Male Andropause – Hormonal & Neurotransmitter Imbalances in Midlife

Male Andropause

Men do not usually present at the doctor’s office requesting an assessment for andropause, or “male menopause.” The more common scenario is a fifty-year-old executive, slightly overweight, appearing exhausted and irritable, reluctantly showing up in the doctor’s office for a consultation.  It was his wife, enquiring into her menopausal status the week before, who had mentioned to the doctor, “You know, I think my husband should have a check-up. He hasn’t been himself lately. He is grumpy. He lies down on the sofa any chance he can get. He complains of vague aches and pains, and I can’t remember the last time we had sex!” 

Upon closer enquiry, it appears that his symptoms were slower and more insidious in onset than his wife’s but, nevertheless, just as dramatic in their consequences. Men traditionally tend to have a more stoic and fatalistic approach to encroaching signs and symptoms, but as hormone depletion typically affects a man’s sexual performance first, this is often what propels him to seek medical attention.  The danger of ignoring all the other signs and symptoms of declining hormones is that andropause is not necessarily a benign process. It is often accompanied by profound physiological and mental changes that, over the long term, can have a significant effect on silent disease processes. According to Dr Jerald Bain, testosterone is much more than just a male sex hormone. It is an important contributor to the robust metabolic functioning of multiple bodily systems.[1] Men with low testosterone die earlier than those with normal levels.[2] Andropause can thus be considered a lethal disease. There is a 41 % decrease in the chance of dying with a testosterone level of 20 nmol/l compared to 12 nmol/l (average level 12-35 nmol/l).[3] For this reason, it is imperative that male andropause enters into consensual reality as forcefully and as well publicized as female menopause, lest we have a whole generation of men developing life threatening disease that may have been prevented with much earlier interventions.


[1] Bain J.The many faces of testosterone Clin Interv Aging. 2007; 2(4):567-76

[2] Shores MM et al, Low serum testosterone and mortality in male veterans. Arch Intern Med. 2006 Aug 14-28; 166 (15):1660-5

[3] Ibid.

It has been estimated that among men more than 45-50 years old, the prevalence of low testosterone is at least 20-30 %.[1] Some of the more common and somewhat insidious presenting features of andropause include:

Loss of drive or competitive edge in business,

  • Various aches and pains in muscles and joints,
  • Loss of memory, a decreasing level of fitness,
  • Endurance and effectiveness in workouts,
  • Loss of muscle mass and increased abdominal obesity,[2]
  • Fatigue,
  • Depression,
  • Negative mood,[3]
  • Irritability
  • Most importantly, decreased libido and erection frequency, endurance, and strength, as well as unsatisfying orgasms.  Sex on a nightly basis turns into sex on a weekly basis as the desire and ability to perform decrease, while general fatigue increases.  Increasing loss of graying hair seems to be the final insult to an already distressing situation. However, this is just the tip of the iceberg. In addition, there may be many other subtle clues as to a declining sense of wellbeing. (See table 1) 

[1] Goepp J, Life Extension June 2010 pg 84

[2] Harman SM, et al, Longtitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrin Metab, 2001 Feb;86 (2):724-31

[3] Zitzmann M. Testosterone and the brain. Aging Male. 2006 Dec; 9 (4):567-76

Table 1: OTHER SIGNS AND SYMPTOMS OF ANDROPAUSE

  • Headache
  • Tinnitus (ringing in the ears)
  • Aging facial appearance with increased wrinkles
  • Quickly out of breath with physical activity
  • Unexplained numbness and tingling
  • Constipation
  • Hypochondriasis
  • Lack of interest in sports
  • Disturbed sleep with less than eight hours of uninterrupted sleep as trips to the bathroom increase due to prostate swelling as well a slower levels of melatonin
  • Hot flushes and sweating spells (mostly head and upper chest)
  • Prostate infections
  • Reduction in ejaculate
  • Gynecomastia (Fat accumulation in the breasts)
  • Longitudinal lines on nails
  • Hemorrhoids
  • Cellulite
  • Loss of hair on legs, especially the external sides
  • Nervousness and irritability
  • Poor concentration
  • Poor memory
  • Voice developing a higher anxious tone
  • Messy clothing (due to the depressive tendency and lack of the desire to be sexually attractive)
  • Becoming shorter in height, dry, thin (atrophic) skin
  • Dry glans penis (tip of penis)
  • Small, flaccid, atrophied penis
  • Peyronie’s disease (skew penis)
  • Lax testicles with reduction in size
  • Male pattern baldness (androgenic alopecia)
  • Dry eyes
  • Decreased axillary and pubic hair

If some of these symptoms and signs start to appear in your life or in the lives of your 40–50-year-old male loved ones, be very suspicious of the insidious onset of what has been termed male andropause.

What Is Male Menopause (also known as Viropause or Andropause)?

Male menopause is generally recognized as a gradual shift in hormonal, physiological and chemical changes that occur in all men between the ages of 40 and 45, although it can occur as low as 35 and as late as 65. [1] The term “hormone” is derived from the Greek word, hormo, which means to set in motion. This is precisely what hormones do. Hormones are involved in almost every biological process, including sexual reproduction, growth, metabolism, and immune function. They stimulate, regulate, and control the function of various tissues and organs and are manufactured by specialized groups of cells within structures called glands.


[1] Jed Diamond Male Menopause Sourcebook INC. Naperville, IL 1998, 1v

These glands, including the hypothalamus, pituitary, thyroid, adrenals, ovaries, and testes, release various hormones into the body as needed. The hormones that decline as a man age are Testosterone, Growth Hormone, Melatonin, DHEA, Progesterone, Pregnenolone and Oxytocin. (See table 2)   Hormone levels that usually go up with andropause are estrogen (the female sex hormone), insulin (the hormone responsible for sugar metabolism and the metabolic syndrome) and the stress hormone, cortisol. Testosterone, the main hormone responsible for andropause,[1] seems to peak in a man at approximately 30 years of age and then begins its gradual decline.[2]


[1] Rosick E.Male Menopause. Life Extension. Oct 2003,  pg 65

[2] Anawalt BD, Merriam G|R. Neuroendocrine aging in men. Endo and Met Clinics 2001 Sep; 30 (3): 647-69

Table 2: HORMONES & NEUROTRANSMITTERS DEPLETED IN ANDROPAUSE

  • Testosterone.
  • Growth hormone
  • Melatonin
  • DHEA
  • Pregnenolone
  • Progesterone
  • Thyroid hormone
  • Oxytocin
  • Dopamine
  • Acetylcholine
  • Gaba
  • Serotonin

The changes experienced by men during andropause can affect every aspect of a man’s life. These changes create not only serious, life-threatening health effects, but often they are harbingers of a deeper social and spiritual transition.  These changes signal the beginning of the end of the first part of a man’s life and herald in a new phase of his evolution, whereby the male may reexamine his life by asking sometimes frightening and often liberating questions.[1] If this transition is well managed medically, it may turn out to be the most productive and purposeful time of a man’s life.

This transition for men has been hotly debated for some time as to whether or not it was a real or imagined phenomenon. While the female menopause is often abrupt and life changing, signaling within a few months the change from her reproductive years to post reproductive reality, the male transition is often more gradual and not defined by reproductive incapacity.  Many people have long believed that levels decline as a natural consequence of advancing age, and thus there is nothing we can or should do about them.[2] Dr Morgentaler, associate professor at Harvard Medical School and author of  Testosterone for Life (McGraw Hill, 2008), explains, “That’s like telling a middle-aged person that since vision typically deteriorates with age, there’s no point in prescribing glasses- or that we shouldn’t treat atherosclerosis to prevent heart attacks, because it too is an age-related phenomenon. It just doesn’t make sense!” [3]

If one compares the physiological changes between men and women during this period of transition, there are striking similarities. For both sexes, as their hormones undergo this transition, body fat increases; well-being decreases; and sexual function decreases. Incidences of cardiovascular disease (heart attacks, hypertension, high cholesterol), type 2 diabetes, depression, obesity, Alzheimer’s and osteoporosis increase. Muscle wasting increases, and both prostate and breast cancer increase (as both cancers arise from similar embryological tissue).


[1] Hollis J. The MiddlePassage. From Misery to Meaning in Midlife. Inner City Books Toronto Canada 1993 pg 7

[2] Goep J..Testosterone Therapy for Life. Life Extension June 2010 pg 83

[3] Ibid, pg 84

Testosterone – Basic Physiology

Testosterone – Basic Physiology

Testosterone plays an essential role in the development of the normal male and in the maintenance of many male characteristics, including muscle mass and strength, bone mass, libido, potency, and sperm production.  Testosterone is also important in synthesizing proteins. It affects many metabolic activities such as the production of blood cells in the bone marrow, formation of bone, lipid and carbohydrate metabolism, and growth of the prostate gland. Testosterone production begins in the part of the brain known as the hypothalamus, which secretes gonadotropin-releasing hormone (GnRH). This hormone then signals the pituitary gland to make either follicular-stimulating hormone (FSH) or luteinizing hormone (LH). FSH helps to stimulate the testes to produce sperm, while LH stimulates the production of testosterone via the Leydig cells of the testes. Like the declining levels of eggs in a woman’s ovary as she ages, it has been estimated that men are born with 700 million Leydig cells and begin to lose six million of these cells yearly after his twentieth birthday. [1]

After testosterone is released from the testes, some testosterone is tightly bound to sex hormone binding globulin (SHBG) as well as loosely bound to albumin, a protein. Together, these are measured in the blood stream as total testosterone. Free testosterone is unbound to sex hormone binding globulin or albumin, and it is this hormone which exerts its powerful anabolic effects on the body (approx. 2-3% of testosterone). Bioavailable testosterone is also measurable – it is the sum of the unbound and the loosely bound portion to albumin. It is believed that the bioavailable measurement is the most accurate for assessing the amount of the most active hormone exerting its effect on the tissues.

As men grow older, not only do their bodies produce less testosterone, but the levels of another hormone called sex binding hormone globulin (SHBG) begin to increase. Levels of this hormone increase due to the aging process, increased alcohol use, increased obesity and estrogen levels, and decreased growth hormone and progesterone levels. As SHBG increases, bioavailable or free testosterone levels plummet.

As we age, testosterone is furthermore converted via an enzyme called 5-alpha reductase into dihydrotestosterone (DHT), a hormone responsible not only for aspects of a man’s libido but also most importantly, for hair distribution, heralding in the usually most unwelcome signs of male pattern baldness. Testosterone can also be converted via an enzyme called aromatase to estrogen, a vital hormone in men for bone health and cognitive wellbeing. [2] Too much estrogen production in men, a common event seen in obesity as well as seen more frequently in injectable testosterone replacement therapy.  This excess of estrogen increases a male’s risk of breast and prostate cancer.


[1] Morales A,Tenover JL. Androgen deficiency in the aging male. Urological Clinics North America 2002: 29 (4); 975- 82

[2] Nelson LR, Bulun SE. Estrogen production and action. Journal of Amer Acad Derm 2001 Sep; 45 (3): 116-24.

Lab Testing for Testosterone

When measuring testosterone levels, it is best to ask your doctor for total testosterone, free as well as bioavailable testosterone. One can measure levels in the serum and the saliva as well as through 24-hour urine collection. The benefit of saliva testing is that it is the only way to measure whether one has therapeutic levels of testosterone once transdermal creams have been initiated. It is absolutely useless to assess serum levels to measure the efficacy of transdermal creams or patches because it will require toxic doses of the transdermal creams to raise the serum levels to therapeutic serum levels. The reason for this is that, when applied transdermally, testosterone stays in the serum for a total of three seconds before being sequestered into the tissues where it exerts its effect. In order to raise serum levels, the tissue levels have to be super-saturated before the excess spills back into the serum. By this time, toxic tissue levels have been achieved. However, if testosterone is given via intramuscular injection, then serum levels are the standard way of measuring therapeutic efficacy.

The average range of male total testosterone levels and one that is considered “normal” by the US based FDA is between 12.15-35.76 nmol/l. However, no single number should be used as an absolute level. It is a man’s symptoms combined with his serum levels that should guide therapy. If a man’s symptoms are consistent with low testosterone and his serum levels are at the low range of normal, that man deserves a trial of testosterone therapy.

Once testosterone therapy is begun, it is advised to test the following blood levels every 3 to 6 months in the first year and then twice a year thereafter: Hemoglobin, hematocrit, total, free and bioavailable testosterone, estrogen, progesterone, pregnenolone, dihydrotestosterone as well as PSA. Blood testing should be accompanied by a yearly digital rectal examination (DRE).

Testosterone declines with age

Testosterone declines with age

Free testosterone declines at a rate of 1% per yr. or 10% per decade.[1] As our total testosterone levels only range from approx. 12-35 nmol/l, (extremely small amounts), one can deduce that, in 20 years, significant inroads may be made into one’s total testosterone stores.  In various studies, testosterone measures correlated with strength, bone mineral density, body composition and fat mass. [2] As our levels decrease, so do these parameters of health. [3] Half of healthy men between the ages of 50 to 70 will have a bioavailable testosterone level below the lowest level seen in healthy men who are 20 to 40 years of age. [4]

One of the reasons why men are not diagnosed as being hormone deficient is that the levels of the hormones that appear on standard lab tests are age adjusted for an aging population with an anticipated reduction in hormone levels. In anti-aging medicine, we aim to restore hormone levels to a healthy youthful range of a healthy 25–35-year-old.


[1] Decreased bioavailable testosterone in aging normal and impotent men. Nankin HR et al. J Clin.Endocrinol Metab. 1986 Dec; 63(6):1418-20.

[2] Measures of Bioavailable Serum Testosterone and Estradiol and Their Relationships with Muscle Strength, Bone Density, and Body Composition in Elderly Men.  Annewieke W et al. The Journal of Clinical Endocrinology & Metabolism Vol. 85, No. 9 3276-3282, 2000

[3] Morley J. Longitudinal changes in testosterone, luteinizing hormone, and follicle-stimulating hormone in healthy older men. Metabolism 1997 Apr;46(4):410-3

[4] Korenman SG, Morley JE, Mooradian AD, et al. 1990 Secondary hypogonadism in older men: its relationship to impotence. J Clin Endocrinol Metab. 71:963–969.

With declining levels of free testosterone as we age, the following health effects have been well documented

Cardiovascular Disease:

Man with cardiovascular disease

Men with coronary artery disease had significantly lower levels of total testosterone as well as free and bioavailable testosterone than the men in the control group. [1] Furthermore, exercise-induced myocardial ischemia (reduced blood flow to the heart) improved with the use of testosterone, showing significant improvements in pain perception with no negative alterations in cholesterol levels or blood clotting capacity. [2] This effect is thought to be due to a direct coronary artery relaxing effect. [3] The many cardiac benefits of adequate levels of testosterone include assisting in the heart beating stronger, widening the coronary artery lumen, increasing blood supply to the heart, reducing serum cholesterol, minimizing atherosclerosis, reducing hypertension by vasodilatation, and making blood more fluid by increasing fibrinolytic (breaking down of clots) activity and thus reducing blood clots. Of note, very high doses of testosterone may suppress the protective high-density cholesterol whereas low levels of testosterone are associated with increased levels of total cholesterol.  As cardiovascular disease is by far the leading cause of death in the aging population in developed countries, [4] it behooves our health practitioners to be extremely diligent in measuring and managing this highly preventable risk factor.


[1] English K et al. Men with coronary artery disease have lower levels of androgens than men with normal coronary  ngiograms.  Eur Heart J 2000 Jun;21(11):890-4

[2] English KM et al.Low-dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina: Circulation 2000 Oct 17;102(16):1906-11

[3] Rosano GM et al. Acute anti-ischemic effect of testosterone in men with coronary artery disease. Circulation 1999 Apr 6;99(13):1666-70

[4]  World Health Organization (2004). “Annex Table 2: Deaths by cause, sex and mortality stratum in WHO regions, estimates for 2002” (pdf). The world health report 2004 – changing history. http://www.who.int/entity/whr/2004/annex/topic/en/annex_2_en.pdf.

Memory and cognitive function:

Multiple studies have proven that men with optimal testosterone levels as they age have fewer symptoms of senility compared to men with lower levels of testosterone. Testosterone supplementation increases working memory in men. [1]  It has also been shown to improve visual and verbal memory and visuospatial functioning as well as reduce the rate of decline in visual memory.[2] Testosterone levels correlate with cognitive function; as testosterone levels are replaced to therapeutic levels, memory and cognition improved accordingly.[3]


[1] Janowsky J et al.Sex steroids modify working memory.J Cogn Neurosci 2000 May;12(3):407-14

[2] Moffat SD, et al. Longitudinal assessment of free testosterone concentration predicts memory performance and cognitive status in elderly men. J Clin Endocrinol Metab 2002 Nov; 87 (11): 5001-7

[3] Alexander GM, Swerdloff RS, Wang C, et al. Androgen-behavior correlations in hypogonadal men and eugonadal men. II. Cognitive abilities. Hormones and Behavior 1998; 33(2):85-94

Mood:

Numerous studies have shown testosterone replacement therapy is effective when psychiatric drugs do not work in with men with depression. [1] In this study, testosterone therapy improved both natural and spontaneous erections as well as mood.[2] Low testosterone was shown to be associated with fatigue, and testosterone therapy produces a sense of wellbeing.[3] Men with low levels of testosterone are more prone to depression [4]as well as dramatic mood swings. [5]


[1] Cooper MA.  Testosterone Replacement Therapy for Anxiety Am J Psychiatry 157:1884, November 2000

[2] Burris A et al. A long-term, prospective study of the physiologic and behavioral effects of hormone replacement in untreated hypogonadal men. J Androl 1992 Jul-Aug;13(4):297-304

[3] Margolese HC et al. The male menopause and mood: testosterone decline and depression in the aging male–is there a link? J Geriatr Psychiatry Neurol 2000 Summer;13(2):93-101

[4] Pope HG, Jr et al, Testosterone gel supplementation for men with refractory depression: a randomized, placebo controlled trial. Am J Psychiatry, 2003 Jan: 160 (1): 105-11

[5] Goep J. Testosterone Therapy for Life. Life Extension June 2010 pg 86

Mortality Risk:

Testosterone deficiency can be seen as a lethal disease as individuals who had the lowest levels of testosterone had the greatest mortality rates. In this study, during an average 11.8-year follow-up, 538 deaths occurred.Men whose total testosterone levels were in the lowest quartilewere 40% more likely to die than thosewith higher levels, independent of age, adiposity, and lifestyle.[1]


[1] Gail A.  Low serum testosterone and mortality in older men. J of Clin Endocrin and Metab. Vol. 93, No. 1, 68-75

Alzheimer’s disease:

Testosterone replacement therapy prevents the production of beta amyloid precursor protein in men,[1] thus reducing the risk for Alzheimer’s disease. In established Alzheimer’s disease, treatment with testosterone improved the patient’s cognition over 1 year, whereas the control group deteriorated. [2]


[1] Gouras GK et al. Testosterone reduces neuronal secretion of Alzheimer’s beta-amyloid peptides Proc Natl Acad Sci U S A 2000 Feb 1; 97(3):1202-5.

[2] Tan RS. A pilot study on the effects of testosterone in hypogonadal aging male patients with Alzheimer’s disease. Aging male. 2003 Mar 6 (1): 13-7

Strength and Muscle Mass:

Man's arm flexing

Testosterone is a major predictor of skeletal mass, synergistic with growth hormone. In this same study, significantly improved strength was demonstrated with testosterone use even without exercise. [1]There was a more marked improvement when exercise was added to the program. With the increase in muscle mass, increased performances were noted in muscle power, strength, and endurance, with a resultant improvement in physical function, athletic performance and overall improved health related outcomes. [2]


[1] Bhasin S. The dose-dependent effects of testosterone on sexual function and on muscle mass and function. Mayo Clin Proc. 2000 Jan;75 Suppl: 70-5

[2] Ibid.

Osteoporosis:

A study of 403 healthy men aged 73-94 years proved that muscle strength and bone mass were at optimal levels in men with the highest levels of free testosterone. [1] This led the researchers to conclude that “a number of clinical problems present in older men may be related to testosterone deficiency, including reduced muscle mass, changes in body composition and loss of bone mass density.” Furthermore, using testosterone has been demonstrated to increase the bone mass of the lumbar spine in elderly men.[2]


[1] Van Den Beld AW, et al. Measures of bioavailable serum testosterone and estradiol and their relationships with muscle strength, bone density and body composition in elderly men. J Clin Endocrinol Metab 32000 Sep; 85 (9): 3276-82

[2] Snyder PJ et al. Effects of testosterone treatment on bone mineral density in men over the 65 years old. J Clin Endo Metab 1999; 84:1966-72

Diabetes and Metabolic Syndrome:

Testosterone therapy has been shown to reduce LDL cholesterol, blood sugar, glycated hemoglobin (a marker of long-term blood sugar control) and insulin resistance.

Testosterone replacement therapy

Most men choose to use bioidentical testosterone replacement therapy when they realize that many of their symptoms may be due to low levels of this hormone. The most obvious symptom that is desirous of being restored is loss of peak sexual functioning. Numerous studies now show the benefit of testosterone replacement in improving both libido and erection capability. [1] [2] [3]  The preferred route of administration is via a transdermal cream, applied to the skin or to the anal mucosal tissue. Anecdotal evidence suggests that some of the transdermal cream be applied to the glans (head) penis if erection strength is a dominant symptom. Some men prefer to have a weekly injection or to apply a hormone patch. Other routes of administration are via a subcutaneous pellet insertion under the skin every three months or via oral administration. The oral route is never used when replacing low levels due to significant potential for liver toxicity. There are also testosterone gels commercially available. A long-lasting injectable form of testosterone called testosterone undecanoate may soon be available. It lasts for 2.5 months. 


[1] Morley JE, et al. Effects of testosterone replacement therapy in old hypogonadal males: a preliminary study. J Am Geriatr Soc 1993 Feb; 41 (2): 149-52

[2] Hajjar RR et al. Outcomes of long-term testosterone replacement therapy in older hypogonadal males. J Clin Endocrinol Metab 1997 Nov; 82 (11): 3793-96

[3] Wang C, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength and body composition parameters in hypogonadal males. J Clin Endocrin Metab 2000 Aug;85(8): 2839-53

Natural ways to raise testosterone:

If applying a cream or injections are not your preferred methods of treatment, there are some natural ways to improve testosterone function although, the truth be told, they are nowhere near as effective as getting a repeated dose of the real thing!

Testosterone supplements
  • Diets low in protein in elderly men (40-70 years old) may lead to elevated SHBG levels and decreased testosterone bioavailability.[1]  Eat a well-balanced diet, rich in protein and full of fresh organically grown fruit and vegetables so as to avoid estrogen producing chemicals. The estrogen mimicking chemical HPTE, a metabolite of a commonly used pesticide methoxychlor, causes a decrease in testosterone production from the Leydig cells.[2] Avoid plastic bottles, laundry detergent and other cosmetics which are man-made mimics of estrogen.
  • Increase cruciferous vegetable intake (cabbage, cauliflower, zucchini, brussel sprouts), or take DIM (di-indole methane). These foods and/or supplements help reduce the so-called bad estrogens (16-alpha-hydroxyestrones) and increase the “good” estrogens (2–hydroxyestrones), thus reducing prostate and breast cancer risk.[3]
  • Increase soy intake (fermented non-GMO varieties) as well as increase one’s levels of omega three fatty acids. Soy appears to inhibit the aromatase enzyme thus lowering estrogen levels.[4] Essential fatty acids, found in non-mercury containing fish and supplements, decrease levels of SHBG thus making more free testosterone available.
  • Engage in daily exercise and keep one’s weight as trim as possible. Strength training in middle aged men (44-48) causes an increase in free testosterone levels.[5]
  • The mushroom extract Cordyceps has been shown to increase sexual vitality in both men and women, particularly increasing male sexual performance. It appears to have a direct effect on the sexual center of the brain and the sex organs.[6]
  • Take Tribulus – 500 mg three times per day. Tribulus is a natural herb known for its testosterone raising properties in many different cultures. It is not a hormone but appears to exert its effect by raising the levels of LH, the hormone that stimulates testosterone production.
  • Take Zinc -30 mg three times per day. This mineral is involved in multiple aspects of a male’s sexuality, including testosterone production, sperm formation and sperm motility and is commonly used in male infertility.  In one study, with the use of 60 mg of zinc, sperm counts rose from eight to twenty million.[7] Supplementation of this mineral may become very important for some men as it has been estimated that with every ejaculate, 0.5 mg of zinc is lost!
  • Take Vit A- 50,000 IU a day for one month, then reduce the dose to 25,000 IU of a mycelized Vit A.
  • Take Boron – 3 mg daily.
  • Take Vitex agnus -1200 mg twice daily – this herb also stimulates the pituitary to make more LH.
  • Sweating in an infrared sauna increases testosterone and nitric oxide synthase (dilating the vessels to the penis, similar in effect to Viagra) by 1400 % and more than over 30 saunas have been shown to reduce toxic burden by two thirds.
  • The amino acid arginine, taken an hour before intercourse, has a milder but similar effect as Viagra. Use 2 grams twice daily or 4 -6 grams 1 hour before intercourse.
  • Use propionyl and acetyl L carnitine- 1 gram of each twice a day. [8] In this study, the carnitine group had a better response than the group given testosterone 160 mg a week. It has been shown that carnitine can be used successfully in prostate cancer patients so as to restore sexual potency after a surgical nerve block. Carnitine and Viagra together seem to be the best combination.
  • Lipoic acid 500 mg daily improves cognitive function as well as increasing libido.
  • Eat enough calories and follow a Paleolithic diet.
  • Use a mixed amino acid supplement or protein drink.
  • Avoid alcohol, vinegar, caffeinated drinks, sugar, sweets, soft drinks, cookies, breads, milk, tobacco, and marijuana.
  • Avoid tight underwear and reduce weight.
  • Avoid chronic stress and strenuous physical activities i.e., triathlon training.
  • Reduce the use of anti-hypertensive beta -blockers as they reduce testosterone levels.

[1] Longscope C, et al. Diet and SHBG. J CLin Endocrinol Metab 2000 Jan; 85(1):293-96.

[2] Kuipper GG, et al. Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor beta. Endocrinology 1998 Oct; 139(10:4252-63)

[3] Muti p et al. Urinary estrogen metabolites and prostate cancer; a case-control study in the united States. Cancer causes Control 2002 Dec ; 13 (10):947-55

[4] Nagata C, et al. Inverse association of soy product intake with serum androgen and estrogen concentrations in Japanese men. Nutr Cancer 2000; 36(1): 14-18

[5] Izquierdo M, et al. Effects of strength training on muscle power and serum hormones in middle-aged men. J App Physiol 2001; 90(40 1497-1507

[6] Zhu J et al, Cordymax: A scientific product review. Pharmanex Phytoscience Review Series. 1997

[7] Netter A, et al. Effects of zinc administration on seminal zinc and fertility of oligospermic males. Ind J Phys

 Pharm 1987 Jan-Mar:31 (1) 30-34

[8] Cavallini G.Urology. 2004;63:641-646

If the serum free testosterone is low but the total testosterone is normal:

  • Pygeum – 3- 4 caps daily or
  • Urtica Dioscorea – 3 caps 2 times a day

If low testosterone with low LH- i.e., the pituitary is the problem:

  • Human Chorionic Gonadotropin (HCG) – 200-500 IU daily. If this is not helpful within 4 weeks, it won’t help, and one needs to stop
  • Vitex agnus – 1200 mg twice daily
vial from testosterone test

It is important to realize that testosterone replacement therapy can take many months before symptom improvement is realized. Restoration to normal sexual functioning may take as long as six months. It is advised to go slow and measure levels from time to time (remember to use saliva if using transdermal creams and serum levels if using injectable testosterone). Measure total, free and bioavailable levels of testosterone. In addition, measure levels of hemoglobin, estrogen, and prostate specific antigen (PSA), a biomarker for prostate cancer risk. DHEA, cortisol, pregnenolone and DHT should also be measured. Maintenance of a sugar and starch-free, as well as relatively alcohol-free, diet is recommended for maximum effect. Apply the hormone to large, hairless skin surfaces with high levels of penetration such as the forehead or inner thigh. Use a cream with a high concentration of testosterone and avoid areas of the skin with increased amounts of fat as fat tissue will have increased levels of aromatase and will easily convert the testosterone to unwanted levels of estrogen. Some individuals apply the cream to anal tissue to achieve a higher level of penetration.

Contraindications for testosterone therapy

An absolute contraindication is active breast or prostate cancer. A relative contraindication is active prostate infections or obstruction of urinary flow due to an enlarged prostate. Testosterone-replacement therapy has been associated with exacerbations of sleep apnea or with the development of sleep apnea in men treated with higher doses of testosterone who have other identifiable risk factors for sleep apnea.[1]


[1] Schneider BK, Pickett CK, Zwillich CW,et al. Influence of testosterone on breathing during sleep. J Appl Physiol 1986;61: 618-23.

Is testosterone therapy safe?

One of the most common questions asked of anti-aging physicians is, “Does testosterone replacement therapy cause cancer “? It appears that, at present, only about 5% of men with low testosterone levels are being treated.[1] It appears that it is the fear of getting prostate cancer that prevents a more proactive approach. Upon review of the relevant literature, the evidence is absolutely conclusive. Testosterone replacement therapy in physiological doses DOES NOT increase the risk of either benign prostatic hypertrophy (swollen prostate gland) or prostatic cancer.[2] In one study, not only was there no correlation between testosterone and increased levels of prostate specific antigen (a prostate cancer biomarker), prostatic volume, percent of positive cancer biopsies, biopsy Gleason score[3] or clinical staging of prostate cancer, [4] it was shown that, on the contrary, low free testosterone correlated with positive prostatic cancer biopsies and with a higher Gleason score (more serious staging of cancer). In another study, intramuscular testosterone injections at a dose of 100 mg, 250 mg or 500 mg a week (these last two doses are considered excessive and will exceed normal physiological levels) showed increased levels of serum testosterone with no change in either prostate volume or serum prostate specific antigen.

The Journal of the National Cancer Institute reviewed the work of dozens of world class researchers in the Endogenous Hormones, Prostate Cancer Collaborative Group who pooled all their data. Eighteen prospective studies that included 3,886 men with prostate cancer and 6,438 control subjects[5] concluded that serum concentrations of sex hormones were not associated with the risk of prostate cancer.

Another study showed that levels of dihydrotestosterone and testosterone were in fact lower than the controls in men with prostate cancer. In fact, with more advanced prostate cancer tumors, the same low levels of dihydrotestosterone held true.[6] It appears that it is not testosterone that is the culprit in the induction of prostate cancer, but that it is more closely linked to levels of estrogen in males, along with a poor western based diet.[7] An article in the World Journal of Urology summarized the current understanding by stating: “Estrogenic stimulation through estrogen receptor alpha in a milieu of decreasing androgens (testosterone, DHT and DHEA), contributes significantly to the genesis of benign prostatic hyperplasia, prostate dysplasia and prostate cancer.” [8]

Most interestingly, many experts are beginning to provide testosterone replacement therapy to men who have had prostate cancer, [9] an approach that was considered strict heresy just a few years ago. This approach is not, however, considered a mainstream approach as many oncologists and urologists are still concerned that testosterone therapy may increase the risk of cancer recurrence. [10]


[1] Rhoden El. Morgentaler A.  Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004 Jan 29; 350(5):482-92

[2] Morley JE. Testosterone replacement and the physiologic aspects of aging in men. Mayo Clin Proc. 2000 Jan; 75 Suppl: S83-7.

