July 9, 2025 • 50 mins
The pursuit of optimal health as we age requires more than just conventional medicine—it demands a deeper understanding of how our hormones, genetics, and metabolism interact. In this continuation of the conversation with Dr. Elena Christofides, Host Dr. Holly Thacker goes beyond the surface of women's health concerns to explore groundbreaking approaches that can literally change how we age.
Dr. Christofides reveals why comprehensive blood testing should include genetic markers that most physicians overlook. From MTHFR mutations affecting B vitamin metabolism to hemochromatosis genes common in those with Northern European ancestry, these hidden factors can dramatically impact metabolic health. Her revolutionary approach includes growth hormone screening for everyone—not just elite athletes—because deficiencies following head trauma (including domestic violence) affect one in five people and accelerate aging processes.
Throughout the conversation, Dr. Christofides and Dr. Thacker emphasize that what many dismiss as "normal aging" is often addressable with personalized medical approaches.
For anyone frustrated by unexplained weight gain, fatigue, poor sleep quality, or declining physical performance despite "normal" lab work, this episode offers hope and actionable insights.
To learn more about Dr. Elena Christofides, visit endocrinology-associates.com.
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Holly L. Thacker, MD (00:09):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, and I am back in our sunflower
house and we are going tocontinue a most interesting
podcast with a wonderful guest.
I'm so thrilled to have DrElena Christofides back on our
(00:33):
podcast to finish our discussionon everything women's health,
anti-aging and hormones.
I gave her very impressivebackground on our first podcast,
so I won't repeat all of that,other than to let our listeners
know that she's the founder ofEndocrinology Associates in
(00:55):
Columbus Ohio and she's aleading medical researcher and
physician on metabolism,diabetes and related processes.
So if you haven't had a chanceto listen to our first podcast
interview, I definitelyrecommend that you go back to
listen to that, because wetalked about how hormonal health
(01:17):
significantly impacts women'swell-being as they age and we
covered some of the commonhealth challenges that women
face, some potential treatmentsand especially the importance of
a personalized assessment tooptimize health through
lifestyle as well aspharmacologic measures.
(01:38):
So we are going to jump rightin and continue that
conversation.
Welcome, dr Christofides.
Going to jump right in andcontinue that conversation.
Welcome, dr.
Elena Christofides (01:45):
Christofides , Thank you.
Thank you so much for having meback on Dr Thacker.
This is such an honor.
Holly L. Thacker, MD (01:57):
Oh, it is so great to have you and you do
such great care of patients andI'm so interested in your
innovative practices and whatyou do to help patients make the
most of their life and theirlifespan.
Tell me what are some of thecommon blood tests?
Elena Christofides, MD (02:14):
or are there any special blood panels
that you recommend for yourpatients?
Yeah, we have actually a wholenew patient panel.
That's kind of automated in oursystem because most patients
tend to come with similarcomplaints, and then a few
extras, obviously, along the way.
But we do have a set panel, andso a lot of it is stuff that
you would think is obvious, likea complete blood count, a
chemistry panel, liver panel, etcetera.
(02:36):
But what's often misunderstoodabout doing these things all at
once is the relationshipsbetween different levels of your
complete panels.
Or your blood count actuallygives me a lot of insight around
.
You know what's the state ofbalance of your system, because,
yes, there's the normal ranges,but you and I both know those
(02:58):
don't really apply inendocrinology, you know.
So I I'm interested in howthings relate to each other, and
then things that I specificallydo that I've never seen anybody
else do are things like theMTHFR hormone or, sorry, the
enzyme pathway which looks atyour B vitamin metabolism.
I do do that genetic pathway.
I do a lot of hemochromatosisgenetic analyses as well,
(03:21):
because, you know, we're sosimilar.
Holly L. Thacker, MD (03:23):
We're so similar.
We're like two sisters fromanother mother.
Elena Christofides, MD (03:27):
You know , I feel like in the Midwest
especially, we have such a large, you know, northern European,
you know British Islespopulation and that's quite
common disease of thatpopulation and I feel like
doctors have stopped talkingabout it and so you have
generations of individuals whohave no idea that this is
(03:48):
happening and contributing rightto their liver disease and
their metabolic health.
And then obviously, the vitaminD.
I mean I think we talked aboutthis even on the last one, like
you got to get a vitamin D, yougot to know where people are.
But the other things that I doactually relate to the lipid
profile.
But the other things that I doactually relate to the lipid
profile I think people aregetting more aware of, like ApoB
(04:12):
levels and little, you know, lp, little A levels, which helped
me really understand you knowwhere someone's lipids are and
where they need to be, whetherwe're going to treat or not
treat.
I mean the point is kind ofneed to know what you're looking
at.
But I also, especially ifsomeone has a concern for lipids
, I also do an ApoE geneticscreen.
Holly L. Thacker, MD (04:29):
You don't think that's opening a can of
worms, do you?
Elena Christofides, MD (04:32):
Well, but they're there to open a can
of worms, Otherwise theywouldn't be seeing me.
Holly L. Thacker, MD (04:37):
I guess you're right.
I mean, I'm just curious, didyou have your ApoE genotype done
?
Elena Christofides, MD (04:45):
Yes, actually, my entire office staff
has done it.
I've done it, I've had myentire family, because we do
have dementia.
That runs in our family.
It runs in several familymembers of various employees and
a lot of patients are veryconcerned about dementia.
Oh very much so.
Holly L. Thacker, MD (05:02):
Very, very concerned.
Elena Christofides, MD (05:04):
And I think that it is an
underappreciated relationship.
I mean, medical researchdoesn't often move forward in a
very rapid progression or veryeven or consistent progression,
but I think that particular catis out of the bag around ApoE.
So if I have somebody who'scoming in particularly concerned
about lipids, I will do theAPOE genetic screening in
(05:26):
addition to a coronary calciumscore exam.
Yes, because I want to be ableto tell them okay, this is where
you are right now, this iswhere your genetics suggest you
might be going, and then let'slook at your family history and
assess what your risk is oftreating and not treating, or
what do we treat with?
Because that's also obviouslypart of the conversation.
So you know, I'm already doingthe MTHFR and the
(05:49):
hemochromatosis geneticscreening.
I don't feel like adding theAPOE is any more risky, because
you know that's still aprevention that people are
interested in.
And do we have good answers yet?
No, but we certainly have.
It's better to know and knowwhat you're working against
versus like wondering.
Holly L. Thacker, MD (06:10):
Now I previously got a lot of MTHFR
mutations and I know one of ourlead geneticists who was a top
scientist, unfortunatelyrecently passed, dr Karis Ang MD
.
Phd opinion was it's such acommon mutation, with half the
population having one defectivegene, that it really shouldn't
(06:31):
be done.
And I still did it because Ihave a hard time having people
do what I say and for the peoplethat are homozygous with two
mutations, they're going tooxidize their brain faster and
so for me to get them on themethylated vitamins.
But then I started to havepushback and insurance companies
would charge people like sevenor $800.
(06:51):
And so now I'm just kind oferring on anyone who's
interested in brain health,anyone who might have an
increased risk of blood clot orprior DVTs or miscarriages.
I'm just saying you need to beon methylated vitamins and in
one of my podcasts on brainaging where I went over some of
(07:12):
the research showing reductionsin brain atrophy and those that
are an acetylcysteine and themethylated vitamins and serifol
and NAC now over the counter asserifol and Brain Wellness that
I'm just so much more liberal atsaying let's just take this
vitamin.
So are you having insurancepushback?
Or also, what about peoplelong-term care if they have a
(07:34):
family history of dementia andthey're ApoE44, is that going to
make it harder for them, maybedown the road, to get disability
or to get long-term health careinsurance?
Elena Christofides, MD (07:48):
I mean that's a lot of great points and
great questions obviously thatneed to be taken into
consideration as part of thediscussion.
So let's talk about theinsurance and the pushback and
the coverage.
I have yet to have a lot ofpushback on that and I have not
had patients getting chargedthat kind of money.
Holly L. Thacker, MD (08:04):
Wow Great.
Elena Christofides, MD (08:05):
Which is great, and maybe just I'm lucky
.
But I will say that enoughpsychiatrists are doing it
through gene site testing andgetting the data.
Holly L. Thacker, MD (08:15):
either way , yes, yes, yes, that's
wonderful.
Elena Christofides, MD (08:18):
Right, and in addition, you get it with
any of the genetic tests like23andMe, ancestry, et cetera,
that people are also doing.
That's showing up on those aswell.
Holly L. Thacker, MD (08:29):
Is that as reliable?
Because I know that when wetalk about cancer genes we
always tell people recreationalgenetic testing, sorry, they
only test for a few genes andeven though 23andMe expanded it,
which I think they've justundergone chapter 11 or
something, so I don't knowwhat's going to happen with all
that data that I still feel likewhen I'm really concerned about
genetic problems, I want themto see a genetic counselor and
(08:52):
get official medical genetictesting, which is getting
cheaper every day.
Elena Christofides, MD (08:56):
Yeah, yeah, I mean you're absolutely
right.
I will say I have yet to find asingle inconsistency in the
23andMe genetic testing for thestuff I'm looking for, like
hemochromatosis and MTHFR, thoseare in there.
The APOE is in there.
So with one $200 test you getthree genetic markers that don't
(09:16):
enter into your medical record.
I sort of feel like they havebeen accurate enough and they
are outside the medical fieldenough that for patients who are
concerned about any sort ofbacklash, that's one way of
doing it and obviously withtheir Chapter 11 reorg that
could be potentially messy.
(09:36):
So I have that discussion.
That's obviously a discussionfor that individual patient.
Some patients are concerned,some patients aren't concerned.
Holly L. Thacker, MD (09:49):
And I haven't had that influence the
issue.
Yeah, it's so interesting interms of data.
My son, who I've had on thispodcast in fact one of my
patients the other day just saidhave him on again I really
enjoyed that and I know I'mgoing to have a lot of people
ask me to keep having you onregularly yourself, but he's a
PhD in molecular genetics andbasically in terms of some of
(10:10):
these discussions about you knowhow much is genes, how much is
an environment?
You know in terms of just costscoming down and how is it going
to influence everything.
It really can be a very thornyissue and there's so many
different aspects to it.
We've had a genetic counselorcome on and talk about the GINA
(10:32):
law and I personally think thatknowledge is power and I always
encourage my patients when youhave something done like gene
site analysis that tells you howyou metabolize psychiatric
medicines, pain medicines,whether you have this MTHFR
mutation, which is how youmetabolize B-complex vitamins,
(10:52):
that affects a lot of brainchemistries that you need to
keep records of it.
But the one discussion I've hadwith my son he did ancestry and
my other son did 23andMe andpeople find out you're related
to other people you didn't evenknow and find out you're related
to other people.
You didn't even know and findout you have other family
members that you didn't knowreally wasn't your grandfather.
(11:12):
It's crazy, but I justpersonally didn't like my
genetic information out there.
And he laughs at me and he saidanybody can get your genetic
information.
Mom, you suck on a straw andthere it is, and that's why when
you say it's outside themedical record so people can't
get it, I mean I just had my-.
Elena Christofides, MD (11:29):
Well, it's outside of the official
medical record.
So I don't disagree with yourson.
I think that I understand theconcerns, but it's not like
people are out there cloninghumans yet.
I think we've got a ways to go.
So you're right, you sip on astraw, you use a cup.
You know if somebody wantedyour genetic material they could
get it.
When I say outside the medicalrecord, I mean outside the
(11:50):
official medical record, becausethose are not part of the
official medical record.
Those are not in your medicalchart unless you choose them to
be.
The pre-existing conditionclauses were part of the ACH, so
you can't.
I mean the ACA Act did forbid,you know, discrimination against
(12:11):
prior knowledge andpre-existing conditions and
honestly, I haven't seen.
So let's also put it this wayIf people were doing perfectly
great and healthy, they wouldn'tbe in my office.
So I think that there's a rolefor this genetic testing.
Again, if you're doing great,congratulations.
Holly L. Thacker, MD (12:27):
I'm happy for you, like that's fine, those
people don't come see you andme.
I understand they're coming tosee me.
