The most profound difference between women and men is the fact that women have babies and men don’t. This basic fact propels us into a whole host of other characteristics that distinguish women from men. In addition to the obvious anatomical differences there are many other unique characteristics of women. Women go through puberty earlier, mature quicker, but have fewer fertile years than men. In order to produce healthy offspring, women must have a higher percent of body fat, and a higher waist to hip ratio. They have different mating, sexual, and orgasmic tendencies than males. Men are taller, with more body hair and have thicker skin. Women tend to tolerate pain better and live longer. Sugar metabolism in the brain is different in women and men. This may help to explain why women are more likely to suffer depression and act impulsively, while men are more likely to be aggressive and hyperactive.

Women generally have smaller organs, including liver and bladder. I can personally vouch for the bladder issue after taking many long road trips with my daughters and having to stop every thirty minutes for the potty. The smaller liver is associated with an increase in sensitivity to toxins. This fact may help to explain why women are much more likely to suffer from multiple chemical sensitivity disease than men. Also associated with the liver is the fact that alcohol is metabolized more quickly by women, therefore the effects of alcohol come on quicker and are more pronounced. Compounding this fact is the tendency of women to be more likely to be binge drinkers. Women also have a higher fat to water ratio which makes it more difficult for them to dilute toxins.

Men and women both have breast tissue, but breast cancer is much more common in women than in men, and it has reached epidemic proportions. This contributes to breast cancer being the most feared disease of women. However, it is vitally important to understand that heart disease kills about six times more women than breast cancer. Hearts are smaller in women. They beat faster and are less prone to atherosclerotic disease while being more prone to spasm of the heart arteries.

Differences in men and women are seen even at the genetic level. In many situations, men and women may have many of the same genes, but the expression of the genes often has a significant gender based component.

Hormonally men and women are quite different. Women have the cyclic production of estrogen and progesterone associated with ovulation, while men have about 10 times as much testosterone as women. This has a profound effect on women at every level.

The implications of these differences are profound for women. In my many years as an ER doctor, we applied a male model of heart disease to women for many years. In order for a women to be considered for a cardiac diagnosis we thought that she had to have the same symptoms that men had, i.e. chest pain, nausea, left arm pain, and shortness of breath. Recently we have begun to realize that almost half of women with a heart attack have no chest pain. The symptoms of a woman’s heart attack may be very subtle. As a result women often don’t get the help they need until it is too late. Women are less likely than men to survive their initial heart attack, less likely to get out of the hospital alive, and more likely to die within a year of their heart attack.

As evidenced by the above differences, women and men are each unique unto their own. Yet most of the medical literature is based on studies of men. Historically we have just assumed that what is good for men must be also good for women. The American medical community was so negligent in this arena that the federal government finally had to step in and in 1993 they passed a law that required that women be included in medical studies. Medicine still has some catching up to do as far as appreciating the uniqueness of women. We need to develop a more gender specific approach to diagnosis, treatment and prevention in order to improve women’s outcomes. If men had to deal with many of the issues that women experience, there would have been solutions long ago, but instead the medical community often turns a blind eye to women’s concerns. Indeed, women are not just different versions of men. There are fundamental differences at every level, which have a profound effect on wellness.

Ninety-nine percent of doctors I have known in my twenty something years in health care have been hard working, conscientious, kind, caring, compassionate, smart, well trained, and well-meaning providers who have gone to work every day with the goal of helping and healing their patients. I have the ultimate respect for their talents, and dedication to their noble cause. However, in this day and age of industrial, big business medicine, driven by government, insurance companies, and drug companies, the average primary care physician has about seven to ten minutes per patient. What is a physician to do when a patient comes into the office and gets out their internet printout and a list of symptoms that includes weakness, fatigue, brain fog, abdominal pain, hot flashes, night sweats, low libido, and insomnia? Most likely they’ll get a few perfunctory laboratory tests and the then the doctor will get out the prescription pad. In this case it’ll probably be an antidepressant a sleeping pill, and maybe a pain pill. It’s the well-worn symptom-pill, symptom- pill revolving door, which inevitably leads to more pills to treat the side effects of the first pills.

Stop the madness! The system is broken. It’s a set-up for failure for the physician and the patient. The physician does not have the necessary time to listen to the patient. Therefore they will rarely get to and treat the root cause of the problem. They’ll only put Band-Aids on the symptoms with more pills, which is a prescription for side effects and often a lifetime of unnecessary suffering.

