Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
The Science Behind Living Better Longer
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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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 to continue a most interesting podcast with a wonderful guest. I'm so thrilled to have Dr Elena Christofides back on our podcast to finish our discussion on everything women's health, anti-aging and hormones. I gave her very impressive background on our first podcast, so I won't repeat all of that, other than to let our listeners know that she's the founder of Endocrinology Associates in Columbus Ohio and she's a leading medical researcher and physician on metabolism, diabetes and related processes. So if you haven't had a chance to listen to our first podcast interview, I definitely recommend that you go back to listen to that, because we talked about how hormonal health significantly impacts women's well-being as they age and we covered some of the common health challenges that women face, some potential treatments and especially the importance of a personalized assessment to optimize health through lifestyle as well as pharmacologic measures. So we are going to jump right in and continue that conversation.
Holly L. Thacker, MD:Welcome, dr Christofides. Going to jump right in and continue that conversation. Welcome, dr.
Elena Christofides, MD:Christofides, Thank you. Thank you so much for having me back on Dr Thacker. This is such an honor.
Holly L. Thacker, MD:Oh, it is so great to have you and you do such great care of patients and I'm so interested in your innovative practices and what you do to help patients make the most of their life and their lifespan. Tell me what are some of the common blood tests?
Elena Christofides, MD:or are there any special blood panels that you recommend for your patients? Yeah, we have actually a whole new patient panel. That's kind of automated in our system because most patients tend to come with similar complaints, and then a few extras, obviously, along the way. But we do have a set panel, and so a lot of it is stuff that you would think is obvious, like a complete blood count, a chemistry panel, liver panel, et cetera. But what's often misunderstood about doing these things all at once is the relationships between different levels of your complete panels.
Elena Christofides, MD:Or your blood count actually gives me a lot of insight around. You know what's the state of balance of your system, because, yes, there's the normal ranges, but you and I both know those don't really apply in endocrinology, you know. So I I'm interested in how things relate to each other, and then things that I specifically do that I've never seen anybody else do are things like the MTHFR hormone or, sorry, the enzyme pathway which looks at your B vitamin metabolism. I do do that genetic pathway. I do a lot of hemochromatosis genetic analyses as well, because, you know, we're so similar.
Holly L. Thacker, MD:We're so similar. We're like two sisters from another mother.
Elena Christofides, MD:You know, I feel like in the Midwest especially, we have such a large, you know, northern European, you know British Isles population and that's quite common disease of that population and I feel like doctors have stopped talking about it and so you have generations of individuals who have no idea that this is happening and contributing right to their liver disease and their metabolic health.
Elena Christofides, MD:And then obviously, the vitamin D. I mean I think we talked about this even on the last one, like you got to get a vitamin D, you got to know where people are. But the other things that I do actually relate to the lipid profile. But the other things that I do actually relate to the lipid profile I think people are getting more aware of, like ApoB levels and little, you know, lp, little A levels, which helped me really understand you know where someone's lipids are and where they need to be, whether we're going to treat or not treat. I mean the point is kind of need to know what you're looking at. But I also, especially if someone has a concern for lipids, I also do an ApoE genetic screen.
Holly L. Thacker, MD:You don't think that's opening a can of worms, do you?
Elena Christofides, MD:Well, but they're there to open a can of worms, Otherwise they wouldn't be seeing me.
Holly L. Thacker, MD:I guess you're right. I mean, I'm just curious, did you have your ApoE genotype done?
Elena Christofides, MD:Yes, actually, my entire office staff has done it. I've done it, I've had my entire family, because we do have dementia. That runs in our family. It runs in several family members of various employees and a lot of patients are very concerned about dementia. Oh very much so.
Holly L. Thacker, MD:Very, very concerned.
Elena Christofides, MD:And I think that it is an underappreciated relationship. I mean, medical research doesn't often move forward in a very rapid progression or very even or consistent progression, but I think that particular cat is out of the bag around ApoE. So if I have somebody who's coming in particularly concerned about lipids, I will do the APOE genetic screening in addition to a coronary calcium score exam. Yes, because I want to be able to tell them okay, this is where you are right now, this is where your genetics suggest you might be going, and then let's look at your family history and assess what your risk is of treating and not treating, or what do we treat with? Because that's also obviously part of the conversation. So you know, I'm already doing the MTHFR and the hemochromatosis genetic screening. I don't feel like adding the APOE is any more risky, because you know that's still a prevention that people are interested in. And do we have good answers yet? No, but we certainly have. It's better to know and know what you're working against versus like wondering.
