Kenneth Orbeck DO - Greenville Bioidentical Hormones Expert

FIBROMYALGIA – What is really going on?

Posted by Dr. Kenneth Orbeck on June 25th, 2012 | No Comments

From: Kenneth Orbeck, D.O.
Sent: Tuesday, June 12, 2012 10:42 AM
To: Kenneth Orbeck, D.O.
Subject: fobromyalgia

Fibromyalgia is a chronic condition diagnosed by exclusion. It is characterized by widespread musculoskeletal pain, hypersensitivity to various stimuli, and often involves sleep disturbances and elements of fatigue. Other common symptoms with fibromyalgia include frequent headaches, difficulty with concentration and memory, underlying anxiety and elements of panic disorder, irritable bowel syndrome, and menstrual pain or irregularities. Fibromyalgia is a frequently diagnosed condition and places significant financial burdens on the individual as well as society as a whole. There are significant healthcare costs associated with the treatment of fibromyalgia as well as significant loss in both productivity and frequent disability. Conventional therapy has not shown an optimal response in a high proportion of cases which involves treatment such as analgesic therapy, antidepressants, trigger point injections, and psychological counseling and stress management.

Let’s now take a look at fibromyalgia from a functional medical standpoint involving possible metabolic derangements and underlying secondary inflammation. Fibromyalgia appears to be an intracellular energy deficient state often involving poor mitochondrial function to produce the proper energy pathways required for health and vitality. In order for the human body to have adequate energy and metabolic function, adequate nutritional intake and absorption must occur; with transport of these micronutrients into the cell, and utilization of these nutrients through the KREBBS cycle to generate adequate energy while eliminating toxic waste. Cellular communication is important which involves both neurotransmitters and hormonal balance. Toxicology issues are also important which can have a negative effect on secondary enzymatic pathways necessary to allow for tissue regeneration and required end products. Before we look at functional and metabolic treatment protocols, we must discuss the necessary evaluation of any individual presenting with signs and symptoms consistent with fibromyalgia. Examining the following physiologic parameters will guide the practitioner to provide a more concise treatment approach which often results in an optimal outcome and reduction of symptoms. Categories that I often look at include detoxification and biotransformation issues, immune imbalance and inflammation, oxidative and reduction hemodynamics, intestinal digestion and absorption, hormonal and neurotransmitter balance, and mitochondrial structure and membrane integrity. Any and all of these factors will have a cause and effect relationship to chronic inflammation.

Toxicology issues are always important when there are issues of inflammation and in patients that present with symptoms consistent with fibromyalgia. The environmental toxic load continues to rise in the food that we eat, the water we drink, and the air that we breathe. As our toxic burden increases, the body will often reach a level of excess which places a burden on the liver and detoxification pathways allowing the body continual build up of these various toxins. This will have a negative effect upon metabolic pathways and the ability to maintain health. Intestinal health is important to rid the body of toxic waste. Liver health is extremely important which involves phase 1 and phase 2 detoxification pathways allowing the body to transform toxic substances into non-toxic byproducts which then can be excreted through the bowel or kidney. Intracellular toxicology issues are extremely important as they have a direct effect on cellular membrane, mitochondrial transport and function, and issues of energy production. Testing is often required to include environmental toxin testing, toxic metal analysis, and organic phosphates. Detoxification protocols begin with intestinal support and proper bowel function, hepatic detoxification of the liver utilizing multiple nutrients and dietary changes as well as adequate hydration, and cellular detoxification involving both nutrients and chelation if toxic metals are identified.

Immune disorders and immune imbalance are also important in individuals who present with symptoms of fibromyalgia. Frequently in chronic inflammatory states, TH1 cellular immunity becomes excessive over TH2 humoral immunity. Humoral immunity is responsible for underlying allergies such as seasonal allergies, or food allergies, especially to dairy. TH2 immunity involves B cells responsible for antibody formation. TH1 or cellular mediated immunity is involved in the delayed hypersensitivity reactions and is responsible for protection against underlying viruses and bacteria. This involves the activation of natural killer cells as well as the production of macrophages. When cellular mediated immunity is excessive, a possible outcome may result in autoimmune diseases. Multiple nutritional products are useful in balancing TH1/ TH2 immune dysregulation. One common product that I often utilized is bioactive proteins through the use of colostrum. Proline rich polypeptides (PRP’s) are tiny carrying proteins that contain abundant information with amazing abilities to balance the immune system. During times of intense physical stress, they enhance the production of cytokines through immune activation. When the situation is opposite and the immune system is healthy, they react to environmental factors and send signals to specific cell receptors to decrease cytokine formation and balance the immune system.

Oxidative and reduction hemodynamics is also important when dealing with chronic inflammatory states and fibromyalgia. Oxidative stress on the body can come from multiple substances, but the most common are environmental toxins and toxic metals. Oxidative stress forms what is known as reactive oxygen species (ROS) which play a role in developing free radicals which can lower metabolic enzymatic activity. These species have been shown to increase sympathetic tone as well as plasma norepinephrine often resulting in an excitatory neurological state and may play a role in pain modulation. Functional testing of the serum and urine can allow the practitioner evidence of toxicity which needs to be removed before biotransformation can be successful. Utilizing several inflammatory markers such as TNF alpha, interleukin 1, interleukin 6, C-reactive protein, and homocysteine will aid in oxidative stress management. When these markers are elevated, the end result is often immune-exitotoxicity. This has an effect on our brain function. Neurotoxicity and brain damage are often the result of this process and is commonly linked to toxic metal stress.

Intestinal health (the function of digestion and absorption) is critical in the management of chronic disease states and fibromyalgia. The ability of our body to properly digest nutrients and transport them across the mucosa into the bloodstream where they can be utilized for cellular energy is vitally important. Issues here involve the proper amount of acid in the stomach to begin digestion, adequate pancreatic enzymes for the breakdown of protein and fats, and proper mucosal integrity to allow for transportation of nutrients. Interference can occur here with underlying pathogens such as yeast, parasites, or non-friendly bacteria. Identifying any pathological burden within the gut must be evaluated and removed to allow for proper nutrient absorption. The mucosal integrity is vitally important as there is only one cell layer separating intestinal toxins from our blood stream. When a break in this layer occurs it results in issues of permeability it is often called “leaky gut”. Functional testing will allow the practitioner to identify issues of intestinal integrity and begin the repair process where needed so adequate nutrition will be available to cells and metabolic pathways.

