Okay, so today we’re going to talk a little bit about progesterone. This is Dr. Pati and we’re going to get started right now. So, what I want to do in this webinar is I’m going to share with you a little bit about the data behind progesterone and then I will do some cases. This webinar is recorded and will be on the website for MDPrescriptives. So, this email and the slides will be there in case any of you need it to ask me questions in the future.
In a Restorative Medicine approach one is really tried to “restore optimal function to the cells and the organs so that they do what they are suppose to do,” which is to give them the sleep, low anxiety, good energy, good health, free of diseases. Moving along. In this approach, as you know, we’re always trying to address inflammation which is known as basically the silent killer which is the underlying thing of all the diseases and all the conditions that we see in general.
There’s two principles that we try to embrace in a restorative approach. One is that underlying imbalances cause symptoms and disease such as: weight gain or/and insomnia, or sleep, tiredness, fatigue, anxiety, and headaches. Many of these being actually symptoms of progesterone deficiency, but the same imbalances and deficiencies also are responsible for the diseases of the muscular, skeletal, nervous, organ, and vascular systems.
In this approach, the belief is that underlying imbalances that lie in the mental area, the physical area, hormonal imbalance, nutritional imbalances, and toxic overload are responsible for an account for diseases and symptoms. That’s the reason why we can use such an approach in somebody as young as five-years old where we’re looking at nutrition and toxins all the way to people with cardiac diseases and cancers.
So, the very first basic premise is that we believe that underlying imbalances cause symptoms and disease. The second one is that we are aware that there’s such a thing as an optimal range and optimal range such as a fasting blood sugar under 85 is associated with a 40% decrease in heart attacks. We know that the higher the level of vitamin D, the lower the incidence of many diseases and cancers. We try to aim for a vitamin D of 70, although the range is 30-100.
The more stressors we have mentally and physically, the quicker we run our hormones and nutrition down. In everybody what we find is that the first hormones to start reducing and taking this hit are actually thyroid and cortisol which start to fluctuate in the mid-twenties, but it isn’t in women until the age of 30-35 when the progesterone starts declining that many of the symptoms become apparent. Mostly because by that age, as the progesterone is going down, it’s unable to support the cortisol system anymore.
Every year we produce less of certain hormones. As I said, progesterone is the first one to go and more of other hormones such as insulin and Estrone, and the receptor sites for these hormones are on every single organ of the body. So obviously, we know that when the progesterone levels or the estrogen levels start to decline, we have a host of symptoms but we also have a host of corresponding diseases such as osteoporosis.
Progesterone is out of the hormones. The major hormone that stimulates osteoblast and is responsible for bone building. Diseases such as cancers. We know that progesterone stops the proliferation of cells. So obviously, if we’re low in progesterone, the cancer rates increase. This happens in both in men and women. In women, as I was mentioning, progesterone starts to decline around the mid-thirties.
If you have a woman who is under a lot of stress and these days we’re starting to see this much earlier than the mid-thirties because of stress and nutritional deficiency. The kind of symptoms that we start to see first are lighter and disturbed sleep, anxiety and panic attacks. This is the number one reason for a prescription like Prozac. Mood swings and irritability, breast cysts, ovarian cysts, and fibroids because of the fact that progesterone is responsible for mitigating the effect of estrogen on proliferation of the reproductive system.
So, as progesterone declines we start to get more cysts and also more cancers, and I will show you some data on that. Because of the same reason we get heavier bleeding and progesterone deficiency is the number one cause for a hysterectomy. It was when I started using progesterone that the number of surgeries that I recommended and did myself decreased by almost tenfold because the bleeding, the cysts, and the pathologies corrected themselves.
Worse PMS, mid-abdominal weight gain, a low sex drive, and hotflashes. In fact, hotflashes are number one primarily attributable to progesterone deficiency before estrogen. So when you have a woman with hotflashes or night sweats who is initially presenting and still having any kind of a period. The answer is always to give progesterone first to try to flatten out the estrogen fluctuations instead of giving estrogen first.
Then when the periods are completely diminished, that’s when I usually start to add the estrogen onboard. Because progesterone is an osteoblastic stimulator, it’s the number one cause of bone loss. That’s also the reason why women start to lose bone at accelerated rates from the mid-thirties onward as opposed to the early fifties when we normally get a DEXA scan. As a matter of fact, according to American College of OBGYN, the recommended age for the first screening of your bone density is age 65.
So, we’re really missing the boat by looking late and this is something which we usually order in our practice extremely early. We know that progesterone deficiency is the number one cause for why women end up on these kinds of drugs. I want to show you this study which you’ll have access to which was published many years ago. It was done in patients who were infertile and it had a 33-year follow-up in women who were long-term deficient in progesterone.