The power of listening is that it can be such a compelling tool in finding and treating what is at the root cause of the patient’s problems. The power of the prescription pad is that it’s the accepted tool of modern western medicine. Unfortunately, after a lifetime of conditioning, it also meets many patient’s expectations (especially with direct to consumer advertising by the drug companies). Practice managers also love it because it helps meet the ten minute deadline to get the patient out and shore up the financial bottom line.

Just yesterday I had a patient in my office who was in tears because she had been suffering for ten years with profound fatigue. She had been to many physicians. She did not feel as though her doctors had ever taken her seriously. The tests were all “within normal limits”, so it must be all in her head. After ten years of searching for an answer to her symptoms she never felt “listened to.”

In fairness to doctors, the issue of non-listening goes well beyond the medical sphere. As parents, friends, brothers, sisters, husbands, wives, politicians, teachers, and world leaders, we would all benefit from being better listeners. It seems to me to be one of the most important skills that a human being can learn. We teach reading, writing, and arithmetic to our kids but we hardly ever teach them about the art of listening.
Such a class should be a part of the curriculum at every stage of ones education. Especially in medical school, there should be an emphasis on the art of listening. It is so fundamental to what we do as healers. It is diagnostic as well as therapeutic. One might say the classes are not needed. “Listening is easy. Anyone can do it” they might claim. But then again, if good listening is so easy why is it such a rarity for a patient to find a medical provider who is a good listener?

In summary, the most powerful tool in medicine is neither a scalpel, a drug, nor an MRI scanner. It is an engaged, caring, compassionate provide, patiently and earnestly listening to the wants, needs, joys, and suffering of the patient in front of him or her, who has honored the healer by entrusting them with their heart, their soul, their mind, and their body. Let’ all strive to be better listeners.

We’ve all heard the adage before: a chain is only as strong as your weakest link. So what’s your weakest link? At the end of the day, what’s going to get you? And just as importantly, what can you do to improve your odds?

Cardiovascular disease: Heart disease is by far the number one cause of death in America. Almost one million Americans die of cardiovascular disease each year. This amounts to about 40%, or 1 out of 2.7 deaths in our country. Your first important decision in avoiding this, the weakest of all links, is to pick your parents well. There is definitely a genetic component for cardiovascular disease. However, much of the risk for cardiovascular disease is also attributable to lifestyle choices, and most of these risk factors are well within your control. Smoking is perhaps the biggest single risk factor. If you smoke, you automatically increase your risk of dying from heart disease by approximately 3 fold. If you smoke, the single most important thing that you can do for your health is to put away the pack. It’s not easy, but the benefits are enormous. Obesity and being overweight are the next major risk factors. In fact, obesity has overtaken smoking as the number one overall cause of preventable death in America. I believe that a few extra pounds is often the beginning the slippery slope of disease leading to a premature death. Many of the other risk factors for cardiac disease are often directly linked to the weight issue, such as hypertension, diabetes, high cholesterol and triglycerides. Obesity is also very pro-inflammatory, and inflammation is evermore being appreciated as a major contributor to many disease processes, including heart disease, as well as Alzheimer’s and cancer.

Cancer: Although cardiovascular disease is by far the most common cause of death, cancer is the most feared. Although we declared a “war on cancer” many years ago, this terrible disease has gone unabated. Two out of every five people in America will develop cancer, and one in five will die from it. Approximately one in every eight women will develop breast cancer in her lifetime. Even worse almost all men will get prostate cancer if they live long enough. To my way of thinking, the key is prevention. Certainly, diagnostic tests are becoming more and more advanced, but they can’t prevent cancer, they can only find it, and by that time you’ve already got the disease.

The number one rule of cancer prevention is “don’t smoke”. Sound familiar? As it turns out, the same preventive measures pertinent to cardiovascular disease, also apply to cancer. It’s all about diet and lifestyle. Studies suggest that if you take people from a country with a low rate of cancer and put them in a country with a high rate of cancer, once they adopt the diet and lifestyle of the new country, their cancer rate goes way up, to equal that of their new home country. In fact a majority of cancers in our country could be prevented with smoking cessation, exercise, diet, and lifestyle changes. Some specific strategies for cancer prevention include the following: stay slim, get regular exercise, avid saturated fats, eat more fiber, avoid excess alcohol, avoid unnecessary radiation, avoid toxins, This is more powerful than any expensive, high tech treatment on earth. Your mother was right, eat your fruits and vegetables!

