May 14, 2025 • 41 mins
Dr. Holly Thacker dives deep into the world of endocrinology and anti-aging with guest Dr. Elena Christofides. Dr. Christofides highlights how hormonal health significantly impacts women’s well-being as they age.
The discussion covers common health challenges women face, potential treatments, and the importance of personalized assessments to optimize health through lifestyle and pharmacological means.
• Explanation of endocrinology and its roles in overall health
• Common health concerns for midlife women
• Importance of understanding aging vs. hormonal imbalance
• Overview of Metformin and emerging treatments like rapamycin
• The significance of mitochondrial health
• Connection between environmental factors and health optimization
• Empowerment through health advocacy and informed choices
For more information on Dr. Elena Christofides, visit endocrinology-associates.com. You can listen to Dr. Christofides podcast on medcentral.com.
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Episode Transcript
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Speaker 1 (00:08):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker,and I'm back in the Sunflower
House and I am so excited to beon a new podcast episode with
endocrinologist and anti-agingspecialist, dr Elena
(00:29):
Christofides.
She is the founder ofEndocrinology Associates in
Columbus, ohio, and she is aleading medical researcher on
metabolism, diabetes and relatedmedical processes.
She earned her undergraduateand her medical degrees at the
(00:52):
Ohio State University and shethen went on to complete an
internal medicine residency atMount Carmel Medical Center and
then she finished a fellowshipin endocrinology, diabetes and
metabolism at Louisiana StateUniversity Medical Center.
And she is a physician with arare distinction of holding two
(01:15):
active board certifications,both in endocrinology and also
in internal medicine.
She actively teaches andlectures and she helps train new
physicians and clinicians andtechnicians regularly in
research and she's a guestspeaker for many conferences and
(01:36):
symposias and she has a podcast.
She also provides, importantly,her patients with expert care
on a wide range of endocrinologyissues plaguing common concerns
, including obesity, metabolism,fatigue, hormone irregularities
(01:57):
, pituitary and also adrenaldisorders.
Welcome, dr Christofides, we'reso excited to have you as a
guest on the Speaking of Women'sHealth podcast.
Speaker 2 (02:10):
Thank you.
Thank you so much, Dr Thacker.
It is such an honor to get tospeak to your listeners and your
subscribers.
I know that you have a hugefollowing and a loyal following
and after you and I had a chanceto connect and talk offline, I
can understand why and I canappreciate very much the
expertise that you provide yourpatients and your listeners.
(02:32):
So I'm super excited to be hereto hopefully add a little more
flavor to what your interest andwhat your listeners' interests
are.
Speaker 1 (02:50):
Well, this whole field of anti-aging and hormones
and graceful aging, andseparating out what's really
correct and true versus what's alot of hype, all these you know
hacks, and we've been teasingthis podcast for such a long
time.
We're so happy to have you here.
Do you want to first just tellus a little bit about
endocrinology?
Speaker 2 (03:08):
Sure, yeah, I love talking about endocrinology.
I'm sure you figured that outwhen we met in person.
You know I describeendocrinology as the spider web
of your body's functions,because you can't really tweak
one part of the spider webwithout feeling it across the
entire spider web.
So it's that integrated, it'sthat closely tied in all the
(03:32):
different bodily functions andsystems.
All of your bodily systems areconnected that way.
So your hormones are thechemical messengers that
regulate all your bodilyfunctions, such as metabolism,
growth, development, mood,reproduction, even immune system
function, and endocrinologistsmonitor these to understand
(03:54):
what's happening with yourindividual physiology, your
things that are going wrong,monitoring the glands involved
in endocrinology, making surethey're doing what they're
supposed to be doing, thingslike your thyroid, your pancreas
, your adrenal, your pituitaryand, of course, your
reproductive glands, like yourovaries or your testicles.
So endocrinologists specializein diagnosing and treating
(04:16):
hormone imbalances and disorders, and some of these disorders
are common knowledge.
A lot of people understand whatthese are, like diabetes and
thyroid.
A lot of people, though, areless familiar with some of the
other things that we do, likeinfertility and weight
management, blood pressure,cholesterol, nutritional issues
like vitamins, and are yougetting enough vitamins and are
(04:38):
you able to metabolize thevitamins that you're taking.
Those are the things that we doin endocrinology, wow that's
pretty expansive.
Speaker 1 (04:46):
What are some of the more common reasons that women
come in to see you, especiallymidlife women?
Speaker 2 (04:54):
Yeah, this, honestly, is some of my favorite groups
of people to help, because Ifeel like I wish we really did
get a manual for our bodies whenwe go into puberty, because
once we hit puberty, sort of allbets are off and obviously as
we age things happen and arebreaking down and are falling
apart in ways that we don'treally always understand.
(05:15):
So the most common reason thatwomen actually of all ages come
to see me are the ones that Ithink probably plague all of us
at some point in time in ourlives Basically feeling more
tired than we should or feelinglike we're more tired despite
getting good rest.
Of course we have weight gain,weight gain without really doing
(05:36):
anything or even though we'regoing to the gym or eating
healthy.
Most of the time I get a prettycommon complaint of people just
feel off, not themselves.
Women just will describe for methat they're developing sexual
dysfunction.
They feel like their nutritionis off, their sleep balance is
off and that just leads them tothis sort of state of feeling
(05:58):
like they're stuck and theydon't really know how to move
forward, because they sort offigured out how to handle their
bodies, their physiology, whenthey were young and more vital,
but now we hit our 40s and our50s and then even older.
You know we don't understandwhat's happening.
We don't seem to understandwhat's happening, and the things
that we used to do to controlour physiology, control our
(06:20):
weight, control our sleep,control our sexual function
don't work anymore.
Control our weight, control oursleep, control our sexual
function don't work anymore, andso the normal habits that we
have stop working, and that'susually when people come to see
me is the things they know to doare no longer working and they
need new guidance.
Speaker 1 (06:36):
Well, I have to endorse.
I hear all of those things andsometimes I wonder how realistic
people are.
I mean, I see women in their50s and I think that they're
expecting and I know I do thesame thing myself that you're
expecting to just have that sameenergy.
I used to be able to work andthen come home and spend all
this time with my kids and thenput them to bed and then burn
(06:59):
the midnight oil and crank outwork and manuscripts and all
sorts of things, and now there'sno way I can crank out anything
after like 9 pm at night.
Speaker 2 (07:10):
Yeah, no, I feel you.
I see that too.
I feel that personally as awoman in her early 50s, and I
see that as well in all of mypatients.
You know, men and women alike.
I think you know, in all of ourminds we are stuck at a certain
age, and certainly for me I'mstuck at like 28 to 32 in my
mind.
Speaker 1 (07:27):
Yeah, I'm 29.
I'm 29.
Speaker 2 (07:30):
Yeah, forever 29.
Right, Like I agree, Like Ilook at that person I was and I
think how did I do that?
You know, how on earth did I dothat?
How on earth did I accomplishall the things I accomplished,
you know, when my family wasyoung?
But I hear you, I don't thinkit's unrealistic, though, that
(07:59):
people feel that they shouldstill be able to do the things
that they want to do withinreason.
I never really feel like Iencounter somebody who is not
being reasonable Within reason.
I never really feel like Iencounter somebody who is not
being reasonable about theirdesire to have more energy or
flexibility or more stamina.
I don't think people areunreasonable to want to be able
to do things when they come homefrom work in the evening and
not feel like they have tocollapse and they don't have any
energy for themselves after awork day.
(08:19):
So I hear you, I agree that Ido sometimes wonder, and you
know what's funny is I feel likemy 70 year olds are actually
the ones that are moreunrealistic than my 50 year olds
.
I think they definitely come inwith this desire to be like
they were when they were 50.
And I do find myself chucklinga little bit more about my 75
(08:39):
year olds and the amount ofenergy that they think that they
should have.
Speaker 1 (08:44):
So how do you tease out like how much of it's
lifestyle versus natural aging,versus hormones, versus
nutrition?
I mean sometimes, by the time Isee people, they have problems
in every single area and a lotof them, unfortunately, are not
getting regular primary care,gynecologic care, hormonal
(09:08):
assessments, let alone anythingnutritional or lifestyle, and
it's like a lot to just dealwith all at once.
Speaker 2 (09:17):
Oh for sure.
I mean, that's exactly whypeople come to us, right?
They come to us to help themsort out what's real, what's
imagined, what's fixable, whatisn't fixable.
You know, realistically,patients come in wanting to make
sure, number one, that thereisn't something terrible that
they're missing.
You know, is there someterrible illness or disease that
this fatigue is a sign of or aconcern of?
(09:38):
But in general, you're right,people want to know, like, what
is real and what can I expect?
And is this rational and whatcan I do to improve my situation
?
