From the Doctor’s Desk: Health and Wellness Defined

Definitions.

Health can best be defined as the absence of disease.  Wellness is best defined as the existence of positive health.  So health and wellness can be best defined as the absence of disease in the presence of positive health.

Why the focus on health and wellness these days? I think modern medicine gets a failing grade. Obesity is epidemic in the American culture today. One of my patients knew that her weight was not healthy. However, her previous physician told her that she should learn to live with her new heavier weight and maybe the weight would level out. That statement haunted her and led her to find a physician who offered her more hope and solutions.

Health and wellness cannot be achieved through a traditional, allopathic (Western modern medicine) medical approach. Why? Western modern medicine (we’ll call it traditional for our purposes) uses a disease-focused model utilizing pharmaceuticals. Pharmaceuticals block biochemical reactions, produce mitochondrial toxins, and deplete important nutrients. There is no positive health there.

In fact, the 4^th – 6^th leading cause of death is from prescription drugs (Mol Aspects Med. 2005 Aug-Oct;26(4-5):363-78). In contrast, functional medicine is a health and wellness model utilizing natural substances found in the body to enhance cellular processes. A health and wellness model looks to work with the body, to facilitate metabolic reactions and optimize physiologic function (The principles of metabolic therapy for heart disease. Heart, Lung and Circulation 2003; 12:S55-S62).

In some ways, the two are complementary; but in many ways, the two are not. I am not advocating a boycott of traditional medicine. In fact, I still practice some traditional medicine when disease exists.

The key is this — does disease exist or not?  If disease doesn’t exist, and health and wellness or health restoration is your goal, then a functional or integrative approach is the way to go to facilitate and optimize physiologic function.

So, what is a functional medicine approach?  To help define functional medicine, let’s look at a few examples.

The traditional medicine approach.

Metformin or Glucophage is a well-recognized drug used to treat diabetes.  Metformin works to improve insulin sensitivity and thus facilitate glucose uptake inside the cells.  Type II Diabetes is marked by very poor insulin sensitivity and thus blood sugar rises.  Traditional medicine prescribes Metformin to provide a 13% improvement in insulin sensitivity.

Remember, pharmaceuticals block biochemical reactions.  Metformin reduces folic acid and vitamin B12 and can elevate homocysteine. Elevated homocysteine levels increase blood clot risk (this is one of the ways that birth control pills increase blood clot risk).  Diabetics and those with insulin resistance are already at an increased risk of blood clots. Can you see how the treatment is piling on in this situation?

The functional medicine approach.

Let’s contrast that with a functional medicine approach. Vitamin D deficiency is rampant today. Vitamin D deficiency has been implicated in heart failure, myocardial dysfunction, sudden cardiac death, and is required for normal insulin release and glucose control.  Remember the 13% for metformin? Higher vitamin D levels resulted in a 60% improvement in insulin sensitivity (Chiu K., et al., “hypovitaminosis D is associated with insulin resistance and beta cell dysfunction,” Amer Jour Clin Nutr  2004).

Remember, functional medicine works with and facilitates the body’s functions. Vitamin D does not block any biochemical reactions, nor does it interfere with any. Thus, there is no negative effect comparable to Metformin. Now, too much of a good thing can be a problem. Too much Vitamin D can elevate calcium. Because of this, Vitamin D should be prescribed under the watchful eye of a physician.

Why do I do what I do?

Amazing results — as naturally as possible. This is why I practice functional medicine. This is why I created Seasons. A health and wellness model, through functional medicine, works with the body to enhance and optimize physiologic function.  Health and health restoration can only be achieved by working with the body. Let’s get out of the way and let the body heal itself.

Our Strategy For Treating Polycystic Ovary Syndrome (PCOS)

After my last post on Polycystic Ovarian Syndrome (PCOS or PCO), a reader from Arizona emailed us and said: “My doctor prescribed metformin for me and my periods came back after 5 months of no periods!! It also is helping me lose some weight. Keep in mind, I am overweight, hypertensive, and have slightly elevated cholesterol. Ugh!”

Let’s focus on her two implied questions. First, why did her periods return when she started taking metformin? Second, why she has lost weight? As we address those two questions, you’ll learn more about our treatment strategy for PCO at Seasons Women’s Care.

As I explained in my last post, PCO is characterized by

• High insulin levels and insulin resistance
• High androgen levels (think testosterone)
• Irregular cycles (due to anovulation)

Additionally, many women gain weight.

At Seasons we focus on alleviating these three areas without introducing any side effects. You work with the body, the body will work for you! Let’s go over them one at a time.

Elevated Insulin

Elevated insulin is the result of poor insulin sensitivity, or insulin resistance. The most commonly prescribed insulin medicine used today is the drug metformin. This is a diabetes medicine that improves insulin sensitivity and reduces the liver production of glucose. Metformin can also be associated with significant gastrointestinal side effects, though.

Metformin isn’t the only treatment to reduce insulin resistance. Alpha-lipoic acid also works, and it doesn’t have the side effects associated with metformin.

