Human Optimization

NUTRIGENOMICS – Advancing personalized medicine

As people age, diet and lifestyle play more prominent roles in the development of diseases than do genetics. The study of nutrigenomics is helping us visualize and understand the subtle, yet the profound connection between our genetic blueprint and the food and nutrients we put into our bodies.

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A long history

As far back as 400 B.C., it is believed that Hippocrates said to physicians: ‘Leave your drugs in the chemist’s pot if you can heal your patient with food.’ Today, Dr. Mark Hyman says, “Food is the code that programs your biology. You can literally upgrade or downgrade your biological software with what you choose to eat.” Every bite you eat is either fighting disease or feeding it.

It has long been known that individuals can differ in their requirements for a given nutrient. Back in 1956, Dr. Roger Williams coined the phrase and wrote the book, Biochemical Individuality, which illustrated how it “related to differing nutritional needs for optimal function among different people. He pointed out that even identical twins could be different in their needs for optimal function based upon the fact that they developed in different environments in utero. Although identical twins share the same genes, their differing nutrition and developmental environments can result in different expression of the genes as they grow older.”

When Williams’ book was republished in 1988, Dr. Jeffrey Bland, wrote in the forward, “. . . Dr. Williams [recognized] that nutritional status can influence the expression of genetic characteristics. Once again Dr. Williams foresaw this important concept in Biochemical Individuality and set in motion research and discoveries . . . that have transformed medicine.”

Some basic definitions

Genetics is the study of heredity and inherited characteristics. It often assesses single genes within congenital disorders, such as cystic fibrosis, muscular dystrophy, etc.

The National Human Genome Research Institute defines genomics as, “the study of all of a person’s genes (the genome), including interactions of those genes with each other and with the person’s environment.”

According to Nature Research, nutrigenomics is “the study of the effects of food and food constituents on gene expression, and how genetic variations affect the nutritional environment. It focuses on understanding the interaction between nutrients and other dietary bioactives with the genome at the molecular level, to understand how specific nutrients or dietary regimes may affect human health.”

Why is this important?

We’re all aware that specialized supplements, natural products, and a healthy diet have been used over the years and have been effective for many people. What if you could find out which nutrients, from food and/or supplements, would be specifically indicated for you based on your genes? Wouldn’t that be valuable information to have?

On page 102 in my book, The Longevity Equation, I raise the point that there is no one-size-fits-all diet. Each person has a complex variation of genes that influence which diet is optimal to stay lean, feel energized, and avoid disease. It’s important to understand that diet and lifestyle choices have a significant impact on the way your genes function. While your genes themselves won’t change, which ones are activated and deactivated can change. The study of nutrigenomics focuses on the way genes and nutrition affect one another.

“For instance, with the variant 164A>C of the CYP1A2 gene, often, a person will have a high sensitivity to caffeine, which can lead to high blood pressure and increased risk of heart disease. While most people won’t have a problem with caffeine, people with this gene will want to avoid it at all costs . . .

Since different diets produce different results for everyone, it’s vital that you determine the optimal diet for your specific biology. The only way to do this is to gain insight into what’s happening in your genetic coding. The best way to gain insight into your genetic coding is to do a genetic test.

In order for treatment to be specific and personalized, The Institute for Human Optimization looks at the single nucleotide polymorphisms (SNP – pronounced ‘snip’) within a person’s genome. A SNP is a DNA sequence variation that occurs when a single nucleotide (the building blocks of DNA) in the genome sequence is altered. SNPs do not cause disease, but they can help determine the likelihood that someone may develop a certain illness. SNPs largely influence our biochemical individuality, which is central to the practice of precision functional medicine. We assess the pattern analysis of a multitude of different SNPs.

Something like 99.6% of the human genome is identical in all people. This is true of everyone, regardless of race or heritage. However, it is at the SNP location that variation does take place. SNPs only make up a tiny portion of the genome (0.4%) but because the genome is so enormous, this equals over 12 million locations. It’s the differences at these SNP locations that make each of us unique.

There are many existing and new apps that measure single SNPs and make generalized recommendations, but they’re not personalized to the level that they should be. They are limited in what they can provide to customers legally, and their reporting is incomplete and broad.

What can the testing tell me?

Dr. Mark Hyman is known for using the phrase, “Genetics loads the gun, but lifestyle/environment pulls the trigger.” Our genes aren’t our destiny. The choices we make can determine how they are expressed. Even if we’re predisposed to a specific disease, we can potentially stop that from becoming reality by looking at SNPs and the specific pathways they affect.

In a 2007 research review, two doctors concluded that, “Effects of genetic diseases previously considered untreatable may now be ameliorated by administering higher amounts of the coenzyme(s) required for more efficient metabolic function. Through genetic and functional testing . . . risk factors may be identified and truly personalized interventions to improve health designed.”

The Institute for Human Optimization uses a test called GenomicInsight®, which combines today’s most advanced DNA testing with the powerful Opus23 Explorer® interface to produce the perfect combination of DNA testing, science, and current research.

Opus23 Explorer® scans over 20 peer-reviewed, evidence-based scientific databases, including metabolic pathways, etiological associations, and pharmacogenomic databases, and cross-references their information with the results of your GenomicInsight® raw data. This report summarizes important findings from your genomic data that will be curated by your clinical team into an easy-to-understand format.

How can The Institute for Human Optimization help me?

Using Opus23 Explorer® requires a highly-trained and specialized clinician to interpret and curate the data for the patient. Our clinicians will put your data in the appropriate context, taking into account your medical history, your stressors, your diet, your lifestyle, and so forth. So much data is available through this incredible analysis platform that your information will constantly be updated like a living document, as new research is done, new literature is published, and new discoveries are made.

Opus23 Explorer® assesses over 900,000 SNPs, but we only focus on 6,000 or so that have been clinically curated and shown to have an impact on disease progression and quality of life. Based on your genomic data, the platform allows our clinicians to assess the efficacy of natural products and foods that may be worthy of attention as potentially valuable therapeutic agents. The platform uses a combination of evidence-based medicine and your genomics to compile the most clinically applicable data that makes nutritional recommendations specific to YOU.

There is also another level to our testing that adds on microbiome analysis and integrates it with your genomic data. In an earlier blog we mention that your microbiome regulates 99% of your gene expression! The test will tell us how your body is integrating your lifestyle and environment with the genetic blueprint you were born with, and make recommendations accordingly!

The promise of precision medicine begins with your story. We provide the most comprehensive, data-driven approach to wellness. It is:

  • Predictive – We use genomics and advanced biomarker testing for risk stratification and empowerment.
  • Personalized – We use data-driven health information to curate actionable change for disease mitigation and prevention.
  • Preventive – We utilize highly individualized programs tailored to your unique genomic blueprint.
  • Participatory – We empower engagement in personal choices, which allows for improved outcomes and enhanced results.

Let’s discover your personalized nutrition plan together!

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AMP-ACTIVATED PROTEIN KINASE (AMPK): How to activate lasting energy

We’ve all learned of the importance of exercise to maintain a healthy body. Have you ever wondered why it’s so important, or considered what happens at the cellular level when you move your body? A very special enzyme with a four-letter acronym is behind it all!

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First, a little background biology

Adenosine Triphosphate (ATP) is the primary energy source of all living organisms. Energy is captured from the food you eat and is stored in the form of ATP. It is then broken down and the energy is released into the mitochondria, which are the powerhouses of the cell (remember high school biology class). The mitochondria then convert the energy into a form that cells can use. Simply put, the end product is called adenosine monophosphate (AMP).

Adenosine monophosphate-activated protein kinase (AMPK) – our above-referenced, four-letter acronym – is an enzyme that is biochemically activated in the presence of increasing levels of AMP (thus, the name) and decreasing levels of ATP. In my book, The Longevity Equation, I reveal, “If you want a bottomless supply of energy, activating AMPK is the #1 thing you need to do. AMPK is the body’s ultimate energy enzyme. This enzyme plays a huge role in the homeostatic control of energy balance. In other words, it helps regulate energy inflow [ATP] and energy outflow [AMP].” (p. 123)

What else does AMPK do in my body?

