hormones, health & behavior
TRANSCRIPT
Hormones, Health & Behavior
Mark Calarco, MBA, DO, ABAARMNational Medical DirectorAmerican Addiction Centers
To keep the body in good health is a duty... otherwise we shall not be able to keep our mind strong and clear.
‐ Buddha
Key PointHormones are powerful
modulators of mood, affect, health and behavior.
• Common examples ‐‐menstrual cycle, hormonal therapies, contraceptives, castration, dominance hierarchy research
• At least 50% of clients have “hormonal headwinds”
• Both genders, all ethnicities, all ages
Why check for hormone imbalances?
• If you do not look, you will not find them.
• People with hormonal conditions may be misdiagnosed.
• May miss important diagnoses.
• May respond poorly to therapy.
Common Hormonal Conditions• Sex hormone imbalances
• Thyroid dysfunction
• Adrenal hormone abnormalities
• Insulin and Growth Hormone abnormalities
• Sleep cycle hormone dysfunction
• Vitamin D deficiency
Sex Hormone Imbalance –Causes and Behavioral Consequences
• Estrogen – over 400 known functions• Testosterone – important for both sexes• Progesterone – 1st to decline in women• Pregnenolone – neurohormone; blunts THC effect in brain
• Prolactin – over 300 known functions; inhibits dopamine
• Oxytocin – the “cuddle” hormone; reduces methamphetamine craving
Adrenal Hormone Imbalance –Causes and Behavioral Consequences
• Cortisol – Short‐term and long‐term stress marker; inflammatory; inhibits testosterone
• DHEA – Intermediate and long‐term stress marker
• Aldosterone – Regulates blood pressure; hearing loss
• Adrenal fatigue and adrenal burnout
Thyroid Dysfunction
• Hypothyroidism – Low thyroid function
• Hyperthyroidism – Elevated thyroid function
• Causes and behavioral consequences
Other Key Hormone Imbalances –Causes and Behavioral Consequences
• Vitamin D
• Melatonin
• Insulin
• Growth Hormone
Inflammation and Mental Health• Paradigm shift in medicine
• Inflammation as the underlying cause of all chronic diseases of humankind – including many psychiatric disorders
• Depression, Schizophrenia, Autism Spectrum Disorder, Intermittent Explosive Disorder
Hormonal Causes of Inflammation
• Abnormal testosterone level• Low estrogens• Abnormal thyroid function• Elevated cortisol• Low vitamin D• Low melatonin• Elevated blood sugar i.e. insulin dysfunction
Key Points
• About 30% of all depressed patients have treatment‐resistant depression (TRD).
• These patients have high values of inflammatory cytokines that appear to interfere with the mechanism of action of many antidepressants.
• Many of these medications are the same ones used in the treatment of substance abuse.
Gut Microbes and Brain Hormones• Phrase “gut feeling” is actually true!
• Concept of “Microbiome”
• Bacteria in gut produce hormones and other chemicals that communicate with the brain.
• Amount and type of bacteria in gut affect predilection for stress and anxiety disorders and obesity.
Gut Microbes and Brain Hormones
• Many mechanisms – short‐chain fatty acids, GABA and serotonin modulators, BDNF, butyrate
• Probiotic cocktail caused fMRI changes in human brain that improved stress response
• Microbial colonization early in life shapes adult brain circuitry that normalizes adult behavior
Gut Microbes and Brain Hormones• Risk factors – maternal stress, infections, antibiotics, processed foods and cesarean delivery
• Disrupt normal neurodevelopment and increase risk for psychiatric disorders?
• Microbiome profiling and transplantation
Types of Hormone Testing
• Blood/Plasma
• Saliva
• Monospot
• Urine
Recommended Baseline Tests
• Estradiol (E2)• Free and Total Testosterone (T)• LH• FSH• Progesterone (P)• Prolactin
Recommended Baseline Tests
• Free T3, Free T4, TSH, Reverse T3, TPO• 25‐OH Vitamin D• DHEA (DHEA‐S)• Cortisol• Hemoglobin A1c• hsCRP
Supplemental Tests
• Aldosterone• IGF‐1• Melatonin• Oxytocin• ACTH• Interleukin‐6• TNF‐α• Leptin• Adiponectin• Ghrelin
Interpreting Test Results• Results – especially hormones – must be corrected for age, lifestyle, time, and concomitant medical conditions.
• Laboratory “normal” ranges are often misleading.
• Reach out to colleagues with expertise who can help guide diagnosis and treatment.
• Include in Axis III.
Treatment Options• Hormone therapies
• Stress reduction modalities
• Identify and treat any sleep disorder
• Nutritional education – anti‐inflammatory foods, fiber, probiotics, body fat reduction, etc.
• Vitamin supplementation
Treatment Options – Key Points
• Consistency is paramount!
• The body likes healthy consistency over time.
• Promotes remodeling from the inside out.
Summary
Human health and behavior are strongly influenced by a complex
hormonal symphony. The first step to improving therapeutic outcomes is to remember to look for hormonal issues
early in treatment.
“Cure sometimes, treat often, comfort always.”
‐ Hippocrates