Diabetes: It is fair and accurate to say that we are currently in the midst of a very frightening epidemic of type 2 diabetes. Between 1980 and 2002 the prevalence of diabetes has doubled. If this trend continues, we may soon start to see shorter lifespan in America starting with the next generation. Unfortunately, these shorter lifespans will be fraught with complications such as: heart disease, hypertension, stroke, impotence, kidney failure, amputations, blindness, and nerve damage. Diabetes has even been linked with cancer.

I know I’m beginning to sound like a broken record, but here we go again. For diabetes prevention, it’s back to basics. You really are what you eat. Diet and exercise are the keys to diabetes prevention. The basic diet principe is called glycemic index. Avoid sugar and anything that acts like sugar, such as white flour. Sugar hides and goes by many names, so learn to read labels. Often “health foods” are really sugar Trojan horses and heart attacks in disguise.

Dementia: So far we’ve had the most common disease, the most feared disease, and the scariest disease. I’ll wrap things up with what I consider the saddest of diseases; dementia. This tragic disease may take many forms including Alzheimer’s disease, vascular dementia, and stroke dementia. Your lifetime risk of dementia now stands at about 10-15 percent. Once again, prevention lies in the foundations of wellness: exercise, diet with plenty of antioxidants. Staying socially involved, and keeping your mind active are also helpful.

The list of weak links goes on to include infectious disease, kidney failure, and liver disease. However, by now it is quite clear that the prevention prescription remains largely the same. Most importantly, it all starts with the conscious decision to live a wellness lifestyle. It sounds simple enough, but in our modern day stressed out society full of junk food and toxins, the wellness path is the exception rather than the norm. In addition, it is not enough to make a decision. One must then set goals and devise an action plan for getting there. In America, we seem to be caught up in a “victim mentality” when it comes to our health. Even the phrase “heart attack” implies that this disease lashes out at innocent victims, like a “shark attack.” When in fact, most of us have been knowingly sewing the seeds of that heart attack for many years. It says on the package of cigarettes in bold letters, yet many of us knowingly keep smoking. We know that most processed food is full of junk, and fast food makes us fat, and causes heart diseases, diabetes, and stroke and yet many of us keep eating it.

My plea is that we wake up out of our victim slumber and realize that we, the patients, have much more control than ever before to make changes for the better. Changes that will shore up our weak link, and allow us to live a life of wellness.

As an ER doctor for 20 years I worked more than my share of night shifts, and I have paid my insomnia dues first-hand ever since. Bless the men and women who staff our hospitals, nursing homes, factories, and other shift work enterprises, who are going to work for their long night’s work just as we are climbing into our cozy beds for a good night’s sleep. Back during my night shift days, I must have heard it a thousand times, “Jim you look tired today.” Duh! I had a right to be tired; I had been up all night. Day shift people just don’t understand night shift people, and visa versa. Finally, after many years in denial, I realized that I was slowly taking years off my life by cheating my body of mother nature’s most potent medicine: a good night’s sleep. Shortly thereafter, I weaned my self out of the ER, into a “wellness medicine” practice, and into a wellness lifestyle. More and more, I try to practice what I preach, and now I sleep in my own bed every night. Just like an ex-smoker who becomes overly indignant about those around him who light up, I have since become a crusader for a night of deep restorative sleep.

When a patient comes in with fatigue, brain fog, or many of the other conditions of chronic disease, one of the first questions I ask them is “how are you sleeping?” More often than not the patient’s response will reflect problems with chronic insomnia. The patterns can vary. Sometimes it is difficulty getting to sleep. Many others get to sleep just fine, only to awaken at 2:00 in the morning. Often they can’t get back to sleep, which makes for a long and fatigued day at work the next day. Occasionally, I’ll find that a patient may get to sleep and sleep through the night, but may never wake up feeling rested and refreshed. Each of these patterns represents their own diagnostic challenges and therapeutic approaches.

Why do we sleep? In our busy lives, it seems like a total waste of time. We spend about a third of our lives sleeping! That adds up to about 25 years in the sack conked out. How the need for sleep evolved over time remains a hot topic of research. However, we do know this much: sleep is absolutely necessary for physical, mental, and emotional health, and even for life itself.

In the old days, sleep patterns were matched with the circadian rhythms of the earth. The sun went down, and it got dark. This triggered our melatonin to go up and our cortisol levels to go down, and thus we became sleepy. However, the electric light bulb changed the paradigm. With artificial electric light, we control our day and night light. Our eyes, brains, and bodies can’t distinguish between daylight and electric night light. Many people have totally lost touch with the rhythms of nature. Studies show that these people have more depression, more ADD, more heart attacks, more illness in general, and they die younger.