 Jeffrey Bland, PhD, calls AMPK the Chief Executive Housekeeper of the body:

When you cut calories or exercise, AMPK coordinates glucose and fat catabolism [breakdown] and anabolism [synthesis] to keep you going, and when you fast or lose weight, AMPK directs the sorting of cellular components for recycling or disposal in your metabolic waste bin. It oversees short-term energy usage as well as long-term energy regulation. In basic terms, cellular AMPK monitors levels of the energy molecules AMP and ATP . . . and communicates throughout the body to optimize their balance, exerting major influence over metabolic plasticity and cellular housekeeping functions.

I summarize in The Longevity Equation: “Along with controlling energy levels, AMPK also increases your metabolism, helps you melt away fat, cleans out old cells, acts as an antioxidant, and increases your overall blood flow. Most of all, it promotes longevity. In fact, research shows that AMPK activation can increase your lifespan by up to 15%! That could mean an extra 11.7 years.” (p. 123)

Activate AMPK with another four-letter acronym for exercise

Exercise builds muscle strength and flexibility, promotes cardiovascular health and encourages healthy lung capacity. But at the cellular level, exercise does so much more.

“If you have trouble finding energy during the day or you just can’t seem to get rid of that extra weight, chances are, you just haven’t figured out how to activate AMPK yet. But you’re in luck – activating [AMPK] is actually pretty simple. There’s one thing you can do today that will help “turn on” this enzyme almost instantly: exercise . . . This is because AMPK is stimulated by your muscle contractions. All forms of exercise will help activate this enzyme. However, research shows that high-intensity workouts produce the most significant results . . . The best way to do this is with high-intensity interval training (HIIT). HIIT uses short bursts of intense exercise, followed by a resting period . . . If you want more energy, you have to get your body moving and your muscles working.” (The Longevity Equation, p. 123-124)

“A lack of time might be the #1 reason why people don’t work out. But what if instead of spending 30, 60, 90, or 120 minutes working out each day, you could get amazing results in WAY less time? Well, [the training coach of a Japanese speed skating team], named Izumi Tabata, developed a 4-minute workout (after warmup) that completely shatters the idea that workouts have to be time-consuming to be effective. In fact, one study showed that this workout method is even more effective than cycling for a full hour. If you want to build muscle, burn fat, and increase your endurance quickly and without lifting a single weight, you can’t go wrong with this workout.” (The Longevity Equation, p. 135)

The Tabata Protocol:

Step 1: Warm up the body for 5-10 minutes.

Step 2: Complete 8 sets of the following:

·         20 seconds of high-intensity action (sprinting, cycling, rowing, burpees, etc.)

·         10 seconds of rest

Step 3: Cool down.

Expanding on cellular housekeeping

In our blog on Cellular Senescence, we talked about autophagy [aw-tof–uh-jee], your body’s built-in cellular recycling program. AMPK is involved in a selective form of autophagy called mitophagy. Dr. Jeffrey Bland continues to expand on this:

One of AMPK’s most important missions is responding to mitochondrial stress and injury caused by redox imbalance, oxygen tension, and mitochondrial toxins such as pesticides and microbicides. Upon these kinds of challenges, AMPK determines when to enact mitophagy to “part out” usable portions of damaged mitochondria and/or order production of new ones. This housekeeping role [is] a crucial aspect of healthy cell life cycles . . . Many of AMPK’s activities take place through an impressively broad communications network with many well-known signaling systems linked to biological aging . . . AMPK regulates glucose uptake, insulin sensitivity, fatty acid oxidation, protein and muscle synthesis, exercise capacity, and the inflammatory response.

In addition to exercise, evidence shows that caloric restriction/intermittent fasting increases lifespan and longevity by activating AMPK’s ability to initiate mitophagy. Research demonstrates that “among the effects of [caloric restriction/intermittent fasting], modulation of mitochondrial activity and a decrease in oxidative damage are two of the hallmarks.”

One more easy way to activate your AMPK

I have developed a potent blend of phytonutrients that can help stimulate autophagy and mitophagy by activating your body’s own AMPK. It’s the only supplement of its kind that works on a cellular level to help flush toxic cells out of your body and pave the way for fresh, new, rejuvenating cells to take their place.

It’s called Restori-Cell, and it gives you a way to rewrite the script and change the way you think about aging. It boosts mental clarity, promotes youthful, all-day energy, and supports a natural, healthy weight. Restori-Cell meets the highest standards of quality and features five highly specialized nutrients in scientifically-supported doses:

  • BERBERINE HCL (Berberis aristata) (root): Research suggests that “berberine displays beneficial effects in the treatment of diabetes and obesity at least in part via stimulation of AMPK activity.” South Korean researchers published a study that demonstrated how berberine activates AMPK. In fact, a study published in the journal Aging Cell found that it could extend the lifespan of mice by 16%! Berberine is such a potent cell-restoring nutrient that many people report that they can almost feel it working its magic.
  • HESPERIDIN (Citrus aurantium) (Citrus peel): Hesperidin is a special flavonoid extracted from the peel of bitter orange that has been shown to activate AMPK resulting in cellular regulation. A study was also published that “rigorously demonstrated [that] daily oral consumption of hesperidin . . . improved endothelial function, reduced circulating biomarkers of inflammation, and favorably altered lipid profiles in subjects with the metabolic syndrome.”
  • GYNOSTEMMA (Pentaphyllum) (leaf extract 20): Gynostemma is distantly related to the cucumber and native to Japan, China, and Korea, where it’s long been called the ‘little herb of immortality.’ That’s because inside its leaves are powerful plant flavonoids called gypenosides that activate AMPK and help supercharge your natural autophagy. There is evidence that shows gynostemma could have powerful effects on mediating weight gain. Another study indicated that gynostemma and activated AMPK can have beneficial effects on glucose and lipid metabolism.
  • QUERCETIN: A 2018 study implies that quercetin may be a therapeutic intervention for the treatment of cardiovascular disorders such as atherosclerosis and hypertension.” While another study suggests that, “AMPK activated by quercetin may be a potential target to enhance the resistance of neurons to age-related diseases.” Researchers have also suggested “the importance of [using quercetin to] modulat[e] AMPK pathway for improved therapeutic approaches to type 2 diabetes and associated disorders.”
  • FISETIN: There’s truth in the saying, “An apple a day keeps the doctor away.” Fisetin is a natural plant compound found in fruits like apples and strawberries. Fisetin is one of the most exciting anti-aging discoveries of all time. One profound study revealed that fisetin inhibits cancer cell growth and “activates AMPK to induce apoptosis [cell death] in multiple myeloma cells . . . inhibits . . . non-small cell lung cancer . . . and induces autophagy-mediated cell death by activating AMPK . . . in prostate cancer cells”

How can The Institute for Human Optimization assist me?

At The Institute for Human Optimization, my team and I leverage the most cutting-edge advances in genetic testing, nutritional, and functional medicine to help our patients treat the root biological imbalances that cause aging. I believe that a long healthspan – not just a long lifespan – is the most important thing you can cultivate. A long healthspan means you don’t miss out on life as you get older. It means remaining independent and having the vitality to travel and see the world.  A long healthspan means that you can be there – in full body and mind – for the people who need you the most and that every day will feel like a gift.

The Institute for Human Optimization provides the most comprehensive, data-driven, personalized approach to wellness. It is:

  • Predictive – We use genomics and advanced biomarker testing to risk stratification and empowerment.
  • Personalized – We use data-driven health information to curate actionable change for disease mitigation and prevention.
  • Preventive – We utilize highly individualized programs tailored to your unique genomic blueprint.
  • Participatory – We empower engagement in personal choices, which allows for improved outcomes and enhanced results.

Let’s create longevity and lasting energy together!

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BIOMETRICS: PUTTING IT ALL TOGETHER

Biometric tracking is at the center of personalized medicine and can be used clinically to monitor useful, real time information about your health. Biometry literally means the measure of life, and in a broader sense, it designates the quantitative study of living beings. 

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The first steps on your health journey

The Wall Street Journal states that, “The Centers for Disease Control and Prevention (CDC) calls lifestyle-related chronic disease such as obesity, Type 2 diabetes, hypertension and cardiovascular disease the greatest health challenge of the 21st century. The CDC estimates that half of all adults in the U.S., or 117 million people, had one or more chronic health condition in 2012, accounting for 86% of all health-care spending.” That is a bold statement and a staggering number!