Over 33 years what they found was a tenfold increase of risk of death from all cancers and tenfold over baseline in 5.4 fold increase of premenopausal breast cancer. Again because for progesterone is associated with mitigating the prolific effect of estrogen and also progesterone’s responsible for decreasing the amount of estrogen that enters a breast cell. So, when women are coming in with breast cancers or with the fear of breast cancers, we have to remember and be able to refer to the data showing that low progesterone is associated with cancers just like a too high progesterone would be.
So, there’s a real risk of being too low or too high in everything. I always quote this study for patients who are you know interested in this kind of information and who are discussing progesterone with. But obviously, I’m telling you that progesterone deficiency causes problems but what about the studies that have shown that progesterone or progestin causes cancer and this is where the terminology makes all the difference.
If you look at our literature, for years we’ve been referring to hormone replacement therapy without actually defining which progesterone we’re talking about and which estrogen we’re talking about, and there lies the difference. So there are over 20 estrogens and we know there’s those estrogens that actually decrease the incidence of heart attacks and strokes and cancers. Those at age 30 are at 80% and then there’s those estrogens which increase clotting, heart attacks, and cancers like Estrone and that at age 30 is at 10%.
As we get into the 50’s, the Estrone becomes more than 80% of the estrogen milieu. Similarly, there are many progesterones. I want to show you the two progesterone here is the one that’s the natural one in the body and that’s the one that’s associated with protection. Then we have medoxyprogesterone acetate which is one of the progestins you can see that there’s a whole extra molecule on it and it’s been associated in over a dozen studies with a fivefold increase in cancers and clots.
So, the difference in the molecules makes all the difference to how the body binds these things. So, progestin is not progesterone. So when you have a patient who’s been told that they should stay away from progesterone, we use the word very loosely like we use the word estrogen. The question that we have to ask is which progesterone you’re using? When we start to show the patient these diagrams, I actually show the patient the diagram that I am just showing you right now.
The other part we know that actually shows the effectiveness in clinical trials, if you look at the Women’s Health Initiative study and you look at the estrogen and progesterone arm, and you look at breast cancer. As soon as we remove to the progesterone which is in the lower row, the breast cancer risk went from 1.2 (20% increase) to .77 (which was a decrease,) which was not completely significant but still we certainly didn’t have an increase there.
So from this study and if you look at what Yale University is saying right now, they actually were able to say that the estrogen was actually protective. If you look at the FDA, they’ve actually changed the labelling on Estradiol and estrogens in general. For invasive breast cancer, they now had to lower it to .80 as the relative risk on the package labelling. So, we’re seeing a recognition of the fact that even the coronary heart disease decreased as soon as the progestin was removed.
There are multiple studies; the Breast Cancer Study, the Swedish Reference Study, the Million Women Study. All of them show somewhere between a 1.2 to a eightfold increase in breast cancer when you used progestin because it stimulates the breast cells and increases cell adhesion. Whereas the bio-identical progesterone, the study shows inhibits breast cells, decreases cell adhesion and reduces the breast cell uptake of Estradiol.
This is another randomized controlled trial showing the same difference. Micronized progesterone was associated with a 30% decrease in Venous Thromboembolism (VTE) whereas the Nor-pregnane derivative was associated with a 0.9 but the Nor-pregnane derivatives was associated with a fivefold increased risk of Venous Thromboembolism. So, we know that this can make a difference, the form.
This is another randomized controlled trial showing that progestin and non-bioidentical estrogen increase blood clots by 290% basically. Another one showing a 50% decrease in plaques with bio-identical progesterone when it’s combined with estrogen. So, the progestagen is increasing plaques. The bio-identical progesterone is decreasing them. Then they’ve actually shown a pathological study in that was done in monkeys that shows that if you add progestin to the estrogen, you get a complete reversal of the benefits of the estrogen.
So, study after study showing exactly the same thing that I told you about previously. Here is what Yale University actually put out showing the effect of estrogen alone in age 50, all the way to age 79 and it was anywhere from 40% to 60% decrease in invasive breast cancer. That’s why they had to actually do a re-label and that was without using the progesterone. In 2010 and this is the study that I quote my patients as one of the studies that actually shows the effect of bio-identical Transdermal Estradiol and progesterone which is the ones that we use.
So, the first thing we tell the patients is there’s many forms of estrogen. There’s many forms of progesterone. There’s protective ones and there’s harmful ones. The French did a study showing that the two protective ones actually led to a decrease in breast cancer and as soon as they added the progestagen, you can see it in the second line. The breast cancer incidence increased by 70%.
