Part 3: The Low

In the last post we established that cholesterol is actually a necessary component of every cell in your body. We briefly discussed some of the things your body uses cholesterol for- things like making vitamin D and various hormones. Now let's take the time to talk about the other side of the cholesterol tail- when your cholesterol is too low. We'll break it down by talking about some of the things you make out of cholesterol.

The sex hormones Estrogen, Testosterone, and Progesterone are all made from cholesterol. While the ovaries and the testes are more than capable of making their own cholesterol, the vast majority of cholesterol in the body is made by the liver(1). Thus, when you don't have enough of their precursor, cholesterol, it would be logical to think you might develop hormonal imbalances as a result.

The adrenal glands- also known as the suprarenal glands, are two triangular shaped glands that sit atop the kidneys. These tiny glands make a multitude of different hormones, most of which are derived from cholesterol. The most famous of these hormones is the so-called "stress hormone", cortisol. Cortisol and melatonin control the sleep-wake cycle, which is also called the circadian rhythm. When the adrenals don't have enough reserve to make cortisol, they can become exhausted. This is known as adrenal fatigue (more to come on this later) and can lead to things like chronic fatigue, trouble getting to sleep or staying asleep, trouble getting up, and gut and brain related symptoms.

Vitamin D is one of only two vitamins the human body is capable of making on it's own, and is incredibly important for gut healing(2), immune function(3), and most famously, calcium metabolism. Studies across the board have shown that vitamin D deficiency is the most common vitamin deficiency in the developed world, with as many as 40-90% of people being deficient(4). If you haven't gotten your vitamin D levels measured lately, it's well worth getting done. Luckily, vitamin D supplements are relatively inexpensive- but remember to take it with a meal with some fat. Vitamin D is a fat soluble vitamin, and will be best absorbed when eaten with other dietary fats so that the liver and gallbladder have a chance to emulsify it with bile salts.

Speaking of which, bile salts are another thing made from cholesterol. Bile is synthesized in the liver, which then is collected and concentrated in the gallbladder. I'll talk about the gallbladder and the consequences of removing it in a later post, but for now we will go over basic physiology. Bile is secreted from the gallbladder in response to the ingestion of dietary lipids (fat). Without bile acids, any fat you ingest would pass straight through the tubes and not be absorbed. I know that sounds like a good thing to a lot of people, but it's really not. Fat is a vitally important part of every cell in your body, particularly omega-3 fatty acids which are very anti-inflammatory.

As you can see, cholesterol is an extremely important part of your body. Because of this, most functional medicine doctors like to see cholesterol that is somewhere between 150-200. But now that we've covered what can happen as a result of low cholesterol, let's discuss some things that may cause low cholesterol.

Most commonly decreased cholesterol is seen in a pattern with other blood markers that are indicative of malabsorption. When you are unable to absorb the nutrients in your food, you can't make things like cholesterol, nor any of it's downstream metabolites. When this is the case, the most effective way to treat the patient with low cholesterol is often times a gut-healing protocol, which we will discuss in later posts. Conveniently enough, when you heal the gut it has a tremendous anti-inflammatory effect across the entire body.

Another interesting angle to look at is the debate about chronic infections and their impact on the body as a whole. In the article Mafia Wars(5) the author mentions that many critters (bacteria, namely) need cholesterol to stabilize their own cell membranes, and it is believed now that these bugs have the ability to steal our cholesterol. There has only been limited research on this so far, but it's an intriguing concept as the world learns more about infectious organisms such as H. Pylori, E. Coli, and Borrelia, the causative agent behind Lyme Disease.

Until next time,

References:
(1) Guyton and Hall Textbook of Medical Physiology pp 847-848
(2) Juan Kong "Novel role of the vitamin D receptor in maintaining the integrity of the intestinal mucosal barrier" Am J Phsiol Gastrointest Liver Physiol 294:G208-G216 October 2007
(3) Kamen, Diane. “Vitamin D and molecular actions on the immune system: Modulation of innate and autoimmunity” J Mol Med 2010 May; 88(5): 441-450
(4) http://www.sharecare.com/question/how-common-vitamin-d-deficiency
(5) http://classic.the-scientist.com/2010/6/1/40/1/

Ah, insomnia. It's such a catch-22. Your health (or lack thereof) can affect your ability to sleep; your sleep (or lack thereof) can affect your ability to heal, and therefore your overall health.

Any number of things can cause insomnia or a disturbance in your circadian rhythm. Stress, whether it be emotional or physical, has the ability to disrupt your 24 hour cortisol rhythm and alter your sleep. That might mean your ability to fall asleep, your ability to stay asleep, or both. Anything that changes the brain can alter your sleep cycle. Anemia, thyroid imbalance, inflammation, autoimmune disease, fibromyalgia, Lyme, you name it and it can probably affect your ability to sleep.

