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See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Health now a days requires following a fresh food diet, with supplements to fill the gaps in nutrition. Vitamins have been treated with disdain by medical doctors since I was in medical school half a century ago. Doctors have routinely told their patients that vitamin and mineral supplementation is unnecessary if a person has a "normal diet".    Sadly no one in our society has a normal, whole food, nutritious diet without fast food, high sugar and fat additives to make us consume more food, or preservatives.  That is the first piece of misinformation the government tells doctors and society about our diets. Second piece of misinformation that confuses doctors who are not trained in nutritional and preventive medicine is that the reference ranges on a lab sheet are healthy levels.  The truth is that the reference range is the lowest range of vitamin blood levels that keep a person alive, not the optimal levels that can keep people healthy! The governmental agency, the FDA, that is paid for by you the taxpayer, does not look out for you as an individual but looks out for the health of the country (financially, and to keep people as a group healthy enough to stay alive, but they do not have the individual patient in mind when they make the rules about supplements, or what medications individuals can take or even afford, and they don't promote health, they only promote NOT DYING! Public health is not the health of individual citizens it is about just keeping people alive even if they are unhealthy without a quality of life. You should know this difference when your doctor who probably still believes everything the FDA and the medical societies say, so they tell you that you are healthy even if you feel terrible, can't walk or can't sleep! Preventive medicine is the medicine that I do.  Medicine that has as its goal, health and a productive quality of life is what we do.  Health in the current American society cannot be obtained listening to the rules of the FDA.  They don't represent you as an individual.  Health now a days requires following a fresh food diet, with supplements to fill the gaps in nutrition we all have, and healthy exercise every day, replacement of the hormones that decline with age, and medications to treat the diseases that lead to disability and death.  Even when taking medications, we have to be aware of the vitamins that each medicine overuses and causes deficiencies, and we need to replace them if we take certain meds, eg Metformin requires that you take extra methyl-B12, and Statins requires you to take CoQ10 daily to replenish normal levels that statins use up. Today I want to talk about the role of B12 vitamin that is generally found in animal products, especially meat, and fowl. B12 is essential to normal muscle growth and strength, and normal neurologic function, including thinking, memory, and normal sensory and motor function of the peripheral nerves.  If you have peripheral neuropathy and you have not been given methyl B12 and Methyl folate then that should be your first move to see if you replace your vitamins, you can reverse your symptoms. What not to do: Don't get blood work and believe your doctor that your B12 is ok if he uses the reference ranges in your blood work.  The blood reference ranges represent the lowest level of a vitamin that can keep a healthy young person alive, not the blood level that is optimal for any person to maintain health. The optimal B12 level is 400-1500, not 250-800 like some labs show as the reference range. The next thing to know about B12 is that 1/3 of the American population has a gene that doesn't allow them to make B12 in their diet into the active form, methylated-B12 so they can actually use it! Vitamin B12 is essential to life and is necessary for a human's ability to think and maintain  normal  brain function.  B12 has many functions in the body including maintaining normal sensory nerves and motor nerves. I'd like to  concentrate on B12's function in the brain. A recent study in Annals of Neurology 2025 found that Vitamin B12 deficiency causes changes in the brain that symptomatically looks like memory loss and inability to problem solve, and over time results in dementia and cognitive impairment. Symptoms of B12 Deficiency Balance problems Memory problems Psychosis Nerve Damage Megaloblastic anemia By the time these changes occur they are usually irreversible and adding B12 to the diet may not treat these changes in neurologic function. The most important thing discovered was that the blood levels of B12 listed in the reference range are too low, and these problems occur when patients have what is considered "normal B12 levels". They found that people need higher B12 blood levels than the reference ranges to prevent these changes, what I have been telling patients for over 20 years! Who is at risk for B12 deficiency, and therefore rapid aging of the brain? B12 is only found in animal products such as beef, lamb, seafood, poultry and dairy foods so Vegans are at high risk for dementia and other neurologic diseases. Vegans If you drink more than one mixed drink, one glass of wine or two beers a day you are at risk for B12 diseases. If you take Metformin and don't replace B12, you are at risk. If your blood level is 200- 400 pg/ml you are deficient in B12. Taking antacids or omeprazole decrease your ability to absorb B12 Some patients lose the ability to make a stomach enzyme that allows them to absorb B12. Brain Aging is diagnosed by the appearance of the symptoms listed above, as well as CT scans or MRI findings revealing brain shrinkage. The Caveat That Makes B12 Treatment Much More Difficult Over one third of Americans cannot take B12 as cyano-cobalamine.  They have an MTHFR genetic defect that makes them unable to methylate the cyano-cobalamine into something that can be used by the body. For those people B12 must be taken as Methyl-B12 and not cyano-cobalamine.  Blood tests for genetic changes in MTHFR genes or a high Homocysteine are diagnostic of this inability to use B12.  The confusing thing is that these patients appear to have normal B12 levels on blood tests but they cannot use it so that fools doctors into thinking that they are safe from the diseases caused by low B12.  Take away from this Blog: You should supplement with methyl B12 to prevent brain aging Blood levels of B12 are not healthy reference ranges—you need more You need a higher than 400 pg/ml blood level to avoid brain aging If you have MTHFR or don't know you should only supplement with methyl B12 If you take Metformin, you should take more B12 than recommended Dose of methyl B12 should be about 5,000 mcg/day

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog WHAT YOU WILL LEARN: How to SCULPT YOUR MUSCLES AND TIGHTEN YOUR SKIN after weight loss! How to decrease VISCERAL FAT A new way to IMPROVE MUSCLE MASS by 30% for strength and beauty in 4 weeks DECREASE SUBCUTANEOUS FAT by 25% in 4 weekly treatments INCREASE MUSCLE DEFINITION with Emsculpt Neo A way to REHABILITATE AFTER SURGERY PRE-TREAT BEFORE SURGERY: Improve your post op joint surgery condition by increasing muscle around the joint HOW TO RECOVER Quickly AFTER CHILDBIRTH A Way to IMPROVE CORE AND PELVIC FLOOR STRENGTH How EM-Sculpt-Neo works Most of you know me as the expert in Bioidentical Hormone Pellet Replacement, but I am also expert in Skin and body care.  If my patients have problems that your PCP has not been able to solve.  I will refer you for new therapies, cutting edge treatments that work to treat your problem. The most common problem that my patients complain of is loss of muscle mass and changes in body fat that make them look old.  I found a treatment that is not a laser, but the Emsculpt Neo uses safe and effective magnetic energy plus RF treatment to reduce fat and build muscle in a 30-minute painless treatment. Today I am going to talk about a painless treatment that we offer at my medical spa, BioBalance® Skin that has just been approved by the FDA for rehab after joint surgery.  The magnetic energy (HIFEM) combined with RF energy increases muscle size and strength by 30%, dissolve fat by 25%, as well as tightens skin with the same treatment! EM Sculpt Neo is a 30-minute treatment that uses magnetic energy to make your muscles contract and is equal to thousands of crunches for 30 minutes. The RF portion breaks down subcutaneous fat in the same area.  There is no work on your part, you just lie there, and your muscles respond to the magnetic pull by increasing in size and strength.  Four sessions one week apart is the ideal number of treatments, and they come a in a package of four treatments to one area. The areas that most of us want to build muscle and lose fat in are our abs, upper arms, thighs, calves, love handles, and hips. If you need to do more than one area at a treatment you can do up to three areas, each for 30 minutes. If you have had joint surgery and need to increase your strength around that joint, EMSculpt Neo is very effective, after your doctor releases you to exercise. One of the big concerns with the new weight loss medications is that people often lose muscle as they lose weight.  This is especially common after age 40, in those people who are not on testosterone pellets. EMSculpt Neo adds a tool that can preserve or even increase muscle mass and decrease fat where you want to lose it. EMSculpt Neo for fat loss and muscle building (not for rehabilitation) should be saved for those weight loss patients who lose enough weight to achieve a BMI under 30. For the best results, we suggest a high protein low carb diet, protein, low carb diet, to give your body the building blocks for muscle tissue. We also will suggest supplements for nutrition and to abstain from alcohol to get the best results. Healthy fat loss takes combination of EMSCULPT NEO, Weight Loss Medication, activity, Low carb high protein diet.  We advise our patients over BMI of 30 to get started on weight loss first and continue diet medications while you are receiving EM-Sculpt Neo treatments. How do you lose weight without losing muscle? The Best Combination for the best results while you are losing weight on medication: EMSCULPT NEO to the areas you want to remove fat from Semaglutide or Tirzepatide medication to treat obesity for weight loss Testosterone Pellets if you are a woman over 40, and man over 50. Regular exercise like walking High protein diet Supplements to improve your ability to make muscle Who should do this EMSCULPT treatment? People who are working out but cannot do sit ups because of back injury Those folks who want fast muscle mass increase in specific areas Anyone who is on a weight loss program who is losing muscle and fat, or who has saggy skin in areas where they lost weight Patients anticipating a joint surgery Patients healing from joint surgery after PT Patients who cannot lift weights because of injury Those people who lift weights but cannot develop definition People with a Beer Belly with a lot of visceral fat Some people may not be able to enjoy this sculpting, muscle building method: We will do a free consultation before you sign up for a package of EMSculpt Neo and some patients will not get optimal results if they have any of the factors below: BMI greater than 30 Metal implants anywhere that are not titanium. Titanium is not magnetic, so it is ok to have a treatment if you have a titanium joint implant. No Rods or pins. Any pacemaker implant, pain pump under your skin, nerve stimulator or you are in the first 6 weeks post-surgery for any muscle area in the area. If you have a large abdominal hernia that was not repaired, then abdominal treatment is not advisable. You can still have other areas treated. If you have unrepaired joint damage, you can still have this treatment but let us know so we can slowly work the energy up around that joint. Those people who have a pannus, an apron of skin that hangs down below the vulva, or penis will not get enough relief from this procedure. These patients will need an abdominoplasty. This surgery is done by a plastic surgeon who removes excess skin and fat and repairs the muscles and fascia. You should not waste your money if you continue to drink alcohol while undergoing this treatment. Alcohol is a toxin and will prevent the growth of muscle and loss of body fat. Don't waste your money if you are not going to follow a low carb high protein diet during and after our treatment.  How does EMSCULPT Work? EMSCULPT combines HIFEM (High Intensity Focused Electromagnetic technology) and RF (Radio Frequency). HIFEM uses magnetic energy to contract muscles in a particular area at intensities that are not achievable with routine weightlifting. Fat tissue in the treated area is also reduced by increasing metabolic activity.  This results in Body Contouring. HIFEM is approved by the FDA for Body contouring, muscle stimulation, growth and to rehabilitate patients with injuries or after surgery. The second treatment that occurs at the same time as HIFEM is RF, Radio Frequency treatment. RF is a low frequency electromagnetic wave that heats up fat in 4 minutes to stimulate collagen and elastin to tighten skin. All this happens in 30 minutes with minimal discomfort.  4 treatments, one a month, is all that is needed to increase muscle 25% and to decrease fat by 30%, and to visibly improve skin tone. Answers to questions about this procedure: What should my diet consist of to optimize my treatment? To gain muscle you must eat your weight in pounds equivalent to grams of protein every day. E.g. If you weigh 200 lbs. and you want to gain muscle, you should eat 200 grams of protein a day. What foods should I eat to optimize my treatment? The best most concentrated protein is found in animal products-eggs, milk products, fish, chicken and red meat. What supplements will help support my treatment? You may want to supplement your diet with our BioBalance Magnesium combination twice a day, Probiotics, Creatine or Arginine and Ornithine combination. You should also take a methyl B12 and Methyl Folate while you are sculpting your body. Why can't I eat a lot of carbs and drink alcohol during or after the treatment? If you eat a high carb diet, your fat loss portion of Em-Sculpt will be limited, because whatever carb you eat over-stimulates insulin, which increases insulin resistance, and increases fat deposition. Whatever is eaten goes directly to fat again and replaces what you just lost. When can I start EMSculpt after joint surgery? After PT is completed or your surgeon releases you for exercise. Can I lift weights while I am being treated? Yes, but we advise not to lift weights the day before, the day of or the day after your EMSCULPT treatment. What does hydration have to be optimal for the treatment to work effectively? The human body is almost all water, and hydration is needed for muscle contraction. Muscles don't contract optimally when you are dehydrated. We put you on a body composition machine to both document your muscle mass and fat mass, as well as tell if you are hydrated adequately. Now that you know how EMSculpt Neo can change your body composition and build muscle, I hope you are comfortable enough to let us help you get the body you have always wanted. BioBalance Skin phone for an appointment:

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog If you ever doubted your doctor because she wrote a script that you later "Googled" and found was not FDA approved, I hope you trusted your doctor enough to realize that she wouldn't recommend any medication that would hurt you…. What is an unapproved use of a drug, also called "off-label"? Unapproved use of an approved drug is often called "off-label" use. This term can mean that the drug is: Used for a disease or medical condition that it is not approved to treat, such as when a chemotherapy is approved to treat one type of cancer, but healthcare providers use it to treat a different type of cancer. The drugs that are not approved by the FDA, yet are commonly used, have been used for decades before the 1964 law that required new drugs to go through extensive and very expensive testing before their release to the public. The operative word is NEW DRUGS AFTER 1964. Today I will talk about the safety of non-FDA approved drugs because they are: Older cheaper drugs used for many diseases and conditions before 1964 and are still used Drugs that are approved for one use, or one condition, but not for other conditions that it is effective and safe for. Drugs made by compounding pharmacies for diseases that the FDA has not approved a drug for, but there is research backing the drug and years of safe use. First, before we discuss the non-FDA approved drugs, I will discuss the safety/risks of FDA approved drugs, and why FDA approval doesn't mean a drug will do no harm or even that it is effective for the use it is approved for. A little background will help you understand the problem and the reason an FDA approval does not necessarily mean a drug is safe.  Since 1964, a law was passed that established testing prior to a drug being approved by the FDA became mandatory.   Since that time several drugs that survive FDA approval and are released but are later removed or banned after their FDA release when the public finds side effects that the FDA didn't discover in their trials. One such drug is Fen-Phen, Fenfluramine/Phentermine. This drug was released during my time practicing medicine and was withdrawn after one study claimed it caused heart valve disease…In the end the "one post approval study" that claimed that heart valves were affected by this drug that caused its bann was found to be false. The withdrawal of the drug followed one study by a single cardiologist from Kansas City had reviewed all of the cardiac valve echo tests and falsified the results to make Fen-Phen appear dangerous to heart valves, when in reality it wasn't.  She lost her license, but the FDA never put Fen-Phen back on the market!  The FDA hates to be wrong twice, so they never allowed this drug back on the market after its removal. Other mistakes made by the FDA include not allowing women in the studies to approve a drug before 2014 which ignores or misses all of the side effects or lack of effectiveness for a drug when taken by women.  