And how I tease that out isbasically a comprehensive panel
of hormonal studies, vitaminstudies, with a complete
nutritional review of whatthey're eating, when they're
(10:00):
eating, what they're drinking,when they're drinking, what time
they go to bed, what time dothey work out.
I mean, this isn't somethingthat can be done in five minutes
, right?
This requires a comprehensiveunderstanding of, you know, from
sunup till sundown andeverything in between.
And that is the point of thisexpertise in endocrinology is to
be able to tease out thecomplaints that somebody has and
(10:23):
then tie it to either alifestyle thing that they may be
doing and or nutritional and orhormonal dysfunctions, and then
to act on those things that wesee and recommend changes and
then see what happens, and somethings might be just a few days
that they might impact.
Like you might make a I don'tknow a simple change with, like,
(10:44):
say, a lifestyle issue and thenwe'll be able to see an impact
within a few days, maybe a fewdays that they might impact.
Like you know, we might make aI don't know a simple change
with, say, a lifestyle issue andthen we'll be able to see an
impact within a few days, maybea few weeks.
Some things take longer.
Some hormonal problems are kindof insidious and they're sort
of underlying and they've beenthere for a while.
It may take us longer to teasethose out and fix them.
It may take months for that tosort out.
But at the end of the day, howwe tease that out is I have to
(11:04):
do an assessment, right.
I have to sort of understandwhere you are right now
hormonally and nutritionally andthen I can understand what we
have as reasonable options to do, to recommend, and then we can
guess okay, this is a reasonableoption for you and this is how
long I think it might take.
(11:24):
And then we reconvene, right,we reconvene and discuss.
Okay, this is a reasonableoption for you and this is how
long I think it might take.
And then we then we reconvene,right, we reconvene and discuss
okay, what happened, whathappened, that was good, what
happened that was bad, whathappened that was that didn't
happen, did anything not happenthat you expected to happen?
And then we can reevaluate.
Speaker 1 (11:38):
Now for women who say they've optimized their health
conditions, their lifestyle.
You know they're.
You know eating whole foods,healthy diet, have taken out,
you know the seed oils and theinflammatory substances.
They've optimized the importantvitamins so many women are low
in vitamin D and magnesium.
(11:58):
They've addressed their sleep,maybe had a sleep study.
Their hormones have beenassessed and if they're in
menopause, you know, and low inestrogen and other selected
hormones which many women are,that's addressed.
Let's say, all of that'soptimized and they're just
looking for optimal health.
(12:21):
Do you promote or recommend,like the anti-aging treatments
of glucophage metformin?
I know in the lab it appears tobe anti-aging.
Do you recommend an otherwisehealthy person take it?
I remember my PhD in molecularmedicine, son Stetson Thacker,
who's been on this podcast whenhe was reading about it years
(12:43):
ago.
He's like mom, I think I needto go on metformin.
I'm like what you know, you'rean athlete, you're ripped, you
have no glucose intolerance.
Like this is a medicine thatcan affect your stomach and your
liver and your kidneys.
Like no, it's a prescriptionmedicine.
So what do you say to patients?
Speaker 2 (13:03):
Yeah, though that's a great question.
I get that question quiteregularly, of course, because
that's the hot topic in agingand healthy aging.
So I first want to just remindeveryone who's listening just
because you think you'veoptimized your health and
nutrition and vitamins doesn'tmean you actually have, because
everybody's different.
Right, I get that all the time.
It's almost a very defensivemechanism, right?
(13:25):
People come in and they say butI've done all the things I'm
supposed to do and you know,like you said, you've eliminated
the seed oils, you'veeliminated the processed sugars,
you're sleeping appropriately.
That isn't always true in termsof what's actually happening.
So I just want to just makethat point before we start
getting into obviously moreexotic things like anti-aging
(13:46):
medications.
So let's talk about metformin,because obviously metformin is
kind of a staple inendocrinology.
A lot of people listening may ormay not know that this drug was
definitely a breakthrough whenit was discovered and used,
starting back really in themid-1900s, mid-1950s or so, for
diabetes patients, and so it'snot a new drug by any means.
(14:07):
In fact, we used it for decadesand didn't even have any idea
how it worked.
Even it really wasn't until theearly 2000s, mid-2000s that we
figured out actually how thedrug worked and you're
absolutely right.
In the lab there is a lot ofsupport that metformin is
anti-aging because it inhibitsthe mTOR pathway of cell
(14:30):
signaling.
Mtor is basically a shorthandterm for the cell signaling that
communicates the longevity ofthe cell, or how long a cell
should live, and it's kind ofglobal, it's not just a
particular part of the body, andso as a result, metformin
garnered a lot of attention forthat in the early 2000s and
(14:51):
there was plenty of work done onthat in the animal models to
show some potential benefit.
And it is interesting becausein the diabetes literature there
is some really interesting datathat supports and suggests that
metformin decreases the risk ofcancer development in diabetes
patients Because we know thatdiabetes patients have decreases
the risk of cancer developmentin diabetes patients because we
know that diabetes patients havean increased risk of cancer due
(15:12):
to the excess sugar in theirblood.
And there is data that goes wayback decades that suggests that
being on metformin somehowstabilizes that risk or reduces
that risk as compared todiabetics not on metformin.
But the reality is it's hard totease out what is good glucose
control from the medicationitself doing that benefit.
(15:37):
So the conversation aroundmetformin is a little more
complicated by the fact that itdoes have a negative side effect
component that I'm not happyabout, and that it does cause
B12 vitamin deficiency and canblock B12 vitamin absorption,
even if you're takingsupplementation.
I think that is something thatcannot be ignored.
(15:59):
I think it is an importantconsideration and one that
actually for a lot of mydiabetics who are more advanced
with their disease, I tend totake them off of metformin
because I'm worried about thedevelopment of neuropathy, which
is a diabetic complicationassociated with B vitamin
deficiency, and so it is acomplicated conversation.
I definitely think there arebetter options than metformin,
(16:22):
which I'm sure you will ask meabout, but if the conversation
with a patient is about mTOR andabout longevity and about the
desire to, you know, decreasetheir cellular aging in a
healthy and a safe way, Iactually think there are better
options to that than metforminfor that purpose, now that we
(16:44):
know how metformin works.
Speaker 1 (16:45):
Very interesting that form and works Very interesting
.
You have been listening to theSpeaking of Women's Health
podcast and I'm your host.
Dr Holly Thacker, the ExecutiveDirector of Speaking of Women's
Health and in the SunflowerHouse, is guest endocrinologist
and anti-aging expert, dr AlinaChristofides from Columbus, ohio
, where she has a veryinteresting and unique practice.
(17:09):
And we're in talking aboutanti-aging and we just went
through glucofage and metforminand I would definitely echo your
thoughts about checking B12,which I check in pretty much
everybody over age 60 or anyoneon glucofage, metformin or also
PPIs, because you don't want totreat one thing and then make
(17:30):
something else worse and alsothe interesting information that
you talked about cancer andsugar.
Certainly a lot of cancerpatients will go on like a high
protein or keto type diet andtake out all sugar because sugar
can feed cancer cells and Iguess teasing out how much is
(17:52):
metformin versus just changingyour diet, which all of us
adults can, you know, prettymuch take sugar.
I always say there's noessential carbohydrate, there's
essential fats, ditto yeah, andessential proteins.
And I'm like the older I get,I've just like lost my sweet
tooth.
So I don't know if that'ssomehow protective it's not
(18:15):
totally gone, but like it's.
You know it's definitely muted.
It's not like I enjoy it asmuch.
So, talking about that wholemTOR pathway and cellular aging,
what about rapamycin?
Tell us about this prescriptionmedication, the risk and
benefits.
Are you using it?
Are people coming to you to askfor it?
Speaker 2 (18:39):
I'm so glad you asked about it because I think this
is probably the hottest topic inhealth span conversations
that's happening right now,because it's such an interesting
drug.
So the short answer is yes, Iuse it, I do like it.
Patients do come to me askingfor it, and it's such an
interesting medication.
Number one, not the least, ofwhich is the fact that it was
(19:02):
named for the islands of RapaNui, because that's where it was
discovered, and a lot of peopleknow this island by its more
European name of Easter Island,which is where the Moa statues
are famously shown on the island.
And it is the original drugthat we were using to suppress
the immune system in patientsreceiving transplants.
(19:24):
You know from the beginningdays when it was first
discovered in our mid-1900s,1970s, I think.
It's technically when it wasfirst discovered in our
mid-1900s, 1970s, I think istechnically when it was
discovered.
So rapamycin is actually veryspecifically an mTOR pathway
inhibitor that does not appearto have any downstream negative
events or consequences likemetformin does.
It does play a very centralrole in regulating cell growth
(19:45):
and metabolism as it relates inresponse to nutrients and growth
factors and stress.
But what's really interestingabout rapamycin and why it has
so risen to the forefront of theconversation about health span
and healthy living is that inthe early days when we used
rapamycin, we used very, veryhigh doses for transplant
(20:06):
patients, very, very high dosesfor transplant patients.