[3] Gleason score refers to the microscopic appearance of prostatic cancer which together with other parameters, is incorporated into a strategy of prostate cancer staging which predicts prognosis and helps guide therapy. Cancers with a higher Gleason score are more aggressive and have a worse prognosis

[4] Hoffman MA.Is low serum free testosterone a marker for high grade prostate cancer?J Urol 2000 Mar;163(3):824-7

[5] Roddam Aw et al. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008 Feb 6; 100 (3): 170-83

[6] Gustafsson et al.  Dihydrotestosterone and testosterone levels in men screened for prostate cancer: a study of a randomized population. Br J Urol 1996 Mar;77(3):433-40

[7] Coffey DS. Similarities of prostate and breast cancer: Evolution, diet, and estrogens. Urology 2001 Apr;57(4 Suppl 1):31-8

[8] Steiner Ms, Raghow S. Antiestrogens and selective estrogen receptor modulators reduce prostate cancer risk. World J Urol 2003 may; 21 (1): 31-67

[9] Morgentaler A. Testosterone therapy for men at risk for or with a history of prostate cancer. Curr Treat Options Oncol. 2006 Sep;7(5):363-9

[10] Goep J. Testosterone Therapy for Life. Life Extension June 2010 pg 89.

Man standing on dock looking out at lake

The other hormones involved in Andropause

Andropause is primarily due to decreasing levels of testosterone, but many other hormones and neurotransmitters may be similarly affected.

DHEA

DHEA is a steroid hormone secreted by the adrenal glands, gonads, brain and skin in both men and women, which also declines with advancing age. By the time we are 70-80 years of age, peak levels of DHEA are only 10-20 % of those in young adults. [1]As DHEA is the dominant and most abundant steroid hormone in the body and the precursor of all other sex steroid hormones, DHEA has extraordinary restorative effects on multiple aspects of one’s functioning. Low levels of DHEA are associated with aging and most diseases of aging. Specifically, a deficiency of DHEA has been found to correlate negatively with immune dysfunction, inflammation, greater risks of certain cancers, heart disease in men and osteoporosis.[2]


[1] Genazzani Ad, et al. Might DHEA be considered a beneficial replacement therapy in the elderly? Drugs Aging. 2007; 24(3):173-85

[2] Greenwell I. Life Extension. August 2001; pg25.

DHEA and Cardiovascular Disease

Studies have shown that the dramatic age-related drop in DHEA levels is accompanied by an equally dramatic rise in cardiovascular disease.  The mechanism of action is that it appears DHEA is incorporated into both high- and low-density cholesterol, protecting it from oxidation. As we age, the cholesterol-bound levels of DHEA become infinitesimal, thus the cholesterol molecules are much more susceptible to oxidation than in younger individuals. 

In the Massachusett’s Male Aging Study, following 1700 men between the ages of 40 and 70 for 9 years, authors found that men in the lowest quartile of serum DHEA at baseline were 60% more likely to develop ischemic heart disease than controls.  Low serum levels of DHEA were also a significant predictor.

In a study done at the University of Wroclaw, Poland, it was found that DHEA decreased the level of serum lipid peroxides in rabbits fed a normal diet but not in rabbits with induced severe hypercholesterolemia. DHEA was able to increase the activity of the platelet superoxide dismutase (SOD), a crucial antioxidant enzyme.  This increase in superoxide dismutase’s activity may partly explain DHEA’s antioxidant effects.[1]


[1] Bednarek-Tupikowska G et al. Influence of DHEA on platelet aggregation, superoxide dismutase activity and serum lipid peroxide concentration in rabbits with induced hypercholesterolemia. Med Sci Monit 2000; 6:40-45.

DHEA and Brain Health

It is well known that cortisol, the hormone resulting from chronic prolonged stress has harmful effects on the brain.[1]  DHEA, due to its action in suppressing cortisol, appears to protect the brain from these damaging effects. Furthermore, a Canadian study found that rats implanted with a high dose of DHEA showed significantly less hippocampus (an area of the brain associated with memory) damage after stroke was experimentally induced. There were 60% injured neurons (brain cells) as compared to 88% in the control group.[2] [3]


[1] Canning MO et al. Opposing effects of DHEA and dexamethasone on the generation of monocyte-derived dendritic cells. Eur J Endocrinol 2000; 143:685-95.

[2] Aragno M et al. Oxidative derangement in rat synaptosomes induced by hyperglycemia: restorative effect of DHEA treatment. Biochem Pharmacol 2000; 60:389-95.

[3] Aragno M et al. DHEA prevents oxidative injury induced by transient ischemia/reperfusion in the brain of diabetic rats. Diabetes 2000; 40:1924-31.

DHEA and Infection/Immune Health

DHEA has also been shown to not only enhance the immune response but also fight infection.  Several studies have confirmed its usefulness in combating bacterial, parasitic, and viral infections including HIV. DHEA has been shown to lower the levels of IL-6, a proinflammatory cytokine (a chemical messenger used by the immune system). [1] Furthermore, it lowers the production of another inflammatory cytokine, tumor necrosis factor alpha (TNF Alpha).  As we age, both of these levels rise, which indicates immune dysfunction and an increasing inflammatory state.  The ability to lower the levels of these inflammatory mediators may be an important part of the neuroprotective mechanism of DHEA.[2] Thus, the decline in DHEA levels is closely tied to immunosenescence.[3]  It can thus be shown that maintaining youthful levels of DHEA means less chronic inflammation.  It has been shown repeatedly that many of the diseases of aging, i.e., heart disease, Alzheimer’s, certain cancers, diabetes, osteoporosis are all linked to the inflammatory process. It thus becomes imperative to maintain youthful levels of DHEA so that we harbor less inflammation as we age.


[1] Greenwell I. Life Extension. August 2001; 26.

[2] Cardounel A et al. DHEA protects hippocampal neurons against neurotoxin-induced cell death: mechanism of action. Proc Soc Exp Biol Medicine 1999; 222:145-49.

[3] Greenwell I. Life Extension. August 2001; 26.

DHEA and Sexuality

DHEA’s role in sexual physiology of both men and women is that of a mood modulator. [1] One study showed that supplementing with 50 mg of DHEA every night for six months in both males and females, aged 40-70, improved energy levels, quality of sleep, mood, and the ability to handle stress.[2] In another study of men with advanced age (90-103), those who had the highest levels of DHEA had the highest levels of normal daily activities. [3]

The average dose for men is 25 to 100 mg and for women, anywhere from 1 to 25 mg.  Testing blood levels for optimal levels is indicated. Too much DHEA in women will cause either acne or increased hair growth. This can be avoided by using a form of DHEA called 7-Keto-DHEA.


[1] Cameron Dr, Braunstein GD. The use of dehydroepiandrosterone therapy in clinical practice. Treat Endocrinol. 2005; 4 (2): 95-114

[2] Morales AJ, et al. Effects of replacement doses of DHEA in men and women of advanced age. J Clin  Endo Metab 1994 Jan; 78(6):1360-67

[3] Ravaglia G, et al. The relationship between DHEA-S to endocrine metabolic parameters and functional status in the oldest-old. J Clin Endo Metab 1996; 81(3):1173-78

Natural ways to raise DHEA

Man tying his shoes about to start exercising

Diet:

A low-calorie ketogenic diet using less than 40 gm of carbohydrates per day (8:57) in rheumatoid arthritis patients resulted in a 34% rise in DHEA within a week. [1] In primates, calorie restriction has indeed been found to preserve higher DHEA levels indicating a slower rate of aging.  Fasting has also been shown to raise DHEA levels in men and women.  Anorexic and bulimic individuals likewise show higher serum DHEA.[2]

Exercise and meditation:

Exercise and meditation have been shown to raise DHEA in some individuals.[3]

Drum Circles:

Participation in drum circles[4] has also been shown to increase DHEA confirming the hypothesis that stress reduction in general boosts DHEA production probably through a shift of adrenal steroidogenesis from cortisol to DHEA.[5]


[1] Cutolo M. Sex hormone adjuvant therapy in rheumatoid arthritis. Rheum Dis Clin North Am 2000; 26: 881-95

[2] Montelone P et al. Plasma levels of Neuroactive steroids are increased in untreated women with anorexia nervosa or bulimia nervosa. Psychosom Medicine 2001: 63: 62-8

[3] Boudou P. et al. Effects of a single bout of exercise and exercise training on steroid levels in middle-aged type 2 diabetic men: relationship to abdominal adipose tissue distribution and metabolic status. Diebetes Metab 2000; 26:450-57.

[4] Bittman BB et al. Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects. Alternative Ther Health Medicine 2001; 7:38-47.

[5] Greenwell I. Life Extension. August 2001; 27.

GROWTH HORMONE

Growth hormone (GH) deficiency in aging males can have a dramatic effect on one’s sense of well being. GH is considered the master hormone with multiple protective roles. It is growth hormone which is responsible for our major growth spurt during puberty, without which we would all be dwarves.[1] In adulthood, GH maintains skin, muscle, and bone health. With a deficiency of this hormone, signs of aging are quickly accelerated.

Skin wrinkles and sags; fat soon replaces muscle. Growth hormone also helps maintain and repair the health of various organs, including the heart, lungs, liver kidneys joints, nerves as well as the brain. As growth hormone activates the calming, regenerative parasympathetic nervous system, a deficiency may result in increased tension, anxiety, depression, and an increasing inability to cope with stress.  From the age of thirty onwards, growth hormone levels decline fairly rapidly, about 1-3 % per year. This loss is quickly accelerated in the presence of obesity. The most efficient way to replace growth hormone is through subcutaneous daily injection, similar to a diabetic insulin injection. Some companies make precursor amino acid preparations (arginine, lysine, glutamine, and ornithine) which have a variable effect on raising GH. Most anti-aging doctors will not treat GH in the first year of restoring optimal hormone levels as a protein rich diet, adequate sleep, and exercise program, and replacing testosterone, progesterone, melatonin, and thyroid levels, may increase GH levels by as much as 20-30 %. (See table 3)   


[1] Hertoghe T. The Hormone Handbook . International Medical Publications. U.K. pg 54

Table 3: NATURAL WAYS TO RAISE GROWTH HORMONE

  • Take Amino acid supplement
  • Exercise daily
  • Replace all deficient hormones
  • Eat a protein rich diet
  • Avoid alcohol, sugar, sweets, breads, and pasta
  • Reduce weight
  • Avoid milk products
  • Avoid sleep deprivation
  • Avoid prolonged stress.

PROGESTERONE

The subject of progesterone replacement therapy in men was well covered in this magazine, Edition 3, 2010.[1] Men typically produce between 1.5 to 3 mg per day, and as men age, progesterone levels fall exponentially. From a biochemical point of view, progesterone is used in the production of cortisol (the stress hormone). Thus, if a man leads a particularly stressful life, it is highly likely he will have depleted levels of progesterone. Progesterone is vital in keeping the higher levels of estrogen in aging men in check and thus minimizing the risk of heart attacks, prostate enlargement, and prostate cancer.  A typical dose of progesterone may lower estradiol levels by up to 30 %. [2] Progesterone also lowers DHT, thus preventing or attenuating male pattern baldness.[3] Progesterone also blocks aldosterone receptors, thereby reducing excessive fluid retention and possibly high blood pressure caused by increased aldosterone production[4]. (See table 4)

Table 4: NATURAL WAYS TO INCREASE PROGESTERONE

  • Eat a diet rich in protein and cholesterol, a precursor of progesterone synthesis
  • Manage stress daily with stress reduction techniques
  • Herbs and nutraceuticals such as Rhodiola, Siberian Ginseng, and Liquorice root extract, Vitamins B 5 and C, and Ashwagandha

[1] Arthur D, Wessels M. Men and the forgotten hormone. Health Intelligence, 2010 Edition 3, pg 20

[2] Hertoghe T. The Hormone Handbook. International Medical Publications. U.K. pg 246

[3] Ibid.

[4] Ibid, pg 247

MELATONIN

Melatonin is another hormone that declines with advancing age. Symptoms suggestive of melatonin deficiency include a superficial, agitated sleep with many anxious thoughts, easy waking during the night, difficulty falling asleep and falling back asleep once awake, poor dream or dream recall, anxiety especially at night, depression (especially seasonal affective disorder) excessive emotionality and irritability, and restless leg syndrome with increased muscle spasms. Intestinal spasms or cramps may also dominate. A positive result of melatonin is the so-called regenerative or anabolic effect that it has on the parasympathetic nervous system, the part of our autonomic nervous system that is involved in rest and relaxation.   Melatonin has a positive effect on the parasympathetic nervous system, that part of our

autonomic nervous system that is involved in rest, relaxation- a so-called regenerative or anabolic effect. Without adequate levels of melatonin, the sympathetic nervous system dominates, leading to a heightened fight/flight response with an overall degenerative or catabolic effect.[1] Melatonin may improve sexual performance, enhancing serenity and relaxation after sex. [2]

Human and animal studies have linked a melatonin deficiency to hypertension, coronary artery disease, cardiac arrhythmias, obesity, diabetes, osteoporosis, lowered immunity with recurrent infections, breast and prostate cancer, and neurological diseases such as Parkinson’s and Alzheimer’s disease. The antioxidant effect of melatonin is responsible for its positive effect in cancer patients.  Some labs now offer a 24-hour saliva melatonin assay.

Treatment involves the use of either an oral or sublingual dosing. It is best to use the sublingual dosing for immediate, sleep-inducing effect, while using the oral route is best to assist in maintaining a restful sleep. Melatonin is best utilized when given in conjunction with vitamin B6 and serotonin precursors such as tryptophan or 5-hydroxytryptophan, which in the presence of the B6, convert to melatonin. High levels of melatonin may suppress cortisol, so use with caution if one desires an active immune system to suppress inflammation. Low levels of cortisol can produce many undesirable side effects, not the least of which is fatigue, headaches and low blood pressure. There are natural ways to raise melatonin. (See Table 5)

Table 5: NATURAL WAYS TO INCREASE MELATONIN

  • Increase morning daylight (a sunlamp may be used)
  • Make the room pitch black at night, use an eye mask
  • Avoid alcohol and caffeinated drinks,
  • Avoid stressful activities
  • Avoid electromagnetic exposures at night such as cell phones, electrical clocks and radios
  • Wear turquoise colored glasses 30 minutes before bed.

Some asthmatics may react negatively to melatonin as one study showed possible increased inflammation with nocturnal asthmatic exacerbations.[1]


[1] Sutherland E, et al Elevated serum melatonin is associated with the nocturnal worsening of asthma. Jour Allergy Clin Immunol 2003; 112: 513-17

[1] Ibid, pg 47

[2] Drago F, Busa L. Acute low doses of melatonin restore full sexual activity in impotent male rats. Brain Res 2000 Sep 29;878 (1-2):98-104

PREGNENOLONE

Pregnenolone is the forerunner of many of our major hormones. It is made from cholesterol and, once made, results in a series of metabolic reactions that lead to the production of other sex hormones such as DHEA, testosterone, estradiol, progesterone, cortisol and aldosterone. [1] In addition to functioning as a hormone, it also functions as a neurotransmitter in specific areas of the brain responsible for memory. Pregnenolone regulates the flow of calcium ions through the cell membrane, and calcium ion exchange determines how memory is encoded by neurons. In addition, pregnenolone increases the neurotransmitter acetylcholine, the neurotransmitter responsible for memory, as well as increasing neurogenesis in the hippocampus, the main part of the brain that stores memory.[2] The most common complaints of individuals with pregnenolone deficiency include memory loss and arthritic pains as well as dry skin and fatigue.  Replacement doses are typically 30 mg twice a day for memory loss.  In addition, one may choose to use other cognitive enhancing nutraceuticals such as:

  • Acetyl-L -Carnitine
  • Vinpocetine
  • Phosphatidyl Serine, combined with omega three fatty acids
  • Phosphatidyl choline
  • DMAE
  • G6PC
  • Huperizine 
  • Vitamin D
  • Blueberries

[1] Hertoghe T. The Hormone Handbook . International Medical Publications. U.K. pg 144

[2] Schumacher M. Neurosteroids in the Hippocampus: Neuronal Plasticity and memory. Stress 1997 Oct; 2 (1): 65-78

Stressed man

OXYTOCIN

Oxytocin, a hormone known to improve social bonding, is secreted from the posterior lobe of the pituitary gland. In women with newborn babies, it starts to flow in abundance at the first attachment of the baby to the nipple and aids in mother-child bonding.  According to researcher Dr Joan Borysenko, author of A Woman’s Book of Life, oxytocin helps a woman to become totally infatuated with her newborn, doting on every movement and every look.[1] Men and women both have endogenous levels of oxytocin naturally created by the body — it likely helps them fall in love, spurs parenting instincts and makes orgasms, well, more orgasmic. [2] It might also help women be so adept at reading social cues.

Researchers in the Journal of Neuroscience, after giving men oxytocin through a nasal mist, write “emotional empathy responses in men were raised to levels similar to those found in untreated women.” Not only were the men more affected by emotional scenes, but they also were better at learning tasks that required social cues. The effects didn’t last long though. The men needed another squirt two hours later. Oxytocin is presently being used by a few select practitioners to mainly enhance sexual arousal and bonding in men.


[1] Diamond J. Male Menopause. Sourcebooks, Inc. Naperville, IL 1998 pg. 211

NEUROTRANSMITTERS

In order for a man to feel at his best, there are multiple, interconnected physiological systems that need optimization to achieve this effect. For healthy sexual functioning this requires not only adequate hormone levels but also requires a healthy vascular system as well as psychological health. The “molecules of emotion” that link a man’s subjective sense of wellbeing to his biochemical pathways are called neurotransmitters and have a dramatic role to play in optimizing mood, sleep, pain, attention, relaxation as well as sexual function.   Sexuality in humans can be broken down into four components: desire, arousal, orgasm, and resolution. Each phase is governed by a corresponding neurotransmitter as well as a contributing hormone.[1]


[1] Bravermann E. Life Extension October 2008 pg 77

DOPAMINE

Dopamine is a neurotransmitter that we all seek out in abundance. It is involved in creating pleasure and a sense of joyful exuberance. Most people with any type of addiction, be it food, sex, drugs, alcohol, or thrill seeking, is self-medicating in order to raise their levels of dopamine. Low levels of dopamine result in loss of desire for sex as well as reduced arousal, interest, and energy for sex.[1] Dopamine levels can be raised by using the antidepressant Wellbutrin, the prescription drug L-dopa as well as naturally with tyrosine, phenylalanine, macuna bean extracts, gingko biloba and guarana.


[1] Ben Z, Tessler R, Cohen L et al, Polymorphisms in the dopamine D4 receptor gene ( DRD4) contribute to individual differences in human sexual behavior, desire, arousal and sexual function. Mol Psychiatry. 2006 Aug; 11 (8): 782-6

ACETYLCHOLINE

Acetylcholine is the main neurotransmitter involved in arousal and has significant effects on cognitive function, especially memory attention and creativity.[1] [2] A loss of acetylcholine particularly effects sexual arousal[3] as well as regulating internal moisture.[4]  Lower moisture levels can adversely affect semen volume in men.  The supplements used to boost acetylcholine naturally are Huperizine, acetyl- l- carnitine, phosphatidylserine, glycerophosphocholine and ginkgo biloba.


[1] Braverman ER. Younger you: unlock the hidden power of your brain to look and feel 15 years younger. New York, NY: McGraw-Hill; 2007.

[2] Amenta F, Tayebati SK. Pathways of acetylcholine synthesis, transport and release as targets for treatment of adult-onset cognitive dysfunction. Curr Med Chem. 2008;15(5):488-98.

[3] Andersson KE. Neurotransmitters: central and peripheral mechanisms. Int J Impot Res. 2000 Oct;12 Suppl 4:S26-33.

[4] Braverman ER. Younger you: unlock the hidden power of your brain to look and feel 15 years younger. New York, NY: McGraw-Hill; 2007.

GABA

Gaba is the main inhibitory neurotransmitter that downregulates anxiety in chronically distressed individuals.  Chronic anxiety often leads to loss of sexual interest and sexual dysfunction in men, particularly with loss of erections.  Gaba has been shown to be responsible for enhancing orgasms.  When Gaba becomes depleted, it is difficult to relax and let go of fear, anxiety, and negative thoughts, thus inhibiting orgasms. Gaba enhancing compounds also increase dopamine which, therefore, enhances sexual satisfaction.  Supplements which increase gaba are taurine, glycine, inositol and gaba itself.  A medical drug called Gabapentin has a similar effect.

SEROTONIN

Serotonin is one of our most powerful neurotransmitters and is responsible for modulating sleep, pain, mood, and gastrointestinal function.[1]  Low serotonin levels can result in negative thinking, a lack of joy and decreased feelings of intimacy.  Serotonin may also play a role in premature ejaculation, a condition which affects 20-30% of men.[2].  The commonly prescribed SSRI drugs, Paxil or Prozac, delay serotonin’s re-uptake into nerve cells and may increase ejaculatory control and delay ejaculation in men with premature ejaculation.[3]  Supplements which are helpful to raise serotonin are tryptophan and 5-hydroxytryptophan which readily cross the blood-brain barrier to exert their effect.  Other supplements that are needed to increase serotonin are magnesium and vitamin B6.


[1] Mohammad-Zadeh LF, Moses L, Gwaltney-Brant SM. Serotonin: a review. J Vet Pharmacol Ther. 2008 Jun;31(3):187-99.

[2] Ali ME, Abdel-Hafez HZ, Mahran AM, et al. Erectile dysfunction in chronic renal failure patients undergoing hemodialysis in Egypt. Int J Impot Res. 2005 Mar;17(2):180-5.

[3] Arafa M, Shamloul R. A randomized study examining the effect of 3 SSRI on premature ejaculation using a validated questionnaire.  Ther Clin Risk Manag. 2007 Aug;3(4):527-31.

Summary

Although a male andropause workup is not yet standard practice amongst primary care physicians, Dr Morgentaler,[1] believes that within 5-10 years, “individuals will know their testosterone levels just like they know their cholesterol and PSA levels today.” [2]  If all men (and their loved ones) were aware of a treatment that not only improved one’s sex drive, mental focus and energy levels but also reduced their risk of the number one killer, heart disease and associated metabolic syndrome, reduced the risk of all age related diseases while also having the potential to increase the quality of one’s life while increasing longevity, it is highly likely that this treatment would be the number one subject on everyone’s lips at the next cocktail party and/or braaivleis!

Furthermore, as a man approaches this phase of his life, it is time to take stock of multiple factors that may be preventing him from living at his maximum potential. This article has focused on only a small percentage of possible factors (hormones and neurotransmitters) that may be preventing him from living at the full capacity of his genetic potential. Other factors are infinite in their scope and include issues such as environmental toxicities, mold and chronic infectious exposures, dental cavitation, and root canal toxicity, nutritional deficiencies, structural imbalances, unresolved emotional conflicts and deep-seated toxic belief systems, family systems that block a healing resolution as well as a lack of a deep relationship to something other than one’s sole ego-based activities.

Our present generation tends to believe that, if something is not feeling quite right, it must be only a physical reason that is causing this sense of malaise. We run to doctors to get a traditional allopathic diagnosis and breathe a huge sigh of relief if there is no definable disease process. We also demand of our doctors that they provide a simple, drug-based solution that is effective almost immediately, does not take any time out of our busy schedules, requires very little effort by us and preferably is at very low cost, lest it interfere with our holiday trip to Majorca or our cosmetic surgery bill.  My answer is, “try showing up one day in your life without your brain or your body. “The fact that health concerns are seldom the number one priority in terms of individual’s value systems is a matter for grave concern in this emergent toxic, nutritionally depleted and stressed world we find ourselves in.

Our bodies and our minds are our greatest assets and must not be taken for granted! Our health and wellness should be guarded on a daily basis with the utmost dedication and the discipline to act wisely in a preventative manner, decades before disease manifests itself. Dr Myron Wentz, owner of the Usana line of nutraceuticals, makes the following profound comment, “Most of us spend our lives working hard to save enough money to enjoy the golden years, only to discover that we are going to have to spend a great deal of money and effort to regain the health we sacrificed in our harried pursuit of material comfort. Many of us think of health care after the fact, as a high-tech cure or series of treatments from a private practitioner or government agency, funded by insurance. We seldom view it as an individual responsibility.” [3]

In order to move away from this adolescent fantasy of someone else who is going to “fix us”, we have to become part of the solution. We all need to raise health as a dominant value in our lives, or at least define our highest values (it may be running a business or a large family) and link our health practices to this value. We need to ask ourselves, “how by staying fit and healthy  and working within a wellness, preventative model of health care, will I be even more effective at what I love to do?”

Every day we should devote time, energy, and money to the preservation of our greatest assets, our minds, and our bodies, and develop a heath team to assist us in this process. After all, the best way to avoid disease is to maintain health, not to get a disease and then treat it. Ask yourself “where do I fit on the health/illness continuum?” Are you experiencing a high level of wellness with education, discipline, regular assessments, and functional medicine[4] (not disease based) lab testing, or are you in the illness mode, experiencing signs, symptoms, and continued disabilities? It is my suggestion that if this is the case, that you act immediately as you may be heading down a slippery slope towards full blown illness, or at worst, a premature death.


[1] Morgentaler A. Testosterone for Life  McGraw Hill, 2008

[2] Goep J. Testosterone therapy for Life. Life Extension June 2010 pg 86

[3] Wentz M. “Invisible Miracles”. Rosarito Beach, Baja California:Medicis, S.C.;2002

[4] Functional Medicine looks at optimizing biochemical pathways so that maximum efficiency is attained in key systems i.e. liver detoxification, food sensitivities and gut health, immune balance and inflammation, nutrition, neurotransmitter and hormonal harmonization, structural alignment and mind/body health. This is not standard allopathic practice.

Moustache drawing

Are High Oxalate Levels Harming Your Health?

Are High Oxalate Levels Harming Your Health?

You’re encouraged to eat a healthy diet, so you make sure you get your seven-a-day portions of goodness, often blending vegetables and fruits into a green juice drink. Yet despite all your healthy eating, you continue to feel diffuse pain, are fatigued, and generally spaced out. Or maybe you experience other symptoms, such as terrible aching in your joints, painful bladder conditions, or feel as if you’re always suffering from some variety of gum disease. Perhaps you’ve been given a mysterious diagnosis of fibromyalgia, a meaningless name that’s used to describe people who have muscles that hurt, or have sleep and fatigue issues, along with other symptoms resulting from diffuse inflammation of undetermined origin.

Unfortunately, a high vegetable or specific carbohydrate diet, while frequently touted as being healthy, may be making your chronic condition worse. Certain vegetables and fruits contain oxalates, which are naturally occurring compounds that comprise part of their natural defense system. Oxalates are believed to create bitter tastes that prevent them from being eaten by animals in the wild. Oxalates are found in large quantities in a plant’s roots and leaves, the part of the plant that’s essential for it to survive. For many people, a plant-based, vegetarian type, high-oxalate diet isn’t a cause for concern, but it can seriously exacerbate kidney stones, digestive issues, mineral absorption, and diffuse unexplained symptoms for those that experience oxalate sensitivity. We also produce small amounts of oxalates ourselves within our cell’s mitochondria, as part of the Krebs cycle. Some individuals with genetic polymorphisms will produce larger amounts of oxalates endogenously that the body is unable to clear, which result in subsequent health issues.

However, it is possible to break free from the effects of oxalate on the body, be tested for high oxalate levels, and treat the condition with the correct diet and with supplements.

What is oxalate?

Oxalate is a fascinating compound that your body commonly absorbs as a result of the consumption of plant-based food. Oxalate is a very simple compound that comprises two carbon and four oxygen atoms, along with two negative charges that seek out positively charged molecules, such as minerals, that are necessary for metabolism. Oxalate prefers calcium to other minerals but also searches for and binds other toxic metals and minerals, (the list appears below). Certain plants create oxalate as a tool to store calcium deposits. This is similar to how vertebrates use bone to store and sequester calcium that can be used later. Oxalates also create insoluble crystals that absorb light, which is essential for photosynthesis. These crystals can be the source of severe pain, acting almost like tiny razor blades or shards of glass on susceptible tissue like mucosal membranes. Oxalates even deter animals from grazing on their leaves, creating pain and toxicity when the animals eat these in large quantities.

Your body also creates oxalate when breaking down vitamin C. In this case, oxalate is a toxic end product that needs to be removed from your body as waste. Humans are unable to digest oxalate, so if your health is optimal, it’s processed from your body via the gut. Specifically, your gut microbiome digests the oxalates. The ‘good’ bacteria in your gut produce enzymes, which work to disintegrate oxalate. The remaining waste products are then removed from the body within your stool. 

When fat maldigestion occurs due to lowered bile production, our dietary fats aren’t emulsified and broken up, resulting in these fats binding to dietary minerals that are excreted in the stool, along with the fats. When this process occurs, the uptake of dietary oxalates by our gut is significantly increased.

Oxalate can also act as an antinutrient as it binds to trace minerals and nutrients, preventing your body from absorbing the mineral. 

Oxalate can bind to: 

  • Calcium
  • Magnesium
  • Manganese
  • Zinc
  • Aluminum
  • Cobalt
  • Mercury

High oxalate levels in the body can thus lead to malnutrition, but they’re also the leading culprits behind the formation of kidney stones, as oxalate prefers to bind to calcium. In fact, 80 percent of all kidney stones are caused by calcium oxalate. Your body can only flush out the calcium oxalate, not destroy it, so your gut acts as an extrarenal pathway to transfer this into your kidneys then into your urine. Unfortunately, as these crystals build up in the kidneys or bladder, they bind together, creating painful kidney stones that are difficult to pass. However, only about one percent of people with high levels of oxalates will go on to develop calcium oxalate kidney stones. In some cases, these oxalate crystals are extremely small, almost nanoparticle in size, binding to sulfate receptors in your body and undetected by normal medical imaging techniques. Connective tissue, fascia, and joints are very high in sulfate receptors and therefore the oxalates can bind to these tissues, causing joint or soft tissue tendon or muscle pain.

You may think that the easiest way to solve this issue would be to stop eating food that contains calcium. Unfortunately, reducing your calcium intake is unlikely to ‘fix’ the kidney stones or prevent your body from holding on to oxalate. Eating sufficient calcium creates the insoluble form of calcium oxalate, which is passed through your bowel and bladder. If your body doesn’t receive enough calcium, the oxalate becomes soluble and is then easily passed into the bloodstream. This means the oxalate circulates through your body, which is unable to remove it all.

If you have a gastrointestinal condition, such as leaky gut, inflammatory bowel disease (IBS), or Crohn’s disease, you may also be unknowingly dealing with high levels of oxalate. While kidney stones are a severe indicator of excess oxalate, there are other, and often more insidious, symptoms to watch for.

What do high oxalate symptoms look like?

Oxalate sensitivity or high levels of oxalate in the body don’t always manifest similarly between patients. If you have an oxalate issue, it may develop in a part of the body you least suspect, particularly if you also struggle with intestinal permeability or what’s commonly known as leaky gut. This is a disorder in which your intestinal barrier is altered, resulting in your gut wall becoming unable to adequately filter the gut’s contents. Harmful particles slip through the wall and into your bloodstream. If oxalate slips through, this can lead to consequences in the rest of your body.

High oxalate symptoms may include:

There may also be symptoms commonly associated with urinary tract infections or UTI, including pain during urination, pelvic pain, and the need to urinate frequently. Symptoms related to multiple sclerosis may also occur, including fatigue, pain, numbness and tingling, brain fog, and muscle weakness.

Some of these symptoms may have been misdiagnosed at some point along your health journey, as oxalate levels aren’t usually examined during routine tests. However, it’s clear that oxalate sensitivity can have a severe impact on your health and the way you live your life.

