The Diabetes Summit 2017
Notes from this interview, for more information visit the speakers web page.
Anna Cabeca DO – Board Certified Gynecologist and Obstetrician also Board Certified in Anti-Aging and Regenerative Medicine.
web page drannacabeca.com
Creating Hormone Balance to Optimize Metabolic Health
Often we forget that our hormones are important for our metabolism. What happens as we get older and our hormones start to decline, even a little bit, we start to become very energy efficient machines. As we start to see in our mid-thirties a decline in our progesterone hormone and that can lead to an imbalanced ratio with estrogen and progesterone. This can also effect our thyroid hormones and create an increase in our thyroid stimulating hormone also effecting our body core temperature, metabolism, and our entire hormonal system in general. Also as we continue to get older there is a natural decline in DHEA and testosterone, these are important hormones for muscle strength and muscle building. That also will tie into our metabolism, rebalancing and empowering our hormones as we get older becomes really essential especially dealing with issues with blood sugar. Really both men and women but especially for women, we know it’s harder to lose weight, we know it takes a lot more time and energy as well. Hormones effect metabolism and blood sugar is a reflection of metabolic function in many ways.
Our energy efficiency increases, however, our lifestyle doesn’t change. Hence there is a bigger gap, maybe our food choices don’t change, or enter into more carbohydrates, or our energy expenditure decreases with less activity. Any of those things is going to affect us. If those are not changing but yet our body is more efficient in energy storage as far as glucose utilization and fat storage, that leads to an increasing problem with obesity in general. If your metabolism is fuel efficient that means you are burning less calories and if you haven’t changed your diet and lifestyle to match that you end up storing all those extra calories in the form of fat usually.
What determines this energy efficiency is in part the thyroid hormones, part of that is cell membrane function. There is that concept as we get older there is a healthy energy efficiency and there is also an unhealthy energy efficiency because of cell membrane permeability. That creates kind of leaky cell membrane so we are expending energy in an inefficient way. I want to differentiate the two because there is both. What we see as we are getting older with the time that we need to repair and improve our cell membrane health such as a health good night sleep, healthy fat intake, proper digestion, optimal microbiota, optimal hormonal balance, are all kind of offset. In order to really optimize our energy utilization we need to optimize those five key areas. Also recognizing that we have other issues adding in as inflammation that’s going to cause cell membrane permeability as well. Those are the issues that create the diseases we associate with 90% of the diseases of aging with hormone imbalance and inflammation. Correcting those two major areas can make all the difference in the world.
With healthy menopause we are designed to have a, we say the wise woman, have really good clear mental faculties. We’re no longer in the reproductive cyclical hormone phase so things should technically be steady state, we have a healthy intolerance for aberrations in general, you know we’re able to speak our mind. In general we have those levels of freedom that are benefits of menopause, that’s the healthy menopause transition. Hormonally what is that going to look like, yes, we are going to age, have wrinkles and laugh lines, smile lines and things like that but that’s awesome. We should be waking up rested and going to sleep on schedule without difficulty and have the sense of peace within us. We have become able to enjoy the life that we have worked so hard to create and also be able to educate, inspire and instruct those around us and the generations that follow us. That’s the ideals in menopause, what is happening however, with environment and toxicities is unhealthy aging and unhealthy hormonal imbalance. What happens is we tend to get overweight, difficulty with weight loss, we tend to have increases in our blood sugar, increases of heart disease. What that feels like too is hot flashes, mood swings, itchy skin, night sweats, irritability, the monster within us can come out. Then unhealthy aging also with issues that relate to sexual health and decreased desire or decreased function, hair loss. Those are signs of unhealthy aging and signs of hormone imbalance and inflammation that we definitely want to correct.
We would like to say the major players are estrogen, progesterone and testosterone, however, the major players when it come to a healthy menopause are insulin, cortisol and oxytosin. This is what I teach and I run menopause programs specifically to get these major hormones in balance then we could fine tune the minor hormones. But unless we are getting the concepts that relate to increasing our body’s ability to have insulin sensitivity and regarding cortisol to have reset our cortisol, our natural circadian rhythm, we’re not going to get hormonal balance at all. And will continue to struggle with inflammation, the weight gain, mood swings, night sweats and all of those. Actually insulin and cortisol have a bigger role in those than estrogen, testosterone, and progesterone, although those are important. And DHEA as well which I replace very frequently but insulin and cortisol are key to healthy menopause.