So obviously, this is a pretty good study showing that difference. They actually show that even short spells of progestagens use less than two years were associated with a significant increase in breast cancer. This study that was published a few years later from the same data showed that the risk of clots did not increase with this regimen. So, before I get into showing you some cases and that’s the data that I’m showing you and you’re going to have those slides.
I want to talk to you a little bit about the difference when we start testing between urine, saliva and Serum. We obviously know that all three of these are showing us different things and this is one of the big things that people are always asking because it’s a confusing issue. The urine is showing metabolites. The saliva is showing tissue levels. The Serum is showing the level in the serum. And, they are going to be different.
No matter which test we use, we are first going to find out that the lab test is not going to tell us anything about function because it’ll give us the level of the hormone but won’t tell us about whether the receptor is active or whether all of the co-factors are present. So for example, in this picture, if you look and measured insulin – you wouldn’t know whether you had chromium and B3 and vanadium and zinc and magnesium to activate the insulin at its receptor and you don’t know of the activity of the insulin receptor is.
So, the first thing we have to recognize is that the only way to know the hormone function is actually to look at the clinical symptoms as opposed to the lab level. So whether we measure urine, saliva or Serum, we’re getting a level that we’re going to use as a guide but not as a definitive number that’s going to tell us exactly what mechanism we should take because it serves as a guide.
I want to show you how we use these levels. So, these are the normal Serum Labs that we order. We usually ask people to go in fasting 12 hours. Drink lots of fluids between 7:30 P.M. – 7:30 A.M. Get your blood drawn before 8 A.M. because we would like to look at the DHEA-S to check the adrenals and that gives us a standard time of testing for all labs. And obviously, it’s relevant if people who are on hormones what time they took their hormones.
What you’re looking for is the variation from one testing period to the next testing period. So this is what we do to keep it consistent. In a cycling woman, you may want to ask them to get this lab test at day 21. I don’t usually pay a lot of attention to what day they get their test although it can vary because as I said you can always go backwards and figure out whether they were drawn at the paper drop.
In males we get a similar lab panel. We don’t check progesterone but I will be talking about the use of progesterone in males. These are just some of the other tests we routinely order. Things like exams, DEXA scans, nutritional testing which we usually use Spectracell, vitamin D, and iron. That’s a boat in South India that I rode in. We have to know that when we’re using progesterone, we have the option of using compounded products but there are some bio-identical patented products on the market and your patients will be asking you for them.
The thing to realize is that Prometrium is in peanut oil and it is an immediate release progesterone. It comes in 100 mg and 200 mg. So, if you want an extended release of fat which you need to keep somebody asleep and also to have the decrease in the anxiety that you want during the day. It’s important to use the slow-release form. Similarly, Crinone vaginal gel has a very good progesterone effect but it’s not going to give you the slow-release formula.
So that I rarely use these forms but sometimes patients will ask about them for insurance purposes and they could be worth trying once you explain what I did to the patient. So, progesterone in women as we talked about declines in the thirties and sometimes before. We know that there’s a number of conditions including PCO, luteal defects, PMS that are actually associated with progesterone deficiency.
This natural decline leads to an automatic estrogen dominance from the age 30 onwards. So when women come in saying, “Well, I’m estrogen dominant.” Well, anytime after the age 30, you’re estrogen dominant. Or, “Hey, I’m pre-menopausal I think.” But you see those hormone declines start at age 25-30 so everybody’s pretty much pre-menopausal from 25, 30 onwards. It comes to a certain point where we have symptoms.
That symptom is when we generally start to say that people are pre-menopausal, but it’s important for people to realize that you don’t all of a sudden fall off a cliff. This is a very gradual decline. Other things that you’ll see associated specifically with progesterone deficiency include things like endometriosis and so on. So progesterone actions include bone building, which we talked about. Decreasing the proliferation of breast and uterine cells.
Also it’s a major player in mood as it binds to the GABA receptor just like Xanax (Alprazolam) and so it’s responsible for converting our data waves to Alpha waves preventing anxiety, panic attacks, sleep disturbance, and PMS. Other actions include uterine lining support. So obviously, if you have a woman who starts to bleed on a hormonal replacement regimen, you’re looking to increase the progesterone dose temporarily or permanently and decrease the estrogen dose for a short period of time.
