Category Archives: Stress

Too Much Knowledge – ? Fear

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fear & knowledge

For a long time I have been wondering about the boundaries that separate knowledge from fear. I have given up on the news media because they generate fear and by not giving factual knowledge.  In general the egocentric commentators are no longer fact- investigative reporters. I can also apply this to our presidential candidates unfortunately. Having health information is really important but  it too can create scare tactics crossing the line of health to illness? We are just inundated with information about toxicity of foods, heavy metals, phatalates, etc..( See my blogs or read my book Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well – being and what you can do about it).  We are told that we should do this or take that  for our health or else. Yes it is necessary to have knowledge about how to protect our health. I just wonder how many of us due to this information end up with depression, anxiety & stress from being told that we are drowning in our environment (our foods, water, air).  All this stress can negate the good energies of trying to be healthy at each meal, in the grocery store or even drinking a glass of water. Maybe one of the solutions is what I am still learning; that there is no way of avoiding all of our environment toxicities & therefore stress from the environment (news media); and also some of the holistic healers that  preach doomsday if we are not taking  specific supplements (of which they sell the best).  One of these known holistic physicians I analyzed: all that he says he does with shopping and preparing healthy foods and then the exercises for his body and brain each day. I figured that he would need to be awake at least 24 hours/day; and then have another 7 – 8 hours to his day since he proclaims each individual should sleep 7-8 hours/day. Then start his day with meditation of some sort. Maybe he is not a parent raising children or having unexpected crises pop up! Also, onw must recognize that a lot of the suggestions of physicians and healers are good to know about, but each person is an individual. Generalizations are just that – generalizations. Most people know the basics of good health: exercise, nutritional live foods, stress relief programs that build a good self-image of oneself.  Yes, I know the last of these is difficult in these stressful times and that is one reason I wrote my book, because the last part of the title is so important:  ……..what you can do about it.

Remember it is not always the stress but how we respond to the stress. I try to surround myself with positive people and try to avoid the emotional vampires both human and external.  As far as environmental toxicities I do what I can by using organics within our economic means, and avoid buying Chinese products as much as we can (which saves a lot of money since most USA products come from China). If one did every health option presented by health experts we would be bankrupt, have more stress and no guarantee that we would not have an illness, disease, or accident. There are no guarantees in life (except taxes, death & political mayhem). Watching funny films & laughing is a great antidote. Each day I try to write down 3 positive things that I did well or that happened to me.

Alan J. Sault MD, ABHM-Diplomat

Author: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.

holisticsecondopinion.net/vampires

 

The Placebo Effect

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PlaceboMany years ago in the ER I proved to myself that the placebo affect is real. I had one person that was in the ER very often (who I called a frequent flier). After a few times I emptied samples and gave the plastic shells to her. I gave her specific instructions and also told her that they were of  high potency and therefore could be dangerous so follow my instructions. She always got better and would only come on my shift since I knew the right medication.

Switching to being an Holistic physician and seeing the results of hypnosis (and self hypnosis) and Interactive Guided Imagery taught me that illnesses can heal without drugs in many instances (BP for example). A lot depends if the person has a negative or positive outlook on either the ailment or life itself. It is known that exercise is equal to pills for mild to moderate depression. I believe this is so not only for the increased hormonal affect but due to the socialization of being with others and their energies; and also being proud of oneself for achievement.

Holistic medicine includes the triad of mind-body-spirit and finding the cause and not just alleviating an ailment whether with pharmaceuticals or alternative medicine. I believe one must note that alternative medicine in many instances is successful also due to the placebo affect it is not just allopathic pharmaceuticals that should be accused. There is a place for both allopathic & alternative medicine; but there is always a place for self-exploration of why one has acquired an illness and what they can do to not only cure or alleviate it but also to prevent future occurrences of it and others. This is why I stress the stress factor and the immune system in my book.  One must realize that it is not the stress but how we react to a stress. Also when a person starts to be pro-active with working on stress solutions they are modulating their life style and therefore their health (and working with the healer).

Part of the placebo effect is having confidence and respect for your healer. One that the client can relate and that takes the time to relate to the client. My theory is: the physician is teaching the client and the client is teaching the physician. The physician is their to guide and for being a life-guard when necessary.

The mind can keep us healthy and heal and the mind can make us sick. The choice and options are ours. It takes a lot of work to clean up our inner negativities and fears. I have been working on this for myself for > 40 years using self hypnosis and Interactive Guided Imagery (and slowly progressing – the dance of 2 steps forward and often one step back). I have treated many patients with chronic diseases including cancers for years and have seen the differences when a person is positive or negative. Even if they came to me with a late stage terminal disease prognosis but positive energies they can still die with quality of life playing with their grandchildren. Often with IV alternative treatments they avoid their death diagnosis. I was one of these 10 years ago. So often the physician tells a person that they have a 60% chance of dying and never gives the positive that they have a 40-50% chance of living. I often wonder if the death sentence that is proposed by the healer and the client goes and spends all their savings and then lives another 10-20 years; are they glad about the extension of life, or angry about not having any money due to a the death prognosis (or wrong diagnosis-it happens). I myself am fortunate since my wife is an expert in both hypnosis and Interactive Guided Imagery. For example,I have sent people to her after my interview that just wanted BP meds and have her do hypnosis (for free) on the person. So frequently they drop their BP because stress is the cause of the vascular problem. So we work from that point on with both my medical and her psychology.