Holly L. Thacker, MD:Now I previously got a lot of MTHFR mutations and I know one of our lead geneticists who was a top scientist, unfortunately recently passed, dr Karis Ang MD.
Holly L. Thacker, MD:Phd opinion was it's such a common mutation, with half the population having one defective gene, that it really shouldn't be done.
Holly L. Thacker, MD:And I still did it because I have a hard time having people do what I say and for the people that are homozygous with two mutations, they're going to oxidize their brain faster and so for me to get them on the methylated vitamins.
Holly L. Thacker, MD:But then I started to have pushback and insurance companies would charge people like seven or $800. And so now I'm just kind of erring on anyone who's interested in brain health, anyone who might have an increased risk of blood clot or prior DVTs or miscarriages. I'm just saying you need to be on methylated vitamins and in one of my podcasts on brain aging where I went over some of the research showing reductions in brain atrophy and those that are an acetylcysteine and the methylated vitamins and serifol and NAC now over the counter as serifol and Brain Wellness that I'm just so much more liberal at saying let's just take this vitamin. So are you having insurance pushback? Or also, what about people long-term care if they have a family history of dementia and they're ApoE44, is that going to make it harder for them, maybe down the road, to get disability or to get long-term health care insurance?
Elena Christofides, MD:I mean that's a lot of great points and great questions obviously that need to be taken into consideration as part of the discussion. So let's talk about the insurance and the pushback and the coverage. I have yet to have a lot of pushback on that and I have not had patients getting charged that kind of money.
Holly L. Thacker, MD:Wow Great.
Elena Christofides, MD:Which is great, and maybe just I'm lucky. But I will say that enough psychiatrists are doing it through gene site testing and getting the data.
Holly L. Thacker, MD:either way, yes, yes, yes, that's wonderful.
Elena Christofides, MD:Right, and in addition, you get it with any of the genetic tests like 23andMe, ancestry, et cetera, that people are also doing. That's showing up on those as well.
Holly L. Thacker, MD:Is that as reliable? Because I know that when we talk about cancer genes we always tell people recreational genetic testing, sorry, they only test for a few genes and even though 23andMe expanded it, which I think they've just undergone chapter 11 or something, so I don't know what's going to happen with all that data that I still feel like when I'm really concerned about genetic problems, I want them to see a genetic counselor and get official medical genetic testing, which is getting cheaper every day.
Elena Christofides, MD:Yeah, yeah, I mean you're absolutely right. I will say I have yet to find a single inconsistency in the 23andMe genetic testing for the stuff I'm looking for, like hemochromatosis and MTHFR, those are in there. The APOE is in there. So with one $200 test you get three genetic markers that don't enter into your medical record. I sort of feel like they have been accurate enough and they are outside the medical field enough that for patients who are concerned about any sort of backlash, that's one way of doing it and obviously with their Chapter 11 reorg that could be potentially messy. So I have that discussion. That's obviously a discussion for that individual patient. Some patients are concerned, some patients aren't concerned.
Holly L. Thacker, MD:And I haven't had that influence the issue. Yeah, it's so interesting in terms of data. My son, who I've had on this podcast in fact one of my patients the other day just said have him on again I really enjoyed that and I know I'm going to have a lot of people ask me to keep having you on regularly yourself, but he's a PhD in molecular genetics and basically in terms of some of these discussions about you know how much is genes, how much is an environment? You know in terms of just costs coming down and how is it going to influence everything. It really can be a very thorny issue and there's so many different aspects to it.
Holly L. Thacker, MD:We've had a genetic counselor come on and talk about the GINA law and I personally think that knowledge is power and I always encourage my patients when you have something done like gene site analysis that tells you how you metabolize psychiatric medicines, pain medicines, whether you have this MTHFR mutation, which is how you metabolize B-complex vitamins, that affects a lot of brain chemistries that you need to keep records of it. But the one discussion I've had with my son he did ancestry and my other son did 23andMe and people find out you're related to other people you didn't even know and find out you're related to other people. You didn't even know and find out you have other family members that you didn't know really wasn't your grandfather. It's crazy, but I just personally didn't like my genetic information out there. And he laughs at me and he said anybody can get your genetic information. Mom, you suck on a straw and there it is, and that's why when you say it's outside the medical record so people can't get it, I mean I just had my-.