At The Institute for Human Optimization, our traditional, functional and precision medical approach gives us the ability to explore and ascertain the deep-seated biological imbalances that influence disease expression. We analyze all of the factors that contribute to this process and use this information to render personalized protocols.

We illustrate the connection between your genetic blueprint, your microbiome and your current state of health, which is measured by biomarkers. These all interweave and become a measurable, visual representation and expression of your life story at the molecular level.

Once we determine your individualized functional medicine protocols and your personalized wellness plan, the next step towards optimum well-being is supported with the use of biometric monitoring. We guide and facilitate your journey through this process with the added benefit of health coaching, so you will not have to make changes on your own. We find that this empowers individuals when they see the connection between the influences of their health decisions on their physical expression.

What is biometric monitoring?

Personalized medicine requires us to understand unique characteristics. With the use of biometric monitoring, The Institute for Human Optimization can establish biological parameters with data that would otherwise not be provided in a regular checkup. When answering clinical questions, physicians have historically had to rely on responses and not data.

Biometric monitoring tools are the foundation of an effective functional wellness program. The utilization of various health technologies to measure lifestyle factors that affect your health, such as nutrition, activity, mindfulness and sleep, allows us to establish a baseline picture of your state of wellness and provide specific recommendations to optimize your lifestyle.

We utilize wearable smart devices and mobile app technologies to clinically track and better understand the relationships between measurable biological processes and clinical outcomes. In other words, they provide a simplified way of understanding of how your body is responding to various lifestyle factors. With the cutting edge development of wearable technology, physicians and patients can come together with lifestyle interventions rapidly, rigorously, and seamlessly.

Using specialized HIPPA-compliant, cloud-based software, we are able to manage and integrate your personal information from the wearables and apps in real-time, which helps us objectively measure your progress. Our goal is to use this data to drive informed decision making and demonstrate how your behaviors influence your outcomes, like a cause-and-effect relationship. Using our longitudinal tracking tools, we are able to document your progress over time and identify areas where we can further optimize your health and fulfill your vision of well-being.

The importance of biometrics

Google, whose English dictionary is provided by Oxford Languages, defines data as “facts and statistics collected together for reference or analysis.” This is significant in regards to how biometrics helps to translate your life story.

Our platform makes it easy to synchronize data from popular apps and wearable devices. This includes the popular activity trackers, watches, weight scales and blood pressure cuffs, as well as data interchanges such as Apple Health.

According to Heads Up Health, one of our partners in managing and delivering your biometric results, “Health can only be measured with multiple data points, over a period of time, not just a snapshot…Using Heads Up you can track your daily glucose from Keto-Mojo, your steps from Apple Watch and your sleep from your Oura Ring.  Plotting all this data on a single graph helps you to truly see patterns of optimal health. By combining apps that track your lifestyle with your medical records, you can see how your lifestyle modifications (diet, sleep, exercise, stress etc.) truly affect clinical markers of health and disease as well as what action steps to take to optimize your well being.”

Robb Wolf, the Founder of Heads Up Health, says, “You cannot change what you do not track! In the modern world of ‘quantified self’ there are nearly limitless options for tracking of various biomarkers and lab values. What’s important? How does one make sense of it? Heads Up Health is unique in that it offers tracking capabilities that focus on the things that matter most. They offer a user experience that is intuitive and informative so you can track, understand and change those areas of your life and physiology that matter most.”

The following are only a few of the many app and device integrations are available through Heads Up Health:

·         Oura ring: Measures sleep quality, heart rate variability (HRV), resting heart rate, and activity levels

·         Biostrap: Measures similar biometrics to the Oura Ring, with the addition of blood oxygen saturation and respiratory rate

·         KetoMojo: Measures ketones, blood hemoglobin, hematocrit, glucose:ketone Index, blood glucose

By tracking your lifestyle and translating that data, it allows you to live in a proactive state, rather than a reactive state. You are able to make or tweak decisions with a calm, sound mind as you go, and possibly eliminate problems before they even appear; instead of waiting for something to happen and having to make sudden, panicked, sometimes life-threatening choices.

Why would I need a health coach?

It is well known that coaches can help improve quality of life, overall mood, and response to stress. And so it is interesting to point out that studies are also showing that health coaches are not only integral in helping to modify risk factors in healthy people, but also in helping to mitigate many common chronic diseases when working with health professionals.

There is no one-size-fits-all approach to changing health habits. People do best with an individualized approach that meets them where they are and guides them to where they need to be. We call that approach person-first. It’s a comprehensive, person-centric, behavior-based primary coach model that integrates lifestyle and condition management, delivering better experience and real results.

The small-step behavior change model found within The Institute for Human Optimization’s Patient Journey is also fully integrated into our live coaching experience. Digital and live health coach support are completely interwoven on a single platform—making our approach unique.

How can The Institute for Human Optimization assist me?

The Institute for Human Optimization streamlines the process of collecting biometric data through a combination of on-site, in-clinic and at-home screening options for more convenience, access and engagement. And we oversee the whole process, so you don’t have to.

Biometrics help the Institute for Human Optimization to follow the precision medicine model of being predictive, preventative, personalized, and participatory. This act of engagement and participation in your health is the first step to achieving your health goals. It empowers you to manage what you can measure, and identify self limiting patterns of behavior that might be preventing you from achieving your fullest potential. It covers a wide range of applications with metric driven results, including weight management, nutritional adherence, exercise, tracking Qqq, and monitoring medication compliance.

We integrate biometric screening data into each patient’s health assessment automatically, saving time, and helping paint a more complete picture of health. The Institute for Human Optimization Access Network makes biometric screening services available to patients and allows for direct patient behavioral monitoring. This can be used to help promote goal-oriented long-term behavioral change towards longevity.

Optimization monitoring and tracking your biometric data is only one component of the advanced translational precision care provided at the Institute for Human Optimization. We provide the most comprehensive, data-driven, personalized approach to wellness. It is:

·         Predictive – We use genomics and advanced biomarker testing to risk stratification and empowerment.

·         Personalized – We use data-driven health information to curate actionable change for disease mitigation and prevention.

·         Preventive – We utilize highly individualized programs tailored to your unique genomic blueprint.

·         Participatory – We empower engagement in personal choices, which allows for improved outcomes and enhanced results.

Let’s put it all together!!

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BIOMARKERS: CONNECTING THE MOLECULAR DOTS USING BIOMARKERS

We’ve talked about how your story begins with the fact that DNA determines an overwhelming amount of information about who you are, what you look like, and how certain environmental factors influence your overall health. We’ve also talked about how the state of your microbiome, which is the important and complex social network of microorganisms that coinhabit your body, contributes to the development of a strong immune system and your overall wellness.

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Let’s continue to connect the molecular dots of your life story.

At The Institute for Human Optimization, understanding your story is a critical element in our approach to your healthcare. Genomic testing enlightens your predisposition to certain health vulnerabilities. Microbiome testing shines the light on how microbial imbalances in your body manifest in illness and disease. And last but definitely not least, comprehensive biomarker testing gives you a snapshot of your current state of health. This enables us to take a deep dive into your story and translate your unique book of life. We gain insights about you individually, and we learn how we can leverage this information to help influence clinical decision making.

Biomarkers, portmanteau for “biological markers,” are measurable substances, usually proteins encoded by DNA, which provide useful information about medical conditions or disease processes. They are found in blood, urine, saliva and various tissues.  They help establish a baseline health status, serve as an early warning sign of potential health concerns, and provide objective goals which can be clinically monitored and used to track your progress.

There are two main ways of assessing biomarker ranges.

The pathological range is used to diagnose disease. Typical reference ranges provided with laboratory testing results are reported in “pathological ranges.” They are generated in reference to all available laboratory results. These usually reflect any number out of this range as having an underlying potential disease process, and see the disease diagnosis as an endpoint in care.

The functional range is used to assess risk for disease before it develops. The Institute for Human Optimization uses this information to help identify and prevent specific conditions using a proactive, preventative approach. We not only asses your basic, conventional biomarker standards, but we take it a step further towards health optimization and disease prevention. Jeffrey Bland, PhD, FACN, FACB, considered the Father of Functional Medicine by many, states in an IMCJ article, “In the functional medicine model, the word function is aligned with the evolving understanding that disease is an endpoint and function is a process.” This is a significant distinction that illustrates the importance of connecting those molecular dots throughout your life and how your life journey resulted in your current state of health.