What health conditions are associated with high oxalate levels?

1. Oxalate arthritis. With this condition crystals collect inside the synovial fluid of knee, hip, wrist, and shoulder joints. Normally, this fluid keeps your joints lubricated while acting as a shock absorber, protecting your cartilage from wear and tear and filtering nutrients into the joint. A build-up of oxalate results in swelling, joint pain, and lack of movement of the joint.

2. Vulvodynia/interstitial cystitis and benign prostatic hypertrophy (BPH). Both these conditions cause chronic pain in the vulva, which can be unbearable for female patients that are afflicted. Vulvodynia is a misunderstood disease, which was linked to oxalate by the late Dr. Clive C. Solomons. He identified that high levels of oxalate can irritate the epithelium of the vulva and cause pain if there was prior trauma in the area. Oxalate aggravates a pre-existing condition, but also irritates the glycosaminoglycan layer in the bladder.

3. Cystic fibrosis. In cases of cystic fibrosis(CF), high levels of calcium oxalate in the urine of patients with the condition indicate a fat malabsorption issue within the gut. In patients with CF, oxalate is unable to bind with calcium. Instead, the oxalate binds with sodium and other minerals and is able to travel around the body via the bloodstream.

4. COPD. Oxalate has been found in the bronchoalveolar lavage fluid and breath of patients with chronic obstructive pulmonary disease (COPD). This indicates that a build-up of oxalate around the lungs can trigger inflammation in the surrounding tissues, with resultant pulmonary fibrosis.

5. Fibromyalgia. As oxalate can travel throughout the body through the bloodstream, it seems highly likely that the extreme aches and pains experienced by fibromyalgia patients may be due to high concentrations of oxalate. In the United Kingdom, Dr. Clare Morrison improved her fibromyalgia by means of a low-oxalate diet and encourages fibromyalgia patients to follow her example.

6. Hashimotos thyroiditis. This is a common cause of hypothyroidism. The symptoms of thyroid disorders can be exacerbated by an inflammatory response to the build-up of oxalate crystals in the thyroid. Hashimoto’s thyroiditis has been associated with high oxalates.

7. ADD. Many children with attention deficit disorder (ADD) require a higher supplement of magnesium in order to reduce their condition’s symptoms. High levels of oxalate can impede magnesium absorption, so there may be a link between extreme ADD behavior and oxalates.

8. Autistic spectrum disorders. Studies have indicated that children with autistic spectrum disorders have high levels of oxalates in their urine. Reduction in oxalate intake through changes in diet can often improve autistic symptoms.

9. Inflammatory bowel disease. The role played by oxalates in the gut also needs to be considered. There’s a connection between the health of the digestive system and where and how oxalate travels around and out of the body. High oxalate levels have also been linked with several gastrointestinal conditions, including  Crohn’s disease and inflammatory bowel disease, and intestinal permeability or leaky gut, which leads to greatly increased levels of absorbed oxalates.

10. Antibiotics. High levels of antibiotic use can also lead to imbalanced gut microbiome, with resulting oxalate issues. When your gut microbiome isn’t functioning at full capacity,oxalobacter formigenes is unable to metabolize oxalate, causing a build-up of crystals. This can often occur after taking a course of antibiotics, which can kill off your ‘good’ bacteria. Probiotics are often recommended as a defense against recurring kidney stones.

11. Intestinal permeability. In the case of leaky gut, when your intestinal permeability is damaged, your gut wall is unable to be as discerning as it once was, resulting in larger molecules, food debris, and toxins entering the bloodstream. Oxalate is also able to slip through the gaps in the gut lining, bypassing important safeguards and becoming more mobile throughout your body.

12. Mold toxicity. Mold toxicity or chronic inflammatory response syndrome (CIRS) is covered in my essay here. Aspergillus mold species will produce oxalates during their fermentation process. In fact, if I discover high levels of oxalates in a patient’s urine samples, I always look for mold species first and then treat mold as an initial step.

13. Anemia. Oxalates can bind to iron and subsequently lead to chronic anemia. The most common cause of unexplained anemia in women is the loss of menstrual blood due to heavy periods, but high oxalates may be something else to consider regarding unexplained iron or ferritin deficiency with anemia, low hemoglobin, or low hematocrit. If patients begin excreting oxalates bound to iron, they may discover that their urine is rust-colored due to the iron/oxalate deposits. 

14. Mitochondrial disorders and chronic fatigue syndrome. In these conditions, oxalates can destroy mitochondrial membranes and lead to vitamin B1 and antioxidant deficiencies.

15. Eye conditions. Cataracts, styes, and blepharitis are all eye conditions that may also be linked to oxalates.

16. Heavy metals. These are similarly associated with oxalates, as high levels may act as a binder, holding on to metals such as mercury. 

17. Other conditions. A variety of medical conditions in the literature associated with high oxalate levels include diverticulitis, breast cancer, sarcoidosis, osteopenia, osteoporosis, vertigo, endometriosis, and uterine fibroids. 

Resources

https://www.ncbi.nlm.nih.gov/pubmed/27002809

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300851/

https://www.ncbi.nlm.nih.gov/pubmed/28624518

https://www.ncbi.nlm.nih.gov/pubmed/24384768

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192488/

https://www.greatplainslaboratory.com/articles-1/2015/11/13/the-green-smoothie-health-fad-this-road-to-health-hell-is-paved-with-toxic-oxalate-crystals

https://www.ncbi.nlm.nih.gov/pubmed/18264917

https://www.ncbi.nlm.nih.gov/pubmed/18060273

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710657/

https://www.ncbi.nlm.nih.gov/pubmed/1816400

https://www.ncbi.nlm.nih.gov/pubmed/9322615

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2589049/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2589049/pdf/yjbm00034-0005.pdf

https://www.ncbi.nlm.nih.gov/pubmed/17526194

http://www.pulsetoday.co.uk/views/off-duty/could-a-low-oxalate-diet-reduce-the-symptoms-of-fibromyalgia/14635294.article

https://www.ncbi.nlm.nih.gov/pubmed/2435146

https://www.ncbi.nlm.nih.gov/pubmed/21911305

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396938/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300857/

Podcast: Practicing the Medical Arts

Practicing the Medical Arts

Full Transcript

Yoshino:

Hey everyone, welcome back to Artist Decoded. This is your host, Yoshino. And, this is yet another Mind/Wave episode. These episodes have been transforming over the course of time, but mainly my intention for these episodes is that I want to explore various modes of thinking. And, I want to hopefully give people an access point to create positive mental health routines. I’m a firm believer in conscious decision-making and in creating a solid foundation for self-reflection, self-care, and self-growth. Creating good habits in all aspects of life is extremely important, which takes a conscious effort to do so. I personally work out about 12 times per week, so that’s twice a day with one day off. I lift weights in the morning and do calisthenics in the morning, and do my cardiovascular activities such as walking, running, and cycling before sunset. I also know from personal experience that good habits, both physically and mentally, have to be developed slowly and over time.

This can be holistically compared to creating a solid foundation for a career in the arts, or just simply having an artistic practice because not everyone necessarily needs to have a career in the arts. But either way, this takes a conscious, consistent, and concerted effort to continue your craft. Which can be likened to anything in life, including developing positive mental health practices, which leads me to my guest for today, Dr. Bruce Hoffman, who is the founder of the Hoffman Centre for Integrative and Functional Medicine.

So let me tell you a bit about Dr. Hoffman. Dr. Bruce Hoffman did not choose the medical arts as a vocation. Originally, he wanted to be a writer and poet. His interest in health and healing developed later in life after a long and winding road of self-discovery, life experience and learning. He only applied to medical school so he could complete a residency in psychiatry and subsequently study Jungian analysis to understand the human condition and behavior. As life would have it, his destiny took him on a different journey. He never did formally pursue a psychiatry residency or Jungian analytic training, but his love for art, poetry, and psychology remains.

Dr. Hoffman was born and educated in South Africa and obtained his medical degree from the University of Cape Town. After two years of compulsory military training, his distaste for the local regime convinced him to immigrate to Canada in 1986, where he pursued family medical practice in rural Saskatchewan, Canada. Once ensconced in the practice of family medicine, he quickly realized that his interests in medicine were broader than just drugs and surgery. The allopathic medical practice was limited to treating symptoms and illnesses, but failed short in restoring the patient’s health entirely. Bruce embarked on a journey to understand what constitutes the human experience. What are the triggers and mediators that perpetuate human suffering? He wanted to assist his patients not only to be free of disease, but to realize their maximum potential.

Well, I hope you all enjoy this podcast episode. There’s a lot of rich information here, so stay tuned for that. But before we begin, please go to our iTunes page, leave us a review. It helps reviewers just like yourself to hear about the podcast. We’re also now on YouTube. There are a lot of new videos and content from past episodes up there. So, check us out over there and be sure to tune into our no wave cinema conversations on Clubhouse. The next conversation will be with me and Justin Dasher Hopkins. We’ll be talking about the classic 1964 Hiroshi Tasha Guevara film, Woman and the Dunes. We will be having this conversation on Wednesday, April 7th at 6:00 PM Pacific Standard Time. So definitely go check it out and listen to us over there. Maybe even contribute to the conversation as well. So anyways, without further ado, here’s my conversation with Dr. Bruce Hoffman. Hope you enjoy it.

Dr. Hoffman, thank you so much for taking the time to do this. And the main reason why I want to bring you on is to talk about good mental health practices and as Maslow would put it to hopefully reach self-actualization. And I think it’s really important for people in general, to be honest with themselves about every single aspect in their life, to live a holistic practice. And I was wondering if you can speak about your early pursuits for wanting to become a writer and poet and how that eventually led you down a path of studying traditional medicine.

Dr. Bruce Hoffman:

Sure. I was brought up in apartheid, South Africa. And initially in quite a conservative traditional home. But at a young age, when my parents got divorced at around age 10, my mother drifted off into more creative endeavors and found herself hanging out with Keith Anderson, who was a head of a circus, also an artist, a set designer with the opera company and the director of the opera company. And so, I found myself hanging out with Keith and his group of merry pranksters, if you will, because they were circus people, artists, creatives, and opera participants. And I found myself as a trapeze artist in a circus that traveled around South Africa, hanging out with these rather unique individuals, clowns, dwarfs, transvestites, just a crazy band of merry pranksters, which at a young age in conservative South Africa was completely unheard of.

So, I was exposed to alternative lifestyles from a young age. But then when my father got wind of this, he sent me off to an all-male boarding school, a thousand miles from home. And when I got to this all-male boarding school, they took one look at me and said; Hoffman, we’re going to knock you back into shape. So, then I was forced into this narrow, masculine boarding school mentality, and I was horrified it was like the worst thing that ever happened. But the school was an outward-bound school based on the boarding school that Prince Charles went to Gordonstoun and Prince Phillip went to. Just based on those same principles, go out into the mountains and find yourself. But after a couple of years of being at a boarding school, I had a school teacher by the name of Roger Loveday. And Roger was a devotee of a guru called Ramana Maharshi. He exposed me to the teachings from India and particularly the subset of Hinduism called  Advaita or non-dual Vedanta. And also at the same time, I got exposed to the writings of Jung; Memories, Dreams, and Reflections- his autobiography had a huge impact on me. And what ended up happening was I had a satori experience.

One day, Roger was speaking to me outside the school, outside the classroom, after he’d given a big dissertation on the bible and Christianity. After I was very cynically inclined at that time. I said to him; Roger, you don’t believe in all of those myths, do you? And he said to me, “of course I do”. And in that moment when he said, of course I do, I had a sudden awakening. I went into the state called non-dual state or satori. And, that’s where all space-time sort of, linear time disappears and you see behind the curtain, so to speak. You see the appearance of reality through the quantum lens, which is, there’s no time, there’s no future, there’s no danger, there’s no fear of death. Everything just dissolves into this oneness and where everything’s light. Which is well-documented in all the literature, many people have had these experiences. But that then set the stage for further exploration of these principles and these studies. I just continued to be inspired by the fact that there was a reality behind the reality that the rest of the world was operating on.

And then my mother applied for me to go to medical school, unbeknownst to me. Why, because she had a friend who had a friend who could get a scholarship for medical school, for somebody from the particular part of the country that I came from. So, she applied and I was actually up in Johannesburg building sets, scenery for a play with Keith Anderson and his group. I got a phone call and my mother said; Oh, by the way, you got into medical school. And I said, what? What’s medicine, I’m go to do what? She said, no, you got to go study medicine. I said, are you out of your mind? I want to go and study literature. Anyway, I ended up going to med school and not knowing what I was doing there. It is quite a peculiar experience. But while I was in medical school, I happened to go and stay on a remote farm up on the mountain. And there were a group of people around that area who were very influenced by the beat poets, Kerouac,  Ginsberg, et cetera. And I started to read them with great sort of joy. And, and then I ended up in my second year of med school, going to San Francisco and started to hang out with Gregory Corso and a lot of the other beat poets. And that was another inspiration for me.

I just got involved in creative endeavors, integrating Jung and Eastern thoughts and philosophies, and then finished my medical training, ended up in rural Saskatchewan as a family practitioner and really loved being a doctor, when I actually discovered what being a doctor was, because I had no clue. But then after a period of a year or two, I realize that this whole N2D2, name of disease, name of drug method of practicing was ridiculous. Even though it serves a function. And then I came across the writings and the videotapes of a medical writer and thinker called Larry Dossey. Larry Dossey had explored the interface between Eastern philosophies and Western medicine. I’ve written quite extensively about it. And, I watched his video and I was like completely moved. I realized that; Hey, I can bring back everything I learned in my youth that I thought I had to leave behind forever into the integration of this kind of medical practice. I flew down, met Larry Dossey, at a conference, had dinner with him. Very inspired, and then started off with that. To eat, discover, and study anything I could across the whole spectrum of medicine. Healing and the healing arts, including anything that could help an individual live at their maximum potential.

People enter into the medical office. I’m sitting in my medical office. I’ve just seen patients this morning and they come in with symptoms of depression, mold illness, Lyme disease, mast cell activation syndrome, a whole host of chronic fatigue or whatever. Then you start to work with a bigger lens are really entry points into a much greater dialogue and a much greater roadmap that you need to bring to the table in order to assist the person through this transformation of illness to wellness. People think they have a disease in which they label, and they think that’s where it begins and ends. But in the system I use and the method I’ve employed, and I’m proud to say that some of the success I have is that I employ a much larger roadmap. It was a much larger set of tools and hence have written about this new curriculum that’s necessary in order to interface with complex patients who can’t just be mechanistically reduced to a diagnosis. It’s actually absurd when you start to think of it. We’re just not trained to think with a different paradigm. We’re very mechanistic in our thought process, but there’s a lot more mystery that goes on into diagnostics and treatment.

What happened after that was that I started to study Chinese medicine, Ayurvedic medicine, homeopathy and German biological medicine, and the the sub-disciplines. And, happened to spend number of years with Deepak Chopra and David Simon. And when I discovered Ayurvedic medicine, they had an explanation of the different layers and levels of what they consider to be human reality, which is stepped down from soul to spirit, to mind, to emotion, to energy, to physicality, to outer world, out there, the expanded universe.

And I started to use that diagnostic model to think of human behavior and illness. And now I’ve incorporated that and expanded that and happened to also, at the time, meet up with a German doctor who’s still alive and still very active, Dietrich Klinghardt. He had also thought of these things and integrated some of these systems into his roadmap. And then I just expanded the roadmap. And now I use the Seven Levels of Diagnosis and Treatment TM across all layers and levels. And when a person enters my room, I use western diagnosis and their symptomatology as an entry point into a much wider dialogue and a much wider diagnostic and therapeutic potential roadmap. So that’s how I work nowadays.

Yoshino:

In terms of just like a, I want to say like a global scale, but I guess, you know, some of the pitfalls for allopathic medicine and the way that it’s practiced in a Western context, like what are some of the things that you’ve observed that needs to change within that context? And how do you think that you implement it in your particular practice?

Dr. Bruce Hoffman:

Well, being a trained western MD, I have the fortunate privilege of being able to look at disease through that lens. And the pitfalls are that the Western diagnosis implies that an organ system gets diseased, then you must find a pharmacology or a therapy or a surgical treatment for that. That is often the case, as we know. Sometimes when you got pneumonia, you want to get intravenous antibiotics, nothing wrong with that. But now we have a whole new paradigm upon us of complex multi-system multi-symptom disease presentations. And that model, that DSM- 10 classification of organ systems and pharmacological interventions is hopelessly inadequate to address those complexities. And it’s quite uncanny really when you start to work with complex patients as to how often western medicine gets it entirely wrong. And it’s only because their tool bag is so limited, it’s this perception that human beings are these mechanistic beings that, a little biochemical particles, that disease just falls out of the sky. And then you got to find a drug to kind of turn down the symptom.

Yoshino:

Do you think that that’s more of a systemic issue or what do you think the actual issue there is?

Dr. Bruce Hoffman:

Well, we think of human beings as being physical bodies, mechanistic bodies. So, it’s the paradigm, it’s the lens through which human beings are observed. That becomes a limiting factor. And we think diseases just fall out of the sky. There’s no antecedents, mediators, and triggers over the inflammatory disease process that is constellated. And we now know generationally, people exhibit, as you spoken with Mark Wolynn, people can come and present with disease processes that the initial triggers have been three generations before they were even born. And that epigenetic transfer of data is real. It’s studied at all the major universities. So that isn’t taken into account in the mechanistic model and the drug-based model. 5 minutes, 10 minutes, what diagnosis, what symptom cluster, what drug, boom. And in America is even worse because your insurance companies control what goes through the gates. And it’s ridiculous. I mean, it’s silly. It’s not how it works.

Yoshino:

Yeah. I think in America, it’s more capitalized, but that’s just part of the whole system. So pharmacologically, it could be traced from that. And also like the way that the educational system is structured as well.

Dr. Bruce Hoffman:

Yeah. It’s a disease-based model, it’s a mechanistic model. And the only therapeutic input that’s of any use is pharmacologically based, and the gateway to that is controlled by the drug industry and the drug lobbyists. It’s very bizarre how it’s all got set up. It’s very peculiar really. Because it’s not real. The human body is the final resting place of every incoming influence. And every top-down influence. The hidden and the obvious. And the body is the final kind of resting place of an individual for all of those influences. And if you don’t start looking at the toxicological logical input of a very diseased planet, the genetics of the individual, which can either detoxify or not that process. And then the influences of the energy body, because we basically, our DNA emits light, which then stands as a standing wave around us, either coherent or incoherently and is highly affected by electromagnetic fields. If you don’t take those things into account, and then the emotional influences we bring up from early childhood, we know from all the literature that children that have been either suffered from abuse trauma, or neglect trauma. Neglect trauma being often more damaging than abuse trauma. They have an infinite amount of increased disease processes later on in life. So, the environmental body, the physical body, the structural body, dentistry, chiropractic, if you don’t take all of those moving parts into play.

Like today, this morning, I saw a woman with a headache, but she had a bite misalignment. She had an overbite, with TMJ issues, had root canals, implants, and had a swollen back of the throat, which we call a Mallampati grade four with sleep apnea. I’m not trained about dentistry as a medical practitioner. I wouldn’t even look in the mouth as a doctor, but its obvious that her dentistry was playing a huge role in her headache presentation. I would just find a drug to treat the headache if I’m using my western practice.

So, the structural piece, then the energetic piece, and then the emotional piece, and then the ego development of the individual. The first half of life, ego structure, which takes us out into the world to become something that drives the first half of life. If we don’t know the internal dialogue of that person, the defenses they develop in order to stay safe, the thoughts that they have, the beliefs that they carry, the value systems, the hierarchy of values that they have. If you sitting in front of a patient and you don’t know their hierarchy of values, you can’t treat them because if their health is a fourth on their value system and running their businesses is the first on their value system, guess what? You have chaos in your low value systems, and you have order, you run your business well, but you’re going to delegate your health to your wife. And you’re not going to show up for all that’s required for you to transform your life. So, if you don’t know the hierarchy of values of people, you can’t really effectively relate to them where they are. Because they will come in and say, they want to feel better. But when you examine their hierarchy of values, it’s fourth on their value list. And unless they raise it, they’re not going to achieve any ends.

Yoshino:

Yeah. I think that’s really important to bring up because, even in that ICI presentation that you were giving, you were talking about how traditional allopathic approaches not taking into account different states of consciousness. And, you know, you could speak obviously more about this than I can, but I’m curious, how would you diagnose someone that doesn’t really take their health into consideration, but is more focused on maybe their business and work and value that as like something that is more important?

Dr. Bruce Hoffman

Oh, I take a history and I have a questionnaire. One of my set of questions, in my 70-page questionnaire, is determining your hierarchy of values. And I ask the question; how do you spend your time, your money, your attention, what you talk about, what you’re surrounded by? And if somebody says, well, I get up at six in the morning, I go to work. I talk business all day. I come home along the cell phone, I’m doing business deals and I’m surrounded by financial books and I watch business TV. It’s pretty obvious where their hierarchy of values is. Well, you got to “rob Peter to pay Paul”. If you want to get your hypertension under control, and  your diabetes under control, how much time are you going to devote to exercise, diet, meditation, sleep, et cetera? And they go, I’ll do my best. I’ll do my best, usually means not much.

Unless you’re inspired to have health as a high value, you have to be motivated from the outside, not inspired from the inside. Motivation lasts six weeks and then you give up, you can’t sustain somebody else’s value system to motivate you if it’s not inside of you.

Yoshino:

Yeah. It’s kind of like that traditional saying, you can lead the horse to water, but ask to take a sip. Maybe sometimes a much bigger sip. So going back to non-duality and speaking of…

Dr. Bruce Hoffman:

Hey, can I just say something? Sorry Yoshino, can I just say something quick just before we leave that subject. Mahatma Gandhi said that the problem with Western medicine is it works. You know, he said that. If you’ve got heartburn, you take a PPI, you take Pepcid, it goes away, nothing to do with what you ate before, how much you drank, blah, blah, blah. So people just take a whole bunch of suppressing drugs and they get on with their life, which is fine. But if you want, if you value health and wellbeing, you want to do a lot to get where you want to be. There’s this whole new group of younger people who are called bio-hackers, who make it their life’s work to study all that it takes to sustain a healthy cell membrane and a healthy internal milieu of the mitochondria. And a brain functioning and sexuality and libido, and they just devote the whole life to enhancing that. And that’s a full-time job. So, there’s is a gradation of what you can expect from a patient from just take a few supplements, to really devote your life, to turning your life around from a health perspective.

Yoshino:

But going back to the non-duality approach, how do you at the Hoffman Centre integrate that into the practice of educating people that are your patients, and then also integrating those more nuanced approaches with allopathic approaches and Western medicine?

Dr. Bruce Hoffman:

Well, the non-duality concept can’t be taught as you know, it’s either happens or it doesn’t happen. You either wake up to non-duality or you don’t. And it’s one of those strange events that other people experience or don’t experience. That’s when you start to see reality from behind, you see it with what they call One Mind. There’s no dual mind, there’s no you and me. We are just part of the same consciousness. Everything is consciousness, and that can’t be taught. Many gurus have set for decades on their stools, talking about the fact that the very thing you seek is preventing you from finding it. So, the very seeking prevents it, it just happens. But that’s a non-dual, that’s Level Seven in my model. But then there’s the other levels which I integrate in my model of assisting people achieve maximum potential within the realms of the dual life. The non-dual part is it can’t be imparted. It happens or not.

Yoshino:

Can you break down your seven-step method, essentially? I’m curious what exactly is in each part of the system.

Dr. Bruce Hoffman:

So, the Ayurvedic or Vedantic breakdown of human reality is we arise from Brahman. The one mind, the unified field, which we call spirit. You won’t be able to see this and I’m not going to attempt, but I sort of broken it down like this. Spirit, soul, intellect, emotion, electromagnetic, physical, extended (bodies). And on each of those stages, each of those layers of an individual’s reality, there’s definitely experiences, anatomical, designations, sciences related, diagnostics and therapeutics. So that’s the system I use. If you look at my website, I believe there’s a chart there, or that ISEAI lecture. That’s a system I practically use in order to assist people and get better. But they all enter through the physical, they come with a diagnosis and their symptomatology. And then I look at all the environmental influences, the biochemical imbalances, the genetics, the structure, the brain, I do, I have a brain treatment center. So, we’re always looking at brain function. And the electromagnetic, heart rate variability, et cetera. And I take a history of early developmental trauma. And then I look at ego structures and defenses and if need be, I send them for psychometric assessments. And then for the soul piece, for the family soul, I use a genogram and do Mark Wolynn’ s work or Bert Hellinger’s work, family constellation work. And for the individual soul, do dreamwork and Jungian type approaches.

So at each layer, there’s different ways of perceiving and experiencing human reality. And so, in a two-hour consult, you’re doing your best to sort of take as much in as you can to get to know that person and where the major blocks are. So even if they come in with Lyme disease, sometimes it’s a question of inherited family trauma, that’s really running the show. Or sometimes it’s due to a traumatic brain injury and they need brainwork. Sometimes it’s all layers, all levels. So having done this for a long time I sort of getting get better and better making the diagnostic and therapeutic recommendations.

Yoshino:

Can you talk a bit about your success stories with this process? I like to understand that a bit.

Dr. Bruce Hoffman

Well, all cases in the end sort of blur into one. But you know, there’s endless amount of patients that present with, say a diagnosis of Lyme disease or mast cell activation syndrome, who believe that that’s the only reason why they are sick. But when they start to explore all the other potential diagnostic possibilities, they all of a sudden realize that that was truly a teleological entry point into a much larger dialogue with themselves. And then they start to explore the whole of their lives and they start to make the necessary adjustments. I’ve got case histories in my upcoming book. I can’t pull one right now because this sort of endless variety of different presentations that I see on a daily basis. I mean, it’s just one little thing today. I saw somebody just very recently who was in her thirties, failed marriage, young child, no direction in life, presents with depression.

Her diagnosis is depression, on antidepressants. And could I help her with her depression and poor self-esteem. Upon further inquiry I found out that she’s moving back home with her parents at the age of 38. And she was very ashamed by all of that. At 38, I don’t know what I’m doing. I’m going back home. What a tragedy. And the man she just divorced, was castigating her for being hopeless, no good, et cetera, et cetera. But when you take a deep inquiry, you see that this soul has had interrupted bonds with her mother at a young age. Mother was separated from her for six weeks. She had a very poor diet. When she went to her mother in teens with developing puberty, her mother was offline, and didn’t see her. She never felt seen. And then she had the series of events, sexual abuse, medication and drug abuse, and then never really found her calling.

So, subsequently turns out that going home to mother and father at age 38 was an opportunity to actually reconnect and heal the interrupted bonds that she’d never been seen in heard for in the first half of her life. So instead of being castigated and feeling so ashamed, she now sees this as an opportunity to reconnect with her mother and father in a truly humble way where the parents, carry the greater weight, and she’s the child. And she can go back and start to integrate her life with her mother’s life and her grandmother’s life, both of whom were artists. She was a makeup artist, but always thought that her makeup career had nothing to do with art. But when it was reframed that she was disconnected from the feminine lineage and her makeup artistry was a continuation of that lineage, she all of a sudden blossomed into the realization that she was part of that maternal lineage and she need not be ashamed of it.

And even though she’d put the makeup artistry aside because of her child and she has to take care of the child because the hours were wrong, she realized she could always pick it up again, and she could step into that female lineage. And she did have a calling. She thought she didn’t, all of a sudden, she knew her whole calling was still on that feminine lineage. Her mother had had a transformation and had said to her; “darling, I realize I didn’t see you when you were younger. I apologize for that”. And all of a sudden, she had this entry into this greater feminine lineage that she could not use so she can pass on to her daughter. So, the daughter doesn’t feel as strained and shameful, et cetera, et cetera. So, yes, she’s depressed. She’s depressed because he’s in an existential crisis of not knowing. She was floundering in life, but she had all this opportunity that’s presenting itself. If she just turned the switches and started to see how it was all part of a grand design that was going to help her realign with her life calling. So, it just gets reframed in a new context and all of a sudden, the life force opens back up.

Yoshino:

Yeah. So, can you speak about the neurological significance of reframing, perceived negative events in one’s life and then transforming them into something positive in one’s mind?

Dr. Bruce Hoffman:

Well, the way I was introduced to, it’s a combination of neuro-linguistic programming and Jungian psychotherapy done cognitively, strangely enough, was through the work of a person by the name of John Demartini. And being exposed to his work, I was able to see how the perceptions that we take into life are often not real. And he uses this teaching tool. He says, look, basically in the quantum world it’s all light. Light gets broken down or dumbed down into matter. Matter is both equal positron and electrons, it’s got both sides. Our lower mind, which always seeks pleasure. One side is always excluding the other side. We always looking for dopamine and trying to avoid pain. And he says, the lower mind can see both sides simultaneously, but you can train your mind to see the integration of both sides to any event, if you just train it. It’s a cognitive restructuring of your mental processes. So, I learned how to do that. I learnt his methodology of how to re-perceive reality through non-dual, if you will, both sides, eyes. So, any event in the future, which looks disastrous, you start asking yourself, where is the upside to this so-called disastrous event? Anything you judge very negatively, like if you judge somebody with very negative trait, you’ll find out where you have the trait, how that trait serves, how that person’s negative trait is benefiting you. It’s not just something that should be a thorn in your side. And how, when you being challenged by a so-called person, who’s is sort of challenging you, where are you being supported? The universe is constantly in this flux of support and challenge, positrons and electrons, which is the basic nature of the quantum reality.

If you can train your higher mind to collapse the world into its opposites, as quickly as possible, you can stay poised in what John calls love. And love to him is just a synthesis of all opposites, where you see both sides simultaneously. And there’s no judgment or no lowering yourself into black and white unipolar perception. So, I try and assist patients like “you going home to mom, this is the most terrible thing at 38, but what is the soul wanting of you? “What is being asked of you? And once I took a history after, she came in saying that this is a horrible thing. She felt so ashamed. She left, she couldn’t wait to go home to see her mother to reconnect because it was reframed. She just saw how it had served her soul’s experience. It was necessary to go home, to receive the love of the mother in a new light, because she had had interrupted bonds all her life with mother. Her mother was ready. She had to be ready. She had to shift the perception from negative, to not positive, but just as opposite. As soon as reframed, boom, I’m going home. Thank God.

Yoshino:

No. Yeah, definitely. I mean, that’s a beautiful story, but I think, especially in the metaphorical sense, you know, when you think of a situation such as a purgatory situation, you can even think about it in certain ways, in a biblical context or in many different stories of purgatory. But we sometimes put ourselves in that purgatory by not seeing the positive association that could be taken out of that negative or what we perceive, quote, unquote, “as that negative lesson of the past”. And if there was something negative that happened the past, if I could say, Oh, that actually helped build my character for who I am today. And then constantly frame it in that context, you can find those lessons. But all those lessons are always there screaming at you to essentially, show themselves in a way that can benefit you. This is at least from my observations.

Dr. Bruce Hoffman:

Yeah. I have the firm belief that every experience that you have, whether it’s positive or negative is serving the projection, the evolution of your life experience. You sort of born over here; you die over there. The acorn does become the oak tree. The acorn needs the wind, the sun, the stresses and support of the environment to become who it’s meant to be. And, I’ve no doubt in my existence, your voids, the things you find most missing, the things you judge the most negatively actually become your highest values. In the end, you look back and I have the unfortunate and fortunate privilege of being in my second half of life. So, when you’re more soul based than ego-based not that you, without ego, not saying that, but you’re more trying to integrate the parts of you that you left behind in your pursuit and the drives of the first half of life when you’re driven. Adler drives, Freud’s drives, that you’re driven to become something in the first half of life.

