Back Clinic Functional Medicine Team. Functional medicine is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms.
Practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, functional medicine supports the unique expression of health and vitality for each individual.
By changing the disease-centered focus of medical practice to this patient-centered approach, our physicians are able to support the healing process by viewing health and illness as part of a cycle in which all components of the human biological system interact dynamically with the environment. This process helps to seek and identify genetic, lifestyle, and environmental factors that may shift a person’s health from illness to well-being.
Making and maintaining healthy lifestyle changes does not have to be as challenging when surrounded by family, friends, and loved ones who support those goals. Healthy gifts or the gift of wellness can be the real difference in improving one’s or another’s health this season. With the right health tools, individuals can make, see and feel the changes happening. Here is a list of a few of the best healthy holiday gifts to help your loved ones begin the New Year with a healthy perspective.
Compact Treadmill and Walking Pad
Walking daily is an integral part of overall wellness. The body was designed to move, and walking about 8,000 steps daily has been shown to reduce all-cause mortality compared to sedentary lifestyles. Unfortunately, it’s estimated that many individuals only walk around 5,000 steps daily.
These units can keep track of lean body mass, metabolism, and neuromuscular function.
They measure body fluid balance, muscle mass, and fat distribution.
They offer real metrics for current skeletal muscle mass.
Data points help individuals better understand their health.
Meditation Mats and Benches
Mental health is as vital as physical health.
Incorporating mindfulness and meditation exercises daily can improve mental and physical well-being and encourage long-term behavioral changes.
Regular meditation practice can help improve sleep quality, mood, and body repair and recovery from work, school, sports, workouts, etc.
Meditation mats and benches can make seated and kneeling meditation practices more comfortable.
Therapeutic Environment of Insight
Dong, Lu et al. “Effects of Air Frying on French Fries: The Indication Role of Physicochemical Properties on the Formation of Maillard Hazards, and the Changes of Starch Digestibility.” Frontiers in nutrition vol. 9 889901. 27 Apr. 2022, doi:10.3389/fnut.2022.889901
Pinho, Alexandre S et al. “Can We Rely on Mobile Devices and Other Gadgets to Assess the Postural Balance of Healthy Individuals? A Systematic Review.” Sensors (Basel, Switzerland) vol. 19,13 2972. 5 Jul. 2019, doi:10.3390/s19132972
Rusch, Heather L et al. “The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials.” Annals of the New York Academy of Sciences vol. 1445,1 (2019): 5-16. doi:10.1111/nyas.13996
Thakare, Avinash E et al. “Effect of music tempo on exercise performance and heart rate among young adults.” International journal of physiology, pathophysiology and pharmacology vol. 9,2 35-39. 15 Apr. 2017
Wu, S., Ning, HT., Xiao, SM. Effects of vibration therapy on muscle mass, muscle strength and physical function in older adults with sarcopenia: a systematic review and meta-analysis. Eur Rev Aging Phys Act 17, 14 (2020). doi.org/10.1186/s11556-020-00247-5
Dr. Alex Jimenez, D.C., presents how hormonal dysfunction can be assessed and treated through various therapies specializing in hormones and how to regulate them in this 3 part series. This presentation will provide valuable information to many people dealing with hormonal dysfunction and how to utilize different holistic methods to optimize their health and wellness. Part 2 will look at the assessment for hormonal dysfunction. Part 3 will look at various treatments available for hormonal dysfunction. We refer patients to certified providers incorporating various hormone therapies to ensure optimal health and wellness. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is an excellent way when asking our providers intricated questions at the patient’s request and understanding. Dr. Alex Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
What Are Hormones?
Dr. Alex Jimenez, D.C., presents: Today, we will look at utilizing foundational PTSD treatment strategy steps. As a treatment strategy, it is about the production, transportation, sensitivity, and detoxification of the hormone in PTSD. So let’s start with how interventions and major factors that influence these pathways within the access impact other body areas. How does an intervention on one hormone affect other hormones? So did you know that thyroid replacement can change the HPATG access in the body? So when people are dealing with hypothyroidism or subclinical hyperthyroidism and are being treated with suppressive thyroid hormone replacement, it induces changes in their bodies. This means they will become hypersensitive from ACTH to CRH or corticotropin-releasing hormone.
What this means is that they will produce and release more ACTH. When the patient becomes hypersensitive from an influx of hormones, it could lead to various issues with the other body systems that affect organ and muscle functionality. This is another reason patients feel great on even low doses of thyroid replacement; it stimulates the adrenals. Many patients tend to overrun their adrenals, and when they get treatment, they get a little hit to their adrenals when their doctors are helping their thyroid. So looking at the thyroid, we see the thyroid gland is producing t4, forming reverse T3 and t3. So when doctors look at the thyroid pharmacological doses of glucocorticoids, which is what they give for anti-inflammatory therapy to their patients, or if people have elevated glucocorticoids as in Cushing syndrome, what that does is it inhibit thyroid secretion because it reduces the TSH response to TRH, which makes less TSH. When there is less secretion in the thyroid can lead to overlapping issues associated with unnecessary weight gain, joint pain, and even metabolic syndrome.
To that point, stress inhibits the thyroid. In contrast, estrogens have the opposite effect, where they increase TSH secretion and the thyroid gland’s activity. So that’s a reason why women feel so much better on even low doses of estrogen replacement. So just like thyroid replacement in low amounts that bump the adrenals, if we’re giving low estrogen doses, it can bump up thyroid function. However, many doctors have to go slow when providing hormone treatments to patients because the additional hormones will affect the other hormones in the body. When it comes to hormone replacement therapy, it is important to learn how interventions within the communication node impact other nodes in the matrix. So, for example, let’s look at how the communication node affects the defense and repair node in the body. Research studies reveal HRT’s effects on inflammation markers and look at 271 women who used conjugated equine estrogen alone, who had a 121% increase in CRP after a year.
And if they used that in addition to synthetic progestin, they had a 150% increase in CRP after a year. So synthetic estrogen is not bioidentical; this is synthetic pregnant mare’s urine, and synthetic progestins are pro-inflammatory. What about the communication node and the assimilation node? This is an interesting study because many doctors are trying to help their patients and the future generation in society. So it’s important to know when the mother is stressed during pregnancy since that can change the baby’s microbiome. That means doctors have an opportunity to support early intervention in microbiome support. Knowing this is vital for prenatal stress based on questionnaires or elevated cortisol was strongly and persistently associated with infants’ microbiome and colonization patterns.
So we’re also here to learn how interventions on the matrix affect the hormone node or the communication node. So as an example, we’ll look at what happens in the assimilation node involving the communication node, as this affects antibiotics on the intestinal metabolome. Everyone knows about antibiotics’ impact on the microbiome, but a metabolome is a change in the metabolic function of a particular organ, the intestine. To that point, when there are so many metabolic pathways that antibiotics affect, the metabolism of steroid hormones was the most profoundly impacted. So eight metabolites that are part of this hormone pathway, which gives us PTSD, were increased in feces after antibiotic treatment. Then we have another way that the gut affects hormones, and this is looking at metabolic endotoxemia. Many doctors learn about metabolic endotoxemia in AFMCP, which mentions leaky gut or increased intestinal permeability. When many individuals are dealing with gut issues affecting their well-being, like problems in their joints or muscles causing them pain, we provide various solutions and develop a treatment plan with our associated providers based on the diagnosis.
Endotoxins Affecting Hormones
Dr. Alex Jimenez, D.C., presents: Endotoxins or lipopolysaccharides are from the cell membranes of bacteria. So bacterial endotoxins are translocated from the gut lumen because of increased intestinal permeability. So with that increased permeability, those endotoxins are translocated, which starts an inflammatory cascade. When endotoxins cause GI issues, the inflammatory markers can affect the upper and lower portions of the body and the gut-brain axis. When the gut-brain axis is affected by inflammation, it could lead to joint and muscle pain associated with somato-visceral and visceral-somatic problems. To that point, the inflammatory cascade from the leaky gut affects the ovary, reduces progesterone production, and contributes to luteal phase deficiency. That’s incredibly important for doctors to take care of patients that are there to optimize fertility. It is especially important for patients to let their doctors know when they have excess estrogen and that they are producing as much progesterone as possible. So we must worry about gut permeability in ovulation, luteal phase deficiency, and estrogen-progesterone imbalance. What about the biotransformation node? How does that affect the communication node? In preschool children, phthalates and thyroid function have an inverse association between the metabolites or the amount of folate and thyroid function in the system measured in children at age three. When inflammatory issues affect thyroid function in children, it can affect cognitive outcomes, thus reducing phthalates production in the thyroid, leading to mental problems.
How do mental, emotional, and spiritual considerations contribute to the communication node? We want to start with the bottom of the matrix like we always do, which involves functional medicine. Functional medicine provides holistic approaches to identifying the root problem affecting the body and developing a personalized treatment plan for the patient. By looking at the lifestyle factors at the bottom of the Living Matrix, we can see how hormone dysfunction affects the communication nodes in the body. A recent paper found that there was a positive relationship between menopausal symptoms and social support and that menopausal symptom decrease as social support increases. Now let’s talk about how stress impacts HPA access. By looking at how stimulation from the sex hormone-producing parts of the body or the goads, the thyroid access, the adrenals, and the sympathetic nervous system (fight or flight) can add up all the stressors affecting us, called allostatic load.
And allostasis refers to our ability to respond to those stressors through stress-coping mechanisms. Many patients are asking us for guidance. They’re asking how they can frame their personal experiences and stressors. Still, they’re also asking how they prepare the societal events in a larger context, And many of us as functional medicine practitioners are seeking the same thing. And so, we’re going to show you in detail what stress does to the body and how to find ways of decreasing anxiety or stress in the body to prevent future issues in the organs, muscles, and joints.
How Stress Inhibits Estrogen
Dr. Alex Jimenez, D.C., presents: Does stress creates adrenal stress, and does it affect our fight or flight primary response hormone (adrenaline)? Stress can cause the sympathetic nervous system to increase blood pressure, respiration, heart rate, and general alertness while redirecting our blood to increase our adrenaline. So when you are in a situation, your adrenaline can cause you to fight or run, which causes your muscles to get blood, which decreases blood to your core or your non-essential organs. So the functional medicine model would identify various triggers or mediators, whether acute or chronic, that can act as an instigator of hormone dysfunction that can create overlapping issues that can disrupt adrenal function in the thyroid.
So, looking at these responses can help us see the physical problems that are happening if adrenaline is chronically increased over the long term, leading to anxiety, digestion problems, et cetera. Now cortisol is our vigilance hormone that helps maintain the emergency response to back up or support the adrenaline. An example would be a fire truck or police that come in after the immediate first responder. So cortisol facilitates the quick adrenaline response to keep the body going as needed. And it has many other roles as well. It helps with increased blood sugar and causes fat storage. So when people come in with weight around the middle and dealing with overlapping issues in their body, think of cortisol since it’s anti-inflammatory and regulates the nervous system. Cortisol can be both good and bad for the body, especially when an individual is dealing with stressful events affecting their health and causing issues affecting their mobility.
So now, let’s talk about how stress impacts the entire body and the immune system. Stress can increase susceptibility to infections, increasing their severity in the body. So here we see stress affecting the defense and repair node, leading to immune dysfunction and stress-induced immune dysfunction. An example would be if a person is dealing with a disorder that affects their gut, like SIBO or leaky gut; it can increase the production of pro-inflammatory cytokines and causes joint and muscle pain to the lower back, the hips, the knees, and overall wellness. When the pro-inflammatory cytokines affect the gut system, they can also cause thyroid dysfunction, disrupting hormone production.
So if someone’s taking that hormone replacement therapy (HRT), it can increase their inflammation, especially if they are stressed. So, as functional medicine practitioners, we’re always thinking and looking for pattern recognition as we start thinking about things differently from conventional methods regarding health and wellness.
What is it when you see a person dealing with chronic stress, and what is their response? They will usually answer, “I sweat a lot; I get nervous and anxious just remembering what has happened to me. I’m afraid of experiencing that ever again. Sometimes these pathways give me nightmares. Whenever I hear a loud noise, I think of carbon rings and get nauseous.” These are some tell-tale signs of someone dealing with chronic stress associated with PTSD, which can affect the hormone levels in the body. Many functional medicine providers can utilize available treatment regarding hormonal dysfunction in PTSD. So the general strategy for treating hormone dysfunction is the production, transport sensitivity, and detoxification of hormones in the body. Remember that when you have someone dealing with hormonal issues, it is best to devise a strategy to deal with this issue.