As I was mentioning, this is actually a study published in OBGYN literature, 83% of women will experience resolution of hot flashes through the use of progesterone alone because it decreases the availability of Estradiol. Progesterone, the major symptoms as we mentioned include: lighter sleep, insomnia, anxiety, panic attacks, mood swings, irritability, PMS symptoms, cyclic headache which also can be from estrogen deficiency and magnesium deficiency but progesterone’s going to be your number one.
Swelling in the fingers and belly, breast soreness and breast soreness can come from progesterone deficiency, progesterone excess, Estriol deficiency, Estriol excess. It can be all of them but it’s important to remember when you’re treating a patient, if you get breast soreness you actually should control the Estriol first before anything else. Heavier bleeding, lower sex drive. Sex drive is a function of not just progesterone and testosterone but estrogen and thyroid. Hot flashes, insulin resistance and bowel changes.
So there’s a lot of things that are a result of progesterone deficiency. You’ll start noticing people complain of these things from the thirties onwards. If their adrenals are lower, they’ll complain more. The major associated conditions. One is prescription anti-depressants and anti-anxiolytics, breast cysts, ovarian cysts, fibroids as we talked about, infertility, PCOS, and endometriosis. Many cases cured just with progesterone that we’ve been seeing in this practice. Hysterectomy, bone loss, osteoporosis.
I showed you the cancer data so I’m going to put cancer in here. The indications for use really are if somebody has symptoms. That’s where we precede with restoring. The oral route is more effective and immediate. One could make the argument that if you use the oral route, it’ll pass through the liver and convert to 5-alpha-pregnananes and give us more propensity towards breast cancer.
What I can tell you is that the largest study that was done with oral progesterone used a 100,000 women which was sixfold larger than the Women’s Health Initiative Study. That’s Fournier’s study the French Cohort Study and that of course, you can show this increase. So I generally am choosing to use the oral route because it supports the adrenals, sleep and anxiety in a better way than the cream forms.
I always use the slow-release unless the patient cannot fall asleep and then sometimes I use immediate release and slow-release but generally just the slow-release works very well. The dose is interesting. It can range from 6.24 mg all the way to 300 mg. Women who have adrenal insufficiency are going to be closer to the 300 mg mark. I’ve had some patients who had to take even more than that temporarily.
Then there’s those patients who don’t even tolerate more than 6 mg. You give them 6 mg and they do just fine. So we always ask them to dose one hour before bedtime, increase the dose every two days until symptoms are resolved. The dosing kind of goes up depending upon what the age and condition of the patient is. So the starting dose in teens, the early 30’s, somebody on oral contraceptive tablet, all the way into the 40’s – could be as low as 6.25 mg.
What I usually tell these people is start one hour before bedtime with 6.25 mg and every day you increase it by one tablet. So I give them a hundred of these 6.25 slow-release capsules and ask them to increase it every single day until they sleep through the night and there’s no anxiety and irritability or cyclic symptoms. The average dose that you end up with is somewhere up to the mid-forties. It’s up to 50 mg.
If you have adrenal insufficiency, the dose is going to be higher. Similarly, in a woman who is menopausal, I start at 25 mg and ask them to go up from there. The benefit of type traiting this dose rather than just picking a dose is that you get an exact dose which is not going to cause too much grogginess.
In fact if it causes grogginess, we ask them to back the dose down or take it a little earlier in the day because they’re not metabolizing it and it also allows you to be precise with this dosing. Transdermal Progesterone is absorbed a little slower and they bioaccumulate. I generally choose to use transdermal progesterone when the patient prefers it first of all and if there’s acne. So, if you get acne and you’re having a conversion issue, it’s better to use a cream form of progesterone and the transdermal route.
The dose that we start on for the transdermal route is somewhere around 50 mg per cc. I give it always in a Topi-Click which is a clickle which is so much easier than these funny syringes. So you should talk to the compounding pharmacy and make sure they’re willing to give you the Topi-Click. One click is a fourth of a cc. Four clicks is a full cc. So if I mix it at 50 mg per cc, every click is 12.5 mg and they move up from there.
Sometimes if I have a very large oral progesterone dose and I can’t bring it down over time, I will split the dose between a cream and the oral. This is very rare, however. The effect is immediate and that’s why it’s possible to increase progesterone every one or two days. So if you see a patient who’s having anxiety and mood swings, irritability, sleep issues, and you start to dose them on progesterone. What I usually do is get the magnesium and enteric-coated fish oil.
You don’t have to wait for four weeks to see what the effect is. You can tell them, “Hey, I want you to type trait this up for 7-14 days. I’ll see you in two weeks, and see where we’re going.” So I follow them a lot closer than that. Some of the possible problems you can have if they’re too sedated during the day, the dose needs to be adjusted downwards or taken earlier.