Elena Christofides, MD (12:33):
So if you're trying to optimize what
you're doing and trying tooptimize your health for
longevity, then these are thingsthat are important to your
longevity story.
But at the same time, when know, when you're filling out these
forms and you're filling out allthis documentation, they don't
believe it anyway.
So you're right, the medicalprofession tends to push back on
(12:54):
these as being irrelevant.
So, on the one hand, we're sortof protected right now due to
the ignorance of the profession,believing that these genetic
tests are not really valid orimportant, and I'm happy for
them to continue to think that23andMe is terrible and not
valid.
It's great, that's fine, letthem do that, because that means
that all this testing thatpeople are doing for their
health and for their longevityisn't going to be viewed as
(13:16):
being viable.
So that's fine, we'll get thedata and then use it to what we
need it to be used for, and thenlet it not be part of the
medical record.
Holly L. Thacker, MD (13:24):
I guess I'm just such a privacy hound
and I recently had my bankaccount hacked and money was
being transferred and one of mybanker sons was like well, mom,
you know all your passwords, allyour data, it's everywhere.
Elena Christofides, MD (13:38):
And so.
Holly L. Thacker, MD (13:39):
I do think that people should at least
respect their own personal dataand keep records, because it
shocks me Years ago when I wasin practice, people came all
organized with their files andnow everyone says, oh, just go
look online.
And all these computer systemsdon't always talk to each other.
But anyway, I want to talkabout part of your specialty and
(14:01):
your practice is growth hormonetesting and screening, and I
know that's very controversial.
So tell us what is growthhormone and what role you see.
Elena Christofides, MD (14:12):
Yeah, that's absolutely right that it
becomes controversial I thinkunfairly so.
So growth hormone, I thinkeveryone understands when you're
young, when you're a child, youneed it to fully realize your
adult height and in proportionwith puberty this reaches your
adult height.
This helps you grow tall, so itmakes your limbs grow longer,
(14:32):
right.
And then, once you're an adult,you need it to maintain
metabolic health and sort offill the spaces in between.
So it doesn't do.
You remember that oldcommercial back in the 80s with
BASF?
They were a chemical companyand they said you know, we don't
make X, we just make it better.
And they used to advertise onlike cassette tapes and all
(14:52):
kinds of manufactured goods.
And I'm clearly dating myself.
Holly L. Thacker, MD (14:55):
You're dating yourself, doctor, and you
look so young.
Elena Christofides, MD (14:59):
Clearly dating myself, but I always
loved that commercial.
Because growth hormone, youknow, it doesn't make you lose
weight but it makes you fitter.
It doesn't make you hearthealthier but it makes your
heart happier and mental health,et cetera.
It does many, many things.
So it maintains stability ofmood, it maintains metabolic
(15:19):
health and, you know, improvesinsulin sensitivity.
It improves muscle function andmuscle strength and muscle
conditioning.
It improves healing, itimproves recovery, especially of
the soft tissues, and it is acritical hormone as we age to
stave off the aging process.
Now, unfortunately, yes, toomuch of a good thing is bad.
(15:42):
Growth hormone has to beregulated and it has a very
clear sort of zone of no-go interms of when you're treating
and when you're replacing andwhen you're managing it where
you don't want to be, because itdoes have consequences when
it's too high.
But what's interesting aboutgrowth hormone is that, you know
, one in five head traumas canproduce adult onset growth
(16:04):
hormone deficiency.
So whiplash, car accidents,sports injuries, concussions and
repeated head injuries.
And let's not ignore the factthat many people might be in a
physically abusive relationship.
Holly L. Thacker, MD (16:18):
Oh yes, we had a podcast on domestic
violence, intimate partnerviolence.
Elena Christofides, MD (16:22):
That's a good point.
Holly L. Thacker, MD (16:23):
I didn't even think to put those two
together.
Elena Christofides, MD (16:26):
Well, I mean, this is a question that I
ask when I'm looking, so I alsoyou were asking me.
Part of my routine screeninglabs is I routinely screen IGF-1
as well.
So an IGF-1 is a screening tool.
It's not a diagnostic tool, butit's a screening tool that
gives us an idea ofdirectionality of your growth
hormone and if it looks out ofbalance with where I really want
it to be, then I might suggesta growth hormone STEM test.
(16:46):
But I'm going to do a historyand when I take the history, I'm
asking specifically about headtrauma and I'm asking about
partner violence.
I'm asking about domestic abuseand obviously I try to make it a
very safe space for people totalk about it, and I'm always
surprised at how much domesticabuse occurs, whether it's from
childhood and it's justcumulative over the years, and
(17:11):
it may not be happening to anadult today, but it may have
happened in their life and I'vehad people tell me, you know,
that they were thrown out ofwindows as children and
repeatedly abused and, you know,thrown out of moving vehicles
and these are things that cancause lifelong trauma to the
poor little pituitary gland.
So, growth hormone the reasonit's so controversial is because
it's such a hormone of abuse.
If it didn't work, the athleteswouldn't all be using it.
(17:34):
So my philosophy is, though butanything is a hormone of abuse
if you let it be.
Everything can be abused in thewrong hands and in the wrong
understanding, and when peoplepush back on that, the next
thing I push back in is I saywell, you know, bodybuilders and
athletes also take insulin as agrowth hormone, because insulin
(17:55):
is also a growth hormone.
Holly L. Thacker, MD (17:56):
Oh, it, sure is.
Elena Christofides, MD (17:57):
Right.
So they also take insulin intheir recovery and in their you
know bodybuilding world.
So are we going to ban insulinnow because somebody is abusing
it?
So the absurdity of theargument that we shouldn't look
at it because it's a drug ofabuse has always irked me.
Because if you have growthhormone deficiency, you age
(18:18):
faster, you have a shorter lifeexpectancy, you are more insulin
resistant, you have moremetabolic ill health, you are
higher in your lipid values, youare higher blood pressure,
you're more likely to bedeveloping premature coronary
disease, more likely to havepoor recovery, and so you're
going to last at the gym longer,you're not going to be as fit.
(18:41):
So there are significant reasonswhy someone might want to
replace their growth hormone ifit's deficient, if they're
interested in maintaining youknow well health into their
older years.
Not just it's not going to turnyou into an elite athlete.
And here's the other, the otherpart that kills me on this one.
You know you could give me allthe elite athlete drugs in the
world you want.
It's not going to turn me intoan elite athlete.
I just don't have the geneticsfor it.
(19:02):
I don't have the physique forit Me either, right Like I.
I used to joke all the timeabout that that I these are
things that enhance what youhave in, you know in genetically
, what you're doing physically.
But if you are someone and oneof my favorite you know stories
is I have a patient who was atriathlete and he was noticing
(19:25):
significant drop-offs of histime and his performance, and we
went through and I'll be damnedif he didn't have
hemochromatosis and MTHFR andgrowth hormone deficiency all
three.
So of course, by the time hewas the age that he was when he
came to me, these threeconditions had cumulatively led
to a significant drop-off of hisperformance.
(19:48):
Not that any one did it right,it's not any one thing that did
it.
It's the fact that he had aseries of things that were
cumulatively leading to likedeclining performance.
So we fixed all these things,fixed his nutrition, got him a
CGM.
You know we're tracking hisnutrition, tracking his glucoses
, teaching him about nutrition,which I know we're going to talk
(20:09):
about later, cgm is continuousglucose monitoring.
Holly L. Thacker, MD (20:12):
for our listeners, yes, exactly, thank
you.
Elena Christofides, MD (20:13):
Yes, and you know his performance
improved.
He was able to use the data toimprove his weight, improve his
diet, improve his lifestyle.
He used, you know, the data tohelp him improve his fitness and
his training performance.
And you know we just gave himenough to make him back into
like his normal, what would behis normal range for his age.
And obviously I'm not one ofthose clinics that just gives
(20:36):
people like these ridiculousdoses and doesn't care about
their levels.
I track their levels.
I track their, you know.
I track their blood count tomake sure they're not, we're not
making them polycythemic.
I track their vitamin levels,make sure they're not being
toxic.
I mean, there are, there areways to do this safely and
appropriately.
And so now he's back toperforming at the level that he
wishes to be performing at.
Holly L. Thacker, MD (20:56):
That's an interesting story about
hemochromatosis because you know, as many of my listeners know,
I run the Center for SpecializedWomen's Health and I was
boarded in internal medicine,going to be a cardiologist, got
extra training in endocrinologyand gynecology and female
hormones and osteoporosis andjust kind of interdisciplinary
women's health.
But one of the things thathelped put me on the map early
on in my institution was therewas this executive who had all
(21:19):
these problems and went frominternist to cardiologist to
gastroenterologist.
No one could figure out whatwas wrong with them.
So I get a call from the CEOsaying you got to figure out
what's wrong with this guy?
I'm like okay, he hadhemochromatosis and so that got
me immediate respect, so thatwhen I went to the CEO to say,
(21:40):
hey, I got to build somethingthat's different than what we
have that really can help women,I mean I had an open door
because of that diagnosticrespect.
So, yeah, and I think that-.
Elena Christofides, MD (21:52):
So kudos to you for that.
I mean, my son calls it likebeing Dr House, but the nice
version, not the mean version.
And that's what I always saytoo, because at the end of the
day, these diseases of geneticsand genetic inheritances, they
take a while to show up.
Yes, and unfortunately, that'salso the time when, you know, we
start to get a little gaslit,along with the providers of, in
(22:15):
our forties and our fifties of,well, you know, that's just
aging.
Well, no, some people are agingfaster than others.
Holly L. Thacker, MD (22:21):
Oh, definitely, Definitely.
So who?
Who are the people that you getthe growth hormone screening on
?
Elena Christofides, MD (22:30):
So every patient who comes through my
door it's part of the newpatient panel we do an IGF-1 on
everybody because the vastmajority of people coming in
have complaints that areconsistent with growth hormone
deficiency as well right Fatigue, difficulty sleeping, gaining
weight around the middle.
Their gym performance isdropping off, so it is part of
(22:50):
my routine piano and you'd besurprised at how many acromegaly
patients we've also foundscreening that way.
And acromegaly is a disease ofexcess growth hormone when it's
produced by a tumor in thepituitary gland and it leads to
significant deformities physicaldeformities as well, as, you
know, medical conditions.
Holly L. Thacker, MD (23:11):
And increased cancer rate.
Yes, exactly, yes, I have had afew in my practice.
Elena Christofides, MD (23:16):
So we have a bit of a reputation in
the pituitary world that all ofour acromegaly patients have
what we call microadenomas, orsmall tumors that are curable
when surgery.
Because we seem to find them soearly, because we're not
waiting until they're 20, 30years on with these symptoms
before somebody is checking thislevel and discovering that they
have quite a large tumor thatis no longer perfectly curable
(23:38):
with surgery.
So it's just part of ourroutine panel now the IGF-1.
And if it's out of range?
Now here's the thing about outof range is that the range is
quite large.
So I will recommend a growthhormone testing protocol which
is a little bit more in depththan an IGF-1 for anybody that
(23:58):
is below the mean and this is animportant distinction because
men and women have differentranges of normal and it's quite
broad.
It's quite broad in range andwe know epidemiologically in
healthy populations that theIGF-1 should be about mean to
about one standard deviationabove the mean.
It's about where the normalrange really is.
(24:19):
The range that's reported onthe lab is the mean plus or
minus two standard deviationsand that's the actual range.
So if you look at the rangeit's kind of misleading because
it actually catches the hypogrowth hormone patients or the
low growth hormone patients.
So I look for it to be mean, tojust you know between the mean
(24:41):
and the upper range.
And if it's not there, then Irecommend growth hormone stem
testing.
Holly L. Thacker, MD (24:47):
Very interesting.
You know you were talking aboutthe metabolic syndrome and
you've been listening to theSpeaking of Women's Health
podcast.
I'm your host, Dr Holly Thacker, the executive director of our
nonprofit Speaking of Women'sHealth, and I am speaking with
endocrinology, metabolic expert,anti-aging expert, Dr Elena
Christofides, who has a practicein Columbus, Ohio, and you were
(25:10):
mentioning this fatigue andweight gain, muffin belly around
the belly, poor sleep, I mean.
