New Millennium Medicine

559 . 297 . 3700

2131 Herndon Avenue
Suite 101
Clovis CA
93611

M-F 8:00 AM  –  5:00 PM

Adrenal fatigue is a common, underdiagnosed problem that may affect up to 80% of us at one time or another during our lifetimes. It is caused by excessive stresses, be they physical, emotional, psychological, environmental, infectious, or any combination of these.

Our adrenal glands respond to any type of stress (be it good or bad) by secreting cortisol, adrenaline (epinephrine) and noradrenalin (norepinephrine). The adrenals are also responsible for secreting aldosterone (which regulates salt balance) and sex hormones, most notably DHEA (dihydroepiandrosterone) which is the mother hormone of testosterone and estradiol. Cortisol, however is the hormone that helps us to recover from the stress.

Life stresses can be traumatic such as death of a loved one, divorce, life-threatening medical illness or accident. However, stresses can be smaller and cumulative such as workplace stress, unhappy relationships, environmental toxins such as alcohol, mercury or pesticides, a poor diet high in sugar and refined carbohydrates, too much or too little exercise, an abscessed tooth, chronic allergies or sinus infections, to name a few. Each time as stress occurs it taxes the adrenal glands. If the amount of stress is too great for the body to compensate for due to the magnitude or the number of stressors, the capacity to recover had been exceeded and adrenal fatigue then results.

Dr. James Wilson, a naturopath and chiropractic is the one who coined the term “Adrenal Fatigue” and has been a pioneer in addressing this problem. He notes that the primary components of lifestyle leading to adrenal fatigue are lack of sleep, poor food choices, using food and drinks as stimulants when tired, staying up late even though fatigued, being constantly in a position of powerlessness, constantly driving yourself, trying to stay perfect, staying in no-win situations over time, and lacking enjoyable and rejuvenating activities.

Common symptoms of adrenal fatigue are difficulty getting up in the morning. This person usually needs several caffeinated beverages then wakes up at 10a.m. but often crashes after lunch.  Energy often is best after dinner and if patients can stay up past 9 p.m. they can get their best work done between 10 p.m. and 1 a.m. but then can’t get up the next day as they find their most refreshing sleep occurs between 6 and 9 a.m. There is often a craving for salty as well as sweet foods.  For people with adrenal fatigue everything seems like a chore and they feel like they are walking around with cement shoes on.  Sex drive is decreased and it can cause hot flashes in women. There is a decreased ability to handle everyday stresses and increased time to recover from illnesses, trauma or injury.  There can be lightheadedness with standing and mild depression with a decreased enjoyment of life. Women may have aggravation of PMS symptoms. Memory may be foggy, thoughts less focused, and more fuzzy. All symptoms may be worsened if meals are skipped. This is not a comprehensive list but does include some of the more common symptoms of adrenal fatigue.

Diagnosing adrenal fatigue is best test done by salivary testing which is obtained at four daily intervals. The first specimen is obtained in the morning one hour after rising, the second between 11 and 1 p.m., the third between 3 and 5 p.m. and the fourth between 10 p.m. and 12 a.m.  This is necessary because the adrenal gland’s output of cortisol varies during the day and blood testing does not accurately reflect levels of this hormone. The levels of cortisol are highest early in the morning.  This is what wakes you up.  Levels decrease during the day and are lowest at night, allowing us to go to sleep. Treatment of adrenal fatigue is complex and comprehensive.  Dr. Wilson’s book Adrenal Fatigue is an excellent self-help guide to changing a person’s lifestyle to heal the adrenals.  There are a number of vitamins and minerals that are important, the most significant of which is vitamin C, which is concentrated by the body in the adrenal
glands.  Depending on the extent of the adrenal fatigue we will add herbal treatments such as licorice root, ashwagonda, Siberian ginsing or maca.  In severe cases we may also add adrenal extract from animals.  Replacement with cortisol is reserved for the most severe cases.  As an anti-aging physician doing bio-identical hormone replacement, I find it is nearly impossible to normalize a person’s sex hormones unless the underlying adrenal fatigue is addressed and treated. Unfortunately, it often takes between 6 and 24 months to heal a person’s adrenal glands through lifestyle changes, vitamins, minerals, and herbs, so treatment is an exercise in patience, especially in our fast paced world that demands immediate results.