Much of the above seems to get off the subject of the placebo effect but the point is that it is the mind  that cures  with a positive outlook on the treatment.  Therefore one can have both, a medicine (whether pharmaceutical or alternative) that helps plus the placebo effect. As an aside, sometimes giving a person a supplement or pharmaceutical does not cure them for two reasons: 1-they feel they have carte blanche to keep their harmful life style and the medicine will be the panacea: 2-They are alleviating a situation instead of finding the cause and working on this.  This is especially true for delving into stress and its relationship to dis-ease.

Alan J. Sault MD, ABHM-Diplomat

Author: “Emotional Vampires and Your Hormones: an holistic physician’s view on how stress affects your well-being and what you can do about it”

holisticsecondopinion.net/vampires

Negativity and Fear = Stress

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FearFrequently I receive letters about fears and stress due to recent events and what to do about them mentally and physically. Trying not to engage our minds in negativity is important. It is about healing ourselves during these trying times by thinking positive thoughts or at least happy ones. Yeah, easier said then done! Some people have written to me of their fears about Ebola, terrorism and especially about so many health hazard caused by our modern life styles (pharmaceuticals, our adulterated foods, pesticides, etc.  The media enhances all of  these fears. For Ebola, some healers keep producing articles on what you should take to prohibit Ebola. Good! But the main thing is not to lower your immune system by fear and stress. Stress lowers your immunity! Losing sleep because of the fear also minimizes the immune system. All this may sound to some like spiritual voodoo but more and more evidence based science exists as to the brain-adrenal – immune – gut system having a direct relationship to our immune system and therefore disease and even the common illnesses like colds. For example, when I was in medical school (50 years ago) we did not realize that the gut was a huge part of our immune system creating what is called secretory immune globulins (sIgA): or that the gut produced hormones such as serotonin (a happy) hormone that we believed only the brain produced. There are many examples of the latter two that all seem to be down modulated by fear and stress. It is no wonder when a person says “It is just a gut feeling, or “I feel it in my gut.”

We have all experienced the flight or fight situation when it is chronic and not just  acute stress that causes fatigue &/or illnesses. In my 45 years of being an MD I also find people that are overly concerned about their physical and/or mental health. They spend a lot of money, time and effort jumping from one supplement & healer to the newest acclaimed healer or supplement. This overly concern about health stresses them with the fear that they could be healthier & negates their health efforts. The economics of the latter is often a source of stress, that is buying many supplements advertised (many without quality control) and jumping from one healer to another. This can also lead to a stress response that affects the adrenals and the immune system. I use many solutions. The easiest one for me is when fears and stress are interfering with me I picture a happy situation to replace the negative. For example: my granddaughter when she was about 3 walking with me she would hold her whole fist around one of my fingers. It was joyous.

Another caution I stress (no pun intended) is to stay away from negative people and make sure that you do not use negative language about situations and yourself. Being with positive and fun people really helps. I used to give my clients a list of funny films to watch like the Pink Panther. I have a lot of options in my book’s final chapter called How to kill a vampire.

It is not always the stress but the way we respond to the stress that causes our illnesses.

Alan Sault MD,ABHM : Emotional Vampires and your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.

holisticsecondopinion.net/vampires

 

WHAT Cortisol REGULATES AND MODERATES

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cortisol

I-Metabolism

  1. Blood sugar levels: this relates back to the mists of time when cave man was faced with fight or flight dangers (for example a saber tooth tiger). The adrenal cortisol reaction stimulated the liver to pour out more sugar for fuel to accomplish the fight or flight; The latter is known as the Acute Stress Reaction (ASR). Unfortunately our modern life  turned this ASR into a Continuous Stress Reaction (CSR) but the adrenal – cortisol – sugar reaction is exactly the same. The problem is that the ASR ended and all went back to normal and the sugar was used. (Unless he did not get away, but then it ended his stress forever). With the CSR it never ends and the body does not return to its normal functioning and the sugar is not used. The evolution of ASR to CSR is in my book which is written for the layperson.

  2. The metabolism of fats and protein are converted to sugar in order to maintain blood sugar levels at physiological levels (what nature intended). This is called gluconeogenesis, which is converting protein & fats into glucose when necessary.

  3. Immune response of moderating the inflammation reactions. This includes the anti-inflammatory responses. For example, that is why they use cortisol medications to control so many medical conditions such as transplants, allergies and dermatitis of different types etc.

  4. Blood pressure moderator-a lot of this is due to the metabolic effect and the weight response by creating too much blood sugar under stress which will be stored as fat in organs and the blood vessels. The latter leading to hardening of the arteries. Again cortisol is responding to stress and therefore I suggest some of my blogs on stress. I have also written about aldosterone which is put out by the adrenals and affects the BP. It is inhibited when stress causes a surge of cortisol.

  5. Central nervous system activation

                                          II-Elevated Cortisol level

  1. Impaired cognitive performance: one reason for this is at first the stress reaction which includes adrenal-cortisol -liver-sugar-insulin response can lead to hypoglycemia. The brain needs the physiological quantity of blood sugar to function. Hypoglycemia can be a precursor of diabetes which causes so many pathologies one of them being hardening of the arteries which certainly affects blood flow to the brain. Because of the sugar surge stimulating an insulin surge the blood sugar can fall below the necessary homeostasis for a person. This is called a reactive hypoglycemia. Symptoms can be anger, hunger, fatigue, aggressiveness and depression.

