Author: Lara Pizzorno, MDiv, MA, LMT

Treating the sequelae of andropause, the age- and stress-related decline in hormones in the adult male, with bio-identical hormone replacement (BHRT) can restore more youthful hormone levels and significantly alleviate symptoms associated with “normal” aging, optimizing health, happiness and quality of life. Successful and safe BHRT, however, necessitates laboratory testing to assess the patient’s current hormonal status, monitor treatment, and ensure that he is metabolizing hormones in ways that reduce his risks for prostate cancer, cardiovascular disease, metabolic syndrome, osteoporosis, and the “low grade” depression often seen in older men, as well as declines in cognitive and sexual function.

As discussed in detail in Part I of this review and recapped briefly here in relation to the male patient, hormones can be assayed using saliva, blood (serum), and urine. Which of the three hormone test methods, or which combination of tests, you will wish to utilize will depend upon what information you require in a given clinical situation.

Topics covered in this article:

• Salivary Hormone Testing – Pros and Cons
• Blood Hormone Testing – Pros and Cons, Testosterone Metabolites, 5-alpha Reductase
• Urine Hormone Testing – Pros and Cons, Interpretation of Hormones/Metabolites

Click here to read the full article on Longevity Medicine Review

The Food Safe Allergy Test (Bloodspot IgG Antibody Assay) is a blood spot test that only requires a simple finger stick. It measures the total IgG antibodies that cause adverse food reactions or allergies to common food allergens (95 foods tested). Learn More

Researchers at John Hopkins did a thorough review of the literature in 2010 and concluded, “among modalities used by many conventional and alternative practitioners, immunoglobulin G (IgG)-based [food allergy] testing showed promise, with clinically meaningful results. It has been proven useful as a guide for elimination diets, with clinical impact for a variety of diseases.”

Mullin GE, Swift KM, Lipski L, Turnbull LK, Rampertab SD. Testing for food reactions: the good, the bad, and the ugly. Nutr Clin Pract. 2010 Apr;25(2):192-8.

Nitric Oxide (NO) Synthesis: the primary factor in erectile dysfunction for many men and can be accurately measured in a 24 hour urine sample.

The Urine NOx Test

Our NEW Urine NOx Test will help you rule out low nitric oxide synthesis as a cause of erectile dysfunction (ED) in your patients as well as help you determine the most effective treatments.

Erectile Dysfunction & Nitric Oxide

Nitric oxide synthase (NOS) under-activity can be a major contributor to erectile dysfunction (ED) because adequate nitric oxide locally is the determining factor in erectile function.¹ Adding NOS testing to the male comprehensive PLUS hormone profile makes a lot of sense because androgens play a pivotal role in nitric oxide synthase activity and expression.²

Adequate testosterone is required to regulate NOS in the corpus cavernosum. Insulin resistance causes hyper-aromatization of testosterone to estradiol. There is often decreased NO production in insulin resistant patients so consider a 4-hr glucose insulin resistance test also for men with ED.³

By knowing both nitric oxide synthase activity via NO metabolites and androgen levels you will be able to provide more targeted and holistic treatments that will help you get results. You will also be able to monitor treatment and adjust accordingly with follow-up testing either in a comprehensive PLUS profile or standalone Urine NOx Test.

A double-blind, placebo controlled study of 50 men aged 50 to 75 years with confirmed ED of at least 6 months’ duration shows that the levels of urinary nitrates pre-treatment with L-arginine will determine the outcome.⁴

The researchers found that the men who responded well to L-arginine “had lower urinary NOx [nitrate and nitrite] levels before therapy and showed greatly increased plasma and urinary NOx after treatment.” They used 5 grams per day of L-arginine but with sustained release L-arginine and other treatments directed at balancing androgens you will be able to reduce this daily dose most likely.

Consider For Women Too

As you know, balancing androgens is an important part of cardiovascular health and there is a large body of research relating urinary NO metabolites to cardiovascular health as well.^6-10 Thus, consider ordering a Urine NOx Test as an add-on to your female profiles too. In both men and women, nitric oxide synthesis decreases with age to varying degrees depending on lifestyle and genetics.¹¹

In your female 24-hr urine comprehensive PLUS profiles we provide the following metabolites that are below the level of accurate quantification in the male profiles and are, thus, only in the female profiles (see updated profile chart):

●     4-Hydroxyestrone

●     2-Methoxyestrone

●     2-Methoxyestradiol

Reduced NO synthesis occurs in women with amenorrhea and after menopause.¹² Urine NO metabolites may also be a helpful predictor of preeclampsia in pregnant women if tested early in the 3rd trimester.^13,14

Accurately Testing Nitric Oxide Synthesis

In order to get the most accurate endogenous NO production levels it is important for your patients to avoid exercise and the following foods for 48 hours before and during the urine collection period:

• Vegetables: cabbage, dill turnip, endive, fennel, kohlrabi, leek , parsley, celery, watercress, lettuce, red beets, spinach, rucola, eggplant, cauliflower, swiss chard, and broccoli
• Preserved meats and preserved fish
  • Ie. Bacon, sausage, and other dry-cured meats
  • Any other foods containing nitrates as a preservative

Thank you to Ray Lian, PhD and Dawn Huo, PhD for their work pioneering the first commercially available serum testosterone metabolites test and Urine NOx Test.