If you get acne, of course I’ve talked to you about possibly changing it to cream but if the person has big adrenal symptoms and sleep big sleep, anxiety symptoms – that becomes hard. This is where you could mix Zinc Citrate with the progesterone and give them a progesterone cream. I find that actually Dimpro which is diindolylmethane groups at 200-600 mg a day will take care of this acne situation.
Generally within 4-8 weeks, you’re able to discontinue it because at the end of the day acne is a conversion issue and has a lot to do with the bowel. We work with the bowel with almost every patient eventually but if you initially have a patient who’s complaining of a lot of acne and you have to keep them on an oral. What you’re going to do is put them on some Dimpro at a couple hundred milligrams and tell them, “You have to stay on it for a couple months until the acne situation calms down.”
As I was mentioning, you can follow up in two weeks and we follow patients in 3-4 weeks or two weeks, depending upon what we do. Check the labs in somewhere between 6-12 months because we’re seeing them every three to four weeks. If a patient gets very anxious about their labs or we’re getting stuck, I will repeat the labs earlier but otherwise I don’t repeat them until the sixth month mark.
I always get this question of whether you should use cyclic or continuous and the majority of our patients are on continuous doses of progesterone. All month long the same exact dose except for the patient who tells you, “I used 25 mg all month long. It controlled all my symptoms and anything more than that, I didn’t feel good. But when I got to my period, I needed 50 mg to keep my symptoms controlled.”
So, that’s a patient who’s going to double their dose during their period or increase it by a little bit. So sometimes it’s appropriate in a premenopausal person to give them the liberty to go ahead and treat themselves symptomatically. The reason why the continuous approach doesn’t really effect the periods is simply because it raises the general level of progesterone throughout the cycle without affecting the actual ovulation.
As a matter of fact, I’ve had many people ask me, “Well, if you use a high enough dose of progesterone, aren’t you going to interfere with fertility?” We’ve had a lot of infertility patients actually as you increase the progesterone, they get pregnant and you don’t stop it. So that’s actually another reason why we don’t have a bio-identical progesterone or estrogen contraceptive because the dose we’d have to use to actually knock that cycling out is closer to 6-800 mg which nobody would tolerate.
The continuous approach is the most common approach because it has better compliance. Eighty-five percent of people who are started on cyclic regimens generally switch to continuous over time. This issue of it mimicking the physiology… I think mimicking of physiology is an extremely valid concern but in order to actually mimic the physiology, you would have to have a subcutaneous pump because the fluctuations of progesterone are in 24-hour periods up and down, up and down all day long. So there is no way to actually mimic the physiology.
The lowest, if you decide to cycle, the minimum number of days you need to protect the endometrium is 10 days. You can give them the dose day one through 25, and then ask them to stop for a few days or just give it to them for 10 days if you’re aiming for endometrium being quiet. For those women who have a hysterectomy and you’ve been told that the only function of progesterone is to stop the cancer of the uterus, they need to think again.
Obviously, the brain has progesterone receptors as we’ve just talked about. The breast has them. The bone has them. The nervous system. The cardiovascular system. There isn’t an organ in the body that doesn’t have progesterone receptors. So obviously, even if the uterus is not there, we still have to give progesterone. The summary of the dose options is 6.25-300 mg of teens and people on oral contraceptive tablets. They start at 6.25.
So, let’s see a couple of examples and choices one could use. So you have a 20-year old who’s presenting with PMS, anxiety, and insomnia. The pill. Do you need to stop the pill? No. You don’t need to stop the pill, you need it for contraception. So, and actually very often the progesterone and the pill does give an anti-progesterone effect. So you get all the symptoms of progesterone deficiency as you see. In a patient like this, somewhere between 6.25-25 mg of oral progesterone or cream form but generally I use oral and in this case is going to be enough.
You’ve always got to put a multivitamin/mineral onboard with active B-vitamins. I use Essentials 5-in 1 for this and RxOmega which is the enteric-coated omega. So I always put pretty much every patient on a multivitamin and omega. This was a 45-year old with the same symptoms who’s not on the pill. By the way, on the last patient, one of the questions I get quite frequently is, is this 20-year old on the pill? Are we going to destroy the contraceptive effect of the pill?
The answer is absolutely not. It won’t touch it. You have to use a much, much larger dose to touch that. So this was a patient at 45. So, I started her on 12.5 mg and have her increase it every day or two until she’s symptom-free. Again, on a multivitamin/mineral and omega. Fifty-five year old in menopause who has anxiety and hotflashes, irritability, and insomnia. Again, just starting at 25 mg and Estradiol 0.1 mg patch. Even if you didn’t start on the Estradiol, 0.1 mg patch you’d still have a very good effect on this patient as long as you also got the omega and the multi onboard.