Despite all the expensive testing before the release of a drug by the FDA, many drugs not tested on women were later often found to have severe side effects only on women. A few examples follow: You might have heard of the FDA approved drug Ambien that causes many women to experience "night eating", sleepwalking, and night terrors, while their male counterparts were not affected, so because they only tested men the drug was approved. In retrospect it should have been tested on women as well, and then either not passed through the FDA or should have had a black box warning for women. It takes years get action from the FDA, notifying doctors of these side effects. Women were not included in testing for any drugs except female hormones until 11 years ago, but no other drugs.   Before 2014 all (non-hormonal) drugs that passed the FDA were not tested on women so the effect on women was unknown until it was tested on the public. The FDA left women out of drug-trials because it viewed women as "mini men", or they didn't consider us important enough to test new drugs on…OR worse, they believed we were too complicated to easily test us because of pregnancy, menopause and other hormonal swings that normal healthy women have.  In any case, we are now suffering their decisions, when a medication works one way for men and another way for women! Finally, we are tested when drugs are being evaluated for approval by the FDA. Professional women have achieved a level of authority in medicine and pharmacology (2025) and are weighing in on the inequity. Women in the medical profession and the public are pulling back the curtain on the side effects of FDA approved drugs that are experienced by women only! Slowly, study by study investigators are now publishing the side effects and problems for women with FDA approved drugs….yet these findings are not included in the warnings on most of these drugs, even now over 15 year after they became obvious to the doctors who treat women! Drugs that either don't work for women, or that have severe side effects include that were approved before 2014. All statin drugs for high cholesterol (Crestor, rosuvastatin, atorvastatin, etc.) cause women to have muscle breakdown and muscle pain. Synthroid (levothyroxine), doesn't cure the symptoms of hypothyroidism in 80% of women, but just makes the TSH lower, so it appears as if it is working! This leads doctors to tell women that their symptoms are all in their heads!! Wrong.  It is the wrong medicine. Women have enzymes that differ from men that make it difficult for them to convert the inactive form (T4) into the active form (T3), so we can't convert Synthroid (all T4) into the active form. Synthroid, the FDA approved drug for hypothyroidism, shouldn't be given to most women. Women should be given the non-FDA approved drug Armour Thyroid or NP thyroid that have both T3 and T4 in them! Ambien Prednisone and other oral steroids We have reviewed the lack of testing on women before 2014, now we will discuss safe drugs that have been used for decades even before 1964 when the FDA required testing for FDA approval? Older, yet effective and inexpensive drugs have been tested by the public, some for almost 100 years that have saved thousands of lives, yet they are not given the FDA stamp of approval!  In fact, the FDA tries to put these drugs out of circulation, replacing them with very expensive drugs that are new! Or they just shut them down, because they are not FDA approved.  Young doctors are told not to use them by their medical schoolteachers who rarely have experienced these medications in private practice…. These doctors in training don't know the history of older safer, cheaper drugs, or even why the FDA tells them avoid them. They comply not knowing why, so you are left with no drug that works for you, or you pay 3-10 times the amount for a newer FDA version of the older drug which may even have more side effects. Some of these older very effective and cheap drugs are Penicillin, Nitroglycerine for chest pain, Morphine (pain), Phenobarbital (seizures), Codeine, Armour Thyroid, hormone injections including estradiol injections and testosterone, Thorazine for psychiatric use, (Pitocin) oxytocin for labor, lactation support and Autism Colchicine:Used to treat and prevent gout. Progesterone in oil (IM) Estradiol in oil (IM) B12 for injection Testosterone Cypionate for injection Compounded Estradiol in any form Compounded Testosterone for women These drugs have been used for so long that any safety risks or side effects have been found through the use of these drugs in the population. Yet the FDA won't grandfather them in and approve them based on their history! What do doctors do when the drug the FDA has approved a drug that doesn't work for a group of their patients (gender, race, blood type, etc.)?  What happens when a doctor can't find a drug that is FDA approved needed to treat a condition she is faced with? Why do we as citizens, allow the government to have power over doctors who are already controlled by their state licensing boards as to what medications they?  Lastly Why do taxpayers allow a government agency that they fund with tax dollars control their health by banning, or not approving drugs, or banning one drug so an outrageously expensive drug is put in its place? Compounded Medications/ Compounding Pharmacies: These drugs are made by mixing ingredients to meet individual patient needs and are not subject to premarket review for safety, effectiveness, or quality. However, they ARE subject to the success or failure for which they were prescribed. If a doctor prescribes a compounded drug that doesn't work, she is apt to be confronted by her patient who is not getting the expected results.  Compounding pharmacies usually don't get paid by insurance, so patients are more invested in getting a drug that works and that is one of the big reasons that Compounded medicines are at least as good or better than big pharma or generic drugs. I absolutely could not successfully treat the thousands of women and men that I have without compounding pharmacies.  They compound hormones/drugs that are safe and effective, mostly hormones that can't be patented because they occur in nature and won't ever be made by big pharma. More than that, big producers of drugs can't produce in mass quantities many doses of a certain hormone like compounding pharmacies do.  Compounding pharmacies provide what people need and they continue to do so because patients prefer their dosing and quality.  FDA approved Generic Drugs can be legally 25 % lower dose than what they say they are.  That would be a big problem if my compounded pellets had that kind of variability. People might need pellets every 2months or every 5 months instead of every 4 months..it would be like guessing what you need ahead of time…..I believe dedicated compounding pharmacists are more accurate than any generic on the ma

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog You will learn: What holds up new treatments for diseases and conditions How long the FDA sits on a known safe medical medication before it is released to the public. Why safe and effective drugs are NOT approved by the FDA Why doctors are forced to use medications off label How you can help During my 44 years of medical practice, I have encountered conditions for which there is no approved medication or surgical treatment available as recognized by the American College of OBGYN or the FDA. This situation can present challenges both for physicians managing these patients and for individuals seeking relief from their symptoms. This issue is not often addressed on Dr Oz, in the news, or at medical conferences. For many conditions, physicians wait for the development of approved medications or treatments, and in the meantime may inform patients that there is currently no treatment or cure available. Some doctors may attribute a patient's concerns to aging, stating that it is a universal experience. While this may be accurate, such explanations may not provide comfort to patients seeking solutions to their symptoms. This lack of helpful guidance can discourage individuals from seeking medical care when they feel their concerns are not acknowledged. This seems to result from insurance companies prioritizing cost savings by minimizing patient care.  Every year insurance companies decrease what they pay doctors for their services, while their expenses go up, and the Government requires more and more work behind the scenes like HIPPA, OSHA, and Clia requirements that costs more to deliver the same service.  If you have a problem with the time your doctor spends with you then blame the insurance companies whose profits rise every year…Soon doctors will do what I do and only take cash.  The practice of medicine is not working in a free market. While insurance limits the prescriptions of medication to those meds that are FDA Approved, the FDA and medical specialty colleges often delay approval of new, low-risk treatments for up to 20 years after their effectiveness is demonstrated. This lengthy process should be reconsidered to treat people who are ill and suffering, now. There is plenty of research in the medical journals that explain the safety of new and effective treatments that can save peoples' lives that are not FDA approved yet. The FDA is not interested in expediting the release of medication/ devices quickly to those people who need help now. They drag out the testing of a medicine that has been effective for years and may or may not approve it. On the flip side they have approved many drugs that later are found to have severe side effects, and they just change the warnings on the medication inserts. They don't take them off the market except in severe cases. Drugs that have worked treating patients successfully are being used but are not FDA approved. These "grandfathered drugs" don't need to go through the testing that new drugs go through because they work with few well-known risks. I use many if these medications because they are inexpensive for my patients and are often more effective than new meds for the same problem. One of the drugs that the FDA has not had to approve is Armour Thyroid, a natural thyroid replacement. My experience with treatments not approved by the FDA Armour Thyroid: Armour Thyroid (AT) has been prescribed by doctors to replace thyroid hormones for about 100 years. It is natural, made from Pig thyroid. It only comes from "medical Pigs" that are raised for medical purposes.  We use medical pigs for skin grafts, and other parts of the pig to treat human diseases like heart valve replacements.  Armour Thyroid is composed of the four thyroid hormones that humans make: T4, T3, T2, T1. The synthetic thyroid replacement, Synthroid/levothyroxine is only T4.  The active form of thyroid is T3, and it requires an enzyme to convert T4 into T3. If a person can't convert T4 into active T3 then nothing improves except the blood levels of T4, and TSH. The majority of women cannot convert T4 into T3. Therefore, if they take Synthroid or levothyroxine and their doctor only checks their TSH level and not the level of free T3 and free T4 to see if the Thyroid is working, then women are told that they are healed, yet they know they are not because none of their low thyroid symptoms are resolved. When this happens, doctors tell female patients that it is all in their heads and dismiss us when we tell them we are not cured with this synthetic T4 medication. Yet Synthroid is a chemical, and AT is natural from medical pigs, so the FDA is trying to Bann the only drug that has successfully treated millions of women. PS. Synthroid was not tested on women like many other drugs that were passed through the FDA before 2014! If you think this is a small problem, think again. Thyroid hormones are vital to human life, and the thyroid gland requires Iodine in the diet. The Midwest US has no Iodine in the soil or water. Therefore, this area is overburdened with hypothyroidism. I have been on AT for 50 years without complication and I have prescribed it thousands of times ever since I went into private practice.  AT works to relieve the symptoms of hypothyroidism for women and men, and it works better for women that the "new" drug Synthroid/levothyroxine, which is FDA approved. You ask how could the FDA approve a drug that doesn't successfully treat women? It is because Synthroid was not tested on women!  Until 2014 the FDA did not test women in the required drug trials.  AT works for us (women), Levothyroxine does not. Now the FDA wants to ban AT. It is not approved because it was around for decades before they started testing medications like they do now, and the history of successful treatment should stand on its own merit! Example 2: Bio-Identical Hormones BIH:  BIHs had not been approved by the FDA until recently and there was no announcement that they are now approved for women who have hormone deficiency symptoms or postmenopausal symptoms. Most doctors and women who have been afraid of the only hormones that can help them, bioidentical hormones, haven't yet been told that NOW, FINALLY the medical colleges and the FDA finally have quietly approved BI hormones.  There are no pure estradiol and pure testosterone pellets that are made by a drug company for women. My patients get their estradiol and testosterone pellets from a compounding pharmacy.  I have been prescribing BIH since 1985 without FDA approval because the oral estrogen formulations that were available at pharmacies caused weight gain and put women at high risk for blood clots. Non-oral BI hormones have fewer risks than FDA approved estrogens.  I waited more than 45 years for the FDA to approve BI hormones for treatment of women.  All those women in the last 45 years who were taking FDA approved estradiol and those who couldn't tolerate them have been harmed by FDA goals of never approving compounded or bio-identical hormones.  The delay has harmed 50% of American women. Example #3 Devices for Weight Loss I was involved in the discovery and testing of a unique device that stimulated acupuncture points with a TENS-unit-type patch connected to your cell phone for easy adjustment of your hunger or "fullness". The FDA requires testing to approve any new device so the group of investors I was part of had to invest thousands of dollars for a device we already knew worked. The FDA told the investigators of all new devices who they should test, who they can't have in the study, and how long the testing should take. I found their parameters for the study of this device to be unrealistic. The women in our test group could not be taking hormones of any kind (birth control, ERT, HRT), and could not be on antidepressants, could not have diabetes or insulin resistance or be on any drug that assisted in weight loss. These women subjects had to be a certain BMI (level of obesity) and had to be tested repeatedly with weight and body composition measurements None of my patients who needed weight loss could participate.  Most GYN patients are on some medication or supplement, so the FDA made this study of our device so narrow that REAL WOMEN weren't tested! Sadly, we lost many women in the control group from the study because they were NOT losing weight while the ones on the device were obviously dropping pounds, so we had trouble maintaining test subjects. The testing phase of this simple device took 7 years! Our device works and no one will ever know about it or be able to use this non-medicinal weight loss device because when the FDA rejects your device you will be breaking the law if you produce and sell it directly to the public. It has no side effects or dangers..it just controls the amount you eat with stimulation of an acupuncture point. There are many ways to change this situation, and it takes years and billions of dollars to change the whole system of bringing treatments to patients quickly.  I'm afraid I won't see a revolution of the way we bring medicines and devices to market during my lifetime. Currently there is a 17-year delay between proving a drug or device works for a particular illness or condition and when it becomes available to doctors and patients. So what do we do in the meantime?  I seek treatments for patients who are unresponsive to traditional medicine by reading journals like Life Extension, that inform doctors and patients alike about new effective solutions for common medical complaints and diseases that the FDA has ignored or stymied with endless drug trials.  Life Extension Magazine highlights studies on new medications for diseases without an FDA approved solution and publicizes diagnostic tests often overlooked by mainstream publications because they are not yet FDA approved. The medical journals I read (New England Journal of Medicine, JAMA, Menopause, Met