Mitochondrial function is very important in the treatment and assessment of fibromyalgia. Membrane integrity and mitochondrial function allow for adequate energy production when proper nutrients are available. Utilizing functional testing and blood work will allow the detection of mitochondrial breakdown. Specific areas of breakdown may be secondary, for example, to specific nutritional deficiencies. Identifying these areas will allow the practitioner to replace specific nutritional needs allowing for energy production to occur within the cell. Since fibromyalgia may involve an energy deficient state within the cell, maximizing energy production remains critical. Some products that have been utilized with success include deoxyribose, L-carnitine, magnesium, and coenzyme Q 10.

Hormonal and neurotransmitter balance is vitally important in the treatment of chronic inflammatory disease including fibromyalgia. Neurotransmitters allow the brain to communicate to the body necessary functions within the endocrine system. Hormones act as cell regulators and allow cell to cell communication. Hormones have a direct influence on genetic cellular communication. This neural – hormonal mechanism allows the brain to influence the body in repair, regeneration, and the maintenance of optimal health. Bio identical hormone replacement therapy has been utilized in my practice with great success to optimize this communication allowing the body’s natural healing process to occur.

After looking at the above issues to identify any breakdown in the metabolic pathways regarding chronic disease and inflammation, treatment considerations are reviewed for optimal outcome. Dietary factors are important in the management of fibromyalgia. Emphasizing proper nutrition avoiding refined sugar and processed food is critical. Eliminating caffeine, alcohol, and food additives is also necessary. Cooking methods are also important, as cooking foods quickly on intense heat can develop advanced glycation end products (AGE’s). These products result from the interaction of the reduced sugar and the protein. This modified type of protein has been shown to evoke an inflammatory response. Studies have shown that when cooking at lower temperatures and in the presence of water, AGE formation will be significantly reduced. Patients should be made aware of any underlying food allergies and eliminate these foods from their diet. Considering a raw food vegan diet is important as studies have shown that consumption of an uncooked vegan diet for three months improve symptoms of fibromyalgia.

Nutritional supplementation is also important in the management of fibromyalgia and chronic disease. Magnesium deficiency is often found in patients with fibromyalgia and magnesium supplementation can be beneficial. Intravenous supplementation of magnesium has been shown to improve myalgias within 48 hours. Intravenous nutrient therapy has often been reported to improve the symptoms of fibromyalgia. SAMe administration has been shown to improve symptoms of fibromyalgia through double-blind trials. Oral administration of SAMe seems to be the preferred route of delivery. 5-HTP is a precursor to serotonin. There are suggestions that serotonin deficiency is involved in fibromyalgia pathogenesis. Since 5-HTP and antidepressants both affect serotonin, 5-HTP should be avoided or used in caution with low doses on patient’s taking antidepressants. Vitamin D has been shown to improve symptoms of fibromyalgia. Musculoskeletal pain is one of the manifestations of vitamin D deficiency. Although the relationship between vitamin D and fibromyalgia is uncertain, vitamin D deficiency should be evaluated and supplemented appropriately where indicated. As discussed above, fibromyalgia is often intracellular energy deficient state. Acetyl-L-carnitine is a good source of l-carnitine which plays a role in mitochondrial energy production. It serves to help transport fatty acids across the mitochondrial membrane. Ribose has also been shown to enhance mitochondrial function. Ribose acts as a key component in the synthesis of ATP.

Certainly fibromyalgia is a complicated disease state which may be secondary to multiple metabolic derangements. Through careful assessment and utilizing functional testing as listed above, appropriate protocols and treatment programs can be initiated with greater success. This disease is often chronic and becomes very frustrating to the patient. Psychological components must be assessed and the possibility of body- mind syndrome must be identified. Carefully identifying any toxicology issues and removing them, assessing bowel health and integrity for nutrient absorption, supplying the body proper nutrition, and enhancing the body’s communication through both hormonal and neurotransmitter balance will result in greater success and optimal outcomes in the management of fibromyalgia.

Kenneth Orbeck DO

ABAARM Board Certified
Fellowship Trained Anti-Aging Medical Specialist
BodyLogicMD of Greenville
300 Executive Center Drive, Suite 200
Greenville, SC 29615
Tel: (877) 341-7407
Fax: (864) 284-6774
korbeckdo@bodylogicmd.com
Blogg @ www.drkennethorbeck.com

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What Is Your Genetic Profile?

Posted by Dr. Kenneth Orbeck on April 4th, 2012 | No Comments

Genetic testing is becoming a hot topic in today’s medical literature. Scientists are now linking many common diseases to specific DNA blueprints. These blueprints will alert individuals that they may run a higher risk for certain chronic diseases than the average population. Genetic testing is now being developed to determine the efficacy and safety of pharmacological medications. Very soon in the near future your risk of taking certain medications and the possibility of side effects will be able to be determined prior to the initial use of the drug. As DNA testing becomes more available to the general public, what can one do with this information? Do lifestyle factors still remain important if you’re genetic blueprint shows low risk of disease? Is it possible to actually alter the outcome of your genetic makeup with lifestyle modification?

There is a new field developing and metabolic medicine called nutrigenomics. This refers to the molecular dialogue between certain dietary components and expression of our genes. Can the foods we eat really talk to our genes? The answer is becoming quite clear that nutrition plays a critical role in genetic expression. Recent studies on the health effects of green tea and GT Polyphenols with their antioxidant properties have demonstrated anticancer effects. These products have been shown to reduce the risk of leukemia and cancers of the breast, prostate, pancreas, G.I. tract, and lung. They are cardioprotective and help to lower blood pressure and prevent LDL oxidation which is a required step in athrogenesis (plaque formation). These products have also been shown to be neuroprotective in reducing risk of Alzheimer’s disease, Parkinson’s disease, and neuronal death after an ischemic stroke. The beneficial effects of trans-resveratrol through potent antioxidant mechanisms have been shown to be anti-inflammatory, anti-aging, increasing stamina and endurance, and be cardioprotective as well as helping in weight management. Cruciferous vegetables have been shown to be cancer preventive, anti-inflammatory, enhance detoxification of toxic substances, and be neuroprotective. The list continues and there are many other nutrients and food products that show similar beneficial effects. So what is the link between dietary intake, nutritional supplementation, and genetic expression? Does the phrase “you are what you eat” have any scientific validation?