I hear this, of course, everyday, and I was remarking to my
specialized women's healthfellows who do a two-year
additional fellowship with meafter their initial board
certification in their primaryspecialty certification in their
(25:33):
primary specialty, that when Istarted in this field it was
like easy and fun, because therewasn't like the negative
connotations about hormonetherapy, which we've finally now
gotten past that almost 23years later post Women's Health
Initiative.
So that part's good.
But what's also harder about itis like when I saw women,
initially they had classicmenopausal symptoms hot flashes,
(25:54):
night sweats, maybe poor sleep,dry vagina plus minus bone loss
.
Now the women I'm seeing, theyhave all those symptoms plus
they have so much more and theyhave metabolic syndrome.
I mean I rarely saw a patientwith type two diabetes or a
woman with central adiposity inmy practice, which was a
(26:14):
referral center when I startedin this field.
Now it's unusual for me to seea thin woman.
So I've done podcasts on ourfood supply and all these
substances that are poisoning us, that are not allowed in other
countries, but it just seemslike the prevalence of metabolic
syndrome is out of control.
And I've, as part of my lipidprofile and LP, little a and
(26:37):
inflammation markers and I'mpretty pretty frequent and lax
to say, yeah, go ahead and get acoronary calcium score,
although I will say some women'shealth cardiologists say you
can't exclude, you know, softfatty plaques.
But since I try to keep womenoff of statins because they
increase diabetes and they don'thave any primary prevention and
(26:58):
everybody wants to put statinsin the water, you know and I
think that's pushed too much.
I mean, cholesterol is neededfor hormones and brain
metabolism and I think we'vegotten too far off on the statin
issue.
But I've been getting omega fatratios.
Are you including that in yourpanel?
And hardly anyone I see isnormal.
The only normal people areeither eating fish four times a
(27:20):
week, not twice a week.
Elena Christofides, MD (27:23):
Yeah, oh no, absolutely.
So we had previously a reallyexcellent lab for doing the
omega ratios and I really reallyloved the lab, and
unfortunately they are no longerin existence, so it has been
difficult for us to find a labthat I can trust for their
omegas.
But you are absolutely correct.
I mean, omega is a huge problem.
When you talk about the foodsupply, omega is one of the
(27:45):
biggest gaps in food supplyhealth that we have compared to
the rest of the world, and it isan interesting problem.
I typically just recommend thisis a funny one.
This is actually where I justusually recommend
supplementation over evenscreening, because no one gets
enough omega-3s in this countryin their diet regardless.
(28:05):
And you, you know aninteresting point.
I'm going to actually bringsomething up because I know
we're talking about a little bitabout nutrition.
A funny little story Did yourealize that grass-fed beef and
bison have more omega-3 fattyacids per ounce than seafood?
Holly L. Thacker, MD (28:23):
No, I didn't know compared to seafood
and I thought, like mackerel andtuna, I had mackerel for lunch.
I'm going to have sea basstonight for dinner.
Elena Christofides, MD (28:31):
For our patients, though for our
patients who are not interestedin seafood or are concerned
about their seafood supply,because that's also a real issue
overfishing of our oceans, Imean, and that's the case, then
I just ask them to look at, makesure they're doing grass-fed
beef and bison and wild gamewhich has plenty of omega-3s in
it, and grass-fed beef inparticular, and grass-fed milk,
(28:54):
grass-fed butter you know thoseproducts.
Grass-fed cheese you've alreadygot a higher concentration of
the omega-3 fatty acids.
Holly L. Thacker, MD (29:03):
Yeah, I pretty much switched over to
most grass-fed products.
It's more expensive, that's forsure.
You have to be, you know,careful that that's what you're
really getting.
Elena Christofides, MD (29:16):
Yeah, you can make up more of that
difference though with, like, ifyou're doing the butter as well
as the cheese and the milk.
Right, and the cream, so it'sincremental benefit.
Right, it's incremental.
Holly L. Thacker, MD (29:26):
Yeah, and I always recommend to my
patients to get the omega-3 eggs.
And of course eggs were so highpriced because they were
killing all the hens, but nowthey're coming down a little bit
.
But if they feed the chickensflax, that's another non-seafood
source.
The only reason I bristle alittle bit about saying just
take a supplement is becauseweight is every woman's concern
(29:47):
pretty much and all I had to dois eat a big apple 300 calories
for six months to gain 25 poundsand have a baby in six months.
And there's extra calories insome of these supplements and I
just personally would rather beenjoying my calories than
swallowing them?
Elena Christofides, MD (30:04):
Sure, because you have to keep
restricting the calories you'reeating the older you get.
Well, so well.
This may blow your mind.
I never have my patientsrestrict calories.
Holly L. Thacker, MD (30:15):
Really.
Elena Christofides, MD (30:16):
Yeah, so the calorie cult is not a cult
that I belong to.
Fat is your friend, not yourenemy.
Holly L. Thacker, MD (30:24):
Yes, yes, protein is critical, right, I'm
definitely in that.
There's no essentialcarbohydrate, is my little
saying Exactly.
Elena Christofides, MD (30:30):
So I would rather someone get their
omega-3s, whether it's asupplement or a food, and I
don't disagree.
Obviously I would rather youenjoy your food as well.
But again that becomes a costissue.
That can become a lifestyleissue, An allergy yes.
Yeah, and a family issue, right,If I'm cooking for my household
(30:51):
, where I have two 25-year-oldsthat are athletes, we can go
through two five-pound brisketsin one dinner.
That gets expensive, and so Iunderstand that.
I understand that people arelike well, I have feeding a
large family.
I can't buy a 10 pound you knowgrass fed brisket for my, my
family.
That gets really expensive.
So I understand that.
Holly L. Thacker, MD (31:11):
So I guess I've gone to give a giving-fed
beef as like a birthday gift tomy older son.
It was unfortunately deliveredto his next door neighbor, a
Browns player, who somehowthought his name was Stetson,
even though there's no Stetsonson the Browns team.
So I had to order another one.
Elena Christofides, MD (31:28):
Yeah, no .
So it is always a funny thingin the summer when the boys are
doing the triathlete trainingsand they're doing their races,
you know, and I, one night I wonfarmer's market and I get I
tend to get a lot of it from thefarmer's market because I want
to support our farmers, I wantto support direct purchasing, I
want to support local, localproduce and I can talk to the
farmer and know what they'redoing and I know where they're
raising their, their cattle, andI know how they're, you know,
(31:55):
doing.
It's sustainable, ethicalfarming, right?
That's what I'm trying to relyon and I'll never forget that.
One Sunday I thought I was goingto make extra and have some for
the week and I put these twobriskets on the grill and, by
God, I didn't barely get themoff the grill before they were
gone and I thought, okay, well,you know, this is maybe not the
wisest strategy for when theboys are in training.
So, with that being said, Idon't disagree with your point
about the calories, I don'tdisagree with your point about
(32:15):
the supplements, and I wouldrather you know better eating
better, living better, betterfocus on our nutrition and
making those calories count,making our food count, because I
, too, love mackerel andsardines.
I mean, I have canned mackereland canned sardines around all
the time and I'm constantlyfighting with the cat when I
have to open them.
So I'm always, always takingthem to my office and eating
(32:36):
them in secret, so the catdoesn't, you know, try to steal
my mackerel.
But but at the same time, Ialso appreciate that if you're
dealing with somebody whosehealth has already been damaged,
then we have to deploy everytool in our toolbox, and that's
one that I'm willing to take thehit on yeah, and what foods and
vitamins um legitimatelysupport a good metabolism in?
(32:57):
particular, yeah.
So I'm going to talk about themin terms of vitamins and then
we'll talk about the foods thatsupport that or the things that
support that.
So omega-3s we've alreadytalked about hugely important
for reducing metabolic syndrome,improving glucose metabolism,
improving vascular reactivity,which lowers blood pressure and
of course improves clotting risk.
So it lowers clotting risk anddecreases atherosclerotic
(33:20):
reactivity, so hugelystabilizing.
And we just talked about thefood sources where you can get
more omega-3s in addition to thesupplement.
I mean you and I have talkedabout vitamin D, I think till
the sun goes down, I meanvitamin D, vitamin D, vitamin D,
vitamin D.
Vitamin D is the first step inmetabolism to every hormone in
(33:41):
the body.
Holly L. Thacker, MD (33:42):
Yes, yes, yes.
Elena Christofides, MD (33:42):
Every hormone, including your lipid
metabolism.
True epidemiologic normals are65 to 85, not what the lab says
Exactly.
Holly L. Thacker, MD (33:49):
If I have another patient tell me that
their primary care doctor toldthem to stop their vitamin D
because it was 87.
I want to pull my hair out.
Elena Christofides, MD (33:59):
I think I turn into the exorcist when
this happens and my head startstwitching and I think I'm going
to start spewing.
I mean, it's so prevalent, it'sdisgusting.
I don't disagree, and so Iagree.
Vitamin D 65 to 85 is theepidemiologic range.
What's the consequence of toomuch vitamin D?
Nothing If it's the inactiveform, because your body will
(34:20):
regulate how much it needs toconvert from the inactive to the
active, and so even drifting upto a hundred is fine.
This is cholecalciferol we'retalking about, which is a white
powder, capsule.
White powder that you purchasefrom special suppliers, like
certain vitamin shops.
Like I do not let my patientsgo to CVS, target, walgreens,
(34:43):
meijer, costco, walmart, becausethose are not high quality
versions of vitamin D, becausevitamin D is so sensitive to
this process of manufacture.
Holly L. Thacker, MD (34:54):
Do you routinely add K2 to it if your
patients aren't eating Japanesenatto or food?
Elena Christofides, MD (34:59):
rich sources.
No, I don't actually, I havenot found that.
Holly L. Thacker, MD (35:03):
Yeah, I know it's back and forth.
I've seen improvements in bonedensity and since there's some
epidemiologic research thatshows more coronary
calcifications with increasedcalcium or vitamin D intake, I
figure I want the calcium in thebone and M7 or K2 helps drive
that.
It has nothing to do with bloodclotting.
Elena Christofides, (35:22):
Completely agree with you.
I mean, if somebody wants totake it, I have no objections.
I just don't proactivelyprescribe.
You are absolutely right aboutthe calcium increasing the risk
of vascular disease andatherosclerotic disease and I
think my personal opinion isthat correlative data is related
to the fact that in the studythese people were all vitamin D
(35:42):
deficient and in the absence ofvitamin D you don't have the
co-factor to take calcium intothe bones.
Holly L. Thacker, MD (35:50):
Yes.
Elena Christofides, MD (35:51):
So because you have to have the two
together to go into the bones,otherwise the calcium is free
floating the two together to gointo the bones, otherwise the
calcium is free floating and hasnowhere to go.
So with the vitamin d there'sonly a few brands and they're
available on my website in termsof links to amazon, just the
brands that I've seen that workbecause, so many brands don't
work.
And this is not a prescription.
You cannot get a prescription.
Holly L. Thacker, MD (36:09):
Vitamin d I know I tell patients the
non-prescription is actuallybetter than the d2 prescription
yeah, because the d2prescription is the active form.
Elena Christofides, MD (36:16):
You can get toxic on it and that's not
what your body needs In theworld of endocrinology.
What's really not understoodsometimes is the world of
endocrinology.
Your body needs the inactiveform of the hormone in order to
be able to convert it to theactive form, in order to do the
job of the hormone.
Sure, so that's the same thingwith T4 and T3.
We give T4 because your body'ssupposed to convert to T3.
(36:39):
Now, obviously we know somepeople don't convert.
Well, we have to supplement andthat's fine.
Holly L. Thacker, MD (36:45):
What percent of your patients do you
have on T3?
Because I know a lot of ourendocrinologists are resistant
to using T3, and I think I haveabout 5% of my women patients.
Elena Christofides, MD (36:51):
Oh no, it's probably closer to 50% for
me, for you, wow.
Holly L. Thacker, MD (36:54):
Wow, you probably see tougher cases.
There was a big.
