THE MAGIFICENT ANTI-AGING SERIESWebinar Sampler (4 lectures; 12 hours)

Brain Health Bone Health and Osteoporosis Prevention Men’s and Women’s Libido Estrogen Dominance

Michael E. Greer, M.D.Holistic, Homeopathic, Herbal Lectures & Consultations737 Olive Way, Suite 1804, Seattle, WA 98101www.michaelgreermd.com michaelgreermd@comcast.net

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About Dr. Greer• U.S. Army trained OB-GYN

• Delivered 1000+ babies

• Board certified in 1984

• Retired in 2011

• Alternative medicine studies since 1996 (Thank goodness!)

• Searching for the best solutions in integrative medicine for optimal patient wellness

Presentation ©2012, Michael Greer, MD. Reproduced with Dr. Greer’s permission.

Photo ©2012, Michael E. Greer, M.D.

Disclaimer

This seminar is intended for healthcare practitioners only. The material and information contained in this seminar is not for the diagnosis or treatment of disease. The information is designed to assist doctors and other healthcare practitioners in evaluating patients’ metabolic and nutritional status.

The information presented is intended for educational purposes only. It is the sole responsibility of the healthcare practitioner using this information to determine if what is outlined herein is appropriate for his or her purpose.

Brain and MemoryEssentials in Building a Better,

Mitochondria-Dense Brain

Guidelines for Prevention of Dementia, Alzheimer’s and Parkinson’s Disease

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The Alzheimer’s Express

“After age 60, we are all likely passengers on the Alzheimer’s Express. These days it’s overcrowded with baby boomers and is predicted by 2050 to claim 115 million victims worldwide, including 13.5 million Americans (up from 5.1 million today), bankrupting our health care system.”

5Jean Carper, Special to CNN October 10, 2010

Brain Loss Feared

• Baby boomers are more concerned with losing their cognitive abilities than they are about cancer, heart disease or stroke– And they should be very, very concerned

• The progression from dementia to Alzheimer’s affects 24-30 million people worldwide

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Alzheimer's Association. 2008 Alzheimer's disease facts and figures. Alzheimers Dement. 2008 Mar;4(2):1 10-33.Hudson AP, Balin BJ, Crutcher KRobinson S. New thinking on the etiology and pathogenesis of late-onset Alzheimer's disease. mt J Alzheimers Dis. 2011;2011:848395.Available at: http://www.alz.org/down1oads1Facts_Figures_201 1 .pdf. Accessed September 28, 2011.

Danger Ahead

• Alzheimer's is now the 6th leading cause of U.S. deaths – 1/5th of all cases worldwide

• Expected to triple by 2050

7Available at: http://www.alz.org/down1oads1Facts_Figures_201 1 .pdf. Accessed September 28, 2011.Available at: http://report.nih.gov/NlHfactsheets/ViewFactSheet. aspx?csid= 107. Accessed September 28, 2011.

Advanced Risk with Age • The risk of developing Alzheimer's disease

rises sharply with aging– 1% at age 60 – Doubles roughly every 5 yrs.

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Age Frequency

60 1%

65 2%

70 4%

75 8%

80 16%

85 32%

Common Links

• Much research links Alzheimer’s to the same lifestyle factors that cause heart attacks and strokes: – High cholesterol– Blood pressure– High blood sugar– Insulin resistance– Diabetes– Obesity and physical inactivity

The Connection: Free radicals and

inflammation

Neurologic Plasticity

• The ability of brain cells to quickly form new synapses and remove old ones

• Large numbers of synapses, and a high density of specialized synaptic structures called boutons, promote rapid retrieval and processing of the information stored by connected cells

10 Ostroff LE, Cain CK, Jindal N, Dar N, Ledoux JE. Stability of presynaptic vesicle pools and changes in synapse morphology in the amygdala following fear learning in adult rats. J Comp Neurol. 2011 Jun 14

Synaptic Boutons

Learning vs. Memory

• Neuronal plasticity is the physical equivalent of learning

• Synaptic density is roughly the equivalent of memory

• Young brains exhibit high levels of neurologic plasticity that produce large numbers of interconnected synapses