Healthy adrenal function is also connected to a healthy menopause. Where our adrenals are pumping out cortisol one of the first things that we want to do to establish healthy adrenal function as well as healthy hormone function is to create an alkaline environment. This is going to effect the hormone cortisol, when we are secreting high amounts of cortisol we are actually going to be robbing our body of the sex steroids including DHEA, estrogen, testosterone, those diminish. It decreases muscle production, that decreases healthy hormone balance that we need for all the actions of estrogen and testosterone. When we are driving cortisol too fast, as well as when we have the brakes on cortisol, when we’re in a hypo-adrenal state. That means cortisol has flatlined across the board. It’s termed adrenal fatigue but it’s really not like the adrenal glands are tired the adrenals have self-regulated and shut down for safety reasons I would say, so we don’t fry our entire nervous system from chronically high cortisol.
By re-establishing a healthy alkaline environment your actually improving cell membrane, it’s really exciting, you talk about cell membrane potential the efflux of the positive and negative ions over the cell. Without that we need healthy minerals, one sign of healthy mineral function and decreased inflammation, healthy cellular function, is an alkaline PH. We are not talking about blood PH here, our blood PH stays very stable we will rob peter to pay paul to keep our blood PH stable. That means we will rob minerals primarily from our bones to keep healthy minerals circulating for a good healthy PH. Also for our cellular function becomes important because our cells will behave differently as well as our microbiome will behave differently in an alkaline environment versus an acidic environment. It depends where in the body we are talking about but looking at PH I’m having clients check their urinary PH to test and see. Do I need more greens, do I need other activities to reduce cortisol like meditation, going out in nature, turning off my EMF’s and having a good night sleep. All those things will effect our PH it’s not just what we eat. It’s important for our clients to realize it’s not only just what you eat, if you’re having four starbucks a day and your pedal is to the metal, running ragged, completely stressed, worried about bills, those are going to cause an acidic environment.
An acidic environment causes inflammation, a disrupted circadian rhythm, disrupted cortisol pattern is part of the picture. That’s where I tie alkalinity to cortisol, this is what I see in most clients, in most women who are in the peri-menopausal, menopausal range are chronically low cortisol levels. Cortisol is our natural anti-inflammatory but also we know when we excrete high spikes of cortisol that’s going to effect glucose production. Whether it’s too high or too low we’re going to have an issue with glucose production and metabolism and increasing hemoglobin A1C and inflammation, so both those we are going to effect our inflammatory pathways.
With diet you definitely want more greens, all different kinds of greens, kale, collards, chard, and beet greens are my favorite thing, they are a gold mine for alkalizing. I choose to introduce those predominantly because they are very low carbohydrate, a low glycemic load, especially for women with difficulty with low glucose metabolism. Maca, which is part of my product mighty maca is an alkalizing root. There are alkalizing greens and vegetables, avocado is alkalizing with a healthy fat component.
The average fifty year old is on three medications which can also create an acidic environment. Later they will be on a fourth and fifth medication it’s really destructive. It’s common for a patient to come in on eleven medications, it’s not right. If we can do something that takes pennies a day and puts it in the patients own hand it’s just test your urine until you’re alkaline. Dehydration can cause acidity that’s another thing. No one has looked at menopausal women and acidity, what I did in my groups I had clients fill out surveys and 90% when they start the program are acidic on the urinary PH. What women find as they get older, as they get alkaline is that they have increased energy, if they are checking their blood sugar because they are diabetic their blood sugar is going down. They have less inflammatory complaints such as hip pain, joint pain, less hair loss, their skin looks better. Feeling more energetic you start to create an environment where you’re utilizing energy in a very powerful way to, you are healing the cell membranes. Where have the studies been done, typically on a college co-eds, male athletes, it’s hard to study women especially in this environment. It’s undeniable what a difference that makes to women with help for weight loss and hormone balance.