In looking at the anatomy of a gene, there is a basic coding/structural region which is the blueprint in the formation of proteins. At the end of the structural region, is a promoter region which responds to an area of the gene called the regulatory/control region. This regulatory control region is called the response element which is where hormones and nutrition have a direct effect on genetic expression. The nuclear proteins that bind to specific response elements on the regulatory/control region of one or more genes are called transcription factors. These transcription factors cause conformational changes which have a direct influence on genetic expression. Bioactive components in food can bind to certain transcription factors and influence their ability to bind to the response element which has a direct effect on the control of genetic expression. Hormones work directly on these response elements which effects genetic expression. Many phytochemicals appear to exert their effects on health via nutri- genomic mechanisms as described above. I often check certain genetic profiles in high-risk patients regarding the use of estrogen. These genetic tests give me information on the individual’s genetic makeup which may predispose the patient to abnormal estrogen metabolites which could raise their risk of cancer. Through the use of certain nutrients and phytochemicals, this risk can be greatly reduced by promoting safer metabolites through the detoxification process.

The future in medicine is exciting in that we are beginning to understand the relationships between genetic expression, nutrition and dietary intake, hormonal optimization, and the adaptive stress response. Personalized medicine is the wave of the future. Through the use of nutritional genomics, we will be able to understand how dietary factors affect the total function of the genome as well as the different responses based on individual genetic makeup. The goal of this research will be to customize diets based on individual needs (macronutrients). Through the use of nutrigenomics, the understanding of molecular relationships between food components and genetic responses (the “food-genome junction”), we will be able to personalize use of micronutrients (supplements).

It is becoming more clear that health is quite complex. Genetic testing allows us to more clearly define individual risk factors and outline personalized treatment programs to have an optimal effect on each person’s outcome. All of this, however, is secondary to a good balanced lifestyle. Eating a balanced diet, getting adequate sleep, and having regular exercise remains critical in the maintenance of bodily health. So let’s all load up on antioxidants and have a colorful plate for dinner and we will begin to steer our ship away from the iceberg.

Kenneth Orbeck DO

Spring Cleaning

Posted by Dr. Kenneth Orbeck on March 12th, 2012 | 4 Comments

As the winter months are fading away with spring and summer right around the corner, many of us get in the mind of spring cleaning. While spring cleaning is good, what about cleaning our bodies? We often become more concerned about getting into the summer clothes and bathing suits as the sedentary winter months have led to some weight gain. If you are shopping for summer clothing and your size has increased, we need to talk about issues of weight control and spring cleaning for your body.

Weight control is a complex and difficult issue and is one of the most common complaints that I see in my metabolic and functional medical practice. Over 120 million Americans are overweight or obese. There are projections that over 75% of adults will be overweight within the next 2 to 3 years. Obesity is one of the major risk factors in 35 major diseases. There is also a direct and indirect cost of obesity which includes medical services that are needed and loss of productivity that accounts for over $100 billion a year in the American budget. Weight loss is a multi-factorial problem that involves allergies, hormones, neurotransmitters, detoxification and inflammation issues, sleep deprivation, proper nutrition, and adequate exercise.

Allergies are often responsible for an inflammatory condition which makes weight reduction very difficult. One common area that I often test is food allergies. These allergies are driven by IgG mediated immunity and often result in craving the very foods that we are allergic to. A simple to test for food allergies at home is within an allergy elimination diet. This diet is used to determine whether or not you have food allergies which may be causing inflammation and difficulty losing weight. Symptoms of food allergies are fatigue, muscle aches and pains, food cravings, insomnia, and intestinal complaints such as bloating. During a period of 2 to 3 weeks, eliminating certain foods in the diet and assessing your symptoms will allow you to determine which foods may be causing this heightened allergic response. I will be following up in the very near future with information outlining a detailed allergy elimination diet.

Hormones are also very important regarding weight gain and issues of weight loss. Adrenal hormones are certainly a leading causative factor in gaining weight as cortisol is a catabolic hormone. The body responds by building more fat at the sacrifice of muscle. When this happens there are shifts in insulin and the body has difficulty utilizing glucose and sugar properly. Thyroid hormones are also affected by cortisol imbalance. Excessive cortisol can block the body’s ability to make T3 from T4. Since T3 is the active form of thyroid that stimulates the receptor cell which affects our metabolic rate, deficiencies in T3 can certainly cause issues in weight management. Cortisol issues and toxicities in the body can produce reverse T3, which will block the receptor site and make thyroid hormone less effective. Both male and female sex hormones are also very important as these are anabolic hormones which allow the cells in our body to communicate effectively. Without hormonal balance, it is very difficult for the body’s metabolic process to function adequately.

Issues of neurotransmitter imbalances are also important in the management of weight. The main neurotransmitters in the brain consist of epinephrine, norepinephrine, serotonin, GABA, glutamate, and histamine. Imbalanced neurotransmitters cause excitatory stress in the brain through microglial stimulation (Immunoexcitotoxicity) resulting in an imbalanced control of our bodies metabolism by the increase in inflammation. Since the brain is one of the most important organs of the body, neurotransmitter health and balance is essential in the control of our metabolism and bodily functions. Please refer to our recent video that I have recorded regarding the importance of various neurotransmitters and their function within the body. Certainly neurotransmitter imbalances have a large impact on the ability to sleep. Insomnia is very important in often responsible for metabolic breakdowns and overall health including weight control.