• Thus young people learn quickly and have strong memories

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Memory Mitochondria & Synapses

• Every memory you have, even those you've lost, produces physical changes in your brain

• Mitochondria are the DNA and energy behind this action

• With learning and new experiences the cells in your memory centers activate and enhance their neuronal connections, known as synapses

13Brown TH, Chapman PF, Kairiss L, W, Keenan CL. Long-term synaptic potentiation. Science. 1988 Nov 4;242(4879):724-8.35

Alzheimer's Disease• The most characteristic symptom of

Alzheimer's disease is a profound impairment of recent memory

• Individuals begin to misplace everyday items, such as the car keys or eyeglasses

• They become disoriented and get lost in familiar surroundings– Such as when driving on well-known streets

14Trick L, Boyle J, Hindmarch I. The effects of Ginkgo biloba extract (LI 1370) supplementation and discontinuation on activities of daily living and mood in free living older volunteers. Phytother Res. 2004 Jul;18(7):531-7.

Alzheimer’s Patient Symptoms

15Cummings 2001

Patients IncidenceAgitation 60-70% Apathy 60-70%Depression 50%Anxiety 50%Irritability 50%Delusional disorders and psychosis

40-50%

Disinhibition 30%Hallucinations 10%

SP - Nervous System Products

• Neuroplex® • Neurotrophin PMG® • Super-EFF® • Choline • Cataplex® G • Cataplex® B• Niacinamde B5

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MH - Nervous System

• Astragalus Complex• Bacopa Complex • Eleuthero• Evening Primrose Oil• Ginkgo Forte

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Bones Down the Drain:

Natural Approaches to Osteoporosis Prevention

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Osteoporosis – A Silent Disease

• Called a silent disease because there are often no obvious symptoms until a fracture occurs

• 44 million Americans are affected

• 10 million already have osteoporosis and 34 million have osteopenia

Looker AC, Orwoll ES, Johnston CC Jr, et al. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res.1997 Nov;12(11):1761-8. 19

Affects Women & Men

• Women– 13%-18% of women (4-6 million) over the age of

50 have osteoporosis– 37%-50% (13-17 million) have osteopenia– Risk factors: Small frame, low body weight,

Caucasian, Asian, etc.)• Men

– 3%-6% (1–2 million) have osteoporosis– 28%-47% (8-13 million) have osteopenia

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Bone Loss Differs by Sex

• In men, the slowdown is gradual and linear, beginning at about age 40

• In women, it is more precipitous, accelerating to a net bone mineral density loss of 2 to 3% annually in the 5 to 10 years following cessation of ovarian function at menopause

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Hip Fracture and Death

• Hip fracture is a serious consequence of osteoporosis

• 20% of hip fracture patients die from complications within a year (usually from pneumonia as a result of immobility)

• Fewer than half resume their pre-fracture level of functioning

22Weil A. Boning up on Osteoporosis. Integrative Med. Jan 2003

Women vs Men

• Women are at risk of developing osteoporosis earlier in life than men – Their levels of bone-building sex hormones decline

sharply after menopause• NOT a normal part of aging• Both preventable and treatable• For men, the lifetime risk of osteoporosis-

related hip fracture is greater than the risk of prostate cancer

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Male Patient Awareness

• One in four men will have an osteoporosis-related fracture in his lifetime– Less likely to know that they have osteoporosis

until the disease is highly progressed– Less likely to receive appropriate treatment once

they are aware of their condition

24Paul D. Thacker PD. The Hidden Dangers of Male Osteoporosis. Life Ext. Jan 2004;78.