Sleep labs to the rescue! Sleep medicine has mushroomed in the past decade. Everybody’s trying to get in the game. Sleep labs are popping up all over the country. However, in my humble experience, many sleep labs have become a laundering service for the sellers of C-pap machines. Certainly sleep apnea is an important part of the equation. Without a doubt, it is under-diagnosed and undertreated. Many patients do get excellent relief from C-pap therapy. I’ve known some who claim that it has saved their life. However, it represents only a small part of the overall insomnia problem. The sleep labs often leave many important questions unanswered.

The beginning of the road back to restorative sleep begins with the understanding and practice of “sleep hygiene.” Contrary to implications from the word “hygiene” this has nothing to do with cleaning up anything. Instead it involves the consistent practice of setting the conditions optimally for a good night’s sleep. I like to tell my patients to take a “mini-vacation” before bed. Turn off the TV, and the computer. Turn on some “white noise” like a fan. Turn the lights down a bit. Do things that you find relaxing, such as reading a book. Better yet, read one of my old articles. That’s bound to put you right to sleep!

As I consider therapy, when possible I like to figure out the cause of the problem. That way I can treat the root cause. With proper testing, I often find that imbalances in estrogen, progesterone, cortisol, thyroid, and neurotransmitters are the culprit. Similarly, low melatonin, or elevated cortisol levels at night may contribute to the problem. Correcting the root cause can bring about dramatic relief in some patients.

Sometimes we must resort to empirical treatments. Finding the right sleep medication is like trying on shoes. The shoes that fit Cinderella did not fit her sisters at all. Similarly, the very supplement that helps one patient “sleep like a baby” may cause the next patient to stay up all night. I prefer to try natural supplements, such as melatonin, valerian, 5HTP, GABA, and other herbal remedies first. I find that about 75% of my patients respond well to these remedies. If these supplements are not working, then I may resort to sleep medications. In this case however, patients and providers must be careful not to choose a medication that promotes sleep, but never allows the patient to get into a Stage 4 REM deep restorative sleep.

A final category of potentially helpful therapeutic measures includes such modalities as acupuncture, hypnosis, neurofeedback, biofeedback, and CES (cranial electrical stimulation). I have found these therapies to be quite helpful for some patients.

In summary, sleep is a vital aspect of your foundation of wellness. If you are not getting a deep restorative sleep, it will eventually take its toll on your health. Work with your health care provider, and at the end of the day, adopt a “whatever it takes” policy toward getting a good night’s sleep. You cannot achieve true wellness, without getting a consistently good restorative sleep.

My wife is a vet so I have heard it a hundred times, “a dog can have ticks and fleas at the same time.” And so goes for many of the patients in my practice. Patients rarely come in for one isolated problem. In fact the classic patient has profound fatigue, generalized weakness, hot flashes, night sweats, brain fog, weight gain, can’t sleep, and on top of all that she has no libido. Sometimes TBF has an insidious onset. It has a mind of its own. It can smolder for many years, and then for some unknown reason it crescendos to become unbearable. On the other hand, some patients can remember the day it suddenly started many years ago. It’s like the day JFK was shot, or for the younger generation, that tragic day of 9/11 when all of our lives changed forever. For these people TBF came over them like a San Francisco fog. It rolled in one day, but unfortunately it never left.

As a physician from the traditional medical point of view, it’s exhausting to try to wrap your mind around the matrix of all of the differential diagnoses associated with the symptoms of TBF. Not to mention the fact that most doctors have about 10 minutes per patient interaction. It’s a square peg in a round hole phenomenon. The current medical system is just not prepared to deal with multisystem severe chronic illness. Furthermore, we live in a world of specialization. We go to our cardiologist for this and our rheumatologist for that. By the end of the day, we’ve gone all over town getting fragmented care from multiple specialists who don’t always have the opportunity to look at the big picture, and who frequently are unable to communicates with each other.

One of the more common symptoms of TBF is fatigue. None of the medical professionals seem to want to take ownership of fatigue. It’s the last thing a doctor wants to hear about. It can take forever, and he’s got ten minutes, with an office manager cracking the whip over him to see more patients. It overlaps into multiple disciplines, and even spills over into areas that we doctors were never trained to deal with such as nutrition, and thought processes that seem foreign to us such as the mind body connection. Try looking up your neighborhood “fatigologist” in the yellow pages next time you get a case of TBF. You’re likely to find infinitely more plastic surgeons than you are fatigue doctors.

