November 2011

Stress, Learning and Estradiol

Published on November 29, 2011

2118 views

In many ways, we assume males and females are the same, even though we know each sex has distinct and obvious differences in physiology and behavior. In the case of the stress, although the basic physiological response is comparable, the chemical reactions that the stress response elicits in males versus females are quite dissimilar. The divergent reactions are mediated by the varying concentrations of reproductive hormones that each sex is exposed to. Far beyond just controlling sex differentiation and reproduction, sex hormones like progesterone, estradiol and testosterone modulate brain and body chemistry quite significantly. The differences in the circulating concentrations of these hormones may account for the unequal prevalence rates of many diseases such as of depression, auto-immune disease, or migraine. These diseases are far more common in women than men.

Hormones also influence neurochemistry, and therefore, learning. In general, males and females learn quite differently from one another. Males tend to be better at spatial tasks while females tend to perform better at verbal tasks. Research suggests testosterone and estradiol may mediate those performance differences.

Estradiol affects learning under stress. When exposed to stressful conditions, male rodents learn certain classically conditioned tasks more rapidly than female rodents. However, when the female rodents’ ovaries are removed or estradiol is blocked by a drug like Tamoxifen, the difference between the two sexes is removed. That is, the female rodents acquire the conditioning as quickly and as effectively as the male rodents.

Even though, humans are far more complicated than rodents and the controlled stress and the scope of classical conditioning tasks in the lab are limited compared to the stress and learning that takes place in the real world, it is clear that sex matters, and thus by definition, sex hormones matter.

To read more about sex differences in neurochemistry:
The End of Sex as We Know It

The Stress of Modern Living

by Chandler Marrs, PhD

Published on November 29, 2011

3131 views

I’m stressed, my friends are stressed, and let’s face it, the entire nation is stressed. In modern life, we’re bombarded with the daily list of to dos, the noise of 24 hour news and cable, the incessant activity of the internet and in the current economy, the constant threat of job loss and financial insecurity. True, the stressors we face today compared to those faced by previous generations are not generally life-threatening, but they are deadly, just over a longer period of time.

Chronic stress, the underbelly of modern life (pun intended), is perhaps as much to blame for the increased rates of obesity, cardiovascular disease, and diabetes as are other lifestyle variables such as diet and exercise. Our physiological responses to stressors were meant to be acute, short-term adaptations that allowed us to survive an immediate threat. The chronicity of modern stress has turned a very basic survival mechanism into a death trap and I’m not sure we’ve fully evolved to adapt to this new, never-ending state of stress.

Think about what happens to the body when it is faced with a stressor; it mounts a physiological response against the stressor. It doesn’t necessarily matter what the stressor is, the physiological responses are quite similar. Have you ever noticed that the early stages of illness look a lot alike, GI disturbances, heart rate changes, loss of appetite, sometimes fever, aches and pains- that general feeling that you are coming down with something? This is your body reacting to an internal stressor, an illness.
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Cortisol: The Stress Hormone

by Chandler Marrs, PhD

Published on November 29, 2011

4610 views

Cortisol is a steroid hormone produced in the cortex of adrenal gland. It belongs to a class of hormones called glucocorticoids and plays an important role in regulating cardiovascular function, blood pressure, glucose metabolism, sugar maintenance, and inflammatory response. Cortisol is best known as the stress hormone. It is released in response to stress, and is part of the fight or flight system.

Under normal conditions the body regulates cortisol levels which are usually high in the morning and low at night. But under stressful conditions more cortisol is secreted. Small increases in cortisol produce positive effects such as increased sustained energy, diminished pain sensitivity or memory enhancement. But a prolonged cortisol increase during chronic stress results in negative side effects: increased blood pressure, sugar imbalance in blood, decreased bone density, cognitive problems, and reduced thyroid function. It also slows down healing processes and suppresses the immune system, perhaps the reason we are more apt to get sick when we are stressed.

Continuously, stress-induced elevated cortisol levels lead to an increase in the level of other hormones (testosterone, estradiol, insulin). High cortisol levels are often linked to insulin resistance (Type 2 Diabetes), weight gain and general inflammatory conditions. High cortisol is toxic to the brain and can cause memory loss and contribute to Alzheimer’s disease or senile dementia. Elevated cortisol levels and lack of diurnal variation have been identified with Cushing’s disease. Low cortisol levels are found in primary adrenal insufficiency (e.g. adrenal hypoplasia, Addison’s disease).