WHO Guidelines for Interpreting BMD Measurements

• Normal– Not more than one standard

deviation(SD) below the average value for young adults

• Osteopenia– More than one SD below the

young adult average, but not more than 2.5 SD below

• Osteoporosis– More than 2.5 SD below the

young adult average• Severe osteoporosis

– More than 2.5 SD below the young adult average with presence of one or more fragility fracturesReference adapted from “Assessment of fracture risk and its application to screening for postmenopausal

osteoporosis. WHO technical reports series, No. 843. Geneva, Switzerland: World Health Organization, 1994.25

Explanation of T Score and Z Score

• T score indicates density of bones compared to healthy individuals in their 20s, when bone density is usually highest

• Z score indicates density of bones compared to individuals in the same age group

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Risk Factors for Osteoporosis:Non-Modifiable

• Age (advanced)• Race (Caucasian or Asian)• Sex (female)• History of fracture in a first-degree relative• Personal history of fracture after age 50• Frailty/poor health

27National Osteoporosis Foundation. Physician’s Guide to Prevention and Treatment of Osteoporosis. Belle Mead, NJ: Excerpta Medica, 1998.

Risk Factors for Osteoporosis:Modifiable

• Cigarette smoking• Low body weight (<127 lb)• Estrogen deficiency

– Early menopause (<age 45) or bilateral oophorectomy

– Prolonged premenopausal amenorrhea (>1 year)

• Alcoholism• Inadequate physical

activity• Inadequate intake

of calcium (lifelong)• Impaired eyesight• Recurrent falls

28National Osteoporosis Foundation. Physician’s Guide to Prevention and Treatment of Osteoporosis. Belle Mead, NJ: Excerpta Medica, 1998.

15 Key Nutrients for Healthy Bones

• Calcium• Copper• Boron• Vitamin D• Zinc• Silicon

• Vitamin K• Magnesium• Manganese• B vitamins• Vitamin C

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Calcium Deficiency

• Calcium deficiency plays a major role in osteoporosis with a 8% reduction in fracture risk for every 1% increase in bone mass

• Calcium has the potential to reduce the incidence of osteoporotic fractures by up to 60%

• Multiple dosing times of calcium will deliver twice as much calcium in the blood as the same dose taken all at once

Heaney RP, Berner B, Louie-Helm J. Dosing regimen for calcium supplementation. J Bone Miner Res. 2000 Nov;15(11):2291. 30

The Role of Nutrients

• Calcium: a component of the mineral crystals that make up bone

• Vitamin D: enhances calcium absorption, prevents falls while improving nerve and muscle function

• Magnesium: Essential for parathyroid hormone production, which is necessary for the activation of vitamin D and therefore the absorption of calcium across the gut wall

Stendig-Lindberg G, Tepper R, Leichter I. Trabecular bone density in a two year controlled trial of peroral magnesium in osteoporosis. Magnes Res. 1993 Jun;6(2):155-63.Cohen L, Kitzes R. Infrared spectroscopy and magnesium content of bone mineral in osteoporotic women. Isr J Med Sci. 1981 Dec;17(12):1123-5.

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Patient’s T-Score

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Normal

Osteopenic

Osteoporotic

Patient’s Z-Score

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WithinExpected

Range for Age

BelowExpected

Range for Age

How Did My Physician Patient Restore his Bone Health?

The treatment protocol will be reviewed during the seminar

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Men’s Health: Discovering a Life of Wellness Essentials

©2011, Michael Greer, MD. May not be reproduced without permission.

U.S. Centers for Disease Control and Prevention

• “The US is home to 145.7 million adult men, and 12% of them report their health status as fair or poor

• Indeed, 32% of men ages 20 and up are obese, and 31% in that same age group have hypertension

• Among adult American men, heart disease, cancer, and accidents (unintentional injuries) are the three leading causes of death”

36U.S. Centers for Disease Control and Prevention. Men’s health. http://www.cdc.gov/nchs/fastats/mens_health.htm. Accessed 4 October 2009.