Einstein had a lifelong pursuit of a fascinating concept called the unified field theory. He felt that there was one underlying fundamental law of the universe that controlled all of matter and energy. Likewise in these “total body funk” patients there are often fundamental processes which have gone awry that may affect multiple systems, and in fact may have a negative impact upon every cell in the body. The challenge for the physician is to peel back the layers of the onion to get at that fundamental dysfunction that is resulting in the patient’s constellation of symptoms.

In order for the physician to properly address these patients he/she must first embrace “total body funk” like an ER doctor on a heart attack. He must dedicate himself to a focused learning process above and beyond (and perhaps a bit different) than his traditional medical training. He must open his mind to new possibilities as far causes and treatments of disease. After all, we are not a collection of body parts, but we are a heavily matrixed complex whole being. He must embrace the mind-body-spirit connection, and he must expand this toolbox to include other therapeutic modalities. He should also resist the knee jerk reach for the prescription pad to write another prescription for yet another drug to put another band-aid on another superficial symptom. To optimally benefit the patient he should reach out and expand his referral network to include new partners who can be a part of his overall patient care team, such as a trusted chiropractor, a nutritionist, an acupuncturist, a massage therapist, an herbalist, a counselor, a yoga teacher, or a biofeedback specialist just to name a few. He must recognize the power of the fundamentals of wellness such as exercise, stress reduction, optimal nutrition, and a good night’s sleep. Finally, he must know going into it that TBF takes time, and it is never a quick fix. Doctor and patient must both be patient. Gradually we must unravel the mystery, stop the downward slide, and step-by-step, turn things around to begin a process of healing.

Even in this day of high tech gadgets, I would suggest that listening to the patient is the single most important medial diagnostic tool, especially when it comes to TBF. The next most powerful tool is to have the mind of a 3 year old. Always ask the question “why?” Peel back the layers of the onion, and leave no stone unturned in order to get to the root of the problem. If you just treat the symptoms with drugs, and you don’t get to the cause of the problem, then new symptoms are going to pop up elsewhere.

In summary, judging by the patients I see in my office, McMinn’s Disease, or Total Body Funk, seems to be an emerging epidemic. Many previously robust people have succumbed to it, and for the rest of us, this frightening disease may be lurking around the corner. The best prevention is attention to the fundamentals of wellness. The best cure is a focused, enlightened, overarching and thorough evaluation with a search for and treatment of the underlying root cause of the problem.

The sign pointing to the left reads as follows: “Travel here for hot flashes, night sweats, brain fog, insomnia, weight gain, low libido, mood swings, anxiety, irritability, rapid heart beat, dry thin skin, headaches, vaginal dryness, painful intercourse, urinary incontinence, hair loss, and osteoporosis.”

The sign pointing to the right reads: “Vibrant living ahead.”

Which path will you choose? To menopause or not to menopause? That is the question.

For most of our history as humans on this earth, women did not have such a choice. For most of our existance, the life expectancy of a woman did not allow most women to reach the age of menopause. They died before they got there. For those rare and lucky women who reached the ripe old age which lead to menopause, they suffered in silence as the sweat of the hot flashes poured off their chins, and they soaked their own beds night after night. Then along came hormone replacement therapy (HRT). Suddenly everything changed. Finally, women had the right to “opt-in” and go through menopause, or “opt-out” and say “no thank you” to the misery.

For many years the only “opt-out” options were synthetic drugs such as Premarin, Provera, and PremPro. Now at this point, I have a confession to make. When I was a young doctor (many years ago), just about every woman who came through our clinic was placed on PremPro. This is an artificial patented drug, that is not a true human hormone, but has hormone like activity. The mantra we all learned was that the women who received PremPro were going to live longer and better. This notion had been drilled into our heads since we were medical students. We bought it hook, line, and sinker. Everything was hunky-dory until the drug companies made the mistake of doing a major study attempting to show what a great drug they had, and how smart we all were for prescribing it. Unfortunately for us all, the studies didn’t show what they thought they would. In fact, they had to halt the studies half way through because so many women were being affected by heart attacks, strokes, breast cancer, and blood clots. Many women were taken off these drugs without being offered any alternative. Others were left on the drugs only to take their chances with the consequences.

Meanwhile in Europe, for the last fifty years women have been offered another option called bioidentical hormones. These are compounds which are made to be 100% exactly the same as the natural human hormones they are intended to supplement. The body cannot tell the difference between its own hormones and bioidential hormones, because there is no difference.