But in the work of DavidSabatini back in the early 2000s
there was a lot ofidentification and understanding
that at lower doses, very, verylow doses a fraction of the
doses that we were using for thetransplant patients you could
actually inhibit the mTORpathway and extend the life of a
cell healthily under normalcircumstances without the immune
(20:30):
suppression.
And interestingly, I believe ifit's not already happened, it's
about to happen that rapamycinis going to get approved to
extend the life of dogs becausethe studies have been done for
life extension for our caninecompanions and, like I said,
minuscule doses so let's talkabout transplant doses are in
(20:51):
the tens and hundreds ofmilligrams daily, whereas when
you're doing it for lifeextension you're talking four or
five, maybe 10 milligrams oncea week.
So a radical difference in thedosing between the two
opportunities.
And I do find it superencouraging that we already have
data and support for gettingthis FDA approved for life
extension for our pets,certainly at least in dogs.
(21:14):
So that's where we're trying tosteer the conversation for
people in regards to the use ofmTOR inhibitors, because it
appears that you can get thebenefits with rapamycin without
the negatives of metformin.
Speaker 1 (21:27):
And so is this something you just offer to
anybody over 50 or anyone who'sinterested, or people who are
still fatigued or feel like youknow their body systems are just
too sluggish.
Speaker 2 (21:42):
Yeah, absolutely.
There's obviously aconversation that has to happen
because this is what we consideroff-label usage right.
So the use of rapamycin in thissetting would be not for an
approved indicated usageaccording to the FDA.
So that requires a separateconversation, as you well know,
and I don't routinely recommendit, but I do bring it up in the
(22:04):
following circumstances Patientswho have persistent fatigue or
evidence of inflammation,despite doing everything that we
know to do within the realm oftraditional medicine and
lifestyle changes.
I do routinely bring it up withpeople who have come to me with
the request or understanding ordesire to improve their health
(22:26):
span.
Obviously they're alreadymotivated and thinking about
that, and I am also recommendingit to people who have ongoing
autoimmune disease.
I have found a pretty, prettystrong correlation with
individuals who have ongoingautoimmune disease and
persistent autoimmune diseaseand where they keep getting
(22:49):
additional problems andadditional concerns.
That's something that I offer.
So what that looks like for apatient is let's say, you have
Hashimoto's hypothyroidism,which is a pretty common
autoimmune disease.
About one in seven women sufferfrom it.
I myself suffer from it.
Many, many, many, many of mystaff and patients suffer from
it.
It's a really common disorder.
Many, many, many of my staffand patients suffer from it.
(23:11):
It's a really common disorderand that by itself may not be a
problem.
You may be able to treat it anddo well with it.
But let's say you startacquiring other autoimmune
issues, which is not uncommon.
You know, you have oneautoimmune problem, you start
acquiring other autoimmuneproblems and in those
circumstances, if a person isreally suffering from those
autoimmune diseases kind ofpersistently and they keep
getting more and more, I mightsuggest something like rapamycin
(23:35):
to modulate the immune system.
It's not about suppressing it.
I'm not interested insuppressing it.
I'm not trying to do transplantlevels of suppression by any
means.
But we do know that at theselow doses of rapamycin once a
week, we can see a calming downof the immune system, and so I
will suggest it to thoseindividuals and I see a lot of
rheumatologic diseaseindividuals that also have
(23:58):
endocrine problems, like, let'ssay, you have Hashimoto's,
hypothyroidism and lupus, orrheumatoid arthritis or
psoriasis.
These overlapping conditionsare frequently where this drug
has its star moment Because, asyou rightly pointed out, a lot
of these individuals havepersistent fatigue.
(24:18):
So if you have persistentautoimmune disease or you have
persistent underlyinginflammation of whatever origin
and you've already done thedietary changes, you've already
done your lifestyle changes,you've already identified what
hormonal changes need to happenand you're still persisting in
this daytime fatigue, sleepiness, lack of mental focus, lack of
acuity, and you feel like you'vejust lost like 100 points of
(24:41):
your IQ.
That's how patients feel andhow they describe it.
Rapamycin may certainly play arole in what we recommend moving
forward, and we'll do a trialof, say, 12 weeks of therapy and
see if a person feels better.
This is by no means you knowthe be-all and end-all.
It may work and it may not work.
But we certainly do like to doa trial of 12 weeks to see how
(25:02):
somebody is feeling on it, andthe response is kind of black
and white, it seems.
Either you do really reallywell on it or you don't feel
anything from it whatsoever, andthat's fine.
But I'm very much happy to havea conversation about residual
inflammation and how that may bemodulated by this drug, and
fatigue may be the only symptomof residual inflammation that
(25:25):
somebody has, and you'reabsolutely right to pick up on
that because realistically youshould be able to accomplish the
tasks you set about foryourself in the day.
I mean assuming they're not,like on laundry list a mile long
, you know, but reasonablethings, like you know.
Go to work and cook food foryourself or your family.
Um, maybe do some exercise,maybe do a hobby, you know,
(25:46):
maybe watch some tv at night.
Like you should be able to dothese things in a day without
feeling like you have to nap orthat you have to save up your
energy for the next day and thenext day.
So absolutely worth aconversation.
Speaker 1 (26:00):
And so I know that my functional medicine colleagues
and I have information on ourspeakingofwomenshealthcom site.
Medicine colleagues and I haveinformation on our speaking of
women's healthcom site about lowdose naltrexone to kind of like
recharge that opiate system forpain, and I see that used in
people with chronic pain and umautoimmune conditions.
(26:23):
So how do you differentiatebetween when you're going to use
low-dose naltrexone versus aweekly dose of rapamycin?
Speaker 2 (26:32):
Oh, that's a great, great question because I love
low-dose naltrexone for all thereasons that you mentioned.
So typically what I will do is,if there is a fair pain
component involved in someone'spresentation or they have a lot
of rheumatologic issues, wemight start with low-dose
naltrexone because it's well Imean, the data on that is well
(26:52):
established and typically easierto find low-dose naltrexone or
typically easier to get low-dosenaltrexone.
But yeah, if there's a largepain component or a history of
opioid resolution like ifsomebody has taken opioids in
the past or they've takenanti-inflammatories of that
pathway in the past and hadsuccess then I'm much more
(27:14):
likely to recommend low-dosenaltrexone first.
Interestingly, there's a lot ofpeople don't appreciate that
one of our anti-obesitymedications actually has
low-dose naltrexone in it.
Speaker 1 (27:24):
Contrave.
Speaker 2 (27:25):
Right Contrave, which is one of my favorite
medications for obesity, and theoral side, not the injectable
side.
So low-dose naltrexone factorsvery prominently in the
Contrave's benefits and, as aresult, if there is obesity as
well, in the conversation thatwe are having with somebody
around their desire to have mTORinhibition or fatigue or
(27:50):
inflammation treatment, I mightrecommend low-dose naltrexone
first in that realm.
So if there's a presence ofoverweight or obesity, chronic
pain in conjunction with theirinflammation, we'll start with
LDN.
I don't always add rapamycin toit.
I will sometimes switch torapamycin if they are not
(28:10):
responding to low-dosenaltrexone, because I want to be
able to differentiate betweenthe two drugs and what they're
doing for somebody.
So we might start with one, goto the other and then we might
combine.
And I do have people who are onboth because they're doing
different things and I need mypatients to help me understand
what the drug is doing for themvery specifically so we know how
(28:32):
to monitor the two.
So yes, I will picklodelsnaltrexone in those
circumstances, maybe switch torapamycin if need be and then
tag team it if we have to later,if it looks like they're doing
two different things for people.
Speaker 1 (28:53):
And what are your thoughts about like trying to
energize the mitochondria, thelittle powerhouses inside the
cell?
You know we all inherit, Iguess, all of our mitochondria
from our mothers.
In fact, my son said oh yes,every person has more genetic
material from their mother thantheir father.
You know, you would think itwould be 50-50, but obviously
you know it's not.
And you know I have patientsasking me about CoQ10, which I
(29:18):
will recommend to anyone who'son a statin, even though I don't
think that's typical Americancardiology practice.
And I really generallydiscourage statins in women who
don't have any vascular diseasebecause of the increased risk of
diabetes, and I don't alwayssee people differentiate that
gender difference but are usingNADH.
(29:39):
I did a podcast and we've gotsome information on our website
on red light therapy.
I know that's like all the rageand I just wondered if there's
obviously a healthy diet.
But you know, certainantioxidants are kind of
promoted as such.
Speaker 2 (29:55):
I wonder how you approach that.
No, it's absolutely true.
I mean, mitochondrial functionis absolutely the hot name in
moving forward with health spanright and healthy aging.
And you are 100% correct.
Right, we get all of ourmitochondria from our mothers,
because it only exists in theegg and the ovum.