As an allopathic physician, five years ago I felt adrenal fatigue was a bogus and completely unsubstantiated diagnosis. After having learned about adrenal fatigue and studying it in the American Academy of Anti-Aging Medicine’s Fellowship program, I have been able to diagnose it and treat it (in family members as well as patients) with gratifying results.

Prolotherapy is a safe and simple, yet elegant method to stimulate the body’s natural healing processes. By injecting a substance (most commonly dextrose, i.e. sugar) onto a ligament or tendon, a local inflammatory process is created.

This is actually a good inflammatory process and triggers the growth and proliferation of new cells of collagen. This good inflammation can result in healing and thickening of damaged or frayed tendons and ligaments.  It cannot work for torn tendons, though there is a recent report of prolotherapy healing a torn anterior cruciate ligament of the knee.

Over time and as we age damage occurs at ligament bone junctions. This causes loosening of the ligaments, which then results in pain or subsequent arthritis as the body tries to compensate for the loose ligaments by laying down calcium to stabilize the joint.

We all know how a very bad sprain may cause more future pain and arthritis than a well-healed fracture. The pain we feel from arthritis when the weather changes is due to baroreceptors, however, these baroreceptors are located in the ligaments, not the joints.

What does prolotherapy work for? Prolotherapy works for neck pain, headaches, tempromandibular joint pain, and all types of back pain including some types of sciatica. It can be used successfully for rib, hip, knee, shoulder, ankle, elbow, wrist, and finger pain. One should consider trying prolotherapy before submitting oneself to certain types of joint surgery as prolotheray can increase collagen and relieve pain. Prolotherapy does not work for severe herniated discs or for torn tendons. Prolotherapy will not work if a person is taking an NSAID (non steroidal anti-inflamatory drug such as naproxen, ibuprofen or aspirin). NSAIDs interfere with the good inflammatory process that prolotherapy is trying to create. Interestingly, cortisone does not interfere with prolotherapy’s inflammatory process.

How is prolotherapy performed?  After a general examination, the anatomy of the affected area is drawn with an eyeliner.  (This prevents the formation of any tattoos.)  The affected area is then palpated and each tender area is marked. Each tender spot will be given a local lidocaine injection and then each is then given a prolotherapy injection of 15% dextrose mixed with saline and lidocaine.  Depending on the area, there can be multiple injections. While not pleasant, multiple injections are tolerable.  One must refrain from any NSAIDs for 6 weeks to allow for healing.  We usually perform a repeat treatment in 6 weeks but shorter intervals are possible.  If there is no relief by the third treatment, it is unlikely that prolotherapy will be helpful.  Many times, one treatment can be adequate for sustained pain relief. Retreatment may be necessary but may not be needed for months.

Dr. Wingert has been to Honduras three times with the Hackett-Hemwall Foundation working in prolotherapy clinics.  These free clinics have been in operation for over 40 years and draw physicians from all over the world.  We perform prolotherapy on people eight hours each day and they often travel hours to come to the yearly clinics.  We have seen many patients who tell us about the relief they received the year before and now would like a different joint treated.  The Hackett-Hemwall Foundation also has yearly clinics in Mexico and the Phillipines.

Adrenal fatigue is a common, underdiagnosed problem that may affect up to 80% of us at one time or another during our lifetimes. It is caused by excessive stresses, be they physical, emotional, psychological, environmental, infectious, or any combination of these.

Our adrenal glands respond to any type of stress (be it good or bad) by secreting cortisol, adrenaline (epinephrine) and noradrenalin (norepinephrine). The adrenals are also responsible for secreting aldosterone (which regulates salt balance) and sex hormones, most notably DHEA (dihydroepiandrosterone) which is the mother hormone of testosterone and estradiol. Cortisol, however is the hormone that helps us to recover from the stress.

