Bioidentical Hormone Replacement Therapy with Dr. Anna-Marie Wysynski: Rational Wellness Podcast 287
Podcast: Play in new window | Download | Embed
Subscribe: RSS
Dr. Anna-Marie Wynsyski discusses the use of Bioidentical Hormone Replacement Therapy in Women with Dr. Ben Weitz.
[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]
Podcast Highlights
4:03 We learned from the 2001 Women’s Health Initiative that the use of synthetic hormones including estrogen made from horse’s urine and synthetic progestins might increase the risk of heart disease by forming clots that can block the arteries in the heart. In particular, it is the synthetic progestins that are dangerous, since in the estrogen only arm, there was no increased risk.
9:10 The Benefits of Bioidentical Hormones, in contrast to synthetic hormones, are that they significantly reduce all cause mortality, which means the risk of dying from any cause, in both men and women when used at the appropriate time.
10:19 Dr. Wysynski prefers to prescribe estrogen creams rather than oral estrogen or in other forms. She prefers not to use oral estrogen, since it tends to raise LDL cholesterol, but she will sometimes use it if the other forms don’t work for that woman. She prefers the Biest cream that contains both estradiol and estriol. She will sometimes use a vaginal route. She is looking into bringing pellet therapy into her clinic, but the difficulty with pellets is that you can’t easily adjust the dose. With Biest cream it is easy to adjust the dose. There are patches that are bioidentical, but they are synthetic rather than natural. Dr. Wysynski prefers to use the Biest creams, which mimic the fact that the naturally occurring forms of estrogen are estriol and estradiol in an 80:20 ratio. Sometimes a higher amount of estradiol, such as 50:50 is necessary to calm down perimenopausal or menopausal symptoms.
15:27 Some doctors in the hormone replacement field feel that estradiol is the preferred hormone to recommend and that estriol is the hormone that predominates in pregnancy and it does not provide the benefits of estradiol. In allopathic, conventional medicine, we give women estrogen in the form of estrogen patches or EstroGel as hormone replacement and if a woman does not have a uterus, we do not offer any form of progesterone or progestin. But that doesn’t make any sense to Dr. Wysynski, since when women are in their 20s, progesterone is typically a hundred or more times higher than estrogen. In perimenopause, progesterone falls faster and greater than estrogen. Progesterone falls about 70-75% whereas estrogen only falls by about 30%. When estrogen levels are higher than progesterone, this is referred to as estrogen dominance and this estrogen dominance leads to the typical symptoms of menopause. If you give estrogen only, this exacerbates estrogen dominance and high levels of unopposed estrogen can makes things grow. It is not physiologically correct to give estrogen without progesterone. And in terms of the form of estrogen, a woman naturally produces 80% estriol and 20% estradiol, so using a 80:20 Biest cream is physiological.
18:34 Dr. Wysnyski likes to recommend slow release oral progesterone compounded, though some women prefer topical creams. She customizes each patient’s hormone recommendations for each woman depending upon her presentation, her needs, and her hormone testing, such as saliva testing.
19:49 Dr. Wysynski leaves it up to her patients if they would like to have their cycle return, then she will cycle the progesterone. If not, she will have them take it daily and perhaps take it 6 days per week and skip one day or perhaps take a lower dose on day six or seven. Progesterone is a brain chemical, a natural antidepressant, helps with water bloat, it’s a diuretic and it is an anti-anxiety hormone as well as a sleep hormone, so it is very beneficial for women.
23:14 Testosterone for women. While Dr. Wysynski will recommend testosterone for women if they need it, she feels that it is not so much a driver of libido in women as it is commonly thought. She feels that when you restore the estrogen/progesterone balance, women’s libido usually comes back without needing additional testosterone.
Dr. Anna-Marie Wysnyski is the Medical Director of her clinic, Dr. Wysynski Bespoke Functional Medicine in Burlington, Ontario. She is certified in Functional Medicine from the Institute For Functional Medicine and she has completed a post graduated fellowship in Anti-Aging Functional and Regenerative medicine from the American Academy of Anti-Aging Medicine. She is a hormone expert and has provided bioidentical hormone replacement therapy for peri-menopausal and menopausal women since 2006, which is our topic for today. Her website is TorontoBioidenticalHormones.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.