Please contact us with any questions regarding this test at 425-271-8689.

The Bottom Line(s)

• The new Urine NOx Test measure both nitrate and nitrite in urine
• Urine nitrate/nitrite levels give a good reflection of nitric oxide synthesis
• Low urine nitrate/nitrite can often be corrected with L-arginine and other treatments
• The Urine NOx predicts which of your patients are most or least likely to respond to L-arginine therapy for ED
• CompPLUS profiles include the Urine NOx Test

References On Next Page

Dear all,

MVL Marketing and Sales is excited to announce the official launch of a new MVL logo and a transformative brand identity that builds upon our company values and our successful 35 year company history.

The New MVL Logo!

Through this new logo and brand identity, we are positioning ourselves to continue bringing leadership to innovation, research and development, and education and awareness in the field of preventative medicine.

The new logo is:
• simple yet bold;
• the “V” depicts a valley where MVL was born;
• the curves represent wholeness, the human aspect of our lab, our excellent clinical support;
• the leaf breaking out of the circle is our innovative testing, hinting at nature and natural medicine

This logo signals MVL’s commitment to excellence, leadership, and innovation.

If you have any questions, please let me know.

Cheers!
H. Caitlin Nguyen
Marketing Department

At least three to four times a month, I see patients with a condition that their primary care doctors have completely missed. In fact, I saw this easy diagnosis completely ignored again—twice—just last week. And along with the missed diagnosis goes the wrong type of treatment for some of its symptoms. This doesn’t help the real problem at all but actually allows it to progress and lead to a whole new set of symptoms and health concerns. I’m talking about the ever-increasing instances of a condition known as insulin resistance.

When Mrs. Williams* came to the Tahoma Clinic with this problem, she had a pretty typical case. Her doctor had given her a statin drug for high cholesterol and an ACE inhibitor for high blood pressure. He told her that these problems were caused by her obesity, and that she should go onto a low-fat, calorie-controlled diet to lose weight.

Learn More About Dr. Wright and the Tahoma Clinic - Seattle, WA

I asked her if any of her relatives had type 2 diabetes, and she said yes, her mother’s sister, but her own blood sugar was normal, so that wasn’t her problem. Then I asked her if the doctor who’d prescribed the patent medications had checked her for insulin resistance or explained “Syndrome X” to her. She looked puzzled, and said “no”—he hadn’t mentioned diabetes at all. So I explained to her that her high cholesterol, high blood pressure, and even her obesity were probably “secondary” problems, and that her primary problem was very, very likely a case of undiagnosed and mistreated insulin resistance. The patent medications she’d been given made as much sense as water to prevent it from boiling over, instead of turning down the heat.

But there are better solutions for alleviating these symptoms—ones that address the underlying cause safely and naturally. When her test results came back positive for insulin resistance, Mrs. Williams started using them: I’m happy to report that she’s already making great progress. And so can you. In fact, implementing these strategies now will not only lower your cholesterol, blood pressure, and weight, but they’ll also reduce—even eliminate—your risk of type 2 diabetes.

Getting rid of the problem that just won’t go away

We’ve covered insulin resistance in bits and pieces before (Nutrition & Healing July and August 2001, and June 2004) but since cases are increasing rather than decreasing, and since mainstream physicians simply won’t diagnose it (or perhaps don’t know how to), it’s time to go over it more completely. Like many other health problems, insulin resistance has both a genetic and an environmental component. If you have these genetics (and estimates are that over 90 million Americans do), and you eat sugar on or in anything, your body responds—and not favorably.

Let’s go over some of the mechanics involved:

When you eat or drink refined sugar—especially fructose, high fructose corn syrup, sucrose, and dextrose—your blood sugar goes much higher than it does when you eat the sugar as part of its “original package” (whole fruit, whole corn, or sugar cane). Your pancreas “cranks up” in response to this sugar overload and makes an overly large quantity of insulin to help clear the excess sugar from the blood stream. Nearly everyone’s metabolic response to refined sugar follows this pattern.

People with a genetic disposition towards insulin resistance and type 2 diabetes also have an extra burden in terms of diet: Simply eating too many carbs overall—even if they are from whole, natural sources—can lead to insulin resistance, too, even though it definitely takes longer than it would from eating sugar and refined carbohydrates.

If you’ve inherited the genetics for insulin resistance, and this pattern happens over and over again, your cells that receive insulin become resistant to repeated exposures. Because of this resistance, as the years go by, your pancreas is forced to make more and more insulin to keep your blood sugar levels under control. Those higher levels of insulin “work” for awhile, but then the receiver cells become even more resistant, so your pancreas must make even more insulin, and the “more insulin/more resistance/even more insulin/even more resistance” spiral continues ever upward, until the insulin simply can’t overcome the resistance at all. At that point, the blood sugar can’t be regulated, and type 2 diabetes is the ultimate result.