Elena Christofides, MD:Well, it's outside of the official medical record. So I don't disagree with your son. I think that I understand the concerns, but it's not like people are out there cloning humans yet. I think we've got a ways to go. So you're right, you sip on a straw, you use a cup. You know if somebody wanted your genetic material they could get it. When I say outside the medical record, I mean outside the official medical record, because those are not part of the official medical record. Those are not in your medical chart unless you choose them to be. The pre-existing condition clauses were part of the ACH, so you can't. I mean the ACA Act did forbid, you know, discrimination against prior knowledge and pre-existing conditions and honestly, I haven't seen. So let's also put it this way If people were doing perfectly great and healthy, they wouldn't be in my office. So I think that there's a role for this genetic testing. Again, if you're doing great, congratulations.
Holly L. Thacker, MD:I'm happy for you, like that's fine, those people don't come see you and me. I understand they're coming to see me.
Elena Christofides, MD:So if you're trying to optimize what you're doing and trying to optimize your health for longevity, then these are things that 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 all this documentation, they don't believe it anyway. So you're right, the medical profession tends to push back on these as being irrelevant. So, on the one hand, we're sort of protected right now due to the ignorance of the profession, believing that these genetic tests are not really valid or important, and I'm happy for them to continue to think that 23andMe is terrible and not valid. It's great, that's fine, let them do that, because that means that all this testing that people are doing for their health and for their longevity isn't going to be viewed as being viable. So that's fine, we'll get the data and then use it to what we need it to be used for, and then let it not be part of the medical record.
Holly L. Thacker, MD:I guess I'm just such a privacy hound and I recently had my bank account hacked and money was being transferred and one of my banker sons was like well, mom, you know all your passwords, all your data, it's everywhere.
Elena Christofides, MD:And so.
Holly L. Thacker, MD:I do think that people should at least respect their own personal data and keep records, because it shocks me Years ago when I was in practice, people came all organized with their files and now everyone says, oh, just go look online. And all these computer systems don't always talk to each other. But anyway, I want to talk about part of your specialty and your practice is growth hormone testing and screening, and I know that's very controversial. So tell us what is growth hormone and what role you see.
Elena Christofides, MD:Yeah, that's absolutely right that it becomes controversial I think unfairly so. So growth hormone, I think everyone understands when you're young, when you're a child, you need it to fully realize your adult height and in proportion with puberty this reaches your adult height. This helps you grow tall, so it makes your limbs grow longer, right. And then, once you're an adult, you need it to maintain metabolic health and sort of fill the spaces in between. So it doesn't do. You remember that old commercial back in the 80s with BASF? They were a chemical company and they said you know, we don't make X, we just make it better. And they used to advertise on like cassette tapes and all kinds of manufactured goods. And I'm clearly dating myself.
Holly L. Thacker, MD:You're dating yourself, doctor, and you look so young.
Elena Christofides, MD:Clearly dating myself, but I always loved that commercial. Because growth hormone, you know, it doesn't make you lose weight but it makes you fitter. It doesn't make you heart healthier but it makes your heart happier and mental health, et cetera. It does many, many things. So it maintains stability of mood, it maintains metabolic health and, you know, improves insulin sensitivity. It improves muscle function and muscle strength and muscle conditioning. It improves healing, it improves recovery, especially of the soft tissues, and it is a critical hormone as we age to stave off the aging process.
Elena Christofides, MD:Now, unfortunately, yes, too much of a good thing is bad. Growth hormone has to be regulated and it has a very clear sort of zone of no-go in terms of when you're treating and when you're replacing and when you're managing it where you don't want to be, because it does have consequences when it's too high. But what's interesting about growth hormone is that, you know, one in five head traumas can produce adult onset growth hormone deficiency. So whiplash, car accidents, sports injuries, concussions and repeated head injuries. And let's not ignore the fact that many people might be in a physically abusive relationship.
Holly L. Thacker, MD:Oh yes, we had a podcast on domestic violence, intimate partner violence.
Elena Christofides, MD:That's a good point.
Holly L. Thacker, MD:I didn't even think to put those two together.
Elena Christofides, MD:Well, I mean, this is a question that I ask when I'm looking, so I also you were asking me. Part of my routine screening labs is I routinely screen IGF-1 as well. So an IGF-1 is a screening tool. It's not a diagnostic tool, but it's a screening tool that gives us an idea of directionality of your growth hormone and if it looks out of balance with where I really want it to be, then I might suggest a growth hormone STEM test.