Detoxification is also important in weight loss. Exposure to multiple agents within our environment which are toxic to the body causes underlying chronic oxidative stress which results in inflammation. I have never seen anyone lose weight adequately with inflammatory markers present. Detoxification is a process that essentially cleanses the live, allowing it to be more effective in removing toxic substances. I often partner with my patients in a detoxification program twice a year, once in the spring and once in the fall. Under proper guidance, a full detoxification program can help greatly in inflammatory conditions. Once inflammation is reduced, the body is able to metabolically repair and weight loss is more likely to be a success. One area that we can easily help in her detoxification process is with the proper ingestion of water. You should be drinking one half your body weight converted to ounces of water per day for your body to properly hydrate your cells and eliminate toxins.

Gut health is very important in the maintenance of our weight as the body must be able to eliminate toxins while at the same time assimilate and absorb nutrients. One common barrier to weight loss that I often see in my practice is intestinal candidiasis, or yeast overgrowth syndrome. Certainly if there are any pathogenic bacteria or fungi, the integrity of our intestinal mucosal will become compromised which has a direct effect on the absorption of nutrients and improper elimination of toxins. Someone with yeast overgrowth will often have chronic fatigue and crave sugar. They may feel bloated, have excessive gas, intestinal cramps, and often have alternating diarrhea and constipation. Yeast syndrome can also cause menstrual irregularities and decreased libido. Candidiasis will affect our allergic response, chemical sensitivity, and our resistance to infections. Friendly bacteria are needed for proper intestinal health and absorption of nutrients. These bacteria often combat underlying pathogens such as yeast. Regular bowel movements throughout the day is a good indication of your gut health.

Finally is the issue of exercise. Routine and consistent exercise is very important in the maintenance of muscle health and strength and proper metabolic functioning. Resistance training has been shown to increase growth hormone which is very important in the body’s maintenance and repair. Exercise releases natural neurotransmitters which greatly affects our caloric burn far after the exercise has been completed. In today’s sedentary lifestyle, we simply do not get the activity that is necessary to maintain our bone and muscle mass as well as our metabolic rate. I recommend that my patients go through a detoxification process after which time we often outline and exercise program that will best match their lifestyle. The combination of hormonal balance, proper nutrition, and routine exercise is foundational to the maintenance of health and control of weight. As you can see, there are multiple factors involved in weight control and weight loss. With proper guidance in assessing your metabolic and hormonal imbalances, utilizing the proper nutrients and hormones for repair, you will be able to spring into your summer with great confidence!

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Hormones – Enhance the Expression of Your Love

Posted by Dr. Kenneth Orbeck on February 14th, 2012 | 4 Comments

During the month of “love” most of us will be examining the amount of love that is present within our own lives. Although the word love is often abused in today’s society, the expression of love is an inherent need to almost every creature on this planet. From infants and through our entire adult life, love is an important component in our health. Certainly one of the greatest expressions that I’ve heard is “to love and be loved in return”. This is one of the great truths of life. What I find most intriguing about the subject of love, is its relationship to our internal health and hormonal balance. I have many consults in my office involving couples sitting in front of me who are frustrated, fatigued, and becoming depressed due to the lack of love and spark within their relationship. Life has a way to entangle us, causing excessive stress to affect our hormonal balance and metabolism. I challenge most of these couples to simply reflect on their internal health and hormonal balance after which I often bring them back together for conversation and counseling on issues intimacy and sexuality. Intimacy is a complex entity which is often affected by past experience, present and anticipated circumstances, as well as hormonal balance. Hormonal balance is critical in achieving the feelings of vitality, vigor, and maintaining energy. There is nothing more frustrating than feeling exhausted and not being able to show the affection and nurturing intimacy that is necessary in maintaining a sound relationship.

I would like to give you an example of a patient that I took care of in the past who had issues of stress greatly affecting her energy levels, vitality, and even the physiologic process of ovulation and fertility. This patient came to me in her early 30s complaining of severe anxiety and mental withdrawal. She actually had to pull off the road while driving because she was unable to focus and could not perform driving tasks accurately. When I questioned her during the initial consultation, she stated that she had no menstrual periods for over 4 to 5 months. She also stated that her menstrual periods were irregular for many years. She was told by six previous physicians that she would most likely be unable to have a child. Her initial symptoms upon presentation included facial numbness, mental withdrawal, difficulty with speech, hot flashes, insomnia, and severe fatigue both in the evening and in the afternoon. She complained of difficulty with memory as well as persistent drowsiness.

On initial laboratory assessment, she had very low progesterone as well as suboptimal estradiol. She had extremely low cortisol during a four point saliva test with a flat line response throughout the day. This was indicative of severe adrenal stress and a breakdown of hypothalamic pituitary axis. The hypothalamus and pituitary gland communicate to the body and send signals to the adrenal glands to release cortisol under stressful situations. When these situations are persistent and stress is continual, the system can breakdown and cortisol can be detrimental. Please see a recent hormonal blog I wrote called “The Greatest Super Bowl of Your Life”. This patient’s thyroid was also affected by her adrenal stress as she could not convert the active form of thyroid (T3) from (T4), the most abundant form of thyroid from our thyroid gland. This made her entire metabolic breakdown much worse. Adrenal stress often involves issues of thyroid function, pancreatic function and glucose utilization, as well as imbalance in our immune system. This in turn will affect oxidative stress on the brain and neurotransmitter balance as well.

The breakdown in this example came from an overproduction of stress on the body which affected adrenal cortisol release. Overproduction of cortisol will cause clinical depression, elevated androgens (male hormone), and elevated blood glucose levels. This causes an excessive amount of insulin secretion which leads to insulin resistance. As insulin secretion rises, more androgen hormone production occurs which is then converted to estrone, one of the estrogen hormones. This results in a disruption of the hypothalamus and pituitary gland to regulate the ovulation cycle by having excess LH (luteinizing hormone) and insufficient FSH (follicle stimulating hormone) which will compromise the ability of the ovary to ovulate properly. Lack of ovulation causes infertility and a reduction in progesterone. The patient will become highly irritable through estrogen dominance.

After correcting this patient’s impact of stress on her body, properly balancing her hormones with bio identical hormone replacement therapy, and supporting her neurotransmitter imbalance with the use of amino acids; her response was quite impressive. This patient’s menstrual periods began to return on a regular basis, and she became more calm and focused. Her energy levels began to increase in the vitality returned to her life. She was planning to get married in the near future and having a child was certainly important to her and her fiancé. This patient was instructed to follow-up with me in approximately three months for her third consultation. The patient called me 60 days after her second consultation and stated that she was pregnant. She had tears of joy as she was led to believe that this would not be possible. I referred this patient to an obstetrician for continual care and close observation during her pregnancy. This patient recently contacted me and allowed me to see and hold her healthy baby boy.