What can my biomarkers tell me?

The Institute for Human Optimization uses advanced biomarker and functional medicine testing to assess how an individual responds to personalized treatment for various health conditions. Providing precise, targeted therapy can be utilized to support physiological pathways and be used to enhance favorable gene expression to promote health and wellness.

We offer over one hundred advanced biomarker tests that can be used to optimize your health.

Here are some examples:

BLOOD LIPID MARKERS – Assessing cholesterol particles helps evaluate heart health and hormonal influences. An example of one of these biomarkers is very low-density lipoprotein (vLDL).  University of Michigan Health Library explains that the main purpose of vLDL “is to distribute the triglyceride produced by your liver. A high vLDL cholesterol level can cause the buildup of cholesterol in your arteries and increases your risk of heart disease and stroke.”

COMPLETE BLOOD COUNT – Red and white blood cells are foundational to wellness. While problems are rare, they often go undetected. Hemoglobin, which measures the total amount of the oxygen-carrying protein in the blood, is one level that is checked with this test panel. If the level is low, it can indicate anemia, which according to The University of Rochester Medical Center, “can be caused by blood loss, decreased production of red blood cells, or increased destruction of red blood cells.” The complete blood count also helps us identify and evaluate your overall health, as well as detect a variety of diseases and conditions, such as infections and blood disorders.

COMPREHENSIVE METABOLIC PANEL – We don’t overlook the basics. These standard markers help us flag problems. This panel evaluates your liver, kidneys, electrolytes, blood sugar and more to provide a picture of your overall health. For instance, in addition to other minerals, potassium is one of the important mineral/electrolytes included in this panel, as it helps to keep fluid balanced in your body. UW Health indicates that, “A potassium level that is too high or too low can be serious. Abnormal potassium levels may cause symptoms such as muscle cramps or weakness, nausea, diarrhea, frequent urination, dehydration, low blood pressure, confusion, irritability, paralysis, and changes in heart rhythm.”

HEAVY METALS AND ENVIRONMENTAL TOXIN MARKERS – If your body is storing harmful toxins, we test for common culprits like mercury, lead and arsenic. Vibrant Wellness, one of our testing partners, asserts that, “Heavy metal toxicity is under-represented as a root cause of illness and disease in humans, is thought to affect over 1 million individuals annually, and can affect virtually all biological systems within the human body.”

INFLAMMATORY MARKERS – Chronic inflammation is harmful to many areas of your wellness. We test for levels of C-reactive protein (CRP), which is made in the liver when there is inflammation in the body. This can be protective, but research shows that prolonged excessive inflammation can indicate infection or higher risk of disease.

DIABETIC MARKERS – We look for early warning signs and make adjustments to your diet and lifestyle to ward off disease development. One of the ways we do this is by measuring your Hemoglobin A1c (HbA1c), which shows the average amount of glucose present in the blood within the past 2–3 months. Research has determined that, “HbA1c is an important indicator of long-term glycemic control…HbA1c not only provides a reliable measure of chronic hyperglycemia, but also correlates well with the risk of long-term diabetes complications.”

HORMONE MARKERS – Hormones are involved with everything – including the way you look, the way you feel, and the energy that you have. Identifying dysregulated patterns can be the missing link in your health. Cortisol, well-known as the “stress hormone,” is a glucocorticoid that plays a key role in our body’s response to stress and glucose metabolism, and modulates many physiological and psychological processes. Studies show that chronic elevation of cortisol can result in depression, abdominal obesity, and mineral loss from bone, among a long list of other effects.

VITAMINS AND MINERAL MARKERS – Vibrant America, another one of our testing partners, shares this information about the importance of measuring your body’s vitamins and minerals: “Your genetics, aging, lifestyle, chronic illness, and medications all affect your cellular nutrient absorption. The intracellular portion of [our] micronutrient test takes all the above factors into consideration to identify [your] cellular nutrient absorption status. This test can reveal a person’s functional nutritional status over a [4-6 month time period].”

ESSENTIAL FATTY ACID INDEX – Your balance of Omega-3 and Omega-6 fats is important for heart health and inflammation. Great Plains Laboratory, which runs our essential fatty acid testing, points out that, “Many studies have shown that people with higher (vs. lower) omega-3 index levels are at decreased risk for a variety of diseases. These include heart disease, stroke, dementia, and depression to name a few. These people even live longer than those with lower levels.”

How can The Institute for Human Optimization assist me?

Understanding the relationship between measurable biological processes and clinical outcomes is vital to expanding our arsenal of targeted treatments for all diseases and for deepening our understanding of normal, healthy physiology. There are a number of advantages to using biomarkers to gauge your progress towards your health goals.

Biomarker testing allows The Institute for Human Optimization to make more precise diagnoses and prescribe more effective, personalized treatments. It also helps us predict disease and take preventive measures to avoid unnecessary treatment. When we combine that with what we know of your unique genetic blueprint and how it’s being expressed, you’ll be able to optimize your health like never before!

We provide the most comprehensive, data-driven, personalized approach to wellness. It is:

·         Predictive – We use genomics and advanced biomarker testing to risk stratification and empowerment.

·         Personalized – We use data-driven health information to curate actionable change for disease mitigation and prevention.

·         Preventive – We utilize highly individualized programs tailored to your unique genomic blueprint.

·         Participatory – We empower engagement in personal choices, which allows for improved outcomes and enhanced results.

Let’s connect the next dot together.

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Microbiome

WHAT’S THE STORY WITH YOUR MICROBIOME?

The human microbiome is a fascinating, emerging area of science and clinical research. Assessing the microbial diversity throughout your body holds promise in looking at how our body’s cohabitants work in synergy with or parasitism against its host.

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Your life story is one of your most valuable assets. It contains everything you need to navigate your health and wellness. When you take the time to look at it, your story also connects all of the dots that make you, YOU! You are made of not only the genetic blueprint you were born with, but your environment, your experiences, your choices, and yes, the state of a little-known, hidden organ:  your microbiome. Let’s find out how!

What is my microbiome?

Do you know that your body is home to around 100 trillion microscopic organisms living and working in delicate balance? To put that number in perspective, the height of a stack of one hundred trillion (100,000,000,000,000) one dollar bills measures 6,786,616 miles – this would reach from the earth to the moon and back 14 times!!  These microorganisms even outnumber your human cells 10 to 1! In fact, you have more foreign microbes within your body than human cells, and when you consider DNA, only 1% of your body’s gene expression is performed by human genes. The rest is by your unique microbiome!

These diverse, complex communities of microbes live on your skin, in your mouth, in your intestines and elsewhere. It is estimated that there are over 10,000 different types of microorganisms living within our bodies, and each of us carry a distinctive manifestation of microbial diversity, just like a fingerprint!

Your unique microbiome started as soon as you were born and is continually influenced by your diet, your experiences, what you’ve been exposed to and where you live. You depend on these complex social networks of microorganisms to help break down nutrients and produce important vitamins and enzymes in your digestive system, which in turn strengthens your immune system. Are you starting to see how important your microbiome is to your life story?

What happens if my microbiome is out of balance?

When this healthy community of microorganisms gets tipped out of balance, certain types of bacteria can grow out of control, causing illness. It’s easy then to see how the microbiome is being linked to so many areas of health, including obesity, autoimmune disease, diabetes, anxiety, depression, Alzheimer’s, Parkinson’s, heart disease, colorectal cancer and more! It’s also the reason why dieting might not have worked for you in the past. Scientists have even identified that your microbiome influences your mood and behavior via bacteria and other microbes signaling pathways throughout your body, which influences your brain chemistry.

There is a plethora of research out there, so let’s look at some quick details to give you an idea of how this imbalance can show up in your story:

Obesity and Gastrointestinal Disease

Obesity, metabolic syndrome, and gastrointestinal disease are all influenced by our gut microbiome. Studies have indicated that the health of our microbiome can influence how our body uses energy from the food we eat. It can also have an effect on our genes that regulate how that energy is utilized and stored.

Autoimmune Disease

Our microbiome controls our immune system more than we realize. In one surprising study, researchers found that bacteria in the small intestines of mice and humans can travel to other organs, where they may trigger an autoimmune response.