As is the case with much of what I see in my office, I see insomnia as a symptom rather than a problem in and of itself. This is why I'm generally reluctant to jump to prescribing melatonin in my office- I'd rather address the sources of inflammation to the best of my ability and see how you react. Seeing a symptom go away (like insomnia) reassures both the doctor and the patient that we're on the right path. It gives us something to monitor.

That being said, I do occasionally put people on melatonin. Remember the catch-22 I mentioned earlier? Well, there is something to be said for the healing properties of a good night's sleep! If I pin-point all the right things and address all the underlying imbalances your body still needs to take the new information/supplements/lifestyle/whatever and heal itself. Make no mistake about it- I don't heal diddly squat- YOU do. If your body is unable to bounce back because of a lack of sleep and a shot circadian rhythm, you can bet your butt I'll put you on melatonin at least temporarily.

Melatonin isn't necessarily the evil that Dr. Oz has made it out to be, either. The biggest issue they outlined in that segment was the fact that people often take one pill to fall asleep, wake up, take another 1-2 pills, fall asleep, then can't wake up. That is why I do NOT recommend going to your local grocery to buy melatonin. I carry an extended release melatonin in my office that not only helps you get to sleep but stay asleep.

If you have tried natural sleep remedies or pharmaceuticals in the past and would like to get to the bottom of why you can't sleep call my office at (919) 238-4094 to see if we are the right fit for you. Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

In health,

Adrenal fatigue. Most of the medical profession denies it's existence while many in the alternative medicine world swear everybody has it. So, who's right here?

I believe adrenal fatigue is a real thing... at least in part because I see it walk into my office on a regular basis. I use Adrenal Salivary Index (ASI) testing to analyze the pattern of cortisol and related hormones such as insulin and DHEA and treat with dietary changes and supplements accordingly... although that is the easy part of what I do.

The thing about the adrenals is that they are almost never the problem, per say. The adrenals, like the immune system, is a reactionary system in the body- they respond to stressors from your environment and adapt however they are able to. It's not that they are "being bad" or "acting up"- they're just trying to keep you alive and reflecting the stimuli they are given. Perhaps we should start calling pathology reactive physiology. The true art in helping the adrenal fatigued patient is in untangling the things that stressed the adrenals in the first place.

This is largely because adrenal hormones, like all hormones, have about a million different actions and affect every cell of the body. Cortisol, the most famous of the adrenal hormones, has profound impacts on the immune system, the circadian rhythm, insulin and blood sugar control, memory, gastrointestinal tract, thyroid, skin, metabolism, and sex hormones. Pathways and enzymes are shared amongst the making of estrogen, testosterone, cortisol, DHEA, progesterone, and vitamin D, so you really can't affect one in isolation of the others. This is what makes hormones so cool and so very tricky- they have the ability to affect everything in the body.

Honestly, I treat the adrenal fatigued patient as I would any other functional medicine patient in my office. I conduct a thorough history and examination, blood work and specialty lab testing in order to get a grasp on what is happening to the patient's body. I try to trace the threads of the web back to the spider from whence they came and treat the body as holistically and naturally as possible. The difference with adrenal fatigue is that once I know that the adrenals are compromised, I may add adrenal supportive herbs, supplements, and targeted lifestyle advice to the patient's treatment plan.

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. ​​Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

In health,

Insomnia and other sleep problems is an ever-growing problem in the United States. Forty eight percent of adults report at least occasional insomnia, while twenty two percent of adults report insomnia almost every night [ref].

Sleeping problems come in a variety of flavors including:

• Trouble falling asleep
• Waking up in the middle of the night
• Trouble waking up in the morning
• Not feeling well rested in the morning/ poor sleep quality

Sleep-wake patterns are controlled by the pineal gland in the brain stem, but it is important to recognize that other parts of the brain fire into that pathway and stimulate it. Therefore, Functional neurology and brain exercises can be helpful when combating sleep problems. From a functional medicine perspective, many things can be done nutritionally to support overall brain and bodily health, which will help those pathways run at their very best.

1. Basic blood work can go a long way in assessing overall body and brain health. With a basic panel, I can assess liver, blood sugar, kidney, electrolytes, red blood cells (anemia), white blood cells, and some vitamin and mineral statuses. All of these, particularly anemia and blood sugar problems, often go undiagnosed (or improperly diagnosed) and have a tremendous impact on brain health.

2. Sometimes I run salivary hormone panels to assess the patient's cortisol rhythm and look for things like adrenal fatigue. Oftentimes, such problems respond remarkably well to diet, supplements and lifestyle changes.

3. Stress is a major contributing factor in many cases of insomnia. Yoga, meditation, and relaxations techniques can go a long way in helping relieve stress.

4. Occasionally, I feel the need to treat the symptom of sleep problems with melatonin. No, melatonin isn't going to do anything to get to the root cause of the problem, but some times it is worth while to just get someone to sleep! Just as we need proper nutrition and health to sleep well, we need to sleep to heal our bodies and recover. While we work on the underlying problems sleep can help people recover and heal faster.

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

Yours in health,