Elena Christofides, MD (36:56):
Well, actually there was a big series
of patient evaluation, bigseries done and presented at the
ADA American DiabetesAssociation meeting a few years
ago that showed that there was ahigher likelihood of T4 to T3
conversion disorders geneticallyin patients with more obesity.
Okay, yeah, so if I havesomebody, who has thyroid.
Holly L. Thacker, MD (37:17):
So if someone's obese, that would be.
Elena Christofides, MD (37:19):
Yeah.
So if I have a thyroid patientwho also happens to have obesity
, or I have a thyroid patientwho also has a leather
autoimmune diseases, they tendto do better with a combination.
Now I obviously prescribe themseparate.
So, with that being said, therule in endocrinology in general
is you need the inactive formto be plentiful in order to
convert it to the active form todo its job.
(37:41):
And this is why the vitamin Dstory is such a complicated one,
because the prescriptionvitamin D version is the active
form that we give in cases wherethey cannot convert to the
active form, like in kidneyfailure and other situations.
And that one, the green, it's ablue-green gelatin capsule.
The minute somebody says, oh,my doctor gave me a prescription
, said I only need to do thisfor a few weeks and we'll be
(38:03):
done, and my question is alwaysis it blue-green or white?
Because if it's white it'sright, so if it's blue-green,
it's wrong.
Now vitamin D.
Interestingly, I've had quite afew patients over the years
who've been very um unable totolerate vitamin D
supplementation for a variety ofreasons.
Usually, they have some sort ofsevere GI disturbance, and so I
(38:25):
do recommend um tanning fiveminutes a day in just the UVB.
And they don't.
They're just five minutes.
They don't even get tan, theydon't no color changes.
Obviously they do it withoutsunscreen on and we do it until
their vitamin D levels get up toa decent level, like say above,
you know, 50, 55.
And then somehow they're ableto better tolerate more low dose
(38:48):
, consistent vitamin D dosing atthat point.
Holly L. Thacker, M (38:50):
Interesting .
I have used the vitamin D lampin some difficult patients.
Yeah, Moving on to longevitytreatments, kind of tell us
what's the hype and what's realwith some of the anti-aging
medicines fasting, and I'm veryinterested in the peptides and
what you do for mitochondrialsupport.
Elena Christofides, MD (39:07):
Yeah, a big topic, right.
So what's very real is mTORinhibition.
Mtor inhibition is amitochondrial function.
That's where all the anti-agingwork is being done.
It's already been shown to betrue in multiple animal species
other than human, like dogs,cats, mice, et cetera.
So I think that there'sactually supposed to be an
(39:30):
approval here coming soon forextending the life expectancy of
dogs for the same reason.
So what inhibits mTOR?
Well, that's sirolimus, that'slow-dose naltrexone and that's
metformin.
I will tell you I absolutely donot want to use metformin in
anybody because of the B12deficiency issues that you can
exacerbate with metformin.
(39:50):
And given that everyone isMTHFR deficient, you're adding,
you're dogpiling that.
So I don't like the idea ofmetformin for a lot of people.
Obviously, if you're talkingabout diabetics, we do know that
that has decreased cancer riskand decreased cardiovascular
risk in diabetics.
So sometimes we use it, but notalways.
Low-dose naltrexone is quiteeffective on a daily basis for
(40:12):
anti-inflammation and people whohave aging issues due to
inflammation, like chronicinflammatory diseases.
Holly L. Thacker, MD (40:17):
I have a few patients who just swear by
it.
Elena Christofides, MD (40:19):
Yeah, I mean I have a few patients who
also swear by it.
Not a lot, it's a fewmilligrams, it's not a lot dose.
Holly L. Thacker, MD (40:24):
Right Very tiny.
Elena Christofides, MD (40:26):
It also forms the foundation of one of
our most successful oralanti-obesity medications.
Contrave Contrave with bupropionhas naltrexone in it with
bupropion, and very effective inthose individuals as well.
And then, of course, serolimusis the big one, right, serolimus
is the big guy.
Small doses, weekly doses, hasbeen revolutionary for my
(40:48):
patients who have unexplained,undifferentiated chronic illness
of an inflammatory nature thatwe can't quite figure out what
it is.
They've been to rheumatology,they've been everywhere and
they're just inflamed.
They're metabolically unhealthy.
You can see their lipids, theirtriglycerides are high, their
HDL is low, their blood pressure.
They're just metabolicallyterrible and we can't figure out
(41:09):
why.
So we'll do a 12 week trial andI and I will tell you, in some
cases it has been miraculous.
Holly L. Thacker, MD (41:16):
I think there's a few people I need to
send to Columbus to see you thatkind of fit, that profile.
You know, speaking of mTOR andrapamycin, there's very few
situations from my perspectiveas a menopause expert that I
cannot give estrogen or hormonetherapy for right.
Because there's very few thingsthat we just reduce all
estrogen.
So one of them islethangiomyomatosis LAM, and
(41:39):
I've only ever had a couple ofcases in my career, and so I saw
a woman the other day that wastold by her pulmonologist to
stop hormone therapy and I said,okay, well, we'll see if by
stopping you got any better oryou stopped the progression,
because I wasn't reallyconvinced.
But she said, well, this iswhat's recommended, and she
brought out the information andapparently they're using
(42:01):
rapamycin for lamb, which Ithought was very interesting.
That is interesting, so I toldher don't don't don't be
hesitant to take it, and maybethat might potentially open the
door for us.
Elena Christofides, MD (42:12):
I completely agree.
I don't hesitate to use it atall as a trial because it's not.
It's really low doses.
You know the doses that we usein transplant medicine are
hundreds of milligrams daily.
We're talking about under 10milligrams once a week, so
fractions of the doses.
And you know some patientscan't tolerate it.
I've had a couple of people whocouldn't tolerate it and that's
fine.
But you don't know until youtry.
But in those circumstances, forthose people who don't tolerate
(42:36):
that, who don't tolerate theother therapies, then we go into
the mitochondrial supportpeptides, which are things like
NAD, methyl blue.
Holly L. Thacker, MD (42:44):
Do you do those by infusions, because I
know you were saying that oralNADH doesn't really have very
good absorption.
Elena Christofides, MD (42:49):
Yeah, oral NAD can't be absorbed.
It's broken down in the gut andthen you can try taking NMN,
but I don't I think the data isstill kind of suspect on that in
terms of whether you actuallyget good absorption.
So we do it by infusion.
We have it by infusion and thenobviously you've got the BPCs
for the joint soft tissuesupport for people who have
acute injuries, and then you'vegot the growth hormone style
(43:12):
peptides, like you knowsemorelin, tesamorelin, et
cetera, ipamorelin that are likegrowth hormone but not they
help, they balance growthhormone.
The better way to explain it forthe audience I'm trying to not
explain it in a reallyconvoluted way they're basically
the peptides, that sort ofsignal growth hormone.
So these are effective inpeople who have growth hormone
(43:34):
but just want to optimize theirgrowth hormone signaling.
So these are.
These are effective in peoplewho have growth hormone but just
want to optimize their growthhormone signaling pathways to
get full advantage of theirgrowth hormone.
Those don't have much efficacyin people who actually have
growth hormone deficiency,because you need an intact
growth hormone access for thoseto work.
So that's why we do such aaggressive job of screening for
growth hormone, because ifsomebody has actual growth
(43:56):
hormone deficiency and they wantto take some, you know,
semirelin, tesamorelin,ipamorelin.
It isn't going to work.
So I'm trying to save them somemoney and time on that regard,
if that's the path that theywant to take.
Holly L. Thacker, MD (44:09):
And how do you use methylene blue?
Elena Christofides, MD (44:12):
So methylene blue is a methyl donor
, so it works like in the MTHFRfamily, right?
So if you have people who haveMTHFR abnormalities, let's say
they don't tolerate some of themethyl B complexes.
I've had a few people who got alot of anxiety from the methyl
B complex vitamins, and so wewere using the methylene blue
instead to try to give themtheir methyl donor groups and
(44:32):
bypass their need for the largedoses of methyl B-complex.
Holly L. Thacker, MD (44:36):
That's interesting.
The only trouble I've gotteninto with really high dose
L-methylfolate of course Ialways make sure that the B12 is
fine and that they're usuallyon methylated B12, is because it
increases serotonin and ofcourse the psychiatrists use it
in high doses for depression.
I've had some people tell methat they can't sexually climax.
It's like they have too muchserotonin on board by pushing it
(44:58):
up too much.
Interesting.
Elena Christofides, MD (45:00):
Yeah, it's only been a couple of
people and I figured that's thething.
Holly L. Thacker, MD (45:03):
So moving into depression and anxiety and
PTSD as we wrap up and againwe're going to have to have you
back again because you're justso wonderful and delicious.
Are you doing ketamineinfusions?
I know there's like a whole lotout in the space about
psychedelics and infusions andother more novel treatments for
mood disorders.
Elena Christofides, (45:23):
Absolutely .
Ketamine has again.
It's been.
I say this and it seems like Imay be just hyperbole, but
ketamine, like some of the otherthings that we've been doing,
has also been equally groundshaking, revolutionary for the
patients who we've been doing,has also been equally
ground-shaking, revolutionaryfor the patients who we've been
doing it for.
So we don't do infusions, we dointramuscular injections.
I feel like infusions areentirely too medicinal, medical,
(45:45):
anxiety-inducing on their own,because you have to have an IV
in place.
You have to make sure that it'sgetting a continuous infusion.
If the patient freaks out or isconcerned or isn't getting a
good dose, it medicalizes theprocedure.
It makes it harder for thepatient to have a good
experience.
So we work with ourpsychiatrists and our therapists
in town and we do an intakereview with the patient.
(46:08):
We make sure that they'reappropriate.
We do prefer to do it forpeople who already are seeking
counseling and therapy.
So we have a partner inpsychotherapy.
Holly L. Thacker, MD (46:16):
Sure, that's so important.
Elena Christofides, MD (46:17):
Yeah, because they're coming to us for
PTSD, for depression, foranxiety, for trauma, for
recovery, and we don't want tohinder their recovery by only
doing the medical part.
There needs to be a psychiatricpart, a therapy part as a
psychotherapy component.
So we do the intramuscularinjections.
They are medically monitoredand my nurse practitioner is in
the room with them the wholetime and so they're babysat, so
(46:40):
to speak, and we have a protocolwhere we do it twice a week for
three weeks for acute therapy.
If somebody has an acute event,so like if they're feeling
quite depressed, maybe they'rehaving, maybe it's an
anniversary, you know, that isinducing the PTSD.
So, especially for veterans,maybe it's an anniversary of,
you know, their injury in thefield, or an anniversary of a
(47:00):
colleague's suicide or somethingof that nature, or anniversary
of somebody who was maybeabducted or abused.
Around anniversary times inparticular, sometimes people can
get a real heightened responseright of their PTSD.
So we'll do it twice a week forlike three weeks and then we'll
do maintenance therapy afterthat.
Whether it's, you know, they.
They transition slowly.
Some people go to once a weekfor a while, then they go to
(47:22):
monthly, other people just gostraight to monthly, some people
just do it kind of PRN asneeded, based on you know how
they're feeling.
We do try to combine it withfasting because, as you were
mentioning earlier, fasting isthe best way to inhibit mTOR and
to improve aging, doing aroutine fasting.
So I try to do at least one, ifnot two, 72 hour fasts a month,
(47:46):
and that usually means that'sgood.
Holly L. Thacker, MD (47:48):
I can only make it 22 hours, and then that
migraine comes.
Elena Christofides, MD (47:51):
Yeah Well, so a lot of that's
hydration.
I will do electrolytessometimes during it.
I try to do it when I'mtraveling because it's easier
when I'm in a hotel and I'm not.
You know, my snack foods arenot right here beside me, and so
I'll typically, you know, fastlike Wednesday, Thursday, Friday
, and then go to the gym onSaturday when I return from my
travels and then and then resumeeating on Saturday.
So I do try to combine thefasting with the ketamine and I
(48:14):
find that that gets really greatresults.
Mental health wise, try to getthem to fast the day of the
ketamine and maybe even the dayafter the ketamine, and so they
at least get a 48 hour fast, ifthey can do it more on the
routine patients rather than theones who are coming in twice a
week.
That would be too much fastingto do it for 48.
