2 D AYS C OURSE P RACTICAL & C LINICAL A NTI -A GING W ORKSHOP P ROF. D R. P AUL L ING T AI D.P.M., FACFS, ABPS, ABBARM, DACBN P ARAGUAY J ULY 5 – 6, 2012

2 DAYS COURSEPRACTICAL

& CLINICAL

ANTI-AGING WORKSHOP

PROF. DR. PAUL LING TAID.P.M., FACFS, ABPS, ABBARM, DACBN

PARAGUAYJULY 5 – 6, 2012

Prof. Dr. Paul Ling Tai D.P.M., FACFS, ABPS. ABAARM, DACBN

2

Ankle & Foot Surgeon, Orthopedic Podiatric Surgical Reconstructive Team, Surgery Department Annapolis-Oakwood Hospital, Detroit, Michigan

Professor of Anti Aging Regenerative Medicine, University of Paulista (UNIP), Sao Paulo, BrazilCoordinator & Professor of Anti-Aging & Endocrinology

Pos Graduaco - Laco Sensu Universidate De Gama FKHO School of medicine Rio De Janero, Brasil

Chief of Surgical Residency - Board of Licensy of Pediatric Medicine & Surgery. State of Michigan

Professor of Integrative Medicine. NYCPM, New York, New YorkProfessor of Anti Aging Master Degree, Pontifical Univ. Catholic, Belo

Horizonte, Minas Gerais, BrazilCo-Coordinator Master of Science in Public Health, Anti Aging/Regenerative Medicine.

Approved Post Graduates Studies by the Ministry of Education, Sao Paulo, BrazilOfficial Latin American Delegate and Coordinator for the World Anti Aging Academy of

Medicine (WAAAM)Founder and Coordinator of A4M Brazil Society and Medical Congress.

Personal Representative for Latin America to Dr. Robert Goldman, MD, PhD, DO, FAASP- Chairman of A4M,

Past Adjunct Professor of Surgery. OCPM, Cleveland, Ohio Vice Chairman & Chief Examiner of State of Michigan

Faculty member, lecturer, workshop, authorAmerican Academy of Anti Aging Medicine (A4M)

Copyrights:OIBConsultants, Inc.

Dr. Tai doing surgery

at Oakwood Hospital

Prof. Dr. Paul Ling TaiD.P.M., FACFS, ABPS. ABAARM, DACBN

5

Medical Board CertificationFellow – American College of Foot & Ankle Surgeons - FOTODiplomate – American Board of Podiatric Surgeons - FOTO

Diplomate - American Academy of Anti Aging Board (ABAARM): Oral Exam and Written Exam (A4M) - FOTO

The Grand Physician General – The Supreme Council of the Sovereign Medical Order of Knights Hospitaller

Professor, Dean of Endocrinology Dept. University of Natural Medicine, Quito, Ecuador.

Member - Royal College of Papal Knights in Americas. Granted by Vatican H.H. Pope Benedict XVI, signed by Vatican

Secretary of State Cardinal Bertone.Chairman & President, A4M Brazil (American Academy of Anti

Aging Medicine-Brazil)


Copyrights:OIBConsultants, Inc. 6



Prof. Dr. Paul Ling TaiD.P.M., FACFS, ABPS. ABAARM, DACBN

• Prof. Dr. Tai is a Knighted physician

• Helped thousands of patients and consulted countless doctors on difficult cases all over the world, earning him the title of the “Doctor’s doctor” and “Doctor of last resort”.

• Member of the Royal College of Papal Knights in Americas. Vatican, His Holiness H.H. Pope BENEDICT XVI.

9Copyrights:OIBConsultants, Inc.

10

Prof. Dr. Paul Ling Tai D.P.M., FACFS, ABPS. ABAARM, DACBN

12

AuthorBook Publication: Cordyceps Miracles, 2005

Book Publication: 8 Powerful Secrets to Anti Aging, 2007

Newsletter: Healthy Lifestyle, 2008Medical Journal: The Bariatrician, 2008

Book Publication: Fabulously Beautiful You! 2009Book Publication: Thin Factor, 2010

Medical Textbook: Non-Invasive Plastic Surgeryand Anti-aging 2010

DVD: Complete Courses, Weight Loss technology for Aging

Advanced Courses of Anti-AgingCopyrights:OIBConsultants, Inc.


13

Saliva Hormone Testing

Evaluate a pooled saliva sample from multiple collections Possible to get reliable assessment

of hormone concentration in diurnal fluctuations

Hormone assessment from saliva allows Specific direct determination of

biologically active of “free” fraction of hormone


14

Saliva Saliva is NOT an appropriate

matrix for conjugated steroids Estrone-sulfate DHEA-sulfate

Affected by flow rate

Saliva also not appropriate for thyroid Presence of T4 in saliva results from

blood contamination


15

Physiology of Salivary GlandsMore than one mechanism exists

for blood components to pass the membrane barrier into the

salivary ducts Passing through the space between

the acinar cells (tight junctions) Only molecules with a relatively small molecular

weight (MW<1900) may pass through MW Hormones ca. 300 MW albumin = 66,000 MW CBG = 46,500 MW SHBG = 115,000


16

Saliva Collection

http://companyweb/HSUSA%20Digital%20Photos/Siliva%20Test%20Procedure%20Photos/STK-03.JPG