Elena Christofides, MD:But I'm going to do a history and when I take the history, I'm asking specifically about head trauma and I'm asking about partner violence.
Elena Christofides, MD:I'm asking about domestic abuse and obviously I try to make it a very safe space for people to talk about it, and I'm always surprised at how much domestic abuse occurs, whether it's from childhood and it's just cumulative over the years, and it may not be happening to an adult today, but it may have happened in their life and I've had people tell me, you know, that they were thrown out of windows as children and repeatedly abused and, you know, thrown out of moving vehicles and these are things that can cause lifelong trauma to the poor little pituitary gland. So, growth hormone the reason it's so controversial is because it's such a hormone of abuse. If it didn't work, the athletes wouldn't all be using it. So my philosophy is, though but anything is a hormone of abuse if you let it be. Everything can be abused in the wrong hands and in the wrong understanding, and when people push back on that, the next thing I push back in is I say well, you know, bodybuilders and athletes also take insulin as a growth hormone, because insulin is also a growth hormone.
Holly L. Thacker, MD:Oh, it, sure is.
Elena Christofides, MD:Right. So they also take insulin in their recovery and in their you know bodybuilding world. So are we going to ban insulin now because somebody is abusing it? So the absurdity of the argument that we shouldn't look at it because it's a drug of abuse has always irked me. Because if you have growth hormone deficiency, you age faster, you have a shorter life expectancy, you are more insulin resistant, you have more metabolic ill health, you are higher in your lipid values, you are higher blood pressure, you're more likely to be developing premature coronary disease, more likely to have poor recovery, and so you're going to last at the gym longer, you're not going to be as fit.
Elena Christofides, MD:So there are significant reasons why someone might want to replace their growth hormone if it's deficient, if they're interested in maintaining you know well health into their older years. Not just it's not going to turn you into an elite athlete. And here's the other, the other part that kills me on this one. You know you could give me all the elite athlete drugs in the world you want. It's not going to turn me into an elite athlete. I just don't have the genetics for it. I don't have the physique for it Me either, right Like I.
Elena Christofides, MD:I used to joke all the time about that that I these are things that enhance what you have in, you know in genetically, what you're doing physically. But if you are someone and one of my favorite you know stories is I have a patient who was a triathlete and he was noticing significant drop-offs of his time and his performance, and we went through and I'll be damned if he didn't have hemochromatosis and MTHFR and growth hormone deficiency all three. So of course, by the time he was the age that he was when he came to me, these three conditions had cumulatively led to a significant drop-off of his performance. Not that any one did it right, it's not any one thing that did it. It's the fact that he had a series of things that were cumulatively leading to like declining performance. So we fixed all these things, fixed his nutrition, got him a CGM. You know we're tracking his nutrition, tracking his glucoses, teaching him about nutrition, which I know we're going to talk about later, cgm is continuous glucose monitoring.
Holly L. Thacker, MD:for our listeners, yes, exactly, thank you.
Elena Christofides, MD:Yes, and you know his performance improved. He was able to use the data to improve his weight, improve his diet, improve his lifestyle. He used, you know, the data to help him improve his fitness and his training performance. And you know we just gave him enough to make him back into like his normal, what would be his normal range for his age. And obviously I'm not one of those clinics that just gives people like these ridiculous doses and doesn't care about their levels. I track their levels. I track their, you know. I track their blood count to make 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 are ways to do this safely and appropriately. And so now he's back to performing at the level that he wishes to be performing at.
Holly L. Thacker, MD:That's an interesting story about hemochromatosis because you know, as many of my listeners know, I run the Center for Specialized Women's Health and I was boarded in internal medicine, going to be a cardiologist, got extra training in endocrinology and gynecology and female hormones and osteoporosis and just kind of interdisciplinary women's health. But one of the things that helped put me on the map early on in my institution was there was this executive who had all these problems and went from internist to cardiologist to gastroenterologist. No one could figure out what was wrong with them. So I get a call from the CEO saying you got to figure out what's wrong with this guy?
Holly L. Thacker, MD:I'm like okay, he had hemochromatosis and so that got me immediate respect, so that when I went to the CEO to say, hey, I got to build something that's different than what we have that really can help women, I mean I had an open door because of that diagnostic respect. So, yeah, and I think that-.