Diabetes

Our gut microbiome is associated with both type I and type II diabetes and the complications that come with it. The TEDDY study, which is looking for the environmental causes of type 1 diabetes (T1D) in children, suggests that early microbiome influences may contribute to T1D risk and disease progression.

Mental Health

Our gut microbiome has been shown to influence depression, cognition, behavior, and neural development. Studies are beginning to demonstrate the importance of the gut-brain axis and suggest that triggers for a variety of neurological diseases can be found in the microbiome of the gastrointestinal tract.

Alzheimer’s Disease

Microbes are involved in the development of Alzheimer’s pathology. Researchers have found evidence that bacteria can influence Alzheimer’s symptoms by triggering and sustaining inflammation pathways in the brain.

Parkinson’s Disease

Our gut microbiota has been linked to Parkinson’s disease. In studies with mice, researchers have found that changes in the microbiome may set off Parkinson’s disease by negatively affecting the brain and triggering motor symptoms.

Heart Disease

Certain bacteria have been linked to atherosclerosis, an all-too-common heart condition. Evidence is starting to show that variations in our microbiome can affect high blood lipid levels, such as triglycerides and cholesterol, which leads to cardiovascular disease.

Colorectal Cancer

Shifts in the makeup of our gut microbiome are associated with colorectal cancer. Animal and human studies have shown that dysbiosis in the gut microbiome has been found in patients with colorectal cancer, which resulted in pro-inflammatory pathogens and a decrease in butyrate-producing bacteria, which helps to protect the mucosal lining of our intestines.

What can my microbiome tell me?

Enhanced microbial species biodiversity is associated with overall wellness. Assessment of the state of your microbiome can aid in the identification of the ideal macronutrient ratios of proteins, carbohydrates, and fats for your diet. It can also help determine the foods that are most compatible with your body, which can assist in compiling an individualized dietary and supplement recommendation that will help you achieve and maintain a healthy weight, increase your energy and focus, and contribute to your overall well being.

Microbiome testing identifies the microbial species associated with disease and poor health so that an effective, personalized treatment plan can be made. It can diagnose dysbiosis disease states, including small intestinal (fungal/bacterial) overgrowth. We can then cultivate beneficial (but missing) bacteria with probiotic supplements and identify prebiotics that enhance the growth of beneficial microbes and promote metabolite health. This process downregulates toxic metabolites and enhances assimilation through optimized digestion and absorption.

How can The Institute for Human Optimization assist me?

The Institute for Human Optimization is exploring the genetic code of the microbiome and is seeking to better understand how the microbiome promotes wellness or enables disease, and how that knowledge can be harnessed to enhance the practice of precision medicine. We are finding new ways to keep the microbiome healthy, repaired, and use its power to prevent and treat disease.

The testing technology we offer is used routinely in clinical and academic research because it provides highly-accurate quantification, as well as high levels of sensitivity and specificity. This information allows us to make early diagnoses and design new and more effective personalized, preventive therapies to optimize your life.

The promise of precision medicine begins with your story. We provide the most comprehensive, data-driven approach to wellness. It is:

  • Predictive – We use genomics and advanced biomarker testing for risk stratification and empowerment.
  • Personalized – We use data-driven health information to curate actionable change for disease mitigation and prevention.
  • Preventive – We utilize highly individualized programs tailored to your unique genomic blueprint.
  • Participatory – We empower engagement in personal choices, which allows for improved outcomes and enhanced results.

And so, here’s where our stories converge. Let’s begin a new chapter together.

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How We Use Your Genome to Optimize Your Health

Your DNA determines an overwhelming amount of information about who you are, what you look like, and how certain environmental factors influence your overall health. This is why at the Institute for Human Optimization, we aim to be a wellness intelligence partner for our patients, using the latest genomic testing to empower them to reach their full human potential. By generating your unique comprehensive genomic profile, we are able to gain insight into your genetic makeup and help you take your health into your own hands. In this week’s post, we’re discussing the human genome, and how we help our patients use this knowledge for the prevention, early diagnosis, and personalized treatment of complex, chronic conditions.

In virtually every cell of your body is a complete copy of the three billion DNA base pairs that make up the human genome.

The study of the human genome is different from the study of genetics in that it focuses on the entirety of the genetic makeup and tries to sequence it. This is an ongoing research subject, mainly carried out by the Human Genome Project. But why is this important to you and your personal health journey?

Everything starts in the genome- from what you look like, to what disorders you’re predisposed to, to what foods you should and shouldn’t eat, it’s all there. And thanks to decades of research, we now have advanced molecular testing that can predict how genes are behaving by assessing their structural makeup and biochemical expressions.

At the Institute for Human Optimization, we utilize what we refer to as a “genotype to phenotype approach”. Your phenotype is the physical expression of the genome. It’s the way your genome produces blue eyes instead of brown, or curly hair instead of straight. It’s the way your genes influence your resting heart rate, blood pressure, or response to stress. These traits can be measured and therefore, manipulated.

An article in the New England Journal of Medicine describes how our genes are marked by experience. There are molecular “tags” that influence gene expression, even to the effect of “turning up or down the volume” on specific genes. For example,

“Men whose grandfathers were exposed to the Swedish famine in Överkalix before puberty tend to die at an earlier age from various common diseases than men whose grandfathers were not exposed to the famine. Both the Dutch Hunger Winter and the Great Leap Forward of China involved mass starvation of the population, and in both cases, fetal exposure to famine during the first trimester of gestation was associated with an incidence of schizophrenia in adulthood that was twice as high as the incidence among adults who had not been exposed during gestation.”

N Engl J Med 2018; “The Key Role of Epigenetics in Human Disease Prevention and Mitigation”
DOI: 10.1056/NEJMra1402513

By combining individualized genomic blueprint analysis and phenotypic biomarkers as well as biometric data tracking over time, the Institute is able to help us guide your health decisions, behavioral patterns, and therapeutic interventions. In return, there’s the potential for improved health outcomes, quality of life, and longevity. 

Your life choices affect how your genes are expressed, and the only way to find out how to hack this system is with genome testing.

How We Test

As an institution that prioritizes hard data over trial and error, we use advanced molecular testing to map out your personal genome and apply this data into what we call a “Personalized Prescriptive Performance Program“. Your genetic makeup, lifestyle, and goals are not the same as the next person’s, so why should your healthcare strategy mirror theirs?

To get the basis for your program, we rely on the cutting edge software developed by Dr. Peter D’ Adamo, Opus23. It uses a sample of your DNA to generate a report detailing any genetic discrepancies you may have. There are distinct polymorphisms that can occur within the genes that change the way those genes are expressed. We covered this in a previous blog post, “Epigenetics: How to Control Your Gene Expression”.

Genomic testing is used to evaluate common genetic variations known as single nucleotide polymorphisms (SNPs). The presence of specific SNPs may indicate a predisposition for health vulnerabilities. SNPs may be assessed in multiple functional areas including cardiovascular, detoxification, methylation, immune modulation, and estrogen metabolism.

By understanding your genetic foundation, we can recommend vitamins, supplements, and therapies to truly optimize your health. This information can give you insight into how your genes are behaving and how to tackle possible health problems at their root cause before they begin. Prevention is always better than a cure.

The platform we use reports on over 5,200 SNP variants and their influence on:

The Future of Healthcare

The Institute for Human Optimization operates on the principles of integrative and functional medicine. We believe the future of healthcare lies in educating patients on how to live their lives in a way that promotes health and builds up resiliency so old age is not synonymous with disease and chronic illness.

Using a variety of testing methods as well as a detailed client intake process, we create a Personalized Prescriptive Performance Program for your unique genome and goals using the following:

  • Nutrigenomics – the way your genes dictate how your body metabolizes vitamins, minerals, and nutrients. For example, a polymorphism in the BCO1 gene can cause a person to not metabolize vitamin A correctly. Supplementing with extra vitamin A may be helpful in negating health consequences from having this genetic polymorphism.
  • Pharmacogenomics – Offers insight into predicting drug responses and clinical outcomes. It can be used to reduce adverse events, and select the correct dosing and timing of administration of medications. This is largely due to the metabolizer status of the individual.
  • Microbial Genomics – the way our genes influence our resident microbiome population and biodiversity. For example, FUT2 gene variations influence an individual’s sector potential of placing an H antigen oligosaccharide on the intestinal mucosa which acts as both an attachment site and a carbon source for intestinal bacteria.
  • Longevity Genomics – the study of longevity genes is a developing science. It is estimated that about 25 percent of the variation in the human life span is determined by genetics, but which genes, and how they contribute to longevity, are not well understood. A few of the common variations (called polymorphisms) associated with long life spans are found in the APOE, FOXO3, and CETP genes, but they are not found in all individuals with exceptional longevity. 