While they’re on the way up, those ever-increasing levels of insulin can cause other problems as well: They can cause your liver’s production of LDL (bad) cholesterol to increase and it’s production of HDL (good) cholesterol to decrease. They can also prompt the kidneys to retain sodium, or the adrenal glands to secrete too much adrenalin, (or both), resulting in higher and higher blood pressure. Most noticeably, the combination of refined sugar and carbohydrate—or simply carbohydrate—consumption and the excess insulin secretion commonly results in increased synthesis of triglycerides (the fat inside body cells), resulting in obesity.

You could wind up with just one of these problems, a combination, or, like Mrs. Williams, all of them.

Mainstream treatment is masking the problem—not solving it

But instead of looking at these conditions as symptoms of one overall condition and addressing them at the source, nearly all mainstream doctors respond by prescribing patent anti-hypertensive and statin medications, as if high blood pressure and cholesterol are always due to patent medication deficiency. Then, when type 2 diabetes ultimately shows up in these individuals, they prescribe yet another patent medication to “control” blood sugar, usually adding it to the “diet” of anti-hypertensive and lipid-lowering patent medications already prescribed.

Patent medication companies are increasing the pressure on mainstream doctors to prescribe in this way. In July, a panel of “experts” from the American Heart Association and the National Institutes of Health issued new guidelines for the use of cholesterol-lowering drugs that would increase the number of Americans “eligible” for them from approximately 36 million to approximately 43 million. But the nine-expert panel neglected to disclose that eight of them had received money from some of the biggest patent medicine companies, including Pfizer, Merck, Squibb, and AstraZeneca. Disclosure of these ties came only after an outcry by consumer groups.

Similarly, “experts” are also urging mainstream physicians to prescribe ever-increasing quantities of patented anti-hypertensives, as “guidelines for healthy blood pressure” call for lower and lower blood pressure readings. And the pressure isn’t just on physicians: Who hasn’t seen a TV commercial (usually featuring smiling senior citizens) telling us hat the way to control cholesterol or high blood pressure is the patent medication they’re touting?

Your step-by-step guide for changing the channel on insulin resistance

So it’s time to change the channel once and for all and get to the root of the problem. Here are the steps for doing just that:

1.) Diagnosing insulin resistance

You’ve probably heard of the glucose tolerance test. It’s the standard tool used to diagnose diabetes. Insulin resistance is diagnosed in exactly the same way, but with an extra step taken by the laboratory. Each time one of the blood specimens is tested for glucose, it’s also tested for insulin, which is why it’s called the glucose tolerance insulin resistance test (GT-IRT). The lab technicians look for several different patterns of higher insulin that are unique to people with insulin resistance.1 (For further details about testing for insulin resistance, see Nutrition & Healing July 2001)

If your GT-IRT shows you do have insulin resistance, that means you’re also at an increased risk for type 2 diabetes. Type 2 diabetes is always preceded by insulin resistance. But it takes decades before it results in the actual onset of the disease: I’ve seen positive insulin resistance tests in teenagers, and children as young as eight. So there’s absolutely no reason at all for type 2 diabetes to “sneak up” on anyone; it can always be predicted by a positive insulin resistance test. And you can avoid it altogether by implementing the next few steps.

2.) Toss the sugar and refined carbs

Eliminating all refined sugars is priority No. 1. Although refined carbohydrates don’t cause damage as fast, they still cause the same problems, and must be eliminated too. Even if you don’t have the genetics for developing insulin resistance, refined sugar will cause you health problems—at the very least accelerated aging. Remember, humans are “designed” to digest and metabolize whole, natural foods, not refined foods. All of our ancestors for hundreds of thousands of years ate absolutely no refined food of any kind.

Admittedly, these are probably the hardest steps of the bunch: Over the years, refined sugar and flour have made their way into more foods than you can even imagine. But it is possible, and there are a few “tricks” you can use to make it a bit simpler. First, reading labels—and knowing what to look for on them—is crucial. Look for ingredients like high fructose corn syrup, dextrose, and enriched flour. If the product contains any of these, don’t buy it. In fact, you’ll be better off avoiding packaged foods altogether, which explains why this step can be so difficult: Supermarket shelves are stocked primarily with processed, packaged foods, and I’d be willing to bet that 90 percent of them contain some sort of refined sugar or carb.

Shopping along the outer edges of the grocery store—where fruits, vegetables, and meats are usually located—will make avoiding the packaged stuff a little easier. And you may also want to find a natural food store in your area.While not everything these stores carry is truly healthy, they often have more options in terms of products made without refined ingredients. These methods of shopping will also help you transition into the next step:

3.) Eat a high-protein, low-carb diet

My No. 1 recommendation is the “original human diet,” which I outlined in the January 2003 issue of Nutrition & Healing—or the versions of it explained in the books The Paleo Diet by Loren Cordain, Ph.D., and The Paleolithic Diet Prescription by S. Boyd Eaton, Ph.D., Marjorie Shostak, and Melvin Konner, Ph.D.

“Regular” high-protein, low-carbohydrate diet plans are OK too. The point is to regulate your blood sugar swings to avoid the release of excess insulin. Limiting your carb intake is the best way to do that—no matter which specific diet plan you choose.

4.) Take your vitamins

I wrote about supplements to reduce insulin resistance at length in the August 2001 Nutrition & Healing issue and you may contact the Tahoma Dispensary for a list of these supplements by calling 425-264-0051. Each of them should be taken daily. However, you probably won’t need to take each of these items separately, since many of them can be found together in good multiple formulations.