The sperm that fertilize theegg don't have any mitochondria.
They fall off.
(30:15):
It's actually they are locatedon the tail of the sperm, but
they fall off once the spermovulates the egg and fertilizes
the egg I should say notovulates, fertilizes the egg.
And so that's why we have moreDNA from our mothers than we
have from our fathers because ofthe mitochondrial contribution.
So some of us are born, or someof us inherit really great
mitochondria and some of usinherit not so great
(30:36):
mitochondria as the case mightbe.
So, first and foremost, thenumber one way to improve
mitochondrial health is going tobe with diet and exercise.
Let's make that very clear.
We know that.
That data is very, very clear.
High-intensity interval therapyworkouts are very good for
improving mitochondrial function, as you've already rightly
pointed out.
Low-carb diets are very goodfor improving mitochondrial
(30:58):
function.
That goes without saying.
When you talk aboutsupplementation, we absolutely
are in the realm of improvingsupplementation for patients who
have mitochondrial dysfunction.
When we do that, as you wellknow, NAD and NMN are not
well-absorbed orally, so we dodiscourage oral intake of NMN or
(31:19):
NAD because they're notwell-absorbed, they're destroyed
by the gut and so they're nothigh quality contributors to
mitochondrial health.
So we do do peptide infusionsand peptide treatment with NAD,
so I do do peptides as well forpeople who are in that realm.
I agree with you.
Coq10 and statins.
We could probably have anentire podcast on statins alone
(31:40):
and the do's and the don'ts ofstatin therapy.
That's a whole separateconversation because, like you,
I don't think statins need to bein the water.
I think there are times to useit and there are times that we
abuse it.
I do think that we are notseeing all the other benefits
yet of things like methylene,blue or red light therapy.
(32:02):
There are a lot of other thingsout there that we have that we
can do.
I think it's a matter of mixand match.
Personally, I find that coldexposure and red light therapy
do more for me than some of thesupplements, and I think we have
to take that into consideration, that cold exposure and sauna
Cold and sauna are well known toimprove mitochondrial function
as well, and so I think it's amatter of cost and access,
(32:26):
Because I don't think anybodycan do everything.
We have to cherry pick, so I dogo through that list with
people.
We used to have a great cryofacility in Columbus, Ohio,
where I live.
It was a fantastic room fordoing cryotherapy, and they've
since left the city and I'm nothappy with what we have you know
that behind, like the placesthat we have currently?
Speaker 1 (32:48):
Is that the cold plunge?
Speaker 2 (32:51):
Well, so this is the thing, right.
So cryotherapy in a room isactually better than a cold
plunge, because the majority ofpeople who do a cold plunge do
not get head cold and when youlook at the data on decreasing
body temperature for longevity,you have to get your hands and
your head cold.
So some cold plunges do notactually immerse you in enough
(33:15):
cold water for long enough toget the benefits of the cold
plunge if you look at the dataand how they did it
statistically.
So yes, I'm referring to coldplunge, but it's actually the
cold room is my preference overthe cold plunge, unless you're
going to dunk your headcompletely, which is the
preference if you're going to doan actual cold plunge.
Speaker 1 (33:35):
Well, my very cost efficient way of cold plunges,
much to my husband's dismay, isI just go outside in the winter
in my sleeveless pajamas andshorts to do yard work.
Speaker 2 (33:50):
He's like 100%, very cost effective.
I do the same.
I go outside without a coat,without hats, without gloves,
and I keep the.
I keep the bedroom really,really cold and I will, when I
can really feel like I cantolerate it, turn the shower
super cold.
Speaker 1 (34:06):
Oh, that's hard for me Before I get out.
Speaker 2 (34:08):
That's really hard, but you're right, that's free.
That's free and that's easy,unless you live somewhere where
you don't have cold year round,and of course, in the summer
that's not super easy, but yeah,so cold exposure is a really
really good one as well.
Speaker 1 (34:20):
How much does that have to do with stimulating the
brown fat, like I just noticed,with the season changes, because
we of course have seasonchanges here in Ohio that, like
I, don't tolerate the cold verywell at the very beginning of
the season, but then the more Iacclimate to it, the easier it
is for me just to go outsidewithout, you know, a coat on.
Speaker 2 (34:41):
Yeah, some of it is definitely brown fat adaptation,
for sure.
But you know, the interestingthing about that is that the
body remember the endocrinesystem is a spider web and you
can't tweak one area withoutaffecting the other area.
And, interestingly, when youare able to stimulate brown fat
through, say, cold exposure,that does improve inflammation
(35:01):
and improve mitochondrial health, because you turn on more
mitochondria for heat productionwhen you do that, and then that
has the knock-on effects ofimproving your overall metabolic
function, which, you know, themore cold plunges or the more
cold exposure you do, the moresustained.
That is which is why you feelsubjectively like you are better
(35:22):
tolerant of the cold at the endof the season than at the
beginning of the season.
Speaker 1 (35:26):
Boy, this is also fascinating.
I really want to have you onagain, because we haven't even
talked about growth hormone orthe panel of blood work that you
order, or you know so manyother important topics, so I
hope I can book you again.
Do you have any final words ofadvice for our listeners?
And you need to tell us howpeople can make an appointment
(35:48):
with you, how your practice isset up, because, of course,
since you're so comprehensiveand individualized, this isn't
something that obviously regular, quick, five-minute appointment
healthcare traditionalhealthcare covers.
Speaker 2 (36:01):
Oh for sure.
Now our appointments are 30 to60 minutes on the first go and
usually 30 to 60 minutes onsubsequent go arounds, and I am
more than happy to come back andtalk any time about hormones.
I obviously love talking aboutthem, and growth hormone is a
really special and unique one,so it's an important one.
But most definitely, if peoplewant to get a hold of me or get
in touch with me or make anappointment in my office, going
(36:22):
to my website is the best way tostart.
That, which iswwwendocrinology-associatescom.
You can also just do a searchon my name, elena Christofidis.
I think I'm the only one that'sin Columbus, ohio.
I hope so.
I haven't found a doppelgangeryet.
So endocrinology-associatescom.
(36:43):
And then the two things I wantpeople to take home with them
after this I want our listenersto be sure to remember.
Number one is to take charge ofyour own health and be your own
advocate, and that also requirestempering your expectations and
understanding that there doesneed to be a health care
advocate in your corner guidingthis process, and that's the
(37:06):
second part.
Staying healthy involvesfinding a team of health care
providers that are just asinterested in preserving your
health as they are, andbelieving in that process, you
know, because you can get reallyoverwhelmed with what you see
online and think you have to doeverything, and that's not
always the case and it needs tobe sort of systematic.
So, you know, my advice isalways just remember yes, you
(37:28):
need to be your own advocate,but that doesn't mean that you
should, you know, go rogue anddo all these things on your own,
without somebody to help youmonitor and identify when things
are going wrong or when thingsare going right, because so much
of this is based on blood work,so much of this is based on,
you know, understanding whereyour body systems are
stabilizing.
Speaker 1 (37:44):
You know, in the background, Well, you certainly
live our motto about beingstrong, being healthy and being
in charge, and we will have yourcontact information in our show
notes and our social media andtell us where people can listen
to your podcast.
Speaker 2 (38:01):
Yes, wonderful.
My podcast is called CaseBreaks in Endocrinology and it's
hosted on medcentralcom.
I co-host it with a good friendof mine, a primary care
physician, by the name of DrJoseph Winchell, and we discuss
all endocrinology differentconditions as well as
medications and our takes on itright Primary care versus
(38:27):
endocrine, and that's onmedcentralcom slash case breaks
and endocrinology, also linkedfrom my website.
Speaker 1 (38:29):
Well, we will put that also in our show notes.
And is that something thatprimarily physicians tune into?
I mean, I have so many smartlisteners and smart patients who
, even if they're not inhealthcare, they like to listen
to the podcast that I sometimesdo with physicians, so I assume
that the case discussions arehigher level, more focused on
physicians, and I should have myfellows listen you know,
honestly, we don't restrictaccess.
Speaker 2 (38:50):
I agree with you that it's a little bit of a higher
level conversation in sometopics, but I don't think that
the topics are a problem ordifficult or not listenable for
anybody.
Really, honestly, I think youknow fellow providers, your
fellows, you know doctors intraining, nurses in training and
certainly your patients.
I think they would findsomething that they could take
(39:12):
from our discussions and use itfor their own health advocacy.
I absolutely think that wecover the topic you know pretty
thoroughly, but not, you know,this is not a conversation that
other people would not be ableto get something out of.
I absolutely would welcome themlistening to it.
Speaker 1 (39:28):
Well, that is terrific, and thank you, Dr
Alina Christofides, and thanksto our listeners for tuning in
to our Speaking of Women'sHealth podcast.
We're really grateful for yoursupport and we hope that you'll
share it with others.