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog When I go to Fitness Edge, the place I have worked out with weights twice a week for 38 years, I know I am increasing my muscle mass and my metabolism for the next 72 hours…that's right, after just an hour of lifting weights, my body burns more calories over the next 3 days.  Lifting weights not only increases muscle mass, strength and is the key element in weight loss, because it raises resting metabolism throughout the day, even while you are sleeping. As long as I have been a physician, we always knew that exercise was important to health, but not until recently did medicine did not know WHY exercise is so important, and WHAT type of exercise is the most important to healthy aging. Recently the research has exploded with research that supports the metabolic truth that muscle mass, and resistance exercise (weight training, training with bands, calisthenics) is necessary for health and longevity! Even though this is a complicated science that is primarily addressed to professional athletes, there are several discoveries that everyone can understand and employ in their quest for a long and healthy life. Muscle Mass, Percent Body fat and Exercising Your total weight doesn't matter as much as your total muscle mass and percent body fat.  So, the amount of muscle you have compared to the amount of fat is the key to metabolic health. Muscle burns calories and decreases blood sugar, while fat is metabolically inactive.  However, the amount of muscle you have isn't as important as how often you use your muscles against gravity.  That is what weight training is: lifting weights against gravity, using barbells, free weights, resistance bands or Nautilus-type machines. Muscle Is the Major Site of Glucose uptake The more muscle you have, and the more you exercise them the more blood sugar is metabolized into energy. Your muscles soak up glucose from the blood for 120 minutes after weight training, and insulin sensitivity increases for 16 hours after exercise. Metabolic stimulation continues for 72 hours. Those people with less muscle who don't exercise use extra glucose to make fat. Body Composition is Improved with Weight Training Body composition can be measured with our InBody Machine.  We follow each of our patient's body composition instead of just getting a weight. We find that when measuring our patient's progress, the percent body fat inversely relates to their Basal Metabolic Rate.  In other words, the lower the body fat percentage, the higher the metabolic rate. The higher the body fat %, the lower the number of calories that patient burns at rest. For example, a woman with 40% body fat, depending on her height, burns about 1,100 calories over 24 hours when at rest.  If the same woman achieves the ideal percent body fat with medical dieting and achieves less than 26% body fat, she will increase her BMI to over 1,400 calories/ day at rest. Weight training alone will increase muscle mass and decrease fat with the outcome of increasing basal metabolic rate, so she will burn her calories instead of storing them as fat. In short, weight training to increase muscle mass will decrease body fat and improve metabolic health. Weight Training Can Reverse the Loss of Muscle that Comes with Aging The above statement is a tricky statement.  Women can exercise with weights their whole life and maintain a healthy body composition until they turn 45, then weight training just can't do the job without adding testosterone pellets.  It is the magic of testosterone pellets—Testosterone PLUS Weight Training increases and sustains muscle mass. "I have worked out with weights since my residency when I was 28 yo.  I realized that because I was 5-3 and 118 lbs, I would not be strong enough to do my job, delivering babies, operating and lifting patients on and off the table.  I began with a Nautilus circuit followed by 10 minutes on the treadmill 2-3 times a week. After I delivered my daughter, Rachel, I was 31 and I started training with a trainer because to get y body and strength back, I needed someone to make me accountable and to guide me to gaining strength where I needed it.  I have lifted weights 2-3 times a week ever since at my training facility, Fitness Edge, across the street from my current medical office. As of last week my body fat is 19%, and my weight is now 113.  I have shrunk a bit and am now 5-2. When I go to the Fitness Edge with my husband, John, I notice that many of the hardest working "fellow exercisers" never change their body composition. I would love to tell my fellow lifters that working out with weights is only part of the program to becoming strong and building good muscle mass.   The fact is they need to increase their testosterone level if they are over 40 for females and 50 for males, to improve their muscle mass and decrease body fat, and their hard work will be repaid with visible, stronger muscles, Fat loss and improved and metabolism." Dr. Maupin's Formula for Building Muscle after age 40: Weight Training 2-3 times a week Testosterone Pellet treatment in women over 40 and men over 50 Diet must include the number of grams of protein equal to your weight Low carb high protein/healthy fat diet Eliminate food with preservatives, canned food and processed food. Eat whole/fresh foods. Supplement with Creatine (if your kidneys are healthy), Arginine, Vitamin D, E, K and Vitamin C, multi vitamin with Methyl B12 and Methyl Folate, Probiotics, Magnesium 400-800 mg/day, Protein powder without Soy. Water consumption in oz = to ½-1x your weight in pounds If I have convinced you to start using weights regularly, here are the variety of types of resistance training that will build muscle and improve metabolism. Must exercise for 50 minutes at one time per day. Resistance Band Work Outs- you can do anywhere even at home. Body weight exercises like squats, push-ups, lunges, planks Free weights using dumbbells, kettle balls, bars Weight Machines that target one muscle group at a time.   Now I Can Almost Hear Half of You Asking What About Aerobic Exercise? My best friend is a runner, and she has run marathons for decades, and now in her 60s, she is still fit and healthy without joint damage.  Most of her fellow runners don't know that she also lifts weights to keep her in the running game…and she takes testosterone pellets. Most runners are fit and have strong hearts, but their muscle mass is not always robust. Cardio-exercises can improve cardiovascular health and burn calories during the activity itself. Strength Training builds muscle mass which has a long-term effect on the metabolism.If nothing else, I hope you are inspired to initiate a resistance training program to benefit your metabolism now and for your longevity in the future.  YOU CAN DO IT!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog All testosterone pellet medical practices are not equal.  Most use pellets that are inferior to ours, inexpensive but have more side effects, and are not as effective as the testosterone and estradiol pellets that I use in my medical practice, BioBalance® Health. Most practices do not understand the many interactions between other hormones and sex hormones (testosterone and estradiol) like we do therefore you are not going to feel renewed, with all of your symptoms of testosterone and estradiol deficiency treated. At BioBalance® Health, we provide more than just testosterone pellets. We not only replace missing hormones like testosterone and estradiol, but also address other deficiencies, manage age-related diseases early, and offer nutrition guidance, medical weight loss, genetic nutrition advice, and exercise planning. Our comprehensive approach is unmatched in the US. Our use of non-micronized testosterone pellets and comprehensive care helps patients restore their health, leading many who leave to return when other practices do not meet their needs. These facts were impressed on me when one of my long-term patients who had moved to Florida, returned to me after a few years and related all of her efforts to find a doctor in Florida who would treat her like we did. A month or so ago I saw a familiar name on my appointment list.  When I reviewed her old chart, I saw that she had moved to Florida and had found a new pellet doctor there.  But I had no idea what she had gone through to find a doctor to treat her like she needed to be treated until she sat down in my office for her consultation. I will protect her identity, by calling her Beth, my best friend's name.  At first, I didn't recognize Beth sitting in my waiting room.  It appeared that she had aged more years than the two she had been in Florida.  She sat down and regaled me with this story of her experience.  Some background.  Beth had had a hysterectomy and had her ovaries removed before she saw me for the first time in 2007. She had been on some kind of hormones since then and pellets with me since 2007.  When she was my patient the testosterone and estradiol pellets literally cured all of her symptoms.  It wasn't easy to come to the right dose of pellets and to treat her other problems:  She converts T into Estrone and Estradiol, and she is a fast metabolizer, so she needs a higher dose of testosterone that the average woman. I ushered Beth into my office and asked how she'd been, and she began a long and sad story about trying to find a doctor who would treat her with pellets so that all her symptoms were resolved.  She went to 5 different doctors, who had her BioBalance chart, and all of them said they had to treat her differently because they were not in line with my treatment.  She argued and got nowhere.  #1 Doctor: The first hormone doctor did not agree with giving her testosterone plus anastrazole (Arimidex), a TA Pellet, yet that was what I treated her with to lower her Estrone and Estradiol from testosterone conversion.  She got straight testosterone and her estrogens soared and inactivated her testosterone, so she felt no different on pellets than she did off of them.  She also gained belly fat and breast size and was very emotional. #2 Doctor: This doctor was a Bio T doctor who refused to give her TA pellets and also wouldn't give her the dose she needed.  Bio T uses MICRONIZED testosterone which are cheap, and cause hair to fall out, acne and oily skin.  That is exactly what he got, and she didn't go back. #3 Doctor: Not only did this doctor refuse her anastrazole in any form but he made her take progesterone even though she didn't have a uterus and told him that progesterone made her fatigued. #4 Doctor was clueless and used a formula one size fits all Testosterone dose, which wore off in 2 months. #5 Doctor was essentially not educated in testosterone pellets. Because of these experiences, she now flies in three times a year and gets the pellets dose, Estradiol dose, with anastrazole in the pellets, without useless progesterone (because she had a hysterectomy), with NON-MICRONIZED pellets that last 4 months that are dosed for her unique metabolism. The moral to the story is all pellet treatment is not the same!  So many doctors have jumped on the bandwagon with a few days of training or no training at all so if pellets don't work for you, PLEASE DON'T GIVE UP ON PELLETS.  Beth didn't.  You need a doctor who understands the interactions of T and E2 and E1, and who use pellets who are non-micronized and who individually dose your pellets for YOU!  This Healthcast  is not about patting ourselves on the back, but it is aimed at informing patients who have been disappointed with their treatment using  testosterone and estradiol pellets because of inability to relieve their symptoms of menopause or testosterone deficiency, that they should find a practice who uses NON_MICRONIZED PELLETS and who have experience taking care of all interactions of hormones with other medications, who understand the trouble shooting for every unusual symptom that may occur after pellet replacement of hormones.  It is not easy to learn to take care of hormones like Dr. Sullivan our staff, and I do, so finding someone with a lot of years in practice, who is not in a "franchise practice" which is just a business and usually use the cheapest pellets. Don't give up if at first you don't feel better.  Just change pellet practices!  BioBalance® knows how to treat all hormone deficiencies, and we have 95% success rate!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog The summer of 2025, the US has experienced record heat. Most Americans have been under a severe heat warning for months, which has caused me to review the symptoms, prevention and treatment for Heat Stroke.  This summer's heat was unusual, however it may recur in the future, so we must learn to deal with the effect of prolonged exposure to dangerous heat. Heat stroke is not classically a stroke as you know it, however heat stroke is a condition of a different kind, but no less deadly.  The conditions that can lead to heat stroke are listed below. Please think of these signs of Heat Stroke before you go outside in severe heat. At Risk Conditions for heat Stroke: High ambient temperature High body temperature (body temp of 104 or more) High humidity, Prolonged sun exposure (more than an hour at a time) Dehydration Loss of electrolytes through sweating which can result in heart attacks, seizures delirium and can lead to death. The hot weather we have been experiencing has been prolonged and has  all the qualities described above that may lead to heat stroke: Temperatures above 90 degrees Fahrenheit, High Humidity (over 50%), Bright sunshine, causing body temp to rise rapidly and continue for a long time even after a person has gone inside to cool off in air conditioning. You Should be aware of the beginning signs of heat stroke so you can remove yourself from the heat before it becomes an emergency, and you can protect your family from heat stroke. The early signs/symptoms of heat stroke include: Heavy sweating/ or no sweating at all Thirst Weakness of muscles Headache And Dizziness When you develop these symptoms, please listen to the signs your body is sending you and seek a cool place inside away from heat and sunlight. If the symptoms don't resolve quickly, then take the steps below to prevent progression of symptoms to result in heat stroke. Lie down (heat stroke can cause you lose consciousness and hurt yourself if you pass out) Drink cool but not cold water continually Drink Electrolytes (preferably products that contain Potassium, and sodium, chloride, magnesium) with every other 12oz of water. If you don't have electrolytes, Gatorade can be substituted for electrolytes (It is only Potassium). If you are unprepared and away from civilization, put several shakes of salt into a glass of cool water and drink it. Apply icepacks on the areas of the body that can cool you quickly: Underarms, groin, and neck. This will cool your body down faster than just sitting in a cool space. Don't be alone. Ask someone to sit with you in case you pass out or seize, and they can call 911 to take you to the ER. They can also make sure you continue to drink water and take electrolytes. If you feel your headache or weakness getting worse call 911 yourself. That is a late sign of Heat Stroke. Lastly, Heat stroke can make a person act out, with a temporary personality change. The affected person can hit and push the people trying to help him or her. That means they are in the late stage of heat stroke, and they need IV fluids a cooling blanket and Medical help. Remember, heat stroke can be deadly, and immediate action must be taken. If you or someone else has the following symptoms, then Call 911: passes out or seizes, gets confused and wanders around, acts out and hits or pushes has a rapid heart rate, has a bounding pulse, has either hot dry or very damp skin, complains of a headache or dizziness, nausea, vomiting rapid shallow breathing, like panting Often, they will complain of feeling cold and they shiver even though the temperature is very hot. Don't Wait!  call 911! In these cases, tell the 911 operator that you suspect heat stroke. So how do you prevent heat stroke? There are many ways to prevent heat stroke, if you recognize the conditions outside will put you at risk. First determine whether you are at high risk (below are the risks). Anyone can get heat stroke but people with the following conditions will develop heat stroke faster and more severely than healthy young individuals. The following conditions should best be treated by staying in a cool area inside away from the sun. Know the Symptoms of heat stroke and follow the directions listed above. Prepare yourself for heatstroke by carrying electrolytes more water than you think you will need, plastic zip locks to put ice in if needed High Risk Medical Conditions and Medications  Previous History of a Heat Stroke The biggest risk for heat stroke is having had it in the past.  People who have a history of heat stroke should be extra careful to avoid going outside or exercising in the heat and humidity.  They should stay inside during the heat of the day or on days that put them at risk. If you have almost had a mild form that you acted promptly and were able to avert the severe symptoms, that still makes you at risk for heat stroke. Heart Disease or other Circulatory medical conditions Diseases of the circulatory system place you at risk for getting a more severe form of heat stroke more quickly, so limit your time in the heat. Sympathetic and Parasympathetic Imbalance, from genetics or medications Disease of the sympathetic and parasympathetic nervous systems that cause excessive fluid loss due to sweating or increased body heat can cause you to develop heat stroke with less time in the heat and sun.  These conditions affect your ability to sweat, which is the way humans cool themselves down. Patients with these diseases don't sweat to cool yourself down like other people.  Stay inside until the temperature and humidity is safer. Age above 50 We all know that we are not as physically able as we age, even if we use testosterone pellets, so older age is a risk factor. Please limit your time outside in dangerous conditions to one hour at a time with 10 minutes or more inside a cool place before going back outside.  Medications that put you at risk for heat stroke when exposed to heat and humidity You may be unaware of the risk that some medications have when it comes to heat stroke.  Medications are part of our lives and most of the time we don't think about them causing problems or side effects, but many types of relatively safe medications can cause you to have heat stroke when the other folks around you are completely normal. My Experience with Heat Stroke I was playing golf in August in St. Louis, when the starting temperature at 8:30 am was 88 degrees F, and the humidity was 65%.  Being me, I thought to myself," Well I'm in good shape because I have minimal body fat and good muscles, I should be able to golf with 3 other women even in this heat." That day the humidity increased to 80% and the temp was over 90. Then the Pro announced that we had to stay on the cart path.  Well that makes golf a lot harder…,it takes twice as many steps  during a round and it requires even more exertion than walking the course and dragging a bag behind you….but I'm not a quitter (but clearly I was not thinking about being sick and taking my life in my hands)…which means I was stupid! I want all of you to be smarter than I was! Right away I started sweating profusely so much so that I had to change my golf glove three times in 6 holes. I still felt ok, but I couldn't hit the ball as far as usual, and I continued to sweat.  Despite 7 bottles of water, 2 with electrolytes, I started getting a headache, and then I couldn't make contact with the golf ball. My balance was off…." Uh-oh," I thought, "it's happening"….At that point I knew I had to go inside but was far away from the club house.  I continued one more hole and I was dizzy and had poor balance….so I quit, and I drove the cart back to the club house not finishing the 9 holes. I sat inside, drank water took another packet of electrolytes and put ice packs under my arms and laid down in the women's locker room until my headache was bearable, but I knew I was not going to be productive the rest of the day. It took 24 hours of lying down in a cool room, drinking quarts of water and taking electrolytes, putting ice around my neck and head, and doing nothing else! I kept thinking "why did the heat and humidity affect me and not the other 3 women?" We are all in good shape for our ages 60-70, and we all exercise and lift weights as well as play golf a few times a week, so I thought about what my risk factors were. Finally, I checked out all the medications and supplements I am on and found that  some of them  put me at risk!  This incident made me look up the all the meds that can impact people and increase their risk of getting heat stroke. Medications That Increase Risk of Heat Stroke Diuretics- Spironolactone is a diuretic given to all women who take T pellets to prevent facial hair and acne. It can cause dehydration in hot weather unless enough water, and electrolytes are taken to replenish body fluids. Other reasons for taking a diuretic is hypertension, heart disease, swelling, and poor circulation.  eg Hydrochlorothiazide (HCTZ) and Maxide are diuretics. Beta Blockers- such as Metoprolol, Propranolol slow down the heartbeat and reduce blood pressure.  The actions of Beta blockers slow the cooling mechanism of the body. Antidepressants- There ae many types of antidepressants but the "Serotonin-reuptake-inhibitors" such as Lexapro, and Wellbutrin can increase the risk of Heat Stroke, but the mechanism is not known. Amphetamines like ADD medicine, Sleep Apnea drugs, and old-fashioned weight loss pills speed up the heart rate, increase baseline body temperature and decrease the body's ability to cool itself. Thyroid Replacement-Thyroid replacement increases the heat produced by muscle tissue therefore it increases body temperature. This causes a patient on thyroid to have fewer degrees to get to a critical body temperature. I will leave you with the warning that hot weather can kill you and knowing the signs and symptoms of Heat Stroke is the fi