  2. low thyroid output (hypothyroidism) an explanation is in my book: Emotional Vampires….but briefly cortisol is the fight-flight response hormone and stops digestions (which is not needed in fight – flight situation) and without gastric juices the breakdown of protein is  inhibited. Without protein breakdown amino acids cannot be produced.  Tyrosine, one of the amino acids is necessary for the thyroid hormones production. Cortisol in the exact physiological amount is needed to change the inactive T4 to the active T3.  Then exact physiological dose of cortisol is necessary to activate the cell receptors to allow T3 into the cells to metabolize for energy production.

  3. Decreased bone density-That is one of the reasons why there is warnings on taking cortisol  for too long. Cortisol inhibits the sex hormones which are the bone builders.  When cortisol is used for a long time it can lead to osteopenia – osteoporosis.

  4. May cause G.I. ulcers and shutting down ones own adrenal functioning. Again there is a black box warning from the FDA about the latter two side affects. Aspirin, NSAIDS (Non-Steroid Anti-inflammatory Drugs) and cortisol are the leading causes for bleeding ulcer hospital admission of the digestive system

  5. Insomnia: but also remember the person under stress does not get adequate sleep  and a vicious cycle is created leading to adrenal fatigue.

  6. Decreased muscle mass

  7. Increase blood pressure: again due to increase of sugar which causes Insulin Resistance thereby eventually converting the sugar to fat (triglycerides) which under certain conditions causes hardening of  the arteries and high BP.

  8. Slow wound healing

  9. An increase of fat deposition and therefore cardiovascular problems, due to stress and the continuous out put of sugar for flight or fight reaction. Being stressed and the adrenal cortisol response can sabotage any diet.

                                   III-Decreased cortisol levels

  1. Brain fog which is part of the Adrenal Fatigue Syndrome. Emotional Vampires…… In the book there is a lot about the antidepressants.  All the book is  evidence based medicine with a biography for  reference.  More and more evidence based science is coming out that it may be the high serotonin levels that the anti-depressants are causing that may be responsible for anxiety.

  2. Depression: of course with all these functions  of the body not functioning (sex hormones and digestion for example) plus insomnia.

  3. Blood sugar: low  hypoglycemia episodes or chronic hypoglycemia due to the eventual adrenal fatigue and the eventual pancreatic collapse

  4. Fatigue

  5. Insomnia

  6. Low blood pressure

  7. Low immune function with adrenal fatigue

  8. Increase of inflammation because of the inability to moderate the chemical blood cell reactions that cause inflammation.

 THE ADRENAL CORTISOL STRESS RESPONSE INHIBITS FUNCTIONS THAT ARE NOT NECESSARY FOR FIGHT OR FLIGHT SO THAT ALL THE BLOOD IS DIRECTED TO THE LARGE MUSCLES OF THE LEGS AND ARMS. THE FUNCTIONS THAT ARE STOPPED ARE DIGESTION, AND THE HORMONES; ESTROGEN, PROGESTERONE, TESTOSTERONE, ALDOSTERONE (WHICH HELPS REGULATE BP) and thyroid eventually. One can easily understand when you inhibit the above functions the illnesses that can be caused.

It is also necessary to realize that at first stress causes high adrenal output of cortisol. When the stress (s) continue eventually the adrenal gland runs down and puts out little or no cortisol = Adrenal Fatigue.  The same is true for the pancreas. At first the pancreas releases a lot of insulin to keep up with the liver’s output of sugar. Eventually the cell receptors get fatigued and insulin resistance  begins. The pancreas once again trys to overcome this problem and puts out more and more insulin until like any engine just quits and we have diabetes.

This is all explained in understandable English with diagrams in my book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.

holisticsecondopinion.net/vampires

Author: Alan J. Sault MD, ABHM – Diplomat

 

SUPERWOMAN

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SUPERWOMANThe song I Am Woman says a lot about the strength of this gender. But what emotional and physical price do many women pay to do all the wonderful things that the song acknowledges and which very often men depend?

Client X has symptoms of fatigue, insomnia, weight gain , headaches and a series of minor illnesses. She denies being under stress and requests an antidepressant. A traditional allopathic physician would probably prescribe one. After all, she exhibits the classic symptoms of depression.

An holistic physician would not take, “No I’m not under stress,” at face value. We can better evaluate the cause of her symptoms when we take the time to listen to a client and learn something about how they live, and the challenges they face. Does she have all the above symptoms because of years of taking care of children, a husband, a job, and not getting much recognition? Is this an all-too-common “Superwoman” putting in 25-hour days and trying to lighten the load for everyone else? We may find she is dealing with the threat of unemployment, or a recalcitrant teenage child on drugs, or a parent with Alzheimer’ disease. The patient may have been living with all or some of these for some time and may not consider them particularly stressful – “It is my job.” But whether or not they are “normal,” these kinds of stresses do have an effect on the body’s system. The body reacts with the Acute Stress Response (ASR) but now it has become the Continuous Stress Response (CSR). Both put out the same adrenal hormones and cancel the non-essential functions for flight or fight. (see book: Emotional Vampires and Your Hormones……) The CSR causes many diseases due to the hormonal imbalance.