Hello, Rational Wellness podcasters. Today we will be discussing the use of hormone replacement therapy in postmenopausal women with Dr. Annmarie Wysysnki. Today we’ll be discussing the potential benefits and drawbacks of recommending hormone replacement therapy in postmenopausal women. After menopause, women often experience a number of symptoms including hot flashes, night sweats, sleep problems, vaginal dryness and atrophy. Post postmenopausal women also have an increased risk of heart disease and osteoporosis. It was common for MDs to prescribe hormone replacement therapy prior to the Women’s Health Initiative, which in 2001 reported that postmenopausal women who take hormone replacement therapy have an increased risk of heart attack, stroke, and breast cancer. After the WHI study was published, many MDs stopped prescribing hormones to postmenopausal women. However, additional analysis of this study has led quite a number of doctors and researchers to conclude that these results may only apply to women who take estrogen derived from horse urine and synthetic progestins, and who don’t start taking hormones until an average of 10 years after menopause. The American College of Obstetricians and Gynecologists, I went to their website, and so they currently recommend that taking unopposed estrogen increases the risk of endometrial cancer while taking combined therapy estrogen plus progestins slightly increases the risk of breast cancer. They also state that combined hormone therapy may reduce the risk of colon cancer. On their website, The American Collagen of Obstetrics and Gynecologist’s website also states that combined hormone therapy is associated with a small increased risk of heart attack for older women.
Now, they also state that this risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy. Some research suggests that combined hormone therapy may actually protect against heart attacks in women who start combined therapy within 10 years of menopause and who are younger than 60 years, and this benefit may be even greater for women taking estrogen alone. However, I will say that I’ve seen guidelines from other nations, other countries, and they come to different conclusions. Anyway, we’re going to discuss all this. Dr. Annmarie Wysysnki is the medical director of Dr. Wysysnki Bespoke Functional Medicine, formerly Vitality Anti-Aging Center in Burlington, Ontario. She’s certified in functional medicine from the Institute for Functional Medicine, and she’s completed a postgraduate fellowship in anti-aging, functional and regenerative medicine from the American Academy of Anti-Aging Medicine. She’s a hormone expert and has provided bioidentical hormone replacement therapy for perimenopausal and menopausal women since 2006. Dr. Wysysnki, thank you for joining us today
Dr. Wysysnki: Ben, it’s my pleasure. Thank you very much for hosting me.
Dr. Weitz: Absolutely. What did we learn from the 2001 Women’s Health Initiative? Did it tell us that hormone replacement therapy increases the risk of breast cancer and heart disease in menopausal women?
Dr. Wysysnki: It did tell us that, Ben. In fact, we know that when there are different hormones used, specifically the synthetic hormones as you spoke about, it can increase risk of heart disease by you forming clots that block the arteries in the heart, and it could increase the risk of stroke as well. What we learned, and this is very difficult in the literature, is that we’re very inaccurate when we talk about hormones. When we talk about bioidentical hormones, for example, we know that those are identical chemically to the body hormones that are made when we go into reproduction starting in puberty. However, the studies have been used with pharmaceutical drugs that are made from synthetic chemicals and specifically, as you said, estrogen from horse urine. Over 50% of that estrogen is not identical to what we make, and we know that that may or may not propose problems. But where the biggest issue came with the WHI study, the Women’s Health Initiative, or the WHI study, is we know that there are synthetic progesterone-like compounds called progestins. This is where the greatest issue came. When the study was stopped because of increased risk of heart attack, stroke, and breast cancer, the arm of estrogen only continued, and they found that that was not as egregiously dangerous and not dangerous at all, frankly, compared to when we combined estrogen with synthetic progestins. This is a really key important point when we’re reading the literature as healthcare providers to differentiate between progesterone and progestins, but it’s not always clear. If we’re not clear what’s happened in a study, how do our patients differentiate what they’re getting versus what they are reading in the common literature and what they’re hearing from their doctors?
Dr. Weitz: I think another important factor is that on the average, these women didn’t start taking hormones until an average of 10 years after menopause. If estrogen is protective against heart disease and these women go 10 years without estrogen, which means during that period of time they’re at increased risk of heart disease and then you incorporate the hormones, well, obviously they’re liable to have more of a risk of heart disease because they went for 10 years without that protection.
Dr. Wysysnki: Absolutely. One of the points that’s really salient here is that when women are at 40 years old and not in any menopausal state yet, because menopause can start as early as 35, but as an example, as a cohort, when we look at women who are at 40 years old who still cycle and have their natural hormones being made, compared to men at 40 years old, women enjoy 10 year protection against heart disease. However, when we go to 50 and within the one year when a woman’s menstrual cycles wind down and she ends up losing her menstrual cycles, by the time that year anniversary of no period, which is called the date of menopause, when that happens, she catches up to her male 50-year-old cohort equivalence. We already enjoy extra protection when we’re cycling and you’re right, that 10 years is usually the time period in which we start seeing things happen like plaquing, early heart disease symptoms, angina, et cetera. When we try and reestablish these hormones and then add a progestin that is synthetic that is known to be embolic, meaning it causes clots, in a population that’s already lost their hormones, lost their protection and has accelerated disease over 10 years, of course we see increased risk.