So what can we do to affect how hormones are produced or have been over-produced in the body? We want to look at how hormones are made, how they may be secreted within the body, and how they’re transported. Because what if they’re transported in a way that the transport molecule is low in concentration, allowing them to be free hormones? So that’s the interaction with other hormone sensitivity, and how do we change or look at cellular sensitivity to the hormonal signal? For example, progesterone affects estrogen receptors which cause detoxification or excretion of the hormone.
So before we think about giving or replacing a hormone, we ask what we can do to affect that hormone in the body. Specifically, how can we influence the hormone’s production, transport, sensitivity, detoxification, or elimination? So when it comes to hormone production, what are the building blocks for thyroid hormones and cortisol? So if we’re low on thyroid hormones, we want to ensure that we have the building blocks of serotonin. So what affects synthesis? If a gland is inflamed with autoimmune thyroiditis, it may not be able to make enough thyroid hormone. And that’s why people with autoimmune thyroiditis have low thyroid function. What about hormone transportation? Do the levels of one hormone in the body impact the levels of another? Estrogen and progesterone are often in a dance in the body. So does a hormone transport from the origin glands to the target tissue, which can impact its effectiveness?
If there is an overproduction of hormones attached to the transport protein, there won’t be enough free hormone, and there can be hormone deficiency symptoms. Or it can be the opposite if there needs to be more transport protein, then there will be too many free hormone molecules and hormone excess symptoms. Therefore, we want to know if we can impact the free hormone level and see if it is transformed. So we know that T4 becomes the active form of T3 or a thyroid inhibitor, reverse t3, and can we modulate those pathways? What about sensitivity? Are nutritional or dietary factors influencing the cellular response to cortisol, thyroid hormones, testosterone, estrogen, et cetera? With many cell membrane binding proteins, the cell membrane is involved in hormone metabolism. And if the cell membranes are rigid, insulin, for example, has a hard time getting in it now as we look into hormone detoxification. How do we alter the metabolism of estrogens or testosterone?
And what can we do to affect estrogen’s binding and excretion? So, can estrogen have to be eliminated healthily? And that depends on whether there’s hydroxylation on a particular carbon, but it also has to be excreted in terms of total amounts. So constipation, for example, will decrease the quantity of estrogen excreted. So we use the vault as a metaphor and the theme, as we said, is to treat the matrix first before directly addressing hormone dysfunction.
Dr. Alex Jimenez, D.C., presents: In the Living Matrix, we have to unlock or treat all the nodes to open the vault to get inside and address hormones. This is because the endocrine system is so complex it often self-corrects when other imbalances are addressed. And remember, hormonal imbalance is often an appropriate response by the body to imbalances elsewhere. That’s why treating other imbalances often addresses the hormonal issue. And also, remember hormones like picograms are in very low concentrations. So it’s very hard to be precise when we give patients hormones and allow the body to auto-correct. That’s why we say to treat the matrix first. And when we get inside the communication node in the body, we look at the center of the matrix and discover the body’s emotional, mental, and spiritual functions to help normalize hormones. And while these are addressed, how can we fix the hormonal communication nodes?
When inside the communication node, the treatment must follow an order: adrenal, thyroid, and sex steroids. So these are important concepts to remember, treat adrenals, thyroid, and finally, sex steroids. And the way we depict the pathways will be consistent. So here you see the standard representation we will use for the steroidogenic path. And you see all of the different hormones here. The enzymes in the steroidogenic pathway are color-coded, so many doctors can know which enzyme affects which step. Next, we will look at the modulation of the steroid pathways through lifestyle, like exercise, and how stress affects aromatase, making estrogen.
Now, as we get into the real, heavy part here about the steroid pathways, we inform many of our patients to take a deep breath as it shows that taking a deep breath can increase a person’s cognition and provide the ability to understand everything. So the big picture here is everything starts with cholesterol and how it affects the hormones in the body. So cholesterol forms the mineral corticoid aldosterone, which then develops cortisol, ultimately creating androgens and estrogens. When patients are given consultation on what is going on with their bodies, many don’t realize that high cholesterol could potentially lead to chronic stress, which is associated with cardiovascular issues that can ultimately invoke visceral-somatic disorders.
Dr. Alex Jimenez, D.C., presents: When a female patient is dealing with fibroids or endometriosis, many doctors devise a treatment plan with other medical providers to reduce the formation of the estrogen hormones by inhibiting and modulating the aromatase enzymes. This allows the patient to make small changes to their lifestyle habits by ensuring their zinc levels are normal, not drinking alcoholic beverages constantly, finding ways to reduce their stress levels, and normalizing their insulin intake. Each treatment plan caters to the individual as they find ways to reduce their cortisol levels and regulate healthy hormone production. This will allow the body to increase estrogen production while decreasing the aromatase. So when we are discussing stress, it can negatively impact the hormone pathways directly by increasing cortisol, thus causing the pituitary glands to increase the CTH when stress is responding to the body. Many individuals are dealing with chronic stress in their bodies, which can cause overlapping risk profiles to the musculoskeletal system, causing muscle and joint pain.
So the pituitary system produces cortisol when the body calls for it directly when the individual is dealing with acute stress. However, chronic stress can indirectly increase cortisol levels; it causes the enzyme 1720 lyase to be inhibited in the body, causing a decrease in anabolism, thus slowing down the body’s energy levels. So stress inhibits this enzyme. So when stress inhibits the 1720 lyase enzyme in the body, it can cause the pituitary system to produce more cortisol and cause more issues like joint to affect the individual. So those are the two ways that stress leads to more cortisol directly through ACTH and indirectly by inhibiting 1720 lyase.
Inflammation is important in the body as it also has a two-way path, as it can impact these pathways the same way stress does. Inflammation can inhibit the 1720 lyase enzyme, causing the body to be pro-inflammatory and can stimulate aromatase. Like stress, when the body is dealing with inflammation, the pro-inflammatory cytokines stimulate aromatase enzymes to cause an increase in estrogen formation. When this happens, it allows the doctors to notice why their patients are overly stressed and have inflammatory markers in their gut, muscles, and joints. To that point, inflammation can also increase an enzyme called 5alpha reductase. Now, 5alpha reductase causes the formation of a hormone called dihydrotestosterone (the active form of testosterone in the body cells other than the muscles, causing hair loss. So insulin, stress, and inflammation contribute to hair loss because insulin has the same effect. Insulin or blood sugar gives the body energy to move throughout the day. When individuals have too much or too little insulin in the body, it can lead to insulin resistance, correlating to metabolic syndrome associated with hair loss.
Holistic Methods For Hormones
Dr. Alex Jimenez, D.C., presents: How do insulin, cortisol, and inflammation play their part in the thyroid? Well, all of these hormones help make the body functional. When the thyroid has an underlying condition like hypo or hyperthyroidism, it can cause the body to over or underproduce hormones to regulate healthy normal body functions. So this forward feed cycle can cause the individual to have various issues affecting their body due to hormonal dysfunction. This combination of insulin resistance, high insulin, weight gain, and stress affects many patients, causing metabolic syndrome. To normalize hormonal function, we must look at all these factors driving hormonal dysfunction in patients.
When going for hormonal treatment, it is important to know about the different nutraceuticals and botanicals because before, it was called a lifestyle change back in the day. In a health clinic, specific neutraceuticals and botanicals can affect estrogen formation through the enzyme aromatase. However, various factors like diseases, medications, toxins, and elevated insulin can also increase aromatase enzymes, leading to more estrogen in the body. And then diseases, medications, and toxins do the same thing. A research study reveals that when men and women interact, the men’s cognitive performance declines, followed up with a mix-sex encounter. This can change how hormone function in the body when there are changes in formal function that can affect the central nervous system’s cognitive function in the body.
When middle age patients get examined by their doctors, the results can show if they have elevated insulin, an increase in stress and if there is inflammation in their bodies. This allows the doctors to work with associated specialists to develop a treatment plan that caters to the patient to begin small changes in their health and wellness journey.
Dr. Alex Jimenez, D.C., presents how to assess different hormones in the body and how different hormone tests can be used to determine the level in the body. This presentation allows many individuals to know what to expect when they are being diagnosed by their primary doctors. We refer patients to certified providers incorporating various hormone therapies to ensure optimal health and wellness. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is an excellent way when asking our providers intricated questions at the patient’s request and understanding. Dr. Alex Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
Dr. Alex Jimenez, D.C., presents: Welcome to everything you need to know about assessing hormones and how to do the testing. We have decided to do this as a webinar because we only have a little time to do it during the module. After all, that’ll make your life easier. You’ll need to have this information under your belt because here is the most important thing you need to know. Hormone therapy is an art, not a science. If you find five or six practitioners who do hormone therapy, you will find five or six different ways to make a prescription and way more ways than that actually to do testing to monitor it.
Dr. Alex Jimenez, D.C., presents: The important thing is that you keep in mind what we know scientifically is a better or not-so-good way of taking care of the patients in terms of testing. Then find what works for you and become the expert in that. Because if you are consistent over time, you can work around the pros and cons of every given testing modality and figure out what you need to do, regardless of what type of test you end up doing. All right, so what do we need to worry about? There are many potential problems in measuring hormone levels because so many hormone levels fluctuate significantly. In order to evaluate hormones in the body, doctors need to know what, when, and who to test. So we’re going to talk about all of that.
Diagnosing Hormones In A Patient
Dr. Alex Jimenez, D.C., presents: Some vary during the day, some vary during a cycle, and some hormones don’t vary at all. So you need to remember which ones you need to worry about in terms of fluctuation. The studies that have been done don’t measure hormone levels. So, finding normal hormone levels is sometimes problematic. It may be different from what the labs currently use. And in the studies where they have come up with normal hormone levels, a lot of them are much older studies, and the methodology was more unreliable than what we use now. So by keeping that in mind regarding what people call normal hormone levels, many of these studies also would average out non-comparable groups. What this means is that they would be comparing, let’s say, a group of apples, oranges, and grapes and put them all together and say, oh yeah, so this average is going to work.
Dr. Alex Jimenez, D.C., presents: So it’s like doing a meta-analysis, and if you are taking a bunch of different data, you can’t necessarily say that this average makes sense. You probably are already aware of the fact that other labs end up developing different reference ranges. And so if you use multiple different labs, you can’t necessarily compare the test results you’re getting because the reference ranges are different. And, sometimes, even within a given lab, depending on which test kit patients use, like a test from Quest, they may one day use one test kit. So a reference range will be XYZ, and they went to the same lab another day, but they used a different test kit and have an entirely different reference range. And so you have to the point that out to the patients. If you’ve got a smart patient trying to track what’s happening with themselves, they may have the wrong impression during an examination.
Estrogen & Progesterone
Dr. Alex Jimenez, D.C., presents: If you’ve got different reference ranges showing up on your test results, it is best to keep track of that in case you need to remember. Now there are big variations between individuals and even within the same individual. The serum concentrations of both natural and synthetic steroids might need to be clarified between other individuals. There’s a huge variation irrespective of the root of the administration of the hormones. What you expect from one person may be different from the next person. And, of course, within any individual, you’re going to get levels of fluctuation throughout the day based on lots of different things. Everything from perceived or actual stress that will change their hormone levels to foods they were eating that day can make a difference. Hydration status can make a difference. So some of the variations you see within a person, but with different blood draws, can be based on what was going on that day.
Dr. Alex Jimenez, D.C., presents: So try to impress upon your patients as you’re getting testing done to keep the blood draw days the same. Now measuring in different body fluids like serum, urine, or saliva doesn’t necessarily tell us about concentration in other tissues, and doctors need to keep this in mind because the patient may get a false sense of security, and it won’t necessarily have anything to do with the tissue they are trying to treat. Now, many doctors must remember all the different kinds of estrogens they might need to keep track of during examination. So, when they notice estrogen, there’s an estrogen pool. There is free and bound estrogen in the body and estrogen production in the woman or a man in themselves. There are exogenous estrogens that you may be giving them. There are stored estrogens, metabolites, and all these different estrogens doctors need to keep track of. So this is just one example of having many estrogen levels in the body, and the patient is wondering, what is it the doctor is looking at? Could one test give me all this different information? And this is only estrogen. The same thing is true, although not quite as complicated. The same thing is true about the other hormones in the body.