The most frequently prescribed anti-depressants are the SSRI’s, (Selective Serotonin Re-uptake Inhibitors), which have the effect of increasing the blood levels of Serotonin, a hormone that creates a feeling of well-being. This latest generation of anti-depressants (for example Prozac, Zoloft, Celexa, Lexapro, to name only a few) at first appeared to be wonder drugs, without the nasty side effects of the previous generation of anti-depressants, the MAO inhibitors and tricyclics. But after many years of their use we are seeing that these drugs too can have side effects, such as weight gain, insomnia, sexual dysfunction and with some younger people suicide and/or aggressiveness. So patient X, after a few months on conventional anti-depressant treatment, may not feel much better, or may even feel worse due to the drug’s side effects which cause more anxieties. Realize also, that taking drugs only may alleviate the symptoms and signs and negate the cause: Putting a band-aid on a large laceration

All of our endocrine (hormone) system is interconnected. If one of our hormones, for example serotonin, is “out of whack,” then probably other hormones- in trying to compensate so that the body will be in homeostasis – have also reached compensatory dysfunction. For example, Patient X may do well on restoring her serotonin levels (preferably naturally), but because of the long-term stress and lack of sleep she may also have Adrenal Fatigue Syndrome. The adrenals put out many of our hormones, especially in stressful situations. Cortisol, for example, is produced in higher levels during periods of stress to help the situation (reacting as if in fight or fight) but eventually can be depleted (Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it. Holistiacsecondopinion.net/vampires). Then, because more glucose is needed to provide more energy to the cells to support the increased metabolic rate during continuous stressful situations, we get the involvement that an holistic physician would consider and discuss with the patient.

If a diagnosis of depression is made there are many options. It may be appropriate to refer this client to counseling. If she is the caregiver and problem solver and general fix-everything person in the family, she may benefit from having someone simply listen to her and give her their full attention. Perhaps she has a problem saying “no” and could benefit from some assertiveness training: or perhaps she has never considered that self nurture, can be nurturing everybody; it is not selfish but necessary. Counseling has been shown to be as effective as the SSRIs for mild to moderate depression and anxiety. So has exercise, which also has many other obvious benefits. Part of the benefit is that taking the time to exercise means taking the time for self-care. It also provides an outlet to be in a different social environment and interfacing with other people.

An holistic physician would consider hypothyroidism, alone or in conjunction with perimenopause or menopause. If there is some hormonal imbalance there is a range of clinically-proven botanicals to be considered that can have the same affect as expensive patented drugs without the side effects. Also appropriate human bio-identical hormone replacement often is the answer. But also consider stress interferes with estrogen, progesterone, testosterone, cortisol, aldosterone, digestion and thyroid. (Emotional Vampires and Your Hormones….)

Patient X can learn to take care of herself by learning how to better cope with stress, or by working through emotional challenges, and by taking the time for self nurture. In so doing, she has a good chance of not having to take medicines, whether they are prescription or botanicals. Either of the latter are reality only alleviating the depression and not curing the source. Until a person comes to a conclusion of how to deal with stress and also that they deserve to have self-nurture they will not be able to create the vibrant health that they deserve. When a client says to me that they do not have time for self-nurture I make them listen to what they just told me and explaining that they are sending a subconscious message that the kids, husband, boss,etc are worth her time but she is not worth at least 30 minutes per day.

Take time to nurture all aspects of your being: physical, Emotional, mental and spiritual. A joy-filled life is Your birthright : CLAIM IT!!!

Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.”

Author: Alan J. Sault MD, ABHM holisticsecondopinion.net/vampi

Thyroid Dysfunction – the shape shifter dis-ease

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Hypothyroidism

The thyroid hormone is one of the main hormones that stimulate the furnace of the cells to produce energy. Without it, or when the thyroid hormone is low, food cannot be used and is stored as fat. The most common signs of hypothyroidism are:

  • low temperature below 96.4 (depending who you read). But definitely feeling cold when everyone else is comfortable.
  • fatigue for unknown reason(s)
  • loss of hair and outer 1/3 of eyebrows
  • dry, scaly skin especially of the shins
  • constipation that is new for the person
  • weight gain even though the person is eating normally for themselves. Especially if they are working out to lose weight

The symptoms and signs of low thyroid production can masquerade as depression, menopause, and psychosomatic. The interpretation of reading the laboratory results can mislead the physician thereby masking this diagnosis of the hypothyroid problem. The main blood test used to diagnose this is abbreviated to TSH (thyroid stimulating hormone). TSH is what is ordered by the physician to see if you have a thyroid problem. The numbers that the physician looks at to see if you are in the normal range has been controversial for a long time. Depending on the lab the TSH range was.35-5.5 but has now been changed to .3-4.5. This because it was found that too many cases were being missed by a lot of doctors looking at a high in the normal of 5.5. Doctors have been debating for years whether to lower the upper limit of what is considered normal for TSH since so many people whose blood work shows their TSH close to this upper normal limit still have the symptoms and signs of a low thyroid. Unfortunately, the missed diagnosis of hypothyroidism because of misleading lab results is not the whole story. The Colorado Thyroid Disease Prevalence Study found that when tested for thyroid dysfunction 10% of the study’s 25,862 subjects had abnormal findings (high normal being 3.5). That figure, if extended to the general population nationally, would mean there are about 13 million people with undiagnosed thyroid abnormalities. And if, as recommended by many physicians, the upper limit of TSH for thyroid dysfunction were reduced  to 3, it would mean that 20% of the population is affected.

But when a busy physician takes a history of all the above symptoms and signs s/he may only hear depressed, tired and menopause and see lab results in the normal range. It would be in the patient’s best interest, I believe, to consider the signs and symptoms first and the blood work second.

A low thyroid level is called hypothyroid or hypothyroidism. Hypothyroidism may also be caused by a poorly functioning adrenal gland, since too much or too little cortisol affects the thyroid hormone. The adrenal gland produces cortisol and adrenaline in response to stress, and powers the Stress Response that prepares the body to fight or flee. In the initial stages stress causes higher than normal levels of cortisol: When the stress is chronic the adrenals eventually wear down, a condition known as “adrenal fatigue,” and cortisol production drops below normal levels. Therefore there is not enough cortisol available to sensitize cell receptors to accept the hormone nor to convert the T4 to T3.