For example, if your body is low on potassium, do you eat a banana, or do you take some patented drug that your body has never seen before which has been synthesized to have potassium like activity, but lots of negative side effects. It seems clear to me that most people would wisely choose to eat the banana. Likewise, it seems only reasonable to chose the bioidentical hormones which are just exactly like the body’s own natural hormones.

At this point as one is standing at the fork in the road, it seems to boil down to risk and benefit. In the big picture the evidence seems to support that bioidentical hormone therapy, if used properly, can help a woman live longer and better. Here are a few examples:

*A study publishes in the journal “Obstetrics and Gynecology” showed that women who took estrogen lived longer than women who did not take estrogen.

*A study in the medical journal Lancet showed that women who took transdermal estrogen had less blood clots than women who took Placebo.

*A huge study in the International Journal of Cancer showed that women who took a combination of bio-identical estrogen and progesterone had less breast cancer than women who took placebo.

*A study in JAMA showed that the incidence of Alzheimer’s disease was significantly reduced in women on hormone replacement therapy.

*Numerous quality studies have shown heart protective benefits of women who start hormone replacement early in menopause.

*Another study in JAMA showed a significant improvement in cognitive function (memory and thinking skills) in women who took hormone replacement therapy.

*Studies have shown that hormone replacement therapy can help to reduce hip fractures in osteoporotic women.

*Major studies have also shown that hormone replacement therapy (HRT) can reduce the incidence of colon cancer.

*A study in the International Journal of Dermatology showed that hormones can significantly reduce skin wrinkle depth, and improves thickness and elasticity of skin.

*Numerous studies have proven that HRT can help to boost a sagging libido.

*Studies have clearly shown that HRT is effective in treating vaginal dryness, vaginal atrophy, and pain with intercourse.

*HRT can be a miracle cure for those awful hot flashes, night sweats, as well as the associated insomnia.

HRT is not for everybody. However as you approach the crossroads of menopause, it’s important to know that you have a choice. Carefully consider your options. The right choice for one woman may not work for another. For many women, the right choice is a carefully designed, evidence based, closely monitored, customized plan of bioidentical hormone replacement therapy, which will help her live a longer and more vibrant life.

Integrative medicine, also called complimentary medicine, attempts to do just that. It is individualized, patient focused, open minded, evidence based, and outcomes oriented. It has an expanded toolbox of therapies. Too many times in this world we tend to put up walls, which define traditional turf battles. The Hatfields hate the McCoys, The Tutsies battle with the Hutus. Alabama and Auburn fans aren’t always the best of friends on game day. Thereto in medicine, healers sometimes lose focus on what is important. Instead of an open- minded search for the best treatment for the patient, we tend to look at the possibilities through a narrowly focused set of glasses. To a hammer, all the world looks like a nail. Likewise, many healers can’t look past their own discipline, training, and bias to consider other modalities, which may ultimately produce the best result for the patient.

Traditional western medicine is a marvel of scientific endeavor. Were it not for this amazing medical discipline, I and many of my family members would not be alive today. I stand in awe of many of the modern high tech capabilities of today’s doctors. However, I and other integrative medicine practitioners also realize that there are also other modalities, which have been utilized for hundreds or perhaps thousands of years, which should also be considered while devising the patient’s treatment plan. These modalities may include nutritional therapies, detoxification, mind body therapies, massage, spiritual healing, breath work, hormone balancing, neurotransmitter adjustment, and acupuncture.
I have personally had patients who have responded well with Acupuncture, who had previously found no relief at vaunted medical institutions such as Mayo Clinic.

I do believe that integrative medicine is the wave of the future. Little by little, patients finding that the old model of “sick care” is not working for them. They get sick, go to the doctor, and get on pill after pill. They are awakening to a new approach, which is true wellness medicine. They are demanding a change, and the medical community is starting to listen. Ten years ago integrative medicine was not on the radar screen. Now you will find that Harvard, Duke, Mayo Clinic, Stanford, Vanderbilt, and Cleveland Clinic (just to name a few) all have integrative medical clinics. The tide is slowly turning toward a more open minded and inclusive form of medicine, and in the long run doctors and patients will both benefit.