And then in the second half of life, you try and pick up the pieces of the parts you left behind. And you try and reintegrate your authentic, innate self. And, in that process, you realize everything that ever happened to you was in service of your soul. There was never a mistake. You never were out of purpose for your soul’s trajectory. Nothing ever occurred to you that wasn’t in service of yourself. You have no regrets. And there’s nothing to forgive because everything was in service. Forgiveness is a ridiculous concept because it’s implying that, that one was given to you was wrong. And now you must forgive them. No, everything’s in service. Thank you for giving me that experience. Forgiveness implies I’m bigger than you. What you did to me, you were wrong, I’m right. And now I’m going to forgive you. How dare you, you know. Say, yes, thank you for giving me that experience. It’s always in service of our soul.

Yoshino:

So, speaking specifically about that forgiveness and you speak so passionately about it, but you know, if someone is suffering from some sort of shame or guilt, what sort of questions would you prompt to them to be able to have them question that shame and guilt and where that comes from. I’m curious about that.

Dr. Bruce Hoffman:

So, guilt is the perception, that in the past you’ve done something that’s caused others more pain than pleasure. So, the only question you need to ask is where do you think that experience that you gave that individual, where did it serve them? How did they perhaps benefit from that experience? Could you please look in the seven areas of their life? We have spiritual, which is our calling. We have relationships, social friends, we have health and beauty. We have careers, we have making money. And we have intellectual, mental development. If you feel guilty by some act you’ve done, it’s incumbent upon you to ask; where do you think that person benefited in those areas of their life that served their evolution? Keeping in mind that everything serves, everything is in evolution of the soul’s progression. So where might it have served them? Not where did it damage them? We know that there’s both sides. Yes, it was maybe painful to them, but how did it serve their evolution in the end? And if you ask those questions, which of the seven areas did they benefit, you could find? Some people because of pain, you’ve caused them, branch out and start to develop. They read, they go to courses, they connect with their family because they sort of destitute and in pain that they have to reach out to whoever they can. So, they start forming relationships back with strange family members. They form new friendships. They go online, they go to self-help, they go to retreats. They build careers around the adversity that you caused them. So, at the end of the day, you’ve got to ask the right questions of individuals.

Nobody suffers without gaining. If it doesn’t exist, the universe is not one sided. It doesn’t work that way. Which brings into question the whole victim mentality of “I’m a victim”. No, I’m not, this can provoke a whole outlandish backlash that victims will be up in arms but if you look through the lens of moral and ethics, yes, there’s victims and perpetrators. I’m not questioning that. But if you look through the eyes of the soul, there’s a balance there that’s evolutionary. And, if you look through the right lens, you can see an evolutionary projection. It’s just how I tend to see the world.

Yoshino:

No, that’s great. And I think that it’s interesting because of your background in more traditional western forms of medicine. And also, how you combined the western perspectives and also these eastern perspectives. Or what would be deemed as western and eastern. And, you’re able to eloquently, within practice, like what you do at the Hoffman Centre within practice, to be able to mold these things. And even on your bio, you said writing and poetry, which led you to the medical arts. I think that’s very important because that is what you do. Cause you’re essentially utilizing all of your experiences, your own personal pursuits, such as your pursuit of literature and poetry. And letting that inform you in a way to ask the right questions of your patients. But at the same time to ask the right questions of yourself.

Dr. Bruce Hoffman:

It’s so important Yoshino that you know to stay in an inquiring mode, a student mode. And once you have the privilege of having lived longer is you start to see patterns and trends. You’ll see an individual present with anxiety and OCD and anorexia and so forth and so on, and like a young woman in her thirties. And then you’ll see this archetypal trend that exists that she’s addicted to perfection. And she’s following the value system of a patriarchy, which is inculcated. And she’s introjected somebody else’s value system, like an overbearing father and wants it to achieve. And you see these archetypal trends emerging in your practice. And that’s based on reading, is based on literature, is based on knowing. In the ancient Greek temples, once you’ve gone through, this is in my lecture, the outer healing and the inner healing, you are then sent out into the theater where you watch Greek tragedies, which were archetypal or depictions of life. And you see these trends occurring. You see these people in certain stages. If you don’t know the stage of life the person’s in. Your first half of life patients, very different from second half of life patients. They’re not the same. They’re different flavor, different. You approach them differently. You got to be sensitive to the stage of life. And if I wouldn’t have known that. If I hadn’t been exposed to all these different paradigms of insights.

Yoshino:

Uh, I’m curious. You were speaking of liking essentially, or interested in Jungian philosophy, but also have you read a lot of Joseph Campbell? I’m sure you have.

Dr. Bruce Hoffman

Well, when I first got interested in Jungian work, Joseph Campbell was very popular. He had that PBS series, I think, in the 90’s…

Yoshino:

Power of Myth. Is that right?

Dr. Bruce Hoffman

I don’t know how old you are, Yoshino. Hahaha

Speaker 5:

No, I’m 34.

Dr. Bruce Hoffman:

You probably were. But, Joseph Campbell did the Power of Myth. It was everywhere on PBS. And we watched that series. I’ve got all the videos. We have all the VHS videos of that. I still have that.

Yoshino:

I know I’ve seen them.

Dr. Bruce Hoffman:

I still got them in my library right there. And I read his books and yes, very moved, very beautiful. He was a big influence.

Yoshino:

No, I was just curious, because you were talking about seeing certain patterns and archetypes.

Dr. Bruce Hoffman:

You do see them; you see them over and over again. It’s quite uncanny when you tune to those archetypes. And, you can see when a person is presenting with symptomatology, when it’s got nothing to do with the western diagnosis. When it’s actually a calling from the soul to wake up to a deeper transformation, that’s being asked of them. And you just get used to knowing how to have that dialogue with people and when to watch out for signs and symptoms. And know that, oh, the Lyme disease is not Lyme disease. It’s the fact that they are misaligned with, they haven’t integrated an aspect of themselves, which is calling to be integrated. They’re still living out the first half of life, dictates, which need to be given up at some stage. You can’t,  a 70 year old man in a Ferrari, that’s diagnostic. It’s just is.

Yoshino:

Yeah. I mean, I’m sure you can see many examples of that from either people that are also in your working profession or there’s so many examples of that. And, just someone having a Ferrari at any point of life, you just have to ask, like, what is the reason for that? You know, and also you can only drive one car at a time. They can’t drive two at a time, at least not from what I understand.

Dr. Bruce Hoffman:

Yeah, there’s all those clues, the history taking is filled with clues. And you just got to be sensitive to them and hopefully tuned in as much as you’re able to. And so that requires a whole new curriculum for the healers of the future. It has to be rewritten. The curriculum must be rewritten. Not to say that MDs must become healers. I disagree. Doctors should stay doctors. Stay with all that. Stay with a mechanized symptom-organ system- method medicine. Be very good at it, be the best at it. And leave them alone. Don’t ask them to become healers. Let’s have a new curriculum for healers. People are called into a different way of interrelating with their patients. And let’s have that curriculum outlined. And let’s co-exist with each other in equal exchange, which doesn’t happen. Doctors have this peculiar arrogance that what they’re not up on, they down on. And so, anything that doesn’t fit into that model, they tend to dismiss, which is unfortunate.

Yoshino:

Makes sense. I mean, it’s essentially breaking up the paradigm that if you believed in this certain way of life being educated by the system. And it creates a certain type of way that you think about the world and your perception of your space in it, essentially.

Dr. Bruce Hoffman:

Absolutely.

Yoshino:

I have one more question for you because I don’t want to take too much of your time and I appreciate you for taking the time to be on the podcast, but what sort of advice do you have for artists and creatives?

Dr. Bruce Hoffman:

Wow. I spoke to you before we got on,  that my great love is art. Now in the last 10 years, I rediscovered this huge passion, interests, and I was deeply moved by art and still to this day. Before I answer the question, I was estranged, I was South African living in Canada, and I felt deeply homesick. But as soon as I started to buy South African art with its imagery and symbology, I could bring it over and have it in Canada, I settled down, I had living symbols of my African heritage with me, and there was no such need to go back home. So, I mean, artists generally are tuned in, at a deeper dimension and they bring forth symbolic messages and are able to translate archetypal stories, like poets. When they tuned in and the higher their skill, both intuitive and skill, the deeper the symbolism, the deeper the impact on that, because we all resonate at some level with archetypal symbolism. It hits us like a break when it’s true. And it speaks to us.

So advice, I’m in awe of artists. I mean, those surrealists’ artists like Leonora Carrington. Oh, my goodness. I mean, what were they bringing forth? And what’s really going on. I’m fascinated. I believe some of their outer lives are maybe quite chaotic, but they sort of balanced it with this inner rock of their own unconscious that just pours through them. So, I think it’s an equal balance between outer neuroses, if you will. Then in a solidity and what a beautiful exchange, what a beautiful gift to humanity.

Yoshino:

Well, I mean that’s a sound observation. It sounds like you have a very deep love for and appreciation for the arts and what the arts can provide for humanity.

Dr. Bruce Hoffman

Yeah. Poetry. I mean, Mary Oliver, The Wild Geese. Oh man. When it speaks, it speaks and you just fall over into ecstasy. It’s so archetypally resonant. It’s just makes life meaningful. Provides meaning. It’s a beauty. Beauty and meaning.

Yoshino:

I agree. I agree.

Dr. Bruce Hoffman:

Have you ever seen that movie? The Great Beauty?

Yoshino:

I haven’t, no. When did that come out?

Dr. Bruce Hoffman:

Oh, it’s by that French (incorrect- Italian) director, Paolo Sorrentino. It’s about a man who gets to be in the 60s and nothing inspires him anymore. And so this whole movie is about him visiting sights and sounds. And is in Rome, all this opulence and decadence and nothing excites him. And he’s just like desperate. Until he realizes that at some stage he was moved by a great beauty. It happened to be in the form of a woman he loved. But all of a sudden, he just wakes up to some things that he’s left far behind. And he wakes up into another phase of his life, realizing how many years he’d lived in this outer world without connecting to his true inspiration. It’s a beautiful movie. Wow.

Yoshino:

You know, what that reminds me of,  have you seen Citizen Kane recently?

Dr. Bruce Hoffman:

You know, I saw it once and I read it. I’d read how perfect a movie it was. And when I watched it, I thought, what are they talking about? But after 10 minutes, I watched each frame and I immediately got the majesty and the marvelous sort of symmetry and exactness of the whole development of that movie. And I’ve got why it’s one of the greatest movies of all time. I just could see it just so obvious actually, you know, Jungian.

Yoshino:

Definitely. Well, I just bring that movie up because what you’re talking about specifically at the end of the film. I don’t think I need to say like spoiler alert because this film came out in, I think 1945 or 43, but at the end of the film he just keeps on saying rosebud. And then you find out what that symbolized to him. And so, I think, he does all these things throughout his life to attain power, to attain wealth, but then this was it, I believe it’s a sled when he was a child carried so much meaning and symbolism to him. And it’s just interesting how there’s that consciousness shift. So it just kind of sounded similar to the film that you were telling me about.

Dr. Bruce Hoffman

Well, now I’m going to watch both movies back-to-back and then keep that in mind to see the connections. Well, we live our lives through symbols and meaning in the end, the outer world is just a playground for meaning and symbol.

Yoshino:

It’s interesting. Just to leave you with this, but yeah. I’ve been meaning to crack open Jung the Book of Symbols. Is that what it’s called? I have it downstairs and I need to spend some time, cracking that open. But anyways, thanks so much for doing this and taking the time. I appreciate you for doing this.

Dr. Bruce Hoffman

Yeah, absolutely lovely. I’m going to look at your podcast and see what else you’ve done. That it is inspired me through your connection to the artists and artistry.

Speaker 2:

Yeah. You might like some of the artists, you know? All right, Bruce. Well, thank you very much. I appreciate it.

Dr. Bruce Hoffman:

Thanks for the talk. I appreciate the talk. Thank you.

The Cell Danger Response: Restoring Cellular Health with Phospholipids and Bioactive Lipids

The Cell Danger Response: Restoring Cellular Health with Phospholipids and Bioactive Lipids

Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine, and today is no exception. I am delighted to be with a very longtime colleague, Dr. Bruce Hoffman. We’ve got an exciting sort of depth conversation planned for you today. Let me actually spell out why it’s going to be a deep conversation just listening to his extensive training will suggest where we’re going.

So Dr. Hoffman is a Calgary, Canada-based integrative and functional medicine doctor. He is the director of the Hoffman Centre for Integrative Medicine, also The Brain Center of Alberta, specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He’s got a master’s in nutrition. He’s a certified functional medicine practitioner through the Institute for Functional Medicine.

He’s board certified with a fellowship in anti-aging and regenerative medicine. He’s trained in the Shoemaker Mold protocol. He’s a certified Ayurvedic practitioner. He’s trained in Bredesen ReCODE brain treatment, in the MAPS autism training. He’s a certified family constellation therapy specialist. He’s trained in ILADS for Lyme and co-infections.

He’s also a contributing author to the recent paper, which is available. In fact, we’ll link to it on our show notes, from Dr. Afrin’s group titled Diagnosis of Mast Cell Activation Syndrome: a Global Consensus-2. So mast cell activation is something that he’s also focused on. I actually also want to bring to your attention more, just kind of the rich depth. I mean, clearly, Bruce, you’re a lifelong learner, but I think you’ve really kind of taken these things in. I just want to give you a little more of his background.

He’s trained in Chinese medicine, and homeopathy, and German biological medicine. You almost went to get board certified in psychiatry. You wanted to be a Jungian analyst. I found that really interesting, Dr. Hoffman, in your history. And so you bring that to your work now with patients. So you did some of that training, even though you didn’t move into psychiatry, but you did some of that training. You worked with Jon Kabat-Zinn, with Deepak Chopra, with Dr. Klinghardt, with Ken Wilber.

I mean, first of all, welcome to New Frontiers.

Dr. Bruce Hoffman: Thank you, Kara.

Dr. Kara Fitzgerald: And what haven’t you done?

Dr. Bruce Hoffman: It sounds like I don’t have a life.

Dr. Kara Fitzgerald: It’s extraordinary, I want to spell it out. I know that you’re just doing this amazing work with your patients, and you’re fusing this intense training that you’ve undergone, and that you continue to experience into what you described as the Seven Stages of Health and Transformation. So it’s not like you do a weekend course and then the books go away, or the PDFs are put away.

I mean, you’re actually working with these tools and making them into something your own. And it’s called the Seven Stages of Health and Transformation. And I know that you’re working with very complex patients in Canada, and actually beyond Canada. I know people are drawn to your work from all over the place. And so, I want you to talk about the seven stages, and what your approach is to these complex patients that are coming to see you.

Dr. Bruce Hoffman: Yeah, sure. When I was a young teenager, I was exposed to a schoolteacher in South Africa who was very different. And he took us out of our sort of South African apartheid, white, privileged background and sort of threw us into … threw me in particular into an alternative universe whereby I was exposed to the world of psychotherapy, psychoanalysis and eastern thought.

And I had, at a very young age, an experience which they call satori, which is this sense of seeing space-time as a continuous whole and not seeing cause and effect as being linear. And it was a sort of … Many people have these. They are sort of called awakening experiences or high experiences. And that just sort of catapulted me into a different way of looking at things, and then initiated in me a curiosity about all aspects of the human psyche and human development and human potential.

And originally, I sort of got interested in Jungian psychoanalysis and wanted to become an analyst and went to med school only to become an analyst. And I was actually accepted into the psychiatric residency, but actually didn’t go through with it. I worked for two years in psychiatry in the military. I had to go to compulsory military training. But I didn’t actually do my residency.

And I do feel quite privileged in the sense that by not taking that particular route, I was able to keep expanding across all layers and levels of experience. And what I found was when I ended up just being a family doctor in rural Saskatchewan, and seeing the limitations of drug-based, which Majid Ali beautifully named it N2D2 medicine, name of disease, name of drug.

Once you start to see the limitations, and then you start to look at the potential of human achievement and what they can aspire to, one sort of moves out of just treating disease to trying to get your patients to look at optimal potential of their entire existence. And so, what I do now through the seven stage model is view pathology, or the so-called disease states or complex symptomatology, as this entry point into a dialogue with a patient.

But I’m also looking at other aspects of the psyche and the experiences to see what it is that their soul, if you will, is asking to come through. What is it that they’re trying to achieve? Symptoms to me are etiological. They’re sort of pointing towards hidden subjects that need to be brought to the surface. I never see symptoms as linear. I always think of them as what is the body attempting to do by throwing out these particular imbalances?

And with that approach, and using my early exposure to Ayurveda and Advaita, which is a system of Hindu philosophy that I was exposed to by the schoolteacher, and I was able to build a model called the Seven Stages of Health and Transformation, which looks at the human experience as being divided, which is a silly term, because there is no division. But it’s conceptually divided into these layers and levels of experience.

The first level being the outer world, the external environment. And that’s sort of level one in this conceptual field. And from that, we draw everything to do with what’s going on in the chemosphere, outside of ourselves, the toxicology and the infectious load. And we look at that from etiological point of view. That’s level one.

Level two is the physical structure, which is made up of biochemistry and structural aspects. And that is what we do in both traditional medicine and in functional medicine, and in all the structural modalities like chiropractic, and bodywork, et cetera. And then level three is to do with the brain, the peripheral, and the autonomic nervous system, and its electrical effects on physiology and biochemistry. And then what are the manmade EMFs effects on that.

And then level four is to do with the emotional body. And as we know, that many people have these adverse childhood experiences, which then get laid down neurologically in the brain as specific defects particularly in right frontal lobe development, and activation of the amygdala, and the fight-flight response with down regulation of the vagal nerve. And because I have this brain treatment center, you can diagnostically look at this and treat it accordingly.

And then level five is to do with ego development, how people negotiate the slings and arrows of this … The world is a tough place. We’re sort of always somewhat vigilant against the next thing that’s going to arise. And so, we develop in the first half of life a very different set of strategies from in the second half of life in terms of how we develop our ego, which is our sense of how we negotiate the world and our belief systems, our values and our defenses.

People grow up with a way of orientating themselves, but they also remain highly defended to those things which are most traumatic. And depending on early childhood experiences, defenses can be highly helpful or healthy, you could say. But they can also be highly pathological when people suppress anything that comes close to an early experience of trauma, and the so-called PTSD response.

So level five is everything to do with the ego and how it negotiates its way in the world. And the first 30 years are all about ego development and they’re characterized by certain drives, drives of the libido, drives of full power, drives to know oneself. And all the great psychoanalysts of the 19th century were very … They had great insight into these mechanisms.

But they’re now used therapeutically in a system called ISTDP, where psychologists look at different structures that people bring to the therapeutic encounter and work one on one with them in transference and countertransference to try and get behind that which they’re defending against and which is asking to be brought forward. So that level is very important.

And then level six is that what we call the soul. This is the most authentic part of who you are, the most instinctual part of who you are, which never really comes to any sort of conscious assertion until the second half of life, I would say. Carl Jung, the great psychoanalyst wouldn’t look at patients before the age of 40. He said they’ve taken up two drives. There’s no conscious awareness of their deepest self to work with. And so he wouldn’t work with anybody under the age of 40, which is rather strange, but it’s true.

Dr. Kara Fitzgerald: It’s very interesting in this anti-aging obsession that we have, isn’t it? I mean, clearly, there’s some wisdom, but keep going.

Dr. Bruce Hoffman: Yeah. So, in our personal, when we’re born and we’re born into our experiences, very often when you’re not seen by your parents adequately, and being seen by parent, you don’t have to be perfectly seen but a good parent who will always support and challenge a child accordingly. But if there’s any neglect or abuse and neglect-trauma appears to be even more traumatic to a child, an abuse trauma.

The child will develop a provisional self, an adaptive self to go out into the world in order to achieve what it’s meant to achieve. But the authentic self, the instinctual self will often go underground and then be hidden by these defenses and this comes up. I can’t tell you how many people present to me in sort of midlife … Midlife being anywhere from 35 to 55. It starts at somewhat of a younger age when entropy starts to set in.

And they are being driven to ask deeper questions of themselves and to reclaim those parts of themselves, which they know instinctively, they left behind in their pursuit of safety and being seen. So their provisional selves go out, achieve something in the outer world, but there’s something crippled and something quite damaged, or well preserved. Some innocence, well preserved, but it’s hidden from sight.

And people in midlife generally kind of know that. And they want to often go back and retrieve those hidden parts of themselves that they know are manifesting as symptoms, but they have no conscious connection with them. So part of the work I do is trying to find out what … I don’t ask this question out loud, but I’m asking it while I’m interfacing with a patient is, what are these symptoms telling me, and what does the soul want?

What is the innate wisdom and innate creativity of this patient that needs to be brought to the forefront? And that’s the fundamental question that sits there while I’m looking at all the functional medicine, toxicology, biochemistry, hormones, mitochondria. I’m always having these conversations in my head, what does the soul want? What is being asked of this person? What do they need to manifest in order to bring parts of themselves back home?

And that is the second half of life quest really, how do you gain your creative, instinctual self. And not only that, but there’s also another hidden part and that’s a hidden part of your family system. Family systems carry secrets and carry hidden entanglements that often manifest themselves epigenetically and get expressed through biochemistry as symptoms.

And I’ve done some marvelous work with, or I haven’t. But I’ve partnered with Mark Wolynn, who is an exceptionally gifted functional family constellation practitioner. And we looked at, once a year, we used to do a workshop where we looked at the symptoms of patients who came to my clinic and try to link them to any inner entanglements or the family system two to three generations before the patient is even born.

And it’s extraordinary what entanglements you find and what dynamics you find, which can manifest as symptomatology in the patient. And this research is very well established now to all the major universities, that there’s an epigenetic chapter of trauma through the generations. And then lastly, is spirit. The level seven is the spiritual body. And that’s the part of ourselves that’s transcendent to any ego-based space-time demands. And that’s where you surrender to some intelligence greater than yourself and just sort of stay open to that potential. And that’s sort of the whole realm of what we call the one mind beyond space-time.

So I use that model. So when patients present, I’m just trying to sense, they come … One of the great tragedies that I find, or one of the great challenges, not tragedies so much as challenges, is that when you become well versed in functional medicine, people will present and they’ll write in their entry forms. You ask them, “Why are you here?” And they’ll say, “Well, I’ve got mast cell,” Lyme or mold, and whatever.

And they will sort of have reduced their entire symptomatology to what they believe to be a lab test or a symptom that they’re experiencing. And it’s never the case. It’s never the case. Those are just inquiries as an entry points into a much deeper dialogue, in my experience. And so, I’m always curious. Yes, you may have a trigger called Lyme or a trigger mold and mast cells have gone awry. Yes, that’s true.

But really, what’s the deeper reality that we need to sort of work with? And sometimes I get to it, and sometimes I don’t. Sometimes I just treat mast cell, and Lyme, and mold and be done with it. But other times, not. Yeah, sorry?

Dr. Kara Fitzgerald: I mean, what an extraordinary entry into our conversation, thanks for all of that. I mean, it’s amazing. And I can just tell that you are sitting with all of these levels. And I think that, in functional medicine, they talk about gathering before the patient encounter.

Dr. Bruce Hoffman: Yes, that’s right.

Dr. Kara Fitzgerald: And I can hear that you’re gathering at all of those levels, which creates a possibility in the encounter. It’s been extraordinary. So is this written? Have you written about this? Have you-

Dr. Bruce Hoffman: Yeah, I’ve written. I’ve got podcasts with transcripts, and I’ve written a book, which unfortunately, sits on my laptop.

Dr. Kara Fitzgerald: You can link to it on our show notes then. I’m kidding. But it’s powerful. And, well, we’ll bug you about it so that we can link to what you’ve got available in our show notes. It’s an expansion on functional medicine principles in a very important way. So that was one question. And then the other thought that I was having and you started to touch on is, so the presentation, this phenotypic presentation of mast cell activation, or Lyme, and it’s true that our patients will come to us with pretty rigid ideas on this, and what it means.

And as you said, either you move beyond it or you don’t, and you address it and life goes on. But you alluded to in the beginning of your unpacking the seven stages, you alluded to sort of these as having information in and of themselves, like what kind of a … Is there kind of a personality type or somebody who comes with a certain type of a family constellation structure that might be more vulnerable to Lyme and co-infection or might be more vulnerable to autism or MCAS? And can you speak to that?

Dr. Bruce Hoffman: Well, the interplay is complex as you know, from genetics to diet, to sleep, to rest, to toxicology. And to ever increasingly, obviously, to early developmental experiences. I can’t emphasize how profound those experiences play on auto-expression of biochemistry. It’s unbelievable.

Dr. Kara Fitzgerald: I want to just say as an aside that I am with you on that. I mean, we’ve just published a study in looking at DNA methylation, so looking at the epigenome. And one of the things that’s just stopped me in my tracks is this idea of biological embedding, which is exactly what you’re talking about, where the signatures of the psychic experience are laid down on the genome.

Dr. Bruce Hoffman: It’s quite extraordinary. And if people come and they see me, say for mast cell, and then they find themselves doing acute EEG, and the NeuroQuant MRI, and doing neuropsych questionnaires and they go, “Why are you doing all this? I’ve got mast cell.” Well, mast cell is the expression of your, mitochondria undergo the cell danger response. They released ATP, ATP caused the granulation of the mast cell, and the release of a thousand mediators.

So yes, you had mast cell activation syndrome, but what’s underlying, what are all the triggers in functional medicine, the antecedents, mediators and triggers that provoked this mast cell to go crazy? The brain is the interface between one’s epigenetic and early developmental experiences, and one’s outer experiences. The brain is the interface, and if you look at acute EEG, and even a NeuroQuant MRI, you can read biographies of those. They’re so alarmingly informative.

And so, I look at a body-based stress assessment. I look at heart rate variability, as we all do. But then I look at acute EEG, and I look at this sort of juxtaposition of the delta-theta-beta-alpha brainwaves, and you can really see imprints of early developmental trauma. And you can see people who are stuck in fight/flight responses, people who stuck in Porges’ polyvagal, dorsal vagal responses.

You can see it right there in the biochemistry and the physiology. And you know that that person, say, who’s stuck in Porges’ dorsal vagal shutdown response, that’s a whole different patient and somebody who just got a few allergies. You’re dealing with a whole different kettle of fish there. And you can’t just jump right in and just do your normal functional medicine and try a few supplements … It’s a whole another experience, which you have to be sensitized as a practitioner to those layers and levels of complexity. And I use these tools to interpret it.

If you look at it and do a NeuroQuant MRI, you can see the amygdala hypertrophy at like 97 percentile. It’s like twice the size of the standard, the paired match group. You can see amygdala hypertrophy. You can see the thalamus hypertrophy, and the thalamus is rich in mast cells. You can see white matter being decreased, and so forth and so on. You can see all sorts of fingerprints of these complex triggers that can create symptomatology in these complex patients.

Dr. Kara Fitzgerald: Absolutely. It’s just extraordinary. So somebody comes in a typical allergy, seasonal allergy, maybe they’re bad, and so you’ll just treat them accordingly and get them balanced, but it’s relatively straightforward. But you’ve got somebody else also coming in and sneezy, allergic, et cetera, et cetera, but you diagnose this amygdala imbalance. I mean, you go down this whole different direction. Just roughly describe your entry into treatment with these two, with similar phenotypic but very different underlying causes.

Dr. Bruce Hoffman: Well, first of all, I don’t see patients anymore with just simple allergies. I wish I did. But those, I would just treat with H1 or H2 blockers, and Quercetin and vitamin C like all of us know how to do. But people with complex illness who have these multiple layers and levels of imbalances, I throw quite a large diagnostic net. I mean, I do a lot of tests. I’m criticized for it because of costs. But I also know myself well enough to know that without it, I’m going to be just another practitioner along the long chain of practitioners who took a little swipe at something and didn’t get much done, and didn’t look at the complex interface of all the different parameters.

So I do throw a large diagnostic net and do ask for the tests we know so well. Food sensitivities, gut microbiome, histamine levels, zonulin, DAO. I do all the mast cell mediator markers. I do all the ION panels and things like levels in methylation. I do all of that. I look at toxicology.

But I also do quite a lot with the brain, heart rate variability, autonomic nervous system functioning, and often refer for psychometric assessment to look for psychiatric diagnosis, whether they’d be cluster B personality disorders or whether they’d just be mood disorders. So I refer out for those. And I gather all this data. I also refer a lot to dentists and chiropractors particularly NUCCA chiropractors, visceral manipulation therapists.

We do a lot of diagnostics and trying to gather an insight into what hierarchically will be the entry point into this person’s therapeutic experience. I left out the most important, which is I look, apart from food and gut, which of course trumps most things. We look at the mitochondrial functioning and we look at the fatty acids because as you know, the mitochondria, the canaries in the coal mine, and they’re the first thing to sense any danger whether the danger is perceived or real, chemical or imagined.

And we have this credible capacity now through the IGL test in Germany to look at mitochondrial functioning and through BodyBio or the Kennedy Krieger fatty acid test to look at fatty acids. And those are the two tools that have trumped everything else in my practice.

Dr. Kara Fitzgerald: Wow, what is that? Tell me just briefly what the IGL is and then we can link to the … And the Kennedy Krieger and we’ll link to both.

Dr. Bruce Hoffman: So before this test came along, we in functional medicine would look at mitochondrial dysfunction, all we really had was a cheek swab. We had the organic acid test, but now we’ve got this ability to look into about 300 lab parameters that tell us the following: A, mitochondrial numbers, if they’re normal or if they are low in number. And mitochondrion, as you know, when they’re low in number, they must be undergoing some form of autophagy or cell death which ties into Naviaux’s cell danger response theory, that when we’re under threat, perceived or real, mitochondria start to self-destruct and release their ATP extracellularly, that then sends off a whole inflammatory cascade that oxidizes lipid peroxide, cell membranes and leads to this innate immune activation, mast cell activation, et cetera, et cetera.

Dr. Kara Fitzgerald: What’s the specimen? What’s the specimen for that test, sorry?

Dr. Bruce Hoffman: Blood. It’s a blood test.

Dr. Kara Fitzgerald: Both are blood tests, okay.

Dr. Bruce Hoffman: Yeah. So, it goes off and then they measure ATP production. They measure percentage of ATP that’s blocked. They measure cell free DNA. I mean, DNA that’s outside the cell shouldn’t be there.

Dr. Kara Fitzgerald: Where it shouldn’t be here.

Dr. Bruce Hoffman: They look at DNA adducts, toxins sitting on the DNA interfering with protein expression, interfering with the DNA expression of all the factors that go to make up messenger RNA and enzymes, et cetera, et cetera. It looks at phospholipid production. Phospholipids, phosphatidylcholine genome, most potent of all the cellular membrane ingredients.

It measures phosphatidylethanolamine, the phospholipid on the inner membrane which transfers electrons and the electron transport chain. It looks at outer phosphatidylcholine. It looks at cardiolipin synthase enzymes to see if they are making cardiolipin which is part of the inner membrane. It looks at whether you have what your amount of cardiolipin is so you’re looking at your phospholipids content.

It also looks at mold markers, markers for fungal metabolites. It looks at microtoxin metabolites. It looks at superoxide dismutase level. It looks at occupation of cell membranes. It looks at glutathione peroxidase, glutathione transferase. It looks at cell membrane voltage, incredibly helpful. When you’re looking at membrane voltage below 170 millivolts, it’s like 150.

And you’re looking at intracellular calcium excess or magnesium-potassium deficiencies. It looks at methylthionine levels. It’s incredible insight into toxicology and mitochondrial homeostasis. And from that, combined with the Kennedy Krieger fatty acid panel, which looks at your polyunsaturated omega 3, omega 6 levels, and it looks at renegade in very long chain fats and it looks to see if you’re myelinating adequately, et cetera, et cetera.