Elena Christofides, MD:So kudos to you for that. I mean, my son calls it like being Dr House, but the nice version, not the mean version. And that's what I always say too, because at the end of the day, these diseases of genetics and genetic inheritances, they take a while to show up. Yes, and unfortunately, that's also the time when, you know, we start to get a little gaslit, along with the providers of, in our forties and our fifties of, well, you know, that's just aging. Well, no, some people are aging faster than others.
Holly L. Thacker, MD:Oh, definitely, Definitely. So who? Who are the people that you get the growth hormone screening on?
Elena Christofides, MD:So every patient who comes through my door it's part of the new patient panel we do an IGF-1 on everybody because the vast majority of people coming in have complaints that are consistent with growth hormone deficiency as well right Fatigue, difficulty sleeping, gaining weight around the middle. Their gym performance is dropping off, so it is part of my routine piano and you'd be surprised at how many acromegaly patients we've also found screening that way. And acromegaly is a disease of excess growth hormone when it's produced by a tumor in the pituitary gland and it leads to significant deformities physical deformities as well, as, you know, medical conditions.
Holly L. Thacker, MD:And increased cancer rate. Yes, exactly, yes, I have had a few in my practice.
Elena Christofides, MD:So we have a bit of a reputation in the pituitary world that all of our acromegaly patients have what we call microadenomas, or small tumors that are curable when surgery. Because we seem to find them so early, because we're not waiting until they're 20, 30 years on with these symptoms before somebody is checking this level and discovering that they have quite a large tumor that is no longer perfectly curable with surgery. So it's just part of our routine panel now the IGF-1. And if it's out of range? Now here's the thing about out of range is that the range is quite large.
Elena Christofides, MD:So I will recommend a growth hormone testing protocol which is a little bit more in depth than an IGF-1 for anybody that is below the mean and this is an important distinction because men and women have different ranges of normal and it's quite broad. It's quite broad in range and we know epidemiologically in healthy populations that the IGF-1 should be about mean to about one standard deviation above the mean. It's about where the normal range really is. The range that's reported on the lab is the mean plus or minus two standard deviations and that's the actual range. So if you look at the range it's kind of misleading because it actually catches the hypo growth hormone patients or the low growth hormone patients. So I look for it to be mean, to just you know between the mean and the upper range.
Elena Christofides, MD:And if it's not there, then I recommend growth hormone stem testing.
Holly L. Thacker, MD:Very interesting. You know you were talking about the metabolic syndrome and you've been listening to the Speaking of Women's Health podcast. I'm your host, Dr Holly Thacker, the executive director of our nonprofit Speaking of Women's Health, and I am speaking with endocrinology, metabolic expert, anti-aging expert, Dr Elena Christofides, who has a practice in Columbus, Ohio, and you were mentioning this fatigue and weight gain, muffin belly around the belly, poor sleep, I mean. I hear this, of course, every day, and I was remarking to my specialized women's health fellows who do a two-year additional fellowship with me after their initial board certification in their primary specialty certification in their primary specialty, that when I started in this field it was like easy and fun, because there wasn't like the negative connotations about hormone therapy, which we've finally now gotten past that almost 23 years later post Women's Health Initiative.
Holly L. Thacker, MD:So that part's good. But what's also harder about it is like when I saw women, initially they had classic menopausal symptoms hot flashes, night sweats, maybe poor sleep, dry vagina plus minus bone loss. Now the women I'm seeing, they have all those symptoms plus they have so much more and they have metabolic syndrome. I mean I rarely saw a patient with type two diabetes or a woman with central adiposity in my practice, which was a referral center when I started in this field. Now it's unusual for me to see a thin woman.
Holly L. Thacker, MD:So I've done podcasts on our food supply and all these substances that are poisoning us, that are not allowed in other countries, but it just seems like the prevalence of metabolic syndrome is out of control. And I've, as part of my lipid profile and LP, little a and inflammation markers and I'm pretty pretty frequent and lax to say, yeah, go ahead and get a coronary calcium score, although I will say some women's health cardiologists say you can't exclude, you know, soft fatty plaques. But since I try to keep women off of statins because they increase diabetes and they don't have any primary prevention and everybody wants to put statins in the water, you know and I think that's pushed too much.
Holly L. Thacker, MD:I mean, cholesterol is needed for hormones and brain metabolism and I think we've gotten too far off on the statin issue. But I've been getting omega fat ratios. Are you including that in your panel? And hardly anyone I see is normal. The only normal people are either eating fish four times a week, not twice a week.