As I listened to her story, I shook my head in the affirmative, as if I knew what she was talking about. After all, I was the doctor, not her. In actuality, I had never even heard of Armour thyroid. All through medical school, residency, and after many years of medical practice, Armour thyroid had never before come across my radar screen. However, here was a teaching moment, and once again, I was the student. Somehow she tweaked my interest enough so that I looked up Armour thyroid when I got home. I learned that it is a natural product containing a balanced blend of the thyroid hormones T3 and T4. This is in contrast to the form of thyroid prescribed by most doctors called Synthroid (generic= levothyroxine), which is a synthetic product containing only T4. I also learned that contrary to popular belief in traditional medical circles, women often feel better on a combination T3/T4 product such as Armour thyroid than on Synthroid. In fact, there was a well done study published in a prestigious medical journal called The Annals of Internal Medicine in which the authors compared the combination T3/T4 regimen (similar to Armour thyroid) with the standard T4 (Synthroid) regimen used by most doctors. They measured many parameters, including quality of life and patient preference. They found that 64% of women preferred the combination T3/T4 treatment, while only 7% preferred the solo T4 (Synthroid) treatment. These results mirror the trend I have seen in my own practice, in that many patients feel better on and prefer the Armour thyroid as compared to the Synthroid.

The problem of under-active thyroid is huge, affecting approximately 10 million women in America. According to the Thyroid Foundation of America, more than half of the patients with low thyroid in America are undiagnosed. Of those who are diagnosed, many are not receiving optimal treatment.

Thyroid affects just about every part of the body. The most common symptoms of low thyroid that I see in my office are fatigue (low energy) and the inability to lose weight. Other common symptoms include constipation, depression, brain fog, anxiety, dry skin, hair loss, low body temperature, low stamina, cold intolerance, cold hands and feet, low libido, generalized aches and pains, swelling, edema, puffiness, and brittle nails. Actual diseases that may be associated with low thyroid include hardening of the arteries, generalized inflammation, cardiovascular disease, abnormal lipid levels, abnormal menstrual periods, infertility, poor pregnancy outcomes, low mood, depression, fibromyalgia, chronic fatigue syndrome, and obesity.

The standard screening test most doctors use is called a Thyroid Stimulating Hormone or TSH test. I think that it is perfectly fine to use TSH alone to screen asymptomatic patients. However, if a patient presents with a clinical picture consistent with low thyroid, such as fatigue, I feel that a more thorough evaluation is warranted. If you dig a bit deeper by getting a complete thyroid panel including a Free T3 and Reverse T3, you often find that the root cause of the symptoms is an underactive thyroid gland, even with a normal TSH. I frequently find that in such cases when the thyroid function is optimized, the patient’s symptoms improve and they feel much better. In many patients, being “low normal” is not good enough. They often get excellent relief of their symptoms, when the labs are brought up to the mid or upper range of normal. This concept is called “thyroid optimization”.

Another underutilized screening and monitoring tool is the basal body temperature. The body’s temperature often correlates with the basic metabolic rate. This is the rate at which we burn calories while at rest. One of the most important regulators of basal body temperature is thyroid function. When a person’s temperature runs low, this may be a signal that the metabolism is slow, and that the thyroid function is suboptimal.

In summary, low thyroid is an important and sometimes insidious medical problem affecting millions of Americans, especially women. The symptoms may be many and varied. Low thyroid may be associated with many disease processes, and can have a profound effect on general health and quality of life. It often goes undiagnosed and under treated. If low thyroid is suspected, a careful symptom analysis and a thorough battery of tests are needed. If indicated, the thyroid function should then be optimized. A combination medication with T3 and T4 similar Armour thyroid should be considered as a viable treatment option.

We as physicians and healers have a lot to learn from three year olds who ask the question “why.” Our focus seems to be misplaced on labeling patients. Like a detective, our training instructs us to search for a suitable diagnosis (preferably something that’s codable and billable), and then to start the patient on a drug to relieve their symptoms. We rarely ask “why” they got the problem in the first place. Although, it is only by asking this simple and profound question that we can get at the root of the problem, and treat the underlying cause rather than putting a patch on the symptoms. Because if we don’t’ treat the cause, the disease will probably rear its ugly head again, and the patient will continue to suffer.

This search for the cause of disease represents a rapidly growing genre of medical practice called “Functional Medicine.” As described in “The Textbook of Functional Medicine” it is “a dynamic approach to assessing, preventing, and treating complex chronic disease.” At its core functional medicine is a search for, and treatment of, the cause of disease. The textbook further states that chronic disease is usually preceded by an extended period of declining function in one or more bodily systems. Such declining functions are caused by lifelong interactions with our environment (such as nutrition and toxins), and lifestyle (such as stress) superimposed upon our genetic predispositions.