Life stresses can be traumatic such as death of a loved one, divorce, life-threatening medical illness or accident. However, stresses can be smaller and cumulative such as workplace stress, unhappy relationships, environmental toxins such as alcohol, mercury or pesticides, a poor diet high in sugar and refined carbohydrates, too much or too little exercise, an abscessed tooth, chronic allergies or sinus infections, to name a few. Each time as stress occurs it taxes the adrenal glands. If the amount of stress is too great for the body to compensate for due to the magnitude or the number of stressors, the capacity to recover had been exceeded and adrenal fatigue then results.

Dr. James Wilson, a naturopath and chiropractic is the one who coined the term “Adrenal Fatigue” and has been a pioneer in addressing this problem. He notes that the primary components of lifestyle leading to adrenal fatigue are lack of sleep, poor food choices, using food and drinks as stimulants when tired, staying up late even though fatigued, being constantly in a position of powerlessness, constantly driving yourself, trying to stay perfect, staying in no-win situations over time, and lacking enjoyable and rejuvenating activities.

Common symptoms of adrenal fatigue are difficulty getting up in the morning. This person usually needs several caffeinated beverages then wakes up at 10a.m. but often crashes after lunch.  Energy often is best after dinner and if patients can stay up past 9 p.m. they can get their best work done between 10 p.m. and 1 a.m. but then can’t get up the next day as they find their most refreshing sleep occurs between 6 and 9 a.m. There is often a craving for salty as well as sweet foods.  For people with adrenal fatigue everything seems like a chore and they feel like they are walking around with cement shoes on.  Sex drive is decreased and it can cause hot flashes in women. There is a decreased ability to handle everyday stresses and increased time to recover from illnesses, trauma or injury.  There can be lightheadedness with standing and mild depression with a decreased enjoyment of life. Women may have aggravation of PMS symptoms. Memory may be foggy, thoughts less focused, and more fuzzy. All symptoms may be worsened if meals are skipped. This is not a comprehensive list but does include some of the more common symptoms of adrenal fatigue.

Diagnosing adrenal fatigue is best test done by salivary testing which is obtained at four daily intervals. The first specimen is obtained in the morning one hour after rising, the second between 11 and 1 p.m., the third between 3 and 5 p.m. and the fourth between 10 p.m. and 12 a.m.  This is necessary because the adrenal gland’s output of cortisol varies during the day and blood testing does not accurately reflect levels of this hormone. The levels of cortisol are highest early in the morning.  This is what wakes you up.  Levels decrease during the day and are lowest at night, allowing us to go to sleep. Treatment of adrenal fatigue is complex and comprehensive.  Dr. Wilson’s book Adrenal Fatigue is an excellent self-help guide to changing a person’s lifestyle to heal the adrenals.  There are a number of vitamins and minerals that are important, the most significant of which is vitamin C, which is concentrated by the body in the adrenal
glands.  Depending on the extent of the adrenal fatigue we will add herbal treatments such as licorice root, ashwagonda, Siberian ginsing or maca.  In severe cases we may also add adrenal extract from animals.  Replacement with cortisol is reserved for the most severe cases.  As an anti-aging physician doing bio-identical hormone replacement, I find it is nearly impossible to normalize a person’s sex hormones unless the underlying adrenal fatigue is addressed and treated. Unfortunately, it often takes between 6 and 24 months to heal a person’s adrenal glands through lifestyle changes, vitamins, minerals, and herbs, so treatment is an exercise in patience, especially in our fast paced world that demands immediate results.

As an allopathic physician, five years ago I felt adrenal fatigue was a bogus and completely unsubstantiated diagnosis. After having learned about adrenal fatigue and studying it in the American Academy of Anti-Aging Medicine’s Fellowship program, I have been able to diagnose it and treat it (in family members as well as patients) with gratifying results.

Acupuncture is a method of encouraging the body to promote natural healing and to improve functioning.  This is done by inserting needles and applying heat or electrical stimulation at very precise Acupuncture points.

Acupuncture: How does it work?

Classically, the traditional Chinese explanation involves channels of energy that travel in regular, well-defined patterns throughout the body and on its surface.  These energy channels, called meridians, are like rivers flowing through the body to irrigate and nourish the tissues. An obstruction in the movement of these energy rivers is like a dam that backs up the flowing in one part of the body and restricts it in others.