Two formulas I have recommended to patients with success are Glucobalance and Blood Sugar Improvement Formula. There are other good multiple formulas available too; check your natural food store to see what they carry and compare the labels to the list of nutrients to the right to find the best one. So far, I haven’t seen any single formula that contains all of the items listed in the amounts noted, so you’ll probably need to take at least a few of them separately to make up for the ones your multi doesn’t contain (or doesn’t contain enough of).

5.) Get moving

Last, but not least, don’t forget to exercise. After all, you can’t expect eating right and supplementing to do all the work: Giving your food and supplements a fit, healthy environment to do their jobs will help your progress along even more. And you don’t have to devote hours on end each day to high-impact aerobics classes. Even a 30-minute walk three times a week may be enough to make a difference. Check with your doctor about the right amount of exercise for you.

Find the real problem and eliminate many others

I’m sure you’ve noticed all the references to prior issues of Nutrition & Healing, and may be wondering why I’m covering this material again. Unfortunately, the word just doesn’t seem to have gotten out about insulin resistance—even though it was first described over 20 years ago. I’m seeing more people than ever who’ve been given patent medications to treat its symptoms (high blood pressure, high cholesterol, high triglycerides) with no attention paid at all to the diagnosing and treating the real problem. And symptom treatment just doesn’t cut it when it comes to preventing the ultimate onset of type 2 diabetes—and stopping the burgeoning epidemic of this disease.

So take a minute to see if any of the following criteria apply to you:high cholesterol, high triglycerides, high LDL cholesterol, low HDL cholesterol, or high blood pressure; overweight; a personal history of hypoglycemia (low blood sugar); a family history of type 2 diabetes; or any combination of these problems.

Of course, there are other reasons besides insulin resistance for elevated blood pressure, cholesterol, triglycerides, weight, and so on. But since insulin resistance is at the top of the “cause list” for these problems, it should always be checked. The more of these problems you have, or are in your family, the more likely it is you have insulin resistance. So don’t let your doctor shrug you off with prescriptions for patented anti-hypertensive or statin medications. Look for a doctor skilled and knowledgeable in nutritional and natural medicine, who can help you with the GT-IRT test and any necessary recommendations. If your test is positive, diet, exercise, and appropriate supplementation will help you control or eliminate all these problems—and may just help prevent many others, too.

Learn More About Testing For Insulin Resistance

JVW

Techincal Director - Ray Lian, PhD

While most of us experience a general decline in the production of hormones after about the age of 40 years old, how to test your body for this loss and what to do about it has been the focus of controversy for many years.

Growth hormone (GH) is one of the more controversial hormones that decline with age due to the potential for use by athletes as a performance enhancer. There are a number of ways to test for growth hormone levels as well as many treatments available that may be beneficial. Our Steroid Dept. Manager Dawn Huo, PhD and Laboratory Director Ray Lian, PhD are the developers of our 24 hr urine hormone profiles.

What is perhaps most important to note is that growth hormone levels are not constant at any one point during the day and a 24-hr collection is much more likely to reflect your patient’s GH production.

Steroid Dept. Manager - Dawn Huo, PhD

The evaluation of partial growth hormone deficiency, also known as GH insufficiency (GHI), can be very challenging and clinical symptoms along with two positive tests are said to be required to make a diagnosis of GHI.¹ Traditional signs and symptoms of growth hormone deficiency may not be present and patients rarely show additional pituitary hormone deficiencies in GHI. Lab tests may be in the “normal gender and age-adjusted range” for IGF-1 levels in patients with adult growth hormone deficiency.² A patient with a suspected growth hormone insufficiency may require multiple tests for detection.

Growth hormone is primarily secreted at night and can easily be measured in a 24-hr urine specimen. Levels of IGF-1 and IGFBP-3 are indirect measurements of GH. The purpose of IGF-1 and IGFBP-3 is to bind GH and prolong their half-life as well as maintain a steady supply of GH. Your body wants a steady supply of GH and although most of it is produced at night, these two binding proteins (IGF-1 and IGFBP-3) help make that happen. Thus, in our sleep we produce – and store – growth hormone so that it is released slowly and steadily to our cells.

The more binding proteins, the more GH we can store but what if there is no GH to store? At a growth hormone deficiency level this is can be detected by pathologically low levels of IGF-1. In terms of growth hormone insufficiency, detecting borderline low levels becomes more difficult with IGF-1. Making clinical decisions on IGF-1 related to GH insufficiency without testing urine GH may make you more liable if your diagnosis ever comes into question. Thus, measuring a 24-hr growth hormone production via urine is likely to be an effective CYA approach as well as accurately assessing the efficacy of your treatments – this will be discussed in greater detail shortly.