Prevalence

• 13 million men have symptoms of low testosterone levels– Only 5 to 10% of these men will ever seek

treatment• Testosterone therapy for men is based on

hormone testing that determines the correct testosterone dosage (part II of this lecture)

37College Pharmacy: Personal Communication

Gradual Decline

• After peaking in the 20s, a man's level of free testosterone tends to gradually decrease and to further decline throughout the remainder of his years

• Low testosterone levels may be a risk factor for cognitive decline and possibly for Alzheimer's-type dementia as well

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Moffat SD. Effects of testosterone on cognitive and brain aging in elderly men. Ann NY Acad Sci. 2005 Dec;1055:80-90Beauchet O. Testosterone and cognitive fucntion: current clinical evidence of a relationship. Eur J Endocrinol. 2006 Dec;155(6):773-81

Estrogen Dominance

• As a result of estrogen dominance, men become increasingly prone to benign prostatic hypertrophy (BPH) and prostate cancer

• Becomes important to monitor estrogen levels – Estradiol primarily, but also estrone– Permits corrective action if those levels are high

• Testosterone levels can be increased without actual testosterone supplementation

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Steiner MS, Raghow S. Antiestrogens and selective estrogen receptor modulators reduce prostate cancer risk. World J Urol. 2003 May;21(1):31-6. Epub 2003 Feb 14.Steiner M. High-grade prostatic intraepithelial neoplasia and prostate cancer risk reduction. World J Urol. 2003 May;21(1):15-20. Epub 2003 Feb 21.Cohen PG. The hypogonadal-obesity cycle: role of aromatase in modulating the testosterone-estradiol shunt--a major factor in the genesis of morbid obesity. Med Hypotheses. 1999 Jan;52(1):49-51.

Aromatase Enzyme

• One of the most important factors that affect testosterone levels in men – Responsible for converting

testosterone into estrogen, thusaltering the ratio of estrogen to testosterone

– Found in fat tissue and produced in estrogenic tissue

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Cohen PG. The hypogonadal-obesity cycle: role of aromatase in modulating the testosterone-estradiol shunt--a major factor in the genesis of morbid obesity. Med Hypotheses. 1999 Jan;52(1):49-51.Rebuffé-Scrive M, Mårin P, Björntorp P. Effect of testosterone on abdominal adipose tissue in men. Int J Obes. 1991 Nov;15(11):791-5.

SHBG DYNAMICS

• Rising estrogen (E2) levels increase SHBG (sex hormone binding globulin) levels– SHBG ties up and inactivates all sex hormones; i.e.,

testosterone, estrogen, etc.– When an estrogen molecule occupies a testosterone

receptor site on a cell membrane, it blocks the ability of serum testosterone to receive a healthy hormonal signal

• So it does not matter how much free serum testosterone is available if excess estrogen is competing for the same cellular receptor sites

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The Role of SHBG

• Estrogen elevation contributes to the elevation of SHBG levels– Which then disrupts testosterone from attaching

to the receptor site • Agents that lower estrogen make more free

testosterone, the active form, available

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Stanworth RD, Jones TH. Testosterone in obesity, metabolic syndrome and type 2 diabetes. Front Horm Res. 2009;37:74-90Saad F, Gooren LJ. The role of testosterone in the etiology and treatment of obesity, the metabolic syndrome, and diabetes mellitus type 2. J Obes. 2011;2011. pii: 471584. Epub 2010 Aug 10.

Testosterone Functions

• Control of male vigor, vitality and fertility• Secondary male attributes• Muscle mass• Cognitive functions• Mood• Male behavior traits• Bone density• Immune function

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Testosterone Deficiency Effects

• Night sweats• Insulin resistance• Erectile dysfunction• Low sex drive• Cardiovascular disease• Loss of bone density

(osteoporosis – osteopenia)

• Mental burnout• Decreased muscle mass• Low physical stamina• Depression• Immune dysfunction

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Dandona P, Dhindsa S, Chaudhuri A, Bhatia V, Topiwala S, Mohanty P. Hypogonadotrophic hypogonadism in type 2 diabetes, obesity and the metabolic syndrome. Curr Mol Med. 2008 Dec;8(8):816-28.