Needling the Acupuncture points can influence the meridians. The Acupuncture needles unblock the obstructions at the dams and reestablish the regular flow thorough the meridians.  Acupuncture treatments can therefore help the body’s internal organs correct imbalances in their digestion, absorption and energy production activities, and in the circulation of their energy through the meridians.

The scientific explanation as to how Acupuncture works theorizes that needling the Acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord and brain.  These chemicals will either change the experience of pain or they will trigger the release of other chemicals and hormones which influence the body’s own internal regulating system.  The improved energy and biochemical balance produced by

Acupuncture results in stimulating the body’s natural healing abilities, and in promoting physical and emotional well-being.

How is Medical Acupuncture different from ordinary acupuncture?

Acupuncture is a very old medical art (in fact, there were Acupuncture points for back pain tattooed on the back of an Alpine ice age mummy found embedded in a retreating glacier), and there are many approaches to learning and practicing it. Medical Acupuncture is the term used to describe Acupuncture performed by a physician trained and licensed in Western medicine who also has had thorough training in Acupuncture as a specialty practice.  The UCLA School of Medicine course on Acupuncture trains physicians in several types of Acupuncture so that they can use multiple approaches and/or combinations with Western medical techniques to treat an illness.  Dr. Wingert completed the six-month UCLA program in November of 2000.

What is the scope of Medical Acupuncture? What can be treated?

Medical Acupuncture is a healing system that can influence three areas of health care:

1          Promotion of health and well being

2          Prevention of illness

3          Treatment of various medical conditions

While Acupuncture is most often associated with pain control, in the hands of a well-trained practitioner it has much broader applications.  Acupuncture can sometimes be used effectively as the only treatment, or as the support or adjunct to other medical treatment forms for many medical problems, which may include:

• Digestive disorders: gastritis and hyperacidity, spastic colon, constipation, diarrhea
• Respiratiory disorders: sinusitis, sore throat, bronchitis, asthma, allergies
• Neurological and muscular disorders: headaches, facial tics, neck pain, rib neuritis, frozen shoulder, tennis elbow, carpal tunnel, various forms of tendonitis, low back pain, sciatica, osteoarthritis
• Urinary, menstrual and reproductive disorders:  female infertility
• Physical problems related to tension, stress and emotional conditions

How many treatments will be needed?

The number of treatments needed differs from person to person. For complex or long standing conditions one or two treatments per week for several months may be recommended.  Unfortunately, not all conditions respond to Acupuncture; it may take six to twelve visits without improvement before it is decided that treatment was not successful.  For acute problems, usually fewer visits are required, and for health maintenance, four sessions a year may be all that is necessary.  The number of treatments is based upon an individual’s response.  Acupuncture treatments build upon themselves and once improvement occurs the time between treatments is usually extended.

What are the needles like and do they hurt?

People experience Acupuncture needling differently.  Most patients feel only minimal pain as the needles are inserted.  There will often be a dull achy sensation when the meridian energy is contacted.  Once the needles are in place, pain is rarely felt.  Acupuncture needles are very thin (far thinner than hypodermic needles), solid and made of stainless steel.  The tip is actually smooth (not hollow with cutting edges like a hypodermic needle) and as it is inserted it pushes the tissues aside, thus minimizing trauma.  The risk of bruising and skin irritation is less than when using a hollow needle.  There is little to no risk of infection as Dr. Wingert uses sterile, disposable needles.

Does acupuncture really work?

The simple answer is yes.  The first textbook on Acupuncture was written 150 years before the birth of Christ.  Since that time, more people have been successfully treated with Acupuncture than with all other health modalities combined.  Today, Acupuncture is practiced in Asia, the former Soviet Union, and Europe.  Its acceptance is increasing in the United States and Canada as more physicians and patients are exposed to it.  You do not have to “believe” in Acupuncture to have it work, as there are well-identified Acupuncture points on animals for the treatment of their illnesses.