SOME DOCUMENTED BENEFITS OF ADEQUATE GROWTH HORMONE

(as you know, experienced practitioners have observed many others)

• Cardiovascular Risk Reduction³
• Immune System Enhancement⁴
• May Benefit Crohn’s Disease⁵
• Reduces Bone Fracture Risk and Improves Healing⁶
• Improves Skin Healing After Burns⁷
• Assists Obese Individuals In Weight Loss When Exercise and Diet Ineffective⁸

The association of growth hormone to cancer risks and mortality is unclear. In a study of 300 premenopausal women diagnosed with breast cancer, their levels of IGF-1, IGFBP-3, and GH had no correlation with risk.⁹ Another study involving colorectal cancer and 41,528 adults found that increases in IGFBP-3 correlated with a reduction in cancer-specific deaths.¹⁰ There was no association found for IGF-1 in this study. Some of the research that implicated GH replacement as a potential cancer risk used subjects who had received radiation therapy and GH from cadavers and monkeys. The need for a full review of research related to cancer risks is apparent.

HOW TO TEST GROWTH HORMONE

The “gold standard” for some time has been the Insulin Stress Test (IST). Please don’t confuse this with the Glucose Tolerance Insulin Resistance Test (GIRT) as they are very different. In the  IST, patients are given insulin in an attempt to reduce their blood glucose to dangerously low limits that could be fatal and is contraindicated in patients with histories of seizures, cerebrovascular disease, myocardial infarction – or anyone who wants to live, according to Dr. Mark Gordon, MD.

Dr. Gordon lectures around the world about growth hormone testing and treatment and has conducted several clinical studies on the topic.^{11, 12, 13} He compares growth hormone replacement to thyroid replacement. If a patient is experiencing hypothyroid but their labs are “low normal” we are likely to treat rather than wait until they come in with myxedema. This is similar to growth hormone deficiency where we can actually run many labs to check their levels and have enough evidence along with patient history to treat.

The purpose of IGF-1 and IGFBP-3 is to prolong the half-life of GH and assist in gradually making circulating levels of GH available to cells. As GH acts by entering the cell nucleus and influencing DNA expression immediate increases of bio-availability may be counter to “what nature intended”. Thus, that is why testing for these markers along with urine GH is essential to proper treatment, diagnosis, and monitoring. IGF-1 and IGFBP-3 are available in the Age Management Panel, which can save you hundreds of dollars and help give you a more holistic view of your blood hormones.

He states, “it is imperative that all hormones are measured at baseline before beginning treatment, and therefore minimum testing includes IGF-1, IGFBP-3, DHEA-s, free testosterone, estradiol, and urine GH. Monitor with urine GH and minimal follow-up with IGF-1 and IGFBP-3”.¹⁴ IGF-1 and IGFBP-3 are indirect measures of GH while urine growth hormone testing will show you how effective your treatment is a direct measurement. IGF-1, IGFBP-3, DHEA-s, free testosterone, and estradiol are all available in the Age Management Panel.

Monitoring improvements – or lack thereof – of GH deficiency with urine testing can help you get a better idea of what is working and what isn’t. Regular testing of IGF-1 and IGFBP-3 is also indicated for diagnosis, safety, and liability.¹⁵ Urine GH is likely also very important for safety as inducing treatment with serum values of IGF-1 and IGFBP-3 are considered insufficient. Testing urine GH is very important when stimulation tests are not used.

Growth hormone in urine has been shown to correlate well with insulin stress tests and is a much safer alternative. The authors of a 1995 study published in the Journal of Clinical Endocrinology, states “the Insulin stress test (IST) which is unpleasant and potentially dangerous, particularly in patients with hypopituitarism.”¹⁶ Based on their research, they found that the “diagnosis of adult GH deficiency can be reliably made without the need for an insulin stress test by using a combination of low urinary GH excretion, subnormal IGF-I levels and clinical assessment with regard to the number of other pituitary axes affected.” And since GH is lowest during the daytime and highest at night, a 24-hr urine hormone profile gives the widest angle of detection.

Growth hormone appears to have synergistic effects with other hormones. Have you ever given testosterone to a patient without the expected dose-related benefit? The problem may be that they have GH insufficiency and are lacking this synergistic effect. Growth hormone has been found to work synergistically with both estrogen and testosterone.¹⁷ This may be due to the ability of growth hormone to upregulate cell wall receptors. Thus, urine prevents a unique opportunity to measure multiple hormones (over 30) because we want to balance as many hormones as possible and do as Dr. Wright suggests, “copy nature”.

HOW CAN I INCREASE GROWTH HORMONE LEVELS NATURALLY?

Research has shown that exercise and arginine supplementation can increase growth hormone levels.¹⁸ Exercise combined with arginine is expected to increase GH by 200% while arginine alone will increase it by 100%. In patients with a history of herpes simplex virus supplementing arginine may be contraindicated as it may cause an outbreak. Consider supplementing with a greater dose of lysine simultaneously.

Arginine has other benefits beyond increasing growth hormone. It has also been shown to increase nitric oxide which is the most important factor in erectile function.¹⁹ Urine testing can also determine how effective arginine will be in patients with erectile function. Low urine nitrate and nitrite levels are highly correlated with successful treatment of erectile dysfunction with L-arginine. Consider supplementing 1.67 grams L-arginine, three times daily (TID).

Successful treatment will likely increase urine nitrate, nitrite, and growth hormone levels as well as improve your patient’s sex life. Remember, testosterone levels also decrease with age along with growth hormone. Adequate testosterone levels for men are key to preventing memory loss and improving memory as well.^20,21,22,23 Improved memory along with the many other benefits from having hormones in physiologic range will help your patient have better sex and remember it too! What good is great sex if you can’t remember it, right?