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog As the founder and Medical Director of BioBalance® Health, an anti-aging longevity practice for 23 years, I have long sought a blood test that serves as a reliable indicator of aging and disease risk. Identifying those at highest risk allows me to better motivate patients to follow my treatment plan and pursue a longer, healthier life. For people who test negative, I would reassure them they are doing well and encourage them to maintain healthy habits. Over time, I assessed common medical tests that many doctors use to steer patients toward certain treatments that do not reduce pain and may shorten life. I examined the actual risk of death and illness through clinical evaluations and credible, though less publicized, research studies. Here is what I found: Elevated blood lipids are not reliably predictive of vascular plaque. In my experience, both high and low cholesterol patients show similar rates of plaque in Cardiac Calcium Scans. Despite this, primary care physicians often prescribe statins, which may be unnecessary for many. Statins were not initially tested on women, who tend to experience more severe side effects such as cognitive impairment, muscle breakdown, and fatigue, likely because these drugs impact mitochondrial function—the cell's energy source. BMI has long been used to assess whether someone is at a healthy or risky weight, but it is often inaccurate. It overlooks individuals with low muscle and high fat, while labeling muscular people as overweight. As a result, BMI is being replaced by body composition measurements.   Recently, body composition analysis using InBody has become more common than BMI for evaluating patient health, frailty, and muscle mass. Measurements of visceral fat and body composition are considered indicators of current health status. BMI is a straightforward calculation that only uses height and weight, whereas body composition includes assessments of visceral fat and percent body fat. Only one weight- and height-based test directly relates to health status. High muscle mass indicates health, while excess visceral fat signals risk, and normal body fat percentage reflects current—but not future—health. Since body composition can shift over time, it is a useful measure of present health but does not reliably predict longevity and is just one aspect of overall health. Several blood tests can indicate current health, such as fasting blood sugar, HbA1c, IGF-1, and fasting insulin. For assessing future health risks and existing damage, HS-CRP (high-sensitivity C-reactive protein) is crucial, as it measures inflammation—a major factor in unhealthy aging and reduced longevity, especially when levels exceed 3.0. An article in Life Extension (July 2025) refers to persistently high CRP as "inflammaging."   The Truth About Aging and Inflammation? Temporary spikes in HS-CRP from infections or surgeries usually do not cause lasting issues unless inflammation persists. Chronically high HS-CRP levels (>3) are linked to various age-related diseases, such as obesity, arteriosclerosis, autoimmune disorders, poor dental hygiene, and other conditions that reduce health and lifespan. We now can measure "inflammaging" with HS-CRP blood test.  This test indicates increased risk of heart disease, cancer, stroke, dementia, autoimmune disease, and other degenerative diseases." A review of studies with more than 400,000 participants revealed that people with a High HS-CRP had 75% increased risk of all-cause mortality compared to people with a low HS-CRP. These studies found that HS-CRP may be a more reliable predictor of heart attack and stroke, than LDL cholesterol! HS-CRP may predict age-related diseases because chronic inflammation leads to issues such as arterial plaque and Alzheimer's. Although white blood cells fight infection, their persistent activity can damage healthy tissue and accelerate age-related conditions. The changes that you can make to decrease inflammation, Inflammaging, include: Fat loss to ideal weight Low inflammatory mediterranean diet Omega 3 oil supplements or in food Daily exercise Probiotics Quercetin supplement Treat joints that are damaged (inflammation is increased with injured joints) At least 3 cups of coffee per day Less than 4 oz of alcohol a day No sugar in the diet ***Replacing hormones to the levels of a young man or women with non-oral hormones, pellet testosterone for men and both testosterone and estradiol for women.   BioBalance® Health assesses new information through medical studies and bases treatments on knowledge of human physiology and the aging processes. No single test can determine if you are aging well, but HS-CRP is a better indicator than cholesterol or BMI. At BioBalance®, we've tested HS-CRP for 20 years and developed treatments to address inflammaging. Citation: Life Extension –July 2025

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog If you are female who is menopausal and you have experienced your OBGYN or internist drawing your blood to check your hormone levels, (Estradiol, and LH and FSH) to see if you are menopausal or to see what your estradiol level is while on HRT, you may have heard your doctor tell you that your estradiol level is too high. That is what I would like to talk about today….. This often occurs when my patients take the blood work I order to another doctor who doesn't know anything about estrogen and just looks at the reference range on the lab sheet. Most of you have heard me talk about the fact that lab reports must be interpreted by the treating physician, because what is written on the lab sheet isn't tailored to your situation. The lab reference ranges for menopausal women are based on women who don't take any hormones, very low estradiol and high LH and FSH, which is not healthy and is the level that causes women overwhelming hot flashes and painful periods. Estradiol blood tests have a list of numbers that don't reflect the healthy estradiol level, but a level that makes women miserable. After I replace a woman's estradiol, their tests show blood levels of a young healthy woman who is pre-menopausal, and that brings them back to feeling like themselves. "I have my life back!  Estradiol and Testosterone Pellets have cured all my symptoms (low libido, hot flashes, poor interrupted sleep, bladder spasms, depression, and I feel like myself again!" No other hormone replacement brings estradiol blood levels to (60-250ng/ml), patches, creams and gels just stop one symptom, hot flashes.  There is a reason that your doctor doesn't know about hormones. The education that OBGYNs get in residency effects what they recommend to their patients for life, and they have very little training about hormones which means that no one is taking care of the hormones for women, and bioidentical estradiol is never discussed because it is not approved by the FDA which is why I DO!  I have made it my business to know everything about women's hormones and have prescribed them to women for over 45 years.  Therefore, when I am told that the primary care or internal medicine doctor told one of my patients that their estradiol and estrone are "too high", I am dismayed.    Women must think about the fact that when they feel normal after menopause treatment, then that is the best treatment for them.  My patients become better, healthier, and their relationships are more fulfilling with Estradiol replacement, and I know the range the Estradiol should be within (60-250), the same as when we were fertile and young. Estradiol taken non-orally (patch, cream or pellet) is safe and does not cause breast cancer or liver cancer or cause blood clots. What Should I Tell My Doctor about my estrogen replacement? Therefore, If your doctor tells you to stop estradiol, you can tell him that estradiol replacement decreases all causes of death in Menopausal women, it decreases heart disease, bladder disease, bladder infections, osteoporosis, and dementia/Alazheimer's Disease! Tell him or her that, they can stop worrying about your Estrogen because you are being prescribed it by a doctor who knows how to manage hormones. Breast Cancer Patients There is another type of patient who I often see in my office. Breast Cancer patients with estradiol receptors are taken off their estrogen, and they are given an estrogen blocker like Tamoxifen® (oral) or Anastrazole (Arimidex®) to get rid of the estrogen in their body which is to "starve" breast cancer cell that may have seeded other tissues in the body. These patients are miserable. I treat them with Testosterone pellets only and monitor their Estrogens. That works until their doctor sees an Estradiol level that is in the premenopausal range in a patient who hasn't had an estradiol pellet in a year.  E2 pellets are tiny and friable, and they can't last longer than 6 months. What happens when the oncologist freaks them out saying it is the Estradiol pellet causing the E2, E1 levels. They are upset but this is estradiol from other sources (not the ovaries). Here are the facts: Estradiol pellets are 2-3 mm in size. They dissolve by blood flowing around the pellet located in the fat. Estradiol pellets dissolve completely over 3-4 months in most women. We cannot see them by ultrasound at 4 months. Therefore, a year later a woman who has estradiol over 60 The oncologist is not a hormone specialist and doesn't know the other sources of estradiol and estrone in the body. a prescribed amount of Estradiol (E2) is given every 4 months. The medium dose of E2 is 25mg and it lasts 120 – 180 days The size of an estradiol pellet = 2×2 mm Causes Of Continuing High Estrogen In a Woman Long After She Stops E2 Pellets: Tamoxifen given for Breast Cancer is an Estrogen and also an Estrogen Receptor modulator, but is really an Estrogen, which turns off the receiving end for E2 (the cellular receptors) so the breast cancer cannot be stimulated by circulating estrogens, but the rest of the body is. When on Tamoxifen it is not the pellets that are raising the blood level of E2, E1, it is the Medication. When someone is on Tomoxifen all their other organs are stimulated by estrogens from Tamoxifen, but the Breasts are not. That means that the estrogen in the blood is from the medication Tamoxifen and not the previous pellets. Obesity increases body fat and E2 is made in the fat and the less fat the lower the Estrone and estradiol. Other Medications and supplements can increase the E2 and E1 in the circulation but rarely help with menopausal symptoms. Your doctor should know what medications you can't take if you are trying to get rid of estradiol and estrone usually prior to Breast Cancer therapy. Drinking alcohol can prevent the liver from processing the estrogen that is meant to be removed normally so it builds up in the circulation. Liver disease causes an increase in E1 as well. Some medications increase estrogens in the body, but do not relieve symptoms of menopause, so have you doctor review your other medications you take. High intake of soy, edamame, soy nuts, soy in nut milk, Tofu, and other vegan (fake meat) is made of soy and soy is a phytoestrogen which can cause uterine bleeding but doesn't help the symptoms of menopause. Soy is in everything so read the labels. Genetic Diseases can cause high estrogen in menopausal women who are not taking estradiol for their symptoms.   Some women have an aromatase defect, which is genetic and can't be cured but can be treated with anastrazole or Arimidex, the same medication. This means that they convert Testosterone into estradiol and estrone. Even before menopause women have very low testosterone, so this is not obvious when they come to my office. The test for the gene defect is very expensive and this is not a common occurrence.  We diagnose this when a woman's estrogen is too high for the dose she is taking, AND her testosterone ran out too fast! We treat that condition with a testosterone + anastrazole pellet in the normal dose of T, and it corrects the conversion of T into E2, E1. Oral anastrazole also called Arimidex blocks that conversion too and is tolerated better by men but women get arthritis symptoms. DIM can treat this genetic conversion by blocking the enzyme at a different place than Arimidex. Fat Loss through dieting releases the estradiol stored in the body fat   Obesity and weight loss can cause estradiol and estrone to be high in the blood. Estrogen is made and stored in fat tissue.  The more you have, the more E1 and E2 you have in your fat.  Obesity can store the hormone and slowly release it which fools us and makes us think we are seeing pellet E2 nd E1. The more fat you have the more estrogens you make! When people lose fat under the supervision of a doctor, they usually have somewhat rapid weight loss.  This floods the blood with both estradiol, estrone, and triglycerides.  It takes longer to clear the estrogens because the liver is also processing fat. PubMed https://pubmed.ncbi.nlm.nih.gov Does reducing body fat reduce estrogen? Making some lifestyle changes may help lower your estrogen levels. Your provider may recommend that you: Decrease your percentage of body fat. Decreasing your body fat can reduce the amount of estrogen that your fat cells secrete. Feb 9, 2022 Above is what your doctor should think about when diagnosing you for high estradiol long after a pellet is gone.  There are some ovarian and adrenal specific problems that are also possible to be the reason E2, E1 are increased. I hope this gives you ammunition to discuss with the doctors who don't know anything about hormones, estradiol and menopausal women.  Tell them what you know to be true and stop blaming a 2mmx2mm pellet that can't physically last more than 120 day.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog You have all heard about smoking and the risks of lung and mouth cancer as the biggest dangers associated with it. However, since the ban on smoking indoors, many people have switched from cigarettes to other forms of nicotine, such as cigars, e-cigarettes, pipes, hookahs, or Nicorette gum. Most of my patients believe these alternatives to be safer and think they are not at risk for cancer. They haven't even considered that nicotine is a drug that, when taken internally, increases the incidence of other deadly diseases. Today, I'll inform you about the risks you are taking by using nicotine in any form. I guess I should back up a bit. The act of smoking cigarettes not only provides the smoker with nicotine but also presents many other concerns. The average cigarette, cigar, pipe tobacco, and hookah contain these chemicals along with 69 others that have been linked to cancer: Acetone – the poisonous ingredient in nail polish remover. Benzene – the ingredient in gas and fuels that causes cancer. Arsenic – in murder mystery movies as the poison of choice. Formaldehyde – the chemical used to embalm dead bodies that causes cancer. Ammonia – the active ingredient in window cleaner. Lead is a toxic chemical that we avoid by treating our drinking water, so it doesn't contain it. It causes neurological damage and can lead to dementia. No adult in their right mind would willingly put any of these chemicals into their body. Yet, the addiction to tobacco and nicotine leads millions to contaminate their bodies with these poisons. We haven't even begun to discuss the effects of nicotine. If you are listening to motivate someone you love to stop smoking, you might want to memorize these chemicals and see if understanding this fact affects their ability to quit smoking. If not, I have some more motivating yet unfavorable news for you. The drug nicotine is highly addictive, and it is indeed a drug. It falls into the category of stimulant drugs. Most individuals with anxiety issues tend to choose nicotine as their drug of choice.   