Testosterone, Andropause, and PSA screening

The male menopause is called the Andropause and is a result of testosterone deficiency. It is not as dramatic as the female menopause because it occurs more slowly over time but it has serious consequences. Low testosterone is associated with increased heart attacks, strokes, high cholesterol, diabetes, metabolic syndrome, arthritis, weight gain, osteoporosis, Alzheimer’s disease and increased inflammation. Symptoms of testosterone deficiency include decreased sex drive and function, poor memory, fatigue, pain in joints and muscles, loss of muscle, fat gain, loss of self confidence, depression and anxiety. (Consider the grumpy old man as testosterone deficient).

For some reason, testosterone levels are declining. In 1987 the average testosterone level of a 60 year old male was 500 but in 2004 it was a little above 400. There are many theories as to the cause of this decline; most involve environmental toxins such as PCBs (polychlorinated biphenyls), pesticides, other plastics (xenoestrogens), and estrogens from water contaminated by birth control pills.

There is concern in the medical community that testosterone can cause heart attacks Unfortunately this is not true. A 10 year study of over 11,000 men showed that men who had naturally high testosterone levels had lower rates of mortality from cardiovascular disease and cancer and no increase in prostate cancer. The men who had low levels of testosterone had a much higher mortality from heart disease.

With regard to prostate cancer it has been widely held that testosterone fuels the growth of prostate cancer. Regrettably, this conclusion was based on one patient in 1941.
Numerous studies have since shown that serum concentrations of sex hormones were not associated with the risk of prostate cancer. Prostate cancer is a disease of an aging man whose testosterone levels are declining so how can it be logical that testosterone causes the cancer to grow? It doesn’t necessarily.

Testosterone has been shown to reduce angina, dilate coronary arteries, and increase cardiac output. The higher the testosterone level the lower one’s blood pressure. Testosterone improves cerebral blood flow, memory, diabetes as well as depression. It also strengthens muscle and bone.

Testosterone can be measured by blood, saliva or urine. Most hormones are attached to binding proteins in the blood, thus only a small amount is bioavailable to the body. Most blood tests do not take this into consideration and thus may overestimate the true level. When measuring testosterone it is important to measure SHBG (Sex Hormone Binding Globulin) and serum albumin. These numbers are used with the total testosterone level to then calculate the bioavailable testosterone.. Testosterone can also be measured through salivary testing and 24 hour urine testing. With these latter 2 tests we can also measure levels of other important hormone such as cortisol, DHEA, progesterone and estrogens. The 24 hour urine test measures the previous hormones as well as the estrogen metabolites (compounds that the body changes the estrogens to). These estrogen metabolites are important for both men and women as high levels of some of the estrogen metabolites increase the risk or either breast cancer for women and prostate cancer for men. In fact, these estrogen metabolites may be key to understanding the development of prostate cancer.

Testosterone can be converted to estrogen by a process called aromatization which is not good if you are a man. There are natural methods to reduce aromatization such as zinc, calcium d glucarate, Chrysin or progesterone. Many anti-aging specialists recommend a 24 hour urine at some point for each man on testosterone replacement to see what the testosterone levels are and what compounds it is being converted to.
Testosterone can administered by intramuscular injection (IM), in pellets, or transdermally.

It is NEVER to be given orally as it is toxic to the liver. When given IM it is usually given weekly to every 2 weeks. Some individuals may need it twice weekly. Advantages to IM testosterone include its cost (least expensive) and that there is no cream that might be transferred to a partner or children/grandchildren. Disadvantages are that there are bigger swings in the testosterone levels that can affect mood and energy, pain from needle injections, and that IM testosterone is more prone to aromatization. Testosterone pellets can be implanted subcutaneously with local anesthetic. These are good for people who are traveling, or do not like needles or cream applications. Transdermal testosterone is applied daily. Disadvantages are that the cream can rub off on someone who does not need testosterone, and a need to rotate application sites as if the same site is used all the time the skin can become resistant to absorbing the hormone. Advantages are that the formulation can be very individualized if it made by a compounding pharmacy, other ingredients can be added at minimal cost such as Chrysin and progesterone and there is less aromatization with transdermal formulations. Another advantage is that recent study found that 80% of erectile dysfunction improved with transdermal testosterone compared to IM testosterone. There are prescription testosterone gels and patches, however it is difficult to individualize treatment as dosing regimens are not as flexible (one size doesn’t work for everyone).