Holly L. Thacker, MD (48:29):
Well, thank you so much, dr Chris
DeFetes, for joining us on theSpeaking of Women's Health
podcast, and thanks to ourlisteners for tuning in.
We're so grateful for yoursupport and we hope that you
consider sharing this podcastwith others.
You can donate to our nonprofitspeakingofwomenshealthcom and
(48:50):
leave us a five-star rating, andto catch all the latest from us
, you can subscribe on Spotify,tune in Apple Podcast and it's
completely free.
Thanks again for listening andwe'll see you again next time in
the Sunflower 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 am back in our sunflower
house and we are going tocontinue a most interesting
podcast with a wonderful guest.
I'm so thrilled to have DrElena Christofides back on our
(00:33):
podcast to finish our discussionon everything women's health,
anti-aging and hormones.
I gave her very impressivebackground on our first podcast,
so I won't repeat all of that,other than to let our listeners
know that she's the founder ofEndocrinology Associates in
(00:55):
Columbus Ohio and she's aleading medical researcher and
physician on metabolism,diabetes and related processes.
So if you haven't had a chanceto listen to our first podcast
interview, I definitelyrecommend that you go back to
listen to that, because wetalked about how hormonal health
(01:17):
significantly impacts women'swell-being as they age and we
covered some of the commonhealth challenges that women
face, some potential treatmentsand especially the importance of
a personalized assessment tooptimize health through
lifestyle as well aspharmacologic measures.
(01:38):
So we are going to jump rightin and continue that
conversation.
Welcome, dr Christofides.
Going to jump right in andcontinue that conversation.
Welcome, dr.
Elena Christofides (01:45):
Christofides , Thank you.
Thank you so much for having meback on Dr Thacker.
This is such an honor.
Holly L. Thacker, MD (01:57):
Oh, it is so great to have you and you do
such great care of patients andI'm so interested in your
innovative practices and whatyou do to help patients make the
most of their life and theirlifespan.
Tell me what are some of thecommon blood tests?
Elena Christofides, MD (02:14):
or are there any special blood panels
that you recommend for yourpatients?
Yeah, we have actually a wholenew patient panel.
That's kind of automated in oursystem because most patients
tend to come with similarcomplaints, and then a few
extras, obviously, along the way.
But we do have a set panel, andso a lot of it is stuff that
you would think is obvious, likea complete blood count, a
chemistry panel, liver panel, etcetera.
(02:36):
But what's often misunderstoodabout doing these things all at
once is the relationshipsbetween different levels of your
complete panels.
Or your blood count actuallygives me a lot of insight around
.
You know what's the state ofbalance of your system, because,
yes, there's the normal ranges,but you and I both know those
(02:58):
don't really apply inendocrinology, you know.
So I I'm interested in howthings relate to each other, and
then things that I specificallydo that I've never seen anybody
else do are things like theMTHFR hormone or, sorry, the
enzyme pathway which looks atyour B vitamin metabolism.
I do do that genetic pathway.
I do a lot of hemochromatosisgenetic analyses as well,
(03:21):
because, you know, we're sosimilar.
Holly L. Thacker, MD (03:23):
We're so similar.
We're like two sisters fromanother mother.
Elena Christofides, MD (03:27):
You know , I feel like in the Midwest
especially, we have such a large, you know, northern European,
you know British Islespopulation and that's quite
common disease of thatpopulation and I feel like
doctors have stopped talkingabout it and so you have
generations of individuals whohave no idea that this is
(03:48):
happening and contributing rightto their liver disease and
their metabolic health.
And then obviously, the vitaminD.
I mean I think we talked aboutthis even on the last one, like
you got to get a vitamin D, yougot to know where people are.
But the other things that I doactually relate to the lipid
profile.
But the other things that I doactually relate to the lipid
profile I think people aregetting more aware of, like ApoB
(04:12):
levels and little, you know, lp, little A levels, which helped
me really understand you knowwhere someone's lipids are and
where they need to be, whetherwe're going to treat or not
treat.
I mean the point is kind ofneed to know what you're looking
at.
But I also, especially ifsomeone has a concern for lipids
, I also do an ApoE geneticscreen.
Holly L. Thacker, MD (04:29):
You don't think that's opening a can of
worms, do you?
Elena Christofides, MD (04:32):
Well, but they're there to open a can
of worms, Otherwise theywouldn't be seeing me.
Holly L. Thacker, MD (04:37):
I guess you're right.
I mean, I'm just curious, didyou have your ApoE genotype done
?
Elena Christofides, MD (04:45):
Yes, actually, my entire office staff
has done it.
I've done it, I've had myentire family, because we do
have dementia.
That runs in our family.
It runs in several familymembers of various employees and
a lot of patients are veryconcerned about dementia.
Oh very much so.
Holly L. Thacker, MD (05:02):
Very, very concerned.
Elena Christofides, MD (05:04):
And I think that it is an
underappreciated relationship.
I mean, medical researchdoesn't often move forward in a
very rapid progression or veryeven or consistent progression,
but I think that particular catis out of the bag around ApoE.
So if I have somebody who'scoming in particularly concerned
about lipids, I will do theAPOE genetic screening in
(05:26):
addition to a coronary calciumscore exam.
Yes, because I want to be ableto tell them okay, this is where
you are right now, this iswhere your genetics suggest you
might be going, and then let'slook at your family history and
assess what your risk is oftreating and not treating, or
what do we treat with?
Because that's also obviouslypart of the conversation.
So you know, I'm already doingthe MTHFR and the
(05:49):
hemochromatosis geneticscreening.
I don't feel like adding theAPOE is any more risky, because
you know that's still aprevention that people are
interested in.
And do we have good answers yet?
No, but we certainly have.
It's better to know and knowwhat you're working against
versus like wondering.
Holly L. Thacker, MD (06:10):
Now I previously got a lot of MTHFR
mutations and I know one of ourlead geneticists who was a top
scientist, unfortunatelyrecently passed, dr Karis Ang MD
.
Phd opinion was it's such acommon mutation, with half the
population having one defectivegene, that it really shouldn't
(06:31):
be done.
And I still did it because Ihave a hard time having people
do what I say and for the peoplethat are homozygous with two
mutations, they're going tooxidize their brain faster and
so for me to get them on themethylated vitamins.
But then I started to havepushback and insurance companies
would charge people like sevenor $800.
(06:51):
And so now I'm just kind oferring on anyone who's
interested in brain health,anyone who might have an
increased risk of blood clot orprior DVTs or miscarriages.
I'm just saying you need to beon methylated vitamins and in
one of my podcasts on brainaging where I went over some of
(07:12):
the research showing reductionsin brain atrophy and those that
are an acetylcysteine and themethylated vitamins and serifol
and NAC now over the counter asserifol and Brain Wellness that
I'm just so much more liberal atsaying let's just take this
vitamin.
So are you having insurancepushback?
Or also, what about peoplelong-term care if they have a
(07:34):
family history of dementia andthey're ApoE44, is that going to
make it harder for them, maybedown the road, to get disability
or to get long-term health careinsurance?
Elena Christofides, MD (07:48):
I mean that's a lot of great points and
great questions obviously thatneed to be taken into
consideration as part of thediscussion.
So let's talk about theinsurance and the pushback and
the coverage.
I have yet to have a lot ofpushback on that and I have not
had patients getting chargedthat kind of money.
Holly L. Thacker, MD (08:04):
Wow Great.
Elena Christofides, MD (08:05):
Which is great, and maybe just I'm lucky
.
But I will say that enoughpsychiatrists are doing it
through gene site testing andgetting the data.
Holly L. Thacker, MD (08:15):
either way , yes, yes, yes, that's
wonderful.
Elena Christofides, MD (08:18):
Right, and in addition, you get it with
any of the genetic tests like23andMe, ancestry, et cetera,
that people are also doing.
That's showing up on those aswell.
Holly L. Thacker, MD (08:29):
Is that as reliable?
Because I know that when wetalk about cancer genes we
always tell people recreationalgenetic testing, sorry, they
only test for a few genes andeven though 23andMe expanded it,
which I think they've justundergone chapter 11 or
something, so I don't knowwhat's going to happen with all
that data that I still feel likewhen I'm really concerned about
genetic problems, I want themto see a genetic counselor and
(08:52):
get official medical genetictesting, which is getting
cheaper every day.
Elena Christofides, MD (08:56):
Yeah, yeah, I mean you're absolutely
right.
I will say I have yet to find asingle inconsistency in the
23andMe genetic testing for thestuff I'm looking for, like
hemochromatosis and MTHFR, thoseare in there.
The APOE is in there.
So with one $200 test you getthree genetic markers that don't
(09:16):
enter into your medical record.
I sort of feel like they havebeen accurate enough and they
are outside the medical fieldenough that for patients who are
concerned about any sort ofbacklash, that's one way of
doing it and obviously withtheir Chapter 11 reorg that
could be potentially messy.
(09:36):
So I have that discussion.
That's obviously a discussionfor that individual patient.
Some patients are concerned,some patients aren't concerned.
Holly L. Thacker, MD (09:49):
And I haven't had that influence the
issue.
Yeah, it's so interesting interms of data.
My son, who I've had on thispodcast in fact one of my
patients the other day just saidhave him on again I really
enjoyed that and I know I'mgoing to have a lot of people
ask me to keep having you onregularly yourself, but he's a
PhD in molecular genetics andbasically in terms of some of
(10:10):
these discussions about you knowhow much is genes, how much is
an environment?
You know in terms of just costscoming down and how is it going
to influence everything.
It really can be a very thornyissue and there's so many
different aspects to it.
We've had a genetic counselorcome on and talk about the GINA
(10:32):
law and I personally think thatknowledge is power and I always
encourage my patients when youhave something done like gene
site analysis that tells you howyou metabolize psychiatric
medicines, pain medicines,whether you have this MTHFR
mutation, which is how youmetabolize B-complex vitamins,
(10:52):
that affects a lot of brainchemistries that you need to
keep records of it.
But the one discussion I've hadwith my son he did ancestry and
my other son did 23andMe andpeople find out you're related
to other people you didn't evenknow and find out you're related
to other people.
You didn't even know and findout you have other family
members that you didn't knowreally wasn't your grandfather.
(11:12):
It's crazy, but I justpersonally didn't like my
genetic information out there.
And he laughs at me and he saidanybody can get your genetic
information.
Mom, you suck on a straw andthere it is, and that's why when
you say it's outside themedical record so people can't
get it, I mean I just had my-.
Elena Christofides, MD (11:29):
Well, it's outside of the official
medical record.
So I don't disagree with yourson.
I think that I understand theconcerns, but it's not like
people are out there cloninghumans yet.
I think we've got a ways to go.
So you're right, you sip on astraw, you use a cup.
You know if somebody wantedyour genetic material they could
get it.
When I say outside the medicalrecord, I mean outside the
(11:50):
official medical record, becausethose are not part of the
official medical record.
Those are not in your medicalchart unless you choose them to
be.
The pre-existing conditionclauses were part of the ACH, so
you can't.
I mean the ACA Act did forbid,you know, discrimination against
(12:11):
prior knowledge andpre-existing conditions and
honestly, I haven't seen.
So let's also put it this wayIf people were doing perfectly
great and healthy, they wouldn'tbe in my office.
So I think that there's a rolefor this genetic testing.
Again, if you're doing great,congratulations.
Holly L. Thacker, MD (12:27):
I'm happy for you, like that's fine, those
people don't come see you andme.
I understand they're coming tosee me.
Elena Christofides, MD (12:33):
So if you're trying to optimize what
you're doing and trying tooptimize your health for
longevity, then these are thingsthat are important to your
longevity story.
But at the same time, when know, when you're filling out these
forms and you're filling out allthis documentation, they don't
believe it anyway.
So you're right, the medicalprofession tends to push back on
(12:54):
these as being irrelevant.
So, on the one hand, we're sortof protected right now due to
the ignorance of the profession,believing that these genetic
tests are not really valid orimportant, and I'm happy for
them to continue to think that23andMe is terrible and not
valid.
It's great, that's fine, letthem do that, because that means
that all this testing thatpeople are doing for their
health and for their longevityisn't going to be viewed as
(13:16):
being viable.
