we discuss so often here in our SAFM model, we need to honor rapid release and our patients' and clients' needs for rapid release. And there are, I think, some excellent supplements that can be not only helpful in the short term but also synergistic with regard to restoring good hormone balance. My personal three favorite supplements for this, I actually showed you not only the types with some references, but I showed you the exact brand. This is actually what I currently used in my own practice. And I want to use this as a reminder of the fact that please don't ever take my examples of supplements as my assertion that these are the only good brands or the only things that can be relied on. I appreciate the fact that we have a diverse audience. We have an international audience, and a number of the brands that I use in my own practice here in the states are simply not available internationally. Also, even here in the states, access from an affordability perspective can be limited, and we always need to be looking at the full list of ingredients in various supplements, so we can make sure from an allergen or sensitivity perspective or perhaps interconnected with other dynamics that play in someone's body, that a particular supplement is right for them as a unique individual. I am simply showing you these as examples of things that I know to be effective.

Inositol, I give you a link here to an excellent detailed writeup with all sorts of research about Inositol that you can check it out, is used for a number of different things in the body but very impressive research showing that it can actually restore ovulation as well as restore insulin sensitivity. But it has to be taken in a large enough amount to actually be able to do that, and it's why I like recommending a loose powder. The powder is basically flavorless, so it has a slight grainy texture. But it can easily be stirred up into a smoothie, into yogurt, or any oatmeal, anything like that at all. I have a few clients who just whisk it up in a little water and kick it back. It really has sort of a non-taste, and the fact that it's available in a loose powder is really quite economical as well as avoiding the addition of more capsules. Yes, this is getting at


the root cause from an insulin resistance perspective. Now in the same vein, chasetree berry, which is often referred to by its Latin name, Vitex or Vitex, has also been shown to restore ovulation and progesterone levels in not only PCOS but actually in a variety of different anovulation or luteal insufficiency scenarios. And interestingly enough, the mechanism of action here is via dopamine, via actually boosting the activity of dopamine, which reduces prolactin, which encourages ovulation. Isn't that fascinating? It's always, I think, interesting and important to learn the pathway via which different supplements work because, again, sometimes there's reasons like if someone is taking a medication that it intended to ... maybe a special medication that's intended to suppress the activity of dopamine. This might be contraindicated, not that that's very common but just a devil in the detail that you want to be aware of. There's some mixed results in the research that I want you to be aware of that has very much to do with dosing. It's actually been shown that very low doses of chasetree might actually increase prolactin. That effect really can vary by individual, and it really is ... It's as we get up into the higher dose that it reduces it, and this is what's particularly good for PCOS. And I also think it's most appropriate for women to be taking chasetree during the days of the menstrual cycle when normally progesterone is something other than rock bottom. And so typically it is only in the luteal half of the cycle that women have notable progesterone because, again, progesterone is produced in the ovaries after ovulation. And then of course we want to address things at the cellular level with regard to insulin sensitivity, and again the reversing diabetes deep dive clinical course goes into this in depth. Things like chromium, B vitamins, alpha lipoic acid, magnesium, high dose biotin. There's a whole bunch of them, and sometimes people have them that need for a particular one. Sometimes this isn't necessary. Sometimes in their early stages of insulin resistance, it's enough to just change the diet, especially in younger people, but the designs for health metabolic synergy here is, I think, an excellent multivitamin actually connected to ... Sorry. Multivitamin actually targeted to insulin ... improving insulin sensitivity.

Let's see. In terms of questions here ... Yeah, so there's a question here about the use of Inositol in response to fasting insulin data. Fasting insulin is a very reliable marker, and I think that's really quite reliable. And keep in mind that it's really quite normal for the body to put out different levels of insulin in response to different meals that can even bury on a seasonal basis, so I think we want to be careful not to get over-prescriptive around micromanaging on a meal by meal basis what the insulin response is. It's very normal for the body to try and respond differently to individual meals and then in a more dramatic way to kind of natural seasonal eating that might vary. What we want to be sensitive to is that when the body has become so preconditioned to the need for higher insulin, that it's actually putting it out in a fasting state. There's also a question that often comes up around using Inositol for other mood imbalances, and indeed Inositol can be used for anxiety or depression, but it's in dramatically higher doses. And actually, the link I give you below talks about that. And yes, Nina, exactly. I think the boost in dopamine is a great example of why in concert with the additional progesterone, there often are really lovely mood improvements in women who are using that as a supplement. Now, you can take Vitex if you are menopausal, and it's interesting. Initially, a few years back when I had done my initial research on hormones, I kind of naturally came to the conclusion that using Vitex post-menopause would not be of value. How was it going to help if we're not getting ovarian production of progesterone any longer? But there are just one or two. It's not a lot, but there are one or two studies that do show benefit in improving menopausal symptoms with use of Vitex.

Now, the interesting thing is that is not primarily shown to be by virtue of increases in progesterone, or if they are, they're very small increases because of course with menopause, all of our progesterone is being made in the adrenal glands. But it does make sense perhaps by balancing their own transmitters that there are symptom release, which regard to menopausal symptoms. So, we'll talk a little bit about that in the fourth webinar. It is not in my main list of recommendations for menopause because I think there are things that'll work much better. Maca was mentioned earlier in the Q&A thread. That's one of my go-to


supplement recommendations for relief of menopausal ... late perimenopausal, menopausal symptoms. But I just wanted to share that it is interesting that there is some initial research that shows that that could be of value.

Okay. Other things that can be considered for PCOS ... So many of you are familiar with berberine, which is an herbal supplement that has been very well researched actually with regard to countering insulin resistance. Now, I only recommend berberine when insulin resistance has progressed to actually driving a significant elevation in blood sugar. I believe that's when it's most effective, but I also have seen in just even in my own experience that typically that's only when it's necessary. We need to keep in mind that the body doesn't have a nutrient deficiency of berberine that creates insulin resistance, and because berberine is an antimicrobial, I am not a fan at all of encouraging long-term use of berberine. I think coincident with other lifestyle changes, it can be a great triage for reducing blood sugar and the oxidative stress effects of elevated blood sugar secondary to insulin resistance. And it does have to be taken in enough of a dose. There's a number of sort of combo supplements out there that maybe only have 100, 200 milligrams of berberine. There is not any research of which I'm aware that shows a significant effect from those very low doses, but it has indeed been shown to be effective. I just don't include that, and this is also very much in the sense of not over-recommending supplements. Again, we want to make sure in particular with people who are still maybe looking for that quick fix pill, and it makes them feel better to have a supplement quick fix pill rather than a medication quick fix pill. I think it's important that we keep that in mind and we do our due diligence around education, around truly addressing the root causes. Now, magnesium deficiency is quite common, and we know that insulin resistance promotes magnesium deficiency and vice versa. And so this is something that can be checked. Omega-3 fatty acids in women have been shown specifically with PCOS to reduce the excess testosterone and improve the insulin resistance and actually to improve the associated lipid markers as well. And ground flaxseed has been shown to also be an effective agent in women for normalizing testosterone, and of course it's also providing a different form of omega-3s.