Possible side effects from testosterone include an increased blood count or red cell mass. This more often occurs with injectable testosterone. Treatment is to donate blood approximately every three months and to monitor blood counts. Gynecomastia or enlarged breasts can occur if aromatization is occurring, and can be controlled with aromatase inhibitors. There can be some fluid retention. Testicular size will decrease due to testosterone and sperm count will decrease, so testosterone should not be used in someone who still wishes to conceive. It is unknown whether testosterone replacement accelerates male pattern hair loss. Also, testosterone does not increase benign prostatic hypertrophy. Other side effects include increased libido and a more assertive personality.

PSA:  A Controversial Screening Test

Prostate specific antigen, or PSA, is a glycoprotein expressed by normal and neoplastic (cancerous) prostate tissue. It was originally developed to measure extent of tumor at time of diagnosis of prostate cancer and then to monitor for recurrence. Thus, if the entire cancerous prostate was removed the PSA should be 0. Any increase from that level indicated the cancer had returned. Somehow in the 1980’s the PSA’s use as a screening test for prostate cancer become widespread despite the absence of any studies to show that testing improved mortality or outcomes.

Here are the facts:

1. 186,000 new prostate cancer diagnoses in the US each year
2. 28,000 deaths each year from prostate cancer
3. Treatment complications occur in 50% of men undergoing surgery- impotence, incontinence or both
4. A few men die as a direct result of treatment
5. Screening PSA detects prostate cancer earlier than clinical methods but also results in marked over diagnosis as “prostate cancer “ lesions that would never have come to clinical attention
6. Prostate cancer rarely causes any symptoms

A good screening test should be able to reliably detect a cancer in the early stages and reduce death rates from the disease. Studies to date have not conclusively shown that PSA screening reduces deaths from prostate cancer or finds the bad type of cancer before it has spread.

A Veteran’s Administration study in 2006 involving 71,661 patients concluded that PSA testing with or without digital rectal exam did not reduce mortality. Two recent long awaited studies were hoped to resolve the muddy waters of prostate screening, unfortunately after their conclusions, the waters are still just as muddy. The U.S. study of 77,000 patients over 10 years found no difference in death rates between men screened and those not screened. The European study involved 182,000 men and found that PSA screening did decrease mortality but the results came at a price; 1400 men would need to be screened and 48 additional cancers treated to save one life. To quote the authors, “At best, prostate cancer screening leads to a modest reduction in prostate cancer mortality over time. However, this benefit comes at a large cost in terms of increasing the diagnosis and treatment of cancers that would not have gone on to cause any problems. Moreover, the harms of screening begin to accrue immediately, whereas the potential benefits are realized only many years later.”
So with regard to prostate cancer screening, whether to do it or not is a matter of opinion at this time and not science. It is best to discuss the pros and cons with your physician. In any case, we need to develop better methods and new approaches of screening, early detection and prevention for this disease.
There are lifestyle factors that increase a man’s risk of prostate cancer and these are obesity, lack of exercise, and lack of intake of fresh fruits and vegetables, particularly cruciferous vegetables. (Interestingly, exercise and cruciferous vegetables reduce the harmful estrogen metabolites as discussed previously). Lycopenes in tomatoes and tomato sauce can lower levels of PSA in patients with prostate cancer. So your best methods of prevention of prostate cancer are to exercise, keep you weight reasonable, and eat 6-9 servings of fruits and vegetables daily, with preferences for broccoli, cauliflower, bok choy, brussel sprouts, cabbage and tomatoes.

References:

1. Khaw KT et al Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men Circulation 2007:116:2894-2701
2. Morganthaler A Testosterone and prostate cancer: an historical perspective on modern myth European Urology 50 2006, 935-939
3. Rothenburg R Forever Ageless 2007 California Health Span Institute
4. Roddam A Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies J Natl Cancer Inst 2008;100:170-183
5. Rosano GM Acute anti-ischemic effect of testosterone in men with coronary artery disease Circulation 1999 Apr 6; 99(13):1666-70
6. Webb CM et al Effects of testoterone coronary vasomotor regulation in men with coronary disease Circulation 1999 Oct 19;100 (16) : 1690-6
7. Khaw KT et al Blood pressure and endogenous testosterone in men; an inverse re
8. Barrett-Conner et al Endogenous sex hormones and cognitive function in older men. Clin Endocrinol Metab 1999 Oct;94(10):3681-5
9. Svartberg J Epidemiology: Testosterone and the metabolic syndrome
10. Bhasin S The dose-dependent effects of testosterone on sexual function and on muscle mass and function. Mayo Clin Proc 2000 Jan;75 Suppl:S70-5
11. Esserman L et al Rethinking screening for breast cancer and prostate cancer. JAMA 1999 Vol 302, # 15 Oct 21 1685-9
12. Wilbur J Prostate cancer screening: the continuing controversy Amer Fam Phys 2008 Vol 78,#12 Dec15 1377-1384
13. Concato J et al The effectiveness of screening for prostate cancer A nested case control study Arch Intern Med January 9, 2006;166:38-43

Progesterone

Progesterone is the hormone that balances estrogen. It has a calming effect and enhances mood. It regulates fluid balance, increases blood sugar and thyroid function, and helps mineral balance. Progesterone relieves menopausal symptoms, decreases the risk of endometrial cancer and may help protect against breast cancer and fibrocystic disease. It also protects against osteoporosis and heart disease.

Symptoms of progesterone deficiency include:

• dry vagina
• fears of aging health, irrational fears
• loss of confidence
• weight gain, especially abdomen, thighs and hips
• indigestion, nausea
• painful intercourse
• palpitations, dizziness
• backache
• loss of femininity
• urinary symptoms
• aggravation of asthma
• periodontal disease
• anger, irritable
• heavy menses
• blood clots during menstruation
• irregular menses – 2 weeks on and 2 weeks off
• bloating
• cold hands and feet
• constipation
• cracked heels
• cramps
• dry eyes
• cravings, binges
• decreased sex drive
• PMS
• fibrocystic breasts
• hair loss
• fatigue
• headache
• hot flashes, night sweats
• hypoglycemia
• infertility
• insomnia
• magnesium deficiency
• memory loss
• migraines
• panic attacks
• osteoporosis
• polycystic ovaries
• post natal depression
• sluggish metabolism
• varicose veins
• water retention
• aggressive personality with mood swings

Progesterone, unlike estrogen, can be replaced either transdermally or orally. The oral form has an added benefit in that one of its metabolites is sedating and thus can be taken at bedtime to help with insomnia, which is a very common symptom of the peri-menopause and menopause. Also, there was a recent study suggesting that the oral form may be more protective against breast cancer than the transdermal formulation. Interestingly, most women who are in the perimenopause and having menopausal symptoms are usually progesterone deficient and not estrogen deficient.

Follow up testing is complicated by the fact that for some reason, transdermal progesterone is concentrated in the saliva, thus giving a falsely elevated level. There is only one laboratory in the United States that has the proper reference ranges for transdermally applied progesterone. Otherwise it must be tested with a 24 hour urine collection. Orally replaced progesterone can be tested with either salivary or urine testing.

Estrogen

Estrogen has over 400 functions in a woman’s body.  It protects against osteoporosis, heart disease, memory loss, colon cancer, incontinence, and tooth loss.  Estrogen enhances sleep, emotional well being, mental acuity and focus, memory, attention span, communication ability, vision, hearing, taste, touch, smell, digestion, libido, and skin tone.  It also relieves menopausal symptoms and depression.

Estrogen deficiency has a myriad of symptoms, some of the more common ones are:

• hot flashes
• sweats
• lethargy, constant fatigue
• loss of libido
• tension, irritability
• insomnia
• anxiety
• headaches
• muscular joint aches
• depression
• hair, skin changes
• loss of memory, concentration
• droopy, reduced breasts
• dry mucus membranes, vaginal dryness
• hair loss upper skull
• thin lips
• “worrier “
• too short or too long menstrual cycles with poor menstruation
• migraines during menstruation
• wrinkles, especially upper lip

Detection of estrogen deficiency is best done by salivary or 24 hour urine testing.
There are three types of estrogen that we monitor:
E1/Estrone, E2/Estradiol, and E3/Estriol.
E1 is the predominant estrogen in post menopausal women, and it can convert to E2. Obese women have higher levels of E1 and it unfortunately can be metabolized to toxic estrogen breakdown products that can increase the risk of breast cancer in women and prostate cancer in men.  E2 is the predominant estrogen in premenopausal women, and has many important breakdown products.  E3 is produced in the placenta in large quantities and premenopausal women make significant quantities.  It has anticancer and beneficial immune functions but it is the weakest estrogen.