Dr. Alex Jimenez, D.C., presents: Now for progesterone, it is the same ordeal. Other results look like this for estrogens and testosterone, and this is to remind us of all the different variability there is. By showing the variation between different people at their biological stages, for example, premenopausal and postmenopausal. The results that the doctor presents to the patient establish a lighter shade of green on the outside of the intercycle variability from within a given woman. And then the yellowy green is the inter-woman variability, meaning one woman to the next. And then that blue line in the middle is the average; this provides what information they might need to diagnose.
Testing Hormone Levels
Dr. Alex Jimenez, D.C., presents: All right, so let’s look at testing and assessing hormones as we look at all the hormone types, the different ways of testing them, and the pros and cons. There are decades of well-validated research on serum hormone levels. So for the estrogens, estrone, estradiol, and estriol, as well as the estrogen metabolites in the serum, the good news is it measures endogenous hormone production. So if you get a serum hormone level, we know what those results mean.
Dr. Alex Jimenez, D.C., presents: The bad news is these results give you the free and bound hormone. It shows you the total estrogens. However, you can’t order total estradiol and free estradiol test as they don’t offer them. There are limited data regarding serum levels of these metabolites in terms of prediction for health risk. And it can be difficult for some labs to get accurate quantification in postmenopausal women because the estrogen levels are very low. So, keeping that in mind is a matter of knowing your lab and how accurate they are. Now when it comes to saliva, the good news is it’s non-invasive. Patients can do this at home, making it convenient if doctors try to do a serial measurement of estradiols across a whole cycle in a premenopausal woman. Cause no one in the right mind will go to the lab and get blood drawn daily.
Dr. Alex Jimenez, D.C., presents: Knowing that salivary estradiol correlates well to free estradiol in serum allows doctors to see what’s in the saliva and what they want to see in the serum. The bad news about saliva is that there are fewer validation studies than serum. There are still quite a few, so it’s a valid testing method. It’s just that it’s not as well validated as a serum because it still needs to be done. Again, it can be very challenging for some labs because the estrogen levels in the saliva are much lower than in the serum. So doctors must ensure the lab is doing a good enough job assessing these very low levels. All saliva testing can be contaminated by blood from the oral mucosa.
Dr. Alex Jimenez, D.C., presents: So if the patient has periodontitis or something along those lines, doctors don’t want them to salivary levels; it is important to tell them to do it before they brush their teeth, not after, in case they bleed when they brush their teeth. But that’s true of any salivary test; you can’t get estrogen metabolites done through the saliva. And the bigger problem in a postmenopausal woman is that many get dry mouth after menopause. And so, it can be really difficult to do the test because they need to produce more saliva to get an adequate specimen. Now, if that happens, they can go for a 24-urine test. The 24-hour urine testing for estrogen and estrogen metabolites can be helpful if you’re trying to get the total daily production of the hormones. You can get measurements of estrogen metabolites, which are stable for a long time.
Dr. Alex Jimenez, D.C., presents: You have plenty of time for processing and get both free and conjugated estrogen measurements. So that’s helpful. The bad news, which is true for any 24-hour urine test, is it relies on accurate volume measurements and complete collections by the patients. Many patients will inadvertently screw that up. When they have a busy day, they’ll go pee and need to remember what they are supposed to do, which can be a problem. So, making sure the patient understands can help with the test results. You cannot use this for people with renal dysfunction because it’s based on creatinine correction. So if their creatinine is abnormal, they will need to be able to give you an adequate, appropriate level and sometimes give you some of these tests that do 24-hour urines will provide you with many metabolites that could be more clinically useful but are not.
Dr. Alex Jimenez, D.C., presents: Now for dried spot, you’re in testing, and you can get estrogen metabolites, which is good because the metabolites are stable for a long time, so that’s no problem. And you can measure both the free and conjugated estrogens on these spots in urine tests. The biggest problem here is that it has the least clinical validation studies. So, it’s a newer way of testing. It is popular and easy for patients, but there is little concern because of the few clinical validation studies they’ve done. Now, additional challenges are mentioned: to think about what a lab has to do; the measurements they need to be able to provide can vary enormously because there are very low levels of estrogen in older women, not on hormone replacement therapy.
Dr. Alex Jimenez, D.C., presents: And then up to measuring these super high doses in women getting ready for IVF. And, you know, the levels can vary by 10,000. Is it reasonable to assume that any test will be accurate for all those circumstances? It is also difficult to assess estrogen levels in women treated with aromatase inhibitors because they will likely have very low estrogen concentrations. So that may not be accurately detected by standardized testing. And then specificity is a problem because we talk about how estradiology focuses mostly on how it gets broken down into estrone and then how the estrones get broken down. But the reality is that estradiols convert it to more than a hundred different metabolites, which may interfere with accurate quantification.
Dr. Alex Jimenez, D.C., presents: So, labs must keep that in mind and ensure that they’re getting adequate specificity for you. Another interesting tidbit is that exogenous sources of S-trial can lead to falsely elevated estradiol levels. So keep that in mind if you have a funny test result that makes no sense.
Dr. Alex Jimenez, D.C., presents: Progesterone and progesterone metabolites in the serum; there’s lots of literature to support using a progesterone level drawn hopefully on day 21 of a 28-day cycle to confirm ovulation. Progesterone has problems as it differs from estradiol. So it is acceptable to use serum progesterone levels for that, as the reproducibility of serum levels is limited if the serum levels are low. So if what that means is if you were to take a person in the first half of her cycle and draw a progesterone level three days in a row at the very beginning of the process and the progesterone should be low, you may not get similar numbers just because the hormone levels are low.
Dr. Alex Jimenez, D.C., presents: So the reproducibility makes doctors a little crazy, but that’s something they need to keep in mind with the serum. Again, saliva testing is not invasive; it’s convenient if you want to follow an entire cycle in a premenopausal woman. Also, research shows that a salivary level of 17 alpha hydroxyprogesterone is just as acceptable as a serum level for diagnosing congenital adrenal hyperplasia. Now the downside for progesterone’s metabolites salivary levels of progesterone in its metabolites is that you’ve got a rapid fluctuation of progesterone levels in the saliva. So, if you’ve got somebody who doesn’t wanna get their blood drawn and doesn’t mind spitting into a tube, you can use this instead.
Dr. Alex Jimenez, D.C., presents: So you should use more than one test result to make a decision; you may need serial sampling to get a feel for the average. There’s also a problem with cross-reactivity that might interfere with immunoassays and affect the results. And again, the same problem is having much lower progesterone levels in the saliva than in the serum. So for some labs, that can be challenging to get preliminary analysis and the same problem in terms of contamination by blood; however, that’s true of all cellular tests. The 24-hour urine and the spot dry urine testing for progesterone have the same problem because the progesterone metabolites will correlate with symptoms. So they’ve studied, for instance, allopregnanolone in urine. The level of that does connect with the sleep quality in perimenopausal women.
Dr. Alex Jimenez, D.C., presents: The implication is that if it’s correlating, it’s probably an accurate level; however, progesterone is hard to quantify in urine. And so, they use metabolites for assessment and determine the progesterone level based on the metabolites. That’s great, except there’s no literature describing the clinical utility of progesterone metabolites. So progesterone in the urine is relatively problematic regarding the accuracy and what you are getting. Part of the issue with serum progesterone is that very little of it is available, and non-protein ground, most of it is bound to all and other proteins; it’s the free progesterone that is available to the target tissues and also to saliva. So the progesterone that you’re measuring in the serum is mostly the bound-up progesterone, not what is clinically important.
Dr. Alex Jimenez, D.C., presents: Transdermal progesterone is extremely difficult to measure because anyone gets metabolism by five alpha reductases in the skin. It’s rapidly absorbed by red blood cell membranes and delivered to the tissue. And really, it comes down to that after the patient uses exogenous progesterone cream or gel, they get these crazy high levels of progesterone in the saliva and the capillary beds, but not in the serum. And so there could be a better way to measure what’s happening to the patient. So transdermal progesterone, trying to follow that with any testing is difficult.
Dr. Alex Jimenez, D.C., presents: There are decades of research on serum hormone levels. In serum testing, testosterone, and its metabolites, you can get both a total and a free hormone level test, and you can also get a DHT level, which is helpful. There are established serum ranges for the diagnosis of androgen insufficiency. So serum levels for testosterone are fine in general. It can be difficult to assist the whole serum if the levels are low, like in women and kids and hypogeal men. So, you need to know your lab and its methodology. Suppose you’re assessing testosterone in women, hypogeal men, or kids because they must ensure they’re doing the appropriate serum test to get these really low levels accurately.
Dr. Alex Jimenez, D.C., presents: For saliva testing, it is very convenient to obtain the sample. There are established ranges for diagnosis of antigen insufficiency, and it’s easy to use this testing for differentiating between gonadal and hypogonadal men. And you can get a free hormone level as lots of published research on using salivary levels for assessing testosterone. However, the problem is like with progesterone; you get this rapid fluctuation in saliva. You might need more than one saliva test result to get reliable information. So you don’t necessarily want to decide based on just one result. And again, you need to know your lab because the levels are much lower than in the serum. So it is challenging to get an accurate story and be careful about blood contamination. In urine testing, the 24-hour and spot urine have slightly different issues.
Dr. Alex Jimenez, D.C., presents: The 24-hour urine testing for testosterone can be used to get a total daily testosterone production. Patients will get a free hormone level and metabolites, which is nice. They can use that information to indirectly assess five alpha-reductase and aromatase activities based on how many different metabolites they’re getting. Only a few data support the clinical utility of all the measured metabolites. There is a polymorphism of UGT to B17; if the patient has that, their urinary testosterone level will return to zero, so keep that in mind if you ever get a test result. After all, it’s so low because it may be that your patient has this issue. Now spot urine will give you some of the same pros as you will get free hormone levels and metabolites. This allows you to use that information to assess the five alpha-reductase aromatase activities; however, the problem is there; like with the other hormones we’ve discussed, this testing generally has fewer clinical validation studies because it’s a newer form of testing, so keep that in mind.
Dr. Alex Jimenez, D.C., presents: Cortisol and its metabolites in the serum are similar to the other hormones mentioned, as there are validated reference ranges for cortisol. Lots of peer review literature detailing the use of this test, and patients can feel comfortable getting these results. It will tell them just total cortisol, not their free cortisol. So by keeping that in mind, they’ll get the diurnal pattern. They can only get a four-point test as they would with saliva because they don’t have normal ranges for four different times in the day. And many patients mention to their doctors as they get the serum cortisol, they go, “Wait, you don’t understand. I am so scared of my blood being drawn that it shoots my cortisol up, and I don’t normally look this bad.”
Dr. Alex Jimenez, D.C., presents: Keep in mind that in serum, they only have normal reference ranges for two times of the day, 7 to 9:00 AM and 3 to 5:00 PM. So you have to ensure that if you use serum cortisol, they go in fasting before nine o’clock, or they can go later in the day. And if they go later in the day, they don’t have to fast. So if you get cortisol at 10 or 11 in the morning, it isn’t very helpful to the results. Now the salivary testing, lots of people are becoming familiar with this.
Dr. Alex Jimenez, D.C., presents: You can get your diurnal pattern because many companies have kits where you’ve got four or five samples throughout the day. There is abundant peer-reviewed literature detailing the use of this. And this is for cortisol, not for the cortisol metabolic. It reflects the unbound plasma concentration, which is not what we’re seeing with the serum. The problem is that 11 beta hydroxy steroid dehydrogenase is an enzyme in the salivary glands that significantly converts cortisol to cortisone. So there are some questions about the results doctors are getting in the salivary cortisol and what’s happening or did it get converted to cortisone, and you’re not picking that up in the test?
Dr. Alex Jimenez, D.C., presents: So when looking at cortisol metabolites in the saliva, which some companies do and some don’t, the salivary cortisone correlates with cortisol exposure over 24 hours. There’s a moderate level of literature using this test but enough that you should feel comfortable. There are issues when your serum cortisol is really low, making it seem like the patient is crashing or under hydrocortisone therapy. That makes the salivary cortisone a superior serum marker compared to the salivary cortisol. Under these circumstances, because of how this is being processed, only a few companies are even looking at cortisone directly in the saliva. So at this point, because especially of the moderate literature level, you will primarily be doing cortisol levels in the saliva.