17

Saliva Hormone Blood Contaminations

As blood contains about 50 times higher concentrations of hormones, special

attention should be given to avoid blood contamination

0 0,01 0,019 0,038 0,075 0,156 0,312 0,625 1,25 2,5 %

The rejection point of blood contamination is when it is visible

to the naked eye at 0.156%



18

The Saliva Collection Container

Saliva hormones are small non-polar molecules which tend to stick to plastic material

Polyethylene is highly absorptive for Progesterone Highly non-polar

Glass seems to be completely absorption-free

Stoppers made of polyethylene are highly absorptive

The best plastic material seems to be Ultra-Pure Polypropylene, not recycled plastic


Human Growt

h Hormo

ne


20

New England Journal of Medicine, October 1999;

341: 1206-1216. HGH Restores normal body composition Improves muscle tone Normalizes serum lipid concentrations Improves quality of life

Energy level, mood & emotions

After six months of treatment Metabolism increased by six percent to

11%



21

Growth Hormone Benefits

Better muscle tone

Loss of excess fat

Improved skin elasticity & thickness

Stronger bones

Improved immune system



22

Growth Hormone Benefits

Improved energy & anti-fatigue, vitality

Increased creativity, positive outlook

Improved memory, thinking, mental clarity

Greater social friendliness

Positive & self confident



23

Psychic Excessive emotions (72.9%) Sharp verbal retorts (64.6%) Permanent fatigue (72.9%) Easily exhausted after physical activity (89.6%) Low resistance to staying up after midnight (83.3%) Anxiety (70.8%) Insufficient aggressiveness (54.2%) Sense of powerlessness (75%) Depression (60.4%) Low self-esteem (50%) Low sociability (tendency for social isolation) (45%)

As reported by 48 adults (aged 27 – 82 years) with low plasma IGF-1



24

Abdominal Scan

GH deficiency Excess abdominal

visceral fat

GH treatment Marked fat reduction



25

Frequency of Psychic Complaints Before & After GH Treatment in Adult Patients

Perman

ent F

atigu

e

Easily

Exhau

sted

Low Resi

stance

to St

ying U

p After Midnigh

t

Depres

sion

Insufficie

nt Agre

ssive

ness

Low Se

lf-Este

em0

20406080

10073

89 8360 54 50

10 12 15 11 14 10

Before Treatment After GH Treatment


26

Supplementation of Strontium

Vertebral fracture – 31%Non-vertebral fracture – 27%

Major non-vertebral fractures – 33%Hip fracture – 24%

n = 1489 Strontium ranelate 2 g/d Reduced risk

Seeman E, et al. Five years treatment with strontium ranelate reduces vertebral and non-vertebral fractures and increases the number and quality of life-years remaining in women over 80 years of age. Bone. 2010 Apr, 46(4): 1038-42. Epub 2009 Dec 21. PMID: 20026265



27

Glucose SupplementationCynannon MHCP 5%, Fulvic/Humate, Quercetin, Alpha Lipoic

Acid, Corosolic Acid, Pancreatic Ext., Chromium PolynicotinateOne capsule three times a day with meals, or more, as needed

Corosolic acid & MHCP Improve the insulin sensitivity at the receptor site

Dr. Yamazaki, Hiroshima U. Sch. Medicine Improve modulation of blood sugar levels by 31.9%

Dr. William Judy, SW. Inst. Bio Res. Florida

Chromium Improve the glucose tolerance of Type I & Type II

Diabetes Anderson RA Chromium and glucose intolerance in Diabetes.

J. Am. Col. Nutr. 1998.



28

ArthritisClematis Chinensis, Trichosanthes Kirilowii, Prunella

VulgarisPark, et al 1995; Ahn, et al 1996; Kim, et al1996. Seoul, Korea

96 patients osteo-arthritis of the knee – 5 weeks95.8% improvement from fair to very good

GingerolBliddal, et al 2000.

75 patients arthritis hip & kneeGinger vs. Ibuprofen



29

Growth HormoneTreatment of Deficiencies

StandardInjection 0.2 mg – 0.5 mg per day

BestInjection 2 units – 8 units per week in divided daily dosages

Caution: Side effects of excess are more frequent Not Physiologic – HGH output highest 10 p.m. – 2 a.m. Best when given in small dosages/frequent shots

Signs of excess: Swollen feet, neuropathy, carpal tunnel, excessive muscle



30

Growth HormoneSecretagogue

Human Growth MatrixOral spray sublingual Nanolyposome

Fulvic Ext., Humate Ext., Deer Antler Ext., IGF-1, IGF-2, EGF (Epidermal), NGF(Neuro), TGF(Transfer), VGF(Vascular), Cocoa, Stevia, Shugr™, Pituitary ext.,

Eurycoma Ext.

Directions: (Adjust dosage to individual needs) Maintenance: Take sublingual 2 pumps a.m. & p.m. – Hold for 1

minute before swallowing Treatment: Take sublingual 3 – 4 pumps a.m. & p.m. for specific

deficiency & for arthritis inflammation For Super Athletes: take 4 – 6 pumps a.m. & p.m.

Signs of excess: Swollen feet, neuropathy, carpal tunnel, excessive muscle


DHEA


32

DHEA Clinical Applications

Aging (hormone marker) Bellino FL, Ann NY Acad Sci

1995; Belancer A, et al.