Dr. Weitz: This whole risk of women and heart disease is kind of an interesting topic because I think in general, women tend to get undertreated for heart disease and under screened for it.
Dr. Wysysnki: I agree with you in the heart disease, but in general, women’s health still is not well addressed. This is why I become passionate about helping women worldwide deal with menopause and their longevity protection. Because typically when we look at studies, and previous to medical school, I was a PhD researcher where I did these types of studies. I was in pharmacology where we would do drug development and typically because we want to keep all these factors controlled, so what that means is we have identical animals with identical genes with identical daylight cycles, et cetera, we don’t want to have female animals in that experiment because when they get their estro cycles, which is the equivalent in animals of the period for women, it confounds or it creates an unknown factor in the studies. Typically all research is done or almost exclusively done on male animals or men when we do human population studies, and then we just extrapolate to women. Not only is heart disease underrepresented, women’s reproductive health and everything about women’s health is underrepresented in the literature.
Dr. Weitz: Right, absolutely. Let’s talk about hormones. What are some of the benefits of taking bioidentical hormones? Then also tell us what types of bioidentical hormones you prefer to use.
Dr. Wysysnki: Absolutely. The advantage summed up in a sentence is when men and women replace their hormones at an appropriate age or developmental reproductive stage, they statistically significantly reduce all cause mortality. That means any disease that we could think about acquiring and dying from or causing disease and leading to earlier death is reduced not only just experientially, but in the literature that real key word of statistically significant. When I use bioidentical hormones, I like to use natural hormones. Most of them are derived from wild yam. Stabilized in the lab, they look identical to what our body makes. There’s no additional groups added to it. There’s no additional chemistry or different picture. If we took our natural hormones and our bioidentical ones that we replace, they marry each other in chemical structure and function.
Dr. Weitz: Let’s start with estrogen. Do you prefer creams, patches, pellets? Some women are still taking oral estrogen.
Dr. Wysysnki: Right. Thank you for that. I prefer creams for estrogen for a variety of reasons. We know that oral estrogen does increase certain risk factors for heart disease. For example, it will actually increase the bad cholesterol or the LDL that we try and control in people to produce heart attacks and strokes. Oral estrogen would not be off the table, but it would certainly not be my first choice. In fact, it would sort of be my I have nothing else to offer a woman and that’s all she could take. I believe it was 2018, there was a great book called Estrogen Matters that was written by a radiation oncologist in California. His name is Avrum Bluming. So Estrogen Matters by Avrum Bluming and he went back to the ’40s when synthetic oral estrogen was discovered. In his meta analysis or grouping together of all these studies and looking at the literature, he actually showed that it’s quite protective to still just have oral estrogen. So that wouldn’t be my choice.
I really prefer to have compounded two estrogens, estradiol and estriol called Biest. We can achieve bioidentical estrogen replacement with patches or EstroGel, but again, those are synthetic. From a chemical point of view, they’re made in the lab from chemicals. They don’t have the same energetic potential, if you might, as natural hormones. I tend to go with natural hormones. Sometimes we’ll use a vaginal route. Oftentimes we can use the topicals, as I said, and then pellets are just coming into fashion here in Canada, quite popular in the United States, and I’m actually looking to bring that into my clinic shortly. I will be an independent provider of pellet therapy soon. The difficulty with pellets is it’s hard to adjust dose. With the creams, we can actually adjust doses. For example, if I give somebody, let’s say, 0.4 milligrams of estrogen and it’s not doing well for them, I can actually have them double the dose by giving more than one or two pumps or turns of a container. Or if it’s too much, I can actually have her alternate one pump and two pumps every alternate day, for example, and that would actually give me an average dose over 10 days that would be in between the dose that I’ve prescribed. They’re very flexible. Custom compounds unfortunately are not covered on most drug plans, which is a drawback, however.
Dr. Weitz: Now, aren’t there prescription patches that are bioidentical?
Dr. Wysysnki: They are bioidentical but not natural. They are synthetic. For example, patches EstroGel are created in the lab from synthetic chemicals. They are not derived from yam.
Dr. Weitz: How much does that matter?
Dr. Wysysnki: I think it matters a lot. If you take a vitamin pill, for example, a vitamin C tablet, and you take one that’s made from synthetic hormone, it will fit into the receptors, so that’s like putting your key into a lock. However, from a natural point of view, if you were to take natural vitamin C, there’s actually energetic auras, if you might, or energetic potential. I would rather eat a natural orange than to take a vitamin C synthetic tablet. For me, it is more dogmatic than it is scientific, but certainly I would rather go with a fully naturally derived hormone rather than a synthetic one.
Dr. Weitz: Then explain why you like the Biest cream, which is a combination of two different forms of estrogen, estradiol and estriol, and what percentage of each do you prefer?