As we have seen, production of many hormones, including thyroid, is lowered when the body is stressed. The Stress Response at first triggers the adrenal gland to produce higher levels of cortisol, that signals the body to put all its energy into the systems that will help to fight or run – the large muscles. To do this it takes energy away from functions that are not essential to those life-saving activities such as the sex hormones, thyroid and the GI tract. In the case of chronic stress, the adrenal is overworked continuously and the cortisol production becomes less and this too results in hypothyroidism.

The machinery of the body functions on precise amounts of each chemical, some measured in billionths of a gram, and this includes the hormones. This precise amount for each hormone is known as the physiological quantity (for that particular hormone). All the hormones have to be available in the appropriate physiological quantity in order to function in harmony for optimum well-being. It is like a symphony with each musician playing exactly the right notes in harmony with all the others.

Many women entering menopause not only experience the effects of diminishing sex hormones but also have a thyroid problem. I believe the depression that accompanies both menopause and hypothyroidism comes also from the physical changes: constipation, hair loss, feeling cold, gaining weight, fatigue that disrupt one’s life. I believe that the thyroid should always be explored before starting pre and post-menopausal woment on antidepressants. OK, now, I want to introduce what can go wrong with the thyroid and why conventional treatment may not work or even make the hypothyroidism worse.

The thyroid gland is stimulated by a complex feedback system. The pituitary gland stimulates the thyroid to produce T4 (thyroxin). The pituitary gland then responds to a feedback to the amount of T4 whether to stop stimulating the thyroid gland (enough of it) or to keep stimulating it (too little). In other words, the pituitary is responding to the amount of the primary(T4) hormone produced by the thyroid.. However, T4 is inactive, and must convert to active T3 in order to do its job. The conversion from inactive T4 to active T3 requires the right amount of selenium and cortisol. If selenium and/or cortisol are lacking or levels are inadequate, the feedback of T4 to the pituitary gland can make the level of TSH appear normal, since the T4 is sending the message that all is okay. The physician reading the lab report sees that the TSH is within normal limits, even though the patient is deficient in T3. All this is made more simple and explained with diagrams for the layperson in my book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.

And the plot thickens. Under stress, T4 may convert into what is known as reverse T3 (rT3). The rT3 molecule is just like the T3 molecule , except that one of the three iodine ions is in the wrong position. This tricks the receptor sites of the cells. rT3 binds to the receptors, thus blocking any remaining real T3. But since the rT3 does not have the same active stimulating effect as T3 because it is not of the right molecular arrangement, it will not stimulate the thyroid’s metabolic functions in the cells. Therefore, prescribing T4 will not solve the problem. The more synthetic T4 a patient takes the more rT3 is produced and the patient’s condition either does not improve or gets worse. When the stress levels rise the same enzyme (iodinase enzyme) which is responsible for the conversion of T4 to T3 is also used for conversion of T4 to rT3. Therefore, there is not enough of the enzyme to convert to both reactive T3 and rT3. For some reason the conversion to rT3 takes precedence. As of today, it has not yet been explained why rT3 takes precedence.

let’s say the patient is being treated with synthetic or natural T3 but still does not feel well. It is possible that the T3 is not getting into the cell, because to get into the cell the T3 is again dependent on selenium and a physiological level of cortisol and these may be deficient. Or if the T3 does get into the cell it may not work if zinc levels are low, because here it is dependent on zinc for its performance on the mitochondria in the cell. Mitochondria are the multitude of little factories in the cells that produce energy.

So to summarize: it is possible for a physician to be fooled by lab work. In this case, T4 levels remain normal but are not being converted to the usable T3 or as just explained the T3 cannot be utilized. The feedback of the T4 from the thyroid is still telling the pituitary that all is okay and therefore the TSH remains normal. But if the patient has all the symptoms and signs of hypothyroidism, then I would say the heck with the lab work being in the normal limits. An rT3 test is needed here and maybe some other thyroid tests: T3, FT3 (F=functioning), T4, FT4 and an autoimmune profile for thyroid (It is a possibility that the body has formed antibodies against an aspect of the thyroid hormone or the receptors for it).

Another interesting theory is that when cortisol is low causing the gut does not absorb normally. This can lead to leaky gut syndrome, which means that certain large protein particles that are foreign to the body are absorbed, and other nutrients that the body requires are not absorbed, such as amino acids.

Tyrosine plus iodine are needed to make the thyroid hormone. Therefore, if one has the leaky gut syndrome it may mean that tyrosine, an amino acid, is not being produced by other amino acids it depends on for its productions.

This was a shortened version of a chapter in my book (Thyroid and stress). I do hope though it illustrates how many things that the thyroid hormone depends on. Stress is still the big factor to sabotage a properly working thyroid and needs to be addressed whether the person is on synthetic hormones or more bio-identical thyroid hormones. Of course a good diet, exercise, a physician you can relate to and takes their time evaluating you and your smile and laughter goes a long way.

Compliance = Responsibility

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ComplianceMagnifying-GlassThere is a joined responsibility of the client (patient) and also the healer during treatment and prevention. I was talking to a friend the other day and asking him about the lab work that he was was supposed to have gotten and found he  was putting it off with various excuses , none of which were economic. Such as, I was too busy; while I know he starts his day at 9-10 AM and could be at the lab at 7:30 am. Yet, he wanted his physician to write him a prescription for a schedule II pharmaceutical which ethically, morally and in the practice of good medicine has to be followed by lab work between every 6-12 months.