Immunodeficiency Syndrome Regelson W, et al. Ann NY

Acad Sci 1994; Khorram D, et al.

Obesity Jakubowicz DJ, et al. J Clin

Endoc Met 1005; Porter J, et al. Ann NY Acad Sci 1995.

Memory Loss Majewska M. Ann NY Acad

Sci 1995; Melanoir CL, et al.

Neuroscience Abs. 1002.

Depression Wolkowitz O. Ann NY Acad

Sci 1995.

Lupus Erythematosus V. Vollenhoven, et al. Arthri

Rheum 1994.

Cancer Prevention Boone CW, et al. Cancer Res.

1990.

Osteoporosis Spector TD, et al. Clin Endoc

1991.



33

DHEA Clinical Applications

Chronic Fatigue Syndrome Galabrese VP, et al. Lancet

1989; Lebihuber FE, et al. Am J Psych 1992.

Inhibition of Atherosclerosis Eich DM. Circulation 1993.

Myocardial Risk Hantgnena, et al. Athero

Sci 1994; J. Shihara F. Cardiology 1992.

Thyroid Hormone McIntosh MK, et al. J Nutr

Biochem 1992; Song MK, et al. J Biol Chem 1989.

Distribution of body fat Williams DP, et al. J Clin

Endoc Met 1993.

Anti-glucocorticoids Wright BE, et al. Int J

Obesity 1992; Brown E. Am J Med Res 1992.

Health & Longevity Shealy N. Book: DHEA:

The Youth & Health Hormone



34

DHEA & Health Benefits

Improves mild to moderate lupus, skin, joint, headache, fatigue Stanford Univ. 1994

50% reduction of Atherosclerosis plaque in rabbits John Hopkins Univ. 1998

1029 men & 942 women 25% less CVD on higher levels of DHEA Univ. of San Diego

Double-blind DHEA 50 mg for adrenal exhaustion decrease anxiety & depression NEJM 1999

Higher DHEA better mental function in Alzheimer’s disease McGill Univ. 1999



35

DHEATreatment of Deficiencies

DO NOT USE ORALFirst Pass Technology & Principle

Cause overstress to liver

Over-stimulate the production of SHBG creates binding of overall hormones Net decrease & deficiencies of free hormone



36

DHEATreatment of Deficiencies

DHEA Maintenance:

DHEA: 12 – 20 mg a.m. transdermal

Treatment: Use double or triple doses

“DHEA oral route has only 10 – 15% of the active compound of

transdermal.”Labrie C, et al. J Endocrinol, 1996 Sep; 150 Suppl: 5107-18



37

Studies on DHEA & Cancer

Dr. McCormick & Dr. Rao (doctors/authors) 1999 – Dr. McCormick & Dr. Rao found that rats

supplemented with DHEA & exposed to cancer seemed to be resistant to further developing other forms of cancer

“DHEA inhibits prostate cancer induction both when chronic administration is begun prior to carcinogen exposure, and when administration is delayed until pre-neoplastic prostate lesions are present.”

McCormick DL and Rao KVN, et al. “Chemoprevention of hormone dependent prostate cancer in wistar unilever rats.” The Journal of European Urology, 1999; 35: 464-467.



38

DHEA & Breast Cancer

No association found between DHEA-S levels Breast cancer risk

Barret-Connor E, et al. Dehydroepiandrosterone sulfate and breast cancer risk. Cancer Res 1999 Oct 15; 50(20): 6571-4.



39

University of California School of

Medicine, 1995What’s interesting about all these reported increases in mood & energy is that they were not what the tests were conducted to prove

13 men & 17 women were administered 50 mg of DHEA for 6 months Among other benefits, the men & women also

reported a “physical & psychological well-being” Men – 67% Women – 84%

Attributed boost of activity & frame of mind to the DHEA-influenced rise of serum IGF-1 levels & its increased bioavailability to target tissues



40

UCSD School of Medicine,

La Jolla, CaliforniaStudy by Dr.’s Samuel Yen, Khorram & Vu

Immunological effects measured in 65-year-old men supplemented with 50 mg per day of DHEA Yen observed an IGF-1 rise of 18% Natural killer cells (the cells that fight cancer) rose by

1/3 Ability to ward off cancerous cells increased by 30 – 75%

T-cells & B-cells (combat bacteria) Responded more quickly to foreign attackers

IL-2 (cytokine imperative to immune cell communication) Rose significantly



41

Labrie C, Flamand M, Belanger A, Labrie F. J Endocrinol. 1996 Sep; 150 Suppl: S107-18.

Laboratory of Molecular Endocrinology CHUL Research Center, Quebec, Canada.

High bioavailability of dehydroepiandrostero

ne administered cutaneous in rats


Pregnenolone


43

Pregnenolone

Pregnenolone provides the

materials for other hormones to grow & multiply in number



44

J.F. Flood, et al. “Memory-enhancing effects in male mice of

pregnenolone and steroids metabolically derived from it.” Proceedings from the National

Academy of Science of the United States of America, 1992; 89:

1567-71. Memory enhancing effects in male mice using pregnenolone

Pregnenolone helps the neurotransmission of the nerves

Neurons communicate

with each other through electrochemicals

Higher levels of pregnenolone able to think clearer by recalling information with less delay



45

Functions of Pregnenolone

Pregnenolone Increases levels of acetylcholine in the

hippocampus & other memory regions in the brain

Modulates the neurotransmitter GABA Helps to repair nerve damage Promotes mood elevation Improves sleep Some women report lessening of hot

flashes or premenstrual symptoms



46

PregnenoloneThe optimum level of

pregnenolone is at 35 years of age

By the age of 75, you will have lost 65% of your

pregnenoloneRoberts E. Pregnenolone from Selye to Alzheimer’s. Biochemical Pharma 1995. Vol. 49, No. 1, Pg. 1-16.