You can donate onspeakingofwomenshealthcom and
leave us a five-star rating and,to catch all the latest from us
(39:49):
on Speaking of Women's Health,subscribe or follow on Apple
Podcasts, Spotify, TuneIn orwherever you listen to podcasts.
It's free to subscribe and whenyou subscribe, you won't miss
future episodes, including whenI am hopefully able to get Dr
Christofides back in thesunflower house.
Remember, be strong, be healthyand be in charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker,and I'm back in the Sunflower
House and I am so excited to beon a new podcast episode with
endocrinologist and anti-agingspecialist, dr Elena
(00:29):
Christofides.
She is the founder ofEndocrinology Associates in
Columbus, ohio, and she is aleading medical researcher on
metabolism, diabetes and relatedmedical processes.
She earned her undergraduateand her medical degrees at the
(00:52):
Ohio State University and shethen went on to complete an
internal medicine residency atMount Carmel Medical Center and
then she finished a fellowshipin endocrinology, diabetes and
metabolism at Louisiana StateUniversity Medical Center.
And she is a physician with arare distinction of holding two
(01:15):
active board certifications,both in endocrinology and also
in internal medicine.
She actively teaches andlectures and she helps train new
physicians and clinicians andtechnicians regularly in
research and she's a guestspeaker for many conferences and
(01:36):
symposias and she has a podcast.
She also provides, importantly,her patients with expert care
on a wide range of endocrinologyissues plaguing common concerns
, including obesity, metabolism,fatigue, hormone irregularities
(01:57):
, pituitary and also adrenaldisorders.
Welcome, dr Christofides, we'reso excited to have you as a
guest on the Speaking of Women'sHealth podcast.
Speaker 2 (02:10):
Thank you.
Thank you so much, Dr Thacker.
It is such an honor to get tospeak to your listeners and your
subscribers.
I know that you have a hugefollowing and a loyal following
and after you and I had a chanceto connect and talk offline, I
can understand why and I canappreciate very much the
expertise that you provide yourpatients and your listeners.
(02:32):
So I'm super excited to be hereto hopefully add a little more
flavor to what your interest andwhat your listeners' interests
are.
Speaker 1 (02:50):
Well, this whole field of anti-aging and hormones
and graceful aging, andseparating out what's really
correct and true versus what's alot of hype, all these you know
hacks, and we've been teasingthis podcast for such a long
time.
We're so happy to have you here.
Do you want to first just tellus a little bit about
endocrinology?
Speaker 2 (03:08):
Sure, yeah, I love talking about endocrinology.
I'm sure you figured that outwhen we met in person.
You know I describeendocrinology as the spider web
of your body's functions,because you can't really tweak
one part of the spider webwithout feeling it across the
entire spider web.
So it's that integrated, it'sthat closely tied in all the
(03:32):
different bodily functions andsystems.
All of your bodily systems areconnected that way.
So your hormones are thechemical messengers that
regulate all your bodilyfunctions, such as metabolism,
growth, development, mood,reproduction, even immune system
function, and endocrinologistsmonitor these to understand
(03:54):
what's happening with yourindividual physiology, your
things that are going wrong,monitoring the glands involved
in endocrinology, making surethey're doing what they're
supposed to be doing, thingslike your thyroid, your pancreas
, your adrenal, your pituitaryand, of course, your
reproductive glands, like yourovaries or your testicles.
So endocrinologists specializein diagnosing and treating
(04:16):
hormone imbalances and disorders, and some of these disorders
are common knowledge.
A lot of people understand whatthese are, like diabetes and
thyroid.
A lot of people, though, areless familiar with some of the
other things that we do, likeinfertility and weight
management, blood pressure,cholesterol, nutritional issues
like vitamins, and are yougetting enough vitamins and are
(04:38):
you able to metabolize thevitamins that you're taking.
Those are the things that we doin endocrinology, wow that's
pretty expansive.
Speaker 1 (04:46):
What are some of the more common reasons that women
come in to see you, especiallymidlife women?
Speaker 2 (04:54):
Yeah, this, honestly, is some of my favorite groups
of people to help, because Ifeel like I wish we really did
get a manual for our bodies whenwe go into puberty, because
once we hit puberty, sort of allbets are off and obviously as
we age things happen and arebreaking down and are falling
apart in ways that we don'treally always understand.
(05:15):
So the most common reason thatwomen actually of all ages come
to see me are the ones that Ithink probably plague all of us
at some point in time in ourlives Basically feeling more
tired than we should or feelinglike we're more tired despite
getting good rest.
Of course we have weight gain,weight gain without really doing
(05:36):
anything or even though we'regoing to the gym or eating
healthy.
Most of the time I get a prettycommon complaint of people just
feel off, not themselves.
Women just will describe for methat they're developing sexual
dysfunction.
They feel like their nutritionis off, their sleep balance is
off and that just leads them tothis sort of state of feeling
(05:58):
like they're stuck and theydon't really know how to move
forward, because they sort offigured out how to handle their
bodies, their physiology, whenthey were young and more vital,
but now we hit our 40s and our50s and then even older.
You know we don't understandwhat's happening.
We don't seem to understandwhat's happening, and the things
that we used to do to controlour physiology, control our
(06:20):
weight, control our sleep,control our sexual function
don't work anymore.
Control our weight, control oursleep, control our sexual
function don't work anymore, andso the normal habits that we
have stop working, and that'susually when people come to see
me is the things they know to doare no longer working and they
need new guidance.
Speaker 1 (06:36):
Well, I have to endorse.
I hear all of those things andsometimes I wonder how realistic
people are.
I mean, I see women in their50s and I think that they're
expecting and I know I do thesame thing myself that you're
expecting to just have that sameenergy.
I used to be able to work andthen come home and spend all
this time with my kids and thenput them to bed and then burn
(06:59):
the midnight oil and crank outwork and manuscripts and all
sorts of things, and now there'sno way I can crank out anything
after like 9 pm at night.
Speaker 2 (07:10):
Yeah, no, I feel you.
I see that too.
I feel that personally as awoman in her early 50s, and I
see that as well in all of mypatients.
You know, men and women alike.
I think you know, in all of ourminds we are stuck at a certain
age, and certainly for me I'mstuck at like 28 to 32 in my
mind.
Speaker 1 (07:27):
Yeah, I'm 29.
I'm 29.
Speaker 2 (07:30):
Yeah, forever 29.
Right, Like I agree, Like Ilook at that person I was and I
think how did I do that?
You know, how on earth did I dothat?
How on earth did I accomplishall the things I accomplished,
you know, when my family wasyoung?
But I hear you, I don't thinkit's unrealistic, though, that
(07:59):
people feel that they shouldstill be able to do the things
that they want to do withinreason.
I never really feel like Iencounter somebody who is not
being reasonable Within reason.
I never really feel like Iencounter somebody who is not
being reasonable about theirdesire to have more energy or
flexibility or more stamina.
I don't think people areunreasonable to want to be able
to do things when they come homefrom work in the evening and
not feel like they have tocollapse and they don't have any
energy for themselves after awork day.
(08:19):
So I hear you, I agree that Ido sometimes wonder, and you
know what's funny is I feel likemy 70 year olds are actually
the ones that are moreunrealistic than my 50 year olds
.
I think they definitely come inwith this desire to be like
they were when they were 50.
And I do find myself chucklinga little bit more about my 75
(08:39):
year olds and the amount ofenergy that they think that they
should have.
Speaker 1 (08:44):
So how do you tease out like how much of it's
lifestyle versus natural aging,versus hormones, versus
nutrition?
I mean sometimes, by the time Isee people, they have problems
in every single area and a lotof them, unfortunately, are not
getting regular primary care,gynecologic care, hormonal
(09:08):
assessments, let alone anythingnutritional or lifestyle, and
it's like a lot to just dealwith all at once.
Speaker 2 (09:17):
Oh for sure.
I mean, that's exactly whypeople come to us, right?
They come to us to help themsort out what's real, what's
imagined, what's fixable, whatisn't fixable.
You know, realistically,patients come in wanting to make
sure, number one, that thereisn't something terrible that
they're missing.
You know, is there someterrible illness or disease that
this fatigue is a sign of or aconcern of?
(09:38):
But in general, you're right,people want to know, like, what
is real and what can I expect?
And is this rational and whatcan I do to improve my situation
?
And how I tease that out isbasically a comprehensive panel
of hormonal studies, vitaminstudies, with a complete
nutritional review of whatthey're eating, when they're
(10:00):
eating, what they're drinking,when they're drinking, what time
they go to bed, what time dothey work out.
I mean, this isn't somethingthat can be done in five minutes
, right?
This requires a comprehensiveunderstanding of, you know, from
sunup till sundown andeverything in between.