While there may be some legal barriers to prescribing injectable hgh there are secretagogues like L-arginine and L-ornithine that can increase endogenous production. At the Tahoma Clinic we often see urine hgh double with a holistic approach. Bottom line: Whatever treatment you do, make sure its effective by measuring 24 hr urine growth hormone levels.

WHERE CAN I PURCHASE URINE GROWTH HORMONE TESTING?

Human growth hormone testing using urine and blood is available at Meridian Valley Lab. Please call 425-271-8689 for details.

References On Next Page

Alan Gaby, MD

Many of us have become doctors or more interested in natural medicine as a result of the work of Alan Gaby, MD and Jonathan Wright, MD. When it comes to holistic medicine and nutrition they offer us the most up-to-date and comprehensive works available. They have collected 50,000 research articles over the past 36 years. With their combined experience of 57 years they offer us an analysis that integrates their clinical experience and clinical pearls.

Dr. Gaby has recently completed a comprehensive textbook, Nutritional Medicine (details available online at www.doctorgaby.com). He was in private practice for 18 years and was Professor of Therapeutic Nutrition and a member of the Clinical staff at Bastyr University from 1995 to 2002. Learn More About Dr. Wright

Jonathan Wright, MD

Dr. Wright is recognized as a pioneer and innovator in the field of nutritional medicine. He wrote the first prescription for bio-identical estrogens combined with progesterone and testosterone in a cyclic rhythm, was the first to use DHEA in private practice, discovered the important relationship between cobalt and estrogen hyper-excretion, and discovered the detoxifying effect of iodine on estrogen metabolism. Learn More About Dr. Gaby

We are very excited to announce that Drs. Wright and Gaby will be presenting a 4-day seminar this year in Seattle, WA. Topics will include:

• fatigue
• depression
• migraine
• irritable bowel syndrome
• inflammatory bowel disease
• peptic ulcer
• acne
• eczema
• premenstrual syndrome
• dysfunctional uterine bleeding
• arthritis, angina
• congestive heart failure
• hypertension
• hyperlipidemia
• prostatic hyperplasia
• osteoporosis
• alcoholism
• and many others!

Here’s what others have said about their past seminars:

“A gem of a seminar, Drs. Gaby and Wright know the literature extremely well . . . and leave you with many practical hints that you can use immediately.”

Michael Schacter, MD
Past President, American College for Advancement in Medicine

“From vitamin A to zinc and arthritis to zoster, this seminar covers it all. I’ve attended three times and consider the information indispensable to my practice.”

Kenneth N. Woliner, MD
Boca Raton , FL

Dates: May 13 – 16, 2011
Location: Doubletree Hotel Seattle Airport, Seattle, Washington
For more details such as CME and how to register: click here

From MedicalCenterConferences.com

“Dr Hertoghe is the President of the International Hormone Society. Born in 1957 and he practices lifespan/reversing aging medicine and hormone therapy. He represents the fourth consecutive generation of physicians who have worked in the field of hormone therapy, where he practices medicine with a team of experienced doctors in Brussels.

He is an internationally known authority in medical therapies oriented to correct hormone deficiencies, reduce aging or even on some aspects reverse aging and possibly extend lifespan.

16 New & Updated Topics by Thierry Hertoghe!

• Overview of Diagnosis and Therapy for Hormone Deficiencies
• Therapies with Adrenal Hormones: DHEA, Safe use of Cortisol
• Sleep Disorders and Hormone Therapies: More Efficient than Traditional Sleep Medications
• Androgen Therapy in Men and Women
• Estrogen and Progesterone Therapies in Women, also for Younger Women before Menopause
• Growth Hormone Therapy in Aging Adults with some New Indications
• Live Diagnosis (consultations on stage)
• Hormone Therapies for Psychic Disorders
• IGF1 Therapy: More Potent than Growth Hormone to Reverse Aging in Adults?
• Parathormone Therapy for Osteoporosis
• Thyroid Therapy
• Oxytocin Happiness Hormone and Relief for Autism
• The Influence of Psychic and Sexual Factors on the Endocrine System
• Hormone Therapies for Sexual Disorders
• Treatment of Obese Persons with Hormone Therapy
• Pineal Hormone Therapy”

Click here for registration and more info www.medicalcenterconferences.com

Food allergies and sensitivities have been associated with numerous symptoms including but not limited to anxiety, arthritis, asthma, chronic fatigue, depression, fluid retention, gout, headache, hives, hyperactivity, multiple sclerosis, obsessive compulsive disorder, premenstrual syndrome, seizures, skin problems, and weight gain.

There are two main types of food allergies and sensitivities: immediate and delayed.

IgG antibodies are associated with non-anaphylactic food allergies, more commonly called delayed food allergies or food sensitivities. These antibodies act as blocking agents to prevent a potentially fatal anaphylactic reaction from an IgE immunoglobulin response.¹

Specific chronic diseases and conditions have been linked to elevated levels of IgG in the body. Symptoms of a non-anaphylactic food allergy are not always attributed to the offending food because they may occur hours to days after ingesting the food. The E-95, A-95 and FoodSafe allergy panels measure IgG levels allowing patients to identify foods that may be contributing to their specific health conditions.