47

PregnenoloneSigns of Deficiency

Forgetful

Can’t think well

Memory loss

Hair loss

Tired & irritated

Life & color seem dim

No interest in beauty & nature



48

PregnenoloneSigns of Deficiency

Incurrent body aches & pains

Lack of muscle tone

Pessimistic

Crave salt

Frequent urination

Don’t concentrate well

Depression



49

PregnenoloneTreatment of Deficiencies






50

PregnenoloneTreatment of Deficiencies

Pregnenolone Maintenance:

Pregnenolone: 18 mg – 30 a.m. transdermal

Treatment: Use double or triple doses


Testosterone


52

Testosterone Production

2% of testosterone is free

98% is bound 38% bound to albumin 60% bound to SHBG

Bagatell CJ, et al. N Engl J Med. 1996 Mar 14; 334(11): 707-14.



53

Relative Potency of Androgens

T – 100

DHT – 300

DHEA – 5

DHEA-S – 5

Androstenedione - 10



54

Aromatase Testosterone

Aromatase Inducer (men)

Insulin resistance & diabetes II Inhibitors

Chinese herbal formula Aralia dasyphylla Curcuma zedoria Cyperus rotundus Smilax glabra



55

Aromatase Testosterone

Aromatase Chrysin

A bioflavonoid component Herb passiflora

Melatonin Quercetin Grape seed extract



56

AromataseMen & Women Over 45

YearsAromatase is an enzyme

Neutralize Aromatase

I3CDIMSoy



57

Sinha-Hikim I, et al. Clin Endocrinol Metab. 2006 Aug; 91(8): 3024-33.

“Effects of testosterone supplementation on skeletal muscle fiber

hypertrophy & satellite cells in community-

dwelling older men.”



58

Women Libido Sexual Function

Lower testosterone & free testosterone Lower libido

Desire Arousal Lubrication Orgasm

Int. J. Impot. Res. 2004.



59

Testosterone & Metabolic Syndrome

Low levels of testosterone have several common features with metabolic syndrome T levels inversely associated with central obesity T inversely associated with systolic BP Men with diabetes had lower T levels Inverse association between T & HgA1C T may have a protective role in the development of

metabolic syndrome & subsequent diabetes mellitus & cardiovascular disease in aging men

Svartberg J. Epidemiology: Testosteorne & the Metabolic Syndrome



60

Endogenous Sex Hormones & Progression of Carotid

Atherosclerosis in Elderly MenHigher

Testosterone = Less

Atherosclerosis

Higher Estrone = More

Atherosclerosis



61

TRT & PC Review of 16 studies, some placebo controlled

Various T formulations

Up to 15 year studies

No increased risk over the background prevalence

Gould DC, Kirby RS. Testosteorne replacement therapy for late onset hypogonadism: What is the risk of inducing prostate cancer? Prostate Cancer Prostatic Dis. 2006; 9(1): 1408.



62

Testosterone & BPH

“Multiple studies have failed to demonstrate exacerbation

of voiding symptoms attributable to benign

prostatic hyperplasia during testosterone

supplementation.”Rhoden NEJM 2004.



63

Treatment of Elevated Testosterone

Saw palmetto

Metformin

Spironolactone



64

Causes of High Levels of 5 Alpha-Reductase

Insulin resistance

Obesity

High-protein diets

Sodium restriction

Licorice

Hyperthyroidism

DHEA supplementation



65

TestosteroneTreatment of Deficiencies





Progesterone


67

Progesterone Hormone that supports

conception & sustain pregnancy

Fast increase after 14 days of menses after ovulation

Highest level at 21 days – drops at 28 days



68

Functions of Progesterone

Pro-gestation

Uses fat for energy Decreases TBG

Natural anti-depressant & anxiolytic

May increase libido



69

Functions of Progesterone

Promotes cell differentiation

Promotes normal cell death

Decreases estrogen receptor synthesis

Improves estrogen receptor sensitivity

Decreases estrogen induced mitosis

Natural diuretic – blocks aldosterone



70

Progesterone Transdermal showed significant

decreases of uterine lining hyperplasia Anasti, et al. 2001.

Laboratory study shows 20 times progesterone in brain cells than in blood serum Lee, et al. 1996.



71

Progesterone Transdermal progesterone decreased breast

cell groth by 400% Chang, et al. 1995.

Progesterone lowers vascular endothelia growth factor (JEGF) potent angiogenic factor Heer, et al. 1998.

Incidence of breast cancer is 540% greater in women with low progesterone than normal levels Corovan, et al. 1981.