You can really transform a person’s biochemistry into something that ships them from this so-called cell-doubt, cell-danger response into a healthy response. And it takes an average four to six months of hard-work. But if you address the mental, the mind-body, the defense, the psyche and the biochemistry and toxicology in a hierarchical manner, and sometimes you got to stop biochemical work and you got to go work psychologically or even spiritually sometimes.

But if you start working with complex patients in this way, you’ll very soon know when to stop by a chemical work and to work at another level. If you’re sitting behind a desk and the patient is in front of you, and you’ve done beautiful biochemical work and you know that your work is impeccable and the patient is still sick, you know you’ve addressed the wrong level and it’s time to look at another level.

Dr. Kara Fitzgerald: I would imagine that you’re not … I mean, you said hierarchical, and I think that is true. But you’re doing it concurrently as well. I mean, you must be.

Dr. Bruce Hoffman: You always are. You always do it concurrently, but you learn to sense when it’s time to address, say, amygdala overactivity and vagal nerve shutdown as opposed to doing intravenous lipids and butyrate. Sometimes you’re doing all these beautiful biochemical interventions repeating the nutrition, food, gut and hormones and the patient stays resistant and/or hyperreactive.

And then you know they got an overactive amygdala and/or underactive vagal nerve. And so, you’ve got to shift focus and go down a different path. And just having done this for a long time, I’m sure you have experiences. You get to know when you probably are working at the wrong level.

Dr. Kara Fitzgerald: Yes, it does. This is such a simple thing, but in my residency, we don’t do IV therapy in my clinic here in Connecticut. We mostly do telemedicine these days. But in my residency, back when you and I used to talk, that was also in a clinic setting as well. And just that IV experience, I thought about it because I know you’re doing IV. We set up the environment to bring the energy down and so, even for those individuals who don’t want to hear it, that there’s a psychological component to their presentation.

There’s sort of backdoor ways to enter into that healing relationship or that healing, meeting the needs for healing in that space even when patients don’t want it.

Dr. Bruce Hoffman: It’s such a dance that goes on in this complex relationship between the so-called healer and the one who’s coming for your help. That if you’re not cognizant of the complexities that may arise, one can attempt to impose therapeutics onto a patient when the psyche is not intending to cooperate. It has no intent to allow that vulnerability.

And if you don’t know sort of the trauma of that person, the defenses, the fragility, the resistances, you can often rarely get into a difficult therapeutic encounter. And so it behooves us as healers, whatever the word may be, to stay very conscious of our own projections and our own inabilities and our own blind spots when we’re interfacing with patients.

And yes, they may have amygdala upregulation. They may be fragile and highly resistant. But does that mean that we get rid of them and say, I can’t help you anymore? Does that mean that we have to dig deeper into our consciousness to try and meet them where they are. And if we can unlock the door that’s previously been not open to them, we can assist in unlocking that door, there’s an incredible flood of therapeutic material and healing material that gets unleashed.

So I don’t like to do neuro biofeedback and amygdala training. If the psyche of that patient isn’t receptive to it, so it-

Dr. Kara Fitzgerald: Absolutely.

Dr. Bruce Hoffman: … a lot of conversation and a lot of negotiation sometimes around some of these issues. And people can remain hyper reactive and highly fragile and resistant. And that behooves us to just stay with that patient if we can until something shifts in the psyche and so often it does. Often it does.

Dr. Kara Fitzgerald: Yes, that been my experience as well that when they don’t achieve what they came to me to achieve or they get through some but not all, then perhaps they are open to a broader inquiry. I want to just ask, so I want to talk about, I want to get to your interventions. I know people will be very interested in how you’re addressing some of the mitochondrial issues that you’re seeing. But I just wanted to ask in your time and practice …

I mean, your practice now is self-selecting for challenging cases because you’ve been doing this for a long time and you’re just recognized as an expert, but are you also seeing sort of uptick in these kind of complex patient presentations?

Dr. Bruce Hoffman: It’s all I see now and sometimes, I wish it wasn’t.

Dr. Kara Fitzgerald: Right, I want to go back to insulin resistance case there.

Dr. Bruce Hoffman: Hormone replacement therapy, sure. But I am excited by the challenge. As you know, there’s no rest. I’m in my 60s and I don’t think I’ve studied more now. I mean, when I was a young medical student, that is nothing. This is boot camp all over again. You better stay ahead of all the research and all the latest series and all the latest issues that come across us.

But yes, am I seeing more complex cases? Absolutely.

Dr. Kara Fitzgerald: And there’s a change though, would you just say there’s sort of a change in the challenge of cases? I mean again, just going back to when you and I talked a lot, SIBO might be a challenging case. But those days seem …

Dr. Bruce Hoffman: SIBO is like one of 24 things that need to be looked at. As we’ve expanded our diagnostic possibilities and as new researchers have come up, Afrin and his mast cell activation syndrome along with the other writers and the other researchers, that’s thrown a huge level of insight into a certain presentation that we didn’t have 10 years ago. So, we have that and Naviaux’s mitochondrial cell danger response, unbelievable what that’s done to our consciousness as practitioners.

It just opened up … Now, before when we did functional medicine training, we learned about food, gut, hormones and nutrition. But now, that’s a subset within a subset of complexity. And that stuff, we have to know backwards, otherwise, we can’t get to anywhere. But what else do you bring to the table? And now, we’ve got to bring in all these other things, all these other factors into the healing relationship.

And it is far more complex. There are a lot more sicker people. And they are still looking for N2D2 solution. Even the ones who are educated, they will come and say, “I’ve got mold, Lyme, as I said in the beginning, and can you treat it?” I say, “Sure. But is that what you really have, or is that just what’s showing up as a presenting feature?” People come with false positive antibodies on Lyme test, and they say, “I got Lyme.” “Oh, it’s three on the Armin Lyme EliSpot. Is that really Lyme disease? Is that a false positive?”

And so you got to know all these subtleties. You got to constantly be in touch with the researchers and the lab directors and you got to listen to all the experts in our fields. You got to shine the light of the single aspect. And you got to know how to incorporate that clinically in patient because patients are smart now. They come with all their research.

Dr. Kara Fitzgerald: Yeah, they are.

Dr. Bruce Hoffman: And they know stuff and sometimes, it’s misguided. Sometimes, it’s spot on and they intuitively can often sort of guide a path that is previously hidden from you. They were often uncovered and helped shine a light down a certain pathway. People are smart.

Dr. Kara Fitzgerald: I want to talk a little bit about your approach. I mean we could look at mast cell activation or I mean, the mitochondria. The conversation I think is pretty provocative and one that’s interesting. I mean, are there core biochemical imbalances that you’re looking for?

Dr. Bruce Hoffman: Absolutely, yeah.

Dr. Kara Fitzgerald: Can you just talk about some of these? Let’s pull together somebody with mitochondrial dysfunction, like I want to just kind of pull together how you’re going to address it and maybe what you’re looking for in laboratory and other tools of evidence and then how you’re actually addressing it clinically?

Dr. Bruce Hoffman: Yeah. When people present their history, two, three-hour history, you do your biochemical workup. Take a very extensive dietary history. Usually get dental workup, get sleep studies, NeuroQuant MRIs, brain studies, et cetera. And once you have those in front of you, what do you do first of all? The first thing I do is always look, I use my traditional medical insight and I look at straightforward pathology.

Free T3 is low and the TSH is high, B12 is low. I’d look at straight biochemistry and I never bypass it. I pay very close attention to traditional medicine’s biochemical imbalances, and look at nutrition in great detail. And it behooves us now with all these complex illnesses to know all those approaches to nutrition that are out there whether it’d be GAPS or paleo autoimmune low histamine, et cetera, et cetera.

So, I look at traditional biochemistry. I look at nutrition and then I use nutritionist chef health coach, Justine Stenger, on our staff to take a dietary history and start to introduce a dietary approach which is commensurate with their presentation. And most of the time, it’s a paleo autoimmune low histamine diet, sometimes low FODMAPs, sometimes low oxalate. But generally, I find getting people off some of those major foods that are inflammatory and getting onto paleo autoimmune low histamine diet quietens the microbiome to an extent that we can begin to repair.

So, traditional biochemistry, nutrition, dietary approaches and then start to look at all the things that most functional medicine doctors look at. The food sensitivities, status of a gut, nutritional levels, macro and micronutrients, antioxidants, toxicology, heavy metals, chemicals, mold, fungi, mast cell activation in great detail, and look at hormone levels.

And I look at hormones in three distinct compartments. I don’t just look blood levels. I look at blood, saliva and urine all on the same day to look at the different compartments of how hormones are attached to transport proteins, how they show up at the cell surface and how they get metabolized through the methylation pathways. I’ll look at all three to start with.

And then I look at infectious agents, and I tend to do quite extensive infectious disease workups, both B cell and T cell assessments. I find if you just do T cell, do ELISpots, it’s not enough. And if you don’t do B cell, you often get very confused and go down the wrong pathways.

Dr. Kara Fitzgerald: What tests are you using? Tell me what tests are you using?

Dr. Bruce Hoffman: I’m using the ArminLabs. I do the ELISpot, and I use IGeneX. I do the IGeneX ImmunoBlots and I do the co-infection panels. I use Galaxy labs for the Bartonella. And I do also use MDL labs for some of the other infections, Garth Nicholson’s lab. Those labs are usually used to look at infectious load. And then, so once I had that diagnostic roadmap, and then therapeutically as I said, I’d correct any traditional metabolic imbalances, thyroid, hormone, whatever.

Dr. Kara Fitzgerald: So, you’ll start … So, you’ve got diet. And then you’re going to start them on some thyroid if they need it, some magnesium, some B12, et cetera. So, you’ll do those foundational first step?

Dr. Bruce Hoffman: Yes. And often if there’s great dysregulation in the qEEGs and/or in the stress assessments, and/or in the MoCA cognitive assessment or the CNS vital signs or TOVA, I’ll often start them in neurobiofeedback. I’ll start them on biofeedback programs and start them on neuromodulation techniques using different devices that we use from traditional feedback to Vielight to photomodulation. We’ll use different techniques.

So I often start those concurrent with food and traditional interventions whether it’d be hormones or nutrition. And if the toxic burden is extremely high, I never go ahead and start to detoxify them day one. And I never treat infections in the beginning. Even though Naviaux is very clear that unless you get rid of the threat, you’re not going to change the cell danger response.

So, I usually start out by using oral and intravenous lipid therapy or membrane therapy to try and provoke a mitochondria backing to more of a healing response. And I found that profoundly influential and help in patient outcomes.

Dr. Kara Fitzgerald: What is that?

Dr. Bruce Hoffman: I do a power drink or a membrane stabilizing shake, if you will, where we put into a blender phosphatidylcholine from BodyBio. BodyBio is the only phospholipid I use because of its very high phosphatidylcholine content, which doesn’t break down in the gut. And it contains the phosphatidylethanolamine. It contains all the subfractionations of phospholipids.

So, I use BodyBio phospholipids and BodyBio balanced oils, usually the 6:3 ratio and 4:1 ratio. You put that in the shake along with minerals and electrolytes and then any other ingredient that has shown up in the test that could be instrumental at restoring some homeostatic imbalance. So for instance, if they have low aminos on the ION panel, we use amino acids. If they have low glutathione, we use liquid glutathione as well as oral glutathione as well as oral NAC, all the standard things we learn as functional medicine doctors.

We put in tons of Resveratrol if we can. People tolerate it. And we use usually half a cup or quarter cup of blueberries. We found most people don’t seem to react adversely to blueberries. And then learning from Dr. Kharrazian, we chop up … On a Sunday, I advise patients to go and get every vegetable they like provided it’s not histaminic or oxalates or something on their testing shows they shouldn’t. Organic, chop it up, put it into the freezer. Every day in your shake, you take a couple of tablespoons or half a cup and you put that into the shake with the phospholipids.

And then that becomes a liposomal polyphenolic compound that then crosses the blood brain barrier and exhibits this antioxidant effect intracellularly. So, that’s been a gamechanger for my practice along with intravenous therapies. I start with very, very low dose phospholipids, sometimes vitamins and minerals just to provide the micronutrients for the enzyme systems, sometimes with intravenous amino acids.

But generally, I move over slowly but surely into phosphatidylcholine and glutathione intravenously, not to provoke a massive detoxification response but to try and repair cell membranes. Cell membrane repair is better done with oral phosphatidylcholine, but the IV phosphatidylcholine conjointly with the oral not only helps the cell membrane repair but it also starts to gently sweep adducts off the toxins that are sitting on the DNA of the mitochondria.

But it’s not aggressive. It’s very gentle. Later on, we start to use butyrate and other short-chain fatty acids to further the removal of adducts in toxins.

Dr. Kara Fitzgerald: How are you introducing those?

Dr. Bruce Hoffman: Intravenously and orally. I use them quite a lot. I use oral butyrate and IV butyrate quite a lot.

Dr. Kara Fitzgerald: What’s the oral butyrate? I mean, it’s kind of smelly, but in a capsule like in an enteric-coated capsule? What do you-

Dr. Bruce Hoffman: You can get different kinds. There’s the cal-mag butyrate. There’s the sodium butyrate. There’s sodium potassium butyrate. So, you got to look at the electrolyte balance of the patient and then introduce the specific butyrate formulation that is going to be most helpful for that person’s biochemistry.

So, if they’ve got intracellular calcium deficiency, you’re going to use the calcium one. If they have POTS syndrome … By the way, that’s one of the greatest. One thing I learned 10, 15 years ago was to make sure every patient does the 10-minute, cheap, lying standing test. If you misdiagnosed POTS, that patient is never going to get better.

And I know you’re familiar with it but I do suggest that any young or new practitioner, just get yourself an Omron blood pressure cuff. Every patient that comes in your door, lie them down, do their blood pressure and their pulse after they’ve laid down for a minute or two. Stand them up one minute, three minutes, five minutes, 10 minutes, look at their blood pressure and pulse and look for drops in systolic blood pressures and look at rises in pulse rates.

And those patients don’t perfuse the mitochondria or the brain and they won’t improve until you get increased perfusion to their cellular structures into their brains. They just won’t. You have to treat that first.

Dr. Kara Fitzgerald: And are you addressing it with this protocol?

Dr. Bruce Hoffman: I address that with the standard POTS approaches with increased fluids with salt, a lot of salt, two to three teaspoons of salt. Salt sticks compression stockings and I liberally use Florinef and Midodrin and other medications. And it’s a gamechanger. It’s absolutely a gamechanger in certain patients.

And many people are misdiagnosed. There’s a combination of sort of different … You can get orthostatic hypertension. You can get postural orthostatic tachycardia syndrome, and you can just get pure tachycardias. And they’re different and if I need to differentiate, I send them to cardiologists.

And we have one particular one in our city who does tilt table testing. He’s written lots of papers, very experienced. And so we refer to him to sort of introduce further medications if need be. And patients always know about the triad of dysautonomia and mast cell and gastric motility issues. Many patients present with mast cell activation, POTS, and Ehlers-Danlos syndrome with dysautonomias and gastric motility issues. And they’re called triad or pentad patients as per Afrin’s group.

Dr. Kara Fitzgerald: Why are we seeing more of these people?

Dr. Bruce Hoffman: I think the stresses imposed upon our modern society are overwhelming our defenses. We just become extremely vulnerable to this incoming toxic load. We’re not genetically resilient enough to withstand this onslaught, whether it’d be electromagnetic fields or chemicals or foods. Even the fact that we could open the fridge five times a day, eat what we want, I mean that’s a stressor on our system, it’s unbelievable.

We’ve got out of sync with our innate biorhythms and there’s been a huge movement in the functional medicine community through biodiversity and regenerative agriculture. And we’re paying lip service to this need, but I don’t know. I think our DNA and I think microbiomes will eventually adjust to these incoming onslaughts. I don’t think we’ll be extinguished. It always appears that stresses on the system create greater resilience down the line and barring a sort of huge six apocalypse. I think we will become more resilient as we sort of evolve through this toxic phase that we’re going through.

But right now, I think we’re very vulnerable and we are under a lot of stress, under a lot of toxic load.

Dr. Kara Fitzgerald: Well, we’re kind of heading towards the end of the podcast. This is to clinicians, and so this is going to create a lot of interests in your approach to care. I guess I have two questions. One is, where do people learn more about this model that you’re working from? This sounds so powerful, and I certainly appreciate you’re casting a very wide net and people are coming to you because of that and so forth.

But as you described such a careful start to the journey … By the way, we’re going to try to piece together that shake recipe. That was so awesome. We’ll put it on the show notes, people. It’s just the most sophisticated shake yet, so I want to see if we can pull that together and put something on the show notes.

But I mean you must be seeing some pretty good outcome just after this evaluation and you’re pushing the ship from the shore. I mean you must be seeing some good change. And if not, I’m sure you’re just really going back to rethinking.

Dr. Bruce Hoffman: I don’t have a research assistant in my office, so it’s hard to know outcomes. One believes that one’s practice is achieving remarkable outcomes, but I think unless you have a statistician in there, a hardcore research, we’ll never really know. But what I’ve noticed … By the way, a lecture I did is on my website. I lectured to the ICI Conference and it’s on my website. We are doing one and a half hour synopsis of the seven stages.

Dr. Kara Fitzgerald: Okay, perfect.

Dr. Bruce Hoffman: I think it’s the most insightful sort of snapshot of the levels and layers and complexity that’s possible. So, the outcomes we have from what I can tell, because one never really knows the drop-off rate. I don’t think it’s very large. When patients present with complex illness and you do your due diligence and you throw the net far and wide and the patients can keep up with it, and many patients can because they’re so educated and so driven, they’re so sick and tired of seeing hundreds of people and not getting any better.

And you’re looking at your data and you’re looking at mitochondrial function and fatty acids function and ION panels and things and you do repeat them from time to time. It has been my experience that within six months on average, on average, the test itself reverts from highly problematic to restored function, the IGL test. You will see mitochondrial numbers go from low to normal. You will see phosphatidylcholine go from extremely low to normal. You will see glutathione levels come back. You will see microbial toxins disappear. You will see mercury, lead, cadmium, glyphosate levels disappear.

But concurrent with that, the patient will tell you, “I feel completely different.” And we keep objective, we do different score systems. But I use the old MSQ from IFM. And patient’s levels drop from 180 to 20 once you start working from the mitochondria outwards into the whole complexity of the mind-body and familial inherited system. If you start using a broad map and you just don’t run down too many rabbit holes, and you keep your head above you and you just work it through. And if you hit the blank wall, you just ask more questions. You don’t give up.

Somewhere along in that experience, the patients, they feel better, their symptoms improve and they move through that cell danger 1, 2, 3, into the cell danger 3 response, the healing response. And they feel amazing. We have a large amount of patients who do experience that once they’d gone through their process, but we always preface it with, “Look, this is only as successful as the amount of effort you put in. If you stay passive, there’s nothing we can do. You have to be a cooperative partner in this experience. If you have side effects, you don’t throw baby out with the bathwater. You come to the table. We find out what happened, and you work through this process. And if you can’t, you get yourself somebody, an advocate, who can help you.”

In that sort of dynamic and with the staff, the great staff I have and the support systems and the ability to rerun lab tests from time to time, I would hazard a guess that the majority of our patients get better, the majority. I wish I had the statistic to tell you, but I don’t.

Dr. Kara Fitzgerald: Maybe now is the time to get a PhD student in your practice. It would be really nice to gather. I know you’ve been at this for a long time. It’d be nice to maybe get some data.

Dr. Bruce Hoffman: I think I should, yeah.

Dr. Kara Fitzgerald: Yeah, get a student, that good PhD work. Well, Dr. Hoffman. It was just really lovely to connect with you and talk about this. Folks, we will gather as much as we can for the show notes and link over to the site to some of the content that he’s referencing. And if you think of anything else, just let us know. Thanks for joining me today, for this really nice dive into what you’re doing.

Dr. Bruce Hoffman: Thanks, Kara, and nice to speak to you again after all these years.

Dr. Kara Fitzgerald: Right, absolutely. And hopefully, I’ll see you in person at AIC, not this year but next year.

Dr. Bruce Hoffman: Yeah, maybe, who knows? I quite enjoyed this sort of remote telemedicine, teleconference …

Dr. Kara Fitzgerald:  Thank you kindly, for your time. Much appreciated.

The podcast was originally posted on Dr. Kara Fitzgerald’s website here.

How Does Time Restricted Eating and Intermittent Fasting Work? Part II

How Does Time Restricted Eating and Intermittent Fasting Work? Part II

Intermittent fasting or IF is a practice involving alternating fasting time and/or calorie restriction with periods of feeding that has proven cellular benefits, metabolic gains and remission or reversal for a variety of symptoms and disease states. Time restricted eating is compressing an eating window to a specific number of hours each day. An example of this would be eating all the day’s food within a 6–8-hour window. 

With the prevalence of obesity and chronic disease impacting our healthspan and quality of life, implementing the practices of intermittent fasting or time restricted eating may prove to be an important lifestyle tool for maintaining health and vitality as we age.

In Part One of this series, I went into detail about how intermittent fasting and time restricted eating works along with the long list of health benefits that have been linked to these lifestyle tools. In today’s article, Part Two takes a more practical view regarding the different ways to structure intermittent fasting and time restricted eating. We will also cover some of the most common questions about the safety and details of these two lifestyle practices. This will essentially be a guide to intermittent fasting and time restricted eating for beginners and experienced fasters alike.

This article covers the following topics:

  • How to intermittent fast
  • Does intermittent fasting work?
  • Intermittent fasting times
  • How to do time restricted eating
  • Is intermittent fasting and time restricted eating safe?
  • Are these two practices different for men and women?
  • Can you drink coffee or tea?
  • Does intermittent fasting and time restricted eating promote weight loss?
  • Can a ketogenic diet be combined with intermittent fasting and time restricted eating?

By the end of this article, you’ll know if intermittent fasting and time restricted eating are for you and how to get started.

Time restricted eating meal plan hours – 16:8, 18:6, and 20:4

There are many ways to implement a time restricted eating and/or intermittent fasting plan. Let’s look at some of the most popular schedules for time restricted eating and intermittent fasting.

Type of time restricted eating or intermittent fastingExplanationSample scheduleWhat to eat in your windowTips
Time restricted feeding (TRF)Fast for 16 hours overnight and condense meals into an 8-hour windowFinish dinner by 8 pm then fast until 12 pm the next dayRegular dietMay be practiced daily or a few times per week
Time restricted feeding 18:6 (TRF)Fast for 18 hours overnight and condense meals into a 6-hour eating windowFinish dinner by 6 pm and fast until 12 pm the next dayRegular dietMay be practiced daily or a few times per week
Time restricted feeding 20:4 (TRF)Fast for 20 hours overnight and condense meals into a 4-hour eating windowFinish dinner by 6 pm and fast until 2 pm the next dayRegular dietMay be challenging to meet nutrient needs if practiced daily
One Meal A Day (OMAD)Eat only one meal per day and fast for 23 hoursEat between 12 pm and 1pm each dayRegular dietMay be challenging to meet nutrient needs if practiced daily 
Alternate Day Fasting (ADF)24-hour fast every other dayFor example Monday – Fast Tuesday – Eat Wednesday – Fast Thursday – Eat  Regular dietSafe for several months, long-term challenges (1)
5:2 fasting (periodic fasting)24-hour fast 2 days per weekMonday, Tuesday – Eat Wednesday – Fast Thursday, Friday – Eat Saturday – Fast Sunday – EatRegular diet 
Fasting-Mimicking Diet (FMD)5 days of plant-based dietMay be practiced monthly for between 3 and 6 monthsPlant-based diet of 800 to 1000 calories per dayFood available through Prolon or Whole Food FMD program, available through the Hoffman Centre

With so many options, it may be challenging to determine how to start time restricted feeding or intermittent fasting. For example, do you just dive in or do you ease into it more slowly? I recommend starting with either time restricted feeding (TRF) or with the fasting-mimicking diet. (FMD). With that experience, you can then work with your provider or myself to determine if you’d benefit from other practices.

TRF may begin with a simple 12:12 schedule, meaning that you begin fasting overnight and then eat your regular diet within a twelve-hour eating window. For many people this isn’t that much different from their typical pattern, although they may have to be aware of any tendencies for late night snacking. A fast from 8 pm until breakfast at 8 am the following day is a good schedule to start with. Once you have this under your belt, you can expand your fasting window, in increments if needed, to a fourteen-hour fast with a ten-hour eating window. You can then potentially lengthen this to include a fast of sixteen hours or longer.

The fasting-mimicking diet (FMD) is a five-day program, typically practiced once per month for between three and six months, and then one time every 3-4 months as a maintenance program. During the five day fast, you follow a plant-based, calorie-restricted diet. The diet is derived from plant sources like vegetables, nuts, seeds, and fruit. The diet relies on plant foods for protein, olives, coconut and nuts and seeds for healthy fats. The diet constituents are carefully chosen by a nutritional expert. There is a commercially available program involving packaged constituents called ProLon.

With calories restricted to approximately between 750 and 1100 per day, with day one containing the most calories. This represents a réduction in calories of around 50 to 60 percent, this diet is designed to mimic molecular and cellular fasting while increasing patient compliance. The stomach sees food, while the cells see fasting. (2, 3)

The fasting mimicking diet has been clinically studied as a therapy for a variety of conditions including autoimmunity, breast cancer, and metabolic disease such as heart disease and diabetes. Extensive studies in mice have been completed, along with a few human clinical trials.

In the most recent randomized controlled trial from 2021, obese women received either a five-day fasting mimicking diet or their typical diet with a calorie deficit of 500 calories each day. This particular study didn’t indicate a difference in weight between the two groups, but the women following the fasting-mimicking plan showed reduced insulin resistance and improved appetite regulating hormones, along with preserved muscle mass and metabolic rate. (4)

At the Hoffman Centre, Justine leads a whole food fasting-mimicking program which I’ve personally undertaken three times and seen the dramatic results. An additional benefit to this structure is the group dialogue component and support provided throughout the process.

Learn more about this program here

It’s important to note that many fasting trends such as juice fasting don’t have the same benefits and may even have risks. Prolonged fasting of more than two days without food may contribute to electrolyte imbalances, dizziness, exhaustion, and other symptoms, making compliance quite challenging. Both time restricted feeding and the fasting-mimicking diet offer the benefits of fasting with intermittent fasting rules that are easy to follow.

Frequently asked questions

Let’s dive into some of the most common questions that I’m asked about intermittent fasting and time restricted eating, who it’s recommended for and who it’s not recommended for, along with some details to help you feel more confident moving forward.

Are intermittent fasting and time restricted eating safe?

Intermittent fasting and time restricted eating are safe and effective practices for many people. However, it’s important to work with your doctor, especially if you have a medical condition or take any medications. A doctor should look at your medical history, complete a physical exam, and review any laboratory testing. Please however note that your doctor may not be that familiar with these approaches to nutrition nor know the science behind it. Be sure that you are practicing the most well informed kind of patient advocacy and be prepared to educate you doctor on the subject .

While intermittent fasting and time restricted eating might be beneficial in a variety of medical cases, as explained in Part One, there are many cases in which intermittent fasting and time restricted eating are not indicated including:

  • Pregnancy and lactation
  • Anorexia, underweight, or chronic malnutrition
  • Type 1 diabetes or insulin-dependent Type 2 diabetes (as insulin requirements may plummet dramatically requiring a lowering of insulin dosing)
  • Recent stroke or heart attack
  • Pulmonary embolism or deep vein thrombosis
  • Cardiac instability or atrial fibrillation
  • Advanced kidney disease
  • Advanced liver disease
  • Advanced heart disease
  • Porphyria, MCAD
  • Inability to discontinue medications
  • Inability to obtain adequate rest while fasting
  • Active growth, such as with children or adolescents
  • Current fever, cough, or signs of an active infection (5)

Alternatively, if you’re working on any of the following imbalances or disease states, it may be worth discussing intermittent fasting and time restricted eating with your personal doctor or with myself.

  • Excess weight or obesity
  • Elevated cholesterol
  • Elevated blood pressure
  • Cardiovascular disease
  • Metabolic syndrome or type 2 diabetes
  • Lymphoma and other cancers
  • Digestive imbalance, including SIBO
  • Autoimmune disease
  • Dependency or toxicity

Fasting side effects may include fatigue, weakness, headache, dry mouth, menstrual irregularity, memory impairment, muscle pain, constipation, sugar cravings, and brain fog. Be sure to stay well hydrated and avoid strenuous exercise or extreme environments while fasting. Fasting is the ideal time for rest.

Is intermittent fasting and time restricted eating different for men and women?

While much of the initial intermittent fasting research has been conducted on animals and human men, we’re starting to learn more about the unique needs of women when it comes to fasting. Whereas men have similar hormonal patterns from day to day, women’s hormones fluctuate on a monthly cycle and then decline through perimenopause and menopause. You can learn more in my article on hormone replacement therapy.

Women seem to be more sensitive to over-fasting and restricting their food intake too much, too often. They might see imbalances in stress hormones, thyroid hormones, and sex hormones. In extreme cases, too much fasting may lead to amenorrhea or the loss of a woman’s period, especially when percentage body fat drops below a certain percentage. When it comes to intermittent fasting for women, it’s important to note that more fasting isn’t always better. A less-is-more-approach often applies.

And while each woman is different, it’s challenging to provide advice for fasting in women on a worldwide basis. For example, some women with autoimmune disease do very well with implementing intermittent fasting practices, while others might do more poorly. Remember that fasting is a stressor on the body and this can be a good stressor that leads to autophagy, detoxification, and cellular rejuvenation. Yet if the system is already stressed, fasting can sometimes be the straw that breaks the camel’s back. Often, if a woman is exhausted, overwhelmed, and feeling burnt out this isn’t the time to add even more stress.

In a study of obese women, intermittent fasting combined with calorie restriction was shown to reduce weight over a ten-week period. (6) However, many restrictive methods work in the short-term and we may need to learn more about the long-term results of fasting for women.

In another study comparing men and women in a forty-eight-hour fast, it was noted that women tend to accumulate triglycerides in their muscles, while men accumulate these in their livers, although other physiological aspects during the fast were similar. (7) We certainly need more research to further establish the differences related to long-term fasting practices and the different types of intermittent fasting between men and women regarding the potential benefits fasting.

As always with functional medicine, a personalized approach is best. As discussed above, I recommend starting with gentle time restricted feeding or with the fasting-mimicking diet.

Can I drink coffee or tea during fasting hours?

This question about hot drinks usually leads to hot debate! Whether you can drink coffee while intermittent fasting may depend on what works best for you as an individual.

Experts in the fasting field recommend “complete abstinence from all substances except pure water.” (5) Biological fasting is the absence of anything that triggers nutrient-sensing pathways. (3) This certainly means no protein, carbohydrates, or fats, but most likely no vitamins, minerals, or plant compounds either.

While black coffee or tea, doesn’t contain any calories, it does contain caffeine, which can influence the hormones cortisol and insulin. It also contains phytonutrients, the antioxidant compounds that are absorbed and which rely on digestion and metabolism.

So, what can you drink during intermittent fasting? If you want to be a purist, stick to only water during your fasting window then enjoy coffee or tea with your first meal of the day or at any time within your eating window.

After that, you can experiment with plain coffee or tea within your fasting window and see whether it improves, or deters from, your results. Coffee or tea with added fat, such as bulletproof coffee, should be enjoyed during the eating window.

Does intermittent fasting and time restricted eating help with weight loss?