Cortisol and progesterone bind to common receptors in cells. Cortisol blocks progesterone activity, and some suggest, that high levels of cortisol, initiated by chronic stress, dispose one to a condition called estrogen dominance. Estrogen dominance is condition where women cease to ovulate regularly and progesterone concentrations are lower than necessary during the second half of the menstrual cycle. Many suspect estrogen dominance underlies PMS and other cycle related symptoms.

Hormones and Mood

by Chandler Marrs, PhD

Published on November 28, 2011

6595 views

Hormones and Mood: Most Women Experience the Mood Changes

Mood swings and depression can occur anytime in woman’s life. But women seem to be more vulnerable to mood changes during the time of hormonal fluctuations – peri-menopause, pregnancy, or their periods. Eighty percent of women acknowledge some increased emotional sensitivity before their period starts, 8-10% have severe ‘hell-on-earth’ mood changes the 2 weeks before their period. For some women hormonal flux can trigger mild to severe mood disorders including depression and bipolar disease. Postpartum depression can affect 10 to 15% of women and can last up to a year after the child is born.

Hormones and Mood: Premenstrual

Research suggests 8-10% of women experience PMDD (Premenstrual Dysphoric Disorder) which is characterized by severe moods swings, depressed mood, irritability, anxiety and physical symptoms (occurring exclusively during the luteal phase (weeks 3-4) and remitting within 3 days of the onset of menses.

Hormones and Mood: Brain Chemistry

Hormonal problems are believed to be linked to the imbalance in neurotransmitters that are directly responsible for mood state, particularly serotonin, norepinephrine, dopamine, GABA, and acetylcholine. Estradiol is a hormone known to affect mood. It increases serotonin and beta-endorphins that are associated with the positive mood state. Estradiol acts to increase neuronal excitability thus producing a brain stimulant-like effect.

Decreased level of estradiol was shown to be linked to panic attacks. Additionally low estradiol can cause headaches, foggy mind, memory lapses, and sleep problems.

The progesterone metabolite, allopregnanolone (ALLO), produces a sedating/calming Valium-like effect. ALLO works on GABA receptors in the brain and is a powerful anxiolytic, anticonvulsant, and anesthetic agent which decreases anxiety and depression.

More Turkey News: Big Breasts, No Sex

by Chandler Marrs, PhD

Published on November 23, 2011

2853 views

A more humorous story for this Thanksgiving holiday; big breasts mean no sex for holiday Turkeys. According to a recent Freakanomics report, our predilection for big breasted turkeys impairs turkey sex- the breasts get in the way of copulation. This has ‘forced’ commercial turkey farmers into artificial insemination. There is not a Turkey on the market today, lest they be a ‘heritage’ turkey that has had the pleasure of sex. Nor for that matter, have most other livestock (90% of all cattle are artificially inseminated). Imagine if big breasts had the same effect on human sex. Unnatural Turkeys: A New Marketplace podcast

Some Good News and Bad News About Your Thanksgiving Meal

by Chandler Marrs, PhD

Published on November 23, 2011

1944 views

So the good news is that the family will be together (now that might be the bad news for some) but there are a few questions to be addressed here. Why is it that when food is served and eaten no one is willing or capable to help clean up? Well, there might be a reason. Read ‘Does Turkey Make You Sleepy?’

It’s not all bad news, if you use fresh ingredients then there are actually many beneficial in the feast. Cranberries have the highest level of phenols, a type of disease-fighting antioxidant. (Among Fruits, Cranberries Are Richest in Potent Group of Antioxidants ). And who can deny the benefits of the green beans, butternut squash, a healthy stuffing with celery, mushrooms and walnuts. (Of course, those are the ingredients in my secret recipe. If you’d like me to share this recipe, just ask for it in the comment section).

The Lucine Team wishes everyone a Happy Thanksgiving.

The match game of healthcare that works (Part III)

by Deb Andelt, JD

Published on November 15, 2011

1718 views

Care for yourself by assessing the “care” in your healthcare

There’s a lot of discussion both within the medical profession and among average everyday patients and family members about what constitutes “quality” healthcare and “care” in general. As with most things in life, the nature of the discussion reflects the frame of reference of those doing the discussing. The result: care is defined, and measured, differently depending on who is involved.