So that's fine, we'll get thedata and then use it to what we
need it to be used for, and thenlet it not be part of the
medical record.
Holly L. Thacker, MD (13:24):
I guess I'm just such a privacy hound
and I recently had my bankaccount hacked and money was
being transferred and one of mybanker sons was like well, mom,
you know all your passwords, allyour data, it's everywhere.
Elena Christofides, MD (13:38):
And so.
Holly L. Thacker, MD (13:39):
I do think that people should at least
respect their own personal dataand keep records, because it
shocks me Years ago when I wasin practice, people came all
organized with their files andnow everyone says, oh, just go
look online.
And all these computer systemsdon't always talk to each other.
But anyway, I want to talkabout part of your specialty and
(14:01):
your practice is growth hormonetesting and screening, and I
know that's very controversial.
So tell us what is growthhormone and what role you see.
Elena Christofides, MD (14:12):
Yeah, that's absolutely right that it
becomes controversial I thinkunfairly so.
So growth hormone, I thinkeveryone understands when you're
young, when you're a child, youneed it to fully realize your
adult height and in proportionwith puberty this reaches your
adult height.
This helps you grow tall, so itmakes your limbs grow longer,
(14:32):
right.
And then, once you're an adult,you need it to maintain
metabolic health and sort offill the spaces in between.
So it doesn't do.
You remember that oldcommercial back in the 80s with
BASF?
They were a chemical companyand they said you know, we don't
make X, we just make it better.
And they used to advertise onlike cassette tapes and all
(14:52):
kinds of manufactured goods.
And I'm clearly dating myself.
Holly L. Thacker, MD (14:55):
You're dating yourself, doctor, and you
look so young.
Elena Christofides, MD (14:59):
Clearly dating myself, but I always
loved that commercial.
Because growth hormone, youknow, it doesn't make you lose
weight but it makes you fitter.
It doesn't make you hearthealthier but it makes your
heart happier and mental health,et cetera.
It does many, many things.
So it maintains stability ofmood, it maintains metabolic
(15:19):
health and, you know, improvesinsulin sensitivity.
It improves muscle function andmuscle strength and muscle
conditioning.
It improves healing, itimproves recovery, especially of
the soft tissues, and it is acritical hormone as we age to
stave off the aging process.
Now, unfortunately, yes, toomuch of a good thing is bad.
(15:42):
Growth hormone has to beregulated and it has a very
clear sort of zone of no-go interms of when you're treating
and when you're replacing andwhen you're managing it where
you don't want to be, because itdoes have consequences when
it's too high.
But what's interesting aboutgrowth hormone is that, you know
, one in five head traumas canproduce adult onset growth
(16:04):
hormone deficiency.
So whiplash, car accidents,sports injuries, concussions and
repeated head injuries.
And let's not ignore the factthat many people might be in a
physically abusive relationship.
Holly L. Thacker, MD (16:18):
Oh yes, we had a podcast on domestic
violence, intimate partnerviolence.
Elena Christofides, MD (16:22):
That's a good point.
Holly L. Thacker, MD (16:23):
I didn't even think to put those two
together.
Elena Christofides, MD (16:26):
Well, I mean, this is a question that I
ask when I'm looking, so I alsoyou were asking me.
Part of my routine screeninglabs is I routinely screen IGF-1
as well.
So an IGF-1 is a screening tool.
It's not a diagnostic tool, butit's a screening tool that
gives us an idea ofdirectionality of your growth
hormone and if it looks out ofbalance with where I really want
it to be, then I might suggesta growth hormone STEM test.
(16:46):
But I'm going to do a historyand when I take the history, I'm
asking specifically about headtrauma and I'm asking about
partner violence.
I'm asking about domestic abuseand obviously I try to make it a
very safe space for people totalk about it, and I'm always
surprised at how much domesticabuse occurs, whether it's from
childhood and it's justcumulative over the years, and
(17:11):
it may not be happening to anadult today, but it may have
happened in their life and I'vehad people tell me, you know,
that they were thrown out ofwindows as children and
repeatedly abused and, you know,thrown out of moving vehicles
and these are things that cancause lifelong trauma to the
poor little pituitary gland.
So, growth hormone the reasonit's so controversial is because
it's such a hormone of abuse.
If it didn't work, the athleteswouldn't all be using it.
(17:34):
So my philosophy is, though butanything is a hormone of abuse
if you let it be.
Everything can be abused in thewrong hands and in the wrong
understanding, and when peoplepush back on that, the next
thing I push back in is I saywell, you know, bodybuilders and
athletes also take insulin as agrowth hormone, because insulin
(17:55):
is also a growth hormone.
Holly L. Thacker, MD (17:56):
Oh, it, sure is.
Elena Christofides, MD (17:57):
Right.
So they also take insulin intheir recovery and in their you
know bodybuilding world.
So are we going to ban insulinnow because somebody is abusing
it?
So the absurdity of theargument that we shouldn't look
at it because it's a drug ofabuse has always irked me.
Because if you have growthhormone deficiency, you age
(18:18):
faster, you have a shorter lifeexpectancy, you are more insulin
resistant, you have moremetabolic ill health, you are
higher in your lipid values, youare higher blood pressure,
you're more likely to bedeveloping premature coronary
disease, more likely to havepoor recovery, and so you're
going to last at the gym longer,you're not going to be as fit.
(18:41):
So there are significant reasonswhy someone might want to
replace their growth hormone ifit's deficient, if they're
interested in maintaining youknow well health into their
older years.
Not just it's not going to turnyou into an elite athlete.
And here's the other, the otherpart that kills me on this one.
You know you could give me allthe elite athlete drugs in the
world you want.
It's not going to turn me intoan elite athlete.
I just don't have the geneticsfor it.
(19:02):
I don't have the physique forit Me either, right Like I.
I used to joke all the timeabout that that I these are
things that enhance what youhave in, you know in genetically
, what you're doing physically.
But if you are someone and oneof my favorite you know stories
is I have a patient who was atriathlete and he was noticing
(19:25):
significant drop-offs of histime and his performance, and we
went through and I'll be damnedif he didn't have
hemochromatosis and MTHFR andgrowth hormone deficiency all
three.
So of course, by the time hewas the age that he was when he
came to me, these threeconditions had cumulatively led
to a significant drop-off of hisperformance.
(19:48):
Not that any one did it right,it's not any one thing that did
it.
It's the fact that he had aseries of things that were
cumulatively leading to likedeclining performance.
So we fixed all these things,fixed his nutrition, got him a
CGM.
You know we're tracking hisnutrition, tracking his glucoses
, teaching him about nutrition,which I know we're going to talk
(20:09):
about later, cgm is continuousglucose monitoring.
Holly L. Thacker, MD (20:12):
for our listeners, yes, exactly, thank
you.
Elena Christofides, MD (20:13):
Yes, and you know his performance
improved.
He was able to use the data toimprove his weight, improve his
diet, improve his lifestyle.
He used, you know, the data tohelp him improve his fitness and
his training performance.
And you know we just gave himenough to make him back into
like his normal, what would behis normal range for his age.
And obviously I'm not one ofthose clinics that just gives
(20:36):
people like these ridiculousdoses and doesn't care about
their levels.
I track their levels.
I track their, you know.
I track their blood count tomake sure they're not, we're not
making them polycythemic.
I track their vitamin levels,make sure they're not being
toxic.
I mean, there are, there areways to do this safely and
appropriately.
And so now he's back toperforming at the level that he
wishes to be performing at.
Holly L. Thacker, MD (20:56):
That's an interesting story about
hemochromatosis because you know, as many of my listeners know,
I run the Center for SpecializedWomen's Health and I was
boarded in internal medicine,going to be a cardiologist, got
extra training in endocrinologyand gynecology and female
hormones and osteoporosis andjust kind of interdisciplinary
women's health.
But one of the things thathelped put me on the map early
on in my institution was therewas this executive who had all
(21:19):
these problems and went frominternist to cardiologist to
gastroenterologist.
No one could figure out whatwas wrong with them.
So I get a call from the CEOsaying you got to figure out
what's wrong with this guy?
I'm like okay, he hadhemochromatosis and so that got
me immediate respect, so thatwhen I went to the CEO to say,
(21:40):
hey, I got to build somethingthat's different than what we
have that really can help women,I mean I had an open door
because of that diagnosticrespect.
So, yeah, and I think that-.
Elena Christofides, MD (21:52):
So kudos to you for that.
I mean, my son calls it likebeing Dr House, but the nice
version, not the mean version.
And that's what I always saytoo, because at the end of the
day, these diseases of geneticsand genetic inheritances, they
take a while to show up.
Yes, and unfortunately, that'salso the time when, you know, we
start to get a little gaslit,along with the providers of, in
(22:15):
our forties and our fifties of,well, you know, that's just
aging.
Well, no, some people are agingfaster than others.
Holly L. Thacker, MD (22:21):
Oh, definitely, Definitely.
So who?
Who are the people that you getthe growth hormone screening on
?
Elena Christofides, MD (22:30):
So every patient who comes through my
door it's part of the newpatient panel we do an IGF-1 on
everybody because the vastmajority of people coming in
have complaints that areconsistent with growth hormone
deficiency as well right Fatigue, difficulty sleeping, gaining
weight around the middle.
Their gym performance isdropping off, so it is part of
(22:50):
my routine piano and you'd besurprised at how many acromegaly
patients we've also foundscreening that way.
And acromegaly is a disease ofexcess growth hormone when it's
produced by a tumor in thepituitary gland and it leads to
significant deformities physicaldeformities as well, as, you
know, medical conditions.
Holly L. Thacker, MD (23:11):
And increased cancer rate.
Yes, exactly, yes, I have had afew in my practice.
Elena Christofides, MD (23:16):
So we have a bit of a reputation in
the pituitary world that all ofour acromegaly patients have
what we call microadenomas, orsmall tumors that are curable
when surgery.
Because we seem to find them soearly, because we're not
waiting until they're 20, 30years on with these symptoms
before somebody is checking thislevel and discovering that they
have quite a large tumor thatis no longer perfectly curable
(23:38):
with surgery.
So it's just part of ourroutine panel now the IGF-1.
And if it's out of range?
Now here's the thing about outof range is that the range is
quite large.
So I will recommend a growthhormone testing protocol which
is a little bit more in depththan an IGF-1 for anybody that
(23:58):
is below the mean and this is animportant distinction because
men and women have differentranges of normal and it's quite
broad.
It's quite broad in range andwe know epidemiologically in
healthy populations that theIGF-1 should be about mean to
about one standard deviationabove the mean.
It's about where the normalrange really is.
(24:19):
The range that's reported onthe lab is the mean plus or
minus two standard deviationsand that's the actual range.
So if you look at the rangeit's kind of misleading because
it actually catches the hypogrowth hormone patients or the
low growth hormone patients.
So I look for it to be mean, tojust you know between the mean
(24:41):
and the upper range.
And if it's not there, then Irecommend growth hormone stem
testing.
Holly L. Thacker, MD (24:47):
Very interesting.
You know you were talking aboutthe metabolic syndrome and
you've been listening to theSpeaking of Women's Health
podcast.
I'm your host, Dr Holly Thacker, the executive director of our
nonprofit Speaking of Women'sHealth, and I am speaking with
endocrinology, metabolic expert,anti-aging expert, Dr Elena
Christofides, who has a practicein Columbus, Ohio, and you were
(25:10):
mentioning this fatigue andweight gain, muffin belly around
the belly, poor sleep, I mean.
I hear this, of course, everyday, and I was remarking to my
specialized women's healthfellows who do a two-year
additional fellowship with meafter their initial board
certification in their primaryspecialty certification in their
(25:33):
primary specialty, that when Istarted in this field it was
like easy and fun, because therewasn't like the negative
connotations about hormonetherapy, which we've finally now
gotten past that almost 23years later post Women's Health
Initiative.
So that part's good.
But what's also harder about itis like when I saw women,
initially they had classicmenopausal symptoms hot flashes,
(25:54):
night sweats, maybe poor sleep,dry vagina plus minus bone loss
.