Nicotine functions like any other stimulant; it causes the arteries to contract, reducing blood and oxygen flow. Over time, this results in elevated blood pressure, arterial stiffness, and an impaired ability to dilate when increased blood flow is necessary in a particular area. The next stage in this progression is arteriosclerosis, which may be followed by a heart attack or stroke. Many people addicted to nicotine in cigarettes try other forms of the drug, generally derived from tobacco, introducing numerous other chemicals into their bodies. Attempting to reduce nicotine by changing the method of ingestion still exposes you to another form of tobacco. In medicine, we refer to smoking as "pack years" to describe the amount of cigarette smoking in the patient's history. A Pack Year is equal to one pack a day multiplied by the number of years the patient has been exposed to the poisons and nicotine from cigarettes. Even though other forms of nicotine carry the same risks, we haven't developed a shorthand for exposure to these forms. However, we do understand the amount of nicotine present in each type of tobacco. Cigarettes contain an average of 10 to 12 mg of nicotine each, but only about 1.5 mg is actually inhaled. A pack of cigarettes delivers approximately 28 mg of nicotine. You can compare that to other forms of nicotine: Product Amount of nicotine Cigar 13.3–15.4 mg (large cigars) E-cigarette 0.5–15.4 mg (15 puffs) Pipe (tobacco) 30.08–50.89 mg  Chewing tobacco 144 mg (whole can) Hookah 1.04 mg (per puff)   Now, the alternatives for stopping this addiction include replacing nicotine with something else that doesn't contain the chemicals responsible for cancer. Nicorette gum or lozenges are the most popular options, but they should not be used for extended periods. They serve as short-term solutions to an addiction, as they can still cause vascular damage. The dose in one piece of Nicorette gum is 2 mg, which is equivalent to 1.5 cigarettes. This is not a permanent solution; other methods, such as acupuncture, hypnosis, and antidepressants, should be used to stop the addiction. A professional counselor or psychiatrist is the best choice for helping a smoker quit. Like any addiction, specialists are available to help and guide you throughout the process.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog This Blog post is for mature women to read.  If you feel embarrassed by sex or offended that I am addressing these genuine female concerns, please skip this Blog. Among the many questions I have received, I am sharing a few with you in case you also have these questions but are hesitant to ask when you visit your gynecologist's office. At BioBalance Health, our doctors conduct consultations with new patients and follow-up visits that last an hour. During these consultations, patients are free to ask questions about their health including sexual questions.   The atmosphere in our office is open to all questions, and the doctors offer hour-long visits, fostering a supportive environment for discussing embarrassing sexual situations, asking awkward questions, and addressing concerns about sexuality and aging. I am going to offer some of the questions I have been asked and the answers that I give to my patients who ask. Question 1:" Am I normal to think about sex and fantasize about having sex all the time now that I have testosterone pellets?" Yes, that is normal and healthy to think about sex…humans are sexual beings and thinking about or planning to have sex with your partner is normal.  After Testosterone pellets are inserted for the first time, they have magnified sexuality for a few weeks.  After that the sex drive of a patient goes back to what was normal for them when they were at their prime. Testosterone is necessary for a person, women and men to have a sexual drive. Those women and men who have had a healthy sex life before their testosterone was lost can still have sex, on their usual schedule, but what we think of sex DRIVE, won't be there without T….just the habit of having sex will make them continue to have an active sex life.  Question 2: "Before pellets I didn't have any discharge in my underwear, and I thought that was a benefit of menopause but now I experience wetness/slight white discharge Am I OK?" When women are mature and have fertility, (women between 12 years old and menopause) have some discharge clear or white in their underwear.  It is from the vagina, and it is a way of the vagina cleansing itself. Without the hormones estradiol and testosterone, as in menopause and when a woman takes low dose birth control pills, the vagina dries up and doesn't "cleanse itself". Vaginal lubrication stops, so does vaginal discharge, and painful intercourse is a real problem for women after they are not producing estradiol or replacing it with HRT. Experiencing normal vaginal discharge is a small price to pay to comfortable sex and a good sex drive. If the discharge changes, please watch or read my last Healthcast #685 or blog #685 to determine if you need to see a Gynecologist. Question 3: A question women ask me before they experience replacement of testosterone and estradiol. "Do I have Alzheimer's disease?  I'm only 50 and I can't remember things. I lose words and I am always late because I can't remember appointments." One of the most important benefits of taking testosterone by pellet insertion is that my patients usually get their brain back!  It is rare that anyone who is having trouble with their memory before age 55 is really starting to have an early onset dementia. By taking Estradiol and Testosterone pellets my patients regain their normal brain function in the first 8-12 months.  Those women who are still struggling with memory after taking Estradiol and Testosterone Pellets should be evaluated by a psychiatrist or neurologist to test them to see if they are having the beginnings of a type of dementia. The sooner a person takes TE hormone pellet replacement, the longer they will have a clear and functional mind.  If a woman takes T and or E2 pellets, they can delay the genetic onset of dementia by 10 years. That means if genetically you were wired to lose your ability to think at age 70, then you should get a ten-year delay in the onset of your dementia. E + T pellets are the only treatment I know can preserve your ability to think 10 years longer than if you didn't take them within 10 years of losing your Estrogen and Testosterone (around age 45).  Question 4: "Now that I have pellets, I have great orgasms but I produce a lot of fluid when I come.  Is that normal?" Yes. Estrogen increases vaginal wetness, and lubrication for sex. Testosterone stimulates the sensitivity of the area around and inside the vagina. Testosterone pellets are the only form I have heard of that can cause vaginal ejaculation, or forceful production of fluid from the vagina.  Not everyone experiences this phenomenon, and some women love it as do their partners, and other women dislike it because it makes sex messier than usual. It is a testosterone dose dependent action, and lowering the T dose in pellets can decrease the response to sexual stimulation. Question 5: "My husband can't keep up with my sex drive.  I have the same drive as I had when I was younger, but he is not able to keep up with my libido.  What can I do?" My response has several options because every sexual partnership is different. You can use vibrators or sex toys to stimulate yourself. He can use the same toys to engage in sexual activity with you. You can lower your dose of T pellets to decrease your sex drive. You can invite your husband to visit us or another Pellet practice to have his level of T and Free T checked and replaced if it is low and he is a good candidate. Question 6: "My husband likes me to give him oral sex. I like it, but what do I do with the semen he produces? The eternal problem:  to swallow ejaculate or not.  You can only decide this for yourself and if you are uncomfortable with this, then have a washcloth or Kleenex handy to handle the fluid. Question 7:" I have had pellets for a year now, and I have never been so happy, and I feel young again, but my gynecologist examined me and said I had an enlarged clitoris, and she told me to stop pellets because of that!  I don't get it!  It doesn't bother me; why is she so upset? What should I do?" Your GYN is clearly not educated in hormone therapy using T pellets. She also seems to be uncomfortable with her own sexuality if she cannot see the benefit of having a clitoris that is slightly larger than normal, so it is easy for a partner to access.  She may be recalling something from residency, that we were taught: "An enlarged clitoris is a sign of an ovarian tumor, and these tumors secrete high levels of testosterone-like hormone. This is not the same as a slight enlargement of the clitoris that is normal with T replacement. She has not considered that you are receiving Testosterone to replace what you are no longer producing. When we no longer make testosterone at fertile levels, our clitoris shrinks so small that it can hardly be found. Testosterone reverses that change reviving the size and function of the clitoris. Honestly, the change is minimal, and the size of the clitoris varies based on a woman's genetics and testosterone levels before the age of 40.  The natural shrinkage of the clitoris after menopause corresponds with low levels of testosterone, along with the loss of clitoral sensitivity, which can lead to a decrease in orgasms!  We are sexual beings, and testosterone is essential for sexual function. The ignorance of your gynecologist is both sad and common.  In the last 20 years, there has been no training for OBGYNs in sexuality or hormone replacement during menopause.  There is complete ignorance regarding treating women with testosterone. As in the general population that has a subset of people who are sexually inhibited, the group of board certified gyns carry their own attitude into the treatment room. Clitoral orgasms are the most common type of orgasm in women. After menopause, they can disappear without testosterone stimulation.  That will stop sexual pleasure completely. Most of my patients don't complain about having a visible clitoris, and they say "I can see my clitoris again and my husband can find it now! It makes sex great again." Question 8: "My internist asked me why I wanted to have sex now that I am old!  I'm 45! I am changing doctors, but what was she thinking?  Again, the training of normal sexuality in residency programs is minimal.  She might also be sexually unaware or inhibited, as she revealed when she told you that it is not normal to have sex as we age (over 40); clearly, she does not view it as an important part of her life, so it shouldn't be an important part of yours! Question 9: "Now that I am having sex again, I am shooting fluid out when I climax!  What is that and where does it come from?  By the way, my husband loves it!" This phenomenon is called "female ejaculation," and it is a normal, yet uncommon, part of great orgasms.  Women can produce fluid through transudation via the vaginal wall (which is incorrectly dubbed "vaginal sweating").  There are no sweat glands in the vagina; the fluid comes from the abdomen and is known as peritoneal fluid.  When a woman orgasms, her vagina contracts, and this fluid squirts out of the vagina with force. The second source of fluid is the Skene's glands, which are small glands located on either side of the urethra (the opening that leads to the bladder). They don't produce a large amount in most women, but it is possible for them to "squirt" fluid with force. Most men find this gratifying, as an unspoken sign that they did a great job.  Women may find it upsetting and ask me to decrease their testosterone levels to lessen the likelihood of "making a mess" when she has sex; however, this also decreases the orgasmic experience. I will keep collecting questions that my patients ask me in my office to offer a continued version of "Embarrassing Questions" in future blogs. I hope this helped you answer some of your unanswered questions!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog This Blog contains dialogue of a sexual nature In my 29-year history of practicing gynecology and 23 years of practicing hormone replacement medicine, there have always been a few questions that only the bravest and most comfortable patients would ask me during a well-woman visit or consultation. During the next few weeks, I will dedicate my blog to those usually unanswered questions, but most probably those questions that women are too embarrassed to ask. The first question is asked in many forms, but the general idea of the question is:" What should I do if I think my vaginal area smells weird?"  "Smelling weird" is a common description that can imply many things, so I will outline what I ask my patients to gather enough information to provide them with a medically relevant answer. What does it smell like? Yeasty, like baked bread? Sweaty-like body odor? Sour- like a towel that has been we too long? Musky – like the musk type of perfumes? Urine? everyone knows what that smells like Old people in a nursing home? OR "Like something is dead in there?" "Like Fish?" These are the actual descriptions that I have received in response to my question, and they all identify different. In case some of you are worriers, I will start with the fact that vaginal odors 1-6 are likely due to a minor infection, either an overgrowth of yeast, or the fact that you don't air out that area at night which makes yeast and bacteria grow in the warm environment between your legs or under the covers. Vaginal odors 7 and 8 are more serious and require treatment. I will first discuss the most important conditions based on their odors. These can be quite dangerous if ignored. Let me start by addressing odors 7 and 8. Odor # 7. If your vagina smells foul, like "something is dead in there," you should probably make an appointment with your GYN. It could result from something as simple as a tampon that was "lost" in the vagina, leading to bacteria growing from menstrual blood and semen.  This is a common cause of such vaginal odor. The GYN will need to use an instrument to grasp the tampon and remove it. She will then prescribe an antibiotic to treat the infection that has developed. While there's no harm in removing it, leaving it in place can lead to a serious pelvic infection. If your doctor doesn't find a tampon and this odor is confirmed by her, then she will do bacterial cultures and a pap to look for cervical cancer or endometrial cancer. It is important that you don't ignore this odor.  It won't get better on its own. Odor #8. If your vagina smells like fish it is likely an infection with a bacteria called hemophilous vaginalis, or from Trichomonas ("Trick"). Hemophilus can be caused by wiping back to front (the wrong way), which allows rectal bacteria to enter the vagina. Additionally, Hemophilus can be introduced into the vagina during intercourse. In these two cases, it is not considered a venereal infection– NOT an infection you acquired from your sexual partner. However, Hemophilus can be a venereal infection that you contract from a sexual partner if he acquired it from someone else and transmitted it to you! The treatment is essentially the same: a medication called Flagyl or metronidazole, taken three times a day for 7-10 days. If your partner has it too, he needs to take the medication at the same time so you don't keep passing it to each other. These infections require examination and testing to receive an antibiotic. The last possible cause of a fishy-smelling vagina is Trichomonas, a parasite that produces a significant amount of thin, greenish discharge along with a fishy odor. It is sexually transmitted, and both partners should be treated.  He should also have his other contacts treated. The group of infections in #8 is treatable and curable with medical help. Another quality of Hemophilus and Trichomonas is that if you have nitrazine pH paper and test the discharge with it, it will turn the paper dark blue.  Dark blue means go to the GYN! We'll start back up at 1-6 discussing the causes of "funny smelling discharge. " These are the least likely to be serious infections. I need to provide some initial information before I discuss the various reasons for vaginal odor. First, there is always a slight odor that is uniquely yours. You shouldn't try to eliminate all signs of vaginal odor because it results from a combination of yeast, good bacteria, estrogen, testosterone, and progesterone, which help protect your vagina and vulva, the area surrounding the vagina.  Changes in hormones such as pregnancy, menopause, hormone replacement therapy, diet, antibiotics, and dehydration can alter the vaginal smell and discharge. The yeasty odor that resembles baked bread comes from normal yeast present in the vagina. Some women naturally have this odor. It becomes a concern only when it is accompanied by itching and a significant amount of white discharge. These yeast infections can occur after taking antibiotics that eliminate good bacteria.  They may also arise when blood sugar levels are elevated, as seen in diabetics or prediabetics. The pH paper will not change color.  Treatment involves yeast medication, which can be either vaginal or oral, along with oral probiotics and sometimes vaginal probiotics to help restore the good bacteria. If you are diabetic, you may experience yeast infections until your blood glucose levels are normalized.   Sweaty-like body odor.The vagina can develop body odor from sweat that fosters the same bacteria found under your armpits.  This matter is simple.  Change out of wet swimsuits, wash gently with the same soap you use for the rest of your body, and allow your vagina to dry by sleeping without underwear.   Sour like a towel that has been wet too long. The ability to detect sour odors is genetically determined. You may not notice it, but your significant other might, or you may smell his clothes that have this odor, while he doesn't.  Either way, it is caused by bacteria from sweaty, damp clothes thrown into a hamper, allowing fungus and bacteria to grow. For some reason, you then wear these clothes, and your vagina ends up harboring the same jungle of bacteria and fungus.  This one is easy: air out clothes before wearing them, avoid putting on garments that are not clean, and wash these clothes in warm water to eliminate the microbes. You may need a doctor's visit for diagnosis and treatment.   Musky -you know, like the musk type of perfumes. A musky smell is the natural scent of fertile women with testosterone, especially when they are sexually stimulated. This is not an infection; it is the normal sexual scent of attraction. This odor usually diminishes with menopause or when you are on the pill and your testosterone levels decrease.   Like urine. The smell of urine is usually caused by leaking urine, poor wiping, or wearing a pad that absorbs leaking urine. It can precede a yeast infection because urine wetness encourages the growth of yeast. Treating urine leakage is imperative for resolving this issue. Options include surgery, Emsella magnetic pelvic floor strengthener, or a pessary. All of these can be discussed with your doctor when you inform them that you experience this odor consistently.   