What I do in my magic menopause program, and I have had clients do their lab work pre, during, post whenever they can. Several clients for example, she is 57 years old and she started the program with her historical hemoglobin A1c had always been seven. In the program we start with getting alkaline by natural healthy detoxifying foods. We start having them check their urine to get a PH and introducing an alkalizing lifestyle as well as ketogenic lifestyles which is also going to improve insulin sensitivity, and we really need this in the menopause. What happens is within a two month frame this client who hadn’t been able to budge her hemoglobin A1c for quite a while went from a seven to a six. We’re still going to get her down to a five but that’s in a two month window and that’s huge. As a physician jump up and down for joy over that because she just reduced her risk for Alzheimer’s and heart disease exponentially.
In my clinical practice I heard of the great benefits for neurologic function and weight loss with ketogenic diets I was ok, it’s a low carbohydrate diet I definitely want this. What I noticed is I would go what I call keto-crazy, ok I’m too low carb, I’m absolutely like a witch, this is not healthy, this is not good for anyone and give me dark chocolate right away. It’s interesting it really is different for men than for women so I couldn’t recommend a ketogenic diet for women because I felt like it threw off our neurotransmitters. What I recognize now is that what was happening is when we go into a ketogenic diet is we are eating very acid forming foods, lots of meats so we’re not getting enough of the alkalizing vegetables. As women we need that carb content to be in very alkalizing vegetables.
If you are working on a ketogenic diet and lifestyle check to see your urine, you’re most likely acidic. Get that PH up into an alkaline range and you will see your neurotransmitters will balance. You will feel calmer, you’ll sleep better, you will start to melt fat away which is huge and that made all the difference in the world combining those two. When I figured that out for myself and it was in a six week time frame, I lost eighteen of the troublesome pounds I had gained in menopause I was ok let me try this on my eight toughest clients. I ran a pilot study of eight menopausal women through it, excellent results and that’s when I started my online program. Then again an excellent result and it’s not an easy thing especially if you’re dealing with blood sugar. But if you keep following the principals and you keep with it and predominantly keep checking your urine so at least that maybe you’re waking up alkaline or hitting an alkaline status once during the day. It can be challenging, I want you to stay there, I want you to stay with a urinary PH of seven. There are going to be times that it’s hard to maintain, that makes all the difference in the world.
The first step for a menopausal woman with hormone imbalances is to test, I am really big on testing. If you are in menopause you can test anytime, if you’re cycling day 19-21 peak hormone levels. Let’s look at the hormones, let’s look at your progesterone, your total estrogen and estradiol, your DHEA-S which is a DHEA sulfate blood test. The testosterone free and total sex hormone binding globulin which is a very good indicator to watch especially for diabetics and clients with polycystic ovarian syndrome. We will watch that number kind of normalize a little bit, often it can be really low or really high and we want to get a healthy sex hormone binding globulin. Not to mention the thyroid hormones, TSH, Free T4, Free T3, thyroid peroxidase antibodies, anti-thyroid globulin antibodies, those are core hormonal tests that I like to look at. There are other markers that I find that are essential in initial management of any client and I want all my clients to know more importantly is what their HSCRP is, their highly sensitive cardio c-reactive protein. I want them to know their hemoglobin A1c of course, their vitamin D 25 hydroxyl, and again their DHEA-S. Those four are really key for us to know to monitor over time, of course there are additional labs I love to have too in functional labs.
We also have to recognize that as physicians there’s an art to medicine and we always want to treat the patient not the labs. When we are doing blood work it’s only that one instance in time we are looking at, for the most part, with the exception of TSH and hemoglobin A1C. We want to really understand over time, checking again and again depending on the frequency, that we need to check to see where those values are going. That will help us for the most part and really kind of tweeking hormones. Typically I start with progesterone cream because progesterone can be bio-identical progesterone not progestins, can be so protective for the brain, breast, and the bones. The other favorite hormone is DHEA also protective of the brain, breast and bones.
As part of our magic menopause program they get surveys, a functional assessment, our medical questionnaire, that’s one of them. Then I also created a hormone review of system questionnaire that I have them do on a monthly basis, a positivity self-assessment questionnaire. The third hormone I’m really big on optimizing all throughout our life, but especially in our menopause, is oxytocin the hormone of love bonding and connections. We have an oxytocin quiz that I have clients take too. These assessments are huge especially when we can’t do full panel blood work but we also can direct them to exactly what labs that we want to see. I have my ten ways to increase oxytocin e-book which is super fun. Part of the practice that we create in the magic menopause program is one of the first things that I have clients do is gratitude journaling, what are you grateful for today.