And that is the point of thisexpertise in endocrinology is to
be able to tease out thecomplaints that somebody has and
(10:23):
then tie it to either alifestyle thing that they may be
doing and or nutritional and orhormonal dysfunctions, and then
to act on those things that wesee and recommend changes and
then see what happens, and somethings might be just a few days
that they might impact.
Like you might make a I don'tknow a simple change with, like,
(10:44):
say, a lifestyle issue and thenwe'll be able to see an impact
within a few days, maybe a fewdays that they might impact.
Like you know, we might make aI don't know a simple change
with, say, a lifestyle issue andthen we'll be able to see an
impact within a few days, maybea few weeks.
Some things take longer.
Some hormonal problems are kindof insidious and they're sort
of underlying and they've beenthere for a while.
It may take us longer to teasethose out and fix them.
It may take months for that tosort out.
But at the end of the day, howwe tease that out is I have to
(11:04):
do an assessment, right.
I have to sort of understandwhere you are right now
hormonally and nutritionally andthen I can understand what we
have as reasonable options to do, to recommend, and then we can
guess okay, this is a reasonableoption for you and this is how
long I think it might take.
(11:24):
And then we reconvene, right,we reconvene and discuss.
Okay, this is a reasonableoption for you and this is how
long I think it might take.
And then we then we reconvene,right, we reconvene and discuss
okay, what happened, whathappened, that was good, what
happened that was bad, whathappened that was that didn't
happen, did anything not happenthat you expected to happen?
And then we can reevaluate.
Speaker 1 (11:38):
Now for women who say they've optimized their health
conditions, their lifestyle.
You know they're.
You know eating whole foods,healthy diet, have taken out,
you know the seed oils and theinflammatory substances.
They've optimized the importantvitamins so many women are low
in vitamin D and magnesium.
(11:58):
They've addressed their sleep,maybe had a sleep study.
Their hormones have beenassessed and if they're in
menopause, you know, and low inestrogen and other selected
hormones which many women are,that's addressed.
Let's say, all of that'soptimized and they're just
looking for optimal health.
(12:21):
Do you promote or recommend,like the anti-aging treatments
of glucophage metformin?
I know in the lab it appears tobe anti-aging.
Do you recommend an otherwisehealthy person take it?
I remember my PhD in molecularmedicine, son Stetson Thacker,
who's been on this podcast whenhe was reading about it years
(12:43):
ago.
He's like mom, I think I needto go on metformin.
I'm like what you know, you'rean athlete, you're ripped, you
have no glucose intolerance.
Like this is a medicine thatcan affect your stomach and your
liver and your kidneys.
Like no, it's a prescriptionmedicine.
So what do you say to patients?
Speaker 2 (13:03):
Yeah, though that's a great question.
I get that question quiteregularly, of course, because
that's the hot topic in agingand healthy aging.
So I first want to just remindeveryone who's listening just
because you think you'veoptimized your health and
nutrition and vitamins doesn'tmean you actually have, because
everybody's different.
Right, I get that all the time.
It's almost a very defensivemechanism, right?
(13:25):
People come in and they say butI've done all the things I'm
supposed to do and you know,like you said, you've eliminated
the seed oils, you'veeliminated the processed sugars,
you're sleeping appropriately.
That isn't always true in termsof what's actually happening.
So I just want to just makethat point before we start
getting into obviously moreexotic things like anti-aging
(13:46):
medications.
So let's talk about metformin,because obviously metformin is
kind of a staple inendocrinology.
A lot of people listening may ormay not know that this drug was
definitely a breakthrough whenit was discovered and used,
starting back really in themid-1900s, mid-1950s or so, for
diabetes patients, and so it'snot a new drug by any means.
(14:07):
In fact, we used it for decadesand didn't even have any idea
how it worked.
Even it really wasn't until theearly 2000s, mid-2000s that we
figured out actually how thedrug worked and you're
absolutely right.
In the lab there is a lot ofsupport that metformin is
anti-aging because it inhibitsthe mTOR pathway of cell
(14:30):
signaling.
Mtor is basically a shorthandterm for the cell signaling that
communicates the longevity ofthe cell, or how long a cell
should live, and it's kind ofglobal, it's not just a
particular part of the body, andso as a result, metformin
garnered a lot of attention forthat in the early 2000s and
(14:51):
there was plenty of work done onthat in the animal models to
show some potential benefit.
And it is interesting becausein the diabetes literature there
is some really interesting datathat supports and suggests that
metformin decreases the risk ofcancer development in diabetes
patients Because we know thatdiabetes patients have decreases
the risk of cancer developmentin diabetes patients because we
know that diabetes patients havean increased risk of cancer due
(15:12):
to the excess sugar in theirblood.
And there is data that goes wayback decades that suggests that
being on metformin somehowstabilizes that risk or reduces
that risk as compared todiabetics not on metformin.
But the reality is it's hard totease out what is good glucose
control from the medicationitself doing that benefit.
(15:37):
So the conversation aroundmetformin is a little more
complicated by the fact that itdoes have a negative side effect
component that I'm not happyabout, and that it does cause
B12 vitamin deficiency and canblock B12 vitamin absorption,
even if you're takingsupplementation.
I think that is something thatcannot be ignored.
(15:59):
I think it is an importantconsideration and one that
actually for a lot of mydiabetics who are more advanced
with their disease, I tend totake them off of metformin
because I'm worried about thedevelopment of neuropathy, which
is a diabetic complicationassociated with B vitamin
deficiency, and so it is acomplicated conversation.
I definitely think there arebetter options than metformin,
(16:22):
which I'm sure you will ask meabout, but if the conversation
with a patient is about mTOR andabout longevity and about the
desire to, you know, decreasetheir cellular aging in a
healthy and a safe way, Iactually think there are better
options to that than metforminfor that purpose, now that we
(16:44):
know how metformin works.
Speaker 1 (16:45):
Very interesting that form and works Very interesting
.
You have been listening to theSpeaking of Women's Health
podcast and I'm your host.
Dr Holly Thacker, the ExecutiveDirector of Speaking of Women's
Health and in the SunflowerHouse, is guest endocrinologist
and anti-aging expert, dr AlinaChristofides from Columbus, ohio
, where she has a veryinteresting and unique practice.
(17:09):
And we're in talking aboutanti-aging and we just went
through glucofage and metforminand I would definitely echo your
thoughts about checking B12,which I check in pretty much
everybody over age 60 or anyoneon glucofage, metformin or also
PPIs, because you don't want totreat one thing and then make
(17:30):
something else worse and alsothe interesting information that
you talked about cancer andsugar.
Certainly a lot of cancerpatients will go on like a high
protein or keto type diet andtake out all sugar because sugar
can feed cancer cells and Iguess teasing out how much is
(17:52):
metformin versus just changingyour diet, which all of us
adults can, you know, prettymuch take sugar.
I always say there's noessential carbohydrate, there's
essential fats, ditto yeah, andessential proteins.
And I'm like the older I get,I've just like lost my sweet
tooth.
So I don't know if that'ssomehow protective it's not
(18:15):
totally gone, but like it's.
You know it's definitely muted.
It's not like I enjoy it asmuch.
So, talking about that wholemTOR pathway and cellular aging,
what about rapamycin?
Tell us about this prescriptionmedication, the risk and
benefits.
Are you using it?
Are people coming to you to askfor it?
Speaker 2 (18:39):
I'm so glad you asked about it because I think this
is probably the hottest topic inhealth span conversations
that's happening right now,because it's such an interesting
drug.
So the short answer is yes, Iuse it, I do like it.
Patients do come to me askingfor it, and it's such an
interesting medication.
Number one, not the least, ofwhich is the fact that it was
(19:02):
named for the islands of RapaNui, because that's where it was
discovered, and a lot of peopleknow this island by its more
European name of Easter Island,which is where the Moa statues
are famously shown on the island.
And it is the original drugthat we were using to suppress
the immune system in patientsreceiving transplants.
(19:24):
You know from the beginningdays when it was first
discovered in our mid-1900s,1970s, I think.
It's technically when it wasfirst discovered in our
mid-1900s, 1970s, I think istechnically when it was
discovered.
So rapamycin is actually veryspecifically an mTOR pathway
inhibitor that does not appearto have any downstream negative
events or consequences likemetformin does.
It does play a very centralrole in regulating cell growth
(19:45):
and metabolism as it relates inresponse to nutrients and growth
factors and stress.
But what's really interestingabout rapamycin and why it has
so risen to the forefront of theconversation about health span
and healthy living is that inthe early days when we used
rapamycin, we used very, veryhigh doses for transplant
(20:06):
patients, very, very high dosesfor transplant patients.
But in the work of DavidSabatini back in the early 2000s
there was a lot ofidentification and understanding
that at lower doses, very, verylow doses a fraction of the
doses that we were using for thetransplant patients you could
actually inhibit the mTORpathway and extend the life of a
cell healthily under normalcircumstances without the immune
(20:30):
suppression.