Dr. Wysysnki: Thank you. I prefer to combine the estrogens because when we talk about estrogen, we talk about it as if it’s one hormone in the body and it’s not. It’s a group of hormones. We know specifically the most information about three: estrone, estradiol and estriol. Why I like to balance the estradiol in the estriol is that that’s how it naturally occurs, usually in an 80:20 percentage. So 80% estriol, 20% estradiol. However, it depends on the patient and their situation. I can custom compound that percentage to be anything I want. I’ve done 70/30, I’ve done 60/40. My greatest success is with 50/50 because we know that there’s a little bit of bioconversion between estriol and estradiol and it keeps the percentages healthy. Estrogens make things grow, but estradiol is actually extremely healthy and safe, so much so that in Europe, estriol is given to women to treat breast cancer. We know, again, as you said, different countries have different consensus guidelines and there’s different uses for these. When I look at the biochemistry of a woman and how she produces her estrogens and what proportions, I’d like to replace a mere identically to our natural levels. Although when women are having symptoms in perimenopause, sometimes a little bit more estradiol to tone down the receptors actually works better.
Dr. Weitz: Let me just bring up a challenge from another doctor who I’ve spoken to a number of times who’s a big proponent of estradiol, and she argues that estriol is really the hormone that’s secreted during pregnancy and is not really … it doesn’t really provide all the benefits that estradiol does, so that’s really not the natural way to do it.
Dr. Wysysnki: Two things I’m going to comment on. In allopathic medicine, which is non-functional medicine, as you know, it’s pharmaceutical oriented medicine, we give women estrogen in the form of estrogen patches or EstroGel as a hormone replacement. Specifically if one does not have a uterus, we do not offer any form of progesterone or progestin. That doesn’t make sense to me because, and I’m just going to use my hands, I don’t have a chart. When we’re 25, progesterone is typically a hundred or more times higher than estrogen. In perimenopause, as things decline, this is what happens. Progesterone falls faster and greater than estrogen. Progesterone falls about 70, 75%. Estrogen only falls about 30%. By definition, estrogen is higher in menopause than progesterone, a state that we call estrogen dominance. If the natural hormones are progesterone higher than estrogen at our peak reproductive ages and our peak wellness ages, why would we give more estrogen to a woman who’s in estrogen dominance and that estrogen dominance is what leads to the typical symptoms of menopause? What happens in allopathic medicine, as I was trained, you give a woman estradiol and it forces that estrogen higher and higher and higher. Why don’t they get more symptoms? Because we have locks and keys. The hormones are the key, the receptors are the lock. When we have too much signaling, it’s too much noise. The body doesn’t want to hear the noise, so eventually the receptors come out of circulation, and now you have unopposed high estrogen. Estrogen makes things grow. It is not correct physiologically if we’re going to create a balanced hormone picture to give estrogen. If we look at resources like standard gynecological and physiological textbooks or resources in the medical literature, we know that a woman naturally produces 80% estriol and 20% estradiol. Why is that? Estroiol is very weak. It’s produced in large quantities. Estradiol is produced intermediate quantities, and it is higher potency. We don’t need that much estradiol to balance the system.
Dr. Weitz: Sounds good. In what form of progesterone do you like to recommend?
Dr. Wysysnki: It depends on the woman and what her situation is. Particularly if women are having mental health issues, mostly anxiety or sleeplessness, I often prefer to have slow release oral progesterone compounded. But some women prefer to have topical creams. Many women are under the impression based on what they read in the popular literature that if you put creams on, it doesn’t go through your liver. We call this first past metabolism where things go through your liver. Anything oral goes through the liver. Sometimes I want to capitalize on that because with an oral progesterone, I can get metabolites formed in a woman’s body that crosses a blood-brain barrier, gives her a sense of a calgon moment or a wusha, reduces daytime anxiety, helps her sleep better, where some women who don’t have those sleep or anxiety provoking or mental health symptoms may not need oral estrogen. When I rebranded the clinic, we called it Bespoke Functional Medicine for a reason, because every treatment is customized specifically to the woman, her presentation and her needs, as well as her biochemical tests, like her saliva testing for example.
Dr. Weitz: Do you like to cycle the progesterone or give it every day of the month?
Dr. Wysysnki: It depends on the woman. Most of my women almost exclusively do not want to cycle. I have one woman in my practice who’s over 70 who wants to cycle.
Dr. Weitz: By the way, for those who are listening who aren’t aware of what we’re talking about, some doctors recommend giving progesterone in a similar way as your normal menstrual cycle. By giving it for a period of time and then not giving it, women may start bleeding and getting their menstrual cycle back.