Now, an interesting item I wanted to insert in here as you're supporting someone is keeping in mind that when people have been using oral birth control pills as a triage remedy, we need to remember that exogenous hormone supplementation is having an impact on multiple levels. And as we are beginning to reverse the dynamics that are at play, part of the challenge with birth control pills is that they increase cortisol, which can be having a pretty significant effect on thyroid function, and they also increase sex hormone binding globulin. And in a woman's body where you're trying really hard to get some level of progesterone into the system and actually balancing, at some point the birth control pills are going to become part of the problem in potentially giving totally counterbalancing their triage benefit. So we always want to make sure there's a proper order of operations, but I think educating patients and clients about this point of interconnectedness and if they have been prescribed a birth control pill as triage, at some point once the estrogen dominance driver like estrogen clearance, poor estrogen detox, these types of things have been addressed, and once the new diet is in place and there seems to be some good progress, then coming off of the medication would actually allow there to be more free progesterone that is actually going to be beneficial for these individuals. Alcohol can have a ... especially excessive intake can have an impact on insulin resistance, and so that's something to pay attention to. And then of course, because estrogen dominance tends to come along for the ride with PCOS simply because of the lack of sufficient or in some cases any progesterone, we need to make sure that we're using the same information from webinar number two as appropriate for the individual. Keeping in mind that some people who struggle with this type of dynamic are still ovulating but just to a lesser degree. Other people have moved on to total anovulation, and so there's a spectrum of needs there. And I won't repeat the various agents that can be helpful here. I did want to give you a reference for an interesting study looking at the combined effects of vitamin D and using primrose oil on supporting countering PCOS.


There's a couple of questions here. Yes, there's a great point being made here. So we need to keep in mind that high dose biotin, which can be very effective for supporting reversing insulin resistance, can make thyroid lab work inaccurate. I want to make sure. Sometimes receiving that information people hear it as "can make the thyroid not work very well". That's not what I said. "It can make thyroid lab work inaccurate", and so we need to keep that in mind. But it can have a ... It's based on the level of circulating biotin, and so there's no problem with having people use high dose biotin. They'll just want them to stop taking it entirely a few days before they go and get their lab work so that it's not affecting the accuracy of the data that is received. That's a technical impact on how the lab measures the data. It's not that high dose biotin is somehow making thyroid function ... It's not that it's affecting thyroid function one way or the other. It has to do with the accuracy of the lab work. A question, what can be at play if berberine not be successful in lowering blood sugar even with added magnesium, omega-3, and a clean diet? That's a great question. So again, the reversing diabetes deep dive talks about this much more. We need to keep in mind the effects of stress, which can be massive. Cortisol, adrenaline, at increasing blood sugar totally separate from diet. In your question you're mentioning clean diet. Well, keep in mind that people's individual tolerance for carbohydrates can vary wildly, and so some individuals, like I said before, need to cut out all grains entirely for a three to six-month period in order ... For a three to six-month period, in order to really give the pancreas enough of a break, in order to respond. In some cases, there needs to be more support for countering oxidative stress, supporting the cell membranes, maybe countering toxins, right? We need to keep in mind that the function of the cell membrane, the integrity and the health of the cell membrane, plays a huge role in how effective insulin sensitivity is, right? Because that's the point of insulin sensitivity, where glucose transporters and the cell membrane is or isn't responding properly to insulin. And so if people are struggling with high levels of circulating toxins or ongoing exposure to toxins, that can have an impact.

What I would offer to you is keeping in mind the other things that might be affecting cell membranes. Getting rid of all vegetable oils entirely might be a good step in the right direction. Maybe they need higher dose omega-3's than they're taking. Maybe the omega-3 needs to be combined with GLA. Like borage oil or even a primrose oil for more anti-inflammatory effects. Maybe their carbohydrate load needs to go down even further. Maybe they need to do some targeted detoxification. Maybe they need more support for reversing insulin resistance. Maybe more alpha lipoic acid, this type of thing. So, food for thought, right? It certainly is a great example of how everyone's different. Okay, great questions. Excellent. So, let's just see if there are any final questions on this topic. There's a few questions here about maca. I'm going to talk about that in depth in webinar number four. So rather than repeat myself here.

There's questions about switching from Metformin to Berberine. There are multiple posts on the SAFM website about that. I have seen in my own practice and certainly from many many practitioners at our school, the switch from Metformin to Berberine, it's just a question of what the right timing is for a given individual. And making sure that they are comfortable doing so, doing so with the involvement of their physician, in order to ensure a good switch over, and having it be a phased titration, with one going down and the other one going up. But it's particularly a great transition for people who are struggling from the vitamin B12 depletion that I mentioned. And or, people who might be struggling with some of the fairly common gastrointestinal distress effects of Metformin. Even in my own practice, I've worked with several people over the years who struggle with loose stool, or some cramping and gas, because of Metformin.

This is actually a good time to catch our breath before we dive into a bit of a completely different topic here. So let's see. Let's take a five-minute break. And I'll be back with you in just a moment. Thank you. Alright. Hopefully you stretched your legs at a minimum. Let me just make sure, am I still coming across loud and clear? Alright, great. Perfect, thank you all so much. I appreciate that.