A review of recent and past research has revealed specific conditions that strongly correlate with elevated IgG levels in the blood. These states of ill health include:

• migraine,²
• arthritis,^2,3
• irritable bowel syndrome (IBS),^7,8,9
• celiac disease,¹⁰
• diabetes,^6,11
• atherosclerosis, inflammation,^6,12
• autoimmunity, neurodegeneration and neuro-autoimmunity,⁶
• chronic diarrhea in children,¹³
• asthma and rhinitis,¹⁴
• anaphylaxis,¹⁵
• and atopic dermatitis.¹⁶

In fact, it appears that food allergy symptoms in infants (up to 3 years of age) correlate more strongly with elevated levels of IgG4 than IgE.¹²

Additionally, elevated IgG levels parallel elevated IgE levels in atopic children, indicating that IgG4 may be a useful predictor of food and sensitivity.^17,18,19

Physicians in clinical practice have identified a wider list of symptoms that appear to be related to food allergies (reviewed in the introduction). Viewing IgG as a “protective” antibody against anaphylaxis due to its IgE blocking action, it is reasonable to conclude that high IgG levels indicate that a person is more allergic, and may have a greater potential for an anaphylactic response. Therefore, developing a chronic disease such as IBS, which correlates with elevated levels of IgG, may be the body’s way of preventing an immediately life threatening event.

To assist in the detection of these food allergy reactions, Meridian Valley Laboratory measures IgG levels using the ELISA method on a sample of serum or from a blood spot collection. This method has been determined to be highly reproducible within labs and between labs, based on split sample testing, compared to other forms of serum food allergy testing.⁵ The E-95, A-95, and FoodSafe test panels are available to assist patients in determining whether food allergies may be contributing to their health condition. The E-95 and A-95 also measure IgE levels and give results in a combined format or total antibody burden per food.

Avoiding foods for which there is a high antibody burden should reduce the levels of IgG and IgE, in turn reducing the patient’s overall allergic load. Reintroduction of some foods may be possible after a period of avoiding them if it has been long enough for the levels of both immune globulins to decrease. However, a rotational diet is recommended to prevent an allergy from returning. Some foods may need to be permanently eliminated.

Researchers at Johns Hopkins University did a thorough review of the literature earlier this year (2010) and concluded, “among modalities used by many conventional and alternative practitioners, immunoglobulin G (IgG)-based testing showed promise, with clinically meaningful results. It has been proven useful as a guide for elimination diets, with clinical impact for a variety of diseases.”²⁰ Every food allergy test done at Meridian Valley Lab includes a food rotation and elimination guide.

The allergy panels offered by Meridian Valley Laboratory provide patients with important knowledge about how their bodies are reacting to foods. Patients can use their results to customize their diet and assist in treatment of their conditions. Any patient with a suspicion of allergy or hypersensitivity, arthritis, migraine, diabetes, chronic intestinal distress and IBS may benefit from being screened using the E-95, A-95 or FoodSafe Allergy Test panel.

Learn more by clicking here:Food Allergy Testing

or by calling Meridian Valley Lab at 425-271-8689.

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So why do we care about the enzyme 5-alpha-reductase?

5-alpha reductase is responsible for conversion of testosterone to 5α-dihydrotestosterone (5α-DHT). 5α-DHT is about 3 times as potent as testosterone due to its greater affinity for androgen receptors.¹

There are currently  millions  of men around the world taking drugs and supplements designed to inhibit this enzyme and the production of 5α-DHT. One of the most potent inhibitors, finasteride,  is a formerly patent medicine and has been accused of causing residual impotence after discontinuation and breast cancer in men.^2,3 This drug has been on the market since the early 1990′s.

While 5α-DHT has been implicated in male pattern baldness and benign prostatic hypertrophy, the real concern is prostate cancer. As early as 1986,  it was suspected by some that 5α-DHT might  be the main contributing factor to prostate cancer growth.⁴ However, recent studies have correlated low levels of DHT with decreased survival in prostate cancer patients.^5,6,7

Note: 3-alpha Adiol is a storage form for 5-alpha DHT and the enzyme 3-alpha HSD is bidirectional. Some researchers tell us that nearly all 3-alpha-Adiol is “cycled back” to DHT.¹⁶ At present, it appears that to get an accurate evaluation of “total” 5-alpha DHT levels (actual and potential)  3-alpha Adiol and 5-alpha DHT should be  added together.

5-alpha-reductase (5AR) is the enzyme that converts (among others):

• Testosterone → 5α-DHT
• Androstenedione→ andosterone
• Cortisol → allo-tetrahydro-cortisol

Using the levels of the above hormones and metabolites in urine and blood we can assess overall 5α-reductase activity.

24-hr urine hormone test with human growth hormone page 4

Increased 5α-Reductase Activity

Elevated levels of 5α-reductase activity in women is associated with polycystic ovary syndrome (PCOS) and hirsutism (increased body hair growth).⁸

In men, elevated levels of 5-α reductase activity are associated with benign prostatic hypertrophy (BPH) and premature baldness.⁸

In both genders, elevated 5-α reductase activity is associated with obesity and insulin resistance.⁹

Decreased 5-α Reductase Activity

Over-inhibition of 5-α reductase results in decreased production of dihydrotestosterone (DHT) and increased levels of testosterone. The resulting conversion of testosterone à estradiol may cause gynecomastia, which is a side effect of 5-alpha reductase inhibitor drugs.