This case is an excellent example of the impact of adrenal stress on multi-organ systems. In addressing underlying metabolic issues such as the thyroid impact of adrenal stress, estrogen/ progesterone imbalance, the patient’s outcome was clearly optimize. There is nothing greater through the expression of love than a healthy newborn child. Hormonal optimization is critical in allowing this process to occur. This is only one simple example of the impact on hormonal optimization. Hormones have a great affect on many physiologic processes of the body, mental health, and vitality. If the love in your life is being squashed by mental fatigue, exhaustion, and feelings of apathy, metabolic testing and hormonal optimization can certainly help, and give you hope. Please see the attached testimony which nicely expresses the importance of hormones in our lives.

Are You Well Grounded?

Posted by Dr. Kenneth Orbeck on February 2nd, 2012 | 2 Comments

In today’s technological environment, advances have become unbelievable in wireless technology. Although wireless technology is convenient, there are associated health issues that we need to be made aware of. Wireless technology results in electromagnetic force(EMF) which has a direct effect upon our body and our health. With the ever-increasing electronic world combined with our disconnection to the Earth, the result is greater EMF exposure, which has an inflammatory effect upon our bodies. I became more aware this after treating a patient recently that had difficulty controlling her atrial fibrillation (cardiac rhythm problem making the heart beat irregularly). She was on appropriate medical therapy, but had continual difficulty in controlling her dysrhythmia. Upon further questioning, it was made aware to me that she was exposed to multiple situations involving wireless technology, as well as living right next to high-tension electrical lines. My recommendation was to place her on a grounding blanket, a simple device to allow her to connect to the Earth during her sleep. To my surprise several weeks later, her fibrillation became better controlled and on follow-up laboratory evaluations it was necessary for me to reduce her Coumadin (medication to thin the blood) as grounding had a significant effect on her coagulation studies.

This is when I really started researching how EMF can affect our bodies and the necessity to reconnect ourselves directly to the Earth. Many of us have gone on vacation to the beach and we notice how much better we sleep, how much more energy we have, and how our overall sense of well-being improves. Certainly there are effects regarding reduction in stress, but have you ever thought of the possibility that walking barefooted on the stand and swimming in the ocean allows a connection to the earth and reduction in EMF. Some of us have a higher electro-sensitivity. When these individuals are exposed to electro-pollution, (a term used for the unfelt and unnatural EMF of electromagnetic fields often generated by electrical wires, appliances, and wireless technology), the response is often detrimental. These individuals can develop arthritic pain, cardiac arrhythmias, underlying anxiety and depression, insomnia, and even chest discomfort. We all know the effects of oxidative stress and chronic inflammation upon the body. There is an increase in the activity going on at the site of inflammation, and the simultaneous destruction of healthy tissue from the free radical environment in the surrounding territory. Free radicals are extremely important in the immune response, but problems occur when these free radicals go out of control. One popular theory when we lose contact with the earth and are not grounded is that there may become an electron deficiency with not enough electrons to satisfy the amount of free radical formation. This constant attack may stimulate in autoimmune response and result in chronic inflammation.

One important impact of EMF exposure is the activation of our sympathetic nervous system. Sympathetic nervous system activation can come from multiple environmental factors including air pollution, EMF exposure, or toxic exposure from the environment. Certain medical conditions may also stimulate sympathetic nervous system activation which include hypertension, obesity, sleep apnea, diabetes, and congestive heart failure. Behavioral and psychological conditions include smoking, high simple sugar diet, sleep deprivation, anger, chronic stress, and the abuse of stimulants. Interventions which may improve nervous system function involve use of natural supplements, lifestyle modufication, and earthing. The use of omega-3 fatty acids has been shown to improve the balance within the autonomic nervous system. Lifestyle modifications include regular exercise, meditation such as yoga or tai chi, restoration of normal sleep, weight loss, stress reduction, and good social support. Earthing (connecting yourself to the earth through grounding) has also been shown to improve the balance in the autonomic nervous system.

So one simple step to improve your health and reduce oxidative stress and inflammation within our body is to simply take your shoes and socks off and go out for a long walk. Take time to connect with the earth. In today’s fast-paced environment, we are often forced to neglect this need. Grounding devices are also available and can be used at home or in the workplace which offer a simple solution to removing EMF exposure that is so prevalent in our environment. Devices are also available to check electropollution enabling you to find out the direct exposure within the environment you live. Simply becoming aware of EMF and the possible negative effects upon your health is a solid move forward in the quality of your life and longevity.

Have you had your Whey Today?

Posted by Dr. Kenneth Orbeck on January 18th, 2012 | 3 Comments

Did you know that as we get older our muscle mass begins to decline and is often replaced with fat? As we approach midlife and after the age of 50, muscle strength becomes paramount in age management medicine. Losing muscle strength makes individuals more prone to injuries and actually increases their fracture risk. Studies are now showing that muscle mass is just as important as bone density and reducing fracture risk as we age. You may read more on my recent blog called “Dem Bones, Dem Bones”. This is a major reason why many people lose mobility and end up in extended care facilities and nursing homes. Just as hormones decline as we age, so does muscle mass. But just because this process is normal with aging, does not mean it’s necessarily good. There is a simple way to keep our muscles strong as we age. This one simple step in your diet can help you maintain your weight, strengthen muscles as they age, and even boost your immune system. This simple step involves the ingestion of protein.

Your body must have proper protein to manufacture muscle and build muscle strength and stamina. Protein is the underlying building block for our muscles, bones, enzymes, and even our hormones. It will help in the maintenance of our skin as well as our joint cartilage. As our body ages, protein digestion becomes more difficult. There are issues of poor absorption, and the protein we eat simply does not get digested and absorbed as well is when we were younger. One easy change in your lifestyle that can increase the protein absorption into your body involves the ingestion of whey protein. Whey protein contains the basic amino acids that are necessary for muscle development in the amino acids that are necessary in your diet. Whey protein is absorbed quickly and can enter your bloodstream as building blocks for your muscles, bones, skin, and cartilage. There is one caution however regarding whey protein products today. Many of the products are over-processed and come from cows containing antibiotics, pesticides, and various kinds of growth hormones. Nutritionally deficient whey protein may actually do more harm than good.