Urine Testing For Hormones
Dr. Alex Jimenez, D.C., presents: So let’s move on to the urine test. Now, in a 24-hour urine test, you can assess the cortisol ratio, which can be helpful when diagnosing. And 24-hour free cortisol correlates with the serum-free cortisol level; however, the only problem is there are limited clinical validation studies for this. And, in the 24-hour urine test, you’re not getting a diurnal cortisol pattern. And, in the spot urine, you can get the cortisol ratio, which can be helpful. You can have the patient do the spot urine test multiple times a day so you can get the diurnal change just like you would with saliva. But unfortunately, the spot you’re in testing has the least clinical validation studies. So you have to keep that in mind. So with this, primarily, people feel most comfortable with using either serum levels done at the right time of day, understanding that you’re not getting the unbound cortisol, or they’re doing a four-point salivary test.
Dr. Alex Jimenez, D.C., presents: The four-point salivary test could see a pattern between what the patient told their doctors about their energy level throughout the day and how they felt and compared that with what the result returned. Many doctors note what they had expected the test result to be before the national labs even had it available.
Dr. Alex Jimenez, D.C., presents: We will discuss DHEA and DHEA sulfates separately since DHEA in the serum has many clinical validation studies that can make you feel comfortable getting adequate results. Now, DHEA has a diurnal pattern. So you have to ensure they get it done at the right time of day since this is fasting before nine o’clock in the morning, just like with cortisol. A DHEA done later in the day means nothing; however, a DHEA sulfate in the serum doesn’t follow a circadian pattern, so a single test done at any time is okay.
Dr. Alex Jimenez, D.C., presents: There are numerous clinical validation studies about DHEA; unfortunately, there is a problem with DHEA sulfate since it has a little circadian pattern. You may miss small variations in a DHEA over time in a person based on how they’re feeling and stressed out. So occasionally, it’s nice to check the DHEA in a patient as long as they’re done in the morning because then you’ll get a feel for the changes over time in the same individual you wouldn’t see with the DHEA sulfate.
Dr. Alex Jimenez, D.C., presents: Salivary testing for DHEA is where you measure free DHEA in the body, which is great. There’s a correlation with serum levels, and it’s not invasive. The problem is that the concentration is inversely related to the salivary flow rate and is also affected by the salivary pH. An example would be someone walking past the bakery, starting to salivate heavily based on what they just smelled. This could change their results for their salivation rate when they are doing their DHEA test. DHEA sulfate has the same basic problem in the saliva, related to the salivary flow rate and the salivary pH. So keep that in mind if you’re looking at salivary levels in urine, whether this is 24-hour or spot urine; there are no clinical validation studies about looking at either DHEA or DHEA sulfate in the urine. So, keep that in mind if you’re doing urine testing and they’re giving you a whole panel that includes DHEA or DHEA sulfate, you may need to know what those results mean.
Dr. Alex Jimenez, D.C., presents: For pituitary hormones, the preferred testing is the FSH, LH, and prolactin serum. Not convenient for serial measurements throughout the day to detect the LH surge, for instance, but the results are very accurate. And in saliva, there’s limited peer-reviewed literature detailing salivary pituitary hormones and whether or not they’re adequate. LH detection kits at home are convenient for urine tests since they are widely used and have been around for a long time. The LH surge correlates with the urine and works well with the LH surge’s serum. So if you’re trying to help people figure out where they are in their cycle and whether or not they’ve ovulated, this test is the way to go. It doesn’t do a good job of quantifying it; it just tells you there’s a surge because these are bigger hormones, so they don’t get into urine very easily.
Dr. Alex Jimenez, D.C., presents: So you’re going to know whether or not you’ve gotten the surge, you’re not going to know what the actual level is, and that’s okay because most of the time, it doesn’t matter what the hormone level is. So essentially, unless you’re just trying to find out if they got an LH surge, you want to use the serum for either FSH, LH, or prolactin. For sex hormone-binding globulin, most clinical validation studies are in the serum; you can’t measure it in saliva or urine, so that’s easy to remember. So we’ve already talked about the issues with different forms of testing, and there are only a few forms of testing that will give you everything you need to know about every hormone you need to know.
When Is The Best Time For Hormones?
Dr. Alex Jimenez, D.C., presents: So now, when is the best time to test hormones? Early morning is when the hormones will be the highest for most hormones. So, the best way to go and test hormone levels like cortisol and gonadal hormones is first thing in the morning since you have to be consistent and fast because what you’ve eaten can change hormone levels. So if you’ve always fasting, at least you’ll find consistency between specimens and the same person. You also need to know where they were in their cycle for certain tests. So, women patients who are still cycling need to record the first day of their next period to know what day you did their testing. Otherwise, they’ll have to use ovulation kits to know exactly where they are.
Dr. Alex Jimenez, D.C., presents: And of course, the downside here is that if you’re trying, for instance, to get a day-21 progesterone, and she typically has a 28-day cycle, so you tell her to go on day 21, but that particular month she has a 35-day cycle, you didn’t get the level that you were looking for. So it can be a little problematic, but remind them to keep track of it so that you won’t be able to look back and know where they were when they had their tests done. So, when do we want these tests in pre and perimenopausal women? Suppose you want progesterone on day 21. You can also do a sex hormone-binding globulin on that day. Menstruating women shoot for as close to day three for estradiol, estrone, FSH, testosterone, or a sex hormone-binding globulin.
Dr. Alex Jimenez, D.C., presents: Now, even though these are ideal, can you get them on other days of their cycle? Yes, but they will have different accuracy. And, of course, it may be an additional day than day three because what if day three happens to land on the weekend and the lab’s not open? So, please consider that what you are looking for here is to test the hormone levels when they’re at their highest. And that’s why we’re shooting for three and 21. So, you know, here’s day three and four. And so the FSH is going to be a nice level here. The estradiol bounces around a lot at this point, so trying to get it in this part of the cycle would be less helpful. And, with progesterone, you’re going to get your peak here, so that’s why you want to try to shoot for 21 days because you know that’s going to be the easiest way to ensure you’re getting it. And also, it’ll help you be more consistent from cycle to cycle if you’re always trying to get it at the same time of the process.
Hormone Replacement Therapy
Dr. Alex Jimenez, D.C., presents: Now here’s where it gets tricky since it’s one thing to find out where the person is before you put them in any hormone replacement therapy; however, monitoring hormone replacement therapy gets more problematic still. If you’re using oral estrogen, it is recommended to get a serum baseline before HRT and then monitor during treatment; if you’re doing oral estrogen, the salivary levels don’t reflect the exogenous estrogen use at all, so they’re not very helpful.
Dr. Alex Jimenez, D.C., presents: And oral estrogen or any hormones that undergo this test must accurately reflect the liver’s first-pass metabolism and the urines’ levels. So if you’re doing oral estrogen replacement therapy, the only way to assess it is with serum because doctors will convince the patient with the module, so you probably don’t want to use oral estrogen anyway. If you’re using sublingual estrogen, the levels will rise and fall rapidly within hours. And so the serum’s not effective in terms of measuring. The saliva will make no sense if you’re doing sublingual because you just had your estrogen there. So what does it mean? It means that 24-hour urine and drive urine testing with sublingual hormones aren’t recommended because there’s always a question of how much you are swallowing and how much is getting absorbed sublingually.
Dr. Alex Jimenez, D.C., presents: Now, if you notice that it says in sublingual, there could be better testing methods. Since you don’t know how much was swallowed and got the first-pass metabolism effect, the result in a 24-hour or dried spot urine may need to be clarified. So that’s problematic. You can still do sublingual estrogen replacement therapy; it just means there’s no great way to test it. If you’re using estrogen creams, serum testing can be effective, and we know that clinical parameters correlate to serum levels when using estrogen creams, so we can do that. In saliva, estradiol and estriol are actively transported into the saliva; the levels are way higher than you would see in the serum and are highly variable. So salivary levels for creams don’t make sense, and there are no good peer-reviewed studies detailing the effective estrogen cream on urinary levels.
Using Hormone Creams & Patches
Dr. Alex Jimenez, D.C., presents: It is probably not a great idea to use urine levels for someone using estrogen creams at the time. If you’re using labial or vaginal estrogen, the serum test appears to be the best choice for monitoring absorption. The salivary levels don’t reflect any dose changes. So basically, it’s probably a waste of time to get a salivary level trying to do urine testing; using vaginal or labial estrogen might be problematic because how do you know you didn’t contaminate the urine specimen. And if you’re using a patch, serum values will rise dose-dependently and then rapidly decline the following removal. It may be helpful, we know that the serum values change based on when you put the patch on and when you take it off, but it is still problematic.
Dr. Alex Jimenez, D.C., presents: There’s no peer-reviewed evidence showing that salivary estrogen can be used to monitor the estrogen patch. And when it comes to the urine testing and the estrogen patch, it does appear that the values in the urine will go up dose-dependently. It may be relatively accurate, but it’s not the best clinically validated test for an estrogen patch. The take-home message here is that no testing is perfect and many of us adjust the dose to the lowest amount, the lowest level we can get, and still have our symptoms controlled. That doesn’t mean they don’t test; you must try to ensure you’re not overdosing on this person. But keep in mind that there are a lot of limitations around what testing can be helpful depending on what form of estrogen replacement you’re using.
Dr. Alex Jimenez, D.C., presents: Now, progesterone and oral progesterone, if you’re using that, the levels rise and fall quickly. You may not be able to catch a serum level that makes sense if you’re taking your progesterone in the evening and then measuring in the morning. Because most women, if they’re taking oral progesterone, will take it in the evening because it helps them sleep. There’s also a problem with the cross-reactivity of metabolites with the immunoassays. So progesterone replacement therapy, if oral, you must take the serum levels with a grain of salt. The same thing with saliva and 24-hour urine testing. We talked about how you’re not getting progesterone; you’re getting progesterone metabolites, so that might be useful. But there’s the problem of how clinically valid the use of progesterone metabolites is. So oral use of progesterone, getting a level, and following it is a little tricky.
Dr. Alex Jimenez, D.C., presents: Now with creams and transdermal progesterone, none of the tests makes any sense because you get mentally increased levels in the serum that don’t rise in any particular way that makes sense. Like all steroid hormones, these are fat-soluble, so if it goes and sits in adipose rather than getting into the bloodstream, it doesn’t necessarily reflect a serum level. Doesn’t necessarily reflect the tissue levels in the uterus and the breast, which is where we care about it. So a serum level for progesterone cream is problematic. Salivary levels after progesterone cream go way up and don’t correspond to symptoms at all. So don’t bother getting salivary level after a progesterone cream. There’s some evidence in urine testing that you can get small increases in the pregnant dial three glucosides if you use progesterone cream. And so it may turn out that we can use that as a measure of what your progesterone is doing.
Dr. Alex Jimenez, D.C., presents: But this still needs some more testing. So it would be best if you remembered that there needs to be a reliable method to track what’s happening when a person uses progesterone cream. So please take your time with getting a level and making a decision based on it. Now, vaginal progesterone suppositories have the same problem. You get minimally increased levels in the serum, which will not give you an adequate result. Progesterone melts or atrocious; you can use serum levels in at troche because you get a more accurate level in the serum than if you had taken it orally. There’s a lack of peer-reviewed research on salivary levels after vaginal progesterone suppositories. And you have to be careful if you’re trying to do urine testing because how do you know you didn’t contaminate the sample?
Dr. Alex Jimenez, D.C., presents: You can’t use a salivary level because you just had the troche or the melt in the person’s mouth. And then, there is at least a potential problem with getting a urine level for a troche or melt because, like a sublingual, how much of this are you swallowing? Individuals may consume some of it and are subject to first-pass metabolism, which means you won’t be able to pick it up in the urine. The larger portion will be absorbed into the capillary blood and probably be accurate in the 24-hour or dry urine test. But that needs to be adequately studied, so keep that in mind if you’re using atrocious or melts. And this is a study that showed that after applying topical progesterone, the saliva and the capillary blood levels were very different compared to those seen in the serum or whole blood.