However, the easiest way to improve insulin resistance is through weight loss. You read that right. Merely losing weight will result in improved insulin sensitivity. At Seasons, we help all women with PCOS to lose weight through nutrition.

One final note about insulin. High insulin levels appear to be a primary factor in testosterone production (discussed below) because insulin binds to specific receptors in the ovaries that augment testosterone production.

Our strategy at Seasons: We work to improve insulin resistence and lower insulin levels, using weight loss, Lipoic acid, and metformin (if necessary).

Elevated Testosterone

Many drugs today are prescribed to lower testosterone. These include spirinolactone, finesteride, cyproterone acetate, dexamethasone, Lupron, flutamide, and finesteride. These are big drugs, and they can have big side effects.

At Seasons, we attack the cause at the source: lack of progesterone and elevated insulin.

OK, this part is a bit technical. Progesterone dominates the last two weeks of a cycle, following ovulation. When you don’t ovulate, your body lacks progesterone. When your progesterone levels decrease, your body stimulates more testosterone production. Raising progesterone levels again can reduce the stimulation to the ovaries for more testosterone production.

Even more important for most women, progesterone lowers the testosterone to dihydrotestosterone conversion. This will reduce the facial hair, hair loss, and acne so commonly associated with PCO.

Progesterone also improves a women’s estrogen dominance (high estrogen to progesterone ratio), and thus improves weight loss.

Our strategy at Seasons: We work with your body to lower testosterone levels more naturally by addressing the root causes of decreased progesterone levels and elevated insulin levels.

Irregular Cycles

Irregular cycles are a hallmark of PCOS. They are, however, just a symptom of the hormone problem. A woman’s uterus will only do what her body tells her to do. You might call the uterus a “Yes, Ma’am” organ. This is why removing a woman’s uterus won’t fix the problem.

The problem is hormone imbalance: high testosterone, high insulin, and low progesterone. When we add progesterone back in, we can address the high testosterone and the low progesterone problems. Additionally, we help women eat better and encourage them to eliminate their exposure to environmental toxins. This helps a woman lose weight, and it helps her body’s insulin sensivity and estrogen dominance.

Now, what about birth control pills? Most of your friends are probably on birth control pills to treat PCOS. Birth control pills do correct the cycle issues, but they replace a hormone imbalance with a hormone overload. This can be a big band-aid with dangerous consequences.

Of course, band-aids aren’t solutions. But we’re more concerned about the consequences of long term birth control. It has been shown to increase your chances of breast cancer and weight gain.

Our strategy at Seasons: When we treat PCOS, we look to the root causes, not quick fix band-aids. Treating the causes—high testosterone, high insulin, and low progesterone—results in long-term solutions that restore your overall health.

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My Doctor Said I Have Polycystic Ovary Syndrome

Each week, I wonder what I should write about on the SeasonsWC blog. Then, I listen to my patients, and they tell me what they want to know. (Funny thing listening to your patients). This week, at least three women had questions about their diagnosis of polycystic ovary syndrome. Some time ago an ultrasound revealed that they had multiple ovarian cysts, and they were given birth control pills to control their symptoms. That was all they knew.

“So I learned I have cysts on my ovaries,” they said. “But what does that mean?”

Doctors call it polycistic ovary syndrome. To make things even more confusing, we’ll often just call it PCOS or PCO. (It’s fewer syllables.)

PCO is a hormonal syndrome. A syndrome is a group of symptoms that collectively indicate a disease or other abnormal condition–and PCO is an abnormal condition, not a disease. Of course, abnormal conditions can lead to disease. But an abnormal condition can also be restored to a healthy condition, whereas disease cannot.

PCO is the most common hormone problem in women today, effecting 5% of reproductive aged women. It causes androgen excess, another fancy medical term that means a woman’s body is producing too many male hormones. This means women may have facial hair, hair loss, low voice, acne… Androgen excess in women has been recognized by doctors since Hippocrates. You may have heard of the Hippocratic Oath. Hippocrates discovered a lot of things, including facial hair in women.

To be more specific, PCO is characterized by

• High androgen levels (think testosterone)
• High insulin levels and insulin resistance
• Irregular cycles (due to anovulation)
• Multiple ovarian cysts

It doesn’t really sound so bad–just facial hair, acne, deep raspy voice, and irregular cycles. Obviously, those symptoms are a very big deal for many women. In fact, they are the primary complaints of women with PCO. But they aren’t the biggest problems. PCO is associated with some pretty serious diseases and health problems:

• Obesity (50% of women with PCO)
• Type II diabetes (10% of women with PCO)
• Infertility
• Cardiovascular disease (hypertension, abnormal cholesterol, atherosclerosis)
• Psychopathology (anxiety, depression, bipolar, eating disorders)
• Cancer (breast, uterine…)
• Metabolic syndrome

Worst of all, polycystic ovary syndrome, if untreated, leads to poor health and early death. But don’t worry! We know how to treat PCO, and I’ll talk about that in my next post.