Here are some easy steps to consider when selecting whey protein for supplementation in your diet. Make sure the whey protein is free from toxins which may include or pesticides, insecticides and various chemicals. Whey protein must be carefully filtered to remove impurities while preserving the necessary amino acids. Many inexpensive products use manufacturing techniques that treat their product with acids resulting in higher amounts of toxicity. Make sure the whey protein contains natural sweeteners such as Stevia, instead of artificial sweeteners or refined carbohydrates and sugar. Check the label to make sure that the whey protein content is high. Usually 15 to 20 gms of protein per serving is considered to be a high-quality protein content. Some products have as little as 5 gms of protein which has little affect on boosting your daily protein intake. Make sure the whey protein is not an isolate. Even though an isolate has a higher percentage of protein content, this type of product is highly processed and removes important nutritional components such as lipoic acid, healthy fats, and CLA (conjugated linoleic acid). Whey protein concentrates contain these important ingredients by avoid being overprocessed. Make sure the whey protein is processed through a cold process mechanism (undenatured). Less expensive whey protein may be treated with heat and may also utilize acid in the cleansing process. Even though this is helpful in destroying bacteria, it destroys the importance ingredients that are necessary such as alpha lipoic acid, CLA, and I- cysteine. Muscle growth and repair is dependent upon these important nutrients. Finally, make sure the whey protein comes from organic and grass fed cows. Grass fed cows produce milk with much higher amounts of immune supporting nutrients. These include conjugated linoleic acid (CLA) and lactalbumin, which have been shown to be cardioprotective.

So one important nutrient that everyone should have over the age of 50 includes a whey protein shake in their daily diet regimen. A shake a day is one of the best ways to maintain muscle strength, gut health, and immune system integrity. Did you have your shake today?

Will You Have Tea With Me?

Posted by Dr. Kenneth Orbeck on January 6th, 2012 | 2 Comments

As we enter into a new year, most of us thought about the previous year and the changes that we would like to make in our life during the next 12 months. Surveys often indicate that these changes typically involve areas of health, weight issues, and personal improvement. First, we must realize that change is difficult. We are typically creatures of habit and breaking old habits to replace them with new ones is often a challenge. I would like to begin a series of health recommendations that I have found to be quite beneficial in helping my patients improve the quality of their health one simple step at a time. Patience and simplicity is the key, as complex changes often fail and individuals become quite frustrated.

Let’s begin by discussing dietary issues that affect our health and then I will follow-up regarding supplementation and what seems to be quite critical in metabolic maintenance. Dietary awareness is crucial in the Western culture as the American diet gradually shifted into high carbohydrate load foods as well as foods that are high in saturated fat. Trans-fats are also very common but are detrimental to cellular function as they impair nutrient transport across the cellular membrane. High fructose corn syrup is present in many of the foods on the grocery shelves today and goes directly into the cell with rapid carbohydrate loading which alters the proper metabolism. Hydration is very important in dietary considerations as fluid intake affects cellular respiration. The minimal amount of fluid consumption should be calculated at one half your body weight (pounds) converted to ounces of fluid consumed per day. Most of the liquids consumed in the Western culture include soda products and other liquids high in carbohydrate loading, such as high-fructose corn syrup. Dietary drinks contain artificial sweeteners which have the potential to elevate insulin. Green tea is an excellent beverage as it has many properties with positive health effects in both metabolic maintenance and disease prevention.

Green tea contains catechins, one of which has an active ingredient called EGCG, which has been shown to reduce cholesterol and improve atherosclerosis. EGCG reduces gastrointestinal absorption of cholesterol, stimulates cell energy expenditure in the mitochondria, and reduces LDL oxidation. LDL oxidation is an important concept regarding atherosclerosis and coronary artery disease. Please see a recent blog I wrote called “Cholesterol, to Be or Not to Be“. Green tea has also been shown to stimulate fatty acid synthase gene expressions in the nucleus of our cells. Animal models have shown that green tea reduces liver cholesterol concentration by increasing the efflux of cholesterol from the liver cells. The catechumens which are present in green tea interfere with many critical steps which are involved in the absorption of dietary fat. Green tea has also been shown to be anti-carcinogenic.

One simple step that I would advise you to consider in beneficial health changes during the next year would be substituting soda, dietary soda, coffee, or milk with that of green tea. Health benefits will include cholesterol reduction, burning fat, and lowering risk of heart disease. Other benefits may include cancer prevention, and the prevention of both diabetes and stroke. Green tea has also been shown to enhance cognitive function and may play an important role in dementia prevention. It is recommended that humans consume about 60 ounces of green tea per day which is equivalent to taking a green tea extract with EGCG at 500 mg twice per day. The remainder of our beverage consumption should include water, pomegranate juice, or fresh vegetable juice. Juicing is also an excellent way to enhance the anti-oxidant capabilities within our body. Happy drinking, and we will discuss further simple changes that have a large impact on our vitality and health in the near future.

Vitamin D – is it Really?

Posted by Dr. Kenneth Orbeck on December 16th, 2011 | 2 Comments

Have you ever wondered about the importance of vitamin D. Certainly with all the publicity regarding the beneficial effects of vitamin D, knowing the levels in your own body and supplementing properly can give you great beneficial effects regarding your future health. Vitamin D is technically not a vitamin. Its active metabolite, calcitriol (1, 25 dihydroxyvitamin D), is actually a secosteroid hormone that targets over 1000 genes. Every cell in our body has a vitamin D receptor that responds to calcitriol.