Testosterone & SHBG

• Total versus free testosterone: an important distinction– When discussing testosterone levels, we must be

sure to distinguish between the total and free factions found in the blood

– The vast majority (between 97 and 99 percent) of testosterone secreted into the bloodstream is bound to sex hormone binding globulin (SHBG)

45Kerry Bone Presentation: Herbal Protocols for Male Endocrine Disorders

Mechanism of Nettle Leaf* and SHBG

• European research has identified constituents of Nettle root that bind to SHBG in place of testosterone, thus reducing SHBG's binding of free testosterone

• These constituents of Nettle root may influence the blood level of free (i.e. active) steroid hormones (testosterone) by displacing them from the SHBG binding site

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A Vicious Cycle

• A low testosterone level or and elevated estrogen level results in increasing abdominal fat ( insulin resistance and pre diabetes)– Leads to an increase aromatase activity – Which further converts testosterone to more

estradiol– Which further reduces testosterone and increases

the tendency toward more abdominal fat

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The Magic Key

Restoring Hormone Balance

Reduce Estrogens Increase Testicular Output

Androgen Supplementation

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Men and Women’s Libido Health

More details to come in the seminar

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Estrogen Dominance & its Role in Cortisol, Weight Management & Hypothyroidism

Definition of Estrogen Dominance

• The term “estrogen dominance” is less related to the amount of circulating estrogen and more related to the ratio of estrogen to progesterone in the body

• In menopause, estrogen levels drop by 40% while progesterone levels drop 90% from premenopausal levels

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Proposed by John R. Lee and Virginia Hopkins in their 1996 book “What Your Doctor May Not Tell You About Menopause: The Breakthrough Book on Natural Progesterone”Fam Community Health. 2003 Jan-Mar;26(1):53-63. A holistic programmatic approach to natural hormone replacement. Watt PJ, Hughes RB, Rettew LB, Adams R.)

Signs of Estrogen Dominance

• Salt and fluid retention• Low blood sugar levels• Blood clotting• Interference with thyroid

hormone function (leading to weight gain and/or feelings of exhaustion)

• Increased cholesterol and triglyceride levels

• Allergic reaction

• Increased production of body fat

• Irritability• Mood swings• Food cravings• Hot flashes• Fatigue• Breast pain and other

symptoms reminiscent of the premenstrual syndrome

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Proposed by John R. Lee and Virginia Hopkins in their 1996 book “What Your Doctor May Not Tell You About Menopause: The Breakthrough Book on Natural Progesterone”Fam Community Health. 2003 Jan-Mar;26(1):53-63. A holistic programmatic approach to natural hormone replacement. Watt PJ, Hughes RB, Rettew LB, Adams R.)

Symptoms of Estrogen Dominance

• Irritability/Mood Swings• Depression• Heavy, irregular menses• Water retention (bloating)• Sleep disturbance• Headaches• Fatigue• Short term memory loss

• Weight gain• Craving for sweets• Uterine fibroids

(previously diagnosed)• Breast swelling

(all month)• Fibrocystic breasts

(by history)• Premenstrual

syndrome (PMS)53Bhavnani 2003, Duffy et al 2003,File et al 2001,Lephart et al 2002

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Conditions Theoretically Related to

Estrogen Dominance• Insulin resistance• Trans-fatty acid intake• Chronic stress• Sleep deprivation• Environmental xenoestrogens• Cigarette smoking• Zinc deficiency• Progesterone deficiency

• Sedentary life style• Cadmium toxicity• Lack of sulfur-containing

amino acids• Lack of good exercise• Magnesium deficiency• Hypothyroidism• Testosterone deficiency

Courtesy Deborah Muth, ND

Causes of Estrogen Dominance

• Suboptimal liver = estrogen dominance (liver congestion, disease, toxins, etc.)