This is a 43-year old patient with the same symptoms with acne. This is a patient who we would start with a cream possibly. As I said, you could start with an oral regimen and control the Estrone Metabolism by giving the DIM, MSM, or the crucifers. I usually use DIM in a strong bowel regimen and alkaline diet, and correction of the estrone metabolism. This is a 22-year old diagnosed with PCOS. Her weight 28 lbs above where it should be. Her energy level, a five. No periods. Coarse chin hair and no periods for over six months.
That’s how this patient presented. Her sleep was disturbed. She had been offered the pill, Metformin and Ambien for her sleep. There are many hypotheses about how people get PCOS and what the cause is, and whether it’s insulin or ovaries or pituitary. But at the end of the day what I find is that if you correct and optimize these areas that we talked about before. Especially the thyroid and the progesterone. Especially the iodine and the magnesium and the pH of the body.
You find that the PCOS goes away. Even the cysts on the ovaries go away. So our approach is going to be to try to optimize each one of these areas in this 22-year old with these symptoms in this particular lab profile. A progesterone level of zero. A very high estrone level of 110; very, very common. A slightly elevated testosterone level. HemoglobinAlc of 6.2. A vitamin D at 18. We’re aiming for a 70 at least. And, a low T3 which means I am going to be treating her with thyroid.
We start with the progesterone and the thyroid at 30 mg, and ask her to type trait the progesterone of 6.25 mg up until she’s sleeping completely through the night. In this patient, I would not hesitate to use Metformin initially until we have a chance to work with detoxification mechanisms and work with the bowel and the liver. The benefit of the Metformin is it’ll stop the sugar swings so I use these in this patient.
Also she was placed on Essentials 5 in 1; two at breakfast and two at lunch. RxOmega at 2-3 grams for the inflammation. Magnesium is a critical part of this regimen for this patient 400-600 mg in a glycinate form. Iodine, she was given 12.5 mg a day and D3. If you look at JAMA in 2002, they actually said that a multivitamin and the fish oil is what people need for prevention of chronic disease.
If you look at the recent study that was done showing that vitamins are not beneficial and we all know that our patients are coming and asking us about that. We have to remember that when you do a study and utilize vitamins with four or five guys that are on the International Cancer Institute’s Carcinogenic List and you’re not measuring nutrient values and all of the nutrients in the particular vitamins are sub-therapeutic – you’re not going to know what the effect is going to be.
The Omega 3 dosing varies depending upon what you’re trying to treat. I usually am using 2 grams of enteric-coated which is equivalent to about four or five grams of non enteric-coated according to The New England Journal of Medicine. We know that when we use supplements that we have to be careful because they’re mostly dangerous so we’re aiming for: vegetable capsule, no dye, no preservative, no filler, glass bottles or plastic that’s BPA free, no heat seal.
We want to make sure that everything’s Spectrophotometrically tested and we’re certainly looking for hormone activators which originally I was using a multiple bottles and something that was not Spectrophotometrically tested. Currently all of those multiple bottles are actually in 5 in 1. So, that’s the one I use; two caps at breakfast, two caps at lunch, and then two of this enteric-coated omega which gives you about the equivalent of 5 grams according to The New England Journal of Medicine article that showed that.
I use a form of magnesium which is a glycinate form. By in week four, in this patient, on this regimen right here – her energy level had gone from a 5 to a 7 and her sleep had improved to 8 hours. When you improve someone’s energy and sleep, the very first thing you know is you have already improved their metabolism and that means that whatever you do from there that’s going to be helping them with their weight.
So, she was placed on Armour Thyroid at 60 mg and by week 12 and I’m jumping ahead. She had lost a few pounds, 6 lbs. Her energy level was completely restored to 9. She had actually had one period. This is very common to periods should be start. The sleep was complete. The progesterone level was at 5. The thyroid was a little better. The HgbAlc was a little better. We started her on what we call our Metabolic Balance Program to control insulin which basically aims to bring the red line to the blue line so that they don’t have big swings.
She started off with a triglyceride level of 240. I’m not going to go into our program for metabolic balance in great detail but it’s rather standard with a vegetable cleanse and a 50% veggies, 25% protein, 25% complex carbohydrates. We also in that process use Gluco-X for glucose support and a probiotic and a bowel and liver cleanse, which you can look up on our webinar that’s on MDPrescriptives’s website.