Vitamin D is available in two forms: vitamin D3, (also known as cholecalciferol), and vitamin D2, (known as ergocalciferol). Vitamin D3 is the form of vitamin D that is created in the skin during exposure to sunshine. The darker your skin the more likely you’ll have less vitamin D produced. Other causes which reduce vitamin D production in the skin is clothing, sunscreen, body fat, and certain drugs such as anticonvulsants and corticosteroids. Vitamin D2 is the form obtained from our food ingestion. Supplementation can be in either form, however, the D3 form is preferred. Both forms can be converted to active metabolites. Vitamin D deficiency is becoming pandemic. In the United States, all age groups are prone to vitamin D deficiency. Vitamin D deficiency is noted when calcidiol levels are less than 20 ng/mL. It is estimated that over 40% of Americans are vitamin D deficient. European studies show deficiencies which range between 30 and 90% of healthy adults. High rates of vitamin D deficiency is worldwide and has been reported in the United States, Mexico, Middle East, India, Asia, Europe, and Australia. Anyone who does not get lots of sunshine or ingest at least will 2000 to 10,000 international units per day is at high risk for vitamin D deficiencies and secondary health consequences. One whole egg is equivalent to 20 international units of vitamin D, 1 cup of fortified milk is equivalent to 100 international units of vitamin D, while cod liver oil delivers 1,360 international units per tablespoon. Other foods which contain vitamin D include tuna, mackerel, salmon, herring, and sardines. Severe vitamin D deficiency leads to an unfortunate disease called Rickets. This is when children develop poor bone formation which leads to deformities from poor mineralization. The growth area in maturing bone is called a growth plate, which becomes widened resulting in severe bone deformation. Secondary hyperparathyroidism is often the result. Adults with severe vitamin D deficiency also develop secondary hyperparathyroidism which leads to increased bone loss, a reduction in bone mineral density, and the development of osteoporosis.

When vitamin D is measured, the storage form must be measured called calcidiol (or 25 -hydroxy vitamin D). Both vitamin D2 and vitamin D3 is converted in the liver to calcidiol. Calcidiol is then converted to the active form of calcitriol mainly in the kidneys. It is this active form of vitamin D that has such tremendous beneficial effects in disease prevention and health maintenance. Optimization of vitamin D has been shown to protect against a variety of cancer, heart disease, stroke, autoimmune diseases, diabetes, mental health, depression, and osteoarthritis. Studies show that levels of calcidiol greater than 50 ng/ml reduce breast cancer and endometrial cancer by 50%. Levels over 40 reduce ovarian cancer by over 20%. There are many myths regarding proper vitamin D supplementation. The body can synthesize as much as 25,000 international units per day in the sunshine. The lowest intake of vitamin D that is associated with hypercalcemia(high calcium) in controlled studies is 40,000 international units per day for several months. Supplementing with adequate amounts of vitamin D3 while following serum laboratory values and keeping these values controlled has shown to be safe and effective. I frequently supplement my patients with vitamin D3 ranging between 3000 and 10,000 international units to get adequate serum levels of vitamin D3. This has been shown to be highly effective in cancer prevention. Vitamin D has been shown to reduce metastasis (the spreading of cancer), increased cancer cell death (known as apoptosis), and initiate gene transcription in cancer modulation (control cancer growth). Vitamin D has also been shown to greatly reduce inflammation and oxidative stress within our body. Levels of vitamin D are inversely associated with levels of CRP (which is an inflammatory marker within the body). Vitamin D3 inhibits NFKB which directly influences inflammation. Multiple studies have shown the importance of vitamin D in reduction of cardiovascular risk and coronary heart disease. Vitamin D insufficiency is linked to hypertension, diabetes, heart failure, and chronic vascular inflammation. Calcitriol has also been shown to increase the production of LL – 37 which is a polypeptide that fights against infectious disease. Calcitriol can help fight both bacterial and viral infections.

Knowing the importance of vitamin D in both disease prevention and control, evaluating your serum levels is paramount. Keeping 25 hydroxy D in the reference range of 60 to 80 ng/mL is important. No toxicity has been reported with serum levels under 150 ng/mL. Check serum calcium levels to avoid hypercalcemia (high calcium), as well as parathyroid hormone levels on an intermittent basis. Optimal doses of vitamin D three range between 3000 and 15,000 international units per day while serum levels are followed. Weekly doses of vitamin D3 is appropriate if desired. Vitamin D3 may not be needed if excessive sun exposure exists. So get your vitamin D checked, supplement appropriately, and you’ll have gone a long way in optimizing your health and preventing a multitude of diseases.

The Aging Eye

Posted by Dr. Kenneth Orbeck on December 6th, 2011 | 2 Comments

I recently had a patient inquire about how he could reduce his risk of losing his eyesight with age. Frequently as we get older, our vision begins to deteriorate. There are many factors that are important regarding visual acuity, but two of the most common seen are cataracts and macular degeneration. Certainly, there are many visits to ophthalmologists for these types of complaints that require surgical treatment and medical intervention.

Macular degeneration affects at least 10 million individuals in United States. It is now known to be the leading cause of blindness in people over the age of 60 years. The underlying cause of macular degeneration is unknown, but two risk factors associated with macular degeneration include exposure to UV light and cigarette smoking. Two types of macular degeneration exist. Dry macular degeneration accounts for 90% of the disease, while wet macular degeneration accounts for approximately 10% of the disease process. Dry macular degeneration involve small deposits called drusen bodies that form in the retina which lead to retinal thinning and subsequent visual loss. Wet macular degeneration has abnormal blood vessel development which causes edema and bulging distortion of the retina and is often accompanied by retinal hemorrhaging or bleeding. One of the difficulties of macular degeneration is that there is little conventional treatment to offer regarding reversal. Laser therapy has been utilized to control some of the retinal hemorrhaging in wet macular degeneration, but certainly preventative measures remains the cornerstone of therapy. Several nutritional supplements have been shown to slow the progression of acute macular degeneration and are certainly important in the prevention of this disease. These supplements generally work with anti-oxidation involving the carotenoid family. Nutritional supplements that have been shown to reduce progression and help in prevention include omega-3 fatty acids, vitamin D-3, NAC, grape seed extract, zinc, bilberry extract, any antioxidant vitamins which include vitamins A, E, and C.