Like Elderly individuals in a nursing home? Sadly, nursing homes do have a characteristic odor; it is a combination of urine and cleaning chemicals, but there is something more. Elderly people who lack hormones have lost protective bacteria and exhibit a dominant odor of deterioration. This is what the vagina smells like without hormones and the beneficial bacteria they support. This is a smell that many women ask me about after menopause when they don't take hormones. The only way to return the odor to normal is to reinstate hormones.   If you have other vaginal odors I have not addressed, then send your email questions to podcast@biobalancehealth.com.  I pray you will trust your gynecologist enough to ask any questions you need to understand your own body. I hope I have provided you with some material to reflect on and compare to help answer your questions.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog You can convince yourself of a fairy tale that the US government provides us with excellent advice on how to be healthy—for instance, what the percentages of each food group should be, like the food pyramid or the food plate. However, time has shown that they aren't focused on our health with their recommendations; rather, they are attempting to promote the food produced in the US. It's all about money. We now understand that the government-approved food pyramid has contributed to an increase in obesity, illness, and diabetes over the last 60 years, primarily because its main goal was to promote grains in the form of cereals to children. This has led to the unfortunate situation we face today, characterized by rising rates of diabetes and obesity.  To make matters worse, iodine has been removed from bread and other foods, leaving many Americans with hypothyroidism.   The allowed food additives extend shelf life (and profits) but diminish human longevity. Ultimately, the government should not dictate our dietary choices! Supplements are substances like minerals, vitamins, peptides, and glandulars intended to enhance the inadequate American diet; however, medical societies and the FDA do not endorse their use. Nonetheless, we need them to improve nutrition, prevent disease, and provide the building blocks for bones and muscles, as well as to counteract the chemicals present in our water, food, and air mandated by the government. Supplements help protect us from the poor advice and environmental pollution we encounter in everyday life. Environmental regulations and processes have resulted in increased illnesses, such as hypothyroidism, due to the addition of fluoride to our water instead of solely to our toothpaste.  Fluoride depletes iodine levels in our breasts and thyroid, contributing to conditions like breast cysts, breast cancer, and hypothyroidism. Regarding water—are you aware that the water treatment managed by our local governments incorporates harmful chemicals into our drinking water, which may be carcinogenic, in an effort to prevent lead from leaching from very old pipes? This system is outdated because most of the population uses copper or plastic pipes, and lead has not been used in construction for more than 50 years. The anti-lead chemicals that are added can adversely affect our health. That is just the tip of the iceberg. Other examples of how our government prioritizes profit over the health of its citizens include allowing big pharma to price necessary medicines beyond the reach of the average person, all to enhance the stock value of these companies. The price of the same drug from the same manufacturer in other countries is significantly lower than for its own citizens. It should be the other way around. Even then, we are sicker and heavier than any other first-world country. Since you are not here to learn about politics, this serves as my segue into discussing the current denigration of the importance of vitamins and mineral supplements for our health. Just consider this:  the average diet consists of processed foods lacking any nutritional value. Fast food contains additives that encourage us to eat more rather than less; portion sizes have increased, and the consumption of whole foods has declined over my lifetime. These are the most compelling reasons I have for taking nutritional supplements that we used to get from our diets before the 1960s. Since we know our patients are consuming chemicals that harm their health, my goal as a preventive medicine doctor, along with my nurses and nurse practitioners, is to keep our patients healthy, even when the government does not!   You should heed our recommendations for specific supplements tailored to your individual symptoms and future health. Public health aims to make the group generically "healthier" by governmental standards, but medical care should prioritize our patients, striving for each individual to live a long, disease-free life. However, we face significant misinformation in this battle! Why don't mainstream medical groups recommend supplements? Their reasons include a focus on illness rather than wellness, making them more reactive than preventive in perspective. Additionally, most doctors lack training in nutrition and are often unhealthy and overweight. Another factor is that they primarily deal with medications and surgeries, which is what they typically recommend. In the twenty-first century, we all need supplemental nutrition.  I don't have a single patient whom I believe is getting everything she needs from her diet without supplements. Supplements include minerals, vitamins, herbs, select foods, and animal glands that help maintain health and prevent illness by compensating for what modern food may lack. The supplements recommended by your BioBalance Health doctor and NPs are tailored to meet various individual needs, so please read about why we prescribe these supplements specifically for you. Supplements add to the nutrients that are missing from our modern diet.   What health benefits can supplements offer? Act as alternatives to medication Enhance the activity of deficient hormones as people age Stimulate the production of hormones Provide the right form of a vitamin that you need and can't get from food Replace the minerals that are lacking in locally grown foods and water Supplements can replace the natural components of drinking water Supplements provide minerals and vitamins that prevent diseases like hypothyroidism. Supplemental animal glandulars are successful at reversing deficiencies that are not available in FDA-approved drugs. Preventive medicine physicians recommend supplements for various reasons: To improve your nutrition To mitigate genetic abnormalities such as elevated homocysteine levels. To counteract chemicals in the environment To treat medical conditions with no known medications To supply certain minerals that are deficient in your area of our country To treat abnormal hormone levels like low thyroid To treat certain symptoms and conditions that have no other solution To prevent future disease To stimulate the production of certain hormones to take the place of a prescription drug To detoxify your liver and gut To improve the absorption of nutrients in the gut To supply minerals and vitamins for osteoporosis To improve your mental health by improving the bacteria in your gut Assist in weight loss My goal is to educate people honestly about the tools they can use to maintain their health and extend their lifespan.  A few words of caution should be added to complete this lesson. Please avoid using the cheapest vitamin or mineral supplement on Amazon unless your doctor has prescribed that specific brand.  Many supplement companies are not "Medical Grade, " meaning they are not tested and approved by agencies that ensure you receive an effective supplement with your purchase.  Amazon has been found to sell vitamins packaged in reputable brand bottles that contain capsules with none of the expected supplements inside! BioBalance Health and BioBalance Skin provide tested medical-grade products, ensuring you take the right supplements for the desired effect.  We cannot expect the same quality from most supplements available online. Avoid taking a supplement just because someone else is using it; you might not need it, or worse, it could have negative effects. Trust experts to evaluate what you truly need and what you can do without. When you have a consultation with a BioBalance doctor or NP for your yearly visit, please bring a list of your medications and supplements to discuss with them. Please do not call our RN or email your list for their opinion. Evaluating your needs and aligning them with your supplements requires time.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Menopausal Symptoms I waited to announce the emerging research regarding the safety of post-menopausal hormone replacement therapy for breast cancer patients suffering from severe menopausal symptoms until the research finally supported my belief that women have the right to receive the treatment that they need if they accept the risks of that treatment. The past year of research (2024-2025) has produced a significant amount of research demonstrating the health risks associated from not taking hormone replacement therapy, as well as the safety of using testosterone after breast cancer and the limited risks of hormone replacement therapy following breast cancer. I have practiced women's medicine for over 40 years, and I believe that female patients should have the right to receive post-menopausal hormone therapy if they understand and accept the associated risks and benefits, as long as it is administered safely. Let me pause here to discuss how doctors ethically make decisions about treatment. First, the aim of medical treatment is to improve health and longevity while alleviating symptoms. It is a doctor's responsibility to evaluate, treat, and advise patients on the best course of therapy based on their medical training, practical experience, and the latest research. However, the third factor is often overlooked when advising patients about hormone replacement therapy after breast cancer. Doctors determine the best course of treatment by using this information and weighing the benefits of a treatment against its risks. We are trained to provide this information to patients to facilitate informed decision-making with the patient, not for the patient. This process requires time that doctors no longer have. Ah, and therein lies the problem. Doctors are trained to follow research related to the diseases and conditions they treat and to integrate that research into their practice. The basic decision-making process involves weighing the benefits of treatment (or no treatment) against the associated risks. When the benefits of a treatment outweigh its risks, it is recommended to the patient. "Recommended" means the doctor, based on current knowledge, believes it to be safer and more effective for the patient's health to pursue a specific treatment. However, this does not imply that the patient must follow the doctor's advice. A patient is autonomous and can assess the risks and benefits once informed, allowing them to refuse a treatment or request one that falls outside current medical guidelines. Doctors do not have to embark on a treatment they do not believe is beneficial or safe. Doctors have autonomy as well! Doctors in mainstream medicine adhere to "medical guidelines" established by our specialties, which represent the minimum level of care expected from a physician. However, these guidelines are often decades behind current research, meaning that the risks and benefits communicated to a patient may be outdated. A legal requirement known as informed consent mandates that a doctor inform the patient or include this information in a consent form that the patient reads and signs, detailing the procedure or treatment. If the treatment is newer than the guidelines, it is categorized as "off-label." It is essential for the doctor to inform the patient that the treatment does not conform to current guidelines, and the patient must acknowledge the known risks associated with the treatment. At BioBalance Health®, we often find ourselves ahead of the guidelines, and my experience indicates it may take up to 20 years for the guidelines to catch up with us. Much of our treatment is considered off-label because it is current and ahead of the guidelines. It is superior to other treatments and remains safe, but risks are inherent in every treatment! Now, let's return to breast cancer and the roles of estradiol, testosterone, and progesterone replacement. Here are the facts about breast cancer: Most breast cancer patients are post-menopausal, and have symptoms of menopause Not all types of breast cancer are stimulated by estradiol or progesterone, and therefore for these cancers hormone replacement therapy is safe. Breast Cancer patients with negative nodes who have had a bilateral mastectomy are candidates for hormone replacement therapy after their treatment. The risks of estrogen replacement for ER+ breast cancer patients may promote the growth of cancer cells, while testosterone replacement lowers the risk of recurrence and alleviates certain menopausal symptoms. When testosterone is combined with estradiol, the risk of developing breast cancer in all women is reduced. Testosterone enhances the quantity and activity of cancer-fighting T-killer and T-helper white blood cells. All breast cancer patients can manage menopause symptoms using testosterone pellet therapy and vaginal estrogen without an increased risk of recurrence. Do you remember when I mentioned that the risks of treatment should be balanced with the benefits of that same treatment? Recently, numerous research articles have outlined the benefits of estradiol treatment, which I included in my 2017 book, "The Secret Female Hormone: How Testosterone Replacement Can Change Your Life." In early 2025, the safety of taking estradiol for menopausal women confirmed the less publicized research that had come before. The Journal of Endocrinology and Metabolism reported that women who underwent estradiol replacement after the age of 60 live 20% longer than those who do not take hormone replacement therapy. This challenges the guideline that advises OB-GYNs to discontinue hormone replacement therapy before the age of 60. The Benefits of Estrogen replacement after menopause, based on multiple research studies over the last 20 years is as follows: ERT alleviates symptoms such as dry vagina, painful intercourse, insomnia, hot flashes, and night sweats. Estrogen replacement prevents and treats osteoporosis in women. Testosterone replacement in women with osteoporosis can reverse the process of bone loss, bringing bone back to normal strength and decreasing fracture risk. Non-oral Testosterone and Estradiol can prevent arteriosclerotic heart disease. ERT and HRT decreases the risk of diabetes with aging. Estradiol replacement during the first decade after menopause can delay the onset of Alzheimer's disease and dementia by ten years. If you are genetically predisposed to developing Alzheimer's or dementia by age 80, E2 replacement may postpone this onset until you turn 90. Testosterone replacement in the first 10 years after menopause postpones the onset of Alzheimer's disease and dementia for an additional ten years. Testosterone boosts immune function in both sexes and diminishes the onset and severity of infectious diseases. Aging causes cognitive decline, marked by challenges in memory and thinking, and menopause speeds up this process. Testosterone and estradiol replacement therapies may aid in reversing this decline. Muscle mass decreases after menopause due to a decline in testosterone but replacing testosterone with bio-identical pellets restores muscle mass to premenopausal levels.   The latest medical article that inspired me to create this podcast was published in the journal Menopause, which discussed the challenges many women face after breast cancer treatment without hormone replacement for their severe menopausal symptoms. Here are the quotes I think you should hear: (MHT = Menopause Hormone Therapy) "Among 226 breast cancer survivors.. the menopause symptom burden was high and women's experience of menopause-related breast cancer after-care was poor. Few women felt actively involved in menopause treatment decisions.  The NICE breast cancer guideline (NG101) states that women with a history of breast cancer can be offered MHT in "exceptional" circumstances if other treatments have failed (off-label use). However, NICE does not define what "exceptional" circumstances are or who gets to decide. Up to 50% of breast cancer survivors, especially those with debilitating menopausal symptoms, may choose to accept a small increase in risk in exchange for an improved quality of life and/or to mitigate future health risks associated with chronic estrogen deficiency.  "Allowing". women to have MHT only in "exceptional" circumstance undermines patient autonomy and limits a clinician's ability to integrate clinical knowledge and judgment with the best currently available evidence (which is decades behind clinical guidelines). Clinicians have a legal and ethical responsibility to patients to make informed treatment choices. If you have had breast cancer and are experiencing symptoms you no longer want to endure, my advice is to find a doctor with whom you can make an informed decision based on the latest research. It's important to understand and accept the risks and to sign a High-Risk Consent for HRT.  If you aren't that brave, then seek a physician who will prescribe testosterone pellets along with vaginal estradiol to alleviate some of your post-menopausal symptoms. Life is too short to follow guidelines that are 20 years out of date when you are suffering.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Last time we reviewed why interpreting your lab may lead you to the wrong diagnosis and treatment.  Today we continue our review of each lab panel and why the reference ranges on your lab results may not be the "Healthy Normal Range" that you should compare your results to. Lab reference ranges are established with a one-size-fits-all mentality, ignoring the numerous variables that influence blood results. Have you ever tried on a "one-size-fits-all "ANYTHING? Those clothes may fit 20% of the population but for the rest of us, the garment doesn't fit our width, weight or height! All one-size-fits-all lab reference ranges are much the same.  For example, the standardized "reference ranges" in the US serve as a one-size-fits-all "ideal range" applied to everyone, despite genetic differences, varying latitudes, and the diverse diets that characterize the American multiethnic population. This presents the first problem with using a single range for all people: variations among individuals based on differing genetic needs.  