By six months, she had 13 more pounds to lose. Everything else was fine. She had three periods and her HgbAlc was 5.2 and her triglycerides were already halved to 130. So, you can see that over a six-month period of time, she’s steadily reversing her disease which is exactly what you want. So I want to give you an example of this woman who’s a 45-year old with an energy of three, panic attacks, and insomnia.
You look at this scenario and you think, “Okay, this is definitely partly progesterone deficiency.” But you have to wonder whether she has a adrenal component because the energy is only three. So she was started on 12.5 mg of progesterone and asked to type trait it but instead of falling asleep and having no panic attacks, she started having hyper vigilance, no sleep, more panic attacks, more heart racing, more nervous, and the question is what happened.
So, this is a patient who really is having a paradoxical reaction to progesterone. When you’ve got her labs, you find that the DHEA-S is 45 whereas it should be at least 150-250 in a woman at 8 A.M. Low cortisol, no progesterone. This patient does have adrenal insufficiency. So she’s shunting that progesterone into the cortisol pathway so what we end up doing is of course, stopping the progesterone at night.
Giving her a high dose of magnesium, omega, DHEA in the morning, and then restarting the progesterone or turning it into sub-lingual or cream. You’re going to see this in your practice because there’s enough people with adrenal insufficiency that we’re seeing this. The next patient here is a typical case with insomnia, anxiety, and low energy, heavy menstrual period and anemia. And of course, she’s been offered a lot of medications to correct this.
This is a typical case because usually anxiety and PMS is going to look exactly like that. A patient like this needs to understand the function of each of the hormones. I always share with them that we’re trying to get them out of a mode of high beta waves and transfer them to alpha waves which are a much slower wave. That’s because the more physical exercise or mental exercise they have, the more hormones and nutrients they’ll burn out.
So we’re always trying to convert them from a beta wave pattern to an alpha wave pattern. The reason why we try to explain this to a patient is because we ask them to reduce their commitments. So this patient ends up having an explanation of that and she’s given usually a written five point plain which is our “Aha!” moment. Normal labs are ordered. She can be started on a regimen of progesterone 25 mg and the Essentials 5 in 1, the omega, the magnesium; the standard things that I’ve mentioned in pretty much every patient.
By week three, this patient on 50 mg has already slept 8 hours instead of four and has already stopped having panic attacks. So this is a big jump. And of course, we saw what we expected to see, which was: a progesterone level of zero, estrogen level of 120 which is normal, and a low thyroid. So, we add because the anxiety’s low, we’re able to add the compounded thyroid at that point.
By week seven, the sleep is 9 hours and the anxiety is gone, and there’s no panic attacks. So at this point you’re very welcome to continue to increase the thyroid. We used slow-release in this case because of the anxiety and by week 11, we increased it a little more but at that point we got a bone density result. By week 11, she was actually corrected completely. Her energy level was perfectly fine.
We increased the thyroid a little more but when you see a bone density of minus 1.1 in a 40-year old, you know that you have to do something. So here is where we know that the one choice is Bisphosphonates but the other choice is to start rebuilding bone by providing the hormones that effect bone, the nutrition that affects bone, correcting the pH, and you having proper physical exercise and not too much stress. You need all of it to go on.
This is the data showing that progesterone builds the cortical bone by stimulating ostoblast. I use a formula which is called OsteoMD; two capsules in the morning and two capsules at night. For the bone formula but more important than that and actually we know different forms of calcium causes different things. So this is a study showing the effect of anhydrous calcium on osteoporosis.
What you find is that if you don’t measure the calcium levels, you really don’t know where you’re going. So, you do not want to use the 800-100 mg standard recommendation. I’m using 600 mg in the form of calcium aspartate and eggshell calcium which is a OsteoMD until I get measurements. So that’s something that’s important to know because if you look at what the data shows, it shows that giving people calcium without measurement actually leads to more strokes.
We always recommend a physical program that includes balance and flexibility. This is about week 16 for this patient. Our patients build bone. So I actually had a patient come in today whose bone density had gone up a .5 in one year. You can expect anywhere from .3-.5 every year if they stick to a program that includes the right nutrition but also includes the pH balance and the right hormones in the picture.
So, I want to show you an example of a 14-year old girl who presented and this is very common these days. Insomnia, anxiety, low energy, severe PMS, not able to focus. She’s with a phone in the hand because this is what you see in these kids. We started her with a little bit of progesterone and melatonin, Essentials, and omega. Taught her a breathe exercise and asked her to remove the electromagnetic field from her bedroom, and within four weeks she’s corrected.