Dr. Wysysnki: There are different philosophies and different approaches how we do this. One of my women wanted her menstrual cycle back, and she’s still in her ’70s, has a five-day light period requiring light protection, feels fantastic on it. Most women don’t want the bother. Oftentimes what I will do is if the woman wants … and again, depending on her symptoms, if she responds well and if she sees me in perimenopause where there are still periods, I will cycle the progesterone in various doses at different times of the cycle in order to support her periods. If we see women who are starting to get scanty, irregular periods or flooding periods, let’s say at age 52, we know the literature shows that if women’s cycle naturally or with hormone support till 55, it is very protective. I will push that envelope for a woman trying to keep her cycling as long as possible without having side effects. If a woman’s very symptomatic, sometimes we need standard dose progesterone, and sometimes that looks like days three to 28, sometimes that looks like day one to 25. I don’t like that cycle because I think if you go to day 25, give them five days off, they get too much instability. As well, I may actually give them progesterone six days a week with one day off. Sometimes my approach will actually help to keep sensitized receptors so they don’t get used to the dose. Sometimes they need a break because they, I don’t know, work shift work or they have other needs. Progesterone actually sensitizes the estrogen receptor as well. It needs to be there even in a hysterectomized woman who’s lost her uterus. Progesterone is in all of our tissues. It is a brain chemical, a natural antidepressant, helps with water bloat, it’s a diuretic and it is an anti-anxiety hormone as well as a sleep hormone. We need that and the women’s needs will tell me how they want to be cycling.
Dr. Weitz: That’s interesting you mentioning six days a week and one day off on the progesterone. That’s the first time I heard that recommendation.
Dr. Wysysnki: I use that very often. This is called a combined continuous dosing schedule and giving a break in the cycle or sometimes if a woman finds that she can’t sleep on that one day off, or often what happens is, let’s say she takes a break on a Saturday night and has to be back in the office on Monday, because she’s not slept Saturday, it will actually catch up with her about 24 to 48 hours later, and she may go into the boardroom or into the office or into the hospital, wherever she works, not be very functional in terms of word recall, et cetera, et cetera. We will actually give her a lower dose on day six or seven rather than no dose. Again, very customized dosing for the woman.
Dr. Weitz: Interesting. Do you often recommend testosterone for women as well.
Dr. Wysysnki: If they need it, absolutely. Interestingly, Ben-
Dr. Weitz: How do you decide if they need it?
Dr. Wysysnki: Through their testing and their symptoms. It’s interesting that, for example, we think that women need testosterone because they have low libido or desire, and I sort of separate libido is up in here and libido down there, right? Desire and libido. To tease it out because sometimes the dysfunction is a desired dysfunction, libido is fine, sexual arousal is fine. Sometimes sexual arousal is difficult, but they desire intercourse. It’s kind of interesting. Again, here’s where that gender bias comes in. Men make all three hormones too, progesterone, estrogen, testosterone, but their main hormone is testosterone in high levels. Testosterone drives the sexual function of men, but not so much in women. In my clinical experience of now over 17 years, I have found that once we restore the estrogen progesterone balance to that 25-year-old level or close to at least 10 years earlier, women’s libido comes back very nicely.
Dr. Weitz: Interesting, interesting. I thought it was pretty much accepted that testosterone was a big factor in women’s sex drive.
Dr. Wysysnki: I think it’s overstated.
Dr. Weitz: Do you ever recommend pregnenolone?
Dr. Wysysnki: 100%. Pregnenolone is a hormone that I’ve used of late in my practice in the later years. As my population and my patient population has evolved, so have their needs. Pregnenolone can be really, really helpful in cases of head injury, for example, past traumatic brain injury, for weight shifting, sometimes we could get really nice effect. But when I am working up a woman for menopause, I’m also looking at their cortisol and adrenal function and oftentimes we need those upstream chemicals of pregnenolone and/or DHEA in order to cause effect with the adrenals. Because when a woman stops menstruating, the majority of her hormones that are still produced in low quantities come from the adrenal glands, which also produce our stress hormones. If we live in the world, period, I used to stay in North America, but if you live in this world and you’re a woman or a man, you have stress. The bottom line is we all think that we handle it well, but chronic stress is a really good indication. When I’m seeing those DHEA levels or those cortisol levels being depleted or over overstimulated, I may use pregnenolone specifically to help those downstream chemicals replete.
Dr. Weitz: I want to ask you about one or two other hormones, but let’s go into testing since that seems like that would make sense right now.
Dr. Wysysnki: Sure.
Dr. Weitz: What’s the best way to measure and monitor hormone levels in women? Do you prefer serum, saliva, urine?
Dr. Wysysnki: That’s a great question, and I think that qualifies with depends what you are looking for. When I was a bench scientist, I was taught very keenly if you want to prove your hypothesis, if you want the answer to your question, ask the right question.