Over-inhibition of 5-alpha reductase also results in decreased amounts of the metabolites of DHT, which include 3beta-Adiol (5alpha-androstane-3beta,17beta-diol), an anti-proliferative hormone that may help prevent prostate cancer. ¹⁰

Finasteride® and Dutasteride®

Patent medicines  that inhibit 5-α reductase are used to treat benign prostatic hyperplasia, prostate cancer, and baldness (androgenic alopecia). Two of these patent medicines are finasteride (Proscar®, Propecia®) and dutasteride (Avodart®).

Risks of adverse drug reactions (ADRs) to 5-α reductase inhibitors increase with dose. Common ADRs with these drugs include impotence, decreased libido, and decreased ejaculate volume. Rare ADRs include breast tenderness and enlargement, and allergic reaction.

Progesterone and DHEA

Two hormones that can be assessed on a 24-hr urine hormone profile are dehydroepiandrosterone (DHEA) and progesterone. DHEA up-regulates 5AR activity.¹¹ Progesterone inhibits 5-alpha reductase.¹²

Over-inhibition of 5α-Reductase Activity

Over-inhibition of 5-alpha reductase is an important consideration because without adequate dihydrotestosterone (DHT) the production of 5-alpha-androstane-3-beta-17-beta-diol (3β-adiol) may be over-inhibited as well.

Research regarding the benefits of adequate 3β-adiol is growing. 3β-adiol is an androgen that stimulates only estrogen receptor beta, which has anti-proliferative and re-differentiation activities. .  Among other functions, estrogen receptor beta  helps regulate prostate growth and differentiation.^13,14,15,16 It is also an important modulator of the stress response in the brain.^17,18Over-inhibition of 5-alpha reductase can result in under-stimulation of estrogen receptor beta, changing the balance of proliferative/anti-proliferative activity in the prostate as well as elsewhere.

Testing for pro- and anti-proliferative metabolites

Consider using serum testing to know your patients’ levels of testosterone, DHT, 3a-Adiol, 3β-Adiol,  and DHT allowing you to ensure that testosterone is being sufficiently converted to 3β-adiol. Any inhibition of 5-alpha reductase must be evaluated for over-inhibition. Over-inhibition of 5-alpha reductase can also be caused by some natural supplements that contain highly concentrated amounts of Saw palmetto and may lower 3β-Adiol too much sometimes.

Natural 5-alpha reductase inhibitors include:

• Gamma-linolenic & eicosapentaenoic acids (GLA and EPA)^19,20
• Vitamin D3 ²¹
• Zinc^22,23
• Serenoa repens (Saw palmetto)^24,25,26,27

Research on the effects of zinc on 5-alpha reductase has shown that vitamin B6 can potentiate its inhibitory potential.

Heavy metals, such as cadmium and arsenic, may also inhibit the production of 3β-adiol.^28,29 These heavy metals have been correlated with increased prostate cancer risks.

In urine, two ratios are commonly used to assess 5-α reductase activity (see 24-hr urine hormone test page 4 above):

• Andosterone : Etiocholanone
• Allo-tetrahydro-cortisol : tetrahydro-cortisol

When we find very low ratios of the above hormones in urine we suspect that the production of 5α-DHT is very low. Follow-up testing with a serum Testosterone Metabolites Profile can give further insight. In this profile you can also assess important ratios such as:

• Testosterone : 5α-DHT
• 5α-DHT : 3β-adiol

Testosterone Metabolism Sample Report

Ratios are important

A higher testosterone to DHT ratio was associated with a 42% decreased risk of BPH when comparing the top 3 quartiles to the first quartile (OR 0.58, 95% CI 0.35-0.97, p = 0.04). ³⁰

A study in 1996 examined DHT and testosterone levels in men who were also screened for prostate cancer. The testosterone/DHT ratio tended to be higher in patients with more advanced tumors. There was an inverse relationship between tumor volume, as defined by PSA level, and 5 alpha-reductase activity, as defined by DHT level, and the testosterone/DHT ratio. This trend was most obvious with stage T-3.³¹ T-stage refers to the level of spread in the prostate and surrounding tissues.

More recently, a 2008 study found that plasma 5α-DHT levels were reduced when testosterone was given to elderly men with below normal levels of testosterone and elevated DHT levels.³²

While 5α-DHT is considered to be a potential cause of proliferation and growth in the prostate, its metabolite 3β-adiol is a differentiating agent that activates estrogen receptor beta and may help prevent cancer. As a leader in preventive medicine we are very interested in the growing body of evidence that the ratio of 5α-DHT to 3β-adiol may much more important than the their absolute levels alone. We are proud to be able to be the first and only lab to make testing for these testosterone metabolites commercially available. Dawn Huo, PhD and Ray Lian, PhD are the developers of this test.

Learn More About Testosterone Metabolite Tests

Thank you to Dr. Ronald Steriti, ND, PhD and Dr. Wendy Ellis, ND for their help compiling the information for this article.

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