And interestingly, I believe ifit's not already happened, it's
about to happen that rapamycinis going to get approved to
extend the life of dogs becausethe studies have been done for
life extension for our caninecompanions and, like I said,
minuscule doses so let's talkabout transplant doses are in
(20:51):
the tens and hundreds ofmilligrams daily, whereas when
you're doing it for lifeextension you're talking four or
five, maybe 10 milligrams oncea week.
So a radical difference in thedosing between the two
opportunities.
And I do find it superencouraging that we already have
data and support for gettingthis FDA approved for life
extension for our pets,certainly at least in dogs.
(21:14):
So that's where we're trying tosteer the conversation for
people in regards to the use ofmTOR inhibitors, because it
appears that you can get thebenefits with rapamycin without
the negatives of metformin.
Speaker 1 (21:27):
And so is this something you just offer to
anybody over 50 or anyone who'sinterested, or people who are
still fatigued or feel like youknow their body systems are just
too sluggish.
Speaker 2 (21:42):
Yeah, absolutely.
There's obviously aconversation that has to happen
because this is what we consideroff-label usage right.
So the use of rapamycin in thissetting would be not for an
approved indicated usageaccording to the FDA.
So that requires a separateconversation, as you well know,
and I don't routinely recommendit, but I do bring it up in the
(22:04):
following circumstances Patientswho have persistent fatigue or
evidence of inflammation,despite doing everything that we
know to do within the realm oftraditional medicine and
lifestyle changes.
I do routinely bring it up withpeople who have come to me with
the request or understanding ordesire to improve their health
(22:26):
span.
Obviously they're alreadymotivated and thinking about
that, and I am also recommendingit to people who have ongoing
autoimmune disease.
I have found a pretty, prettystrong correlation with
individuals who have ongoingautoimmune disease and
persistent autoimmune diseaseand where they keep getting
(22:49):
additional problems andadditional concerns.
That's something that I offer.
So what that looks like for apatient is let's say, you have
Hashimoto's hypothyroidism,which is a pretty common
autoimmune disease.
About one in seven women sufferfrom it.
I myself suffer from it.
Many, many, many, many of mystaff and patients suffer from
it.
It's a really common disorder.
Many, many, many of my staffand patients suffer from it.
(23:11):
It's a really common disorderand that by itself may not be a
problem.
You may be able to treat it anddo well with it.
But let's say you startacquiring other autoimmune
issues, which is not uncommon.
You know, you have oneautoimmune problem, you start
acquiring other autoimmuneproblems and in those
circumstances, if a person isreally suffering from those
autoimmune diseases kind ofpersistently and they keep
getting more and more, I mightsuggest something like rapamycin
(23:35):
to modulate the immune system.
It's not about suppressing it.
I'm not interested insuppressing it.
I'm not trying to do transplantlevels of suppression by any
means.
But we do know that at theselow doses of rapamycin once a
week, we can see a calming downof the immune system, and so I
will suggest it to thoseindividuals and I see a lot of
rheumatologic diseaseindividuals that also have
(23:58):
endocrine problems, like, let'ssay, you have Hashimoto's,
hypothyroidism and lupus, orrheumatoid arthritis or
psoriasis.
These overlapping conditionsare frequently where this drug
has its star moment Because, asyou rightly pointed out, a lot
of these individuals havepersistent fatigue.
(24:18):
So if you have persistentautoimmune disease or you have
persistent underlyinginflammation of whatever origin
and you've already done thedietary changes, you've already
done your lifestyle changes,you've already identified what
hormonal changes need to happenand you're still persisting in
this daytime fatigue, sleepiness, lack of mental focus, lack of
acuity, and you feel like you'vejust lost like 100 points of
(24:41):
your IQ.
That's how patients feel andhow they describe it.
Rapamycin may certainly play arole in what we recommend moving
forward, and we'll do a trialof, say, 12 weeks of therapy and
see if a person feels better.
This is by no means you knowthe be-all and end-all.
It may work and it may not work.
But we certainly do like to doa trial of 12 weeks to see how
(25:02):
somebody is feeling on it, andthe response is kind of black
and white, it seems.
Either you do really reallywell on it or you don't feel
anything from it whatsoever, andthat's fine.
But I'm very much happy to havea conversation about residual
inflammation and how that may bemodulated by this drug, and
fatigue may be the only symptomof residual inflammation that
(25:25):
somebody has, and you'reabsolutely right to pick up on
that because realistically youshould be able to accomplish the
tasks you set about foryourself in the day.
I mean assuming they're not,like on laundry list a mile long
, you know, but reasonablethings, like you know.
Go to work and cook food foryourself or your family.
Um, maybe do some exercise,maybe do a hobby, you know,
(25:46):
maybe watch some tv at night.
Like you should be able to dothese things in a day without
feeling like you have to nap orthat you have to save up your
energy for the next day and thenext day.
So absolutely worth aconversation.
Speaker 1 (26:00):
And so I know that my functional medicine colleagues
and I have information on ourspeakingofwomenshealthcom site.
Medicine colleagues and I haveinformation on our speaking of
women's healthcom site about lowdose naltrexone to kind of like
recharge that opiate system forpain, and I see that used in
people with chronic pain and umautoimmune conditions.
(26:23):
So how do you differentiatebetween when you're going to use
low-dose naltrexone versus aweekly dose of rapamycin?
Speaker 2 (26:32):
Oh, that's a great, great question because I love
low-dose naltrexone for all thereasons that you mentioned.
So typically what I will do is,if there is a fair pain
component involved in someone'spresentation or they have a lot
of rheumatologic issues, wemight start with low-dose
naltrexone because it's well Imean, the data on that is well
(26:52):
established and typically easierto find low-dose naltrexone or
typically easier to get low-dosenaltrexone.
But yeah, if there's a largepain component or a history of
opioid resolution like ifsomebody has taken opioids in
the past or they've takenanti-inflammatories of that
pathway in the past and hadsuccess then I'm much more
(27:14):
likely to recommend low-dosenaltrexone first.
Interestingly, there's a lot ofpeople don't appreciate that
one of our anti-obesitymedications actually has
low-dose naltrexone in it.
Speaker 1 (27:24):
Contrave.
Speaker 2 (27:25):
Right Contrave, which is one of my favorite
medications for obesity, and theoral side, not the injectable
side.
So low-dose naltrexone factorsvery prominently in the
Contrave's benefits and, as aresult, if there is obesity as
well, in the conversation thatwe are having with somebody
around their desire to have mTORinhibition or fatigue or
(27:50):
inflammation treatment, I mightrecommend low-dose naltrexone
first in that realm.
So if there's a presence ofoverweight or obesity, chronic
pain in conjunction with theirinflammation, we'll start with
LDN.
I don't always add rapamycin toit.
I will sometimes switch torapamycin if they are not
(28:10):
responding to low-dosenaltrexone, because I want to be
able to differentiate betweenthe two drugs and what they're
doing for somebody.
So we might start with one, goto the other and then we might
combine.
And I do have people who are onboth because they're doing
different things and I need mypatients to help me understand
what the drug is doing for themvery specifically so we know how
(28:32):
to monitor the two.
So yes, I will picklodelsnaltrexone in those
circumstances, maybe switch torapamycin if need be and then
tag team it if we have to later,if it looks like they're doing
two different things for people.
Speaker 1 (28:53):
And what are your thoughts about like trying to
energize the mitochondria, thelittle powerhouses inside the
cell?
You know we all inherit, Iguess, all of our mitochondria
from our mothers.
In fact, my son said oh yes,every person has more genetic
material from their mother thantheir father.
You know, you would think itwould be 50-50, but obviously
you know it's not.
And you know I have patientsasking me about CoQ10, which I
(29:18):
will recommend to anyone who'son a statin, even though I don't
think that's typical Americancardiology practice.
And I really generallydiscourage statins in women who
don't have any vascular diseasebecause of the increased risk of
diabetes, and I don't alwayssee people differentiate that
gender difference but are usingNADH.
(29:39):
I did a podcast and we've gotsome information on our website
on red light therapy.
I know that's like all the rageand I just wondered if there's
obviously a healthy diet.
But you know, certainantioxidants are kind of
promoted as such.
Speaker 2 (29:55):
I wonder how you approach that.
No, it's absolutely true.
I mean, mitochondrial functionis absolutely the hot name in
moving forward with health spanright and healthy aging.
And you are 100% correct.
Right, we get all of ourmitochondria from our mothers,
because it only exists in theegg and the ovum.
The sperm that fertilize theegg don't have any mitochondria.
They fall off.
(30:15):
It's actually they are locatedon the tail of the sperm, but
they fall off once the spermovulates the egg and fertilizes
the egg I should say notovulates, fertilizes the egg.
And so that's why we have moreDNA from our mothers than we
have from our fathers because ofthe mitochondrial contribution.
So some of us are born, or someof us inherit really great
mitochondria and some of usinherit not so great
(30:36):
mitochondria as the case mightbe.