Dr. Weitz: Of course.
Dr. Wysysnki: I extrapolate that into my medical practice. If I want to know what the hormones are doing, look in the right compartment. If I want to know what’s available, I will look in the blood. Now, blood is still standardized because it is in the literature. Most of the studies are done on blood. However, various factors will affect blood hormones including the way that they’re carried through the body, whether they’re free or bound, et cetera. It’s not always a clear picture and here’s why. Many, many women worldwide have gone to their doctor and said, “I think I’m in menopause. I have hot flashes. I’m disinterested in sex. I’m yelling and screaming all the time. I feel like I’m going out of my mind. My vagina is dry, sex hurts. I can’t sleep. I’m having hot flashes, night sweats,” et cetera and they’ll do a battery of blood work and hold up the paper and go, “No, you’re fine.” Well, you can’t be fine if you’re symptomatic. Right? If we had somebody with cancer who came in and said, “I’m fatigued all the time, I’m losing weight involuntarily. I have profused night sweats,” which is classic symptoms of potential cancer and we just said to somebody, “You’re fine,” you’re not fine. When we look in the blood, it can be beneficial to see certain aspects of the hormonal cycle. For certain protocols, for example, the one where a woman will choose to use different doses to produce and keep her cycle going, that often tests better on blood. However, the reason a woman is symptomatic is that the tissues are not being bathed in the right amount of hormone. When we use saliva testing, the blood bathes the salivary gland, the hormones go into the salivary gland and are secreted through the salivary gland into the saliva, similar to what’s going on in our bone, our brain, our breast, our uterus, our ovaries, our heart.
This becomes a proxy measure for what we term intracellular or in the cell levels. That’s what I want. I want to know what the end target is doing. Some people like to dose on urine. For me, when I use urine, I see the potential for dosing on urine. I’ve had a great success record with using saliva to guide my dosing. I prefer to look at urine when I need metabolites. What’s coming through the kidneys? How is it metabolized? For example, we talked about the two estrogens, estradiol and estriol. We haven’t really talked much about estrone. Estrone is very important. How it breaks down in is metabolized in the body to different pathways, metabolic pathways, the urine sample for me is ideal for that ideal. Ideal. When I’m worried about somebody potentially having breast cancer or family history, breast cancer, estrone has been implicated in breast and uterine cancer in susceptible individuals. When we look at the pathways of how that estrone is broken down, I could see if a woman needs metabolic support or biochemical support to enhance or tune down different pathways that may or may not be favorable in terms of producing her metabolite outcomes from estrone.
Dr. Weitz: We’re talking about the 2, 4, 16 estrogen pathways, right?
Dr. Wysysnki: Exactly. The methoxy and the hydroxy pathways of 2, 4, 16 metabolites.
Dr. Weitz: You’ll do a urine test like a DUTCH test or something like that?
Dr. Wysysnki: Exactly. I would look at a urine metabolite test, such as DUTCH or other companies out there do provide those tests as well. If a woman’s history, again, a bespoke approach depending on her family history or she’s highly concerned about breast cancer, then I will offer a DUTCH test or a similar test, a urinary metabolite test to see how she’s breaking down her estrone. It does not predict breast cancer. It does not predict who’s at higher risk. When we look at the ratios of how the metabolites of estrone are broken down, as you said in those 2, 4, 16 pathways, there were a few small studies, particularly off an isle of France called Guernsey where they noted that women with certain patterns of estrone breakdown or metabolism had up to 30% protection against developing breast cancer. I can’t say a woman won’t get breast cancer. I can’t say she will. All I could say is that her ratios are or are not favorable based on these studies out of Guernsey and if we optimize her pathways, it appears to confer some protection.
Dr. Weitz: For those of us who are familiar with this in working with women, there’s a lot of controversy over which pathway is most important and we used to look at the 2 to 16 and now some people place a lot more importance on 4 pathway. What do you consider the most significant pathways and what do you like to see, and then what sort of nutritional strategies do you use to optimize things?
Dr. Wysysnki: Absolutely. The 2/16 ratio I still look at specifically. When you ask me what pathway, they’re all important to me. Because just like when I’m looking at my salivary tests, I’m looking for not only absolute numbers, I’m looking for relative ratios. When I’m looking at the urinary metabolite tests for estrone, I’m looking at relative ratios like the 2/16 pathway where the methoxy metabolites are, because those are known to be unstable and to cause DNA adducts. I’m looking at their COMT profile, I’m looking at their methylation profile to see exactly what is going on in her body.