So, let's step away from detailed recommendations for a moment here. I want to address the question that a few different practitioners have brought up in our forum over the past many months. This is a very astute question and I think just general area of inquiry, that makes good sense. But it's also something that is a great example, I think, of our need to really think through what we read, and the popular medical media. I'm amazed at how often a practitioner will reference another practitioner's blog as a research source. And we always want to be rigorous in looking for proof, right? Looking for validation, looking for true understanding of what is at play. As opposed to looking for factoids spouted by others, without reference to some type of third party reviewed original sourcing. And, the scientist in me several years ago started to wrestle a little bit with the questionable distinction between xenoestrogens and phytoestrogens. And started exploring a little bit more. So we think about xenoestrogen as being a chemical, and so we think of it as something artificial, and therefore bad, right? So xenoestrogens are chemicals like the bisphenol-A that have estrogen potentiating effects. We consider them to be harmful. Avoided, right? We should make them illegal. We want to wipe them out of regular cultural use, we have done a lot of research looking at how they might be at play in potentiating estrogen so excessively that they are a part of cancer creation. Yet on the other hand, phytoestrogens are natural, molecular substances, found in foods and herbs and beautiful things that grow in the ground, that have been with us for a very long time. They have potentially estrogen potentiating effects, yet for the most part we consider them to be beneficial. So of course, the scientist in me says, "Huh? Is that just an opinion? Is that more our popular belief that things that are natural are better or good, and things that are man-made or what we refer to as a chemical are therefore necessarily bad?" And I do think that there is a certain cultural myth in that space, that all things that are natural are better, although if you or someone you've supported has struggled with arsenic or mercury toxicity, we could certainly have a good debate about just how harmful natural things can be. But also on the other side, the assumption that all things chemical are necessarily harmful, and as you well know, medications I believe are overused, they're overprescribed, but they are a tremendous blessing in terms of providing triage and in some cases lifesaving benefits. I think there's a devil in the detail here, and I spent quite a bit of time trying to find good documentation of some of the differences in the dynamics at play, and I've read a lot of clinical articles on this. And I just wanted to use this slide to introduce you to one of the documents that's posted on this course page. In the documents section it's called the pros and cons of phytoestrogen. And if you're curious about this topic, if it's in, you feel like geeking out on it a bit, I really encourage you to read the whole thing. And sit with the detail, even if it feels a little overwhelming, just read through the whole thing. Because it's a fascinating exploration. While I do think there are some cultural biases that make people necessarily run after the notion that more and more and more of phytoestrogens is always better, and less and less and less of xenoestrogens is always better, there are some notable biochemical differences, and I wanted to explain that.

When we talk about a phytoestrogen, we need to remember that we're talking about a very specific substance or substances that occur within a particular plant. A whole food, or a whole herb. And obviously, there are hundreds of ingredients that have various biochemical effects in the human body. In a stalk of broccoli, or in a leaf of stinging nettle. Or in turmeric root. It's not just one single substance. It's a collection of things that can have a rich variety of effects, and in some cases, supportive and balancing effects. And I think that's one of the things that really makes phytoestrogen different.

In terms of the notion of whole food and herbs versus food extracts, I do think that some individuals overload their body with phytoestrogen extracts, and can take so much of it, that instead of balancing estrogens, the dose becomes excessive and they end up in aggregate, increasing the overall estrogenic downstream activity. So dosage does matter. One of the best effects, I think, of a phytoestrogen is being able to fill estrogen receptors with a weaker estrogen than estradiol, or even then estrone. So, there is absolutely still an estrogenic effect happening. Absolutely. By design. But it's intended to be a weaker one,


so that there is still a steady state estrogenic experience, which especially for women is important, but it has the opportunity to be a milder one. As the write up I reference below explains, phytoestrogens also generally have much lower binding affinity to sex hormone binding globulens, and estrone and estradiol. So that also helps to keep the stronger estrogens bound, so that again the weaker estrogens can fill receptors. So that is something to consider in terms of the balance of things. Obviously, an individual who is already having an estrogenic overload needs to address the root causes of the estrogenic overload, especially if estrogen clearance problems are involved, before throwing a bunch of high dose phytoestrogens at it. This just goes back to the notion of just not choosing a supplement or choosing a food choice blindly but thinking about changing downstream dynamics that might not be working very well before we put more volume through that pathway from an upstream point.

So, dosage matters. The situation of the individual matters. The other thing that I think is a really interesting dynamic which is a fun exploration into, I think, the notion of estrogen receptors, is again the difference between the alpha and the beta versions of the estrogen receptor. And the fact that phytoestrogens usually bind both, but they bind the beta receptor many times more strongly. Depending on the study you're looking at, I believe if I remember correctly it's between 15 and 40 times as much. We're understanding more and more and more, from research, how critical the beta receptor for estrogen is for countering and balancing the effects of the alpha receptor, because the beta receptor generally discourages cellular proliferation, and can actually calm the nuclear protein activations that the alpha receptor might drive, that women today can be so fearful of in terms of promoting a carcinogenic type of environment. So, that necessarily provides more of a balancing type of dynamic. EDC is estrogen disrupting chemical, or compound, I think. So, being able, exactly... So, there's some comments coming in here, so there's increasing research to help us see that beta receptor activation can actually be very important in preventing a hormone mediated cancer, estrogen mediated cancer, or in countering the proliferation of the cancer. Which is a very interesting furthering dynamic, as we begin to understand more and more and more about hormone mediated cancers overall. The alpha estrogen receptor is definitely the one that is most often shown in clinical research, so actually be driving the uncontrolled cellular proliferation that is the hallmark of cancer. Again, in hormone sensitive cancers.

The last factor I want to bring up is that it's not even just about the receptors. Part of what we need to remember again, is that these foods or herbs or extracts have hundreds of components. They tend to feature a number of anti-inflammatory and also antioxidant agents, which also provide calming, balancing influences for handling any downstream information or oxidative stress that might come from its estrogen potentiating ingredients. While on the other side, and this as a fact won't surprise many of us, that xenoestrogenic chemicals often have other components that are actually very well-known and acknowledged to be pro-inflammatory and oxidative.

I wanted to bring this up in terms of being able to talk about balance. Now, what this means in my view, is again, we have to use this knowledge to make recommendations intelligently. So, if a person is at a point in their life where the body is trying to really well hone and orchestrate hormones for a particular purpose, like, a child, like let's say an 11, 12-year-old girl, right? Who's going to maybe be coming into her menses in the next year or two, or a woman who is trying to get pregnant, or who is already pregnant. Where there's a really finally honed particular skewing of hormones that the body is trying to maintain. Or a case where a woman has already an active, say, hormone mediated cancer process in her body. None of those times are intelligent times to begin experimentation with a whole bunch of phytoestrogen, without knowing the effects on that particular individual. It very mch goes back to the concept that I mentioned in the beginning of the class about the notion of, there's a therapeutic type of intervention that can help to deal with the dynamics that are at play, and then on the other side of that there's the notion of prevention and then there's the notion of maintenance. But we need to make sure that we're


not falling into black and white thinking, that oh, this is good for that, and so it's always good for that, for every person all the time. There's really nothing for which that is true. In the same sense that it goes back to eliminating grains for people with strong insulin resistance. Does that mean grains are going to be dangerous for them for their whole life? Absolutely not. It just means for a period of time, in my experience about six months, while we're trying to give the pancreas a full out break and helping the cell membranes recover and restore insulin sensitivity, we need targeted, specific interventions that honor where that person is right now.