Now the women I'm seeing, theyhave all those symptoms plus
they have so much more and theyhave metabolic syndrome.
I mean I rarely saw a patientwith type two diabetes or a
woman with central adiposity inmy practice, which was a
(26:14):
referral center when I startedin this field.
Now it's unusual for me to seea thin woman.
So I've done podcasts on ourfood supply and all these
substances that are poisoning us, that are not allowed in other
countries, but it just seemslike the prevalence of metabolic
syndrome is out of control.
And I've, as part of my lipidprofile and LP, little a and
(26:37):
inflammation markers and I'mpretty pretty frequent and lax
to say, yeah, go ahead and get acoronary calcium score,
although I will say some women'shealth cardiologists say you
can't exclude, you know, softfatty plaques.
But since I try to keep womenoff of statins because they
increase diabetes and they don'thave any primary prevention and
(26:58):
everybody wants to put statinsin the water, you know and I
think that's pushed too much.
I mean, cholesterol is neededfor hormones and brain
metabolism and I think we'vegotten too far off on the statin
issue.
But I've been getting omega fatratios.
Are you including that in yourpanel?
And hardly anyone I see isnormal.
The only normal people areeither eating fish four times a
(27:20):
week, not twice a week.
Elena Christofides, MD (27:23):
Yeah, oh no, absolutely.
So we had previously a reallyexcellent lab for doing the
omega ratios and I really reallyloved the lab, and
unfortunately they are no longerin existence, so it has been
difficult for us to find a labthat I can trust for their
omegas.
But you are absolutely correct.
I mean, omega is a huge problem.
When you talk about the foodsupply, omega is one of the
(27:45):
biggest gaps in food supplyhealth that we have compared to
the rest of the world, and it isan interesting problem.
I typically just recommend thisis a funny one.
This is actually where I justusually recommend
supplementation over evenscreening, because no one gets
enough omega-3s in this countryin their diet regardless.
(28:05):
And you, you know aninteresting point.
I'm going to actually bringsomething up because I know
we're talking about a little bitabout nutrition.
A funny little story Did yourealize that grass-fed beef and
bison have more omega-3 fattyacids per ounce than seafood?
Holly L. Thacker, MD (28:23):
No, I didn't know compared to seafood
and I thought, like mackerel andtuna, I had mackerel for lunch.
I'm going to have sea basstonight for dinner.
Elena Christofides, MD (28:31):
For our patients, though for our
patients who are not interestedin seafood or are concerned
about their seafood supply,because that's also a real issue
overfishing of our oceans, Imean, and that's the case, then
I just ask them to look at, makesure they're doing grass-fed
beef and bison and wild gamewhich has plenty of omega-3s in
it, and grass-fed beef inparticular, and grass-fed milk,
(28:54):
grass-fed butter you know thoseproducts.
Grass-fed cheese you've alreadygot a higher concentration of
the omega-3 fatty acids.
Holly L. Thacker, MD (29:03):
Yeah, I pretty much switched over to
most grass-fed products.
It's more expensive, that's forsure.
You have to be, you know,careful that that's what you're
really getting.
Elena Christofides, MD (29:16):
Yeah, you can make up more of that
difference though with, like, ifyou're doing the butter as well
as the cheese and the milk.
Right, and the cream, so it'sincremental benefit.
Right, it's incremental.
Holly L. Thacker, MD (29:26):
Yeah, and I always recommend to my
patients to get the omega-3 eggs.
And of course eggs were so highpriced because they were
killing all the hens, but nowthey're coming down a little bit
.
But if they feed the chickensflax, that's another non-seafood
source.
The only reason I bristle alittle bit about saying just
take a supplement is becauseweight is every woman's concern
(29:47):
pretty much and all I had to dois eat a big apple 300 calories
for six months to gain 25 poundsand have a baby in six months.
And there's extra calories insome of these supplements and I
just personally would rather beenjoying my calories than
swallowing them?
Elena Christofides, MD (30:04):
Sure, because you have to keep
restricting the calories you'reeating the older you get.
Well, so well.
This may blow your mind.
I never have my patientsrestrict calories.
Holly L. Thacker, MD (30:15):
Really.
Elena Christofides, MD (30:16):
Yeah, so the calorie cult is not a cult
that I belong to.
Fat is your friend, not yourenemy.
Holly L. Thacker, MD (30:24):
Yes, yes, protein is critical, right, I'm
definitely in that.
There's no essentialcarbohydrate, is my little
saying Exactly.
Elena Christofides, MD (30:30):
So I would rather someone get their
omega-3s, whether it's asupplement or a food, and I
don't disagree.
Obviously I would rather youenjoy your food as well.
But again that becomes a costissue.
That can become a lifestyleissue, An allergy yes.
Yeah, and a family issue, right,If I'm cooking for my household
(30:51):
, where I have two 25-year-oldsthat are athletes, we can go
through two five-pound brisketsin one dinner.
That gets expensive, and so Iunderstand that.
I understand that people arelike well, I have feeding a
large family.
I can't buy a 10 pound you knowgrass fed brisket for my, my
family.
That gets really expensive.
So I understand that.
Holly L. Thacker, MD (31:11):
So I guess I've gone to give a giving-fed
beef as like a birthday gift tomy older son.
It was unfortunately deliveredto his next door neighbor, a
Browns player, who somehowthought his name was Stetson,
even though there's no Stetsonson the Browns team.
So I had to order another one.
Elena Christofides, MD (31:28):
Yeah, no .
So it is always a funny thingin the summer when the boys are
doing the triathlete trainingsand they're doing their races,
you know, and I, one night I wonfarmer's market and I get I
tend to get a lot of it from thefarmer's market because I want
to support our farmers, I wantto support direct purchasing, I
want to support local, localproduce and I can talk to the
farmer and know what they'redoing and I know where they're
raising their, their cattle, andI know how they're, you know,
(31:55):
doing.
It's sustainable, ethicalfarming, right?
That's what I'm trying to relyon and I'll never forget that.
One Sunday I thought I was goingto make extra and have some for
the week and I put these twobriskets on the grill and, by
God, I didn't barely get themoff the grill before they were
gone and I thought, okay, well,you know, this is maybe not the
wisest strategy for when theboys are in training.
So, with that being said, Idon't disagree with your point
about the calories, I don'tdisagree with your point about
(32:15):
the supplements, and I wouldrather you know better eating
better, living better, betterfocus on our nutrition and
making those calories count,making our food count, because I
, too, love mackerel andsardines.
I mean, I have canned mackereland canned sardines around all
the time and I'm constantlyfighting with the cat when I
have to open them.
So I'm always, always takingthem to my office and eating
(32:36):
them in secret, so the catdoesn't, you know, try to steal
my mackerel.
But but at the same time, Ialso appreciate that if you're
dealing with somebody whosehealth has already been damaged,
then we have to deploy everytool in our toolbox, and that's
one that I'm willing to take thehit on yeah, and what foods and
vitamins um legitimatelysupport a good metabolism in?
(32:57):
particular, yeah.
So I'm going to talk about themin terms of vitamins and then
we'll talk about the foods thatsupport that or the things that
support that.
So omega-3s we've alreadytalked about hugely important
for reducing metabolic syndrome,improving glucose metabolism,
improving vascular reactivity,which lowers blood pressure and
of course improves clotting risk.
So it lowers clotting risk anddecreases atherosclerotic
(33:20):
reactivity, so hugelystabilizing.
And we just talked about thefood sources where you can get
more omega-3s in addition to thesupplement.
I mean you and I have talkedabout vitamin D, I think till
the sun goes down, I meanvitamin D, vitamin D, vitamin D,
vitamin D.
Vitamin D is the first step inmetabolism to every hormone in
(33:41):
the body.
Holly L. Thacker, MD (33:42):
Yes, yes, yes.
Elena Christofides, MD (33:42):
Every hormone, including your lipid
metabolism.
True epidemiologic normals are65 to 85, not what the lab says
Exactly.
Holly L. Thacker, MD (33:49):
If I have another patient tell me that
their primary care doctor toldthem to stop their vitamin D
because it was 87.
I want to pull my hair out.
Elena Christofides, MD (33:59):
I think I turn into the exorcist when
this happens and my head startstwitching and I think I'm going
to start spewing.
I mean, it's so prevalent, it'sdisgusting.
I don't disagree, and so Iagree.
Vitamin D 65 to 85 is theepidemiologic range.
What's the consequence of toomuch vitamin D?
Nothing If it's the inactiveform, because your body will
(34:20):
regulate how much it needs toconvert from the inactive to the
active, and so even drifting upto a hundred is fine.
This is cholecalciferol we'retalking about, which is a white
powder, capsule.
White powder that you purchasefrom special suppliers, like
certain vitamin shops.
Like I do not let my patientsgo to CVS, target, walgreens,
(34:43):
meijer, costco, walmart, becausethose are not high quality
versions of vitamin D, becausevitamin D is so sensitive to
this process of manufacture.
Holly L. Thacker, MD (34:54):
Do you routinely add K2 to it if your
patients aren't eating Japanesenatto or food?
Elena Christofides, MD (34:59):
rich sources.
No, I don't actually, I havenot found that.
Holly L. Thacker, MD (35:03):
Yeah, I know it's back and forth.
I've seen improvements in bonedensity and since there's some
epidemiologic research thatshows more coronary
calcifications with increasedcalcium or vitamin D intake, I
figure I want the calcium in thebone and M7 or K2 helps drive
that.
It has nothing to do with bloodclotting.
Elena Christofides, (35:22):
Completely agree with you.
I mean, if somebody wants totake it, I have no objections.
I just don't proactivelyprescribe.
You are absolutely right aboutthe calcium increasing the risk
of vascular disease andatherosclerotic disease and I
think my personal opinion isthat correlative data is related
to the fact that in the studythese people were all vitamin D
(35:42):
deficient and in the absence ofvitamin D you don't have the
co-factor to take calcium intothe bones.
Holly L. Thacker, MD (35:50):
Yes.
Elena Christofides, MD (35:51):
So because you have to have the two
together to go into the bones,otherwise the calcium is free
floating the two together to gointo the bones, otherwise the
calcium is free floating and hasnowhere to go.
So with the vitamin d there'sonly a few brands and they're
available on my website in termsof links to amazon, just the
brands that I've seen that workbecause, so many brands don't
work.
And this is not a prescription.
You cannot get a prescription.
Holly L. Thacker, MD (36:09):
Vitamin d I know I tell patients the
non-prescription is actuallybetter than the d2 prescription
yeah, because the d2prescription is the active form.
Elena Christofides, MD (36:16):
You can get toxic on it and that's not
what your body needs In theworld of endocrinology.
What's really not understoodsometimes is the world of
endocrinology.
Your body needs the inactiveform of the hormone in order to
be able to convert it to theactive form, in order to do the
job of the hormone.
Sure, so that's the same thingwith T4 and T3.
We give T4 because your body'ssupposed to convert to T3.
(36:39):
Now, obviously we know somepeople don't convert.
Well, we have to supplement andthat's fine.
Holly L. Thacker, MD (36:45):
What percent of your patients do you
have on T3?
Because I know a lot of ourendocrinologists are resistant
to using T3, and I think I haveabout 5% of my women patients.
Elena Christofides, MD (36:51):
Oh no, it's probably closer to 50% for
me, for you, wow.
Holly L. Thacker, MD (36:54):
Wow, you probably see tougher cases.
There was a big.
Elena Christofides, MD (36:56):
Well, actually there was a big series
of patient evaluation, bigseries done and presented at the
ADA American DiabetesAssociation meeting a few years
ago that showed that there was ahigher likelihood of T4 to T3
conversion disorders geneticallyin patients with more obesity.
Okay, yeah, so if I havesomebody, who has thyroid.
Holly L. Thacker, MD (37:17):
So if someone's obese, that would be.
Elena Christofides, MD (37:19):
Yeah.
So if I have a thyroid patientwho also happens to have obesity
, or I have a thyroid patientwho also has a leather
autoimmune diseases, they tendto do better with a combination.
Now I obviously prescribe themseparate.
So, with that being said, therule in endocrinology in general
is you need the inactive formto be plentiful in order to
convert it to the active form todo its job.