Weight loss is difficult and traditional strategies are largely based on reducing calories and increasing exercise. However, these strategies, especially extreme versions, typically only produce short-term results. Many factors contribute to weight, including hormones, sleep, stress, nutrient levels, toxin exposure, mindset, and so much more. Simply looking at calories doesn’t always address the situation and a short-lived fast may only result in a Band-Aid effect. Yet for some, even a quick boost in hope and confidence that the body can lose stubborn weight can be a catalyst for deeper change. That’s why discussing how to use fasting with a trained professional is key.

Using intermittent fasting and time restricted eating for weight loss might be a solution, or just part of the weight solution, especially for someone who spends the majority of their time in the fed state. Fasting might provide the metabolic balance that will address some of the underlying physiology contributing to weight gain, such as inflammation, elevated insulin, and oxidative stress.

In a review of different types of intermittent fasting, IF produced similar weight loss results to those derived from caloric restriction. 5:2 fasting was similar to restricting daily calories in nine out of eleven studies. In addition, the majority of the weight loss occurred in the first three months before weight hit a plateau and results were similar with different distributions of macronutrients. Time restricted feeding and caloric restriction also seemed similar as far as weight was concerned. (8)

In a long-term study that compared alternate day fasting or ADF with daily calorie restriction in obese adults, weight loss after one year was 6 percent in the ADF group compared to 5.3 percent in the calorie restriction group, so there wasn’t a huge difference. (9)

When examining human studies involving individuals with diabetes, those practicing time restricted feeding as opposed to consuming six small meals per day lost more weight. The studies also showed more results with intermittent fasting in terms of decreasing A1C and blood glucose, which are markers of diabetes, compared to a common recommendation of eating frequent small meals. (10)

The definitive answer to this question regarding the intermittent fasting weight loss diet may not be clear in the science. However, I’ve seen it used successfully in my practice for patients who are good candidates, along with other functional medicine interventions.

Does intermittent fasting and time restricted eating work while following a ketogenic diet?

Ketogenic diets, time restricted eating, and intermittent fasting are often discussed as going hand in hand. Keto, which is an abbreviation for the ketogenic diet, is a high fat, low carbohydrate eating pattern that in its own way mimics the fasting state through the restriction of dietary glucose. The ketogenic diet, time restricted eating, and intermittent fasting all have the potential to increase ketones in the blood that can be used as fuel by the cells instead of them employing glucose. The ketogenic diet combined with time restricted eating and intermittent fasting may also have similar benefits related to a treatment approach to chronic and metabolic diseases.

To answer the question, yes, intermittent fasting and time restricted eating can be combined with a ketogenic diet. Those following a ketogenic diet that are in a state of ketosis, where the body is efficient at turning fat into ketones and using them as fuel, may have a better experience with fasting and fewer negative side effects. Similarly, those with an existing fasting practice might have an easier time transitioning to a ketogenic diet because their metabolism is already primed to use ketones.

So, while intermittent fasting or time restricted eating combined with a keto diet may certainly be an important dietary approach for some people healing from chronic disease or working to promote longevity, it may be too restrictive for others. This is another reason why working with an experienced practitioner can be so helpful. You can dial in your nutrition plan and then have support adjusting, and even expanding, the diet over time.

We all want to remain healthy and high-functioning as we get older, but it’s about more than living a long time. It’s about improving our quality of life. Intermittent fasting is meant to mimic the balance between feast and famine that humans have always experienced throughout history. Regular feasting is a relatively recent development and this excess time in the fed state may deter us from experiencing all of the important health and longevity benefits that come from fasting. The best part about intermittent fasting is that it makes fasting simple, gentle, and fit into modern life.

To learn more about working with me individually or to join our next group fasting-mimicking diet, please contact my office.

References:

  1. Stekovic S, Hofer SJ, Tripolt N, et al. Alternate Day Fasting Improves Physiological and Molecular Markers of Aging in Healthy, Non-obese Humans [published correction appears in Cell Metab. 2020 Apr 7;31(4):878-881]. Cell Metab. 2019;30(3):462-476.e6.
  2. Di Francesco, A., Di Germanio, C., Bernier, M., de Cabo, R. A time to fast. Science. 2018;362(6416),770-775.
  3. Hong, K. Intermittent Fasting and Fasting Mimicking: Clinical Applications. Presentation. University of Southern California.
  4. Sadeghian M, Hosseini SA, Zare Javid A, Ahmadi Angali K, Mashkournia A. Effect of Fasting-Mimicking Diet or Continuous Energy Restriction on Weight Loss, Body Composition, and Appetite-Regulating Hormones Among Metabolically Healthy Women with Obesity: a Randomized Controlled, Parallel Trial [published online ahead of print, 2021 Jan 9]. Obes Surg. 2021;10.1007/s11695-020-05202-y.
  5. Goldhamer, A. Can Fasting Save Your life. TrueNorth Health Center.
  6. Klempel MC, Kroeger CM, Bhutani S, Trepanowski JF, Varady KA. Intermittent fasting combined with calorie restriction is effective for weight loss and cardio-protection in obese women. Nutr J. 2012;11:98. Published 2012 Nov 21.
  7. Browning JD, Baxter J, Satapati S, Burgess SC. The effect of short-term fasting on liver and skeletal muscle lipid, glucose, and energy metabolism in healthy women and men. J Lipid Res. 2012;53(3):577-586.
  8. Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA, Melanson EL. Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss. Nutrients. 2019;11(10):2442. Published 2019 Oct 14.
  9. Trepanowski JF, Kroeger CM, Barnosky A, et al. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Intern Med. 2017;177(7):930-938. doi:10.1001/jamainternmed.2017.0936
  10. Muñoz-Hernández L, Márquez-López Z, Mehta R, Aguilar-Salinas CA. Intermittent Fasting as Part of the Management for T2DM: from Animal Models to Human Clinical Studies. Curr Diab Rep. 2020;20(4):13. Published 2020 Mar 12.

How Does Time Restricted Eating and Intermittent Fasting Work? Part I

How Does Time Restricted Eating and Intermittent Fasting Work? Part I

If you’re interested in living a healthier lifestyle, you’ve probably heard of time restricted eating, or intermittent fasting and the success stories associated with incorporating these practices into your life. Despite living longer these days, the healthspan of many Americans is actually cut short as the average person spends seventeen of their final years living in poor health. This is due to chronic diseases such as diabetes, heart disease, cancer, and Alzheimer’s. In fact, 80 percent of older adults have at least one chronic condition, which is primarily related to their lifestyle.

What if time restricted eating or intermittent fasting could be a solution, one of the tools in the kit, to help combat the underlying factors that contribute to such diseases? Is time restricted eating and intermittent fasting simply a diet trend? Or is there a substantial and credible scientific basis to warrant its therapeutic use?

In this two-part series, we’ll explore these questions, and more.

In Part One we’ll examine the nature of time restricted eating and intermittent fasting, how it works, and the health benefits of both practices.

Part Two will cover methods of fasting and time restricted eating, along with answers to the most commonly asked questions regarding this popular practice.

What are time restricted eating and intermittent fasting?

Time restricted eating, (TRF) and intermittent fasting, also referred to as IF, are often treated as if they are one and the same, but there are actually some major differences between the two.

Time restricted eating involves simply alternating periods of eating with periods of fasting. With TRF, all of your eating is compressed into a 1 -12 hour feeding window. Most hours of the waking day, you’ll spend in a feeding state—say from 8:00 am to 4:00 pm. The other hours, you don’t consume any calories, although you are allowed calorie-less drinks, like water, sparkling water, decaffeinated tea and black coffee. Some people, (known as OMAD’s), eat only one meal a day (OMAD) and fast for 23 hours. 

The term intermittent fasting can be confusing and inaccurate. The term ruffles some researchers feathers because there are many different forms of fasting or restriction. It’s important to distinguish between them. The other problem with the term intermittent fasting is the flexibility around the term “fasting.” Most studies on various intermittent fasting schedules allow up to 700 calories per day on fasting days, while others don’t allow any calories. I want to be very particular about the definitions because I think different forms of fasting and different types of restriction may have different physiologic effects, and by lumping all forms of fasting together, we may dilute such insights.

Intermittent fasting includes the fasting-mimicking diet or FMD, where your intake is restricted to between 750 and 1050 calories (approximately) per day for a five-day period out of the month. This has been shown to mimic some of the physiological benefits of water fasting.

In addition, intermittent fasting also includes alternate day fasting or ADF. With this type of fasting a regular diet is followed for one day followed by a day of fasting. Another option is 5:2, which involves five days of regular eating followed by two fasting days in one week. With each of these methods, the fasting days can feature either a water fast or a calorie-reduced diet.

In contrast, a long-term or prolonged fast is considered more than two days and up to several weeks without food.

As you can see, there are several versions of intermittent fasting in which individuals can engage and that have been explored with scientific research. I’ll cover these in more detail when we discuss an intermittent fasting schedule and how to implement it in Part Two of this series.

How intermittent fasting works

If we take a look back in time to more ancestral or hunter-gatherer ways of eating, feasting was always balanced with famine. There were naturally times of the year when food was abundant and times of the year when food was scarce. The human body has the ability to adapt and thrive in both cases.

With the onset of our modern agricultural system, most of us in the developed world no longer have natural periods of fasting and life is a perpetual feast. We have access to whatever food we desire, grown anywhere in the world, every day. It’s no wonder that rates of obesity are the highest they’ve ever been, leading to inflammation and chronic disease. These days the body’s systems never have an opportunity to rest and reset.

So how exactly does intermittent fasting work? To answer this question, we need to go behind the scenes and into the cell to understand what’s happening on the cellular level, in both the fed state and the fasting state.

When we eat a meal, the body’s system is dedicated to processing food, which places the cell in growth mode. Insulin levels are higher, signaling the cell to grow. More specifically, insulin signals mTOR, meaning mammalian target of rapamycin, which instructs the cell to grow and divide. mTOR also decreases autophagy, the process of cellular recycling, that’s predominant during fasting and important for regular repair and maintenance of the cell. (1)

Autophagy naturally declines with age and decreased autophagy is related to neurodegenerative disease, cardiomyopathy, cancer, metabolic syndrome, suppressed immunity, and signs of aging. Boosting autophagy by means of intermittent fasting methods may help to slow or reverse these changes.

In the fasting state AMPK, or 5’ AMP-activated protein kinase, slows down mTOR. This causes fat breakdown and works to activate autophagy, allowing the body to run on its own stored fuel in the form of fat. AMPK also cleans up and repairs parts of the cell that don’t work, an important process that contributes to healthy aging and preventing diseases such as cancer. (1)

In addition, fasting, intermittent fasting, and calorie restriction down regulates IGF-1, or insulin-like growth factor-1. IGF-1 signaling is important for protein synthesis, as well as blood sugar regulation and growth. Later in life, increased IGF-1 can accelerate the aging process and decreasing it, through methods such as IF or time restricted eating, may increase longevity. Studies in mice indicate that employing different types of intermittent fasting can result in an increased lifespan. (1)

When food is scarce, the body conserves energy by downregulating or decreasing both mTOR and IGF-1, which increases stress resilience and protection on the cellular level. In fact, this can be considered inner rejuvenation, which reduces inflammation and increases autophagy. The results include increased stem cell regeneration and improved immunity, especially during fasts lasting more than a few days or by means of fasting-mimicking. (1)

Decreasing IGF-1 also decreases cellular senescence, in which the cell loses its ability to divide, as measured by telomere length. This process of cellular senescence is caused by underlying factors that produce oxidative stress, changes in the epigenetic gene expression, metabolic dysfunction, and mitochondrial dysfunction and the process is considered irreversible. However, decreasing IGF-1 or mTOR increases sirtuins, via the antiaging molecule NAD+, autophagy, and enables DNA repair. (1)

When the body is in a fed state, cells are highly acetylated so that genes are turned on. This helps cells to survive and proliferate. When these genes are on, the ones that are more related to fat metabolism, stress resistance, and cellular repair are turned down. (1)

This is what happens metabolically throughout a longer fast or a fast-mimicking diet over the course of five days.

  • 12 hours: The body transitions from primarily using glucose as fuel to increasing ketones as the preferred fuel for cells, including cells in the brain. (2) This causes an increase in BDNF, or brain-derived neurotropic factor, which allows for increased brain plasticity and neurogenesis. (1)
  • 18 hours: Ketone levels continue to rise. More ketones lead to a decreased need for glucose and insulin, along with more BDNF.
  • 24 hours: Cells increase autophagy, allowing for recycling and the breakdown of old or broken cellular components. (3)
  • 48 hours: Growth hormone (GH) is five times higher than normal, helping to preserve lean muscle mass, reduce fat, and is important for longevity. (4)
  • 54-72 hours: Insulin sensitivity increases and new stem cells and immune cells form. (5)

In summary, on the cellular level, fasting results in the following:

  • Decreased mTOR
  • Reduced IGF-1
  • Increased AMPK
  • Increased autophagy
  • Greater NAD+ and sirtuins
  • Increased ketones
  • Increased BDNF
  • Increased GH
  • Reduced levels of insulin and blood glucose
  • Decreased cellular senescence
  • Increased fat metabolism
  • Improved resistance to cellular stress
  • Reduced inflammation

Our bodies still need both the fed and fasting state, but in our modern culture the balance strongly favors always being fed. Intentional fasting may be a way to add greater balance to the system by allowing for these natural cellular processes that primarily happen in the fasted state.

Health Benefits of Intermittent Fasting and Time Restrictive Eating

Now that we’ve covered the science of fasting and time restricted eating, the question I’m often asked is whether these practices work in regard to health and longevity. This is an exciting area of study, using a wide variety of animal models, along with increasing numbers of studies in humans, in order to decipher the potential benefits of intermittent fasting and implementing time restricted eating.

Research has indicated a number of positive clinical benefits related to intermittent fasting and time restricted eating

  • Weight loss
  • Changes in body composition/fat loss
  • Improved insulin sensitivity or decreased insulin resistance
  • Reduced oxidative stress
  • Increased cellular autophagy
  • Stem cell regeneration
  • Optimized neurogenesis
  • Enhanced parasympathetic nervous system response
  • Improved gut motility, which is important for conditions like SIBO
  • Reduced heart rate
  • Reduced blood pressure
  • Improved lipid/cholesterol balance
  • Improved cognitive function
  • Improved detoxification
  • Improved physical performance
  • Improved sleep patterns
  • Improved immunity (1,6,7)

Taken together, all these clinical benefits translate into important applications related to longevity and chronic disease reversal. Intermittent fasting results are clearly beneficial for a variety of disease states and populations, including those with cardiovascular disease, diabetes, obesity, dementia, cancer, depression, and a number of other conditions. (6,7)

Intermittent fasting addresses the metabolic root causes that contribute to disease over time. IF and time restricted eating may be an important lifestyle tool, along with diet, physical activity, and stress reduction, that brings health more into balance.

In Part Two of this series on intermittent fasting, we explore the specifics of the different types of intermittent fasting, along with how to implement an intermittent fasting schedule. We’ll then cover some frequently asked questions on the topic and provide details and guidance to get you started.

If you’re looking for more personalized guidance, or are interested in our whole food fasting-mimicking program available through Justine Stenger and the Hoffman Centre for Integrative and Functional Medicine, please contact us for more information.

References:

  1. Hong, K. Intermittent Fasting and Fasting Mimicking: Science and Molecular Mechanisms. Presentation. University of Southern California.
  2. Anton SD, Moehl K, Donahoo WT, et al. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity (Silver Spring). 2018;26(2):254-268.
  3. Alirezaei M, Kemball CC, Flynn CT, Wood MR, Whitton JL, Kiosses WB. Short-term fasting induces profound neuronal autophagy. Autophagy. 2010;6(6):702-710.
  4. Hartman ML, Veldhuis JD, Johnson ML, et al. Augmented growth hormone (GH) secretory burst frequency and amplitude mediate enhanced GH secretion during a two-day fast in normal men. J Clin Endocrinol Metab. 1992;74(4):757-765.
  5. Klein S, Sakurai Y, Romijn JA, Carroll RM. Progressive alterations in lipid and glucose metabolism during short-term fasting in young adult men. Am J Physiol. 1993;265(5 Pt 1):E801-E806.
  6. Hong, K. Intermittent Fasting and Fasting Mimicking: Clinical Applications. Presentation. University of Southern California.
  7. Goldhamer, A. Can Fasting Save Your life. TrueNorth Health Center.
  8. Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA, Melanson EL. Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss. Nutrients. 2019;11(10):2442. Published 2019 Oct 14.

Patient Questions – HRT and Weight Gain

hormone replacement therapy weight gain

Question 

I’m an active baby boomer who tries to stay in good shape. I walk a lot, go to aerobics twice a week, inline skate in summer, and curl twice a week in the winter. I try to eat healthy food but I’m finding it nearly impossible to lose that excess fat around my waist. My question is, does taking hormonal drugs, such as Premarin and Prometrium, have any effect on trying to lose weight? I’ve tried several times to get completely off the drugs and although I’m only taking half my original dosage, I can’t bear the hot flashes and night sweats without the drugs. I personally believe that I’d be better off without the drugs but I don’t know if it would then be any easier to lose the abdominal fat.

Thank you,
Cathy 

Answer 

Dear Cathy,

Your letter has raised a number of very pertinent questions that every woman that’s approaching menopause should be aware of. 

First of all, we know that the negative conclusions reached by the Women’s Health Initiative study¹ led to 50 percent of women being removed from or voluntarily stopping their hormone replacement therapy. The negative findings were suggestive of an increased risk of heart disease, strokes, breast cancer, and dementia.

However, in later reviews and critiques of the study, many researchers have reversed some of their earlier conclusions. Please see my blog post on this subject, entitled Risks of Hormone Replacement Therapy in Women. The researchers suggest that women become informed regarding the many helpful benefits of hormone replacement therapy, not just about the symptomatic treatment of hot flushes and night sweats. In the journal Fertility and Sterility in December 2005, the authors critiqued the study design and proposed two major reasons why the original authors of the study reached the conclusions that they did². The authors criticized the use of continuous combined estrogen/progestin or estrogen alone as a standard regime to an aging female population with little previous hormonal treatment, who because of their age were naturally predisposed to cardiovascular and cerebrovascular disease. The authors also criticized the use of continuous synthetic progestin or Provera, which is known to have significant side effects and has been linked to increasing rates of breast cancer. There are now over a hundred published studies indicating that estrogen can be safely prescribed to women with a history of breast cancer. The hormone estrogen when prescribed alone, rather than in combination with the synthetic progestin Provera, hasn’t been found to be harmful in any study to date. The hormone combination Prempro was to blame and more specifically, the synthetic progestin, Provera. 

Due to the premature termination of hormone replacement therapy, many women are being exposed to increased risks of osteoporosis and hip fractures, colon cancer, and increased risks of heart disease, strokes, and breast cancer. In the field of anti-aging medicine, we’ve been warning patients of the detrimental effects of synthetic hormones and have strongly suggested that women use bioidentical hormones instead. Restoring one’s hormones to youthful levels seems highly appropriate and is supported by scientific literature. It’s strongly encouraged that you begin to use hormones as soon as possible after menopause. You should also check with your doctor that you have no personal or family history risk factors for hormone replacement therapy before beginning your regime.   

Cathy, bearing this in mind I’d strongly suggest that you continue your hormone replacement therapy, but switch to bioidentical hormones and be sure to reach therapeutic levels. If your doctor prescribes hormones to merely relieve hot flushes and night sweats, and doesn’t reach therapeutic levels with your hormones, you’ll not be protected against the deterioration of your bones, brain, and cardiovascular system. In addition, your risk of colon cancer will increase. 

With regards to the weight issue, it’s well established that Provera, which is synthetic progesterone, can lead to significant weight gain. Sometimes physicians use synthetic progestin in cancer patients suffering from severe wasting to increase their appetite and reverse a condition known as cachexia³. I suggest that you switch to bioidentical progesterone and see if this makes any difference. Prometrium is a reasonable choice but I prefer sublingual slow-release progesterone, which is available from compounding pharmacies. 

I suggest that you also check your levels of estradiol. If the level’s too high, this may lead to weight gain. The suggested level is between 186-367 pmol/l. I also suggest that you have your blood level taken approximately twenty-four hours after your last estrogen dose, if you’re taking oral estradiol. This will reflect the ‘steady state’ level in your bloodstream. If you’re taking transdermal estrogen cream, you’ll need to do a saliva hormone test to measure estradiol, estriol, and estrone levels to more accurately reflect your levels at the surface of your cell’s receptors. Blood levels of estrogen do not reflect levels of estrogen when given in a transdermal form, a mistake made by many practitioners new to the prescribing bioidentical hormones. You’ll also need to test your urinary metabolites of estradiol to ascertain if you’re making the less harmful metabolites of estradiol, which is known as 2-hydroxyestradiol, as opposed to the potentially more harmful metabolites of estradiol known as 4-hydroxy and 16-hydroxyestradiol.

In a study published by the Oregon Health and Science University, scientists observed a group of forty-six pre- and post-menopausal women. The scientists reached the conclusion that the drop in estrogen levels commonly associated with menopause is linked to an increase in the stress hormone cortisol. This hormone is strongly linked to an increase in abdominal obesity. It was determined that if the women received therapeutic levels of estrogen, cortisol levels decreased and there was a reduction in visceral fat.

In addition, as we age, we lose muscle mass and there’s a corresponding decline in the metabolic rate. As a result, many perimenopausal and menopausal women who continue to eat the same amount of food that they did when they were younger find that with decreasing energy expenditure, they gain weight that’s difficult to lose. Find out if the gym or health clinic closest to you has a bioimpedance machine that can measure your percentage of muscle mass and ask them to track it over time. We routinely measure such biometrics at every visit when patients complain of weight gain or loss. 

Most weight gain during perimenopause and menopause is usually secondary to an increase in appetite. It’s well known that all hormones can significantly increase a person’s appetite. If there’s been rapid weight gain, this is usually due to fluid retention and brief use of a diuretic may be helpful. If your weight gain is gradual, it’s most likely due to an increase in appetite. 

It’s established that hormones have no caloric value. In fact, in a study in 1999⁴, the authors concluded that not only does hormone replacement therapy prevent weight gain, it also favours weight loss by significantly increasing the breakdown of fat after three months of treatment. It also positively influences the insulin/blood sugar response, plasma cholesterol, and energy expenditure.  

In another study published in 2004⁵, the authors determined that hormone replacement therapy in postmenopausal women, along with testosterone replacement therapy in older men, appeared to reduce the degree of central obesity. 

So Cathy, in conclusion I suggest the following:

  • Continue your hormone replacement therapy, but find a doctor who knows how to prescribe bioidentical hormones in therapeutic doses. 
  • Eat a low glycemic paleo autoimmune type diet with a decrease in the total daily dose of calories consumed.
  • Increase the amount of hot, spicy, bitter foods that you consume, as it has been shown in studies of Ayurvedic medicine that these tastes increase one’s metabolism. 
  • Concurrently, decrease your consumption of sweet, sour, and salty foods as these tastes have been shown to increase weight gain. 
  • Exercise five days a week with an exercise regime that includes significant muscle strengthening with large muscle groups, such as those in the legs, to increase your metabolic rate. 
  • Be sure to get a good night’s sleep as this naturally increases your levels of growth hormone, which has also been linked to weight reduction. 

If you’re interested in learning more about how hormone replacement therapy can affect or is affecting your health, then please don’t hesitate to read the other posts on the Hoffman Centre blog or contact my office to set up an appointment.

Resources:

¹JAMA. 2002;288(3) 321-333

²Fert Steril. 2005 Dec; 84 (6): 1589 -601

³Sem Oncol 1991: 18:35-42

⁴Maturitas 1999 Aug 16; 32(3);147 -53

⁵Obesity Review 2004 Nov; 5 (4);197 -216

Risks of Hormone Replacement Therapy in Women

Risks of Hormone Replacement Therapy in Women

Does Estrogen and Progesterone HRT Increase Breast Cancer?

Hormone replacement therapy, or HRT, for peri or postmenopausal women is one of the most satisfying treatments that we, as ‘anti-aging’ doctors, are able to prescribe. We all have high numbers of very satisfied women who let us know that since the prescribing of HRT, they ‘got their lives back.’ I can attest to this as I have post-graduate training in HRT, being board-certified and having a Fellowship in HRT therapies with the American Academy of Anti-Aging Medicine (A4M).

However, getting to this place of being able to help women through the hormonal transitions of life using natural and bioidentical options has been a long time coming. Many were turned away from a large early study from the Women’s Health Initiative that warned of the dangers of synthetic hormones, and unfortunately this fear continues to permeate much of the conversation around using HRT. 

In this article, I’m going to walk you through the history of HRT, along with the studies that came after that first Women’s Health Initiative trial that clarified many of our questions regarding HRT, so that it can be used safely and effectively to improve the quality of life for so many women. 

Keep reading to learn more about HRT – Is it our enemy or our friend? 

This article will cover: 

  • Hormone replacement therapy for women,
  • Health risks of hormone replacement therapy,
  • Estrogen HRT breast cancer risk,
  • The history of HRT,
  • Findings of observational studies and randomized controlled trials,
  • Benefits of estrogen and progesterone HRT,
  • Conclusions about hormone replacement therapy and breast cancer, 
  • And where medicine is moving in terms of HRT.

Hormone replacement therapy for women

When discussing HRT for women in their perimenopausal or post-menopausal years, we are mostly talking about estrogen and progesterone hormone replacement therapy, the two main sex hormones involved in a woman’s sense of well-being.

As estrogen and progesterone levels fluctuate and eventually decline through the perimenopausal years and then reach the very low levels during menopause, many women experience uncomfortable symptoms and a loss of the wellness and protection that these hormones provide. Replacing these hormones often does wonders for how a woman feels, looks and enjoys her life. 

Estrogen is known to protect against depression, mood disorders, insomnia, loss of memory and cognition, dementia, colon cancer, reduction in bone fractures, dry vaginal tissue, wrinkles, and loss of teeth. Estrogen also contributes to the prevention of urogenital atrophy, the improvement of lipid metabolism and increasing libido. Overall, estrogen improves wellbeing and general symptoms of malaise. 

The benefits of progesterone include improved sleep, reduced anxiety, and protection against breast cancer, coronary artery disease, and osteoporosis.  

Risks of hormone replacement therapy – The WHI study

Does HRT increase the risk of breast cancer? Does HRT cause cancer? What about increase strokes, heart disease, and blood clots? What are the risks of hormone replacement therapy? 

These are the most common questions I get from women when discussing HRT. 

The reason for their concern is still firmly etched in everyone’s mind from when the conclusions of the Women’s Health Initiative (WHI) study were published in 2002. This showed that women on HRT had increased rates of breast cancer of 34 percent, strokes of 37 percent, blood clots and pulmonary emboli of 24 percent, and heart disease of 27 percent. When these figures were published, there was a huge media frenzy highlighting HRT risks, patients were immediately taken off HRT, and all research into this type of therapy was seriously curtailed. 

Since that time, there’s been considerable research, some carried out by the same WHI group, that actually refutes aspects of these findings and also examines some of the pitfalls and perils of the original WHI publication. However, none of the same fanfare and publicity has been given to these new findings. Many patients and doctors are still influenced by the 2002 guidelines initiated after this trial was first published.  

Keep in mind that when we prescribe HRT for women in the postmenopausal years, the hormones that we use include, but are not limited to, estrogen, progesterone, testosterone, DHEA, pregnenolone, thyroid, oxytocin, hydrocortisone, and melatonin. However, the WHI study was concerned with oral Premarin, a synthetic, non-bioidentical estrogen made from horse urine, along with oral Progestin, which is also a synthetic progestin rather than bioidentical progesterone HRT. The elucidation of these distinctions is vital to understanding these results, as we’ll explore later. 

HRT and breast cancer

With breast cancer incidences, it’s well established in oncology that anti-estrogen approaches to breast cancer, such as oophorectomy (removal of one or both ovaries), tamoxifen (a medication that blocks estrogen), or aromatase inhibitors (medication that blocks the conversion of testosterone to estrogen), are all beneficial for breast cancer response, survival, and even prevention. 

So, if these anti-estrogenic approaches are beneficial, by inference estrogen must be carcinogenic. However, as mentioned above, with recent updated publications on breast cancer and hormone replacement therapy, the results reflect that this may not be the case. 

In fact, recent data suggests the exact opposite: Estrogen-based hormone replacement therapy appears to reduce breast cancer and all-cause mortality rates

How can this be? Let’s explore this conundrum and the history of breast cancer and HRT. 

Here are the results from some historical studies outlining forty years of research on this very question, with some surprisingly new observations that will require our serious attention. 

The history of HRT

The relationship between hormones and breast cancer dates back to the late nineteenth century. At that time a George Beatson, a British surgeon, was the first to postulate an association between the hormonal action of the ovaries and the proliferation of breast cells, first discovering the relationship in lactating sheep. He wondered if removing the ovaries, that produce estrogen and progesterone, could be a treatment for breast cancer. He tested his theory in June of 1895.

A thirty-three-year-old woman had noticed a small lump on her left breast while she was breast-feeding her first child. This lump became larger after the birth of her second baby. A large tumor was successfully removed from her breast, but the cancer was already far advanced. She was referred to Dr. Beatson who removed both her ovaries. He reported the case to the Edinburgh Medico-Chirurgical Society and published details in the Lancet in July 1896. The woman survived for nearly four years before dying of recurrent disease. Thus, the removal of the ovaries as therapy for breast cancer was born and continues in present day. What’s so interesting is this discovery was made thirty years before estrogens were identified. 

But, Dr. Beatson didn’t know what the full function of the ovaries was. In the 1920s, researchers Edgar Allen and Edward A. Doisy from St. Louis University identified, extracted, and characterized the molecule of estrogen from a pig’s ovarian follicle. This was a major scientific breakthrough and explained the success of oophorectomy. Once estrogen was isolated from the ovaries and an oophorectomy induced a positive breast cancer response, it implied that estrogen is most likely breast carcinogenic. 

Indeed, when anti-estrogens such as tamoxifen and aromatase inhibitors were subsequently developed in the 1970s and 1980s, with tamoxifen as the best example of a dedicated, specialized antiestrogen, a positive response rate of between 20 and 50 percent was seen in stage IV breast cancer. In the 1980s, when aromatase inhibitors were used, a 25 to 30 percent reduction of breast cancer mortality was noted and a reduction in new breast cancer incidence was determined to be between 30 and 40 percent.  

Estrogen HRT has been used since the 1940s, became popular in the 1960s then gained a very high level of popularity in the 1990s. It was primarily used to reduce hot flashes, the classic sign of menopause. Yet, in the very beginning their use was also tied to the issues of femininity and sexuality, very well described by Masters and Johnson in the early 1970s. After the seventies, more science emerged within HRT research, confirming that the therapy improved energy, reduced the incidence of bone loss and bone fractures, reduced cholesterol, and had many potential benefits for the cardiovascular system and the risk for heart attacks.

Observational studies

There are approximately fifty-nine observational studies summarized by the Oxford Group on the question of HRT and breast cancer mortality over the past forty years. These studies show an increase in breast cancer mortality with HRT, ranging from 30 to 80 percent, meaning that HRT increases the risk by a considerable amount. Let’s dive more into what this means and the limitations of this type of study. 

In observational studies, participants aren’t randomly assigned to a treatment or a control group. Instead, they’re simply observed over time to see whether a particular treatment or intervention helped, harmed, or did nothing. The results are then compared to a similar group that received a placebo or no treatment at all. In the HRT studies, women selected themselves to receive treatment. After twenty years, the researchers would eventually follow up and study these self-selected HRT users against the general population of non-HRT users in a non-randomized fashion.

The benefit of observational studies is that they’re less expensive, can be done more quickly, and can include a broader range of patients. They’re often used when a randomized trial would be impossible or unethical.