This is a long introduction on what is the role of the patient and the physician or healer. Of course this is my opinion! The client has the responsibility of following the physician’s requests or addressing the physician with questions of why the requests are necessary. I believe the physician has the responsibility of explaining why the steps of the treatment are necessary and what they mean. If the client does not agree after the explanations, in my mind he does not trust or agree with the expertise of the healer and should move on to healer which s/he feels more comfortable

I have experienced too many avoidable problems in medicine with physicians trying to be too accommodating and sacrificing what they know as good medical practice so that the patient can be accommodated. The healer is usually doing this with an open heart and empathy for the patient. But it is comparable to a parent not explaining to their child the consequences of doing or not doing an act and then not being forceful enough to enforce what is right for the child’s safety.

On the other hand, too often the client wants the convenience of the physician doing all the work for them and believing that the “pill popping” will make them better. Obviously this is false! The medicine or alternative treatments will help alleviate or cure the person but only if directions are followed by them and/or practiced by them . For example; an orthopedic surgeon can put a prosthetic shoulder in the patient but the patient has to dutifully follow through with the post surgical assigned program to get full beneficial range of motion.

It really bothers me if the physician or healer does not sit and explain the importance of their regimen for whatever the pathology with the attitude that the client is not smart enough to understand: but it also really bothers me when the client is nonchalant about the explanation and directions and believes that the responsibility is all on the healer. Ultimately it is the client that suffers physically and mentally when the healing is not as complete as possible. I find it helpful for the client to prepare a list of questions before the interview with the physician since often time is limited and also the client is nervous and forgets problems that s/he wants to have answers. This tactic helps the physician alleviate stress of the client and also get to know the client better.

So compliance is a two way avenue. The physician can only be a guide (and life-guard when necessary) for the client and not the full time caretaker. The medicine is so often only to relieve the symptoms and signs but not the panacea for wellness. The client is responsible for following advice or not with the knowledge that there are always options and also consequences for any action. The client also needs to practice good health regimens as much as they can to keep a good immune system

I hope this blog helped to enlighten some readers it was a good cleansing for me.

What about the caretaker?

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Take care of the caregiverIt’s time to take care of the Caretaker!

As a physician for about forty years I have encountered so much stress in people taking care of their loved ones. The sad part of this is that so often they do not get any positive recognition, or worse just criticisms. It seems everybody knows how and what the caretaker should be doing, but so often that is the extent of their participation in caring for the person in need. I do not think it wrong for the caretaker to be assertive when outsiders (even friends) criticize the caretaker for what and how they are doing this task. It is alright for the caretakers to state they are the ones that are doing this job and “I will consider what you say, but remember that you are not me and not in my shoes or circumstances.” This may even be the time to hint strongly that positive active help would be appreciated.

This is a typical case! Sylvia is an 88-year-old woman that is having her fourth bout of cancer. Her husband has progressive Alzheimer’s Disease (AD). Sylvia was never a patient person and may even be described as a hyper -obsessive personality. She was also a very demanding and angry person with her husband who she believed did not make enough money although they lived quite comfortably. But she was a caring mother and wife and always worked to help support the family. She was also very active in many social activities about everyday of her life before having to be watchful every minute due to her husband’s dementia that could potentially cause a dangerous situation if left alone. When her husband Martin was diagnosed with AD he was at first quiet, but as the AD progressed it was not a case of just not understanding, he also became quite abusive to Sylvia and often got mixed up who his wife was with other women and was abusive to them. Martin in his salesman’s life was a very gentle person with a good sense of humor, even to the point of injecting his humor when the conversation was serious and therefore he could be annoying even in his cognitive days. He became not only abusive verbally but also started to get physically abusive. Fortunately he was feebly weak; but to an 88-year-old woman this was scary.

When friends and relatives came to visit they were always concerned about how Martin was doing and of course had many suggestions of what Sylvia should and could do for him. Most stopped coming after awhile since Martin could not communicate and Sylvia was always too tired to really entertain. Visitors showed little concern about her cancers, her treatment status, taking care of Martin and her emotional and mental status of caring for him. In a short time Sylvia was depressed and tired and often in tears. She decided it was time to put Martin in a nursing care center, which she did. She visited him many times a week, which was not easy for her at 88 years old especially one with cancer.

This case is so typical and the story can go on and on. But we are interested in the psychology of the caretaker and options they can take to alleviate a sad situation. We have an elderly person (but the person could be much younger) taking care of a person that they have been with for many years. She still loves the person but also a lot of this love has turned to obligation and guilt. She also has anger.

The anger may or may not be on a conscience level or admitted to oneself. So the following are hypothetical but could be real with some caaretakers. She could be angry because her life has been completely changed from being an active person with lots of friends and acquaintances to one of being a stay-at-home caretaker. Angry because she herself has health problems that she has to put in the background to be a caretaker. Angry because most of her recognition by others for being a caretaker is negative contributions of what she should be doing and/or could be doing foor her spouse. In line with the latter is also that she is not getting recognition for having cancer since all the sympathy is going towards her husband. Angry because she has guilt about not wanting to be in this situation with someone that she may not even love anymore except in her past memories. Anxious maybe because we all know that we may be the one that needs to be taken care of someday and who will be there? If it is a loved one will they feel angry about being put in this situation? There is the visual knowledge when caring for someone that they may be in the same situation having to give up their independence such as a car for example. This may not be an overt thought but just underlining the conscience mind that we are getting older and our society has no great provisions for these “golden years”.