• Low progesterone = estrogen dominance (SHBG receptor sites, elevated cortisol, poor adrenals, inadequate supplements and fish oil)

• Suboptimal bowel habits = estrogen recirculation and non-elimination (inadequate fiber to bind estrogens and toxins)

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Poor Sleep & Insomnia• Stressed patients, or patients who through a

change in their sleep-wake cycle, who have elevated or disturbed the diurnal rhythm of cortisol WILL NOT BE ABLE TO DETOXIFY• There may be a

‘misfiring’ between the matrix and the liver

56With permission: Life Extension Foundation

Androstenedione

Cortisol Upregulates E1

& High EstrogenUpregulates

Cortisol

Testosterone

High Estrogen IncreasesT4-Binding Globulin (TBG) 2-3X

Estrone (E1)Estradiol-17 (E2)

Estriol (E3)

Lower Metabolism Leads to Weight Gain

Lower Thyroid Hormone Activity Suppresses Metabolism

Estrogen Dominance & Cortisol

Source: Molecular Endocrinology, Vol 2, No. 4 313-323, 1988 Design ©2012, Michael E. Greer, M.D. 57

(The Catch 22)• Estrogen triggers inflammation (i.e., cortisol), which binds sex hormone

binding globulin (SHBG) including TBG (thyroid binding globulin)• Fat cells make leptin and produce estrogen• Leptin, insulin, cortisol and estrogen all increase aromatase activity• Vice versa: Leptin and estrogen increase fat deposition and inhibit

insulin receptors making the body compensate by making more insulin, which in turn increases estrogen receptor number and activity

• Decreases metabolism, energy, heat production and weight loss• Increased estrogen, increased insulin and elevated cortisol all inhibit

leptin receptors (that signal satiety), thus allowing overeating (glucose) and thus elevated insulin (triggered by the elevated blood glucose) and aromatase with the estrogen dominance cycle unabated

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Graeme P. Williams, The role of estrogen in the pathogenesis of obesity, type 2 diabetes, breast cancer and prostate disease; European Journal of Cancer Prevention 2010, Vol 19 No 4Kaaks R. Plasma insulin, IGF-I and breast cancer. Gynecol Obstet Fertil. 2001 Mar;29(3):185-91.Catalano S, Marsico S, Giordano C, et al. Leptin enhances, via AP-1, expression of aromatase in the MCF-7 cell line. J Biol Chem. 2003 Aug 1;278(31):28668-76. Epub 2003 May 6.

Estrogen Dominance & Cortisol

Guidance for Detox

STOP External supply of toxinsSUPPORT Organs of Detoxification

& DrainageSTIMULATE Elimination of toxinsSENSITIZE Patient for further detoxification

and lifestyle changes

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Methods of Detox

• Respiration: Breathing (gas exchange), coughing, sneezing, clearing mucous

• Skin: Sweating, sebaceous (oil) gland secretion, tears• GI System: Liver function, gall bladder, bowel and

intestinal tract function (our first line of defense)• Kidneys: Acid/alkaline balancing, urination• Circulation and lymph systems: Blood flow, lymph

circulation and immunity function

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SP Cleanse®

• Complete phase 1 and phase 2 detoxification• Uses the properties of 20 different whole

vegetarian foods for this purpose• Assists liver detox, enhances kidney funtion,

promotes GI elimination, assists the lymphatic system and acts as an antioxidant

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Detoxification Suggestions: Estrogen Dominance

Kidney Support

• Renafood

• Arginex • Cal-Amo

• Cranberry Complex• UriCo

Phytosynergist

Epithelial Tissue & Skin Support

• Cataplex A• Dermatrophin PMG

• Wheat Germ Oil• Cataplex F Perles

• Black Currant Seed Oil• Evening Primrose Oil

• DermaCo

Detoxification Suggestions: Intestine and Lungs

Small Intestine Support• Enzycore• Lact-Enz

• Lactic Acid YeastTM • Okra Pepsin E3

• Chlorophyll ComplexTM • ProSynbiotic

• Prebiotic Inulin • Gut Flora Complex

Lung Support• Pneumotrophin PMG

• Emphaplex

• Allerplex

• Resco

• Broncafect

• PulmaCo

This Webinar is a Sampler Only

Attend theMagnificent Anti-Aging Seminar for immediately applicable information

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Michael E. Greer, M.D.Holistic, Homeopathic & Herbal Lectures and ConsultationsExclusively to Physicians

737 Olive Way #1804, Seattle,Wa 98101

www.michaelgreermd.commichaelgreermd@comcast.net