Then depending on what pathways I’ve used, and in men as well, I’ve used grapefruit to bring up some pathways and increase enzymatic reactions, cruciferous vegetables, diindolylmethol or methane or DIM or I3C, indole-3-carbinol, those are all part of the pathways that are derived from cruciferous vegetables and those are provided as supplements. Sometimes I will recommend those. Sometimes it’s as easy as having somebody stop smoking or decrease their alcohol intake, increase flaxseed. There’s multiple pathways and multiple mechanisms and again, it depends if somebody doesn’t like to take pills, which most of us don’t, even though they are supplements, a woman won’t adhere to that therapy. But if she will add a tablespoon of flaxseed to her diet and incorporate a cup of green cruciferous vegetables, then that’s the way we’ll go.
Dr. Weitz: Do you ever use iodine as something that might be protective?
Dr. Wysysnki: Absolutely. Iodine is a nutrient, I think, that is very misunderstood and underutilized. We know that table salt had been iodized because of goiter, but we also know that iodine is useful in conditions like polycystic ovarian syndrome and in fibrocystic breast disease. I just recently had a patient who did not have optimized thyroid levels, and so I added a little bit of iodine to her diet through a supplement, liquid supplement, and to optimize her deiodination of her T4, really her less active thyroid hormone, but also because she had lumpy painful breasts and I had her taking a little bit by mouth and then also applying it to the breast tissue works beautifully to relieve fibrocystic breast pain.
Dr. Weitz: Interesting. Applying it directly to the breast tissue?
Dr. Wysysnki: Yes. Of course, it’s going to be messy and stain that iodine brownish color. She wasn’t concerned about that because her breasts were so tender, she didn’t care.
Dr. Weitz: Now what about calcium DG gluconate?
Dr. Wysysnki: Calcium DG gluconate is great for getting rid of some of those estrogen metabolites and lowering estrogen levels. I can use it if I need to. Oftentimes women don’t need a whole bunch of estrogen. Typically, my doses are not high. We see women getting six, 12 milligrams of estradiol. Mine are not near that high, and I get great outcomes with the women.
Dr. Weitz: Cool. You mentioned DHEA. When you do a serum lab test, what level of DHEA do you like to see in women?
Dr. Wysysnki: I don’t do serum. I collect that on their salivary tests. I can test it on serum and actually my preference, and not all labs offer this, is to do the DHEAS. We could do both. DHEA is great as an anti-aging hormone, the higher the level, the better, but DHEAS also tells me a lot about the cortisol response and what’s going on with their adrenals. I like the DHEAS from a stress response. Again, if you want the answer to your question, ask the right question. What DHEA form are you using? How are you testing it? What are you looking for? If I’m looking for adrenal health, I will look for it in the saliva, ideally as DHEAS, although DHEAS and DHEA levels in saliva tend to be parallel as they do in blood. If DHEAS or DHEA were robust, the other one will be as well and you can almost use that as a assumption that the other is just as robust.
Dr. Weitz: Are you typically doing the adrenal cortisol stress test where you measure the saliva at different points during the day?
Dr. Wysysnki: Correct. Okay. I don’t really like people to wake up in the middle of the night to take a test because, of course, that pops their cortisol up, it breaks their melatonin cycling, but we will do at least a four point cortisol. For monitoring, when I know my patients are stable, I’ll look at least at the morning cortisol because things change.
Dr. Weitz: Right. We’ve been having a bit of an issue trying to get women to do the CAR part, the first two parts, especially if they have to fill up this tube with saliva and they’ve just woken up and they haven’t drunk any water and it’s really hard to fill that thing up.
Dr. Wysysnki: I know. I know. Not only from a patient point of view, but from a personal point of view. I know.
Dr. Weitz: It’s interesting that you like to use saliva, and I know a number of functional medicine doctors who do, but there are a number of doctors who say, “Well, look, saliva’s just not accurate. It really hasn’t been standardized.” What do you say to that?
Dr. Wysysnki: NASA uses saliva testing for its astronauts. If it’s good enough for astronauts, it’s probably good enough for us docs and our patients.
Dr. Weitz: There you go. That’s a good one. I hadn’t heard that before.
Dr. Wysysnki: But again, if you want the answer to the question, ask the right question. We tend to overdose our patients in blood because it’s just an available level at the time. There are diurnal variations and we know that. Especially when people are on hormones, if I ask them to put hormones on their skin and go down to the lab and get a blood draw, I’m probably getting a whole whack of hormones that are residual on the skin or that are in those skin cells as the needle goes through and the circulating levels are not necessarily as accurate as I would like them to be. I’m using more blood now than I ever have, which is a teeny minuscule amount of serum testing for various reasons. Sometimes when women aren’t getting the response that they want, or if I’m finding that saliva levels are just astronomically off the charts, I’ll check again in blood. You can’t always compare them and almost never do I see them correlate.