72

Progesterone Lyposome

20 mg progesterone dose

PMS One dose per day at night Start on 12th day of menses to 28th day or bleeding

Perimenopause One dose per day or one dose a.m. & night Start on 8th day of menses to 28th day or bleeding



73


20 mg progesterone dose Endometriosis

Use one dose a.m. & 2 doses p.m. Start on 6th day of menses to 28th day – wait 5 days Severe bleeding may persist or worsen the first few

days, then improve

Birth control pills – synthetic Use the dose in the p.m. while on the bill Start on 6th day of menses to 28th day – wait 5 days



74


20 mg progesterone dose Osteoporosis

One dose daily a.m. & p.m. Start on 6th day of menses to 28th day –

wait 5 days



75

PCOS

Three criteria set up by the National Institutions of Health Irregular or absence of menstruation Excess androgen production Lack of other reasons for irregular or

absence of cycles & excess androgens



76

PCOS Having ovarian

cysts is not one of the three criteria for the diagnosis of PCOS

Ovaries with many cysts does not necessarily mean that the patient has PCOS



77

ProgesteroneTreatment of Deficiencies

Progesterone Pre-menopause

20 – 60 mg Transdermal – 14th – 28th Day Post-menopause

20 – 100 mg Transdermal – 14th – 28th Day Post-partum Depression

50 – 300 mg Transdermal – Daily Infertility

50 – 150 mg Transdermal – 14th – 28th Day Birth Control

100 – 200 mg Transdermal - Daily



78

ProgesteroneTreatment of Deficiencies

Progesterone Specialist(5 mg Progesterone per pump)

Fulvic Ext. EPL, Evening Primrose Oil, Shea Butter, Glycerin, Progesterone, USP, Chastetree,

Dong Quai, Rhodiola, Panax Ginseng, Aloe Vera, Lavender Oil, Almond Oil, Hemp Oil, Alpha Lipoic Acid, Vitamin E, Vitamin A, Allantoin, NaPca, Dimethicone

Directions: (Adjust dosage to individual needs) Apply 2 pumps to soft skin area – rub vigorously – for

25 days – Discontinue for 5 days or if bleeding – Repeat cycle.

Signs of excess: Sleepiness, dizziness, droopy breasts, low libido,

sleeping too much, short menstruation



79

Sitruk-Ware, et al. Treatment of Benign Breast Diseases by Progesterone Applied Topically. International Symposium on Percutaneous

Absorption of Steroids, Academic Press, 1980,

pp 219-229.

Number +++ + 0

Mastodynia 250 78 19 3

Increased Nodulatiry 80 80 10 10

Fibroadenomas 30 0 20 80

Cysts 30 0 40 60

Fibrocystic Disease 80 75 18 7

Telethermographic modifications after 3 months

of percutaneous progesterone treatment in diverse benign breast diseases:

+++ good results, + partial improvement, 0 failures (Lafaye & Aubert, 1978)

Estrogen


81

Estrogen Contributes

Development of secondary sex characteristics

Defining difference between men & women

In women characteristics include: Breasts Widened pelvis Increased amounts of body fat in the buttock, thigh &

hip region Less facial hair Smoother skin than men



82

Estrogen Sources Ovaries

Fat

Aromatized from DHEA & Testosterone

Estrone E1 – Menopausal

Estradiol E2 – Productive years

Estriol E3 – Pregnancy

SHBG liver protein binder



83

Estrone (E1)

Predominant estrogen post-menopausally

Aromatized from androstenedione in peripheral tissues; also derived from E2

Reproduction, sexual development, bone health

Positive correlations with insulin & BMI



84

Estradiol (E2)

Most potent estrogen

Predominant estrogen pre-menopausally

Derived from both Estrone & testosterone

Assists in female reproduction, sexual development, bone health, arterial blood flow, neuroprotection



85

Estriol (E3) Least potent estrogen

Derived from E1 & E2

Competes with E2 binding at estrogen receptor, therefore considered safer than E1 & E22006 HRT study: E3 was not associated with breast cancer – Lyytinen H, 2006.



86

Enzyme-Inducing & Inhibitors

Estrogens increase 2-OH Estrone: 16α Estrone

“Brassica” family vegetables Exercise Linseed Indole 3-carbinol (I3C) Diindolylmethane (DIM) Soy Progesterone



87

Functions of Estradiol

Helps Maintain potassium Absorb calcium,

magnesium & zinc Maintain bones Maintain memory Improve sleep

Increases HDL Growth hormone Serotonin

Endorphins

Decreases LDL Total cholesterol Triglycerides Platelet stickiness Fatigue

Works as an antioxidant

Vliet E, Women Weight & Hormones. New York: M. Evans & Company, 2001; pg 85.