By detailing your genome, we can often predict what will happen before it does. We can understand how your body is functioning and what we need to do to optimize your health from the genome to the phenome.

To schedule a consultation with the Institute for Human Optimization or find out more about genome testing and the Opus23 software, click here.

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    Sex Hormones: Not Just for Sex

    Evolution has two ultimate goals: survival and reproduction. We’ve covered the basic survival hormones, adrenaline, and cortisol, responsible for dealing with stress and initiating the “fight or flight” response. We’ve covered most of the hormones that serve as chemical messengers to tell your organs what to do. And we discussed the all-important thyroid and how to test its functions. In the final installment of our endocrine series, we’ll be delving into the reproductive aspect of hormones, how they regulate body functions and the latest technology for comprehensive hormone testing.

    Most people are familiar with the three basic sex hormones- testosterone, estrogen, and progesterone. What’s less well-known is that these hormones do so much more than regulate sexual functions. They’re a vital part of keeping the body working properly, just like the rest of the hormones involved in the endocrine system.

    Nothing in the body exists in a vacuum. Hormones are part of a complex system consisting of chemical signals, cellular receptors, glands, and organs. Researchers are still in the process of discovering the ins and outs of the endocrine system, and therefore it can be difficult for medical practitioners to diagnose and treat hormonal imbalances.

    Thankfully, today there is a wide base of knowledge regarding hormones and testing you can do to get an idea of how yours are behaving. Men and women have very different requirements for their sex hormones and understanding the difference can be helpful to take proactive steps to better endocrine health.

    Testosterone

    Testosterone is the sex hormone most people relate to manliness- muscles, beards, deep voices, and testicles. And though it does have an effect on all these things, the truth is women have testosterone too (though in less abundance).

    Testosterone is produced in the testes in men and the ovaries in women. All testosterone production is stimulated by the master pituitary gland and has a variety of functions including bone development, muscle growth, and body hair. It is testosterone that tells a boy’s body to become a man’s and keeps them feeling energetic and vital throughout life.

    Like all hormones, the body requires a balance to operate efficiently. As men age, they experience a decline in testosterone that can happen gradually or quickly depending on a number of factors. Decreased testosterone in men can cause weight gain, decreased sexual desire, type 2 diabetes, thyroid imbalances, bone loss, muscle loss, and even cancer. That’s why it’s important to take note of testosterone levels as you age and make sure you’re living a lifestyle that promotes healthy production.

    When a man is stressed (either from lifestyle factors, eating too few calories, or constant extreme cardio exercise), he produces the stress hormone, cortisol. Cortisol is known to decrease the amount of free testosterone in the body, meaning there is less that can be absorbed into cells to make things happen.

    Measuring testosterone levels has been an ongoing challenge in medicine. Currently, blood serum is used to test hormone levels and is often used to diagnose endocrine disorders. It is known that in men, testosterone secretion follows a circadian rhythm, being highest in the morning and decreasing during the day. Therefore, it’s best to take samples for testing in the morning hours for the most accurate results.

    Men, on average, have 7-8 times more testosterone than women. This makes testing for imbalances in women more challenging. There have also been varying measurements observed between laboratories, giving researchers a reason to begin looking for better methods of testing.

    Estrogen

    Estrogen is the “female hormone” but is also found in men. It’s produced mainly in the ovaries, but also in the adrenal glands and fat tissue.

    Estrogen is not a single hormone, but a collective name we give to all three forms of it- estrone, estradiol, and estriol. Together they help tissues grow (namely, the breasts, ovaries, and prostate) and help regulate serotonin in the brain.

    Estrone (E1) is a weak estrogen. It is mostly produced by women that are post-menopausal. The effects of low estrone or high estrone levels are not currently well known but it is commonly associated with breast and prostate cancer. Because it’s produced in adipose (fat) tissue, women who are obese will produce more estrone and be put at risk for these cancers.

    Estradiol (E2) is the primary estrogen produced in women during their child-bearing years. Its main duty is to mature the reproductive system and maintain it. It is the strongest of the estrogens and protects bone density, growth hormone levels, and mood in both men and women (though women have higher levels).

    Having too much estradiol has been associated with acne, loss of sex drive, constipation, and depression. Extremely high levels can put women at risk for uterine and breast cancer. As a woman ages, her estradiol levels drop, resulting in the cessation of the menstrual cycle and the symptoms of menopause- hot flashes, mood swings, and vaginal dryness.

    Estriol (E3) is the weakest form of estrogen and is responsible for protecting breast tissue and vaginal health. By occupying the receptors for estrone, it blocks its cancerous effects and maintains a healthy reproductive system.

    Progesterone

    Progesterone is a precursor for testosterone, estrogen, and cortisol. In women, it works with estrogen to regulate the menstrual cycle and prepare the body for pregnancy. Most contraceptives are a mix of estrogen and progestin, a chemical created to bind to progesterone receptors and stimulate the same effects. (Progesterone is not well-absorbed orally.)

    Because progesterone becomes cortisol (the stress hormone), people who are constantly stressed will often have low levels of progesterone. In men, this means less progesterone gets to become testosterone, which can lead to problems like depression, muscle loss, weight gain, decreased sexual desire, and bone loss.

    Women with low progesterone levels may struggle to conceive because the body needs the hormone to create an environment for a fertilized egg to grow. These women may also have a higher risk of miscarriage.

    The Dutch Test

    At the Institute for Human Optimization, we take testing to the next level. While most physicians rely on blood serum testing for hormone levels, we prefer the Dutch test. Using five dried samples of urine over a 24 hour period, the Dutch test provides the most comprehensive assessment of sex and adrenal hormones and their metabolites. It also includes the daily, free cortisol pattern, organic acids, melatonin (6-OHMS), and 8-OHdG.

    Hormone levels vary throughout the day. Additionally, there is a lack of extensive metabolite testing when using serum (especially for cortisol and estrogens). Our goal is to get the most accurate depiction of your health so we can guide you to the hacks and habits that will increase your healthspan. Some people metabolize and produce hormones in the balanced amounts, some don’t.

    This is why we treat each patient as an individual, using the latest testing technology as it changes to meet the growing demand for personalized, integrative medicine.

    To schedule a consultation with the Institute for Human Optimization, click here.

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    The All-Important Thyroid Gland and How to Test It

    There’s a tiny gland in your neck, right below the Adam’s apple, that is responsible for almost all of your bodily functions. It’s called your thyroid and because you literally can’t live without it, it’s vital to keep it functioning properly. In Part I of our endocrine series we discussed the basic structures and functions of the endocrine system. In Part II we dove into how the HPA axis works with cortisol to manage stress. In this part, we’ll talk about the all-important thyroid and how the Institute for Human Optimization assess patient thyroids with the latest testing to guarantee accurate results.

    Your thyroid works a bit like your air conditioner. The pituitary gland is the thermostat, it senses when your body is low on hormones and sends a signal to the thyroid using TSH (thyroid-stimulating hormone).

    When the thyroid picks up the TSH, it pumps out the exact amount of hormone needed to make sure everything runs smoothly. Your thyroid is responsible for a variety of functions including menstrual cycles, metabolism, heart function, brain functions, digestion, and mood.

    Its main responsibility is converting iodine from food into thyroid hormones, known as thyroxine (T3) and triiodothyronine (T3). Thyroid cells are the only cells in the body that can absorb iodine. T4 is responsible for your metabolism, mood, and body temperature, among other things. T3 is made in the thyroid gland but can also be made in other tissues within the body by converting T4 into T3.

    If you have a properly working thyroid, it’ll dispense about 80% of the T4 hormone and 20% of the T3. About half of the T4 will be converted into T3 throughout the day. Whatever isn’t used gets flushed out in a process called reverse T3.