This is a 14-year old. This is how quickly you can correct a 14-year old if you’ve seen them. So you can see that progesterone is a pretty powerful thing. You can correct a lot of major conditions with it, a lot of symptoms with it. I’m trying to get to the last slide and these are the symptoms we’ve talked about. You can also correct a lot of major conditions with it which we’ve mentioned many of them through this presentation.
Additional conditions helped by progesterone include breast cancer and include any condition associated with low adrenals like inflammation in general, so, joint pains, allergies, eczema, and psoriasis. Any time you use these things, patients will tell you how they feel and they feel better in all of those regards.
So, in men, I use progesterone for anxiety and sleep and it’s a major player as we know for the GABA receptor and for anxiety. Generally, I use somewhere between 1-25 mg starting at 6.25. Some advocate doses of 100 mg in men but I’ve found that anything above 25 and people get very emotional. I have one male on 300 mg of progesterone because it’s the only thing that controlled seizures which he was having several times a week to now absolutely none.
Other than that, generally I start them at 6.25 mg. I generally add progesterone in men for anxiety and sleep after I’ve already corrected testosterone, magnesium, melatonin, and omega 3. So, this is the point at which I add the progesterone. I always tell people that they should congratulate themselves for any step they take and because you know when you get people programs, you know that there’s many things that can affect the success.
You don’t want your patients to feel as if they have to do everything. Let’s see. I wanted to go ahead and announce that we have one more webinar that will take place on March 16th, which is a Wednesday at 6:00 P.M. At this point, I also do want to take some questions. So I have to put this thing on to take questions. There we go. So the first question that I have is… A little bit difficult to actually see. Let’s see here. Okay. How do you dose and type trait thyroid medicine clinically like progesterone? At what point do you repeat labs?
So basically, I repeat labs at three months and six months when I’m doing the thyroid, but the next webinar which I just announced is going to be the ins and outs of thyroid replacement therapy. So, that’s going to be what we’re going to be discussing the next time. So, if you join that webinar, you will see multiple cases and get the idea of what we’re going with that one.
Then the next question is, how costly is the compounded progesterone capsules since using small doses, the cost might get costly if they end up on high doses? Also if using slow-release to people, do they absorb it well? So, if you write for a 100 mg of 6.25, they’re going to pay somewhere between $25 and $40 for it depending upon where they get it from. Once you get to the point where you know the full dose which is usually within 2-4 weeks, we go ahead and we give them only one pill at the full dose.
We don’t ask them to keep using the small doses. So obviously, then the cost drops back again, down into the $35 a month range. So, the majority of our patients who are on progesterone getting it from a compounding pharmacy are paying about $35 a month. As far as the slow-release, do they absorb it well? We can get levels of progesterone all the way from 5-25 using that. So, yes. The answer for absorption is extremely good. So, thank you for that question.
The next question is, you mentioned T3, T4 dose of 76 mcg and 152. What is the proportion of T3 and T4? The 76 mcg is physiological thyroid mixed at 1:3.3 is the normal physiological thyroid mix. So, if you wrote it out at a compounding pharmacy and you said, “I want physiological thyroid 76 mcg.” They are going to put into it 10 mcg of T3 and 33.3 mcg of T4 because that is how it’s defined.
It’s the biological equivalent of 76 mcg of Synthroid which doesn’t exist. So, that’s how that goes. What are the data for using progesterone in older women 70+ who have all the classic symptoms? As far as data for women in the 70+ range, there is the French Cohort’s Study actually did have women in that range but I can’t say they were all 70+. So, I think that in order to have good data on 70+, you have to have the study filter out people who are above 70.
I can tell you from my experience and I have probably at least 500-1,000 patients who are in that 70+ range with excellent results on progesterone. They feel like they’re getting their life back. They sleep. No anxiety. Things like that. So, it’s very beneficial. How do you check calcium levels and what is optimal?
So, I usually check intracellular calcium levels by using Spectracell and that is I’m looking for the 75th percentile. If the calcium’s low intracellularly, you also have to look at magnesium. Everything goes together. So obviously, if the calcium intracellularly is low but the magnesium is also low – we can’t correct it without correcting both. Is the breast cancer protective effective progesterone dose related? Is POSR 12.5 mg large enough dose?
Whether it’s a large enough dose or not is probably going to depend upon what the symptoms are and what the level is in the patient, but we know for example that a level of less than five in any woman is going to increase proliferation. So, you’re really aiming for a level of at least five. So that brings us to the number of questions we can take for tonight.
This webinar has been recorded. It will be on MDPrescriptives.com website. So, feel free to take a look at it again if you’d like and we’d love to have you join us for the ins and outs of thyroid replacement on March 16 at 6:00 P.M. Thank you so much.