This is not just true for food, it's also true for exercise. Women who are addicted to aerobic exercise often need to stop doing that in order to allow restoration of the HPATG access and adrenal reserves. Does that mean running's toxic? No. It just means it's just not the right choice for them right now. So I don't think that it's appropriate, and there's a whole bunch of questions coming up here about, you know, phytoestrogens for cancer. So, the challenge is that you want that to be a black and white question, and it's never going to be. Because every cancer is different, every person's body is different, and because so many other factors are at play in cancer beyond the hormone, the dynamics at play in individuals are unique. But we also have to accept the fact that if there is an immediate cancerous process happening, we have to acknowledge the fact that the body is skewed, and until that skewing is restored, there can be choices that will be safe or even helpful long term that can potentially be very dangerous in the short term.

We can obviously talk about this all day. I would be happy to geek out with you, and we could pull up a cup of tea here and talk about it all day. I do encourage you to read the documents. Please remember for all of our Deepak clinical courses, really encourage you to read all the posted documents, because again, I looked at hundreds of them in an effort to bring you not only the hyperlinks, there's a very small set of hyperlinks down in the footers of these pages, but the even much smaller and more refinely curated list of posted documents, for you to review. I want to shift gears and talk about more particulars around male hormone balance. Of course, I wanted to save the deeper discussion about PCOS interventions for today, because of course because PCOS is an androgen dominant dynamic, a lot of what we've already discussed so far is going to be relevant for this discussion as well. We have already been talking about... bear with me just a second here. Here we go. We've already been talking about androgens in the last webinar. We've already spoken of the fact that the five alpha reductase kind of dominance, right? Where the body might be choosing more of this pathway and less of the five-beta pathway, right? We want to keep in mind that most of these metabolites are androgens, right? It's just that the dihydrotestosterone is a very very potent androgen, and its' a potent androgen that in particular, is expressed in the prostate and on the skin. This makes sense when you think about the things that men can end up struggling with from too much dihydrotestosterone, right? We think about things related to the skin. Acne, and excessive facial and body hair growth, and loss of hair right up on the crown of the head. Or the benign prosthetic hyperplasia that I mentioned earlier, right, the BPH that leads to urinary challenges, that- It leads to urinary challenges that are really deeply frustrating to men, from an emotional viewpoint it's sort of the PMS equivalent for males, right? It can be a very frustrating dynamic that the other sex has a hard time understanding because they don't experience it.

One of the most potent imbalances is of course, this one. We end up with too much DHT and a smaller complement of testosterone going down the five-beta pathway to produce the Androstanediol, which is still an androgen, it's just a weaker one, as opposed to DHT, which is about three times the level of potency of regular testosterone. The other thing that comes into play in particular for men, is this whole arm of the diagram over here, where we end up with excessive aromatization of testosterone, generating excessive estradiol in peripheral tissue in men. This can happen in particular in skeletal muscle, right? With the trading off muscle mass for fat. And of course, as we know, being in an insulin resistant or high insulin


state is just exacerbating this particular pathway. So there's a number of different things that can be at play with men, but as I said earlier, the five alpha or the dihydrotestosterone dominant pathway, the estrogen dominant pathway, which in this case is usually an aromatase issue in particular, or there can just be an aggregate insufficient level of androgens, and especially insufficient testosterone, right? Because DHT is of note, but we only have DHT receptors in certain parts of the body, and so it can have some significant effects, but it doesn't have the same dramatic systemic effect that imbalance levels of testosterone can have.

Alright. So, androgen, it's a word whose Greek origin means man-making. It's appropriate, no? We would think about androgens as creating a lot of things we regard as male or masculine features. Androgens, particularly critical for men. Contrary to common myths, men do make and need both estrogen and progesterone, but they make tiny amounts and then have less estrogen and progesterone than women have testosterone. So, there is a need for balance, but men are particularly vulnerable, in terms of overall physical and mental well-being, to a need for optimal levels of androgens. Sexual hormone binding globulin is particularly important there, because it's highest binding affinity is for androgen, and in particular DHT. And so, when an individual, because of stress, has higher levels of sex hormone binding globulin, this is a great example of how stress can really pack a wallop on men's vitality. A little pearl for you there that stinging nettle root, not leaf, is very effective for reducing sexual non-binding globulin. It's included in a number of different sort of collective male health prostate health type of supplements. But I do want you to realize the distinction: stinging nettle leaf is an excellent antihistamine, an alternative for example, to coresatin. But stinging nettle root is what has been shown to be effective for reducing sex hormone binding globulin.

And then we talked about the five alpha pathways creating DHT. But like anything, wellness and hormone balance are about not overdoing it on either extreme. So obviously the five alpha pathway is not able. DHT is particularly critical for Early Life Development for boys in optimal maturation, right, of all of their different sexual anatomy. And we use those enzymes also to metabolize progesterone and to metabolize cortisol, and it's actually the five-alpha pathway for progesterone that metabolizes progesterone into what helps to increase the level of GABA in the body. When we think about progesterone metabolites being a muscle relaxant and something that increases GABA and helps us sleep. Be careful not to start thinking that the five alpha pathway is bad. It's not bad it's just sometimes out of balance. We need a five-hour pathway to get some of those excellent benefits of progesterone and similarly the five alpha, and the five beta pathway are both helpful in breaking down cortisol in order to help the body have relief after its experienced a surge in cortisol so we can return to normalcy and relaxation sooner rather than later. So, like with anything when we use things like medications to kind of overtly block a pathway, there's always a cost. Versus if we can make a lifestyle change and choice and maybe short-term use of supplements to modulate a pathway rather than more aggressively shut it down, we make it more likely that the body will find the balance that it ultimately wants to have.

Now as I said earlier, DHT is very potent but it has primarily a local action. This is a really critical concept to understand. So, we talked in the first webinar about sex hormones generally are what are called endocrine hormones, right? Meaning they are produced by a certain gland and then they move. They go to the blood and they circulate throughout the body. They can activate receptors in a variety of places. For the most part, DGT is a local hormone we call that a paracrine hormone meaning it is going to fit in receptors and have effects in the local tissue where it was produced. So, the prostate is a piece of anatomy that's particularly vulnerable to hormone imbalance in men because there is a lot of DHT production in the prostate. So, there's ten times as much five alpha reductase in the prostate and there are many many androgen receptors in the prostate. And there also, there's more receptors for estrogen in the prostate than anywhere else in the body, which is, I'll get to that point in just a second. But we want to be thinking


about the local effect, right? Now it is true that the androgen receptor, unlike the estrogen receptor, there's one androgen receptor in terms of a classic steroid receptor, and absolutely mutation or gene amplification are implicated in prostate cancer. But there are just like with breast cancer or anything else, there are so many different myths around root causes of cancer and indeed, hormones can be witless exacerbators of a cancer process. And we have to honor that, right? That's the truth. But I think so much of conventional or fear-mongering medicine can start encouraging us to look at look at our hormones as though they are evil. And I think we are always taking a dangerous path when our approach to quote unquote managing hormones is to try and stop the body from making them, or to completely block receptors for ongoing periods of time, because of course, hormones are messengers and they are absolutely critical for functioning of the brain, functioning of the organs, and also the heart in particular.