Such a philosophy of medicine is also founded on the principle of “biochemical individuality.” Each patient is unique and complex in relation to the stage they have set for the development of disease or the maintenance of optimal health. Therefore a cookie-cutter, one size fits all, “here, take this pill” approach to health care frequently does not work for the individual, especially those with chronic and complex problems, like fatigue. Because of biochemical individuality, health care for these complex problems must be patient centered, not disease centered. Mrs. Jones and Mr. Smith may have the same diagnosis, but the physician may find that what works for Mrs. Jones does not work for Mr. Smith, and vice versa. The challenge of the healer and the patient is to find the healing modality that works for that particular patient, in order to treat disease and to optimize health.

Once we embark upon the journey of “why” we find that the patient’s dysfunction is often due to causes such as hormonal and neurotransmitter imbalances, inflammation, immune dysregulation, stress, poor sleep, trauma, emotional issues, toxins, allergies, occult infections, or problems with poor nutrition, digestion, or absorption. These are the common denominators of many symptoms and diseases. The search for these underlying causes may require a “leave no stone unturned” approach to the patient’s problem. However, by taking the time to identify and correct these underlying imbalances, we often find that the symptoms improve dramatically. As we have seen with our migraine patient above, such an approach can literally give the patient her life back. And nothing brings me greater joy as a healer than to relieve pain and suffering, and to start the patient on the path to optimal health and vibrant living.

My wellness medical practice is equally welcoming to men and women, yet I find that at least 90% of my wellness patients are women. For many reasons, women seem to be much more in tune with their bodies, and much more comfortable asking for help and advice. I have often wondered why there is such a gender discrepancy. The data are quite clear and well known, showing that men routinely die prematurely compared to their female counterparts. Yet, men rarely come seek help in order to improve their heath until they are circling the drain. Perhaps it has something to do with the fact that men refuse to stop and ask for directions when they are lost. When men do finally come in, they are often kicking and screaming, coerced by their wives out of concern about their wellbeing. The wives have a right to be concerned. Look around at the state of health of the average middle-aged American male. Chances are that he is overweight, has hypertension, maybe a bit of pre-diabetes, and is totally stressed out. He may also be getting a touch of low libido, or even some degree of erectile dysfunction. These symptoms are often canaries in the coal mine, signifying serious underlying problems brewing.

Men do sometimes go to their doctors now and then when they feel poorly. They may even get an occasional physical exam. However, the American medical system is clearly not a “health care” system, it is a sick care system. Under the current third party payer system, doctors can only get paid if they make a diagnosis of a disease. So the average doctor is not trained or set up to promote advanced prevention, or wellness medicine. Ask yourself, when is the last time your doctor had a significant discussion with you about nutrition? If you’re like most patients, the answer is “probably never”.

The optimal wellness approach looks deeper than acute symptoms in order to find the cause, and with a focus on the fundamentals of wellness, we try to correct the underlying cause and strive toward optimal wellness. This requires a very personalized process. It’s more than preventive medicine, it’s a quest to be the best you can be physically, mentally, and spiritually. Every person has to start where they are, and then move, step by step, toward their optimal place of health. Every man has his own genetic physical inheritance to deal with. He may or may not have a significant past medical, psychosocial, or sexual history. He may be dealing with the legacy of a poor diet, inadequate exercise, or excess stress. As such, the first step is to take stock of where we’re starting. This requires a thorough history, physical exam, and depending on the individual, may also include a thorough medical work-up including a nutritional and hormonal evaluation. Once we gather and analyze the data to determine our starting point, then we can then begin to move forward to devise a customized plan for optimization.

My general approach revolves around what I call the “Pyramid of Wellness (see below).” By building a firm foundation of our pyramid, we can often prevent the root causes of disease rather than just treating the superficial symptoms with drugs. Attention to the foundations of the pyramid forms a link in the chain of wellness that helps to make us whole, healthy, happy, and vibrant.

Gentlemen, this is a call to action for my fellow men-folk. Listen to your body. It is the precious vessel that is going to take you through this journey of life. The law of natural consequences says that if you take care of it, then you are much more likely to have a great trip. If you don’t then you will suffer the consequences and may have a very bumpy ride. Don’t wait until it’s too late. By the time you’re symptomatic, you’re well down the slippery slope of disease. You’re much better to be proactive and nip it in the bud.
Put down the cigarettes. Take off that spare tire. Get back in the gym. Stay away from junk food, and turn to wholesome nutrition. Do whatever it takes to get a good night’s sleep. Stay socially active, and intimately connected with your partner. Develop a plan for stress reduction. Turn your life around by starting your own personalized wellness program. For the rest of your life, you and those you love will reap the benefits.