88

Estrogen In Men Active in every

tissue studied Brain

Hypothalamus High concentrations

of Erα & Erβ

Pro-optic High in Ers & Ars

Controls sexuality Libido Erectile function

eNOS

Pelvic & penile arteries Pre-optic sexuality centers

Estradiol needed Vascular system through

eNOS activation Pro-inflammatory activity

of vascular plaque iNOS, MMPs, IL-6, COX2



89

2-OH Estrone: 16α-OH Estrone

Data provides support 2:16 ratio

Associated with Reduced breast cancer risk Prostate cancer

Ideal ratio range Between 2 - 4



90

2-OH Estrone/Methylation Good estrogen

Does not stimulate cell growth Blocks action of stronger estrogen products that may be

carcinogenic

2-OH Estrone Protective against cancer when methylated by catechol-

O-methyltransferase (COMT) into 2-methoxy-estrone

Ratio of 2-methoxyestrone to 2-hydroxyestrone can be measured in urine Good gauge of the body’s ability to methlate



91

Diurnal Changes of Estradiol in Plasma

in 2 Females During Luteal PhaseEstradiol in Plasma, Diurnal Fine Profile

0

50

100

150

200

250

300

8:00AM

12:00PM

4:00PM

8:00PM

12:00AM

4:00AM

8:00AM

Co

ncen

trati

on

in

pg

/ml

Plasma sampling every 20 minutes: C.V.: ~20%Single values between 90 pg/ml (minimum) – 265 pg/ml (maximum)


92

Archives of Dermatology, December 1997; 133:

339-342. Estrogen therapy decreases skin wrinkling & dryness

Estrogen increases dermal thickness as it preserves skin texture

Collagen decreases by 30% after menopause Skin changes are reversible with estrogen

replacement therapy



93

Phyto-Estrogen Increases bone mass

Lowers LDL & triglycerides St. Germain, et al. 2001.

Friendly estrogen – Estriol-like from Genistein, Daidzen, Glycetein Setchell, et al. 2001.

Genistein & Daidzen shown to protect against breast & uterine cancer & CVD Hawrylewicz, et al. 1995; Goodman, et al. 1997;

Anthony, et al. 1998; Olive, et al. 1998.



94

EstrogenTreatment of Deficiencies

Bi-Estro 0.6 mg E2 1.5 mg E3

An optimum physiologic ratio of 20% E2 & 80% E3



95


Max Estro E(1 pump phyto Estrogen is 0.3 mg E2 & 1.5 mg E3)

Fulvic Extract, Essential Phospholipids, Evening Primrose Oil, Shea Butter, Glycerin, Aloe Vera, Black Cohosh, Genistein, Daidzen, Pueraria Mirifica, Gynostema, Rhodiola,

Lavender oil, Almond oil, Hemp oil, Alpha Lipoic, Vitamin E, Vitamin A, Allantoin, NaPca

Directions: (Adjust dosage to individual needs) Apply to soft parts of skin 3 pump per day a.m. or

in divided doses. May repeat 3 pump in p.m.

Signs of excess: Tender breast, swollen abdomen, heavy periods,

anxiety, irritable, emotional, moody, short temper



96

Dr. Tai’s Health Pearl

Too much Estrogen

Need more Estrogen

Estrogen level OK – Progesterone OK

Need more Progesterone



97


Estrogen Defense

Idole-3-Carbinol (I-3-C), Diindolymethane (DIM), Evodia, Resveratrol, Fermented Grape Skin & Seed, Chrysin, Piperine Extract

Lower dosages of Estrogen supplements

Indol-3-Carbinol & Diindolylmethane proven to lower circulating Estrogen

Directions: (Adjust dosage to individual needs) Take one capsule twice daily or more as needed


Thyroid


99

Importance of Optimal Thyroid Function

Effects on cellular metabolism

Activates brain & neurological function

Cardiac contractile support

Osteoblastic support of bone

Menstrual cycle regulation

Activates all other hormone receptors Hormone restoration

must start with thyroid



100

Thyroid Gland Function

Control metabolic rate

Control body temperature

Skin & mental health

Mitochondria

Control infections



101

Thyroid


102

Metabolism of Thyroid Hormone

Requires about 50 mg of iodine per year

About 70% of the T4 secreted daily is deiodinated to yield T3+rT3 in equal parts

80% of circulating T3 comes from peripheral monodeionization of T4 at the thyrosyl ring Occurs in the liver, kidney & other tissues Circulating rT3 is made the same way


103

Thyroid & Muscle

No thyroid – No increase in muscle Thyroid hormones influence muscle

metabolism Low thyroid does not build muscle


104

Interesting Facts About Thyroid

Low thyroid directly causes low pregnenolone Tagawa, N., Clinc Chem 2000; 46: 523-5828.

Thyroid dysfunction is associated with heart disease Rouzier, N., Longevity and Preventive Medicine Symposium, 2002.

Decreased T3 hormone causes increase of cholesterol up to 50% & LDL Brownstein, D. Overcoming Thyroid Disorders. Medical Alt. Press,

2002. p. 8.

Low thyroid hormone is associated with chronic fibromyalgia Brownstein, D. Overcoming Thyroid Disorders. Medical Alt. Press,

2002. p. 8.


105

Thyroid

Affects all organs Metabolism Body composition Energy levels Mood Hair & skin


106

rT3/T3 Ratio rT3/T3 ratio may increase with

Pregnancy Estrogen therapy Fasting Liver disease Renal disease Drugs (PTU, some beta blockers,

amiodarone) Stress


107

Tissues & Organs Most Readily Affected by Cellular

Energy Declines(In order of Impact)

Central nervous system Hearty & skeletal muscle Kidneys Hormone-producing tissues

Wallace D. Mitochondrial DNA is aging and disease. Scientific American, August 1997.