So, we may be using a crazy aggressive approach to silencing hormones for fear of cancer but creating a whole other disease process. I have often wondered how many cases of cardiovascular disease are being created by an attempt to prevent a recurrence of cancer. It's just a theoretical question. But I really think we need to understand the truth here that in blaming the hormones, we're sort of blaming the people who are standing on the sidewalk when there was a drive-by shooting. So, the hormones are not evil. This goes back to what I said in the beginning. We have issues with male adaptations of hormones. And I believe we have huge issues with excessive veno-estrogen exposure, huge amounts of oxidative stress and toxic exposure, very high stress and lack of nutrients from food in order to optimize hormone clearing, right? So, this goes back to you know what's causing disease? Crap food, stress, and toxins. Excess DHT in men can promote some really aggravating symptoms. And of course, now we spoke of PCOS, right, in women, they end up with a bit of a double whammy if they are producing too much testosterone, and they end up producing too much DHT as well then that just makes their symptoms even worse. But men can struggle with some of those similar types of challenges, especially neurologically, mood balance, right? On the skin, and then for men uniquely because women don't have prostates, they can end up with BPH. And of course, the whole obesity, high insulin dynamic plays right into here. That's why I wanted to pull these topics together because the high insulin is a huge driving factor for both of the most common male hormone imbalances.

So, let's talk a little bit about the prostate. So, diving into you know, what do men care about? What are men frustrated about, right? So, BPH: Benign Prostate or Prostatic Hyperplasia. So, this is sort of a phase of life type of thing. I feel in many ways it's becoming kind of the modern peri-menopause of manhood. Because as we age, men tend to produce more DHT, right? And they're producing less testosterone. I mean andropause is a thing. It is actually a thing that is validated, and men can really end up being very frustrated with these urinary issues. And of course, there, we also need to remember that it can have a significant mental-emotional effect, not only because of just their embarrassment and frustration, but because it tends to disturb their sleep with a lot of urinary urgency that may be not rewarded with a nice reassuring urination, but you know, they repeatedly awaken to run to the bathroom for nothing to come out. And so the disturbed sleep is obviously promoting greater stress, and exacerbating the whole interconnectedness of hormones. So, I just wanted to show you, this is a great photo I think here, or diagram, rather, of what's actually happening when the urethra actually gets compressed. And this is what's actually happening where there is a hyperplasia you know, and a growth, excessive growth of the prostate and it squeezes the urethra, and therefore contributes to spasming in the urinary tract, and also to incomplete urination, incomplete emptying, and then that feeling of urgency associated with that. So, it's a very simple blockage, right? It’s a functional impairment.

I wanted to talk a little bit about some of the myths that go on here. The BPH is incredibly common and there is some interesting data showing coincidence of prostate cancer with top of the head balding. However, very low levels of DHT in the blood at the time of diagnosis are associated with reduced survival


from prostate cancer. You know me, I like to jump in the pool and start to point out some of the things that don't seem to go together, right, that hopefully will keep us from jumping to overly simplified though perhaps logical conclusion. There is not an association to be found here, in fact I think it was fascinating that this was even necessarily being looked at, but as I said before, DHT is a paracrine hormone. And in fact what studies show is that blood levels of DHT do not correlate with prostate levels. It's a local hormone having local action. This goes back to, you know if someone is having hypothyroid symptoms, but their blood levels of thyroid data look perfect, what are we going to go with? We're going to go with the symptoms we're going to go with people's real-life experience of a hypothyroid state. Well same type of thing here in a man. There's a local action of DHT that can be having a dramatic impact on the prostate. So even if the blood levels of DHT are rock bottom, but men are experiencing all of these crazy urinary symptoms, we want to go with and explore the notion that, yeah, you've got a localized issue in the prostate. And so this comes back to the devil in the detail around the fact that just because we measure something in the blood does not mean it's accurately representing what's happening elsewhere, especially what's happening in targeted sensitive tissue. This is why people can have perfectly optimal normal levels of cholesterol and still die of a heart attack or stroke. This is why people can have perfectly normal optimal levels of estradiol and still get breast cancer, right? There are localized issues that have to do with localized sensitive tissue getting overwhelmed, or not being able to balance or appropriately clear hormones. Very important detail and something, again that you can really get comfortable with explaining to your patients and clients especially if sort of super simple ideas is promoting fear in them.

Now what you may find very interesting, certainly I do, is that blood levels of estrogen, and again estrogen is an endocrine hormone, right, estrogen's a fully circulating hormone, correlate very well with the virulence of prostate cancer. And I gave you some really awesome references here. These are all fascinating. So, if you, if men's prostate health, or serving men, addressing this is of interest to you, you definitely want to check this out. I had a hard time even limiting it to, I think there's eight references here, I could have easily put 30 really fascinating ones. These are really fabulous because there is a connection between xeno-estrogens, estrogen clearance, and again that alpha and beta estrogen receptor balance, not just in the incidence of prostate cancer but more importantly the survival of prostate cancer, right, the virulence of prostate cancer. And today our typical conventional treatment of prostate cancer is about full tilt androgen suppression which may work for a period of time. But generally speaking when that therapy is stopped, if the other root causes have not been addressed, there is common recurrence. Or if the disease process has not been fully stopped there can be a strong exacerbation of it and there is really fascinating data to basically show that estrogen is the culprit and that. But when we think about it, as I said before, obviously DHT is an exacerbate, a driver here, right, in terms of dysfunction in the prostate itself. But in terms of density of estrogen receptors, the prostate is at the top of the list for men. And so it's an interesting canary in the coal mine around the effects of estrogen and perhaps the level of estrogen overload that a male might be struggling with. And I don't think that's just about xeno-estrogen, right, I think an awful lot of that has to do with poor estrogen clearance. We're not taking in all the nutrients that we need to clear estrogen in terms of detoxification. I also think that we're using medications that are using detoxification pathways. People have snips that are relevant. It's a very rich and bio-individual type of scenario for each person. But I believe the combination of DHT overload and estrogenic overload explains an awful lot of prostate cancer when there's already a predisposition for cellular dysfunction in the cell itself, which is mediated by oxidative stress. And we have a deep-dive clinical in cancer that talks in immense detail about this and that core common root cause of oxidative stress which is at play in all cancers.