The second issue is that the ranges on the lab report indicate the minimum levels necessary for survival, not necessarily the healthiest blood levels for most individuals. Another example of one size doesn't fit all is the reference range for women's hormones. A range is displayed for cycling women, but there is no healthy range for menopausal women.  Does the range displayed refer to menopausal women with HRT, or menopausal women without HRT to treat their menopausal symptoms? Is the range based on what is healthy, or what is average? We aren't sure. Labs don't ask patients questions that could help interpret lab values. Therefore, they cannot provide a truly diagnostic reference range for any illness. They only consider gender and age, as reference ranges are solely adjusted for these two factors.  A doctor must interpret individual lab results alongside a patient's medical and surgical history, including established diseases, medications, supplements, hormonal treatments, and past lab values. For instance, laboratory companies should offer reference ranges based on whether a patient is menopausal, a woman is undergoing ERT, a man is receiving testosterone, a patient is on thyroid medication, a person is being treated for diabetes, or the diabetic tests are performed to diagnose diabetes.   Some Reference Ranges are Based on comparing results to Misleading formulas The best example of this issue is the Lipid Panel. Doctors use this panel to determine a person's risk for heart attacks caused by atherosclerosis. Most doctors don't know the formula for determining Total Cholesterol. This test doesn't predict heart disease in most patients, as the formula used to arrive at that number is not indicative of the disease. However, doctors have been advised that when   total cholesterol levels are high, a patient should start taking a statin, a drug that reduces blood cholesterol and sometimes lowers the rate of heart attacks in certain individuals, though it is rarely predictive in 50% of the population. The problem with the lipid panel is twofold: the LDL level indicates future atherosclerosis in only about 50% of the population and is not a specific test for future heart disease risk. Total cholesterol is even less predictive of heart disease because it stems from a flawed formula. Doctors interpret a high Total Cholesterol level as an indication that a patient may be at increased risk for heart disease in the future. When I test patients with elevated Total Cholesterol or high levels of LDL using a Cardiac Calcium Scan to measure plaque, only half of them actually produce plaque, and consequently, are not at risk for atherosclerotic heart disease. I believe that the Total Cholesterol number is derived from an inaccurate formula for determining a person's risk of future heart disease. The Total Cholesterol number is calculated using a flawed equation. The equation is as follows:         LDL + 1/5 Triglycerides+ HDL = Total Cholesterol Total Cholesterol = LDL (bad cholesterol) + 1/5 Triglycerides (high risk factor) + HDL (good cholesterol) Let's examine this formula simply like this:   Bad + Bad + Good does not equal Bad. Due to this incorrect formula, thousands, if not millions, of patients have been prescribed statin drugs for a lifetime without justification!  Statins carry risks. The list of side effects is extensive and includes muscle deterioration and statin-associated dementia. Unfortunately, most people who experience statin side effects are women. Women tend to have higher HDL levels than men. Additionally, they typically do not have atherosclerotic plaque until menopause and usually do not develop it after menopause if they undergo estrogen replacement therapy! This gender issue is just one of the problems with laboratory reference ranges that are not adjusted for sex. The total cholesterol values were developed solely from the blood levels of men, who typically have lower HDL levels. Women were excluded from the tests conducted to create this blood panel. For women, I dispel the myth that high total cholesterol predicts heart disease by recommending a Cardiac Calcium Scan to check for plaque. If a woman has no plaque by the age of 50 and is taking estrogen, she is unlikely to develop plaque in the future.  I still test them every 2-3 years to ensure that no metabolic changes have altered their risk, but I don't put much faith in the unreliable cholesterol blood panel. There is another blood test that has deceptive reference ranges: IGF-1 How about the GH-IGF-1 test, the test for Growth Hormone?  IGF-1 is a metabolite of GH that we can measure to determine how much the patient produces.  This hormone aids in healing and replenishing aging cells in patients after their growth is complete.  The healthy normal range with which I was trained, (150-350 MIU), has been changed to an age-adjusted normal that compares a person to others in her age category who had their blood drawn the previous year.  What is wrong with this? Growth hormone (GH) decreases with age and contributes to the declining health people experience as they grow older. Similarly, IGF-1 diminishes with age and illness, which means that the "reference range" essentially reflects that you are "average for the sick individuals who visit Quest to have their IGF-1 levels checked. " IGF-1 levels can be enhanced through weight loss, testosterone replacement, and an increase in muscle mass. The current reference range does not indicate health or illness; it merely shows whether you fall within the average for your age group. This non-scientific method of determining "health" is widespread in contemporary medicine. By comparing aging individuals to others within the same age group, for hormones that decline with age, based on samples from sick patients who visit a specific lab in the past year, these labs label patients as "healthy" even when they are as ill as other individuals their age who go to that lab! This practice constitutes age discrimination! Regarding hormones, the levels we maintained during our fertile and youthful years correspond to the blood levels indicative of health in all individuals ages. For example: People who check their IGF-1 (Growth Hormone) levels and see a low "52 ng/ml" might feel satisfied that they are within the standard range (50-280 ng/ml). However, they may not realize that this range applies to older, unhealthy individuals, not to healthy young ones (150-350 ng/ml).  This is just one example of the issues that arise when non-medical individuals, who do not monitor these tests regularly, draw conclusions from the numbers.   Some illnesses require more than one blood test for diagnosis If you consider only one of the three tests for diabetes or prediabetes (Fasting Blood Sugar, HbA1c, and Insulin), you cannot self-diagnose as diabetic, prediabetic, insulin resistance or healthy.  Diabetes is a disease that has coincided with the rising number of obese individuals.  Both conditions affect nearly 50% of the American population. Blood tests cannot be interpreted accurately unless a patient has fasted for 12 hours; all three tests should be evaluated. When diagnosing diabetes and insulin resistance, we perform three tests to assess whether a patient has insulin resistance, prediabetes, or diabetes. These tests guide our diagnosis and inform the treatment we provide based on their results. Fasting insulin is a highly misleading test. Over 15 years ago, a significant study was conducted that was believed to change the reference ranges for fasting insulin.  The new range set for normal fasting insulin was less than 10 mIU/ml. By publishing the reference range less than 18 mIU/ml, they miss diagnosing many patients with insulin resistance HBA1C is a test that gives a value of average blood sugar over three months. The results are often used alone to determine prediabetes and diabetes; however, considering all three aspects makes the diagnosis and treatment plan more specific for the patient. FBS (fasting blood sugar) is the third diabetes test. It is generally used as a screening test that prompts the ordering of the other two blood tests; however, some patients exhibit symptoms of diabetes and insulin resistance without having elevated fasting insulin levels. Many medications can raise diabetic test values, causing a patient to seem diabetic when they are actually experiencing a side effect of the drug.  One such medication is Atorvastatin.  The solution is not treating diabetes but rather adjusting the medication.  Hormone tests are especially challenging to interpret, Especially when testing free Testosterone in women Here are the problems with the free Testosterone test itself: Women have extremely low levels of free testosterone and testosterone compared to men. I have been informed by Quest that women's free testosterone lev

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog There is a new federal rule for lab companies that requires them to report your blood tests to you as soon as they are finished, often even before your doctor has seen them.  This rule, deemed unreasonable, was established by individuals without medical expertise (politicians), who know little about interpreting lab data or the workings of doctor's offices. Sending your lab results to you before doctors can assess them is not a decision rooted in sound medical practice but rather in the notion of individual freedom. While this is important, it does not compare to having an expert interpret your results with you. The law requiring that your lab results be sent to you as soon as they are completed does not consider the fact that these results are not designed for laymen to interpret. Additionally, lab results are meant to be analyzed alongside a patient's medical history, age, gender, and medications.  The results are not tailored to report information specific to your situation, which is how a doctor would interpret them. Lab results often lack layperson-friendly explanations. This new protocol can cause anxiety, as patients may panic over results that appear abnormal, even if they are normal for their specific medical condition and treatment. Furthermore, lab companies only request your age and gender. The factors that doctors evaluate when interpreting your results are diverse and numerous, each influencing the overall interpretation. What are the considerations that doctors add to their interpretation? Menopausal status Medical conditions Healthy normal for young and healthy adults The newest recommended ranges for health Body weight Other lab values seen on the same report The problem with you getting your own lab and interpreting it as written is multifactorial: The lab is sent to you digitally with very little explanation except for reference ranges. There is no information about who you are being compared to. Other women, both men and women? Old women? Young women? Women with symptoms or women who are well without symptoms.  The reporting of the lab results to a patient directly may hide problems that need action or create fears that are unnecessary. Anxiety over your results will continue until your doctor's appointment to discuss … so you may experience unnecessary worry in many circumstances. Reference ranges make many assumptions, but labs don't input vital information about you into their computer. your age of menopause, your weight your height (or BMI) previous illnesses and your medications. if you are on hormones or testosterone   Here is a good example. The test for pituitary hormones FSH and LH. When a woman aged 45 is menopausal, and has a very high FSH and LH, the lab says it is "normal" (in the reference range), yet the woman is having severe hot flashes, night sweats, anxiety, and insomnia.  That is not healthy or "normal". The same two tests can be used to determine if a person is menopausal. Let's say a 42-year-old woman has elevated FSH and LH, but her estradiol is very high (200-300). To the layperson, this looks like menopause, but in reality, it is the picture of ovulation, not menopause. One has to look at another test, estradiol, to determine whether she is premenopausal and ovulating or menopausal (her estradiol would be very low, and FSH and LH would be high). See the problem? Reference Ranges don't tell you what the doctor is looking for. The same two tests, FSH and LH, are used to diagnose polycystic ovaries (PCO) too.  In women without PCO, the FSH is higher than the LH, but if the LH is greater than the FSH, the diagnosis of PCO should be considered! There is no information about this interpretation in the lab report. Falling within the reference range doesn't guarantee health or absence of symptoms. If patients are to interpret their own lab results, reference ranges should reflect health in every possible scenario. FSH and LH are influenced by BCPs and menopausal HRT. Lab results should be interpreted considering the information regarding BCPs or ERT that the patient is taking. When women are on BCPs and HRT or ERT, their FSH and LH levels are suppressed to an extremely low point. If you are unaware that the patient is taking these hormones, it may appear that the diagnosis is pituitary failure affecting estrogen levels and ovulation. Only doctors can interpret this test. There should truly be a "normal" range for those undergoing hormone replacement therapy, along with a reference range that reflects overall health, rather than merely the average for your geographical area in the US or your age group. Please make an appointment with your doctor to review your lab results so you can understand how they are interpreted. If you have questions about your lab results that are concerning you, schedule a time to discuss them with your doctor. Doctors don't have the time to explain results over the phone or through email—that is what appointments are meant for. Phone calls to doctors' offices are not intended for lab result interpretation. You or your insurance will not compensate the doctor or NP for this service over the phone.   The reference ranges for many tests and medical situations are actually wrong. If you aren't trained as a doctor or Nurse practitioner who interprets metabolic lab results every day, you could get the wrong diagnosis!!! For example, when evaluating a patient for insulin resistance, the reference range was officially changed almost two decades ago. Still, the lab companies have left the normal range very high (insulin> 18). In the revised range, fasting insulin diagnoses insulin resistance if the value is > 10. The resulting outcome is that many people are not diagnosed at a time when they can be easily treated without drugs and are told that they are "normal" when they are really experiencing insulin resistance. This is misleading and just wrong! Lab values are not adjusted to your individual situation.   Many tests are adjusted for gender; however, some are specifically adjusted for women who are menstruating regarding H/H. In other words, men and women have different "normal" H/H levels in the reference range. Women who do not menstruate or who are menopausal should be compared to the same reference range as men, but that does not happen. This leads to menopausal women, who are normal, often being told they have too many red blood cells when that is not the case. Conversely, menopausal women who are truly anemic are told they are normal, which means it takes longer to diagnose their anemia from colon cancer! The H/H should have a reference range that is considered "normal" for a woman's stage in life, depending on whether she is experiencing menstrual periods or not. Many reference ranges are averages for regions of the US and vary between lab companies; therefore, they are not reliable values for comparing patients.   For instance, the Homocysteine test has a normal range that is relatively high, and each lab has different reference ranges. This test serves as a screening tool for MTHFR genetic risk related to embolic stroke and heart disease.   The suggested treatment involves methylated B vitamins; however, the interpretation on the lab printout advises taking B12 and folic acid, which, in my experience, tends to increase the number rather than decrease it. Reference ranges for nutrients, vitamins, and minerals reflect the minimum levels needed for survival, not optimal health. For example, B12 reference range levels for B12 blood levels are listed as 200-1100 pg/ml, yet I was trained to try to achieve 400 -1500 pg/ml. The lower range of the written reference range (200-400) is not healthy. The desired blood levels for vitamins are often controversial, and various medical colleges issue new recommendations on Vitamin D levels each month. Consequently, doctors must determine which level of Vitamin D to recommend for their patients. These institutions not only provide changing reference ranges but also offer differing advice on how frequently to test Vitamin D. This inconsistency arises primarily from the ongoing debate about the minimum acceptable level of Vitamin D. I have more information about your lab results next week that your doctor may not share with you. There is a lot of controversy surrounding the reference ranges on the lab sheet, and you should know the truth in case your doctor doesn't.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog The newest miracle drug for weight loss is changing the lives of thousands of people who have battled obesity for extended periods of time….These GLP-1 medications are also treating or preventing the diseases that go with long term obesity: Diabetes, Heart Disease, Joint replacements, Arthritis, Sleep Apnea, and Alzheimer's Disease. Researchers are finding more indications every day for patients to take these weight loss medications. But like anything else there is no perfect answer to any problem.  Among the few side effects of this drug, the most frequent side effect is reflux, also called acid indigestion, or GERD (gastroesophageal reflux disease).  Often my patients don't even know what their diagnosis is, they just tell me about their symptoms. The symptoms of GERD include: Asthma symptoms A bad taste in the mouth Difficulty swallowing Dry, hacking, cough Chest pain after meals These symptoms are worse after a big meal, at bedtime, after spicy food, or dose related.  Most of my patients don't want to discontinue the GLP-1 inhibitors because they are finally losing weight!  