At some point, most women on bioidentical hormone replacement therapy should have a 24 urine to measure the estrogen metabolites.  One relationship we measure is the ratio of 2-Hydroxyestrone to 16-Hydroxyestrone.   If the ratio is less than 2, that person is at increased risk of breast cancer if female, and prostate cancer if male (yes, men make and need estrogen, and the testosterone we administer to them can be converted to estrogen).  However, it the ratio is bad, it can be manipulated and improved with hormones, dietary interventions, supplements, and exercise.

Estrogen is replaced via application of a cream or gel to the inner thighs or buttocks.  We use E2 and E3 to replace estrogen deficiency and it must be made by a compounding pharmacy.

Estrogen should not be taken orally as it
1) lowers the 2/16 ratio (bad)
2) rapidly raises the C-Reactive Protein (CRP) , a marker of inflammation which can be an indicator for heart disease
3) increases triglycerides (a blood fat)
4) increases blood clotting factors increasing risk of stoke and leg clots
5) increases risk of endometrial cancer (unless progesterone is given to balance it)
6) oral estrogen raises E1 levels thus promoting estrogen metabolites which can increase the risk of breast cancer

After estrogen replacement therapy has been started, it takes at least 2 months for levels equilibrate before retesting can be performed.  My philosophy leans more toward going low and going slow when replacing hormones, as excessive levels of all hormones can be just as damaging to the body as a deficiency.

Medical Education and Family Practice

Dr. Kevin Wingert received his B.A. from Stanford University in Human Biology, graduating with distinction in 1976.  He attended the University of California, San Francisco, for his medical education, receiving his M.D. in 1980.  He was in the UCSF Fresno Family Practice Residency from 1980-1983.   Since 1984, Dr. Wingert has been board certified in Family Practice with a traditional family practice in the Fresno/Clovis area since 1983, currently practicing four days per week with Community Medical Providers in Clovis.

Medical Acupuncture and Prolotherapy

He has practiced medical acupuncture since 2000, and is board certified by the American Academy of Medical Acupuncture, having completed testing and clinical requirements.  Dr. Wingert has practiced prolotherapy since 2007 and has attended several free clinics in Honduras with the Hackett Hemwall foundation.

Anti-Aging Medicine

Dr. Wingert recently completed the Advanced Fellowship in Anti-Aging (A4M), Functional and Regenerative Medicine by the American Academy of Anti-Aging Medicine.  Having completed oral and written exams and required clinical and classroom experience, he is board certified by the A4M in Anti-Aging, Functional and Regenerative Medicine.

Principal Investigator in Pharmaceutical Clinical Research

Dr. Wingert has also served as Principal Investigator in more than 150 studies for pharmaceutical companies.

Personal Life

He has been married since 1983 to Catherine, a Registered Nurse who also holds a Master’s Degree in Divinity from the Mennonite Biblical Seminary.  They have two grown children, Charles and Mary.

Welcome to the New Millennium Medicine website.  Our goals are to maximize your potential for optimal health using bioidentical hormones, nutritional supplements, lifestyle changes, medical acupuncture and prolotherapy.   The old way of thinking about aging was that declining hormones were a natural event of aging.  From a simplified perspective, New Millennial thinking is that we age because our hormones decline and that by replacing deficient hormones and maintaining reasonable levels of these hormones we can slow the aging process.  Aging is a complex process which cannot be stopped or reversed, but may be slowed with proper balance of hormones, lifestyle, and supplements.  If we maintain our mobility, vision and memory, our elder years will continue to be productive and enjoyable.  Anti-aging specialists feel that middle age now begins at 60.  Dr. Wingert invites you to explore the in depth articles regarding these topics on the website.