It’s Important To Do Research
Dr. Alex Jimenez, D.C., presents: So this is just an important research study to remind you of the reliance on serum levels for progesterone. If you’re monitoring, topical dosing can lead to underestimated tissue levels, so you’ll give more than you need. So, be careful about relying on serum levels for topical progesterone because you’re going to overdose people like crazy. And remember, if you overdose on progesterone, it’s high up in the steroid hormone pathway, and you don’t know what this person’s body will do with it; they might turn it into pretty much anything else. Now, testosterone replacement therapy creams or gels can cause blood levels, and the serum level rapidly increases with the application and doesn’t reliably reflect dose changing, any dose changes. So the serum and blood levels are probably not the great way to go. In the saliva, the levels are much higher than the serum and are highly variable since they may give a false indication of overdose.
Dr. Alex Jimenez, D.C., presents: In the urine testing, there’s not good in the 24-hour urine. You probably want to use something other than 24-hour urine. The good news is the dried urine. Now in dried urine, the epitestosterone can be measured if there’s going to be suppression due to exogenous testosterone production if that’s what you think is going on. You can measure the epitestosterone in dry urine testing, which will tell you whether or not, you’ve suppressed this person’s production of testosterone by giving them some. Now, vaginal or labial application of testosterone, there’s no good way to get a blood level that makes sense. The salivary levels, like any other cream or application we might have on your hands, you have to be careful because if you’re handling the specimen vials, to get the saliva, you might get it into the testing medium.
Dr. Alex Jimenez, D.C., presents: And then, just like any vaginal or labial application, if you’re trying to get urine specimens, you have to be careful that you’re not contaminating the urine and getting a falsely elevated level. Blood levels are good if you’re doing testosterone injections, either injection or pellet. Get one-third baseline, and use them for monitoring. It gives you adequate levels. You’ll get a significant elevation in saliva after an IM injection, but there’s wide variability from person to person. So you must take that with a grain of salt regarding how accurate your result might be. The same thing happens in the 24-hour urine specimen. You’re going to get an elevation after an IM injection, but then, there’s a great deal of variability, so who knows how accurate it is?
Dr. Alex Jimenez, D.C., presents: With a salivary level, there’s only some correlation to the bioavailable testosterone. If you’re using a testosterone patch, you can get adequate levels, and there are good studies to show that a blood level will be okay. If you’re using a testosterone patch, the urinary levels, both in 24-hour urine and dry urinary levels, will reflect the increasing doses. You’re getting a reasonably good level with using that. Now, if you’re using DHEA treatment or oral DHEA, you’re going to get a rapid increase in the blood levels right after the oral supplementation as you get with the saliva. You get that also in saliva and also in urine. So you’re picking up on the fact that you took the DHEA test.
Dr. Alex Jimenez, D.C., presents: The problem is variability in the blood, saliva, and urine results. Many don’t particularly appreciate using a lot of oral DHEA anyway because, like all steroid hormones, your body’s going to take it to the liver, and the liver has the opportunity to change it into something else before it even gets into the bloodstream to do its job. Other applications may be more helpful, like transdermal DHEA or topical DHEA; you’ll have to see how the patient feels in terms of symptoms because if you use topical DHEA, the blood levels you’ll get a big rise right after the initial application.
Dr. Alex Jimenez, D.C., presents: So what does that mean because it drops right away? Then, in the saliva after transdermal application of DHEA, the levels will increase, but not linearly. So that doesn’t make any sense. And there is no peer-reviewed research detailing what happens in DHEA levels in the urine after transdermal application. The bigger issue then becomes you might want to keep an eye on what the downstream breakdown products are doing because if you’re not able to get a good DHEA level, you might want at least look at testosterone and estradiol. And that’ll give you some fuel if you’ve overdosed or underdosed on the DHEA. Now, with the vaginal or labial application, the levels in the blood don’t go off at all.
Dr. Alex Jimenez, D.C., presents: There’s no research detailing levels after vaginal application looking at salivary or urinary levels. So you can’t use that as a way of monitoring it. So again, this will be just a matter of following the person and how they feel after using it. You’re not going to need to worry about getting any measurements afterward. It’s simply clinical. The test you choose depends on what you’re giving the person, the form you’re giving it in, and then what you’re trying to find out. By finding a treatment form you like and feel comfortable with, understand whether or not to get testing depending on the structure and replacement you’re using. And then, make sure that you are getting helpful information and not misleading information.
The holidays are a wonderful time to gather with family and friends and celebrate. However, it can be a time of overindulgence and overeating. Managing holiday eating habits is achievable by having options to help you make better choices so you can indulge and enjoy the festive food and drinks without overdoing it. Here are a few techniques to be successful.
Managing Holiday Eating
Many individuals overeat during the holidays. It’s understandable as the holiday season means letting loose, relaxing with friends and family, and enjoying the moment are major factors in overeating as auto-pilot is engaged. The next thing you know, the plate is clean, and more food is being added. It’s all about maintaining a healthy balance. Here are a few ways to manage holiday eating.
Adding superfoods to your holiday nutrition plan to help balance food indulgences. These are foods with high levels of vitamins and nutrients, dietary fiber that helps reduce cholesterol, and antioxidants that fight free radicals.
Vitamin A – Protects against infections and promotes eye and skin health.
Vitamin C – Helps heal wounds and aids in iron absorption.
Vitamin K – Supports healthy digestion and blood clotting.
Superfoods include dark leafy greens, nuts, fruits, dark chocolate, olive oil, and oily/fatty fish. Here are a few superfoods you can enjoy:
Rich in vitamins A and C, fiber, and potassium.
They are high in fiber and protein, magnesium, and potassium.
High in fiber and vitamin A.
Rich in flavonoids and tannins are a healthy source of folate, potassium, and vitamin K.
Contain antioxidants with anti-inflammatory properties that help reduce the risk of cardiovascular disease.
Low in calories.
High in vitamins A, C, and K, manganese, potassium, and fiber.
Preparing for the holidays is exciting but can generate intense stress and anxiety. This can cause individuals to feel tired constantly, which can lead to other issues like sleep problems, brain fog, digestive issues, and musculoskeletal disorders. Chiropractic care can return the body to optimal function, increasing circulation, restoring spinal alignment, re-energizing the mind and body, and preventing future fatigue and exhaustion.
Exhaustion and Fatigue
Primary causes of fatigue and exhaustion are stress, overworking, school work, lack of sound sleep, excessive caffeine or other energy boosters, and the holidays.
Stress is a leading contributor to fatigue and exhaustion.
Stress causes the muscles to contract, restricting blood circulation.
Chronic stress causes the musculoskeletal system to be in a state of continued constriction.
Constant muscle tension can cause injury and chronic conditions that can lead to secondary disorders like tension headaches and migraines.
High-quality rest means falling asleep naturally, staying asleep through the night comfortably, and waking rested and refreshed.
Lack of enough sleep strains the nervous system.
Not enough sleep or disruptions to the sleep-wake cycle (that can happen with shift work or traveling work) can cause physiological fatigue.
This causes reduced motor skills, similar to having a blood alcohol content of 0.1.
Proper nutrition is key to overall health and stress management. An unhealthy diet can be the main cause of fatigue. Just like putting the wrong gas into your car can cause major issues stalling or stopping entirely. The same is true with the body. The body is a complicated engine that requires healthy fuel to work properly.
Macronutrients(fat, carbohydrates, and protein) and Micronutrients (vitamins and minerals) are essential.
Chiropractic Care and Functional Medicine
Chiropractic care can be a long-term solution for fatigue and exhaustion.
Spinal realignment resets the body through better posture and brain function through the improved circulation flowing through the spinal cord.
Optimal spinal realignment:
Alleviates discomfort symptoms
Restores range of motion
Relieve Pressure On The Nerves
Chiropractic releases pressure on the nerves.
The central nervous system’s response to pain, energy levels, comfort, and mobility is impacted by the health of the nerves.
Just a minimal amount of pressure can reduce the strength of a nerve by 90%.
Nerves that are not working correctly have difficulty transmitting messages, often causing pain.
Loosen Tense Muscles
Chiropractic care and massage therapy can help relieve the tension in overworked muscles.
Fatigue and exhaustion can cause the muscles to work harder/overcompensate to try to maintain balance.
Over time, the muscles can’t keep it up and become frozen and tense.
Nervous System Regulation
Chiropractic care can restore nervous system function.
When the spine is not correctly aligned, the electrical impulses are not transmitted properly.
Common side effects include headaches, neck and back problems, and digestive issues.
Chiropractic care can restore the body to a refreshed and rejuvenated state. It can improve circulation, rebalance the body, increase oxygen levels and strengthen the immune system.
Adrenal Insufficiency: Symptoms, Diagnosis, and Treatment
Azzolino, Domenico, et al. “Nutritional Status as a Mediator of Fatigue and Its Underlying Mechanisms in Older People.” Nutrients vol. 12,2 444. 10 Feb. 2020, doi:10.3390/nu12020444
Chaudhuri, Abhijit, and Peter O Behan. “Fatigue in neurological disorders.” Lancet (London, England) vol. 363,9413 (2004): 978-88. doi:10.1016/S0140-6736(04)15794-2
Evans, William J, and Charles P Lambert. “Physiological basis of fatigue.” American journal of physical medicine & rehabilitation vol. 86,1 Suppl (2007): S29-46. doi:10.1097/phm.0b013e31802ba53c
Finsterer, Josef, and Sinda Zarrouk Mahjoub. “Fatigue in healthy and diseased individuals.” The American journal of hospice & palliative care vol. 31,5 (2014): 562-75. doi:10.1177/1049909113494748
Rosenthal, Thomas C et al. “Fatigue: an overview.” American family physician vol. 78,10 (2008): 1173-9.
The fascia is important for connecting the musculoskeletal system, stabilizing function, and keeping the body healthy and balanced. Sugar consumption and the abundance of sugar in the body that doesn’t get burned directly negatively affect the fascia, making it lose its elasticity and affecting other connective tissues. Excess sugar in the blood leads to a pathological process called glycation. One effect of glycation is binding sugar molecules to fascial proteins, causing them to thicken and stiffen. The body sees the tangled molecules as foreign bodies initiating an inflammatory response to get rid of them. This can lead to chronic inflammation causing various symptoms. The Injury Medical Chiropractic and Functional Medicine Clinic Team will address soreness, pain, and discomfort associated with fascia problems.
Myofascia or fascia is a layer of tissue that connects and supports the spine and muscles. It wraps and links internal body parts in bands, fusing them. This ensures the muscles can move freely without experiencing friction with other body parts.
Fascia is made of collagen, creating a tough and flexible texture that provides tension and elasticity.
Fascia is found around muscles, nerves, blood vessels, blood and cells, organs, and bones.
When the body stays or moves in repetitive patterns, the fascia can memorize certain positions/postures and hold the fascia in a contracted state. For example, sitting at a desk workstation causes the gluteal muscles, tendons, and ligaments to stretch and pull the muscles around them. The gluteal muscles can become restricted without releasing and training the fascia to return to a retracted position, causing tension and myofascial discomfort. When the body is in balance/homeostasis, and the fascia is healthy:
The viscoelastic gel flows without restriction in all directions.
The collagen fiber network moves freely.
Lymph and blood circulation flow correctly.
Communication between cells, the nervous system, and all tissues in the body work correctly.
In the event of an injury and activation of the healing process, specific components interact with cells to create the condition for healing and generate inflammation, allowing new cells to easily move and heal the tissue. An obstruction in the circulation increases pressure where the fluid sits stationary, preventing tissue communication. Sometimes the healing process doesn’t stop, and the inflammation response worsens and can become chronic.
Many think of sugar as candy, sweets, chocolates, and desserts. However, all carbohydrates are sugar, and eating too much bread, pasta, grains, fruit, and cereals, contributes to a lot more sugar consumption.
Foods believed to be healthy such as wholemeal bread, low-fat alternatives, and granola cereal, have high amounts of sugar.
The connective tissues need collagen for the smooth functioning of joints.
High blood sugar exacerbates aches and pains and can lead to impaired joint movement and, eventually, arthritis.
Impaired flow and mobility
Fascia that has thickened and hardened impairs gliding ability.
In places where the body has become stiff and numb, the nervous system can’t transmit signals as quickly to control movements.
Muscles can constantly twitch or go into convulsions from misinterpreted signals.
A tight connective tissue chain can distort the skeleton causing the joints to wear faster.
Chiropractic Myofascial Massage Release
Chiropractic myofascial massage and release provides several benefits to the body’s health and well-being, including:
Relieves the overall effects of stress on the body.