Another negative emotional feeling that may creep into a caretaker’s mind is guilt for the way they believe they treated this disabled person in the past. They can of course talk to this person and discuss calmly why they did not always understand the other person’s side and instead became aggravated by this person that they really did love. This is even more apparent and difficult when the loved one dies and then it is very difficult to communicate regret of how they acted toward this person. But the caretaker can still forgive himself or herself. This can be done in a verbal way with different techniques using visualization. There are counselors and psychologists trained in the latter. It works!

This case study only illustrates one common situation whether it is a man or a woman that is the caretaker caring for a long time companion. As stated some of this case can be applied to young people that fall into a caretaker situation with a spouse or girl/boy friend. Or a young person that is involved in a similar situation with a parent and that their life now revolves around care-taking that person. They may love that person but it is a change of life that may interfere even with other evolving opportunities in their life. There may be an ambivalence of love and anger of the situation. This guilt diminishing the love because care taking can be a full time job. This is especially true if money is inadequate to get help and the government only helps sparsely, and this after very time consuming paperwork and interviews.

So often the caretaker starts off feeling love and responsibility for the person but after a time they may not see this person as the same one that once bonded them together. In fact, the caretaker may view the person as a complete stranger occupying the body of the loved one. Because of this they may feel stuck in a situation of a time consuming and often an unclean job of taking care of the person.

For both the caretakers young or old, there is often the unromantic role of the caring of someone that was once strong and often the caretaker of the caretaker. So often the new role of caretaker is worsened because they were always the one cared for by this new person and they themselves do not know how to manage all the everyday business things that are required by our society.

One trap that the caretaker may fall into or create themselves is that of being an enabler. This is a person that does or overdoes so much for the person that the person becomes less and less capable of doing things for themselves or even gives up trying to do anything for him/herself. The incapacitated person still may be able to do a lot of things themselves and probably wants to do so. An example of an enabler is the following: take a person that is an alcoholic and ends up in jail a lot. If the same person rescues them from jail all the time they are allowing the alcoholic to remain status qua since the alcoholic knows he will be rescued. The person doing the rescuing is not really helping the alcoholic make decisions to change but rather enabling the person not to have to make this decision. This simple example can be transferred to an incapacitated person when the caretaker does not allow or more so encourage the person to do things for themselves.

When compassion becomes pity and nurturing becomes rescuing there is a problem. Compassion and nurturing are empowering to the caretaker and the patient. Pity and rescuing are not only a burden to the rescuer but also devalue the targets of those sentiments. Because the underlying message is that the disabled are incapable of growing or learning to take care of themselves.

Enabling people may have different paths that lead them to be enablers. They may have been taught to be so since childhood watching one of the parents enact this. It could be that it makes them feel righteous or powerful. With the later I find that this type of person is often an enabler to many people not just for the one that they are in charge of caring; but it may just be the one person. They may even have ambivalent feelings for the person and get enjoyment at having them at their mercy. Then there is the martyr personality type person that wants all to see including the invalid how they are sacrificing their life away by care taking.

There are probably other reasons for people becoming enablers. Of course, there are the caretakers that have really earnest, loving motives. But in their method of showing love, if they are not cognitive of overdoing things for the person, they may not be realizing that they could be furthering a crippling situation or facilitating an eventual progression. For example, there is the parent that keeps feeding their child to show love and the child is getting fatter and fatter causing social problems and eventually maybe even diabetes. So often this is done with good and loving intentions. This latter example of the type of loving person can be forwarded to the caretaker that believes they have to do everything right away for the invalid and more because this is what love is to them – no guilt or anger-just love.

So what are some of the things a caretaker can do to protect and take care of him/herself? If the caretaker does not take care of his/her health physically and mentally they may not survive the ordeal of helping another. They may even be shortening the time that they will be the patient.

1-I believe first the caretaker should analyze the situation as to how much money and how much time caring for another will be.

2-Consider what available helpthere is for giving the caretaker time off for themselves. This couold be close friends, relatives, and I have had good luck when I worked as an ER physician with Social Services. Also, as an holistic physician I have called Social Services and almost always received help or optioans for my client.

3-Either at the same time or just after this assessment they should try and reason out why they are undertaking this task. What are their real feelings about becoming a caretaker? This is so that they can come to terms with the situation and themselves.

For this latter they may need outside help that helps them discover the whys. They can do this with a person that is non-judgmental and gives unconditional love. It is difficult to find a friend that can do this being the latter two qualities are rare in a friend who can step outside the situation knowing the two people involved. A trained social worker or counselor I think would be the best source for this task.

Another option, is to venture into hypnosis or integrated guided imagery; I know from many experience of my own and clients that this helps. Again with a trained person that gives unconditional love and is non-judgmental.

Namaste, and maybe being a caretaker is the road for some of us to realize and come to terms with evolving; it did for me.