Okay, so there are definitely some things that can help to alleviate symptoms and return quality of life or BPH. And of course, in terms of you know hyperplasia of the tissue, all things that promote better balance between the five alpha and five beta enzymes are going to be of value. This is where I go back to my test-


of-yes dynamic, because some men have only a very small or maybe no imbalance between those. Some men have very high levels of testosterone period, and so they end up with high use of both metabolic pathways and their unique prostate can end up getting overloaded. Sometimes there's more of an estrogen type of dynamic at play here and it's less about the five alpha pathway and more about the estrogen overload. Again, the wonderful thing about Dutch is it's measuring hormone metabolites not just aggregate, total, and free hormones. And so you have a chance to see more closely what might be a play. I think suboptimal levels of zinc are rampant and I think they're particularly rampant in men. And this is particularly powerful for shifting the five alpha, five beta pathways and the hormonal diagram that we've been talking about all throughout this course talks about a number of different agents that can be helpful for shifting that. I've listed here some of the most potent ones: saw palmetto pumpkin seeds, pygeum, rye grass pollen, beta sistosterol, these these have all been shown to be very effective. The Gaia Herbs prostate health formula, which for mild issues can be taken as recommended. I've had men with more dramatic issues double the recommended dosing and have that be quite effective. And I also believe that eating ground flaxseed can be very helpful for this. I've got a whole little paragraph down here about this because I know that we have some practitioners who are really passionate about hormone balance who are very anti flaxseed for men in general. And for me this comes back to the notion of again, considering the individual. So ground flaxseed is indeed a phytoestrogen and if if a man does not have any issues with excessive five alpha reductase activity or estrogen dominance, then there's likely no therapeutic need for them to use ground flaxseed and put in more estrogenic effect in their body. It's simply not necessary. It's not appropriate for them.

However, if the a man is struggling with these types of dynamics already and needs to better balance them out then I believe ground flaxseed can be actually very helpful. And I love the study, actually, it's a great example of the placebo effect, which our semester students know we like to teach about. But this is a great study that shows the magnitude of the impact of flaxseed. And it was a fully blinded test, and the very strong placebo effect for the men who thought they were taking flaxseed as well, which I find really fascinating. But I wanted to call this out as an example because again it goes back to this being careful of black and white thinking about "Okay, this is never good for men," or "Okay, this is never good for women." There are scenarios where specific solutions make specific sense as therapeutic intervention for a period of time until balance is restored.

Okay let's see ... I think zinc deficiency is rampant for a lot of reasons. Zinc is mineral, and we require good strong stomach acid take it up. I think we're eating a lot of refined foods that don't have minerals in them, period. Zinc and copper compete for absorption and depending on dietary intake there can be an imbalance there as well. When we have higher estrogenic activity in the body, it increases the level of a binding protein called ceruloplasmin in the blood, which binds copper. And so given the issues with estrogen overload that we're talking about here for that, it's perhaps not a surprise that we might end up with copper-zinc imbalance issues. Some people end up with just mineral deficiency, period, and so they need zinc, but they need copper, too. So, I do think checking data is a good idea, really optimally liking red blood cell zinc to be well into the upper half of the reference range. We have to keep in mind, reference ranges are not optimal ranges, it's just what everybody has in an environment of a lot of deficiencies, so we want to be cautious about that. Okay, and yes, the prostate health for women who have maybe a PCOS kind of dynamic, and maybe they have checked their data and they do have a lot of five alpha reductase, and they have a lot of DHT levels, women can certainly take this formula as well. There's nothing specific about it in a man. It's helping with balancing that pathway

So, let's talk a little bit about testosterone, right? I think the most important thing to realize given that what people are looking for from us as practitioners, yeah andropause is a thing. Production of testosterone reduces as we age, and it starts earlier than in women in terms of hormone dynamics and


shifts and reductions, typically around age 30 or soon thereafter. It's not a linear reduction, but a one to two percent per year on average. If men are falling into the kind of classic "I'm working a lot and not working out and eating crap food," it's going to happen sooner. For that reason, men typically produce more estrogen as they age, because of increased body fat, again, because of higher insulin, exactly, especially workaholics. And that increased aromatase is not only producing more estrogen, but also reducing testosterone. So it's sort of a double whammy on dropping the testosterone to estrogen ratio, and men get symptoms that are really debilitating to them. And a burst of estrogen is too high itself. They end up not only with kind of a low-T type of dynamic, but they end up with a high-E dynamic, right, which can go to actually changing their anatomical features, where they may get softer skin they may end up fuller in the hips and the thighs, in the buttocks, and then a loss of muscle mass in the chest and the arms, the upper torso. They can also end up with gynecomastia in terms of male, enhancement of male breast tissue. And so, the natural aromatase inhibitors that we talked about can be helpful for this. And again, this goes back to the notion of using things like ground flaxseed for this purpose. The unfortunate thing for men is that a lot of men are self-medicating through this window of time with higher alcohol and alcohol is the real nemesis for testosterone. As a good reference here, references here for looking at the impact, it's multifactorial, right? It actually is not only impairing its synthesis, but actually speeding up its metabolism. As opposed to resistance training is great for testosterone. All exercise is good because of its impact on stress hormones, but in particular resistance training that is especially building up muscle mass ... the resistance training that is especially building up muscle mass, it's particularly powerful for increasing testosterone. And of course, again, the xenoestrogens matter, and they can definitely get in the way. Of course, it's also about balance. Again, men aren't striving to have zero estrogen, just like we're not striving to have zero cholesterol, right? The body doesn't endemically make substances that are toxic to itself. Erectile dysfunction is a very common frustration of men. Talk about wildly satisfying the client, I've had a number of them where they were able to fully address erectile dysfunction and return to a nice vital confident sex life. I can think of one gentleman in particular who is still sending me referrals from a good six or seven years ago, because he had such an amazing experience because he got educated, right? He got inspired and he actually was empowered to change his life and change his lifestyle choices in a way that has been truly sustainable for him.

Okay. I do want to say a word, just briefly, about DHEA. We could talk about all of the different androgens, but certainly testosterone and DHT are the most important ones, because they're the strongest. DHT is important to chat about for a moment, because it's an adrenal androgen. In fact, it's just as an aside, speaking before about the very extreme therapies that are being used for hormone-mediated cancer, it's one of the reasons why they struggle for being fully efficacious, by blockade from the testes or the ovaries for example is, the lowly, little adrenal gland is still making hormones. In the case of DHEA, especially in midlife, it's still making dramatic levels of hormones. DHEA is a weaker androgen, but it is an androgen. In fact, for women, it's a major component of our overall androgen load throughout life. As men age, it becomes more dominant also as testosterone production directly from the testes wanes with age. DHEA can be converted downstream. We're going to talk about hormone supplementation in the next webinar, but I want to go ahead and put it out there, because I see practitioners taking this misstep all the time. You do not recommend DHEA to someone who has low testosterone and sky-high estrogen. Odds are, they're just going to use that DHEA and keep doing the same thing that they've been doing, right? It's logical that the body will keep doing what it's been doing. We need to address the downstream dynamics that are dysfunctional first, before we put more fodder upstream.