Relieves soreness and pain.
Increases blood and lymph circulation.
Improves tissue recovery.
Improves joint range of motion.
Restores proper-length-tension relationships for dynamic movement.
Maintains normal functional muscular length.
Improves neuromuscular function.
Nutritional Guidelines Fascial Health
Barros-Neto, João Araújo et al. “Selenium and Zinc Status in Chronic Myofascial Pain: Serum and Erythrocyte Concentrations and Food Intake.” PloS one vol. 11,10 e0164302. 18 Oct. 2016, doi:10.1371/journal.pone.0164302
Dong, Shoubin, et al. “A three-dimensional collagen-fiber network model of the extracellular matrix for the simulation of the mechanical behaviors and microstructures.” Computer methods in biomechanics and biomedical engineering vol. 20,9 (2017): 991-1003. doi:10.1080/10255842.2017.1321113
Mattei, Giorgio et al. “Engineering Gels with Time-Evolving Viscoelasticity.” Materials (Basel, Switzerland) vol. 13,2 438. 16 Jan. 2020, doi:10.3390/ma13020438
Okumus, M et al. “The relationship between serum trace elements, vitamin B12, folic acid and clinical parameters in patients with myofascial pain syndrome.” Journal of back and musculoskeletal rehabilitation vol. 23,4 (2010): 187-91. doi:10.3233/BMR-2010-0264
Vlassara, Helen, and Jaime Uribarri. “Advanced glycation end products (AGE) and diabetes: cause, effect, or both?.” Current diabetes reports vol. 14,1 (2014): 453. doi:10.1007/s11892-013-0453-1
Maintaining kidney health is important to the body’s overall health and well-being. The kidneys are fist-sized organs located beneath the rib cage on both sides of the spine. A kidney detox maintains health allowing the body to filter and expel waste properly and produce hormones to help the body function at its full potential.
The kidneys perform several functions that include:
Filters and cleanses out impurities from the blood.
Produces hormones that regulate blood pressure and control the production of red blood cells.
Filter’s waste products stored in the bladder and expelled through urine.
Activates vitamin D to support body absorption of calcium for bone repair and regulating muscle function.
A key measure of keeping the kidneys clean and healthy is to engage in a healthy nutrition plan. Doctors recommend implementing lifestyle changes to help the kidneys filter at full capacity. Certain foods can help detox the kidneys and promote their health.
Pumpkin seeds can help prevent the accumulation of uric acid, one of the compounds that cause kidney stones.
These fruits contain a compound called resveratrol to reduce kidney inflammation.
Lemons help with digestion.
They have vitamin C, which enhances the immune system and supports white blood cells to fight infections.
Citrate binds with calcium in the urine to stop the growth of calcium crystals, preventing kidney stones.
This is an example of a two-day kidney cleanse to help strengthen the kidneys and detoxify the body.
Smoothie made with:
8 ounces of fresh lemon, ginger, and beet juice
1/4 cup of sweetened dried cranberries
Smoothie made with:
1 cup almond milk
1/2 cup tofu
1/2 cup spinach
1/4 cup berries
Two tablespoons of pumpkin seeds
Large mixed-greens salad
4 ounces of lean protein – chicken, fish, or tofu
Top with 1/2 cup of grapes
1/4 cup peanuts
Smoothie made with:
1 cup soy milk
One frozen banana
1/2 cup spinach
1/2 cup blueberries
One teaspoon spirulina
A bowl of:
1 cup orzo rice
1 cup fresh fruit
Two tablespoons of pumpkin seeds
Large mixed-greens salad
4 ounces of lean protein – chicken, fish, or tofu
Top with 1/2 cup of cooked barley
Add fresh lemon juice
4 ounces each of unsweetened cherry juice and orange juice
Consult a healthcare provider, nutritionist, or dietitian to ensure it is safe.
Chen, Teresa K et al. “Chronic Kidney Disease Diagnosis and Management: A Review.” JAMA vol. 322,13 (2019): 1294-1304. doi:10.1001/jama.2019.14745
Den Hartogh, Danja J, and Evangelia Tsiani. “Health Benefits of Resveratrol in Kidney Disease: Evidence from In Vitro and In Vivo Studies.” Nutrients vol. 11,7 1624. 17 Jul. 2019, doi:10.3390/nu11071624
Pizzorno, Joseph. “The Kidney Dysfunction Epidemic, Part 1: Causes.” Integrative medicine (Encinitas, Calif.) vol. 14,6 (2015): 8-13.
Saldanha, Juliana F et al. “Resveratrol: why is it a promising therapy for chronic kidney disease patients?.” Oxidative medicine and cellular longevity vol. 2013 (2013): 963217. doi:10.1155/2013/963217
Tack, Ivan MD, Ph.D. Effects of Water Consumption on Kidney Function and Excretion. Nutrition Today: November 2010 – Volume 45 – Issue 6 – p S37-S40
It is difficult for individuals to achieve health and fitness goals when they don’t like to eat vegetables. Intermittent fasting, Paleo, vegan, Mediterranean, or New Nordic, almost all healthy nutrition plans require vegetable consumption to achieve optimal health. However, it is never too late to learn to enjoy vegetables. Injury Medical Chiropractic and Functional Medicine Clinic can recommend ways not just to eat vegetables because they are healthy but to truly enjoy them.
Training Oneself To Enjoy Vegetables
Everyone’s taste preferences are different.
Many individuals grew up in homes where vegetables were prepared in unappetizing ways.
Over boiling and steaming are common preparation methods that many had experience with, including broccoli, cauliflower, asparagus, and Brussels sprouts, which made them flavorless, mushy and is where many decided they were not going to eat these foods.
Vegetables feed the intestinal bacteria that help the digestive tract.
Vegetables provide hydration that helps the fiber eliminate waste products.
Vegetables add variety to help maintain healthy nutrition.
The key is to branch out incrementally. Most individuals will have a vegetable or two that they can tolerate. This could be a starting point by expanding on new variations on those tolerable vegetables that will lead to broadened taste preferences. This can be done through different cooking methods that include:
It means pairing food with a vegetable to activate various tastes and flavors pleasing to the palate simultaneously.
On the tongue are a variety of receptors that bind to the chemicals in food.
When these receptors are activated, they send a chemical signal to the brain about the taste.
Variations in the number and type of receptors help develop flavor preferences.
Basic tastes – sweet, sour, spicy, salty, bitter, and umami.
Pairingbitterness with other distinct flavors, like sweet and spicy, can develop and change the brain’s perception of bland or bitter vegetables to tasty and delicious.
Cushions for bitterness include honey, real maple syrup, sour cream, Mexican crema, hot sauce, oils, almonds, and butter used in balance to enhance and bring out flavors.
The objective is to start small and work your way to becoming more comfortable with experimenting and combining more flavors. Consultation with a professional nutritionist can help individuals get on a healthy nutrition plan that they can enjoy.
Tip From A Dietitian
Christoph, Mary J et al. “Intuitive Eating is Associated With Higher Fruit and Vegetable Intake Among Adults.” Journal of nutrition education and behavior vol. 53,3 (2021): 240-245. doi:10.1016/j.jneb.2020.11.015
Melis M, Yousaf NY, Mattes MZ, Cabras T, Messana I, Crnjar R, Tomassini Barbarossa I, Tepper BJ. Sensory perception of salivary protein response to astringency as a function of the 6-n-propylthioural (PROP) bitter-taste phenotype. Physiol Behav. 2017 Jan 24;173:163-173.
Mennella JA. Development of food preferences: Lessons learned from longitudinal and experimental studies. Food Qual Prefer. 2006 Oct;17(7-8):635-637.
Tordoff, Michael G, and Mari A Sandell. “Vegetable bitterness is related to calcium content.” Appetite vol. 52,2 (2009): 498-504. doi:10.1016/j.appet.2009.01.002
Wallace, Taylor C et al. “Fruits, vegetables, and health: A comprehensive narrative, umbrella review of the science and recommendations for enhanced public policy to improve intake.” Critical reviews in food science and nutrition vol. 60,13 (2020): 2174-2211. doi:10.1080/10408398.2019.1632258
Wieczorek, Martyna N et al. “Bitter taste of Brassica vegetables: The role of genetic factors, receptors, isothiocyanates, glucosinolates, and flavor context.” Critical reviews in food science and nutrition vol. 58,18 (2018): 3130-3140. doi:10.1080/10408398.2017.1353478
When it comes to the torso is surrounded by various muscles that help protect the vital organs known as the gut system and help with stabilizing the spinal column in the body. The abdominal muscles are essential to maintaining good posture and core support for many individuals. When normal activities or chronic issues begin to affect the body, the abdominal muscles can also be affected and can cause referred pain all around the torso area. When the abdominal muscles are dealing with referred pain, it can develop into trigger points that mask other chronic conditions affecting the torso and the thoracolumbar region. Today’s article looks at the abdominal muscles and their function, how trigger points are affecting the abdomen, and how various treatments help manage trigger points associated with abdominal pain. We refer patients to certified providers who provide different techniques in abdominal pain therapies related to trigger points to aid many suffering from pain-like symptoms along the abdominal muscles along the torso. We encourage patients by referring them to our associated medical providers based on their examination when it is appropriate. We designate that education is a great solution to asking our providers profound and complex questions at the patient’s request. Dr. Alex Jimenez, D.C., notes this information as an educational service only. Disclaimer
Do you have trouble moving around? Have you been dealing with muscle spasms along your abdomen? Does it hurt when you are sneezing, laughing, or coughing constantly? All these actions affecting your abdominal muscles might correlate with trigger points along the muscles and disrupt the torso area. The abdomen in the body has various muscles, a complex organ with many functions that contribute to a person’s quality of life. The abdominal muscles have many important parts, from supporting the trunk, allowing movement like twisting and turning, and holding the organs in the gut system in place through internal abdominal pressure regulation. The abdominal muscles have five main muscles that work together with the back muscles to keep body stability. They are:
Studies reveal that the abdominal muscles can help increase the stability of the lumbar region of the body from the vertebral columns by tending the thoracolumbar fascia and raising the intra-abdominal pressure. This allows the abdominal muscle to bend and flex in different positions without feeling pain. However, overusing the abdominal muscles can lead to unnecessary issues that can affect not only the torso but the surrounding muscles around the torso.
How Trigger Points Are Affecting The Abdomen
The book “Myofascial Pain and Dysfunction,” by Dr. Janet Travell, M.D., mentioned that abdominal symptoms are common and can cause diagnostic confusion for many people. Since the abdominal muscles can provide stability to the body’s trunk when a person overuses the abdominal muscles through various activities like quick and violent twisting of the mid-section, lifting heavy objects with the core instead of the legs, overdoing exercise regimes, or having a persistent cough, these various activities could potentially lead to the development of trigger points in the abdominal muscles causing pain in the abdomen and causing referred pain to the lower back. Studies reveal that trigger points along the abdominal muscles are developed through aggravating factors like prolonged sitting or standing can cause the abdominal muscles to become extremely tender and hyperirritable along the taut muscle bands. When trigger points affect the abdominal muscles, they can produce referred abdominal pain and visceral disorders (somato-visceral effects) that work closely together to mimic visceral diseases. This pertains to many individuals thinking something is wrong in their gut system, but their abdominal muscles are causing issues in their bodies.
Releasing Trigger Points In The Abdominal Muscles-Video
Have you been experiencing abdominal issues around your torso? Does it hurt when you laugh, cough, or sneeze? Do you feel muscle stiffness or tenderness along your abdominals? If you have been dealing with these symptoms throughout your life, you could be experiencing abdominal pain associated with trigger points in your torso. Abdominal pain is common for many individuals and can vary from gut issues or muscle issues that various factors can cause in the torso. Abdominal issues can even cause confusion to doctors when they are diagnosing the issues that are affecting their patients. When various actions cause pain to the abdominals, it can develop referred pain associated with trigger points. Trigger points develop when the muscle has been overused, creating tiny nodules in the taut band. Trigger points can be tricky to pinpoint but are treatable. The video above shows where the trigger points are located in the abdominal muscles and how to release them from the affected abdominal muscles to provide relief and reduce the mimic effects of visceral-somatic pain.