The Collaborative Group on Hormonal Factors in Breast Cancer, in Oxford in the UK, the leading authorities recognized in this particular field of epidemiological studies, summarized the observational studies of the previous thirty years of research and published their findings in the Lancet Journal in September 2019, using the comparative analysis of users against non-users. They showed that taking Premarin or progestins had double or a 208 percent increase in the risk of breast cancer. 

With estrogen alone, for women after hysterectomy, the risk is lower but incidence is still increased by almost a third or 33 percent. Progestin is used along with estrogen in women who still have a uterus to prevent the risk of endometrial cancer, since estrogen alone stimulates the growth of the endometrial lining. 

When looking at mortality rates or death cases with estrogen alone HRT versus non-users, there was a 35 percent increase in mortality. For estrogen plus progestin, there was an almost 64 percent increase in breast cancer mortality. This is the present understanding of the HRT outcomes, when you examine observational non-randomized studies, as reported by the Oxford overview group. 

Indeed, from these studies it appears that the incidence and mortality of breast cancer associated with HRT was definitely increased and thus by deduction, estrogen is undoubtedly breast carcinogenic. This information, understandably, would raise caution in a woman looking for symptom relief and anti-aging benefits in menopause. Luckily, there is more to the story. 

Limitations of observational studies

Other researchers have looked into the issue of potential flaws in these studies, particularly when new studies have shown that estrogen use alone has shown a reduced incidence of breast cancer, with many added benefits of estrogen HRT. Dr. Ragaz’s group has raised the issue that in non-randomized studies like the Oxford overview, with self-selection of HRT users, a potential bias could be created in that women with high-risk of breast cancer were selected. One bias was that more affluent women take HRT. Therefore, the question arises regarding the link between affluence and breast cancer risk.

Affluence and higher socio-economic status have been associated in many studies with an increased risk of breast cancer. 

Affluent women have:

  • More carbohydrate-rich diets 
  • Higher body mass index
  • Less physical activity
  • Reproductive factors that are substantially different from non-affluent women, such as lower parity, less breastfeeding, and later age pregnancy
  • More frequent breast examinations and mammograms 

There’s plenty of data indicating that all these particular factors are very much linked with higher breast cancer rates.

What’s most important is that randomization is essential when attempting to analyze breast cancer risk in HRT users. Researchers must use a sampling of women from all socioeconomic groups in order to equivalize as many variables as possible.

Randomized studies

Randomized controlled trials (RCTs) are considered the gold standard and an ideal method when it comes to medical research.  In an RCT, women are randomly assigned to receive hormones, or any other treatment being studied, or a placebo. If the study is double-blinded, neither the patient nor the investigators know which patient is taking what. 

The start of large randomized HRT trials began with the WHI studies. The Women’s Health Initiative (WHI) was established in the 1990s under the leadership of Bernadine Healy, the first female director of the National Institute of Health. In 1992, the WHI project conducted a series of four randomized trials examining issues of women’s health, two of which were aimed at the HRT issue. 

The Women’s Health Initiative is the most active epidemiological group in USA. Unfortunately, soon after the beginning of these WHI studies, Bernadine Healy died of brain tumors resulting from glioblastoma. She sadly never saw the result of her initiative. 

The biggest randomized study to date was initiated by the WHI and called Trial 1. In routine randomized studies the numbers usually amount to a few hundred, but in this study group there were 16,000, a huge amount by routine standards.  

In the WHI Trial 1, 16,608 women with an intact uterus were randomised to Arm 1 using estrogen (Premarin) plus a progestin (Provera). Arm 2 received a placebo only. This was the first study looking at both estrogen and progestin and showed a 44 percent increase in breast cancer mortality.  

The WHI Trial 1 was terminated prematurely and the results published in JAMA 2002. As mentioned earlier, there was a substantial media frenzy. The media and television networks were full of the data and publicity was aggressive and prolific. This study showed an almost 27 percent increase in heart attacks, 34 percent increase in breast cancer, 37 percent increase in strokes, and a 24 percent increase in pulmonary emboli or blood clots in the lungs. There were some benefits, as quality of life markedly improved and bone fractures were reduced quite significantly. The interpretation by the lead investigators of the WHI Trail 1 dramatically changed guidelines for HRT. 

  • HRT was to be used for the shortest time only 
  • HRT should only to be administered for the treatment of postmenopausal symptoms 
  • The risks of HRT far outweighed the benefits
  • The risks of coronary heart disease and breast cancer far exceeded the benefits of osteoporosis prevention and a decrease in colon cancer

With HRT discredited as a therapy, sales dropped by 50 percent in one month and all the major clinical organizations, such as the American Association of Clinical Endocrinologists (AACE), the American College of Obstetricians and Gynecologists (ACOG), and the North American Menopause Society (NAMS) recommended only using HRT for a very short time and solely for the control of menopausal symptoms. 

With regards to the cardiovascular risk factors, some of the initial criticisms of the study declared that most of the women studied were much older and already had significant baseline coronary artery disease. In addition, they were given oral estrogen which is known, particularly in the first year of taking it, to increase clotting factors in the liver. 

Soon after the WHI Trial 1 findings were made public, Dr. Lobo published the findings from four large randomized trials in Family Practice News in 2003. These showed that that the risk of cardiovascular diseases is extremely low in healthy women in early menopause and that the results of the WHI didn’t apply to younger women between fifty and sixty years of age who initiate HRT around menopause. 

There was overwhelming evidence that the anti-atherosclerotic effect of HRT depends on the time of initiation and that early initiation is protective. The Nurses’ Health Study (NHS), which has produced the most data for observational studies for risk factors for major chronic disease causation in women, didn’t find any association between coronary artery disease (CAD) and HRT. It was hypothesised that once CAD is established, HRT has no protective or beneficial effect, but estrogen given to menopausal women significantly retards progression of CAD by its positive effects on lipids and endothelial functioning, which is related to the inner lining of blood vessels. However, oral estrogen given to women over sixty with CAD may make the condition worse. 

WHI Trial 2 – Positive results for HRT

A second study by WHI, called Trial 2, using estrogen hormone replacement therapy alone, showed astounding results, but in the other direction. 

In the WHI Trial 2, 10,739 women, after hysterectomy, were randomized to estrogen against placebo. Arm 1 used estrogen-based HRT alone, while Arm 2 was a placebo only.

In 2004, the first publication of the WHI Trial 2was released regarding the estrogen-alone arm, which has continued onwards until the present. These results were from women under the age of sixty. 

The WHI Trial 2 mostly indicated benefits, including a 40 percent reduction in breast cancer mortality! Remember, in WHI 1 there was an increase in breast cancer, but here we have a 40 percent reduction in breast cancer mortality with the use of estrogen HRT alone. It’s very important to note in this case that progestin wasn’t used. 

Furthermore, there was a 25 percent reduction of diabetes, a 26 percent reduction of Alzheimer’s dementia mortality, a 55 percent reduction in myocardial infarction among patients between fifty and fifty-nine years old, a 21 percent reduction in all-cause mortality, and a 32 percent reduction in bone fractures with an 80 percent improvement in quality-of-life benefits. This is remarkable and the findings are very different from the WHI Trial 1 results. 

However, unlike the WHI Trial 1, which according to these publications had revealed mostly remarkable benefits, there was no publicity. There wasn’t a single article or television report. Not a thing. From 2004 to 2020, the WHI has updated this study, with the same benefits being shown, but they’ve entirely suppressed their own publicity. Consequently, nobody knows much about these outcomes. 

Does HRT cause cancer? – What I tell my patients about the risks

So, when patients inevitably ask me if HRT therapy is safe or inform me that their doctor has told them to stop using HRT because it isn’t safe, I immediately know that they aren’t aware of the WHI Trial 2 studies, which have refuted the majority of the WHI Trial 1 findings. 

These findings are completely opposite to the WHI Trial 1 studies, which incorporated estrogen and progestin. A further WHI Trail 2 study published by Stefanick et al in 2006 showed a reduction in the estrogen-alone HRT group, the breast cancer incidence reduced by between 20 and 43 percent. However, nobody has heard about these outcomes. There was no publicity at all. As a result, the consensual opinion of patients and the majority of health practitioners continue to be based on the WHI Trail 1 findings.   

With continuation of the WHI Trial 2, published by Andersen et al in Lancet Oncology 2012, showed the persistence of benefit with estrogen alone. There was a 23 percent reduction in breast cancer incidence with a 63 percent reduction in breast cancer mortality and a 38 percent reduction in all-cause mortality with estrogen alone. This is unbelievable. 

Almost twenty years later, the WHI Trial 2 continues to publish data. An updated study, published by Manson J. et al in JAMA 2017 showed a 45 percent mortality reduction with estrogen alone and the 2020 Chlebowski R. et al JAMA 2020 publication showed mortality for breast cancer reduced by 40 percent. 

Please note that the conclusions from the WHI Trial 2 findings from all studies from 2004 to date show a very statistically significant 40 percent breast cancer mortality reduction with estrogen.  

Benefits of Estrogen

So here we have to ask how is it possible that estrogen, which for decades has been linked to breast cancer, provides benefits? 

There’s some evidence for the biological impact of estrogen on breast cancer cells. Research by Dr. Joseph Ragaz’s group has shown the following:

  • Estrogen reduces apoptosis 
  • An increase or improved stem cell differentiation with lower invasiveness of breast cancer cells means that the breast cancer becomes less aggressive
  • Estrogen also influences insulin growth factors in a positive way  

As far back as 2010, Dr. Ragaz’s group presented the potentially very important concept of estrogen duality, which shows that exogenous estrogen in HRT is protective, whereas endogenous estrogen made by the body proliferates the breast cancer cells. We know that exogenous estrogen in HRT is protective as the WHI Trial 2 data above attests. 

We also know that because of the endogenous estrogen, we can remove the ovaries and administer anti-estrogens such as tamoxifen, with these being aimed against endogenous estrogen. These studies show that suppression of endogenous estrogen is breast cancer beneficial. Therefore, endogenous estrogen stimulates and remains carcinogenic. 

The message is that now there’s clear evidence of exogenous estrogen emerging as a potent, powerful anti-estrogen to the endogenous estrogen. This is basically the information that needs to be published, publicised, and the message spread amongst the lay and medical communities. 

What about progesterone?

The other question is why there’s so much difference between the two trials. The evidence very clearly appears to be centered on the issue of the synthetic progestins used. It’s been known for some time and there’s adequate evidence to show that the progestin/Provera used is actually carcinogenic and inflammatory and can erase the benefit of estrogen. 

In Trial 1 with estrogen and Provera, the incidence of breast cancer mortality was increased by 44 percent. In the WHI Trial 2, with no progesterone but estrogen alone, there was a 45 percent reduction in breast cancer mortality. However, the new generation of bioidentical progesterone, including Prometrium and compounded bioidentical progesterone rather than progestin, don’t appear to be as harmful to breast cancer. That’s a very important concept as most patients and many doctors equate the two, meaning progestins such as Provera and bioidentical progesterone, as being the same. 

Progesterone was isolated and produced in the 1930s and so named because it’s the hormone that supports pregnancy and is pro-gestation. Today, the word progesterone is often misleadingly applied to many different forms of this hormone, rather than the natural progesterone that the body produces. Prometrium is the most common bioidentical micronized form of progesterone used in North America. 

In contrast, progestins are synthetic compounds, not bioidentical to what your body produces. The most frequently prescribed synthetic progestin in North America is called methoxy progesterone acetate (MPA), which has the trade name Provera. Prempro is a combination of synthetic estrogen and synthetic progestin and was the one used in the WHI Trial 1. 

Progestins are known to adversely affect mood, fatigue, edema, anxiety, bloating, depression, breast swelling, and reduce HDL levels. Progesterone is devoid of these side effects, unless given in amounts above what’s normal for the body. 

All this to say that the form of HRT really matters and bioidentical is the most beneficial with the least risk. 

Estrogen and all-cause mortality 

Estrogen has an impact on all-cause mortality, referring to the health of women and the cause of death for all other conditions other than breast cancer, and is decreased considerably in those who take estrogen-only HRT. 

Dr. Ragaz and his group obtained data from the WHI and transformed the numbers into crude, absolute numbers of deaths that could be avoided each year by women taking estrogen-only HRT. Their final aim was to influence the HRT prescribing guidelines, because the current HRT guidelines haven’t yet taken into consideration the updated data or results since 2004, which have been explained above.

In the 2017 overview from Mason’s WHI Trial 2 publication, breast cancer mortality reduction was 45 percent, Alzheimer dementia mortality reduction was 26 percent, and all-cause mortality reduction was 21 percent. This includes every other cause of death, other than dementia and breast cancer. They took the annualized mortality rates for these three conditions, applied the reduction in deaths from them as published in the WHI Trial 2 and came up with the following figures. The results were stunning! 

Every year in the United States, with the use of estrogen-only HRT, there would be 9,292 fewer breast cancer deaths, 18,966 fewer Alzheimer’s dementia deaths, and 21,750 fewer deaths from other causes, such as diabetes, bone fractures, or from cardiac factors. In total, the lower mortality rates amounted to 50,008 fewer deaths from all causes every year by using estrogen-only HRT. 

The evidence is clear that we see an unexpected numerical HRT benefit with avoidance or breast cancer cases, Alzheimer’s dementia, and all-cause mortality. 

Moving forward with anti-aging medicine

Dr. Ragaz’s recommendation is to adopt and implement HRT, without synthetic progestins, to the current medical guidelines in order to pass on the benefit to millions of women. This means that hundreds or even thousands of deaths could be avoided worldwide. In the USA alone, 50,000 deaths could be prevented and many more women could be saved if these recommendations are adopted worldwide.  

In summary, the absence of randomization in the previous observational studies highlights the fact that these studies were methodologically flawed and the conclusions they reached have to be viewed from this perspective. Secondly, because of the carcinogenicity of progestin/Provera included in the randomized WHI Trial No 1, this trial’s conclusion can’t be applied to modern prescribing of HRT, which excludes progestin/Provera in favour of bioidentical progesterone. 

As a result, the estrogen-alone based HRT evaluated in the WHI Trial 2constitutes the new gold standard. This is a basic constituent for present HRT regimens to be recommended in new guidelines, with the new generation of progesterone, which aren’t carcinogenic, to be applied for most women approaching menopause.

There’s hope that breast cancer prevention is possible and that estrogen will likely play a larger role.  If you’d like to explore if HRT is a good fit for you, please contact my office to schedule a consultation.

Heal Your Chronic Illness and Take Your Life Back

Heal Your Chronic Illness and Take Your Life Back

Mary Vallarta:

Hey everybody. Welcome back to the virtual summit. I’m your host, Mary Vallarta.  As you know, we are here to talk about healing your chronic illness and taking back your life.  Basically how to balance your mind, body, and spirit to restore your health and vitality.

Mary Vallarta:

Today I have Dr. Bruce Hoffman and I am super excited to chat with him. Before I get into the questions, let me tell you a bit about who he is. Dr. Hoffman is board certified in anti-aging medicine, has a master’s degree in clinical nutrition, and is a certified Functional Medicine practitioner. In addition to his clinical training, Dr. Hoffman has studied with many of the leading mind, body, and spiritual healers of our times, including Deepak Chopra, Osho, Ramesh Balsekar, and John Kabat-Zinn. He has shared the stage with Deepak Chopra and Dr. John Demartini, and he continues to spread his inspiring vision of healing and wellness with audiences and patients around the world. Once ensconced in the practice of family medicine, he quickly realized that his interests in medicine were broader than just drugs and surgery. The allopathic medical practice was limited to treating symptoms and illnesses but fell short of restoring the patient’s health entirely. So Dr. Hoffman embarked on a journey to understand what constitutes the human experience and what the triggers and mediators are that perpetuate human suffering.  He wanted to do this not only to help patients be free of disease but to realize their maximum potential.  Dr. Hoffman welcome. That is quite a resume.

Dr. Bruce Hoffman:

Nice to be here.  I’m looking forward to this conversation and seeing what we can come up with.

Mary Vallarta:

Me too. I’ve been looking forward to this conversation. I’m super energized to be speaking with you. Let’s get into it.  Dr. Hoffman, I love how you’ve combined the strengths of Western medicine with the mindful and spirit-centered approach of Eastern medicine. As your bio states, you didn’t actually start out this way. You were practicing Family Medicine. What pushed you to go into the path of functional and integrative medicine that takes mind, body, and spirit into account?

Dr. Bruce Hoffman:

Well, the part leading to where I am now is quite interesting in that when I was a young boy in my teenage years, I went to boarding school and I had a teacher there. My teacher was very interested in not only Western psychology, particularly the work of Carl Jung but also very interested in Eastern mythology and religions, particularly the work of a subset of the Vedantic Hindu medicine called Advaita. Advaita takes the point of view that there is no “there out there”. Everything springs from one source. So there is just one mind, one consciousness, and there is no separation. It’s a very specific way of looking at reality. Many of the quantum physicists who came onto the scene at the turn of the century had a very similar point of view. When they dissolved matter into light, they said, all light is continuous. There is no separation

Dr. Bruce Hoffman:

So this ancient, theological concept, was being married with Western physics. My teacher, Roger, I just hung out with him and we explored all these things and so I became very interested. When I was about 15 years of age, I had what they call a Satori experience, where I directly experienced this One Mind, One Reality. It descends upon you, and you just know that to be true. Before too long, you descend back into your dualistic past, present and future, gain and loss reality and the awareness is lost.  I still remember that. Then I had a second experience like that in my thirties. So having had two experiences of One Mind, One Reality. It sort of cemented, in my body based understanding, that was behind all systems of appearance.

Dr. Bruce Hoffman:

Nonetheless, I continued my high school education. My mother applied for me to go to med school. I had no idea. I find myself in med school. I wanted to be a poet, go hang out with all the beat poets in San Francisco, but my mother thought I should have a more formal education. So she applied for med school and I found myself in med school. Actually, after six years of medical training, I became a Family Physician and fell in love with it. I actually loved what I did. I ended up in Saskatchewan, Canada, practicing Family Medicine. When I got to Canada practicing Family Medicine, it was very apparent that that system of medicine is very limited in terms of what you can offer. We call it the N2 / D2 system of medicine. Name of disease, name of drug. That’s about it.

Dr. Bruce Hoffman:

But what happened was then I also came across a video by Dr. Larry Dossey, one of the great thinkers of the last 50 years in the field of integrative medicine. I watched Larry Dossey sort of draw out this long explanation as to how he combined East and West into his medical practice and his thought process. That triggered another huge explosion of interest and reignited my childhood experiences with my high school teacher and Advaita and psychology. All of a sudden this whole roadmap just opened up and I thought, this is a very interesting possibility. So I then just started learning as much as I could about the human experience. I became a student of as much as I could possibly absorb across all spectrums of human reality from toxicology to illumination. I started to develop a roadmap and with different teachers and different experiences and different ways of seeing and being exposed to different systems of information.  I did Ayurvedic training and they talk about different bodies, different systems of the body.  I spent time with a very well-known doctor from Germany who lives in Seattle by the name of Dr. Dietrich Klinghardt.  I spent years studying with Deepak Chopra and David Simon, et cetera, et cetera. And I just started to develop a roadmap for looking at the human condition from traditional medicine, then expanding it a bit to Functional Medicine and then moving to the brain and then to the emotions, then to the mental field, then to the soul and then to the spirit, which is beyond all confines to space/time. So I developed this roadmap of experiences at each level, diagnosis at each level, potential treatments at each level, because many people will want to go to an acupuncturist, which is at level three in this energy model, but they really should be seeing an oncologist or they’ll go to an oncologist where they really should be doing trauma work.

Dr. Bruce Hoffman:

I tried to sort out all these different possibilities across all layers and levels and help teach/write a new curriculum, really for doctors or healers. Not really doctors. MDs should keep doing what they do. They do it well. Every patient that sits in front of me says well, why doesn’t my doctor know this.  Well,  because it wasn’t his interest and he didn’t train to know this. So give it up. Don’t even ask the question, don’t waste your time. We need a new curriculum for a new expansive model. That’s been my life calling, my life passion, and to which I’m still a student. I mean, I study more now than I did when I was young. I just keep expanding the knowledge base.

Mary Vallarta:

I think that’s what makes your work so fascinating to me. You have sort of like a 360-degree view since you’ve been on the MD side, the family medicine side, and then you’re now continuing to learn more about the Eastern methodologies. So you’re kind of taking everything and putting it all together to make these roadmaps that you’re talking about.

Dr. Bruce Hoffman:

It’s not just Eastern, Mary,  it’s all systems of knowledge, you know, from phenomenology to theology, to psychology East to West, to up and down, it’s all layers, all levels. It’s not only Eastern insights. Some of it is Eastern, but it’s not only Eastern insights.

Mary Vallarta:

I see. Interesting. So integrating all that together is very fascinating and it gives you more of a well-rounded perspective. As you mentioned, MDs aren’t trained to have that type of approach. That’s why there’s a time and place where that’s going to be appropriate. There’s also another time and place where something else might be more appropriate for a patient. So I think that’s important to note. There is a lot of research coming to light on the important role that food plays on one’s ability to prevent disease and sometimes also reverse or heal. As you pointed out, there are such things called trauma. You’ll recommend people see some trauma specialists or stress. What are your thoughts on having more emphasis or focus on things like mindset, changing internal narratives, and healing emotional trauma when it comes to healing?

Dr. Bruce Hoffman:

One of the great challenges of working with patients is when they present with complex multi-system illness, which is the only kind of patient I see these days, they are still very in that diagnostic mindset of “what do I have”? Usually singular, what one thing do I have? Is it mold or Lyme or Mast Cell or whatever? Then they start to think diagnostically and therapeutically in an allopathic way. When you start to have a broad spectrum of understanding the human condition, and you start to understand all the antecedents, mediators, and triggers that eventually ended up in biology and pathology/disease, you can’t stop yourself from taking a far more comprehensive history. So the healer of the future can commit both acts of commission, as well as acts of omission. It’s not what he knows, but it’s also what he doesn’t know.

Dr. Bruce Hoffman:

So if you’re sitting in front of a patient and they are presenting  with symptomatology at this moment in space-time, it behooves you to ask every single possible trigger that may have led up to that presentation. It’s our Western understanding and consensual reality that diseases kind of fall out of the sky. It’s like, Oh, I’ve got rheumatoid arthritis. Then you can go to the doctor and get an immune modulator, or you can go to a naturopath and get an herb, but it’s still that singular mindset. When we look at patients from a more complex model, we have to start looking at not only diagnosis from a Western perspective, because you need to know that, that it’s an inflammatory and immune system-based disease based on autoimmunity, which has its links in leaky gut, et cetera, et cetera, and the genetic predisposition.

Dr. Bruce Hoffman:

You’ve got to know that, but you’ve also got to understand how people arrive at a point in time with a diagnosis. You know, people, they inherit epigenetically the traumas of their forefathers. So if you don’t ask a history of their forefathers and the ancestors you are missing out on a piece. Then they get born into a family system, and whether or not they were adequately seen by the mothers in the first 10 years and by their fathers in the second 10 years and peers, and by the loved ones in the third decade, they don’t adequately myelinate the three different brains that grow up, the reptilian, limbic and adult brains. So if they are not self-regulated by external parental figures, they don’t learn to self-regulate themselves and they have a fragile personality structure very often.

Mary Vallarta:

So how do you help them uncover all of this information?

Dr. Bruce Hoffman:

You’ve got to take a very thorough history. I take a two and a half to three-hour history and ask all of these questions.

Dr. Bruce Hoffman:

Then those experiences, your epigenetic transfer, ancestral trauma, early childhood experiences that all gets then translated into your perception of reality, your internal dialogue, your thoughts, your value systems, your beliefs, and your defenses. So many people stay highly defended from feelings that arose in the first 30 years of life because they are too painful. So they’re defended and they are traumatized. That then translates into electrical messages in the brain, which you can read on a qEEG. I have a brain treatment center, which reads qEEGs. You can see hallmarks of early trauma on the brain. You’ll see the one brainwave, the [1] beta brainwave highly red, highly amplified. That then gets turned into chemical signals. That then starts to interact with your phospholipid cell membranes, which you can measure, which then turn on receptors, which then turn on genes, which then turn on proteins, which then turn on all the biochemistry that runs your life.

Dr. Bruce Hoffman:

So you have this whole cascade of possible antecedents that can set you up for what’s happening at this moment with so-called symptomatology or disease expression, but it’s not just rheumatoid arthritis. It’s way back in the ancestry, trickling all the way down to physiology. And then you have the environment coming in. That plays havoc with your, your detox pathways and sitting on DNA. Sitting as adducts on your DNA and mitochondria affecting their expression of lipids and proteins. So if you don’t ask all these questions, you’ve got a limited roadmap and you got a couple of tools in your toolbox. You’ve got to have a very broad toolbox, and that’s why education becomes important. We have to educate healthcare providers of the future to broaden their toolbox. Not only to broaden their toolbox but also to broaden their self-understanding as well.

Dr. Bruce Hoffman:

If a healer approaches a patient with a hero type approach, I’m all-knowing, and you’re all sick. They also perpetuate a very lopsided point of view. The patient’s well side doesn’t get activated. They don’t activate the healthy part of who they are. They identify with the disease, the doctor as the hero is going to fix them. That’s a very lopsided relationship. Often patients sort of, in order to survive that lopsidedness, they just don’t activate their intent to do what is required for them to activate the healer within. The healing archetype within. Without activating that there’s no outcome.

Mary Vallarta:

Right. So would you say your approach is also about giving power back to the patient? Like letting them realize that they have a big role to play in their healing?

Dr. Bruce Hoffman:

We try to. Some people are highly defended.  People have value systems, a hierarchy of values. People will say that their health is a high value. They come to you to treat their health or help them treat their health. When you start to take a history, you’ll find out, particularly with men, by the way, this is like a big male thing. Their highest value is their career, making money, health is secondary. They often delegate their health to the loved ones, their spouses, or somebody else. They don’t really want to rob Peter, their career-making money, to pay Paul, to invest in their health. So they don’t raise health up as a value. Unless patients are prepared to raise health up as a value and become a participant in their own healing experience, they remain passive and they have what we call “projection of will”.

Dr. Bruce Hoffman:

They project their will to heal onto you. If you rise up in the healing archetype “I’m all-knowing, I’m going to fix you”, you start working harder than the patient. It’s a very lopsided relationship, almost doomed to fail. So you’ve got to try and enter into their system and sort of feel where they are in their own evolution.  Is health a high-value? How healthy is their ego strength? Is it fragile? How much projection of will do they have? Do they have outer resources to assist them or are they without resources? Do they have personality disorders? Do they have what it takes to take on such an extensive journey? And, of course, finances.  Most of this isn’t funded by healthcare systems and nor should it be because it would bankrupt most of them.

Mary Vallarta:

Right. Also, one of the most important questions for them to know the answer to is why do they want to heal? Why do they want to get better?

Dr. Bruce Hoffman:

On the first page of my 70-page questionnaire is “Why are you here, How can we help you, What is it you want to achieve?” and how committed are you to making the changes necessary? It’s interesting when it comes back 50% or 75% committed. Immediately I say we have to have this conversation first and find out what that’s about. Because if people haven’t been seen by their parents, if they haven’t been supported and challenged in a healthy, supportive, challenging way, which is how love evolves and how you develop a concept of self. You only develop a good concept of self, good ego strength if you are both supported and challenged by your parents, not just supported. If they don’t have a healthy sense of self, they can’t take on what is being required of them to sort of move through this experience. They just don’t have the resources to do so.

Mary Vallarta:

Right. That’s very true.

Dr. Bruce Hoffman:

You have to find out where they are with that, you know, and where is health in their value system. You really have to ask that question before you launch into “tell me about your disease”. You have to find out who this person is sitting in front of you and where they are at in their hierarchy of values as to doing what it takes to get better. You know, there are many possibilities for healing. The first possibility is just treating disease. Get this symptom out of me. I want to do it quickly without money and without me being involved, just give me a pill. Mahatma Gandhi said the tragedy of modern medicine is that it works. There’s that possibility. Then the other possibility is they see symptoms as teleological. Those symptoms are actually asking them to enter into their own life, to try and find out why they are this way in space-time. Then they see mind, body connections.  That the way that they construct reality may influence the systems they put in place to support them and the way they perceive things and what they eat, it all plays a role. So they become more conscious of their own advocacy. That’s the second possibility. The third possibility for healing are those people who do not only want to be free of disease, which is sometimes not possible, you’ve always got some symptomatology and, but they want to live at the highest maximum potential. To do that, they have to go through a lot of personal development and personal growth to know their value systems, to know how inspired they are. To find out what wakes them up every morning. Are they called from above by some spiritual purpose or do they just get out of bed and just sort of see what happens?

Mary Vallarta:

Right.  So that brings us back to the why.  Let’s talk more about maximum potential, because I know that’s a big part of your work. Can you describe what maximum potential is?

Dr. Bruce Hoffman:

Well, when a person wakes up in the morning inspired by what they do, that’s living at your maximum potential. They are living at their maximum potential. It’s a vision of what they are here to do on this planet while they’re in a body. In psychology, it was called a daemonic calling. Your inner constellated self calls you from above to become who you’re meant to be. So you’re just inspired to do what you do, and you know what you are meant to do and you throw all your life force into that outcome.

Mary Vallarta:

Which is basically their higher purpose.

Dr. Bruce Hoffman:

Their highest value, their highest purpose. They don’t need to be motivated to get out of bed. They get out of bed and just do what they do. They stay up very late at night trying to manifest it. Their life force is invested in it. There’s that old image that I love, if you will go to a university and you stand outside and you look at the different levels of a university, the undergraduate student’s lights go out at four o’clock, the postgraduate at six o’clock, the doctoral students at 10 o’clock and the Nobel prizewinner’s their lights get switched off at one o’clock in the morning. They are just called into the daemonic calling. They just know who they are and what they meant to do.

Mary Vallarta:

…and that’s what pushes them, yes.

Dr. Bruce Hoffman:

But that’s only the third possibility. The fourth possibility of healing is when you know that you are part of a connected whole. You don’t identify with your body, your emotions, your mind. You identify with that aspect of you that is beyond all of that.  Your deepest self, your soul, which is sort of linked to this one mind, this eternal consciousness. You know you’re not your body, you’re not your mind, you’re not your thoughts, but instead, you’re part of this continuous oneness and you stay connected to that in that field of consciousness that is that. I’ve had patients die, fully healed, connected to that aspect of themselves. They just know who they are. They know they are not their bodies, they’re not their minds,  they’re not their thoughts, they’re not their actions. They are beyond that.

Mary Vallarta:

That reminds me of the concept of  Satva  in Ayurveda.

Dr. Bruce Hoffman:

It’s called Brahmi in the Vedantic model.

Mary Vallarta:

Oh, nice. I’m just getting into more Vedic studies. I’m in Ayurveda right now, which I’m really loving. That’s really what inspired my own healing journey.

Dr. Bruce Hoffman:

I took my model from Ayurveda because I studied it for years and went to India and did an internship there.

Mary Vallarta:

That’s my dream. I want to go to India and study it one day.

Dr. Bruce Hoffman:

But they have these koshas, these bodies. I took that model and added a few and I made the seven stages to health and transformation model based on Ayurvedic and Vedantic scriptures.

Mary Vallarta:

Oh, got it. So what are those seven stages? Can you share them with us?

Dr. Bruce Hoffman:

Yes. Spirit, soul, mind, emotion, energy, physiology and structure, environment.

Mary Vallarta:

Okay. Interesting.

Dr. Bruce Hoffman:

Yeah. They are based on the five koshas from the Vedantic philosophy, the five bodies, the five layers.