Now, the thyroid adrenal class talks more about this in depth, but there is a orchestration across the HPATG axis, right? The phases of a stress response, that can have a big impact on DHEA and its hormone synthesis downstream. It's important to understand that sustained chronic stress can cause the body to go into a protective mode and shift from very high cortisol to low or even very low cortisol, but DHEA


tends to be plummeting as a protective mechanism. That can have dramatic effects on vitality and certainly things like fertility and cardiovascular health and libido and sexual health, sexual wellness. We have to understand that this is part of how the body is orchestrating all of the primary hormones of the HPATG axis, to try and help us optimally thrive or at least withstand, to weather, the environment in which we're asking it to live. We need to keep in mind that this is a factor for men and women. Production of DHEA also wanes as we age. So, depending on what you learn on hormone testing, it may actually be possible to supplement with DHEA as a way of trying to get more optimal levels of downstream hormones.

There's a couple questions here about DHEA supplementation, which [Kasha 02:00:55] might get to here, and if not, I'll answer them in the next webinar. There's questions about adrenal insufficiency, which I really need to defer to the thyroid adrenal class. In the absence of an adrenal cancer or an actual auto-immune disease of the adrenal gland, I have definitely seen people reverse adrenal insufficiency, for sure. I've seen it done multiple times. It takes time and a tremendous amount of patience, but I do think it can be done. It is much more challenging in situations where the actual tissue in the adrenal gland itself has been damaged from disease or auto-immune attack or injury.

Okay. I just want to close on the topic of estrogen here. Again, we need to keep in mind that this is a delicate balance, right? We are not on a mission with men to recommend that estrogen should be as low as possible, because there's a role of estrogen for men in bone health, in cardiovascular health. There's really interesting studies that I've referenced here for you that look at increased risk of cardiovascular disease based on the highest levels of estrogen, but also the lowest levels of estrogen, right? This is what we actually see in postmenopausal women as well, right? It's all about balance, right? Estrogen is neither always the boon savior, but it's also not the evil toxin. It's always about something in between. It's balance that we tend to struggle with. Men need estrogen to maintain bone health as they age. It's interesting. There's some interesting dynamics here in terms of looking at some clinical research. There's a really fascinating study here referencing exogenous testosterone therapy. In this case, a gel, actually increasing the total arterial plaque volume in senior aged men that already had a relatively high incidence of insulin mediated issues. The author is really focused on, "Oh, the testosterone. These guys are using the testosterone gel, that must be the problem." What I found really interesting is that their data, when you dive into the data, it shows how much notably the estradiol went up in response to the testosterone therapy. They didn't comment on that at all, which I found to be very interesting.

Of course, it's a great reminder to everyone that sometimes there are serious pearls in studies that the authors don't focus on. Sometimes that unfortunately is highly mediated by who's sponsoring their research. They're not so much lying in their conclusions, but they are avoiding the opportunity to make conclusions based on certain data points. I just found this really interesting. Again, keeping in mind that any time you supplement with an upstream hormone, you risk the body choosing downstream to convert it into something that you don't want. This goes back to if a man is already over-aromatizing and over-converting testosterone to estrogen, just putting more testosterone in the system, it's illogical to think the body is not going to just keep doing more of what it's already doing.

Another interesting study looking at men in their 60's with overall low testosterone, less than 300, definitely low. In groups with lower levels of pre-existing cardiovascular disease, then the testosterone was beneficial and was associated, at least in this study, with a reduction in mortality. Within groups that already had pre-existing cardiovascular disease, the testosterone therapy increased mortality. Again, the studies tend to focus on, "Oh my gosh, what's the devil in the detail about testosterone that we're not understanding, that leads to this confounding data?" What I find fascinating is estrogen wasn't measured in either of these studies. They didn't even look at it. So again, we need to keep in mind that it's a hormone soup dance, right? They're interconnected. They are not separate.


Okay. To finish us up today, I just want to ask everyone to come over to the questions tab, and if you're listening to the recording, pull out a piece of paper, because I want to give you another chance to practice right? Another typical real-life patient or client, right? This is a middle-aged man, very busy, feels very over-committed, lots of responsibilities, sole bread-winner in his family, three children, really nice house, too busy to exercise, typical 60-70 hour a week mid-level corporate job, definitely a desk job, very stressed already, but really trying to go aggressively after a promotion that would breed more money, and that he feels would just be kind of the ultimate in terms of finally bringing some relief. I always find that funny. When people are extra-stressing them out, extra-stressing themselves out in pursuit of something that they think might bring them relief. Of course, as we all know, choosing to extra-stress yourself out tends to be a way of life. He feels exhausted. He has typical cafeteria food for breakfast and lunch, because it's convenient, it's easy. Does feel that he's getting healthy options though, as he puts it, "I could be eating crap. What I'm having is a sandwich. It's a healthy sandwich because it's got whole-wheat bread and I'm choosing the low-fat chips. I don't eat a cookie. I eat a container or two of fat-free yogurt, and my only real vice is I have a few beers on the couch in the evening when I get home." Definitely struggling with low libido. Struggling with shorter, weaker erections. Most of the time he finds that he is able to enjoy sexual most in the morning. We know that that's actually when testosterone tends to be the highest, so that makes sense. Definitely waning libido and coming to see me because of a recent wake-up call from his doctor where his triglycerides keep going up. LDL is up, blood sugar is up, and as he put it blood sugar was actually shockingly high, which can sometimes happen from a white-coat perspective at the physician.

He got the wake-up call he needed to really seek out some help. Feeling like he is putting on more fat, specifically about his middle, having to use the last notch on his belt, and really struggling with the whole BPH type of dynamic. Really rough getting up getting up so often, go to the bathroom on top of lying awake, ruminating about the upcoming job opportunity. Yes, there's several of you questioning whether or not this is your husband. That's funny. I want to know what you think. What interconnectedness do you see? In light of our discussion here, what do you think is at play? What jumps out at you? What do you think is at play and what? I hope everyone can see right off the bat, this is not uncommon, right? We all know probably dozens of people who have a life snapshot similar to this. Kasha, if you would just show as many of those as possible, so they can see what each other is responding to, that would be very helpful. I'm just going to give you a minute to show what you think. What jumps out at you? There's a lot, that's for sure.