Managing Trigger Points Associated With Abdominal Pain Through Various Treatments
When abdominal pain affects the muscles, the symptoms can develop trigger points. When this happens, it can lead to confusion and often misdiagnosed. All is not lost; there are ways to manage trigger points associated with abdominal pain through various treatments. Studies reveal that various therapies like dry needling combined with palpations can reduce trigger points from causing more referred pain issues in the abdomen. Other ways to prevent trigger points from developing in the future are through exercises that can help strengthen the abdominal muscles. Exercises like abdominal breathing, pelvic tilts, sit-ups, and even laughter can help strengthen weak abdominal muscles and positively affect the body.
The torso has various muscles, known as abdominal muscles, that help protect the vital organs in the gut system, help stabilize the spinal column, and maintain good posture for many individuals. Various factors affecting the abdominal muscles can lead to a confusing diagnosis, as it could be an internal or external issue. When the abdominal muscles are affected by being overused through various activities, it can develop into trigger points in the muscles, causing visceral referred pain to the torso and cause muscle weakness. Luckily multiple treatments can help reduce the effects of trigger points associated with abdominal pain and can help strengthen the core of the body. This allows the individual to feel better and consider what not to do to their abdominals.
Rajkannan, Pandurangan, and Rajagopalan Vijayaraghavan. “Dry Needling in Chronic Abdominal Wall Pain of Uncertain Origin.” Journal of Bodywork and Movement Therapies, U.S. National Library of Medicine, Jan. 2019, pubmed.ncbi.nlm.nih.gov/30691770/.
Seeras, Kevin, et al. “Anatomy, Abdomen and Pelvis, Anterolateral Abdominal Wall.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 25 July 2022, www.ncbi.nlm.nih.gov/books/NBK525975/.
Stress and anxiety treatments can include a range of therapies, including talking therapy, meditation techniques, and medication. Chiropractic care, adjustments, and massage are also used as a treatment plan to de-stress. Whether diagnosed with an anxiety disorder or experiencing intense stress, chiropractic functional medicine can address the physical symptoms to rebalance the mind and body.
Physical and mental health are connected. Stress and anxiety can cause tension, fatigue, headaches, and aches and pains. It can make sleeping and/or relaxing difficult, affecting mental and physical health. Signs of stress include:
Blood sugar level changes
Every day or almost every day, tension headaches
The spine is the conduit for the sympathetic and parasympathetic nervous systems.
The sympathetic nervous system activates when the brain thinks sudden action or important stressful decisions needs to be taken.
The fight or flight response speeds up the heart rate and releases adrenaline.
The parasympathetic system deactivates the fight or flight response, calming the body into a more relaxed state.
Problems arise when the sympathetic nervous system gets activated repeatedly, causing the fight or flight system to remain semi-active. This can come from long commutes, traffic jams, loud music, deadlines, sports practice, rehearsals, etc. The parasympathetic nervous system never gets a chance to activate and settle the mind and body. The result is constantly feeling stressed and agitated.
Chiropractic care to de-stress decreases stress hormones and releases feel-good hormones like oxytocin, dopamine, and serotonin, which allow healing and help the body relax. Chiropractic adjustments let the brain know it’s time to activate the parasympathetic nervous system and ease down. Chiropractic helps by:
Relieving Muscle Tension
When the body is under stress, the muscles tense up, causing discomfort, aches, and pains.
The continued stress can lead to health issues, panic attacks, anxiety disorders, and depression.
Chiropractic relieves tension restoring the body to its natural balance.
Chiropractic can help effectively restore bodily functions.
Adjustments and massage rebalance blood circulation and energy flow, allowing clear nervous system transmission.
Lowering Blood Pressure
Chiropractic care has shown positive results in lowering blood pressure.
Improving Quality Sleep
Chiropractic care improves sleep patterns by correcting spinal misalignments.
Chiropractic adjustments can release and relax muscle activity, allowing the body to relax and de-stress completely.
Jamison, J R. “Stress management: an exploratory study of chiropractic patients.” Journal of manipulative and physiological therapeutics vol. 23,1 (2000): 32-6. doi:10.1016/s0161-4754(00)90111-8
Kültür, Turgut, et al. “Evaluation of the effect of chiropractic manipulative treatment on oxidative stress in sacroiliac joint dysfunction.” Turkish journal of physical medicine and rehabilitation vol. 66,2 176-183. 18 May. 2020, doi:10.5606/tftrd.2020.3301
Mariotti, Agnese. “The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication.” Future science OA vol. 1,3 FSO23. 1 Nov. 2015, doi:10.4155/fso.15.21
The body needs food for fuel, energy, growth, and repair. The digestive process breaks down food into a form the body can absorb and use for fuel. The broken-down food gets absorbed into the bloodstream from the small intestine, and the nutrients are carried to the cells throughout the body. Understanding how the organs work together to digest food can help with health goals and overall health.
The Digestive Process
The organs of the digestive system are the following:
Martinsen, Tom C et al. “The Phylogeny and Biological Function of Gastric Juice-Microbiological Consequences of Removing Gastric Acid.” International journal of molecular sciences vol. 20,23 6031. 29 Nov. 2019, doi:10.3390/ijms20236031
Ramsay, Philip T, and Aaron Carr. “Gastric acid and digestive physiology.” The Surgical clinics of North America vol. 91,5 (2011): 977-82. doi:10.1016/j.suc.2011.06.010
The body’s ability to heal itself is quite remarkable. When injury or illness presents, the body’s systems activate to deal with the problem and restore itself to health. The spine’s bones protect the communication pathways of the spinal cord and nerve roots. If the nervous system suffers injury or is damaged in some way, causing impairment, it can cause malfunctioning of the tissues and organs throughout the body. Chiropractic care combined with functional medicine can restore and enhance the body’s self-healing abilities to optimal levels.
The Body’s Ability To Heal Itself
A healthy body regenerates, fights infection, heals wounds, and repairs damage. The body is in a constant state of removing damage and producing new, healthy tissues.
Cells can heal themselves when they become unhealthy and replicate to replace injured or damaged cells.
The body produces new cells to heal the damage if a bone gets fractured or broken.
When the skin gets cut, the blood clots, stopping the bleeding, white blood cells remove the injured and dead cells, and new healthy cells repair the damaged tissue.
The immune system deals with viruses, bacteria, and toxins.
Natural destroyer cells recognize when the body’s cells have been invaded by a virus and destroy the infected cell.
Inflammation is the body’s reaction to an injury or infection, activating the immune system to restore the injured or infected area to health.
A fever is the body’s raising its temperature to levels that will kill viruses and bacteria.
The elevation in temperature also triggers certain cellular mechanisms which help the body fight the infection.
The body heals and regenerates itself through stem cells.
Once the body is formed, embryonic stem cells disappear, and adult stem cells take over.
The adult stem cells divide, producing an identical stem cell and a healthy, mature cell of a specific type.
Each type of adult stem cell only can become certain types of tissue.
Neural Stem Cells help regenerate nerve tissue in the brain and spinal cord.
Epithelial Stem Cells regenerate skin.
Adult stem cells can reproduce for a long time but eventually stop reproducing as efficiently.
The nervous system assists the whole body in maintaining communication, using electrical and chemical impulses to send and receive messages. The system reacts to changes inside and outside the body. Infections, injuries, disorders, and conditions can cause imbalances causing communication problems that can lead to health issues. Common problems of the nervous system include:
Sciatica – Pressure on a nerve/s caused by a slipped, bulging, or herniated disc in the spine or arthritis of the spine and, sometimes, other factors.
Parkinson’s disease – The death of neurons in a part of the brain called the midbrain. Symptoms include shaking and mobility problems.
Epilepsy – Abnormal electrical activity in the brain causing seizures.
Meningitis – Inflammation of the membrane covering the brain.
Multiple sclerosis – The myelin sheaths protecting the nerves of the central nervous system become damaged and deteriorates.
Subluxations are misaligned or damaged joints that are not functioning correctly. These joints can place pressure on a nerve, which interferes with the normal nervous system function. Chiropractic care can realign, restore and maintain neuromusculoskeletal system health to reactivate the body’s natural healing abilities.
Cerebral Palsy Chiropractic Treatment
Haavik, Heidi, et al. “Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in Chronic Pain Patients: A Preliminary Study.” Journal of manipulative and physiological therapeutics vol. 40,3 (2017): 127-138. doi:10.1016/j.jmpt.2016.10.002
Lee, Courtney, et al. “Mind-body therapies for the self-management of chronic pain symptoms.” Pain medicine (Malden, Mass.) vol. 15 Suppl 1 (2014): S21-39. doi:10.1111/pme.12383
Maltese PE, Michelini S, Baronio M, Bertelli M. Molecular foundations of chiropractic therapy. Acta Biomed. 2019 Sep 30;90(10-S):93-102. doi: 10.23750/abm.v90i10-S.8768. PMID: 31577263; PMCID: PMC7233649.
McSwan, Joyce, et al. “Self-Healing: A Concept for Musculoskeletal Body Pain Management – Scientific Evidence and Mode of Action.” Journal of pain research vol. 14 2943-2958. 21 Sep. 2021, doi:10.2147/JPR.S321037
Navid, Muhammad Samran et al. “The effects of chiropractic spinal manipulation on central processing of tonic pain – a pilot study using standardized low-resolution brain electromagnetic tomography (sLORETA).” Scientific reports vol. 9,1 6925. 6 May. 2019, doi:10.1038/s41598-019-42984-3
Mindful eating involves paying attention to what and how individuals eat, helping to become more aware of the body’s natural hunger and satisfaction cues. The process can help individuals become aware of the reasons behind their hunger and help to reduce cravings, control portion sizes, and develop long-term healthy eating habits.
It’s easy to rush through meals and snacks without pausing to enjoy the experience while refueling the body. Like meditation, individuals focus on what they are eating, how it smells, tastes, and the bodily sensations experienced. It is a way of checking in with the mind and body throughout a meal or snack. Mindful eating puts the individual in touch:
Mindful or intuitive eating has been shown to improve:
Blood sugar levels in pregnant women.
Inflammatory markers in postmenopausal women.
Lipid and blood pressure in overweight adults.
Food Consumption Health
Put away electronics and set aside time and space for eating only.
Eat in a setting where you are relaxed.
Eating in the car, in front of a computer while working, or on the phone doesn’t give full attention to the eating process and, as a result, can cause the individual to eat more or eat foods that are not healthy.
Sit down and take a few deep breaths before starting the meal.
If emotions are running high and are geared towards eating, see if you can acknowledge and express those emotions rather than eat through them.
This will help the digestive process and get the most out of the meal.
Eat a palette of colors, sample various salty, sweet, spicy, and umami/savory flavors, and take in the food with all the senses.
Not eating a variety of flavors at a meal can cause a feeling of missing something that can lead to unhealthy cravings.
Eat with others, as sharing food can enrich everyone involved and help focus on the experience, not the amount of food consumed.
Chew thoroughly, as digestion begins in the mouth, where enzymes are secreted in saliva to break down food.
Not properly chewing and making the food smaller can cause indigestion and other digestive problems.
Listen to your body and recognize when you have had enough or want more.
Waiting five minutes before getting another serving can help the body become more attuned to hunger and fullness cues.
Cherpak, Christine E. “Mindful Eating: A Review Of How The Stress-Digestion-Mindfulness Triad May Modulate And Improve Gastrointestinal And Digestive Function.” Integrative medicine (Encinitas, Calif.) vol. 18,4 (2019): 48-53.