For providers, “care” is typically what they can easily measure

Hospitals generally tend to consider quality care, and its measurement, in three categories: 1) what didn’t happen, for example: decreasing re-admissions or reducing or eliminating adverse drug interactions and infections, and of course the ultimate “never event” ‒ no deaths; 2) patient improvements on any number of laboratory tests that may be relevant for what is desired to be measured; and 3) patient satisfaction survey scores which typically provide patients a list of “events” and ask patients to rate what occurred or didn’t occur, such as: did staff members introduce themselves and did they listen.

For practitioners, their measure of quality of care may be similar to what hospitals measure. It’s not uncommon to see practitioners list services, treatments or procedures as a means to communicate the type of “care” they provide. Non-allopathic physicians (NDs, TCMs, etc.) may related quality of care to improvements in the health and well-being of their patients based on how their medical sciences define health. (see The match game of healthcare that works ‒ Part II: Make healthcare truly about you – your personal definition of “health).

All of these things identified as aspects, qualities or attributes of “care” are quantifiable in numbers. Being in the shoes of the patient, or family member, the question to ask is: do those numbers add up to care that you care about?

For patients, “care” is how they feel

Patients seek healthcare to feel better.

“Patient care is emotional work.” *

From both the patient and physician perspective, emotion and care are intertwined. Yet how patients feel is rarely central to identifying, measuring, or achieving “care” that matters to the patient. Such an emotional framework may be considered elusive because emotions are deemed to be intangible. Yet with a manageable framework, we can do this. If the industry isn’t doing this in a way that is meaningful to patients, perhaps like the “we are the 99%; Occupy Wall Street” movement, it’s up to patients and their families to identify the emotional attributes and measure care that matters.

Create your personal assessment of “care”

As a starting point, do you know the healing feelings? When we experience the feelings of being:
• comfortable
• understood
• connected
• strengthened
• renewed

Those feeling set the stage for our mind/body systems to heal. These feelings will be your guide to know when your experience is one of “healthcaring.” If these healing feelings don’t resonate with you, find five other feelings that reflect how you want to feel at each step in a healthcare experience.

Whether you’re at a regular appointment with a physician, at a lab for tests, or contemplating procedures at a hospital, follow this simple three step assessment to determine if you’re experiencing “care” that supports you. At each stage in your interaction:

• Pause: At meaningful moments in the experience, pause and pay attention to what’s going on – what are you seeing, smelling, touching, hearing, or even tasting.
• Connect: Then connect with what you’re feeling, find the words for how you feel.
• Assess: Weigh how frequently you were feeling one of the healing feelings (or some other positive emotion) and how often you were feeling something not as positive.

Keep a small notebook handy to track this. Moments in the experience go by quickly. What you end up with may partially look like this:
• Walking in, I’m overwhelmed and anxious because the directions I had were bad, I got lost, and now I’m late.
• As I’m greeted, I feel a bit calmer, more comfortable; the man at the front desk was friendly and greeted me by name.
• While filling out paperwork I’m frustrated. As a returning patient, I’m thinking surely with technology there has to be a way to see my past information and simply update.
• Post paperwork, I’m a bit more relaxed, fairly comfortable. The waiting area has comfortable chairs, not to close together, no loud discussions.
• Being guided through the building or space, I have no idea where I’m going and don’t feel comfortable I can find my way back out or find a restroom.
• I feel grateful, strengthened even, when talking with my physician; she let me talk for a full 30 minutes and tell her everything; she asked relevant questions; as a result I feel understood.
• Leaving, I’m confused. I have a piece of paper with brief instructions of what to do next, but on reflection I don’t remember all of the conversation and these limited notes are insufficient to feel confident that I can manage my care.

Why how you feel matters to your well-being

We all know how important positive emotions are to our well-being and how disruptive negative emotions are to our healing. If our healthcare experience is filled with more aspects that trigger negative emotions, we’re actually going a bit backwards – or at least we may find ourselves feeling like we now have to catch up to our prior point of “being.” Supporting positive feelings throughout each aspect of the experience should be part of the “care” healthcare providers provide.