108

Most Common Signs & Symptoms of

Hypothyroidism Fatigue & loss of

energy

Increased susceptibility to infection

Weakness

Weight gain or increased difficulty losing weight

Decreasing memory & mental slowing

Dry, rough, pale, cold skin

Thinning hair & eyebrows (outer 1/3)

Cold intolerance to hands & feet


109

Most Common Signs & Symptoms of

Hypothyroidism Muscle cramps & frequent muscle aches

Depression

Irritability, emotional instability

Dry, coarse skin &

brittle nails

Decreased libido & sexual performance

High cholesterol

Voice change (deepening & hoarseness)


110

Dr. Broda Barnes’ Recommendations

Thyroid must be taken on an empty stomach at least 20 – 30 minutes before meals

Add ½ grain each month & continue to increase each month as needed

Our bodies usually require at least one month to respond to the increase in dosage

Stop when patients feel well, experience any side effects, or reach the dosage of 4 grains (occasionally 5 grains were used)


111

Thyroid Intolerance

Number one sign of intolerance is an increased heart rate More than 10 – 15 beats per minute above

baseline

Worsening of hypothyroid symptoms is a red flag for Mild adrenal fatigue Iodine deficiency Environmental toxicity


112

Compounded T4/T3

1 “grain”T3 – 9 mcg

T4 – 38 mcg

½ “grain”T3 – 4.5 mcgT4 – 19 mcg


113

Optimal Thyroid Replacement

TSH-0.3 – 5.5 (N)

Below 2.0 (Optimal)Below 1.0 (Personal)

FT3-2.3 – 4.3 (N)

-3.5 – 4.3 (Optimal)

rT3-90 – 350 pg/ml (N)-50 – 150 (Optimal)


114

Metabolism Supplementation

Homeopathic Thyroidinum 3C with rare minerals & amino acids Selenium – 30 Selenol enzymes

conversion T4 to T3

Manganese, Zinc, Fulvic/Humate

L-Thyrosine

Homeopathic Thyroidinum 3C, Ashwangandha, Rhodiola


115

Selenium Study looked at critically ill patients

supplemented with 200 mcgs selenium

Normalization of T3 & T4 with improvement of T3/rT3 ratio with selenium supplementation Berger N, et al. Influence of selenium

supplementation on post-traumatic alterations of the thyroid axis: a placebo-controlled trial. Intensive Car Med 2001; 27(1): 91-100.


116

Iodine Deficiency

Up to 72% of the world’s population is affected by an iodine deficiency disorder WHO Nov 12, 1998.


117

Hypothyroidism & Breast Cancer

Areas of the world with high iodine intake (Japan) Low rate of breast cancer

Estimates are that the breasts need approximately 5 mg of iodine per day 50 kg woman


118

Iodine/Iodide The reduced form of iodine is

iodide with an extra electron

Both forms are needed for optimal function of every organ & cell in the human body Abraham GE, Flechas JD, Hakala JC.

Orthoiodosupplementation: Iodine sufficiency of the whole human body. The Original Internist, 9: 30-41, 2002.


119

RDA of Iodine The recommended daily amount of iodine

for supplementation by clinicians 12.5 – 37.5 mg

Turns out to be the exact range for sufficiency of the whole human body Based on a recently developed loading test

Abraham GE, Brownstein D, Flechos J. The Saliva/serum iodine ratio as an index of sodium iodine symporter efficiency. The Original Internist. Vol 12: 4: 152-6.


120

Iodine & Fibrocystic Breasts

Iodine has been shown to be extremely

effective in treating & preventing fibrocystic

breasts Ghent W, et al. Iodine Replacement in

Fibrocystic Disease of the Breast. Can J Surg. 36: 453-460, 1993.


121

Thyroid & WeightT3/T4 falls during acute & chronic calorie restriction

Is this a factor why lost weight is usually regained?

Weinsier RL, et al. Do adaptive changes in metabolic rate favor weight regain in weight-reduced individuals? An examination of the self-point theory. Am J Clin Nutr 2000 Nov, 75(5): 1088-94.


122

Hans Selye’s Mode of Stress

Adrenal fatigue

Stress reactions affect mainly the adrenal cortex (not the medulla)


123

Stress Response

Three phases of response1. Alarm phase2. Stage of

resistance3. Stage of

exhaustion


124

Alarm PhaseInitial Reaction Phase

Adrenal congestion & hypertrophy with deletion of vitamin C in cortex

Increased secretion of cortisol followed by a decrease in secretion

Thymic atrophy

Lymphoid tissue atrophy


125

Stage of Resistance

Accumulation of secreting granules in cortex

Blood diluted – receptor resistance

Increased ability to withstand stress


126

Stage of Exhaustion

Decreased ability to withstand stress

Decreased cortisol levels

Severe fatigue

Premature aging

Adrenal Fatigue

& Chronic Fatigue


128

Adrenal Fatigue Daily Energy Patterns

Morning fatigue – Low cortisol a.m. Difficulty waking up early in the morning

(doesn’t really wake up until approx. 10 a.m.)

Usually feels much better & fully awake after noon meal

Afternoon low 2 – 4 p.m.

Usually feels best after 6 p.m.