Dr. Weitz: Interesting. One more hormone. It’s a minor hormone, but I’ve read a little bit about it recently, is oxytocin.
Dr. Wysysnki: Oxytocin is amazing. One of the things for oxytocin, there is a rule for oxytocin in functional medicine. The difficulty with oxytocin, it’s about $600 a month. It is very, very expensive, at least here in Canada and probably in the US it’s a lot more. Oxytocin is the hormone that’s released from the pituitary gland, typically when a woman is going into labor. That’s what increases the onset of labor, that rhythmic contraction of the uterus, et cetera, et cetera, and primes the cervix for delivery. But we can use oxytocin in many instances. Oxytocin can be very, very effective for chronic pain, fibromyalgia type pain, arthritic pain. Also, I have prescribed oxytocin when somebody was in a situation where desired human interaction and human affection, but were very shy and withdrawn from being in that human interaction to get the emotional support that this patient wanted.
Unfortunately, one of my patients with pain used oxytocin and has a very complex pain situation. As a single approach, she did not find it overly beneficial and my other patient with the emotional disconnection from humans but desiring human affection was not able to afford oxytocin. But yes, oxytocin is a pretty interesting hormone.
Dr. Weitz: You get it compounded, is that the form?
Dr. Wysysnki: It actually comes in as Pitocin. It is synthetic.
Dr. Weitz: Oh, so you use it as synthetic pitocin?
Dr. Wysysnki: Right. I don’t know that there is any actual raw material. That’s a great question because I haven’t needed to look at that. But the Pitocin itself is what we would’ve used as a sublingual spray or other methods, and it can work just beautifully.
Dr. Weitz: Right. Great. Let’s see. Those are the questions that I had prepared. Is there any other things that you would like to cover?
Dr. Wysysnki: I think women need to be knowledgeable and know that there are options out there. It’s not the standard one size fits all approach. At least that’s the approach that my clinic takes and I think many functional medicine doctors do. Just because your doctor may want to do a saliva kit doesn’t make them wrong or if they want to do serum analysis, it doesn’t make them wrong. What it means is that that’s their comfort level in the art of medicine. Remember we say the science and art of medicine. I’ve had great success with saliva testing. Also understanding the role of adrenals helps me use that saliva test to the patient’s benefit because I really do want to know what’s going on with the adrenals. In allopathic medicine, we don’t pay any attention to the adrenals unless they’re not functioning at all or over functioning to create disease, and there’s a whole spectrum in between them.
So if a physician or practitioner, functional or not, doesn’t know how to deal with adrenal dysfunction well, then it may not be beneficial. Yes, things are costly, but the cost of not being well and functioning well and being at our best is also very expensive. It doesn’t count in dollars and cents, but our ability to stay well, avoid diseases, we know that through functional medicine and hormone replacement as well as other modalities and functional, we know that we could keep patients well. We know we can reverse disease and continue to longevity, whatever our natural lifespan is, without illness and disability. That’s really important to me is to support women in that. I also treat men, but my ability to support women because this is such an under-recognized and undertreated area of medical science for women is really important.
Dr. Weitz: That’s great. For those who are listening, who would like to seek you out to possibly have you help them or find out more about you, where would they go?
Dr. Wysysnki: Right now the best place to go is by email at info@drwizz.com. It’s I-N-F-O @ D-R-W-I-Z-Z for those south of the border or D-R-W-I-Z-Z for those of us north of the border dot com. Our website is currently under construction, so that should be coming soon, probably launching in the new year. Also, Ben, for those women who can’t afford or are in countries where bioidenticals are not available, I have written a 12-week menopause 911 coaching program that will also launch early in the new year so people can look forward to seeing that as well.
Dr. Weitz: Okay, that’d be great. Do you see patients remotely as well?
Dr. Wysysnki: I do. I am also licensed in one state in the United States, but across Canada, certainly I do telemedicine and can see patients coast to coast.
Dr. Weitz: That’s great. Awesome. Dr. Wysysnki.
Dr. Wysysnki: Thank you so much, Ben.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or Spotify and give us a five-star ratings and review. That way more people will be able to discover the Rational Wellness Podcast. I wanted to say thank you to all the patients that we’ve been working with at our Weitz Sports Chiropractic Nutrition Clinic, most of whom we’ve been able to help with a range of various health conditions from various types of gut disorders to thyroid and hormonal issues, autoimmune diseases and various other cardiometabolic conditions. I very much appreciate you and I’m excited about going forwards, helping you to improve your health on your journey towards optimal health and I wanted to let everybody know that I do have a few openings now for new clients, and you can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition Santa Monica office at 310-395-3111, and we can set you up for a new consultation for functional medicine nutrition, and we can get that going as early as the new year. Give us a call and I’ll talk to you next week.