(37:41):
And this is why the vitamin Dstory is such a complicated one,
because the prescriptionvitamin D version is the active
form that we give in cases wherethey cannot convert to the
active form, like in kidneyfailure and other situations.
And that one, the green, it's ablue-green gelatin capsule.
The minute somebody says, oh,my doctor gave me a prescription
, said I only need to do thisfor a few weeks and we'll be
(38:03):
done, and my question is alwaysis it blue-green or white?
Because if it's white it'sright, so if it's blue-green,
it's wrong.
Now vitamin D.
Interestingly, I've had quite afew patients over the years
who've been very um unable totolerate vitamin D
supplementation for a variety ofreasons.
Usually, they have some sort ofsevere GI disturbance, and so I
(38:25):
do recommend um tanning fiveminutes a day in just the UVB.
And they don't.
They're just five minutes.
They don't even get tan, theydon't no color changes.
Obviously they do it withoutsunscreen on and we do it until
their vitamin D levels get up toa decent level, like say above,
you know, 50, 55.
And then somehow they're ableto better tolerate more low dose
(38:48):
, consistent vitamin D dosing atthat point.
Holly L. Thacker, M (38:50):
Interesting .
I have used the vitamin D lampin some difficult patients.
Yeah, Moving on to longevitytreatments, kind of tell us
what's the hype and what's realwith some of the anti-aging
medicines fasting, and I'm veryinterested in the peptides and
what you do for mitochondrialsupport.
Elena Christofides, MD (39:07):
Yeah, a big topic, right.
So what's very real is mTORinhibition.
Mtor inhibition is amitochondrial function.
That's where all the anti-agingwork is being done.
It's already been shown to betrue in multiple animal species
other than human, like dogs,cats, mice, et cetera.
So I think that there'sactually supposed to be an
(39:30):
approval here coming soon forextending the life expectancy of
dogs for the same reason.
So what inhibits mTOR?
Well, that's sirolimus, that'slow-dose naltrexone and that's
metformin.
I will tell you I absolutely donot want to use metformin in
anybody because of the B12deficiency issues that you can
exacerbate with metformin.
(39:50):
And given that everyone isMTHFR deficient, you're adding,
you're dogpiling that.
So I don't like the idea ofmetformin for a lot of people.
Obviously, if you're talkingabout diabetics, we do know that
that has decreased cancer riskand decreased cardiovascular
risk in diabetics.
So sometimes we use it, but notalways.
Low-dose naltrexone is quiteeffective on a daily basis for
(40:12):
anti-inflammation and people whohave aging issues due to
inflammation, like chronicinflammatory diseases.
Holly L. Thacker, MD (40:17):
I have a few patients who just swear by
it.
Elena Christofides, MD (40:19):
Yeah, I mean I have a few patients who
also swear by it.
Not a lot, it's a fewmilligrams, it's not a lot dose.
Holly L. Thacker, MD (40:24):
Right Very tiny.
Elena Christofides, MD (40:26):
It also forms the foundation of one of
our most successful oralanti-obesity medications.
Contrave Contrave with bupropionhas naltrexone in it with
bupropion, and very effective inthose individuals as well.
And then, of course, serolimusis the big one, right, serolimus
is the big guy.
Small doses, weekly doses, hasbeen revolutionary for my
(40:48):
patients who have unexplained,undifferentiated chronic illness
of an inflammatory nature thatwe can't quite figure out what
it is.
They've been to rheumatology,they've been everywhere and
they're just inflamed.
They're metabolically unhealthy.
You can see their lipids, theirtriglycerides are high, their
HDL is low, their blood pressure.
They're just metabolicallyterrible and we can't figure out
(41:09):
why.
So we'll do a 12 week trial andI and I will tell you, in some
cases it has been miraculous.
Holly L. Thacker, MD (41:16):
I think there's a few people I need to
send to Columbus to see you thatkind of fit, that profile.
You know, speaking of mTOR andrapamycin, there's very few
situations from my perspectiveas a menopause expert that I
cannot give estrogen or hormonetherapy for right.
Because there's very few thingsthat we just reduce all
estrogen.
So one of them islethangiomyomatosis LAM, and
(41:39):
I've only ever had a couple ofcases in my career, and so I saw
a woman the other day that wastold by her pulmonologist to
stop hormone therapy and I said,okay, well, we'll see if by
stopping you got any better oryou stopped the progression,
because I wasn't reallyconvinced.
But she said, well, this iswhat's recommended, and she
brought out the information andapparently they're using
(42:01):
rapamycin for lamb, which Ithought was very interesting.
That is interesting, so I toldher don't don't don't be
hesitant to take it, and maybethat might potentially open the
door for us.
Elena Christofides, MD (42:12):
I completely agree.
I don't hesitate to use it atall as a trial because it's not.
It's really low doses.
You know the doses that we usein transplant medicine are
hundreds of milligrams daily.
We're talking about under 10milligrams once a week, so
fractions of the doses.
And you know some patientscan't tolerate it.
I've had a couple of people whocouldn't tolerate it and that's
fine.
But you don't know until youtry.
But in those circumstances, forthose people who don't tolerate
(42:36):
that, who don't tolerate theother therapies, then we go into
the mitochondrial supportpeptides, which are things like
NAD, methyl blue.
Holly L. Thacker, MD (42:44):
Do you do those by infusions, because I
know you were saying that oralNADH doesn't really have very
good absorption.
Elena Christofides, MD (42:49):
Yeah, oral NAD can't be absorbed.
It's broken down in the gut andthen you can try taking NMN,
but I don't I think the data isstill kind of suspect on that in
terms of whether you actuallyget good absorption.
So we do it by infusion.
We have it by infusion and thenobviously you've got the BPCs
for the joint soft tissuesupport for people who have
acute injuries, and then you'vegot the growth hormone style
(43:12):
peptides, like you knowsemorelin, tesamorelin, et
cetera, ipamorelin that are likegrowth hormone but not they
help, they balance growthhormone.
The better way to explain it forthe audience I'm trying to not
explain it in a reallyconvoluted way they're basically
the peptides, that sort ofsignal growth hormone.
So these are effective inpeople who have growth hormone
(43:34):
but just want to optimize theirgrowth hormone signaling.
So these are.
These are effective in peoplewho have growth hormone but just
want to optimize their growthhormone signaling pathways to
get full advantage of theirgrowth hormone.
Those don't have much efficacyin people who actually have
growth hormone deficiency,because you need an intact
growth hormone access for thoseto work.
So that's why we do such aaggressive job of screening for
growth hormone, because ifsomebody has actual growth
(43:56):
hormone deficiency and they wantto take some, you know,
semirelin, tesamorelin,ipamorelin.
It isn't going to work.
So I'm trying to save them somemoney and time on that regard,
if that's the path that theywant to take.
Holly L. Thacker, MD (44:09):
And how do you use methylene blue?
Elena Christofides, MD (44:12):
So methylene blue is a methyl donor
, so it works like in the MTHFRfamily, right?
So if you have people who haveMTHFR abnormalities, let's say
they don't tolerate some of themethyl B complexes.
I've had a few people who got alot of anxiety from the methyl
B complex vitamins, and so wewere using the methylene blue
instead to try to give themtheir methyl donor groups and
(44:32):
bypass their need for the largedoses of methyl B-complex.
Holly L. Thacker, MD (44:36):
That's interesting.
The only trouble I've gotteninto with really high dose
L-methylfolate of course Ialways make sure that the B12 is
fine and that they're usuallyon methylated B12, is because it
increases serotonin and ofcourse the psychiatrists use it
in high doses for depression.
I've had some people tell methat they can't sexually climax.
It's like they have too muchserotonin on board by pushing it
(44:58):
up too much.
Interesting.
Elena Christofides, MD (45:00):
Yeah, it's only been a couple of
people and I figured that's thething.
Holly L. Thacker, MD (45:03):
So moving into depression and anxiety and
PTSD as we wrap up and againwe're going to have to have you
back again because you're justso wonderful and delicious.
Are you doing ketamineinfusions?
I know there's like a whole lotout in the space about
psychedelics and infusions andother more novel treatments for
mood disorders.
Elena Christofides, (45:23):
Absolutely .
Ketamine has again.
It's been.
I say this and it seems like Imay be just hyperbole, but
ketamine, like some of the otherthings that we've been doing,
has also been equally groundshaking, revolutionary for the
patients who we've been doing,has also been equally
ground-shaking, revolutionaryfor the patients who we've been
doing it for.
So we don't do infusions, we dointramuscular injections.
I feel like infusions areentirely too medicinal, medical,
(45:45):
anxiety-inducing on their own,because you have to have an IV
in place.
You have to make sure that it'sgetting a continuous infusion.
If the patient freaks out or isconcerned or isn't getting a
good dose, it medicalizes theprocedure.
It makes it harder for thepatient to have a good
experience.
So we work with ourpsychiatrists and our therapists
in town and we do an intakereview with the patient.
(46:08):
We make sure that they'reappropriate.
We do prefer to do it forpeople who already are seeking
counseling and therapy.
So we have a partner inpsychotherapy.
Holly L. Thacker, MD (46:16):
Sure, that's so important.
Elena Christofides, MD (46:17):
Yeah, because they're coming to us for
PTSD, for depression, foranxiety, for trauma, for
recovery, and we don't want tohinder their recovery by only
doing the medical part.
There needs to be a psychiatricpart, a therapy part as a
psychotherapy component.
So we do the intramuscularinjections.
They are medically monitoredand my nurse practitioner is in
the room with them the wholetime and so they're babysat, so
(46:40):
to speak, and we have a protocolwhere we do it twice a week for
three weeks for acute therapy.
If somebody has an acute event,so like if they're feeling
quite depressed, maybe they'rehaving, maybe it's an
anniversary, you know, that isinducing the PTSD.
So, especially for veterans,maybe it's an anniversary of,
you know, their injury in thefield, or an anniversary of a
(47:00):
colleague's suicide or somethingof that nature, or anniversary
of somebody who was maybeabducted or abused.
Around anniversary times inparticular, sometimes people can
get a real heightened responseright of their PTSD.
So we'll do it twice a week forlike three weeks and then we'll
do maintenance therapy afterthat.
Whether it's, you know, they.
They transition slowly.
Some people go to once a weekfor a while, then they go to
(47:22):
monthly, other people just gostraight to monthly, some people
just do it kind of PRN asneeded, based on you know how
they're feeling.
We do try to combine it withfasting because, as you were
mentioning earlier, fasting isthe best way to inhibit mTOR and
to improve aging, doing aroutine fasting.
So I try to do at least one, ifnot two, 72 hour fasts a month,
(47:46):
and that usually means that'sgood.
Holly L. Thacker, MD (47:48):
I can only make it 22 hours, and then that
migraine comes.
Elena Christofides, MD (47:51):
Yeah Well, so a lot of that's
hydration.
I will do electrolytessometimes during it.
I try to do it when I'mtraveling because it's easier
when I'm in a hotel and I'm not.
You know, my snack foods arenot right here beside me, and so
I'll typically, you know, fastlike Wednesday, Thursday, Friday
, and then go to the gym onSaturday when I return from my
travels and then and then resumeeating on Saturday.
So I do try to combine thefasting with the ketamine and I
(48:14):
find that that gets really greatresults.
Mental health wise, try to getthem to fast the day of the
ketamine and maybe even the dayafter the ketamine, and so they
at least get a 48 hour fast, ifthey can do it more on the
routine patients rather than theones who are coming in twice a
week.
That would be too much fastingto do it for 48.
Holly L. Thacker, MD (48:29):
Well, thank you so much, dr Chris
DeFetes, for joining us on theSpeaking of Women's Health
podcast, and thanks to ourlisteners for tuning in.
We're so grateful for yoursupport and we hope that you
consider sharing this podcastwith others.
You can donate to our nonprofitspeakingofwomenshealthcom and
(48:50):
leave us a five-star rating, andto catch all the latest from us
, you can subscribe on Spotify,tune in Apple Podcast and it's
completely free.
Thanks again for listening andwe'll see you again next time in
the Sunflower House.
Remember be strong, be healthyand be in charge.
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