Okay great, so keep it coming, but I'm just going to start discussing some of the things. Many of you are noting a likely inflammatory diet. Certainly a few beers on the couch every night. Not occasional beers with his buddy, but really kind of self-medicating at the end of the day, probably to try and counter high cortisol is undoubtedly contributing to a reduction in testosterone, even beyond his stress, even beyond his age. That's a multi-whammy there on testosterone levels. Definitely has some combination of a 5-alpha-reductase-dominant type of dynamic and a estrogen-dominant dynamic happening because of the prostate issues and the increases in body fat. Lack of exercise is undoubtedly also contributing to higher stress levels, to higher insulin levels. I appreciate the interconnectedness there. Everyone's talking about higher levels of aromatase. Excellent. The interconnectedness, right, of higher levels of insulin contributing to the higher triglycerides, right, and the higher levels of cortisol, contributing also to the higher blood sugar beyond the food and to the higher LDL. This can also ... At the time, there's no CRP data, no homocysteine data, but it wouldn't have surprised me at all, if the physician had run a more thorough assessment, that we would have seen low testosterone, really low free testosterone. We would have seen concerningly elevated hemoglobin A1C, we would have seen an elevated CRP, and we might have seen an elevated homocysteine as well. Okay, good. Excellent. Someone talked to be a little bit about what the interconnectedness might be between his diet and his erections. What might the connection be there? What might the connection be between his diet and his erections?


So, one of the things we need to remember is that elevated blood sugar is toxic to the lining of our arteries. We end up, over time, through sustained of elevated levels of blood sugar, with oxidative stress, and eventually oxidative damage to the lining of arteries. Indeed, this is what creates the perfect storm for hypertension. It actually damages that precious endothelial lining in blood vessels. We can end up with impaired production of nitric oxide because of that, which can very directly contribute to difficulties getting and maintaining an erection. This is where this whole insulin-resistance, especially as it trends over into metabolic syndrome, we don't often see it published in the list of symptoms, but we could easily see erectile dysfunction listed as a symptom with that, because of the impact on the circulatory system, right, the cardiovascular spillover. All right. Good. Thank you so much for all of the input there. That's really excellent. So yes, I was not going to talk about it too much, but erectile dysfunction, various nitric oxide formulas can be very helpful for that. Combinations of argenine and citrulline can be helpful for addressing that. All of the good supplement companies that we typically recommend have good nitric oxide mixed formulas, or the aggregate amino acids can be done. Again, that may be helpful for triage, but ultimately, we know we've got to get to the root of this, right? What's at play?

I think across the board, collectively, you all mentioned everything, right? Again, you're very astute. You're getting this. It's extremely powerful education, to go to this person and explain the role of high cortisol. Overwhelmed, anxious, high cortisol. All receptors are being primed, so whatever hormones are prevalent or being particular affected. High cortisol is impairing melatonin synthesis overnight. That's making his ability to stay asleep even worse. On top of the urinary urgency, we've got an increase in body fat, perhaps because of estrogen dominance, but for sure because of increased blood sugar and insulin's role of storing excess fuel as fat. We've also got high insulin increasing aromatase activity and creating excess estrogen and even exacerbating what is probably already an inappropriate or suboptimal ratio of testosterone to estrogen. The alcohol intake is impairing that even further. Stress is increasing sex hormone binding globulin and further reducing available hormones. Keep in mind that sex hormone binding globulin wants to bind androgens first. This is why you heard me say that stress from the hormonal balance perspective, I believe biochemically, can have a much worse effect on men than on women.

The combination there I just mentioned around arterial inflammation, which can promote cardiovascular disease risk factors. Likely episodes of higher adrenaline, right? What he didn't know at the time, but we found out later after he was feeling much better and wanted to look at some genetic data, was that he was homozygous, or COMT SNP, which was, unfortunately for him, impairing the metabolism of both estrogens and also for adrenaline, the catecholamines for him. Continuing to be in a high insulin, high stress type of environment was really packing a wallop on him, because he wasn't detoxifying those. Of course, because of that, wasn't detoxifying a number of things that need E methylation. Again, when we went back and actually measured ... Sorry, I just totally lost my train of thought. When we actually went back and measured homocysteine, right, his level was up above 20. Not a surprise, and definitely just in the nick of time, right, in order to begin to reverse some alarming cardiovascular disease dynamics as well. Right? So again, I just want to acknowledge, collectively, you all homed in on these. Being able to explain what people are actively doing and its impact on hormones and to educate them in a way that's inspiring, so that they can make lifestyle change is huge. This is not an abnormal dynamic, right? The commercials that talk about, "Do you have low T?" A whole bunch of people have low T. That is being in a low testosterone state. A whole bunch of men struggle with this dynamic.

What I want you to really understand is that this is not atypical. You now have some education around targeted intervention, but again, don't lose sight of the fact that foundational interventions are powerful, right? It goes exactly back to what we talked about way in the beginning. We are not designed, right, to be in a chronic, low-grade state of stress and toxicity and inflammation, right, and maybe some area infections and crap food and be unrested and still have great erections, right, and still have vitality and


still feel like playing tennis and all of these types of things. We're just not designed to do those two things at the same time. As always, I hope that you balance the idea of targeted intervention. Maybe they're valuable, or even necessary for rapid relief. We need to get to the foundational interventions that are actually going to address root causes to help people to get sustainable relief.

All right, great job. Thank you so much for participating. I really appreciate that. I hope you have a really good sense now for androgens, right, the role of androgens. I feel really great and excited about that collection of topics altogether, because it also helps us to see how men and women are different and yet how men and women are suffering in different ways from the same modern, common lifestyle choices that can result in hormone imbalance that may have some idiosyncrasies for the two sexes but are highly debilitating to both.

I hope you've enjoyed today. As always, I want to encourage you to experience this webinar again before we move on to part four, where we'll be talking about perimenopause and menopause. We're going to be moving more into the overt scenario of true low hormones, right? We talked about imagine low hormones or the myth of low hormones quite a bit in some of these earlier webinars. We're going to talk about what happens when the body starts making its natural movement into the latter stages of life. That tends to be the time of life when overt hormone supplementation is more commonly considered. We're going to talk a little bit about some considerations for that. Then also, some medication considerations and then we're going to talk a little bit about hormone testing.

Thank you all so very much for your participation today, and I wish you happy studying and follow-up in furthering your learning. I look forward to being with you for part four. Have a great day.

hormones demystified part 3 (revised) - welcome …...hormones demystified (revisited) – part 3:...

Documents