Mary Vallarta:

So obviously when your patients are working with you, I can only imagine some of them get challenged. Right? Some of them might get frustrated during this whole process. So how do you go about helping them and supporting them push through or be comfortable with feeling this discomfort? Cause a lot of times people run away from discomfort.

Dr. Bruce Hoffman:

Again, it’s incumbent upon me if I’m doing a reasonable job, not to impose my model on them, but just ask what they want.

Mary Vallarta:

Ok, going back to that.

Dr. Bruce Hoffman:

Some people just want to not have asthma.  They’re not interested in seven levels of healing. I respect that. Then I pull out all my functional medicine, toxicology tricks, and just treat asthma.  Treat triggers of asthma such as mold and food sensitivities and Mast Cell blockade and mitochondrial resuscitation. I do all my functional medicine things. Other people come to me and say, I’ve been sick my whole life and they give you 50 symptoms. And you know, immediately that that person probably has not had the most advantageous experience from either ancestrally or from birth. Almost definitely you can tell that. The adverse childhood experiences studies show that people who’ve had adverse childhood experiences had three to four times increased health disadvantages as they mature.

Dr. Bruce Hoffman:

So you know when people tell you they’ve been sick for as long as they remember. You immediately go into early childhood trauma history and it’s always there. You can always tell. Interrupted bonds with their mothers. They have merged with mothers. They were sent off to boarding schools at young ages. They go to intensive care units and incubators and the mother has problems with the father so the mother takes her eyes off the child and doesn’t myelinate the child’s sense of self. Then mother’s offline. Then they have stillbirths and miscarriages and they’re all there in the history almost every time in a complex illness patient.

Mary Vallarta:

Hmm. So basically you meet them where they’re at.

Dr. Bruce Hoffman:

Yes, I tend to meet them where they’re at. You try and work out each level.  At level one what’s going on? Is it food? Is it mold? You do your normal medicine. Then you ask deeper questions. Are some of these symptoms teleological? Are these symptoms bringing patients to you because they have to heal a part of themselves that they never integrated in their evolution? For instance, I had a patient with MS whose father was a very famous sports coach and she never felt seen by her father, always neglected. She had a superego that is highly punitive, and she didn’t feel ever seen. So she was constantly beating herself up and attempting/strivinh to become more than she could possibly be. She tried and tried and tried, but dad was always coaching the team.

Dr. Bruce Hoffman:

Then the dad, when she was 18 or 19  I believe, her father got fired from the team. The next day she developed MS. The next day. That symptom was saying, dad, you were never there to take care of me. Now, look at me, I’m sick. He rose to the occasion. When he was fired, he was at home and he could be with his daughter. It was set up that way, that the symptoms drew that complexity together for it to be resolved. When she got that installed that she used that to use that in healing. It was very powerful. I have many, many cases and stories like that, where symptoms guide people to heal a part of themselves they’ve left behind.

Mary Vallarta:

Right. That is fascinating.

Dr. Bruce Hoffman:

Symptoms don’t fall out of the sky.  They have intent. In my experience.

Mary Vallarta:

Yeah. I think that the more I speak to all of the experts that I’ve talked to so far, the more I’m realizing that symptoms are really an opportunity for people to get to know themselves on a deeper level.

Dr. Bruce Hoffman:

I did a workshop with Mark Wolynn who is one of the great family constellations authors and workshop leaders out there. Once a year, we’ll do a workshop on illness and your family system and early developmental trauma. Almost to the person, we can link the rising of symptoms to events in the lifespan that needed to be resolved and healed. Once we linked them and made them conscious and gave them the homework to do, there was a vast new release of healing potential because you don’t heal until you have a new internal dialogue, a new story, a new narrative. If you have the old narrative, you create the same biochemistry. People with a new narrative, they have a new insight. It releases a potent internal life force that then constellates the biochemical pathways downstream to advocate healing.

Dr. Bruce Hoffman:

So we would do this workshop. Mark was a master at family constellations. Patients would sit next to him, and we would ask what their problem is and they’d say thyroiditis or leaky gut or Mast Cell, mold, whatever.  Then you’d say, well, tell me about your mother. Tell me about your father. Tell me about your grandparents and your siblings. Then he’d put up people in this constellation and worked with them energetically as to what was going on in the system and how their symptoms correlated with the dynamics of the system, the entanglements of the system. They could see how their symptoms didn’t just arise from nowhere. They were contingent upon some of these entanglements that needed to be healed. Once they saw what they hadn’t perceived before because children will often tell themselves a story that’s not true.

Dr. Bruce Hoffman:

They’ll say their mother was mean and angry, but their mother lost two children before they were born. The mother got very little from her mother. The mother was always bothered about the father who is out doing something or other. So the mother just had a little bit to give and unless the child sees that, and sees the mother through new eyes, the judgment of the mother will be there.  A person is half their mother, half their father. If they start judging half of themselves, guess what? They’re not open to the healing force, which is their whole self.  So everybody ultimately has to realign with their parental mothers and fathers. If you don’t say yes to your mother and father, your healing is going to be limited, no matter what you’ve experienced.

Mary Vallarta:

Because it’s pushing yourself away. They’re half of you like you mentioned.

Dr. Bruce Hoffman:

That’s the setup for auto-immunity by the way.

Mary Vallarta:

Oh yeah, because you’re rejecting yourself and autoimmune, right? Oh my God, that is powerful. I don’t even know what to say right now, but it shows how important it is to really understand yourself, but also understand your parents.  Also understanding your grandparents because your grandparents affected your parents’ psyche. It affected how your parents treated you.

Dr. Bruce Hoffman:

No question. 100%. There’s a one-to-one correlation.

Mary Vallarta:

So Dr. Hoffman, switching gears here a little bit because I’m also quite interested in anti-aging medicine, but I don’t know too much about it. Could you tell us a little bit about what that is?

Dr. Bruce Hoffman:

It’s a myth.  I’ve trained in it but there is no anti-aging medicine. It’s a nice sort of slogan for slowing down the process of aging. Okay. We all age. You’ve got the hormones of youth and you’ve got these drives.  In the first 30 years, you can do no wrong. You just push yourself through everything. Then entropy sets in and you start to sort of come apart slowly but surely.

Mary Vallarta:

You’re noticing it now.

Dr. Bruce Hoffman:

No question. The wrinkles and the skin sags.

Mary Vallarta:

The low back pain

Dr. Bruce Hoffman:

Then you get the inflammatory diseases of aging. Then you get separated into either heart disease or cancer or one of those things. They are all driven by genetics and environment and lifestyle and mind/ body.  The more inflamed you are by your lifestyle, the more unresolved you are with multiple triggers, the more interleukin six and tumor necrosis factor and all the inflammatory signalings are flying around, destroying your mitochondria, which then reduce your ATP, which then reduce your life force. So what we do in anti-aging medicine is try and slow down that trajectory before all is lost.

Mary Vallarta:

Yeah. There’s no way that you can stop yourself from aging. It’s just really about how to stop those symptoms of aging or delay them, right?

Dr. Bruce Hoffman:

Modify it so that your entropy isn’t like this.  Then you drop dead one day because your gene pools run out,  it’s time.

Mary Vallarta:

Yeah. It reminds me of my grandmother. She died, but she didn’t really die of any disease or illness. I think it was just because she was older and her body was just tired.

Dr. Bruce Hoffman:

The genes give up.  Everything ends.

Mary Vallarta:

Yeah. So share some of the most important things you’ve learned from your spiritual teachers. You’ve named a lot of big names, in your bio, like Deepak Chopra and Osho.

Dr. Bruce Hoffman:

So, here’s the answer. You probably won’t want this one.

Mary Vallarta:

Give us the real answer, not what you think we want to hear.

Dr. Bruce Hoffman:

People who’ve had difficult upbringings, who’ve had some complexity in their early developmental years, will often go to find spiritual teachers to take the part of the good parent that they feel they didn’t get. So whenever I have patients come in who have spiritual teachers and gurus, I’m very suspicious. Having had very many spiritual teachers and gurus myself. Having been to India three times and sat on many mountain tops meditating. So that’s the first insight that I really want to emphasize. It’s not wrong. It’s just when people don’t heal with their individual mothers and fathers, they’ll find a great mother and father that will look upon them benignly.

Dr. Bruce Hoffman:

You’ll find a lot of the great spiritual teachers who went to Burma and Thailand and India in the seventies, all of the Western students of spirituality. There are a lot of them. Jon Kabat-Zinn is one of them, Jack Kornfield is another. They all went and meditated for 15, 20 years, put on red robes and then came out of the forest, went back into cities of America, started to see people and all of a sudden realized, hold on a second, we are just performing spiritual bypass. These people have got messed up lives and they all went and became psychologists.  They all needed to heal the early traumas that people were trying to bypass to develop spiritual awakening. So that’s one of the greatest insights I’ve seen over the years. It’s not that spiritual teachers can’t provide some insight, but I always get a little uneasy when I see a guru sitting on a big white pedestal.  Then there are all of these devotees.  And I’ve done that for decades.  I’m judging myself.

Dr. Bruce Hoffman:

Then I just always ask, what is it about this experience that was being bypassed? What is it that they are trying to gain? What, what layer and level is still unfulfilled in their evolution? That’s what my curiosity is because an awakening experience into Satori is a sort of a brief exposure where you go beyond mind/ body and you actually know that everything is unified. There is no past/present/future. There’s nothing to fear and you’re sort of eternal,  immortal and you’re never born and you never die. That is what happens when you awaken.  But to sit in front of a guru to try and get that experience, I’m not sure that’s the best use of your time.

Mary Vallarta:

Yeah. I think it’s just an illustration of how you’re still searching for answers outside of you.

Dr. Bruce Hoffman:

That’s what Advaita says.  The essence of Advaita, which I learned at 15 was the very act of seeking prevents you from being who you are because you are that. So what are you seeking? You are already that thing.

Mary Vallarta:

What are you seeking? Exactly. I get that. That is really good advice when you think about it.  The answers are not out there. They are in here.

Dr. Bruce Hoffman:

Carl Jung said the urge to be whole is evolutionary. You can’t avoid it. Dianne Connelly said all sickness is homesickness. You try to come home to the most integrated aspect of who you are.  You can’t just go and sit with a guru.

Mary Vallarta:

That won’t give you the answers.

Dr. Bruce Hoffman:

It’s fun, and it’s very pleasant for a time. And I’ve done it for a long time, but you still got to go down the chakras and work your way through them. Early developmental trauma.  All of that stuff. You’ve got to heal that stuff.

Mary Vallarta:

If anything, it’s sort of a way where someone could continue resisting actually looking at themselves, getting to know themselves by sitting with a guru, and not ever advancing to internal examination.

Dr. Bruce Hoffman:

Perfect, perfect example you just gave.  It really does, in many cases, exemplify and exaggerate, the very pathology that’s brought them to the guru in the first place, which is resistance and projection. By sitting in front of the guru they are refusing to face the very thing that they need to face, which is themselves and their defenses.

Mary Vallarta:

Yes. Fascinating. So aside from sitting or seeing your patients, one-on-one Dr. Hoffman, you also actually have online programs and courses that people can take. Can you tell us a bit about what those are?

Dr. Bruce Hoffman:

Well, it’s funny, I used to do weekend workshops and all sorts of things. Then I condensed it all into a Friday afternoon lecture, a one-hour lecture for my new patients. Then the one-hour lecture became seven hours. I felt sorry for my patients. So then I took that lecture and made it into a book. So that book and those videos are available.

Mary Vallarta:

Nice.

Dr. Bruce Hoffman:

Yeah. So if you want to learn Seven Stages to Health and Transformation, I have a video and I have a PowerPoint explanation of it all, but I no longer lecture to that degree. I’m going back and starting to do lectures on different topics like Alzheimer’s disease and Mast Cell Activation and mold exposure and various aspects of mind-body healing. Those are in development. Most of the time now I’m helping other practitioners. Guiding them through this new curriculum of Seven Stages to Health and Transformation where not only do they learn new skills, but they learn about themselves.

Dr. Bruce Hoffman:

They have to stay congruent, they have to be present in that experience. I forgot to mention as part of my explanation, I went off at a tangent, that patients who don’t have good relationships with their parents have low trust. If they have medical PTSD or trauma from the medical system, that gets projected on you as a healer because all medical systems are very patriarchal and you are a parental figure. So if you’re sitting in front of a patient and there’s no trust established, there’s nothing you can do. So you have to ask that question first. You know I’m trying to teach people, other practitioners, how to be present with patients before they get more tools in their toolbox and go into courses and learn things.

Mary Vallarta:

That is so important.

Dr. Bruce Hoffman:

How to develop trust with a patient. Sometimes you can’t, they’re too traumatized and you try your best, but it’s just not possible.

Mary Vallarta:

But that just shows the role that each person plays. The role that the practitioner plays and also the role that the patient plays. If either one of them is not invested, it’s not going to yield the highest potential outcome.

Dr. Bruce Hoffman:

It won’t. Some people are too traumatized with too much mental health illness that they just can’t do what it takes to show up in that experience. Then you just have to admit that it’s not going to work out. You have to learn who is sitting in front of you. Also, know yourself through your own Myers – Briggs typology, through your own Ayurvedic typology,  you have to know if you’re Vata, Pitta, Kapha. Is that patient Vata, Pitta, Kapha because the Vata patient is not going to do what the Kapha patient does. They are an entirely different person.

Mary Vallarta:

Yeah. And then honoring and accepting that type of person and not projecting another type of person in that chair.

Dr. Bruce Hoffman:

If I’m a Pitta practitioner in my hero archetype and I know everything, I’m going to tell you what to do. And the Vatta patient walks in and is very sort of inspired for like three days and then they lose interest. If you impose your value system and your Ayurvedic typology or dosha onto them, and you don’t resonate and know how to treat Vata patients, you will lose them and you’ll feel frustrated.  Like a Kapha patient, they always show up, they never do what you asked them to do, or they do very little, but they’re always very loyal.

Mary Vallarta:

Very loyal. And we’re talking about Kapha, Vatta, Pitta. Those are the different dosha constitutions, that we talk about in Ayurveda.

Dr. Bruce Hoffman:

Then the Pitta patient, if you’re not the best in the city, they’ll leave you and go find the best.

Mary Vallarta:

They are looking for the facts. They’re like the fact-finder.

Dr. Bruce Hoffman:

You’re not sharp enough and don’t have the best office and are always on time….

Mary Vallarta:

You gotta check all the boxes for the Pitta patients.

Dr. Bruce Hoffman:

But as a practitioner, you’ve got to know who’s coming in the door because you’ve got to adjust the way you interact with them.  Knowing your Myers-Briggs typology as well, thinking people are not the same as feeling people. You’ve got to know that.

Mary Vallarta:

That’s very true. It’s sort of like detective work that you have to do when you work with your patients. Well, Dr. Hoffman, I can talk to you for hours. There are so many different questions that I can keep asking you, but for the sake of this particular interview, I’d like to ask if there’s anything else, one thing that you can leave us with here today that you didn’t get a chance to cover.

Dr. Bruce Hoffman:

In regards to talking to well people? Or people with complex illnesses? Or could you give you more direction?

Mary Vallarta:

Yeah. Well, the title of the summit is Healing Your Chronic Illness and Taking Your Life Back, meaning taking control of your health, right? Being the person and seeing the power that you have to own your life, to own your health. And so what would be the last thing that you’d want to leave us with here today?

Dr. Bruce Hoffman:

I think what’s most important is that people have to understand that if they present with chronic ill health or chronic complex illness, they have to try and find a practitioner who has a broad range of experience with multiple tools in their toolbox. They can’t just do one stool test and hope to heal. That’s number one.

Number two, they have to become their own patient advocates. If they are not invested in advocacy, there is very little that you can do.

Number three, they can’t project all the will to heal on the practitioner. They have to take some of that responsibility themselves.

Number four, they have to raise health up as a value. If the health isn’t one of the first or second values, it will default to number four or five, wherever you have your highest value, you will have your most order. Wherever you  have your lowest value you will have your most chaos. If health truly isn’t your highest value, be honest with yourself. Then look at it and say in the future, I will make it my high-value but right now I want to keep working and eating poorly and making money because that’s where my highest value is. Not wrong or right.  Just be honest and truthful and know your value system.

Mary Vallarta:

Wow. That is a great way to end the discussion. I feel like you beautifully summarized our conversation and added new thoughts to it. So I appreciate that. I will go ahead and make sure that I link Dr. Hoffman’s website, where some of his writings and programs are, so you all can take a look. I’ll also include that in the post-summit email. Dr. Hoffman, you’re also on social media. So what is your handle where people can find you and possibly connect with you there?

Dr. Bruce Hoffman:

So Instagram. My staff said, “make sure you say this at the end”.

So Instagram is www.instagram.com/drbrucehoffman/

Facebook is www.facebook.com/TheHoffmanCentreforIntegrativeMedicine/

and then the website is www.hoffmancentre.com.

I also have a brain treatment center, www.braintreatmentcentreofalberta.com I think those are all the handles.

Mary Vallarta:

Yeah. I mean, there are more.  Do you have a Tik Tok? Do you have a Twitter?

Dr. Bruce Hoffman:

Yeah. Yeah. Yesterday my Twitter account was activated by an assistant. I have no clue.

Mary Vallarta:

There you go. Well, Dr. Hoffman is on Instagram, so you can catch him there. I think that everyone’s on Instagram. So find him on IG. You should see the links in the handles below. Look at his website. There are a lot of resources there where you can get started if you are interested in everything that we’ve talked about. As Dr. Hoffman said, be truthful to yourself and meet yourself where you are. Stop, resisting, and meet yourself where you are, because that is an integral part of starting and continuing the healing journey.

Dr. Bruce Hoffman:

Also, the outer aspects of healing often in complex illness have to be congruent with inner healing too. You can’t just take a potion or herb. It’s much more complex than that. You’ve got to take a full system approach. There is a lecture being posted on my website soon on YouTube, where I give a 1 ½ hour lecture on the Seven Stages of Healing which will summarize some of the things we’ve mentioned.

Mary Vallarta:

Ooh, yes. I’m gonna watch that for sure. Okay. Thank you so much for joining us today. Hope you got a lot out of this.  Dr. Hoffman, you are amazing. Thank you for speaking with me.

Dr. Bruce Hoffman:

Yeah. It was nice talking with you.

Health Benefits of NAD+ Supplements

Health Benefits of NAD+ Supplements

NAD+ is a molecule that’s found in every cell of your body that plays many key roles in energy production, health, and longevity. Exciting research has uncovered why NAD+ is so essential and has led to many clinical applications, addressing everything from the signs and symptoms of aging to treating and preventing chronic disease.

In this article, you’ll learn more about:

  • What NAD supplement is
  • The two forms of NAD, namely NAD+ and NADH
  • The role NAD+ plays in health and disease
  • Why increasing levels of NAD+ is important
  • What sirtuins are and how they require NAD+
  • The role sirtuins and NAD+ play in vascular aging
  • Health conditions that benefit from increasing NAD+
  • The three ways the body produces NAD+
  • Natural ways to increase NAD+ levels in the body

What is NAD+?

A fair amount of attention has been given to NAD+, particularly for its ability to slow down the effects of aging. NAD+ stands for nicotinamide adenine dinucleotide and it’s used as a coenzyme in many molecular processes that keep your cells and body alive. A coenzyme is like an enzyme helper or assistant and needs to be available for the reaction to take place.

Adequate intracellular NAD+ levels don’t just prevent hastening of cellular aging. They also help to prevent the visible signs of aging that become apparent on the skin. The use of NAD treatment for addiction relies on the speedy delivery of NAD IV therapy and there are numerous NAD+ addiction clinics operational in the United States.

The NAD+ molecule is found in every cell in the body, enabling the conversion of food we eat into energy and chemical products that the body needs to sustain itself. This is very important, since the health and function of every cell relies on this tiny molecule.

NAD+ also plays a critical role with enzymes that regulate gene expression involved in the repair of damaged DNA. Through these pathways, NAD+ influences a variety of processes involved in every cell in your body, improving mitochondrial efficiency, enhancing cell viability, down-regulating inflammation, increasing the antioxidant capacity of cells and tissues, and activating SIRT1, a sirtuin enzyme that plays a role in longevity.

NAD+ and NADH are two different forms of the same molecule, picking up and dropping off electrons. This energy exchange of electrons is what allows the Krebs cycle and electron transport chain to produce ATP, the energy currency in humans. When it picks up an electron, this is NADH, while without the electron it is known as NAD+.

The role of NAD+ in health and disease

Several of these critical roles have already been mentioned, but let’s take a closer look at some of the life-sustaining benefits of NAD+ .

NAD+ is a cofactor for hundreds of enzymatic reactions, such as chromosomal stability and DNA repair. DNA damage is linked to deteriorating chronic health problems, as recently discussed by Robert Naviaux and his theory of the Cell Danger Response.

NAD+ also plays a vital role in energy production, in the Krebs cycle conversion of macronutrients including protein, fats and carbohydrates, and micronutrients such as vitamins and minerals, to ATP. This is the energy molecule that’s crucial to the running of all the body’s essential functions.

In addition, NAD+ is also a cofactor for hundreds of similar enzymatic reactions that are involved in:

  • Immune cell signaling and immune strengthening
  • Decreasing inflammation
  • Decreasing oxidative stress and ‘rusting’ of cells
  • Telomere production, with longevity enhanced by longer telomeres
  • Neurotransmitter production
  • A healthy circadian rhythm and sleep cycle
  • Increased activity of sirtuins, which play a role in longevity (see more on this below)
  • Prevention of blood vessel damage that reduces the risk of heart disease
  • Healthy aging

The importance of increasing levels of NAD+

NAD+ plays a central role in every one of the body’s functions. We simply can’t do without it. In addition, if we boost its levels, we can further optimise cell functions and energy outcome. Unfortunately, as we age levels of NAD+ decline, leading to signs and symptoms of aging.

Low levels of NAD+ are associated with:

  • Accelerated aging
  • Increased sunburn and skin cancer
  • Decreased cellular antioxidants
  • Decreased metabolism along with thyroid hormones
  • Harmed immune function
  • Increased inflammation
  • Impaired brain function
  • Hypoxia (low levels of oxygen) intracellularly

When NAD+ levels are higher and more robust, we see the following:

  • Improved mitochondrial health
  • Improved cellular metabolism and energy production
  • Improved production of sirtuins
  • More NAD anti-aging benefits
  • Improved DNA repair and recovery
  • Increased immunity, with NAD+ stimulating CD38 that’s present on T-cell immune cells, effectively boosting the immune response
  • Stimulation of CD38 activity increasing oxytocin, a hormone associated with social intimacy and bonding
  • Increased autophagy or cellular recycling
  • Increased redox potential, with more antioxidant action protecting cells
  • Improved insulin sensitivity, decreasing the risk of metabolic syndrome and diabetes
  • Improved protection of brain cells from oxidative stress, rescuing neuronal loss and improving myelination
  • Improved skin health by boosting levels of collagen, keratin, elastin, and hyaluronic acid, a compound found in many skin rejuvenating creams
  • Increased stem cells
  • Improved exercise performance

NAD+ provides these benefits through several key mechanisms, including:

  • Promoting AMPK activity, an enzyme that improves metabolism and helps protect against obesity and diabetes.
  • Modulating p53, a tumor suppressor gene that repairs damaged DNA and protects against cancer initiation
  • Inhibiting NF-kB or nuclear factor-kappa B, a protein that induces the chronic inflammation tied to many diseases and premature aging
  • Inhibiting mTOR, a molecular complex whose abnormal activation contributes to many chronic diseases of aging

Sirtuins and NAD

Sirtuin is an acronym for ‘silent information regulator’. This refers to any family of enzymes, made up of proteins, that occur in all living organisms. They’re thought to regulate a wide array of cellular processes such as cellular aging, apoptosis, and stress resistance in more complex organisms. It’s been demonstrated that increasing sirtuin activity leads to longer life and reduction in age-related loss of function. It also protects against DNA damage. NAD levels decline with aging, which also results in reduced sirtuin activity. Boosting NAD+ helps to ramp up this activity.

Seven sirtuins have been identified and play different roles in the body.

  • Sirtuin 1 (SIRT1) repairs DNA and vascular tissue and is highly dependent on NAD+ levels
  • Sirtuin 2 (SIRT2) reduces body fat and oxidative stress
  • Sirtuin 3 (SIRT3) influences longevity
  • Sirtuin 4 (SIRT4) can repress tumors and autophagy
  • Sirtuin 5 (SIRT5) reduces fatty acids in the liver and oxidative stress
  • Sirtuin 6 (SIRT6) regulates blood sugar and decreases insulin resistance
  • Sirtuin 7 (SIRT7) benefits the heart

NAD+, sirtuins, and vascular aging

As we age, our small blood vessels die off. This compromises blood flow and the oxygenation of organs and tissues that are fed by these small vessels. Vascular aging is responsible for a constellation of disorders, such as cardiac and neurological conditions, muscle loss, impaired wound healing, and overall frailty.

Dr. David Sinclair, a researcher at the Department of Genetics at Harvard Medical School and a co-director of the Paul F. Glenn Center for the Biology of Aging at Harvard Medical School, has discovered a way to reverse vascular aging by boosting the presence of naturally occurring molecules in the body that augment the physiological response to exercise. He states that, “The approach stimulates blood vessel growth and boosts stamina endurance in mice and sets the stage for therapies in humans to address the spectrum of diseases that arise from vascular aging.”

Dr. Sinclair’s study revealed that NAD+ and SIRT1 enable the conversation between endothelial cells in the walls of blood vessels and muscles, but specifically the cells in young mouse muscles, activating SIRT1 signaling generating new capillaries that supply oxygen and nutrients to tissues and organs. Conversely, the study demonstrated that as NAD+/SIRT1 activity diminished over time so did blood flow, which left muscle tissue deprived of nutrients and starved of oxygen.

Dr. Sinclair gave an NAD supplement, as an NAD+ precursor, for two months to a group of mice that were twenty months old, roughly equivalent to seventy in human years, to test its effect on SIRT1 signaling. The treatment worked and restored the number of blood capillaries and capillary density to those seen in younger mice. Blood flow to the muscles also increased and was more significantly higher than blood supply to the muscle seen in mice of the same age that didn’t receive the NAD+ precursor.

The most striking effect emerged in the aging mice’s ability to exercise. These animals showed a 56 to 80 percent greater exercise capacity when compared to that of untreated mice. It was concluded that this observation underscored the notion that age plays a critical role in the crosstalk between blood vessels and muscles. This points to a loss of NAD+ and SIRT1 as the reason behind the reduction in exercise effectiveness after middle age. The researchers believe that their findings might pave the way to therapeutic advances that might be able to help the millions of older people for whom regular physical activity is no longer an option.

“Even if you’re an athlete you eventually decline,” Sinclair says. “But there is another category of people – what about those who are in a wheelchair or those with otherwise reduced mobility?”

Dr. Sinclair’s mouse study suggests that NAD+ may support exercise performance in humans. In a study involving elderly men, supplementation with an NAD+ precursor resulted in improved exercise performance. The men had an 8 percent improvement in peak isometric muscle torque, which is a measure of muscle force, and a 15 percent improvement in lessening of fatigue associated with exercise.

Health conditions that benefit from increased NAD+

Considering what we’ve explored regarding NAD+ energy production in every cell and the importance of this molecule in all aspects of health and longevity, it’s no surprise that NAD+ may benefit a number of health conditions, including chronic disease. Conditions that may benefit from increased levels of NAD+ in the cells include:

  • Addiction
  • Allergies
  • Neurological deficits
  • Depression
  • Brain injury
  • Cholesterol metabolism issues
  • Cancer
  • Chronic fatigue syndrome
  • Fibromyalgia
  • Irritable bowel syndrome (IBS)
  • Diabesity spectrum, including obesity, metabolic syndrome, and Type 2 diabetes
  • Systemic inflammation
  • Lyme disease
  • Malabsorption syndromes
  • Parkinson’s disease
  • Alzheimer’s disease
  • Huntington’s disease
  • ALS
  • PTSD
  • Autism spectrum
  • Small bowel overgrowth syndrome (SIBO)
  • Cardiovascular disease
  • Multiple sclerosis
  • Hearing loss
  • Renal disease

NAD+ pathways of production

There are three major pathways that our body employs to synthesize in NAD+. Influencing and activating these pathways are a way to increase NAD+ within the cells of the body.

The first pathway is the de nova synthesis from the amino acid tryptophan from food protein sources, which also intersects with vitamin B3. This is the long way round.

The second is a salvage pathway, used by the supplement company PRICERA, that our body uses daily to recycle nicotinamide (NAM) according to circadian rhythms. This is the dominant and most robust path for any NAD+ synthesis.

The third pathway is specialized for nicotinamide riboside (NR) reactivation. NR is a shunt product in NAD+ synthesis.

The supplement company claims that PRICERA is the only available compound that utilizes the naturally dominant pathway to generate NAD+ efficiently and robustly. This product is said to improve the tissue distribution of NAD+, maintain and enhance mitochondrial health and creation, and plays a key role in calorie restriction for increased lifespan and exercise response. PRICERA is also said to prevent neurodegeneration and reduce age-related cognitive decline. In addition, it’s claimed that PRICERA increases ATP and maintains antioxidant levels including glutathione, which generally becomes depleted with higher energy requirements or when we’re under stress.

PRICERA differs from other NAD precursor products in that it includes D-ribose, a known source of energy for the mitochondria in the heart, brain, and muscles. Other NAD precursor products need ATP to prime the pathway. However, since PRICERA spares the body’s own energy, one of its key applications may be to serve individuals with compromised mitochondrial function. This can actually hamper performance under oxidative stress.

How To Raise NAD+ Naturally

Fasting, calorie restriction, exercise, and NAD boosters increase the intracellular levels of NAD+, activate SIRT1, and have other physiological benefits. There are a number of ways to boost your NAD+ levels naturally through lifestyle change, diet, and supplementation.

When we exercise, we use up NAD+ and replenish it rapidly. As a result exercise can help us to build up our reserves.

When we burn fat for energy instead of carbohydrates, we preserve adequate levels of NAD+ and increase levels of NAD+ in the brain. This reduces DNA damage in the hippocampus, which is the location of memory storage. Ketosis is achieved by following a ketogenic diet. In addition, ketosis might be enhanced for part of the day through practices such as intermittent fasting, fasting mimicking, or periodic longer fasts. Calorie restriction and intermittent fasting will also increase NAD+ levels.

Vitamin B3 or niacin supplements, along with foods rich in vitamin B3, such as green vegetables, chicken, portabella mushrooms, rice, nuts, tuna, although you need to be careful of mercury, will benefit the body’s NAD+ production. Niacin is believed to act as a building block for NAD+ levels. Lycopene-rich foods, such as tomatoes, also help to prevent NAD+ depletion.

You can take a NAD+ supplement orally or apply it to your skin. When taking an oral preparation you have to take a precursor molecule, as NAD+ will break down in your gut without being absorbed. Nicotinamide riboside (NR) is this type of NAD+ precursor.

NAD IV may be an option for individuals with certain conditions such as addiction, who have access to this type of therapy. NAD+ bypasses the gut and is delivered directly to the bloodstream, where it can enter cells.

NAD repletion strategies, such as those outlined above, have shown therapeutic potential as a means to restore a healthy metabolism and physiological function. Many health conditions are multifactorial and require a root cause approach. Bearing in mind the robust and expanding research on NAD+ I’m often considering NAD+ depletion as a factor in patient’s cases, working with them to restore these pathways and reap all of the physiological and anti-aging benefits.

To work together one-on-one, please contact my office for an appointment.