In this practice of self review, daily review or daily discernment that can help us focus on the positive. We know from neuroscience research that there is a definite re-wiring that occurs during this practice. That’s one of the activities I love to initiate, certainly hugs and kisses are beautiful, doing things, bringing the play back into our life, things we enjoy. Because often as we have hormone imbalance and inflammation we become somewhat hermetic. We don’t want to go out and do things, we don’t feel as social, we’ll avoid contact with people and that’s a sign of very low oxytocin as well as the issues of hormone imbalance with inflammation. That’s not what we worked so hard for, we worked hard to have a loving relationship with our spouse. To have friends and family, good relationships with our children, and the zest of life, the twinkle in our eye, the skip to our step, we’ve earned that at this point. There are so many things that will rob us from that experience and there is a retraining that we really have to focus on in this process of a healthy and magical menopause.
For anyone wanting a doctor to do these tests I typically send them to FnctionalMdicine.org and for a complete list of the lab tests that I recommend I have those at UltraLabTests.com/DrAnnaCabeca. Clients can self-test and get those values which is really beneficial, we need to know these numbers just like we need to know our weight, even more importantly than we need to know our weight. It’s hard, it’s true, with my magic menopause clients often, even if they have asked their physicians to get this panel of blood work they maybe ordered the wrong thing. It’s not the right version, we got DHEA instead of DHEA-S, or the vitamin D profile they ordered is incorrect, or the lipid panel is not the comprehensive. There are issues you want exactly the highest sensitivity for this information. Then their insurance may have huge deductibles and end up paying three to four times what they would pay if they didn’t file it with their insurance, there are some issues with that as well. Pretty much the core testing, vitamin D24-hydroxyl, hemoglobin A1c, high sensitive CRP, and DHEA-S in the blood. Every patient should be able to get their physician to order that, luckily we have ways to order them ourselves if we can’t.
I want to make it as easy for women as possible, it’s all about creating solutions so I created urine test strips that are just the PH and the ketones. I tell my clients I want the urine in the green and the ketones to get in the red zone just like Christmas and clients say it is like that when you get there, they’re so happy. It’s not easy, it takes a while to get there but it’s what I’m blogging about these days. There are limitations to urine ketone testing as well, if we get keto-adaptive then we’re not going to see the ketones in our urine but until you get there you are going to see the ketones in your urine. I have yet to meet a consistently keto-adaptive woman let alone a menopausal woman. I struggled with that myself, half a glass of wine would take me out of ketosis, so there is a constant reset that’s involved but it’s good we can keep testing our urine until we get there. There’s advantages to be able to test for pennies, it’s a really nice way that patients can test especially the clients that are checking their blood sugar at home. I know it’s really hard, for diabetics especially, getting into alkaline and to get into ketosis but what a difference when you get there.
In 2006 I actually went on a healing journey around the world with my girls, homeschooled them for a year. Through my travels around the world I experienced indigenous foods and healing philosophy’s and food as medicine in a really big way. One of the very proudly revered fruits and herbals in medicine is the maca root from Peru. The Peruvians would say if you’re not feeing good, you’re tired have maca. If your baby’s not thriving have maca, if you’re infertile have maca, if you need some Peruvian Viagra that’s maca. That was really key and I found that it’s one of the ingredients I started choking down because I couldn’t stand the tase of it. But as I continued around the world I experienced other foods and adding greens and acerola and mangosteen, and many other ingredients I included in my product, which is Mighty Maca Superfoods, it’s a combination of over thirty superfoods. And it tastes great, my daughter was two tasting it and re-formulated it making it even better. You can mix it with water or put it in your smoothie. I started using it in my medical practice and my clients would say it improved my blood sugar, improves blood pressure, increased their energy, increased their sex drive. All these things are important because it’s not just one mechanism of action there is adrenal adaptogens in there to help support our adrenals. There are ingredients to help support our body’s natural anti-inflammatory response effecting the cytokine pathway to so if we decrease inflammation and balance hormones a lot of things start to fall into place. This works well for both men and women and we do see results.
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M. Scherker medical researcher