Stress and your Well-being II

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good grief

Vampires are known for their clandestine attacks upon unsuspecting people. I choose the word Emotional Vampires because there are elements in our society be they human beings or environmental toxins that are sucking life’s energy out of so many of us. These elements are often either invisible to us, avoided by us on a subconscious level of self-protection; and /or fear of change. There are also some of these elements that seem to be forced upon us. They could be either human or environmental because we feel we have no choice, for example GMO foods. In any case, over time they cause stress and illness.
Avoiding stress is difficult for most of us since our modern world has made stress an inherent part of life. Stress begins in early childhood and never lets up throughout our linear lifeline. So, it is accepted on an unconscious level but not on a mental and physical health level. For instance, a female child may start to learn very early that it is her responsibility to become a caretaker, (and sometimes an enabler). She watches her mother do this and is given certain responsibilities that enforce this behavior until it becomes her life style. Then as a mature woman when anything goes wrong in the household she may believe it is her fault, whether this is true or not. This creates stress, also because the woman is often trying to make everyone content and many times she is also the buffer between members of the family who have conflicts..A male child  as a toddler is cuddled when he falls. But then at a 4-5 year level if he falls and cries he is told big boys do not cry which up to this point was rewarded with caresses. So he has a double message implanted in his head. He is also told that he should be kind to others. He also may be told to watch his back for manipulating people (emotional vampires) and not to trust anyone: Another double message, which latter can cause relationship stresses.
Stress does not have to be from other people (who I call emotional vampires since they thrive on sucking out our emotions) but we are also getting toxic stress from our environment, such as mercury intoxication, from our foods and some vacinations, heavy metals such as aluminum and cadmium, arsenic,etc.. From these vampire affects we are more likely to get different cancers, diabetes, arteriosclerosis, cardiac diseases and hormonal dysfunctions. Obviously having a chronic dis-ease is another stress.How does all this relate to emotional vampires? It is important to know that the environment plays a big part from birth on that is often not considered by the average person and is often ignored by physicians as a source of stress. Then there are the many vampire organizations like the medical-pharmaceutical alliance and big corporations’ greed that affect hormonal well-being. In other words, this vampire effect does not always have to be one individual attacking another but our value system that invokes catastrophic poisoning to our immune and hormonal systems via the stress that we allow.

After 40 years of medicine and thousands of patients I am completely convinced that genetics may be a predisposition for some dis-eases; but in the majority of cases the pathology would stay dormant and not become overt until stress causes it to surface.

In my book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well – being and what we can do about it; I go much deeper into all the above topics.

To contact Alan J. Sault M.D., ABHM go to his email: drsault@holisticsecondopinion.net

What to do about stress

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Businessman solutions the problem

We are affected not only by overt stress (emotional vampires) but also the stress of which we are unconscious, that we may accept as just the way life. But there are things we can do to either alleviate stress or diminish stress. Think of yourself as an energy bank: energy is deposited, and energy is withdrawn. When the withdrawals exceed the deposits, fatigue, lowered immune function, depression, and ultimate systemic breakdown results. In any uncomfortable situation you always have three choices:

  • do nothing, and continue to put up with it

  • change the source of the discomfort

  • change your response to it

The “do nothing” option.

If you choose the first, of course, nothing will change except you will become more and more worn down.

The “change the source” option.

If you choose the second, you can politely but firmly tell the person that you can no longer talk to them, or—if that kind of assertiveness does not feel right, or possible —you can think of strategies to limit their demands on you. Close your eyes and imagine yourself answering the phone; caller ID has alerted you to an acquaintance who typically launches into a litany of complaints. Imagine saying: “Phil. Hi. I only have five minutes I’m afraid.” And when four and a half minutes have passed, saying: “I’m so sorry you’re having all these difficulties, but I’m going to have to say goodbye. I hope things get better soon.”

The “change your response” option.

The third option is for the situations in which it is not possible, or perhaps not even desirable, to eliminate the stressor from your life. Maybe your boss is driving you up the wall, but you like everything else about your job—it is interesting and challenging, it pays well, the hours work well for you, you get along well with your co-workers, and it’s conveniently close—and you really don’t want to quit. In this situation, changing your response to the stressor would be the best course of action for you. Easier said than done, right? Right. But eminently possible.

And again we begin with imagery, creating a special place in your mind where you can face your boss. Remember that within your own mind you have complete control: you can create any place you want, indoors or out; you decide on the vegetation, the color scheme, the season, the time of day. And if your boss tends to intimidate you, you can give yourself whatever you need in order to feel powerful and safe: a magic cloak, a shield of light, your guardian angel, or your own Samurai.

And perhaps there is so much stored up resentment that you first need to vent, and tell your boss exactly what you think of him or her. So go ahead, scream and curse all you want, and when you’ve got all that out of your system, you take a deep breath, surround the angry words in a bubble of light, and blow them away. Venting in the privacy of your own mind will give you relief; venting at your boss may give you temporary relief but is not going to get you to where you want to be. “A soft answer turneth away wrath: but grievous words stir up anger,” so says Proverbs. Stirring up his or her anger is not in your best interest, because the boss has more power than you and your goal is to stay at your job.

So there you are, in the safety of the mental sanctuary you have created. You have vented all the wrath and now you turn to the soft approach, speaking your truth clearly and firmly, articulating what you want and imagining him or her responding in the way you want them to respond, saying what you want to hear or at least being open to negotiation.

However disgusted, angry, frustrated, whatever, this person makes you feel, remember that your goal is to make your workplace a pleasant place for you. Your negative emotions just fuel the negative atmosphere. So approach this person as you would a stranger, with positive expectations. When you do feel ready to speak to your boss in person, whether or not he or she responds in the way you want you will feel better for having spoken your truth; you will not take personally his or her bad moods; and you will feel strong enough to say “no” to unreasonable demands.

Boy this blog has turned into a small dissertation and I am far from through about stress-related illnesses, well-ness and expanding on the real pathways of cortisol involvement.. But for anyone that needs more or who has questions:

 Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being.