    Basically, reverse T3 (rT3) is an inactive ‘thyroid hormone’, but one that can sometimes cause health issues when everything else is seemingly functioning as it should be. Because T3 and rT3 compete for spots on cellular receptor sites. If there’s too much rT3, regular T3 can’t bind to the receptors, weakening its effects. This can result in symptoms of hypothyroidism, even if T3 levels are within range.

    In early humans, stress from starvation or danger would trigger the reduction of rT3, slowing the metabolism and conserving energy. This is why today when we go on sudden crash diets or suddenly take up intense cardio workouts, our bodies respond the same way they always have- shutting down functions like sexual reproduction and digestion. If you’re running from danger or starving, your body sees no reason to have kids and can inhibit sex hormones such as testosterone.

    Some common reasons for thyroid disorders include:

    • Starvation or radically reducing calories for an extended period of time
    • Poor blood sugar management
    • Nutritional deficiencies
    • Chronic inflammation
    • Chronic stress (cortisol, the stress hormone, is vital for converting T4 into rT3)
    • Chronic illness

    Thyroid Disorders

    It’s estimated that about 12% of the United States population will experience some kind of thyroid disorder in their lifetime. It’s helpful to know the differences between the most common thyroid disorders and their symptoms so you can get treatment as soon as possible.

    • Hypothyroidism
      This is caused by an underactive thyroid and can cause fatigue, weight gain, weakness, depression, sensitivity to cold, slow heart rate, and in extreme cases, coma. Diagnosis for hypothyroidism generally follows a test resulting in high TSH l and low T4 levels. Treatment generally includes supplementation of thyroid hormone and doctors must be careful to get the dosage right and not cause the opposite reaction.
    • Hyperthyroidism
      Hyperthyroidism is the opposite- the thyroid is overactive and producing too much hormone. This is more common in women than men and can cause anxiety, racing heart, thin skin, irritability, brittle hair and nails, and weight loss. People who suffer from hyperthyroidism generally test low for TSH and high for T4. Doctors will prescribe drugs that inhibit the thyroid or in extreme cases, surgically remove a portion of it.
    • Hashimoto’s Thyroiditis
      In this form of hypothyroidism, the immune system attacks the thyroid and begins to destroy it. Symptoms include heavy or irregular menstruation, pale puffy face, fatigue, intolerance to cold, thinning hair, or enlargement of the thyroid. There is no cure for Hashimoto’s and it can only be distinguished from hypothyroidism by testing the blood for TPO antibodies. A recent study suggested that cutting out gluten could provide clinical benefits to women with Hashimoto’s disease.
    • Grave’s Disease
      This is another autoimmune disease in which the immune system mistakenly attacks the thyroid. However, Grave’s disease causes the thyroid to overproduce the hormone responsible for regulating metabolism, resulting in increased heart rate, anxiety, bulging eyes, and possibly hand tremors. People with Grave’s disease will have low levels of TSH and high levels of T4, similar to hyperthyroidism. Similar to Hashimoto’s, there is no current strategy to stop the immune system from attacking the thyroid so managing symptoms using beta-blockers, iodine, and possibly surgery are the common forms of treatment.
    • Goiter
      Goiter is a noncancerous enlargement of the thyroid gland. Generally, this is caused by a lack of iodine in the diet. In the US people consume plenty of iodine in the form of table salt, so a goiter is usually a symptom of hyperthyroidism. Due to the thyroid’s placement in the throat, enlargement can cause difficulty breathing or swallowing, hoarseness, and tightness in the neck. Goiters can be left alone if they’re not severe but often require surgery to remove.

    Testing the Thyroid

    Doctors today have an abundance of testing technology to properly diagnose thyroid disorders. While they used to rely solely on testing TSH, they’re now able to test all thyroid hormone levels and get a more accurate depiction of function.

    At the Institute for Human Optimization, we provide a complete hormone panel for our patients. We test for TSH, T3, T4, and reverse T3 levels to take a deep dive into how your thyroid is functioning. So many organs and structures rely on the thyroid to work properly, so it’s of the utmost importance that we treat any signs of hyper or hypothyroidism immediately.

    A recent study found that taking biotin supplements can actually throw off testing, making it seem like Grave’s or Hashimoto’s when the thyroid is actually functioning properly. It’s important to let your doctor know if you’re taking biotin before testing and possibly stop the supplements temporarily to get accurate results.

    If you suspect you might have thyroid issues, contact your physician for testing or schedule a discovery call with the Institute for Human Optimization here.

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    HPA Axis and Cortisol

    Stress is a strange phenomenon, a signal that indicates to your body something is threatening your life and you need to do something about it immediately. As cave-dwelling Homo sapiens, stress looked like animals trying to eat you or not finding enough water to survive. Today, our stressors are not always life-threatening, but our bodies don’t know the difference. In Part I of our hormone optimization series, we discussed the major structures of the endocrine system and which hormones are responsible for what body functions. This week, we’ll zero in on the complex feedback loop that strives to keep you safe, the role of cortisol, and what you can do to reduce the negative effects of prolonged stress on your health.

    Jack just opened a restaurant. Though he’s worked in restaurants for most of his adult life, this is the first time he’s owned his own business and taken on all the stress that comes with it. There are employees to manage, orders to make, bills to pay, and a slew of customers to win over.

    As Jack walks around the restaurant, he thinks about all the things that could go wrong. The cook could quit. The food could be spoiled upon arrival. The waitresses could be stealing money. The customers could be unsatisfied with their experience.

    Jack’s brain processes these imaginary events as reality. It doesn’t completely distinguish between perceived danger and actual danger. As a result of millions of years of human evolution, Jack’s body prepares itself for stress the only way it knows how- activating the HPA axis.

    Role of the HPA Axis

    The HPA axis is a feedback loop that regulates your reactions to stress. Specifically, it links the hypothalamus, pituitary gland, and adrenals- all vital parts of the neuroendocrine system.

    The loop begins when something stressful happens- one of the waitresses at Jack’s restaurant gets ill in the middle of the busiest shift of the week. As soon as Jack hears the news, his sympathetic nervous system is activated. Epinephrine and norepinephrine are released, the hormones responsible for the “fight-or-flight” response we once used to run from saber-toothed tigers.

    With these hormones released, Jack’s HPA axis is in full swing. His hypothalamus (a small part of the brain concerned mainly with keeping the body in a state of homeostasis) secretes corticotropin-releasing hormone (CRH) into his bloodstream. In the brain, CRH increases feelings of anxiety and temporarily improves Jack’s memory and selective attention. He’ll need his brain in an attentive state to deal with whatever stressor he’s facing.

    CRH is a message to the pituitary gland to secrete adrenocorticotropic hormone (ACTH) which travels to the adrenal cortex like a letter traveling to your mailbox, binding to adrenal receptors, and causing the final section of the loop- the secretion of cortisol, the “stress hormone”.

    Role of Cortisol

    As the night goes on, and more inevitably stressful events occur, Jack’s bloodstream becomes inundated with cortisol as his adrenal cortex pumps out the hormone a little at a time. Cortisol’s main job is to release glucose into the bloodstream to be used as instant fuel for either fighting or running from his problems. Each pump results in about fifteen minutes of sustained cortisol release.

    Cortisol also helps shut down secondary functions like sexual desire and urinary urges. You wouldn’t want to have to pee while running for your life or fighting an enemy and Jack is able to cover the waitress’s entire shift without having to use the restroom.

    Unfortunately, Jack’s stress does not end after the difficult shift. He carries the weight of the night home with him and wakes up to another day of difficult obstacles. Each event re-actives the HPA axis and starts the whole process over again, inevitably leading to elevated cortisol levels for long periods of time.

    Many studies show this kind of chronic stress is not beneficial for longevity and overall well-being:

    “It appears that being exposed to stress can cause pathophysiologic changes in the brain, and these changes can be manifested as behavioral, cognitive, and mood disorders (Li et al., 2008). In fact, studies have shown that chronic stress can cause complications such as increased IL-6 and plasma cortisol but decreased amounts of cAMP-responsive element-binding protein and brain-derived neurotrophic factor (BDNF), which is very similar to what is observed in people with depression and mood disorders that exhibit a wide range of cognitive problems.”

    Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI journal, 16, 1057–1072. https://doi.org/10.17179/excli2017-480

    If Jack is constantly bombarded with cortisol, his immune system is constantly suppressed. This leaves him vulnerable to disease and inflammation that can be detrimental to the body over time.

    Cortisol also activates the autonomic nervous system, indirectly affecting the cardiovascular system. Jack’s heart rate increases, his muscles tense and contract, and blood flow is diverted from his organs to parts of his body that will help him fight or run. Again, this is all fine for a short period of time, but the organs need blood flow to operate correctly.

    In addition, his hippocampus is extremely sensitive to stress and also responsible for the conversion of short to long-term memory. Animal studies show that a chronic state of stress can cause a reduction in the accuracy of spatial memory and negatively affect learning. Temporarily, Jack is sharper and better able to handle his environment. But over time, this kind of attention is not sustainable, and his brain physically begins to change to compensate for the abundance of cortisol.

    How to Manage the HPA Axis and Cortisol

    If you can understand how your body works, you can learn to work with it instead of against it.

    If Jack wants to avoid the problems caused by an overactive HPA axis, he must start with what triggers the feedback loop in the first place- stress.

    It isn’t an option for Jack to sell the business he worked so hard to acquire. Even if he did, he’d still have to deal with the stressors of modern life- finding new work, paying bills, handling family life, driving at speeds of 60mph on a daily basis, and anything else that comes up.

    Eliminating stress is not possible and in short bursts, it’s not even harmful. It is the chronic, constant stress that slowly erodes our body functions and mental well-being.

    Jack understands it is not the elimination of stressful situations, but how he deals with them that matters. He begins to implement the following lifestyle hacks to counteract the effects of cortisol and minimize the stress he feels from work and life:

    • Practice good sleep habits.
      Studies show a clear connection between sleep and cortisol levels. Not getting enough quality sleep affects you in all aspects of your health and being groggy during the day can cause more stressful situations to occur. Aim for 7-8 hours with little disruptions. Going to bed at the same time each night helps regulate the chronobiome and cortisol levels.
    • Exercise.
      A recent study had young participants perform moderate aerobic exercise three times a week and tested their cortisol levels via saliva. Interestingly, the study found that exercise increased cortisol levels initially following the workout to deal with the stress, but over a course of four weeks, their overall cortisol levels decreased. Many people report being exercise being beneficial for their mental state, helping them make more clear decisions and better able to regulate their emotions.
    • Practice meditation or mindfulness.
      Unfortunately, there haven’t been many large scale studies on the effects of mindfulness (focusing on being in the moment and doing things intentionally instead of letting your mind race on autopilot) on the HPA axis.

      Recently researchers did use a mediation retreat to test subjects’ cortisol levels before and after meditation as well as before and after the retreat as a whole. They did find that cortisol levels were decreased, but without another control group, the results are not unquestionable. However, it makes sense that quieting the mind and focusing on the moment would create less stress, and as a result, lower cortisol levels.

      Jack strives to focus on one task at a time and notice when his mind begins to worry about things he can’t control or things that happened in the past. Our bodies don’t understand the difference between a perceived threat and a real one and secrete cortisol either way.
    • Have fun.
      Jack’s business is important to him, but he understands that a balance must be struck if he’s to live a long and healthy life. He begins to make time for things he enjoys and doesn’t stress him out. He goes fishing on the weekends and hangs out with his family. If he finds himself feeling stressed at work, he makes a conscious attempt to put on music that makes him happy or make a joke about the situation to lessen the tension.

      If your mind perceiving stressful situations is what stimulates the HPA axis, then by changing the way you feel about the situation can help dramatically. Viewing obstacles as challenges, shifting your thoughts to ones of gratitude, and laughing all help to naturally lower cortisol levels. So make stressful things into fun things.

    At the Institute for Human Optimization, we recommend our patients receive a hormone panel to get an idea of how their body is handling daily stressors. We take an integrative approach and aim to give people practical lifestyle hacks that can lower their cortisol and reduce the likelihood of diseases that occur as a result of chronic stress.

    For more in-depth information on how to hack your health, check out Dr. Anil Bajnath’s book, “The Longevity Equation” or schedule an appointment with the Institute here.

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    Hormone Optimization Series: Endocrinology 101

    There’s a postal service inside of you. A team of messengers carrying instructions through the blood to all your systems, organs, and structures. These messengers are your hormones, secreted by the many glands that make up your endocrine system. Your body is extremely sensitive to hormones, and even a slight imbalance can impact your health. That’s why this month we’re doing a four-part series on the endocrine system, it’s functions, and what you can do to help balance your hormones and live a happier, healthier life.

    Hormones act as signaling molecules and are responsible for a variety of functions in the body including growth, maintaining body temperature, mood, cognitive abilities, sexual functions, metabolism, and so many more.

    If the endocrine system is a postal service, the anterior pituitary gland is the postmaster. When a hormone comes in from the hypothalamus, it will either trigger the release of the hormone or block it. If the hormone signal gets through, it will then go on to act on endocrine structures, making important things happen in the body.

    There are two main categories of signaling: paracrine and endocrine. Paracrine means the signal acts on nearby cells and endocrine uses the circulatory system for transport.

    In medical school, students are taught the mnemonic device FLAT PEG to memorize the anterior pituitary hormones. They are:

    • FSH (follicle-stimulating hormone)- responsible for controlling women’s menstrual cycles and stimulating the growth of eggs in the ovaries. In men, FSH helps control the production of sperm.
    • LH (luteinizing hormone)- works with FSH to regulate the menstrual cycle and reproductive systems. In men, it stimulates the production of testosterone in the testes.
    • ACTH (adrenocorticotropic hormone)- aids the adrenal glands to respond appropriately to stress.
    • TSH (thyroid-stimulating hormone)- regulates the thyroid gland which is essential to growth and metabolism.
    • Prolactin- responsible for breast growth and the production of milk.
    • Endorphins- act on the opiate receptors in the brain, reducing pain and boosting pleasure.
    • GH (growth hormones)- regulates growth in children and adolescents. Also helps regulate body composition, fluids, muscle and bones, metabolism, and possibly heart function.

    Hormone Binding and Regulation

    All of the cells in your body are exposed to the hormones floating in your bloodstream. But not all of them are able to react. Specific cells have receptors for specific hormones to act on. These are called “target cells”. When the hormone binds to a target cell’s receptor, it causes a response inside the cell. If the endocrine system is a postal service, the receptor is the mailbox. It will only receive messages meant for that particular cell.

    Nuclear receptor sites are proteins within cells that are responsible for sensing thyroid and steroid hormones. Unlike regular cell receptors, nuclear receptors are able to bind directly to DNA and affect gene expression. You can have genes for certain diseases that lie dormant until acted upon by certain factors- hormones are one of these factors.

    Hormone binding sites can be upregulated or downregulated depending on what the body needs. Upregulation increases a cell’s sensitivity to a specific hormone while downregulation does the opposite, decreasing the amount of available receptors.

    Upregulation and downregulation can happen naturally, or as a response to drugs. For example, during pregnancy, there is an upregulation of receptors that cause the cells in the uterus to become more sensitive to the hormone oxytocin. In the case of drugs, constant exposure to certain substances during adolescence can induce the down or upregulation of genes, manifesting addiction and other mental illnesses that may not have surfaced before due to the effects on the brain’s reward systems.

    Hormonal Imbalances

    The endocrine system is fragile- even a slight imbalance can have a negative effect on your overall health. Imbalances can be linked to genetic polymorphisms in your DNA, circadian rhythm dysregulation (getting poor sleep), and environmental substances that are foreign to your body.

    Some common signs of a possible hormone imbalance include:

    • Unexplained weight gain
    • Constant fatigue
    • Changes in bowel movements (either decrease or increase in frequency)
    • Dry skin
    • Sensitive to temperatures
    • Frequent thirst
    • Frequent urination
    • Thinning or brittle hair
    • Decreased libido
    • Pain and stiffness in the joints

    At the Institute for Human Optimization, we order a variety of hormone testing for our patients as part of the intake process. Our goal is to get the most accurate representation of a person’s health possible and then move in the direction of increased healthspan and longevity.

    Endocrine system health is an underlying variable for a variety of health problems. We strive to use the least invasive procedures first with a focus on prevention, keeping hormone levels properly regulated with proactive lifestyle habits.

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