So, first and foremost, thenumber one way to improve
mitochondrial health is going tobe with diet and exercise.
Let's make that very clear.
We know that.
That data is very, very clear.
High-intensity interval therapyworkouts are very good for
improving mitochondrial function, as you've already rightly
pointed out.
Low-carb diets are very goodfor improving mitochondrial
(30:58):
function.
That goes without saying.
When you talk aboutsupplementation, we absolutely
are in the realm of improvingsupplementation for patients who
have mitochondrial dysfunction.
When we do that, as you wellknow, NAD and NMN are not
well-absorbed orally, so we dodiscourage oral intake of NMN or
(31:19):
NAD because they're notwell-absorbed, they're destroyed
by the gut and so they're nothigh quality contributors to
mitochondrial health.
So we do do peptide infusionsand peptide treatment with NAD,
so I do do peptides as well forpeople who are in that realm.
I agree with you.
Coq10 and statins.
We could probably have anentire podcast on statins alone
(31:40):
and the do's and the don'ts ofstatin therapy.
That's a whole separateconversation because, like you,
I don't think statins need to bein the water.
I think there are times to useit and there are times that we
abuse it.
I do think that we are notseeing all the other benefits
yet of things like methylene,blue or red light therapy.
(32:02):
There are a lot of other thingsout there that we have that we
can do.
I think it's a matter of mixand match.
Personally, I find that coldexposure and red light therapy
do more for me than some of thesupplements, and I think we have
to take that into consideration, that cold exposure and sauna
Cold and sauna are well known toimprove mitochondrial function
as well, and so I think it's amatter of cost and access,
(32:26):
Because I don't think anybodycan do everything.
We have to cherry pick, so I dogo through that list with
people.
We used to have a great cryofacility in Columbus, Ohio,
where I live.
It was a fantastic room fordoing cryotherapy, and they've
since left the city and I'm nothappy with what we have you know
that behind, like the placesthat we have currently?
Speaker 1 (32:48):
Is that the cold plunge?
Speaker 2 (32:51):
Well, so this is the thing, right.
So cryotherapy in a room isactually better than a cold
plunge, because the majority ofpeople who do a cold plunge do
not get head cold and when youlook at the data on decreasing
body temperature for longevity,you have to get your hands and
your head cold.
So some cold plunges do notactually immerse you in enough
(33:15):
cold water for long enough toget the benefits of the cold
plunge if you look at the dataand how they did it
statistically.
So yes, I'm referring to coldplunge, but it's actually the
cold room is my preference overthe cold plunge, unless you're
going to dunk your headcompletely, which is the
preference if you're going to doan actual cold plunge.
Speaker 1 (33:35):
Well, my very cost efficient way of cold plunges,
much to my husband's dismay, isI just go outside in the winter
in my sleeveless pajamas andshorts to do yard work.
Speaker 2 (33:50):
He's like 100%, very cost effective.
I do the same.
I go outside without a coat,without hats, without gloves,
and I keep the.
I keep the bedroom really,really cold and I will, when I
can really feel like I cantolerate it, turn the shower
super cold.
Speaker 1 (34:06):
Oh, that's hard for me Before I get out.
Speaker 2 (34:08):
That's really hard, but you're right, that's free.
That's free and that's easy,unless you live somewhere where
you don't have cold year round,and of course, in the summer
that's not super easy, but yeah,so cold exposure is a really
really good one as well.
Speaker 1 (34:20):
How much does that have to do with stimulating the
brown fat, like I just noticed,with the season changes, because
we of course have seasonchanges here in Ohio that, like
I, don't tolerate the cold verywell at the very beginning of
the season, but then the more Iacclimate to it, the easier it
is for me just to go outsidewithout, you know, a coat on.
Speaker 2 (34:41):
Yeah, some of it is definitely brown fat adaptation,
for sure.
But you know, the interestingthing about that is that the
body remember the endocrinesystem is a spider web and you
can't tweak one area withoutaffecting the other area.
And, interestingly, when youare able to stimulate brown fat
through, say, cold exposure,that does improve inflammation
(35:01):
and improve mitochondrial health, because you turn on more
mitochondria for heat productionwhen you do that, and then that
has the knock-on effects ofimproving your overall metabolic
function, which, you know, themore cold plunges or the more
cold exposure you do, the moresustained.
That is which is why you feelsubjectively like you are better
(35:22):
tolerant of the cold at the endof the season than at the
beginning of the season.
Speaker 1 (35:26):
Boy, this is also fascinating.
I really want to have you onagain, because we haven't even
talked about growth hormone orthe panel of blood work that you
order, or you know so manyother important topics, so I
hope I can book you again.
Do you have any final words ofadvice for our listeners?
And you need to tell us howpeople can make an appointment
(35:48):
with you, how your practice isset up, because, of course,
since you're so comprehensiveand individualized, this isn't
something that obviously regular, quick, five-minute appointment
healthcare traditionalhealthcare covers.
Speaker 2 (36:01):
Oh for sure.
Now our appointments are 30 to60 minutes on the first go and
usually 30 to 60 minutes onsubsequent go arounds, and I am
more than happy to come back andtalk any time about hormones.
I obviously love talking aboutthem, and growth hormone is a
really special and unique one,so it's an important one.
But most definitely, if peoplewant to get a hold of me or get
in touch with me or make anappointment in my office, going
(36:22):
to my website is the best way tostart.
That, which iswwwendocrinology-associatescom.
You can also just do a searchon my name, elena Christofidis.
I think I'm the only one that'sin Columbus, ohio.
I hope so.
I haven't found a doppelgangeryet.
So endocrinology-associatescom.
(36:43):
And then the two things I wantpeople to take home with them
after this I want our listenersto be sure to remember.
Number one is to take charge ofyour own health and be your own
advocate, and that also requirestempering your expectations and
understanding that there doesneed to be a health care
advocate in your corner guidingthis process, and that's the
(37:06):
second part.
Staying healthy involvesfinding a team of health care
providers that are just asinterested in preserving your
health as they are, andbelieving in that process, you
know, because you can get reallyoverwhelmed with what you see
online and think you have to doeverything, and that's not
always the case and it needs tobe sort of systematic.
So, you know, my advice isalways just remember yes, you
(37:28):
need to be your own advocate,but that doesn't mean that you
should, you know, go rogue anddo all these things on your own,
without somebody to help youmonitor and identify when things
are going wrong or when thingsare going right, because so much
of this is based on blood work,so much of this is based on,
you know, understanding whereyour body systems are
stabilizing.
Speaker 1 (37:44):
You know, in the background, Well, you certainly
live our motto about beingstrong, being healthy and being
in charge, and we will have yourcontact information in our show
notes and our social media andtell us where people can listen
to your podcast.
Speaker 2 (38:01):
Yes, wonderful.
My podcast is called CaseBreaks in Endocrinology and it's
hosted on medcentralcom.
I co-host it with a good friendof mine, a primary care
physician, by the name of DrJoseph Winchell, and we discuss
all endocrinology differentconditions as well as
medications and our takes on itright Primary care versus
(38:27):
endocrine, and that's onmedcentralcom slash case breaks
and endocrinology, also linkedfrom my website.
Speaker 1 (38:29):
Well, we will put that also in our show notes.
And is that something thatprimarily physicians tune into?
I mean, I have so many smartlisteners and smart patients who
, even if they're not inhealthcare, they like to listen
to the podcast that I sometimesdo with physicians, so I assume
that the case discussions arehigher level, more focused on
physicians, and I should have myfellows listen you know,
honestly, we don't restrictaccess.
Speaker 2 (38:50):
I agree with you that it's a little bit of a higher
level conversation in sometopics, but I don't think that
the topics are a problem ordifficult or not listenable for
anybody.
Really, honestly, I think youknow fellow providers, your
fellows, you know doctors intraining, nurses in training and
certainly your patients.
I think they would findsomething that they could take
(39:12):
from our discussions and use itfor their own health advocacy.
I absolutely think that wecover the topic you know pretty
thoroughly, but not, you know,this is not a conversation that
other people would not be ableto get something out of.
I absolutely would welcome themlistening to it.
Speaker 1 (39:28):
Well, that is terrific, and thank you, Dr
Alina Christofides, and thanksto our listeners for tuning in
to our Speaking of Women'sHealth podcast.
We're really grateful for yoursupport and we hope that you'll
share it with others.
You can donate onspeakingofwomenshealthcom and
leave us a five-star rating and,to catch all the latest from us
(39:49):
on Speaking of Women's Health,subscribe or follow on Apple
Podcasts, Spotify, TuneIn orwherever you listen to podcasts.
It's free to subscribe and whenyou subscribe, you won't miss
future episodes, including whenI am hopefully able to get Dr
Christofides back in thesunflower house.
Remember, be strong, be healthyand be in charge.
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