129

Functions of Cortisol

Balances blood sugar

Weight control

Immune system response

Bone turnover

rate

Stress reaction

Sleep

Protein synthesis


130

Diurnal Rhythm of Salivary Cortisol

Different Wake-Up Times

0

2

4

6

8

10

12

14

16

4 6 8 10 12 14 16 18

Time of day [h]

Salivary C

ortis

ol [n

g/m

l]


131

CortisolTreatment of Excess

Max Glucose Specialist Directions: Take one capsule three times a day with

meals or more as needed by your specific condition or recommended by your physician

Max Performance Specialist (Adaptogen) Directions: Take 1 tablet 3 times daily

Max Sea Extract Directions: Take 6 drops in a drink once daily

Max Metabolism Directions: Take 1 capsule a.m. & 1 capsule at noon with

large glass of water. May increase the dosage to 3 capsules per day


132

CortisolTreatment of Deficiencies

Max Performance (Adaptogen) Directions: Take 1 tablet 3 times daily

Max Adrenal Specialist Directions: Take 1 capsule daily as needed

DHEA PleoLyposome Directions: Apply to soft skin area.

Female: 3 pumps daily a.m.; Male: 5 pumps daily a.m.

Melatonin


134

Light at Night Chronodisruption,

Melatonin Suppression & Cancer Risk Crit Rev Oncog. 2007 Dec; 13(4):

303-28. Reiter RJ, Tan DX, Korkmaz A, Erren

TC, Piekarski C, Tamura H, Manchester LC

Department of Cellular and Structural Biology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.


135

(Blue-Green Wavelengths) 460 – 480 nm

Most Inhibitory to Melatonin Synthesis & Regulating SCN


136

Genetic

Defines the

Amplitude of the

Nocturnal Melatonin

Peak


137

Duration of Darkness

Direct Proportion to the

Production of

Melatonin

0

10

20

30

40

50

60

70P

las

ma

Me

lato

nin

(p

g/m

l)

0000 0800

0

10

20

30

40

50

60

70

Pla

sm

a M

ela

ton

in (

pg

/ml)

1800 0800

L:d 16:8

L:d 10:14


138

The Brightness of Light at

NightProportion

ally suppresses melatonin

levels

0

20

40

60

80

100

120

0

20

40

60

80

100

120

0

20

40

60

80

100

120

12 20 22 24 01 03 08 10

0

20

40

60

80

100

120250 lux

500 lux

1500 lux

Time of date (h)

pg m

ela

tonin

/ m

l se

rum


139

Melatonin

Inhibits Growth of

MCF-7(Human Breast

Cancer Cells)


140


141

Melatonin

Inhibits Tumor

Growth & Tumor

Metastases J Pineal Res, 2003.


142

Melatonin Levels Decrease

With Increasing Age(Cancer is an age-related disease)


143

Symptoms of Melatonin Deficiency

Mental Light, anxious, agitated sleep Easily woken Difficult to fall asleep Poor dreaming Hypersensitive Irritable


144

Melatonin Excess Very deep sleep during 3 – 5

hours + too early waking up + “heavy” head in the morning

Sometimes Deep & prolonged sleep(iness) the

whole night through until late in the morning

Too vivid dreams

Combination of L-Citrulline & L-

Arginine Increases Nitric Oxide Production

Cardiovascular, Immune Boosting, Sexual Health

Benefits


146

How are Citrulline & Arginine Related?

Citrulline converted into arginine assoon as it enters Kidney Vascular endothelium Other tissues

Plasma & tissue levels of arginine Necessary for production of nitric oxide & relaxation of

blood vessels

Romero MJ, Platt DH, Caldwell RB, Caldwell RW. Therapeutic Use of Citrulline in Cardiovascular Disease. Cardiovasc Drug Rev. 2006 Fall-Winter; 24(3-4): 275-90.


147

Citrulline & Arginine

Help Improve Sex Life Arginine has been well studied

for its ability to enhance sexual satisfaction

Both men & women report longer & more intense orgasms when their intake of arginine increases


148

Citrulline & Arginine

Help Improve Sex Life

Arginine is often used by men to achieve long lasting & harder erections

Citrulline & arginine can be combined for enhanced sexual pleasure & vascular health Citrulline is a precursor for arginine Arginine is a precursor for nitric oxide


149

Importance of Nitric-Oxide

to Healthy Blood Flow Helps prevent blood aggregation or platelets from becoming sticky When platelets are not sticky,

they can move single file through capillaries

When vascular system is working efficiently – less chance blood clot will form Less chance of having a heart

attack or stroke


150

References• Dessy C, Ferron O. (2004). “Pathophysiological Roles of Nitric

Oxide: In the Heart and the Coronary Vasculature.” Current Medical Chemistry – Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry. 3(3):207-216.

• Osanai T, Fujiwara N, Saitoh M, Sasaki S, Tomita H, Nakamura M, Osawa H, Yamabe H et al. (2002). “Relationship Between Salt Intake, Nitric Oxide and Asymmetric Dimethylarginine and Its Relavance to Patients With End-Stage Renal Disease.” Blood Purification 20(5):466-8. doi: 10.1159/000063555. PMID 12207094.

• Kang L, Reyes RA, Delp JM. “Aging Impairs Flow-Induced Dilation in Coronary Arterioles: Role of NO and H2O2.” Am J Physiol Heart Circ Physiol. 2009 September; 297(3):H1087-H1095. Published online 2009 July 17.

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2 D AYS C OURSE P RACTICAL & C LINICAL A NTI -A GING W ORKSHOP P ROF. D R. P AUL L ING T AI D.P.M., FACFS, ABPS, ABBARM, DACBN P ARAGUAY J ULY 5 – 6, 2012