Along with your personal worldview of health, your definition of health, this process is a valuable component to determine what organizations and practitioners you will partner with for your well- being. If you don’t feel “good” about something or someone, that’s your cue to adjust and make a change. Remember, these feelings are influencing your overall health and well-being every moment of the day.

Note: This is part an ongoing series to equip you with a process, a path, to identify and experience healthcare that works for you.
— Foundation: The heart of healthcare that works: know your personal worldview of health: http://www.hormonesmatter.com/the-heart-of-healthcare-that-works-know-your-personal-worldview-of-health/
— The match game of healthcare that works series ‒ Part I: Understand the landscape set by insurance companies: http://www.hormonesmatter.com/the-match-game-of-health-care-that-works-part-1/
— The match game of healthcare that works series ‒ Part II: Make healthcare truly about you – your personal definition of “health”: http://www.hormonesmatter.com/the-match-game-of-healthcare-that-works-part-ii/

Deb is co-owner of Experience In Motion, which equips organizations with tools to curate meaningful experiences for customers and employees. Deb’s personal journey from decay to well-being inspired an emphasis in improving healthcare experiences for patients and practitioners by focusing on experiences that heal, and self-caring as a way of organizational being. www.experienceinmotion.net.

*http://depts.washington.edu/toolbox/emotion.html

How To Become A Thought Leader. Hint, You Have To Think.

by Chandler Marrs, PhD

Published on November 15, 2011

2128 views

And then act.

A recent article on KevinMD, “How Jenny McCarthy became a medical thought leader” bemoaning her role in the Autism/Vaccine conversation, got me thinking. What is it about the guilds of medical and academic science that all but prohibit listening to outsiders; that sanction who can ask questions or what types of questions can be asked?

Why was a mere mortal, a mom no less, able to assume the role of the thought leader? Why not an academic or a physician? Aside from the Shakespearean truth- ‘hell hath no fury’ which doubly applies to moms protecting their young- Ms. McCarthy rose to this role precisely because she was not within the guilds of medicine or science. She was not encumbered by a particular line of research. She had no need to impress her superiors, maintain her grant funding or continue the publication mill required to succeed in academia. She was an outsider. She could ask the questions either too obvious or too controversial for any well-respected physician or academic to ask- like ‘is it really a good thing to put thimerosal in vaccines?’ And by doing so, loudly enough and long enough, she created a movement, much to the chagrin of the medical-pharmaceutical establishment.

Her story and that of other medical outsiders should serve notice to the academic and medical establishments. It’s not sufficient to hide behind one’s academic laurels or regurgitate the party line. It’s not sufficient to communicate only amongst one’s peers. The dissemination of medical information is no longer top down (see PatientsLikeMe and 23andMe). It is no longer controllable by the profession. Social media blasted that control wide open. And pledging some misguided fealty to the hegemony of a medical truth simply because the evidence to contrary is posed by an outsider says more about the intellectual poverty of the ‘experts’ than the lack of education of the patient. Keep this in mind, when you read the comments posted in response to the Jenny McCarthy article, comments made presumably by physicians.

Aside from the very real risk for obsolescence that physicians and academics face when disparaging and dismissing the concerns of their patients, by failing to communicate with their patients, by not entering the conversation in an honest and thoughtful way, they feed the very ignorance that is feared most. When physicians don’t enter the conversation, or when they simply regurgitate the party line without addressing the possibility that there is grain of validity to the question or concern posed, the void of medical leadership will be filled by others and sometimes dangerously so (chicken pox infected lollipops sold over the internet).

When we began this company, to find connections between hormones and disease, we did so knowing full well that to many of the medical guilds measuring hormones is considered unnecessary and doing so saliva is especially suspect. (This despite the fact that salivary analysis has been used in academic research for over 30 years and when controlled correctly, is far a superior matrix for certain lipid soluble analytes than blood). Think about what it means when an industry where 70% of decisions are made by consensus rather than evidence says measuring key biological variables for women’s health (building evidence) is unnecessary. It says, ‘we want you to stay ignorant of your physiology.’ That is not leadership. That’s not even particularly thoughtful. That’s a knee jerk.

The public needs physicians and academics who are willing to get in the game of public discourse.

He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” “Listen to your patient, he is telling you the diagnosis,” William Osler.