Espel-Huynh, H M et al. “A narrative review of the construct of hedonic hunger and its measurement by the Power of Food Scale.” Obesity science & practice vol. 4,3 238-249. 28 Feb. 2018, doi:10.1002/osp4.161
Grider, Hannah S et al. “The Influence of Mindful Eating and/or Intuitive Eating Approaches on Dietary Intake: A Systematic Review.” Journal of the Academy of Nutrition and Dietetics vol. 121,4 (2021): 709-727.e1. doi:10.1016/j.jand.2020.10.019
Hendrickson, Kelsie L, and Erin B Rasmussen. “Mindful eating reduces impulsive food choice in adolescents and adults.” Health psychology: official journal of the Division of Health Psychology, American Psychological Association vol. 36,3 (2017): 226-235. doi:10.1037/hea0000440
Morillo Sarto, Hector, et al. “Efficacy of a mindful-eating program to reduce emotional eating in patients suffering from overweight or obesity in primary care settings: a cluster-randomized trial protocol.” BMJ open vol. 9,11 e031327. 21 Nov. 2019, doi:10.1136/bmjopen-2019-031327
Nelson, Joseph B. “Mindful Eating: The Art of Presence While You Eat.” Diabetes spectrum: a publication of the American Diabetes Association vol. 30,3 (2017): 171-174. doi:10.2337/ds17-0015
Warren, Janet M et al. “A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviors: effectiveness and associated potential mechanisms.” Nutrition research reviews vol. 30,2 (2017): 272-283. doi:10.1017/S0954422417000154
The chest has the pectoralis major muscle that works with the upper half of the body that provides mobility and power. The pectoralis major also surrounds the clavicle skeletal structure and works with the thoracic spine. The chest allows mobility to the arms and stability to the shoulders while working together with the shoulder and arm muscles. Many individuals utilize the upper body more when working out, lifting, or carrying objects from one place to another. This causes the muscle to become overused and succumb to injuries that can affect the functionality of the chest and invoke pain-like symptoms in the body. One of the chest muscles affected by pain is the pectoralis muscles, especially the pectoralis minor muscle. Today’s article looks at the pectoralis minor muscle, how myofascial pain affects the pectoralis minor, and how to manage myofascial pain associated with the pectoralis minor. We refer patients to certified providers specializing in chest pain therapies to aid many people suffering from trigger point pain affecting the minor muscles of the pectoralis. We brief patients by referring them to our associated medical providers based on their examination when appropriate. We indicate that education is a great solution to asking our providers profound and complex questions at the patient’s request. Dr. Alex Jimenez, D.C., notes this information as an educational service only. Disclaimer
Have you been experiencing pain in your upper-mid back? Do you feel like your chest is feeling compressed constantly? Do you feel the tension in your shoulders that makes it difficult to reach behind your back? Most of these symptoms are signs that many individuals are developing myofascial pain along the pectoralis muscles, especially the pectoralis minor. The pectoralis minor muscle is a thin triangular-shaped muscle below the pectoralis major. It has a crucial part of the chest as it helps stabilize the scapula (the shoulder blades) and is in front of the thoracic wall of the spine. The pectoralis minor is also part of the respiratory muscle group that works with the lungs. The pectoralis minor muscle has many functions for the shoulder blades, which include:
Abduction or Protraction
When environmental factors begin to affect the lungs and cause respiratory issues in the body, the surrounding respiratory muscle group also gets involved, causing the body to be hunched over.
Myofascial Pain Affecting The Pectoralis Minor
When environmental factors begin to affect the lungs, it causes the respiratory muscles to contract and become compressed. This is just one of the many factors that can affect the pectoralis minor muscle. The other factor is that the pectoralis minor muscle may be short in the chest and when individuals try to reach behind their backs. This causes the pectoralis minor muscle to to be overstretched and develop myofascial pain or trigger points along the muscle fibers. The book, “Myofascial Pain and Dysfunction,” written by Dr. Travell, M.D., described the pain from myofascial pain associated with the pectoralis minor to be similar to cardiac pain. This is known as referred pain caused by myofascial pain syndrome and it can be a bit difficult to diagnose since it can mimic other chronic issues. Studies reveal that shortening or any sort of tightness of the pectoralis minor is one of the potential biomechanical mechanisms that is associated with an altered scapular alignment which causes pain and shoulder movement impairments. Overusing the pectoralis minor muscles creates tiny nodules that can affect the stability of the shoulders and causes upper-mid back problems in the thoracic region of the spine.
An Overview Of Trigger Points On The Pectoralis Minor- Video
Have you been experiencing difficulty inreaching behind your back? Do you feeling your body becoming more hunched over than usual? Or have you been experiencing chest pain constantly? These pain-like symptoms are caused by myofascial pain associated with the pectoralis minor muscle. The pectoralis minor muscle helps with the stability of the shoulders and studies reveal that when the presense of myofascial trigger points are linked to shoulder and upper body disorders, it can increase the risk of overlapping conditions that trigger points can mimic. Myofascial trigger points are a common complaint as it can significantly impact a person’s daily activites by causing the taut muscle band to be tender or hypersenitive. When this happens, it can lead to issues of muscle imbalance, weakness and impaired motor function. Thankfully, there are various techniques that can help reduce the pain symptoms and issues in the pectoralis minor muscle, while mananging the trigger points. The video above explainshow to tell when your chest muscles are tight and various tests to know when the pectoralis muscles (both the minor and major) are being affected by trigger points.
Managing Myofacial Pain Associated With Pectoralis Minor
When dealing with chest pains associated with myofascial pain along the pectoralis minor, there are many techniques they can incorporate to prevent myofascial pain from causing further damage to the muscle itself and the surrounding muscles. Various chest stretches can help gently loosen the stiff muscles, warm the pectoralis minor, and improve mobility to the chest and shoulders. Correct posture can help prevent the body from being hunched over constantly and let the surrounding muscles and the pectoralis minor relax. If the pain is unbearable, studies reveal that treatments like dry needling and palpations on the pectoralis minor muscles can help manage the pain caused by trigger points. This kind of treatment allows the muscle to release the trigger point and, combined with a hot or cold pack, can reduce the chances of myofascial pain from forming again in the muscle.
Underneath the pectoralis major muscle, the pectoralis minor is a thin triangular-shaped muscle that helps stabilize the shoulder blades and is located in the front of the thoracic wall of the spine. This tiny muscle is part of the respiratory muscles that have a causal relationship with the lungs and can succumb to environmental factors that can lead to the development of myofascial pain or trigger points on the pectoralis minor. Myofascial pain associated with the pectoralis minor muscle can mimic cardiovascular issues and invoke pain in the muscle. Fortunately, various treatments can help relieve and manage myofascial pain from re-occurring in the pectoralis minor.
Bagcier, Fatih, et al. “Three Simple Rules in Pectoral Muscle’s Trigger Point Treatment, Which May Be a Cause of Chest Pain: Position, Palpation, and Perpendicular Needling.” American Board of Family Medicine, American Board of Family Medicine, 1 Nov. 2020, www.jabfm.org/content/33/6/1031.long.
Baig, Mirza A, and Bruno Bordoni. “Anatomy, Shoulder and Upper Limb, Pectoral Muscles.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 11 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK545241/.
Morais, Nuno, and Joana Cruz. “The Pectoralis Minor Muscle and Shoulder Movement-Related Impairments and Pain: Rationale, Assessment and Management.” Physical Therapy in Sport : Official Journal of the Association of Chartered Physiotherapists in Sports Medicine, U.S. National Library of Medicine, Jan. 2016, pubmed.ncbi.nlm.nih.gov/26530726/.
Ribeiro, Daniel Cury, et al. “The Prevalence of Myofascial Trigger Points in Neck and Shoulder-Related Disorders: A Systematic Review of the Literature.” BMC Musculoskeletal Disorders, BioMed Central, 25 July 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6060458/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 1:Upper Half of Body. Williams & Wilkins, 1999.
The chest in the upper half of the body comprises various structures that each have a job to keep the body functioning. The chest has different large muscles surrounding the ribcage and helps protect the vital organs that allow the host to breathe. The essential organs protected by the ribcage and the chest muscles include the heart and the lungs. These two organs aid the chest with blood circulation, breathing, and digestion to keep the body moving and functional. When injuries or chronic conditions begin to affect the chest, it can cause the muscles surrounding the ribcage to contract and tighten, causing the heart and lungs to work harder and causing various issues to affect the body. This can lead to chronic symptoms in the chest and affect a person’s life. Today’s article looks at the pectoralis major muscle in the chest, how trigger point pain is associated with chest pain, and how to manage trigger points in the chest. We refer patients to certified providers who specialize in chest pain therapies to aid many people suffering from trigger point pain affecting the pectoralis major muscles. We brief patients by referring them to our associated medical providers based on their examination when appropriate. We indicate that education is a great solution to asking our providers profound and complex questions at the patient’s request. Dr. Alex Jimenez, D.C., takes note of this information as an educational service only. Disclaimer
Have you been experiencing unexplainable chest pains that mimic heart issues? Do you feel muscle stiffness near your clavicle? Or do your chest muscles feel tenser and sorer than usual? Many of these issues affecting the chest could result from trigger points associating with the chest along the pectoralis major muscles. The pectoralis major is the superior and largest muscle in the chest wall’s front area. This muscle looks like a thick fan that surrounds the clavicle and works with the chest and arms to provide mobility and power to the upper body. Studies reveal that the pectoralis major muscle plays an important role in upper limb movements. To that point, it can help with the adduction and medial rotation of the arm, according to the book by Dr. Travell, M.D. “Myofascial Pain and Dysfunction,” the pectoralis muscle works with the rest of the chest muscles while being assisted by the teres major and minor muscles, the anterior and posterior deltoid muscles, the subscapularis muscles, and the tricep muscles. The pectoralis major muscles can also be affected by multiple issues affecting the chest and the rest of the upper half of the body.
Trigger Point Pain Associated With The Chest
When the pectoralis major muscles are affected by various issues, they can mimic other chronic conditions that are causing referred pain in different body areas. This is known as trigger point pain, and it can cause overlapping risk profiles on the pectoralis major muscles that can affect the chest. Trigger points are slightly difficult to diagnose as many factors, like repetitive motions or lifting heavy objects, can cause the affected muscles to develop tiny knots along the muscle fibers and cause pain-like symptoms. Many people with chest pains often complain that something is affecting their heart as they place their hands on their chest and gently rub the affected area. However, when their doctors examine them, the issue is not their hearts but their chest muscles. Studies reveal that trigger points affecting the affected muscle can mimic issues like cardiovascular dysfunction in the heart. To that point, active trigger points in the pectoralis major muscle can cause somato-visceral pain to the heart, mimicking cardiovascular issues like paroxysmal arrhythmia. It can also cause visceral-somatic pain where the heart suffers from cardiovascular problems affecting the pectoralis major muscles.
Trigger Point Therapy On The Pectoralis Major-Video
Have you been dealing with chest pains that cause you to hunch over? Does your chest seem to feel tight when you stretch? Or have your chest muscles feel tender to the touch? These pain symptoms are caused by trigger points affecting the pectoralis muscles. Trigger points are generated when a person overuses their muscles from daily activities or succumbs to muscle injuries that cause referred pain in different body areas. So trigger points affecting the pectoralis major muscle may cause chest pains. The video above explains the pectoralis muscles and where the trigger points are located that cause referred pain to the shoulders and the rest of the upper half of the body. Trigger points associated with the chest along the pectoralis major muscles can be treatable through various treatments and techniques that can reduce the symptoms and prevent trigger points from forming along the affected muscle in the future.
Ways To Manage Trigger Points On The Chest
When trigger points affect the pectoralis major muscles, they can invoke chest pain-like symptoms that resemble a cardiovascular disorder. Fortunately, pain specialists like chiropractors, massage therapists, and physiotherapists can utilize various techniques to help reduce the pain caused by trigger points. Studies reveal that when local and referred pain affects the pectoralis major muscle, multiple massage treatments targeting the trigger points can help alleviate the symptoms causing chest pains. Another way people can manage trigger points is by stretching the pectoralis major muscle to relieve tension and soreness in the chest. Incorporating various stretching techniques to alleviate chest pain can help loosen up the stiff muscles and warm them up before a vigorous workout. This allows the pectoralis muscles to provide optimal output on a person’s health and wellness.
The pectoralis major is a thick fan-shaped muscle located on the chest. This muscle works with the shoulders and upper half of the body while protecting the heart and the lungs from various injuries and chronic conditions. When these muscles become affected by injuries or chronic conditions, they can develop trigger points along the chest, causing referred pain to the pectoralis major muscles. This can lead to somato-visceral and visceral-somatic pain symptoms in the chest and make many individuals miserable. Luckily pain specialists who can help manage trigger points along the affected muscle utilize various techniques to reduce the symptoms and prevent trigger points from forming in the affected muscle again. This allows the individual to continue with their daily activities without worrying about chest pains.
Haładaj, Robert, et al. “Anatomical Variations of the Pectoralis Major Muscle: Notes on Their Impact on Pectoral Nerve Innervation Patterns and Discussion on Their Clinical Relevance.” BioMed Research International, Hindawi, 2 Apr. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6466946/.
Moraska, Albert F, et al. “Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial.” American Journal of Physical Medicine & Rehabilitation, U.S. National Library of Medicine, Sept. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5561477/.
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