We manage the GLP-1 side effect of GERD by decreasing dose of the medication and slowly increase the dose back to an effective level. We also offer lifestyle and dietary treatments before we offer prescription medication. Therefore, if reflux is not constant, and is not causing any lasting damage to the patient's esophagus, we can treat it with lifestyle changes and over the counter medication, to lower the stomach acid that is refluxing into the esophagus. The lifestyle changes patients can employ on their own are described below. Lifestyle changes needed to avoid or treat Gastric Reflux caused by GLP-1 agonists. What can you do to prevent and treat this side effect: Eat smaller meals: Large meals expand your stomach and put pressure on your lower esophageal sphincter (LES). Don't go to bed less than 2 hours after eating Avoid trigger foods see below Sleep on your left side Elevate the head of your bed Avoid tight clothing: Chew your food well– chew each bite for 20 seconds. Quit smoking: Smoking weakens your LES and makes your stomach more acidic. Stop drinking alcohol Chew (non-mint) sugar-free–gum  In addition to changing your active lifestyle, changing your diet is necessary as well. There are trigger foods to avoid minimizing your reflux symptoms.  tomato sauce and other tomato-based products high fat foods, such as fast food and greasy foods fried foods citrus fruit juices soda-diet and regular Caffeine Garlic onions mint of any kind milk based products My patients ask me, "So what can I eat?" …I admit I did take away some of the most exciting foods, however my patients ask me what they can eat so the list of foods that help avoid and treat GERD are listed below. High-fiber foods: vegetables, fruit, and whole grain bread. Alkaline foods. Foods fall somewhere along the pH scale (turns litmus paper blue). Drink alkalinized water (PH > 8) Ginger—fresh sushi Ginger from Asian food stores. Apple cider vinegar on salads and a Tablespoon in water every morning Lemon water—just squeeze a slice of lemon in your water. Coconut water Honey. Lean Protein including meat Low-Fat and Nonfat Dairy Products. Non-Citrus Fruits like apples, pears, bananas, and melons Vegetables like broccoli, Carrots, Corn, Cucumbers, Green Beans, Green peppers, Potatoes and Sweet potatoes   For my patients who take herbal and other supplements, the following is a list of the supplements that may decrease your symptoms of GERD. Chamomile Tea Licorice Marshmallow Slippery Elm Tablets Probiotics-Mega Brand Prebiotics-Mega Digestive Enzymes Aloe Vera Juice Baking Soda Magnesium glycinate What happens when you have made all the lifestyle changes you can and have lowered your GLP-1 dose or changed to a different type of GLP-1 Agonist, and you still have GERD? As a physician I prescribe medications to help my patients treat their GERD, however most of the medications have been placed over the counter so I can recommend them to my patients, and they can buy the medication without a script. The class of medication that treats GERD include Antacids, H2 Blocker, and Proton Pump Inhibitor.  Antacids neutralize stomach acid, but they typically only work for short periods. They are generally made of calcium. This type of medication is best used prn for symptom relief.  Side effects of antacids may include constipation and diarrhea. The second option for treatment of GERD is an H2 blocker. These drugs reduce the amount of acid the stomach releases. Eg. Pepcid, Tagamet, Gaviscon. Proton pump inhibitors (PPIs): These drugs are available by prescription from a healthcare provider, and now some doses are over the counter. PPIs help reduce the amount of acid the stomach makes.  They should be used for a two-week period only for severe attacks and then you should change to an H2 blocker or antacid. WHY stop a PPI after 2 weeks?   Omeprazole is an example of a PPI.  Theses medication kill the good bacteria in your intestines, change your breath and can affect how you absorb your nutrients. If you must take them chronically to treat and prevent the progression of damage to the esophagus. What if I did everything and GERD is still a problem: If your condition is severe, your doctor may recommend a consultation with a GI doctor for an endoscope or other diagnostic procedure.  In addition, you may have to hold your GLP-1 Agonist for a period of time while you treat your esophageal inflammation. Just as in all medical issues there are many ways to treat side effects of drugs. Your provider will prescribe the medication that she or he is most comfortable with. What next? So if you have reflux and are on a GLP-1 inhibitor, you may be advised to decrease your dose or switch to Tirzepatide medication (Mounjaro, Zepbound). There are many steps you can take before you need prescribed medication. Your doctor may even change your GLP-1 agonist prescription or refer you to a GI doctor, but before this is necessary you should try the lifestyle and dietary changes that I recommend in this Blog first. This side effect of GLP-1 agonists doesn't affect every patient and can be managed as you see above, however the lifestyle changes and dietary changes can only be done by you, so the ball is in your court!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Almost every week I hear from my male patients that their PCP doctor has scared them by telling them to stop taking testosterone pellets because their Hematocrit is too high.  Alternatively, their doctor recommended a lower dose of T. These two recommendations are those doctors who don't understand all the good that the testosterone is doing for these men. My male patients come to me for Testosterone pellets to treat their ED, lack of libido, loss of muscle, inability to think, weight gain, lack of motivation, anxiety attacks, poor stamina, arthritis, loss of balance, and basically everything that makes a man a man!  The most amazing thing is that I can treat them with ONE hormone, Testosterone in pellet form, and cure all these problems! If a man stops taking Testosterone, they get these symptoms again and have to take a multitude of drugs to feel just a fraction better! The treatment for a high H/H is simple…it is a routine removal of blood, either a blood donation or a phlebotomy (removal of 500 cc of blood) in the office, every 2-6 months to keep their H/H under control. The advice their doctors give them is going to cause them great pain and actually shorten their lives and there is little risk if any to removing blood every few months! In the event that a man demands that I lower their dose…..and I do it…the next inevitable phone call is to complain that their symptoms are coming back!  They literally blame me for the advice of their PCP! I would like to tell these men that the same doctors who could not help them with their low T are the same ones who are giving them the advice to lower or stop their testosterone therapy with T pellets.  It is human nature and especially that of doctors to try to criticize the advice of the doctor who got better results with a patient than they did! So, if you develop a condition called erythrocytosis secondary to your testosterone replacement, then you can keep your T therapy, if you are compliant and follow your testosterone doctor's directions and get your blood removed when it is scheduled.  This should prevent any severe reaction from your doctor. This is a typical response to my patient who has concerns.  However, I have given my patients many sources of written and video information about every aspect of testosterone replacement, the risks and benefits including erythrocytosis.  These include my book, Got Testosterone? was given to them on the first visit.  We also have over 650 informational blogs and videos on You Tube, FAQs and a very extensive handout given to each of them on the first visit. They just have to read! I have read your concern about erythrocytosis and testosterone replacement that was brought up by your PCP.  It is true that T replacement increases the H/H in both sexes.  It is useful if you are anemic, but if you have a genetic response to testosterone that elevates your H/H above what is considered normal, then we advise blood donation or phlebotomy every 2-6 months. It is true that the dose of T can affect the H/H, but men often need a high dose of T to feel normal. The removal of blood is low risk and effective. I am a Specialist in   Hormone Replacement Medical care with a 38-year history of replacing bioidentical hormones and 23 years of experience replacing bioidentical hormones with T and E2 pellets.  You came to me because your doctors were not helping you with the symptoms of testosterone deficiency and because I have the most experience in the Midwest. #1.    The first issue that we must always consider while we treat anyone is the primary goals for treatment, the relief of low testosterone which is why you came to me. You made an appointment with me because you had un-addressed issues that your PCP (Primary Care Doctor) didn't treat satisfactorily Your symptoms were treated with testosterone pellets successfully at a dose that is individual to you. Your health as you get older is also dependent on your blood level of free Testosterone (the total T is not significant) by delaying the diseases of aging. The level that is required to treat your symptoms is the young healthy Free T blood level of a young and healthy man. Most labs give a reference range for older men which reflects the fact that free testosterone levels drop with age. Old men don't feel well BECAUSE they have low free T.  The low free T level is why you don't feel well. Our practice has found that everyone has an ideal free T level that we try to maintain, and these are young-healthy level but not old-man level.  That is what we have been trying to achieve for our patients. #2. The second issue is a side-effect that you, as an individual, have experienced with pellets and will experience with any T replacement that you receive that is a high enough dose to treat your symptoms.  Erythrocytosis is a side effect that some men experience on any form of testosterone, however its occurrence doesn't mean you are on too much testosterone, it means you have a side effect of having a normal free T level.  Erythrocytosis is genetic, and your free T blood level stimulates the production of too many red blood cells.  We don't stop the treatment that is making you better, to treat the side effects of it.  We treat the side effects. We treat this side effect with phlebotomies to keep your H/H within the safe range.  Did your medical doctor/cardiologist tell you why this is important?  We tell you: too many red blood cells can increase the work of the heart, however the Hematologists that we consult with give us the HCT% number we should stay below is 58%.  We like to keep your HCT% below 52% but that requires you to be compliant with your regular blood donated or phlebotomized in our office (that takes an appointment). You must be compliant to keep your H/H normal. These 2 issues are at odds with one another. I cannot give a man enough testosterone to treat his symptoms, without stimulating some production of RBCs.  I have no other low T treatment that doesn't stimulate your bone marrow to make red cells BUT I do have a simple treatment to remove your extra blood cells routinely to keep you from having too many blood cells circulating. Only you can make the decision to choose health with T pellets and do phlebotomies regularly as recommended, or to stop T and allow your blood count to decrease., and your symptoms will come back. I want you to read your post-pellet instructions, locate my book Got Testosterone? and read it especially the section on Erythrocytosis, and look at FAQs (frequently asked questions) on the www.biobalanacehealth website, read related episodes of my 677 blogs and or listen to my health casts for your answers.  You can imagine how I feel when my patients don't read what I provide to them in multiple forms to answer their questions. In the future you should read the information I have given you or come in for an appointment to discuss these matters.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog I am not sure if you play THE "WHAT'S THE DISEASE THAT I DON'T WANT TO HAVE GAME with yourself, but since I am a doctor I have spent a lot of time thinking about what diseases I do not want! I started my list in medical school when I witnessed what certain diseases can do to your life.  Medicine has many cures and treatments, yet some diseases that are treated still can negatively change your life forever. Even though losing a limb and amputation were at the top of my list there is one disease that tops my list.  Of course, I also have under stroke the usual scary situations like paralysis, or having an incapacitating heart attack that prevents an individual from taking care of himself or herself. However, my most feared diagnosis is having a STROKE! You may not fully comprehend how a stroke can change your life, but it can affect your speech, your ability to move, to think, to go places, to have a sense of humor, to write and communicate, even to have a sexual relationship with your loved one. A stroke essentially can take away your ability to be the person you have always been, AND it requires that someone must become your caretaker.  That helplessness is something I am most afraid of….We all have our personal fears, but whether you fear having a stroke or not, you should  try your hardest to avoid having one! DEFINITION: a stoke is a medical emergency that occurs when blood flow to the brain is  blocked or a blood vessel bursts. This can damage or kill parts of the brain, which can lead to long-term disability, brain damage, or even death.  This can cause s a loss of function, physical, mental, and  emotional, and loss of one or more of the senses like sensation, speech, sight, hearing and  taste and smell! In my practice at BioBalance Health we always work with our patients to prevent them having a stroke and or heart attack. These two conditions are the biggest villains that steal the joy of our "golden years" from us.  From the start of my BioBalance Health practice, I have incorporated  healthy diet training, exercise options and encouragement, how and what to take to supplement my patients' diet and how to outsmart their genetic makeup so they can be healthier than their parents. All of these lifestyle changes can decrease the risk of stroke and heart attack in a person. So what is it like to have a stroke? First let's go over what symptoms are typical of someone having a stroke. The symptoms of a stroke are multiple, and a person might not have all of them. Weakness on one side of the body Facial drooping on one side of the face Dizziness Numbness Loss of balance Sudden loss of vision. Trouble making sense when speaking Trouble talking, reading or understanding Sudden nausea and vomiting Brief loss of consciousness such as fainting, seizures, confusion, or coma. When someone has one or more of these symptoms it is an emergency, and you should call 911, then start asking the patient to open their eyes, smile, raise both arms and hold them up. Ask them to talk to see if their speech is impaired. Your findings will be helpful to the EMTs who come to the scene. An event is called a stroke, when there is a deficit in physical or mental function and that deficit continues and doesn't go away.  If it the symptoms completely resolve, it is called a TIA- a transient Ischemic attack. It is a warning to see a doctor and make sure you don't have a stroke in the future and it is a wakeup call to stop all poor lifestyle choices.   PREVENTING A STROKE: This last month, the American Heart and Stroke prevention Association released new Guidelines on how to prevent a stroke.  I think talking about the risk factors for stroke and discussing how to prevent having one, is worthy of discussion. Recently the medical guidelines for stroke prevention have been revised, and even though I think a few more things should have been included, the fact that they made the first change in the guidelines in 10 years is a first step. Here is what they advise all people who are aging should do.   #1 See your internal medicine or Family physician regularly, at least yearly #2. Stop sedentary behavior—walk/exercise/ do Yoga, just get out of the chair for the majority of your day! #3. If you are diabetic, they advocate going on Ozempic/Mounjaro to lose weight—that will lower your risk of a stroke, and heart attack.. #4 If you are hypertensive, take your BP medicine every day #5 Follow these lifestyle changes called Life's Essential 8: Your behavior and lifestyle put you at risk for having a stroke:    Healthy diet, low carb Mediterranean diet, no junk food!  Physical activity every day  Achieve a healthy weight,  Make sure your sleep is restful  Stop use of tobacco products, No smoking or vaping  Achieve healthy levels of blood glucose, and blood pressure.  Don't drink more than one 4 oz glass of wine a day  I add these recommendations to theirs for the care of my patients:   Drink ½ your weight in water every day Wat at least half your weight in grams of protein a day Get a Cardiac calcium scan to see if you have arterial plaque. If you do have plaque (arteriosclerosis) then you are at risk for stroke as well. See a cardiologist to be treated preventatively and tested. Option other than a cardiac calcium scan, get a carotid ultrasound to make sure you don't have plaque in the neck vessels that lead to your brain.. Make sure your Homocysteine level is normal (<8.0) by taking Methyl B12 and Methyl folate to lower your risk of embolic stroke. Take vitamin D3 and K2 to lower your risk of stroke. Women should take non-oral estrogen after menopause Take Testosterone pellets to decrease your risk of stroke caused by loss of elasticity of the vessels. Take Arteriosil® or Neo 40 every day to improve the nitric oxide in your arteries so they dilate, like when you were younger. Make sure you take electrolytes when you are sweating or working outside in the heat. Every third bottle of water should have NUUN sport or another electrolyte additive to prevent dehydration which raises pulse and lowers blood pressure (in a bad way) causing you to faint or have a stroke. Lower your cholesterol by treating a low thyroid, and or limiting your intake of carbohydrates (food from animals is ok, so are eggs and milk products) Decrease inflammation (which damages your blood vessels) by losing weight, exercise, supplements that lower inflammation. If you have done all of these things then monitoring your arteries with yearly cardiac calcium CT scans and blood work is a good way to see your improvement!