A 38 year old female was returning to The Netherlands with her husband and children while driving from France. All of a sudden she developed heart palpitations. Her husband drove to the nearest hospital and while there blood tests and an trace of her heart were performed. The emergency medicine physician there said she was fine to drive home but she needed to see her own GP for a follow-up.
She saw her own local GP a week later with on and off feelings of faint without collapse and at times she felt her heart beat fast. During the visit, vital signs were fine. A 24-hour heart beat monitor was normal and blood tests revealed no abnormality to her liver, kidney, complete blood count, thyroid, she had no elevated inflammatory markers. All physical examinations were normal yet she attended her GP 4 times more after with vague symptoms, most recently she wakes up at night in a state of fright, needs to go to the toilet to urinate and then feels a strange feeling in her head.
She has no fever, no abdominal pain, no chest pain, no breathing problems and no neurological symptoms for instance loss of feeling or power to her upper and lower limbs. After 4 months and while waiting to be seen by a neurologist and a psychologist her GP has not yet found what her diagnosis. We at EHC consider what her GP could do in this complex chronic disorder case.
Here are 2 main things we will want to find out in this 38 year-old expat patient.
Have your health issues happened out of nowhere?
Are you waking up multiple times every night?
At EHC, we appreciate having close relationships with our patients. This is why a conversation about nutritional status and hormone balance is possible with the time we give you. In this post we will cover ways to minimise risk when we discuss nutritional status and the possibility of hormone replacement therapy in complex hormonal imbalance cases. We want you to understand the role of nutrients in your body and how to address symptoms that keep on going on despite having good hormone levels.
Disclaimer, when we modify hormone balance, we are potentially putting you at risk. For instance women on hormonal replacement therapy (HRT) are at risk of excess breast tissue and men with testosterone replacement therapy (TRT) are at risk of prostate tissue growth.
Before we start hormone replacement therapy at EHC, we need to address anything in your lifestyle that may increase your need for hormones. Essentially we need to optimise your diet as well. In order for us to know how your gut is working and how you deal with stress overall we do the following:
- Lifestyle assessment: In essence we want to find out whether you sit all day. Those that sit all day will have less hormone levels than those that are active.
- Blood sugar levels: we know that the lower the blood sugar levels, the better your health. Insulin resistance, cholesterol, thyroid, methylation panel.
- Excretion of faeces and urine: Before we start you on any prescription we assess bowel movement and urine frequency. We also encourage going to the sauna and drinking enough water
- Does your weight fluctuate easily? Evidence shows that weight that fluctuates can be an early sign of insulin resistance or high blood sugar levels.
An example of 4 tests we recommend before and after hormone replacement therapy at EHC:
- A comprehensive test to look at your metabolism.
- Are you clearing up enough, do you have toxicity that may contribute to the way you are feeling?
- Do you have the right nutrients?
- Do you have the correct levels of folic acid and vitamin B12, if that is the case then your oestrogen deficiency levels resolve without even the need to add oestrogen
- Regular serum tests (Complete blood count (CBC), liver, kidney, thyroid hormone)
- Sex Hormone Binding Globulin (SHBG)
- Insulin dynamic status (high insulin can lower SBGH)
At EHC we have partnered with GDX diagnostics lab to offer the NutrEval test, specifically designed to look at root causes of dysfunction and treat clinical imbalances that are inhibiting optimal health. It is the most comprehensive, functional and nutritional assessment to include
- Organic acids
- Oxidative stress
- Amino acids
- Essential and metabolic fatty acids
- Nutrient & Toxic elements
Each test includes customised nutrient recommendations for key vitamins, minerals, amino acids, fatty acids and digestive support based on functional evaluation of important biomarkers.
When do we start hormone replacement therapy?
Before we start HRT, we want to clear up some underlying issues such as diet, sleep pattern and exercise.
- In women with new hormonal changes, loss of lubrication or low oestrogen levels are indications to start HRT. There is increasing evidence that a rapid decline in women with cognition and concentration are linked to low oestrogen levels. So this too will be a reason to consider HRT.
- In males, with mood changes or those that don’t want to engage in anything – this is a good cue that their testosterone is low. If their oestrogen levels are normal – this may be a safe reason to start testosterone supplementation.
What we at EHC do to monitor your progress:
- Check weight gain. If males have low testosterone and normal oestrogen is put on THT but start to gain weight then we need to take a closer look at this.
- Always test urine metabolite for oestrogen to find out how well you are clearing this
- If a patient is still not sleeping or emotionally imbalanced, then we will look at their adrenal glands to make sure that they are producing enough cortisol.
- Look at amino acids, folate, vitamin B12 and Vitamin B6
There is a good chance that after a comprehensive assessment by EHC you will get more about your nutritional status and get a better understanding of the root cause for hormonal imbalances.
In the example above, her GP provided her direct measurement of her blood tests (what is going on outside the cell). At EHC we provide functional measurements that take into account various biochemical pathways and look at what is going on within the cells. In some circumstances, direct evaluation is included to fulfil the entire picture. Hence at EHC we look at nutritional needs and the clinical application of these tests.
Book an appointment with a doctor to find out more about how functional tests can find out the root cause of your nutritional status and balance your hormone