Another common disease in reducing visual acuity as we age includes cataract formation. Cataract formation involves the opacity of the lens in the eye not allowing accurate visual perception to pass through to the retina. It would be like having a foggy magnifying glass and not being able to see through it clearly. Risk factors of cataract formation include UV radiation, diabetes, smoking, poor nutritional intake, and topical or systemic steroid use. One mechanism involving cataract formation centers around the production of free radicals. Glycation is a process where we have the binding of sugar to a protien resulting in extreme free radical production. This process has been shown to accelerate cataract production. Prevention of cataract disease involves limiting ultraviolet light exposure to the lens, and taking nutrients that will protect the eye against oxidative stress and free radical formation. These nutrients include Carnosine, Taurine, Glutathione, Cysteine, and antioxidant vitamins which include vitamins A, E, and C.

Vision is something we often take for granted. Imagine yourself trying to be active in the world today with limited or little eyesight to guide you through the course of a day. Aging is a process that involves oxidative stress and is accelerated by accumulated toxins and environmental exposures which accelerate organ damage. Reducing toxic exposure such as the elimination of smoking, wearing sunglasses to protect the eye from ultraviolet light, and reducing the body’s exposure to the many toxins that are in the world today will reduce one’s likelihood of visual loss. Certainly nutritional supplements are recommended, as they have been shown to be effective in the prevention of these common eye diseases listed above. So throw away the cigarettes, take your antioxidants and recommended vitamins, go buy some good sunglasses with known UV protection, and you’ll more likely be able to see into your future.

Growing Old, Bitter vrs. Better

Posted by Dr. Kenneth Orbeck on November 22nd, 2011 | 2 Comments

In looking at today’s population, there is a steady increase in the oldest portion of living Americans. As recently outlined in the publication, TIME Healthland, called “America’s Oldest Old”, the ninety-year-old population is booming. Statistics are staggering as they outline that the oldest old are projected to increase from 1.9 million to 8.7 million by the midcentury; making up 2% of the total US population, and one in ten older Americans. It is also pointed out that this increase is mostly due to better nutrition and advances in medical care. Living longer presents additional risks for both chronic conditions and disabilities. Arthritis, diabetes, Alzheimer’s diseases, and various other chronic illnesses increase, as outlined by the Associated Press release on Friday, November 18, 2011.

As we continue to live longer, we must question if the quantity of our life is as important as the quality of our living. Certainly if living older means to heighten disabilities and chronic illnesses, frustration and depression can often be a component on the mental impact of aging. Let’s take a brief look at the aging process, and discuss various factors that may help regarding the quality of our living as we continue to age in years. We will break this down into several categories that affect our health. These include environmental toxins which produce oxidative stress, internal inflammatory conditions that reduce our resistance, hormonal optimization which affects cellular communication, and nutritional optimization which is essential to our metabolism.

Environmental toxins are certainly important and are in the environment to stay. They are present in the air we breathe, the water we drink, and the food that we eat. These are often called “xenobiotics”, which is defined as any substance that is foreign to man. This category includes environmental pesticides, insecticides, air pollutants, cleaning products, health and beauty aids, toxic metals, and more. When the body’s metabolism is exposed to xenobiotics, it has a negative effect on the metabolic pathways. Xenobiotics create inflammatory oxidative stress within the body which can affect our brain, immune system, and our cell’s ability to regenerate properly. There is also an impact upon genetic expression and alteration which may lead to various forms of cancers. Certainly; an important factor in living not only longer, but with a higher quality of health, is to reduce environmental toxicity within the body. Eating organic food is critical, and reducing exposure to various man-made substances such as cleaning solvents, skin care products, and various forms of insecticides or pesticides is critical. For further information regarding environmental toxicity and recommendations, please see a recent article that I wrote called “Toxicity in the World Today”.

Internal inflammatory conditions often result from oxidative stress within the body. This can be a result from unnecessary stress environmentally, psychologically, or internal stress from other metabolic breakdowns. Oxidative stress within the body often results in chronic diseases such as arthritis, autoimmune diseases, and other various metabolic derangements. Altered glucose metabolism and diabetes, cardiac diseases, and brain diseases such as Alzheimer’s represent just a few. As outlined earlier in discussing the aging process, chronic diseases as listed above are often associated with aging. By optimizing both nutritional health as well as reducing internal inflammatory stress, chronic diseases can often be reduced or even avoided. The use of nutritional supplementation guided by proper individual nutritional analysis, will enhance the body’s genetic predisposition to shift towards a healthier outcome. This is known as epi-genetics. Bio identical hormone supplementation and optimization is foundational in this process, as hormones allow our body’s cells to communicate properly. Hormones are partly responsible for the genetic signaling process and allow the body to regenerate rather than degenerate. Bio-identical hormones, the hormones that your body naturally makes, are critical here as these hormones represent the master keys that influence both are genetic expression and proper metabolic process. Bio-similar hormones, while they may fit the receptor site, may give the wrong signal which will alter the cell’s genetic response and metabolic outcome. Bio- similar hormones often breakdown into metabolites that are less desirable and risk the issues of hormonal safety.

Once toxic stress has been evaluated, environmental toxins have been removed, and hormonal optimization has been achieved, nutrition becomes vital in the continued process of tissue and cellular regeneration. Nutrition is broken down into vitamins, minerals, fatty acids, and amino acids. Multiple enzymatic pathways within the body have dependent cofactors and coenzymes that involve these nutritional products. While each person is individual, their nutritional needs must be individualized as well. Understanding intracellular nutritional deficiencies allows proper supplementation to achieve maximum response in metabolic health. Testing is now available for individual optimal nutritional analysis as well as intracellular nutritional analysis. With this powerful functional testing, optimal nutritional recommendations can be given which will enhance the body’s ability to regenerate and reduce the process of developing chronic disease. Eating a well-balanced diet of organic foods, eliminating food additives such as chemicals and hormones, and avoiding the intake of bad fats, will have a great impact on our nutritional health. Alcohol should be limited, as excessive alcohol has detrimental effects upon the body and the brain. Adequate sleep is essential in metabolic health, as our reparative mechanisms and regenerative pathways “kick in” during the sleeping process. Certainly as the population of our “oldest old” continues to climb, so does the importance of nutritional and metabolic medicine. This will not only extend lives, but to give good quality into the lives that are extended.

Kenneth Orbeck DO – Greenville Bioidentical Hormones Expert