Elena Christofides, MD:Yeah, oh no, absolutely. So we had previously a really excellent lab for doing the omega ratios and I really really loved the lab, and unfortunately they are no longer in existence, so it has been difficult for us to find a lab that I can trust for their omegas. But you are absolutely correct. I mean, omega is a huge problem. When you talk about the food supply, omega is one of the biggest gaps in food supply health that we have compared to the rest of the world, and it is an interesting problem. I typically just recommend this is a funny one. This is actually where I just usually recommend supplementation over even screening, because no one gets enough omega-3s in this country in their diet regardless. And you, you know an interesting point. I'm going to actually bring something up because I know we're talking about a little bit about nutrition. A funny little story Did you realize that grass-fed beef and bison have more omega-3 fatty acids per ounce than seafood?
Holly L. Thacker, MD:No, I didn't know compared to seafood and I thought, like mackerel and tuna, I had mackerel for lunch. I'm going to have sea bass tonight for dinner.
Elena Christofides, MD:For our patients, though for our patients who are not interested in seafood or are concerned about their seafood supply, because that's also a real issue overfishing of our oceans, I mean, and that's the case, then I just ask them to look at, make sure they're doing grass-fed beef and bison and wild game which has plenty of omega-3s in it, and grass-fed beef in particular, and grass-fed milk, grass-fed butter you know those products. Grass-fed cheese you've already got a higher concentration of the omega-3 fatty acids.
Holly L. Thacker, MD:Yeah, I pretty much switched over to most grass-fed products. It's more expensive, that's for sure. You have to be, you know, careful that that's what you're really getting.
Elena Christofides, MD:Yeah, you can make up more of that difference though with, like, if you're doing the butter as well as the cheese and the milk. Right, and the cream, so it's incremental benefit. Right, it's incremental.
Holly L. Thacker, MD:Yeah, and I always recommend to my patients to get the omega-3 eggs. And of course eggs were so high priced because they were killing all the hens, but now they're coming down a little bit. But if they feed the chickens flax, that's another non-seafood source. The only reason I bristle a little bit about saying just take a supplement is because weight is every woman's concern pretty much and all I had to do is eat a big apple 300 calories for six months to gain 25 pounds and have a baby in six months. And there's extra calories in some of these supplements and I just personally would rather be enjoying my calories than swallowing them?
Elena Christofides, MD:Sure, because you have to keep restricting the calories you're eating the older you get. Well, so well. This may blow your mind. I never have my patients restrict calories.
Holly L. Thacker, MD:Really.
Elena Christofides, MD:Yeah, so the calorie cult is not a cult that I belong to. Fat is your friend, not your enemy.
Holly L. Thacker, MD:Yes, yes, protein is critical, right, I'm definitely in that. There's no essential carbohydrate, is my little saying Exactly.
Elena Christofides, MD:So I would rather someone get their omega-3s, whether it's a supplement or a food, and I don't disagree. Obviously I would rather you enjoy your food as well. But again that becomes a cost issue. That can become a lifestyle issue, An allergy yes.
Elena Christofides, MD:Yeah, and a family issue, right, If I'm cooking for my household, where I have two 25-year-olds that are athletes, we can go through two five-pound briskets in one dinner. That gets expensive, and so I understand that. I understand that people are like well, I have feeding a large family. I can't buy a 10 pound you know grass fed brisket for my, my family. That gets really expensive. So I understand that.
Holly L. Thacker, MD:So I guess I've gone to give a giving-fed beef as like a birthday gift to my older son. It was unfortunately delivered to his next door neighbor, a Browns player, who somehow thought his name was Stetson, even though there's no Stetsons on the Browns team. So I had to order another one.
Elena Christofides, MD:Yeah, no. So it is always a funny thing in the summer when the boys are doing the triathlete trainings and they're doing their races, you know, and I, one night I won farmer's market and I get I tend to get a lot of it from the farmer's market because I want to support our farmers, I want to support direct purchasing, I want to support local, local produce and I can talk to the farmer and know what they're doing and I know where they're raising their, their cattle, and I know how they're, you know, doing. It's sustainable, ethical farming, right? That's what I'm trying to rely on and I'll never forget that.
Elena Christofides, MD:One Sunday I thought I was going to make extra and have some for the week and I put these two briskets on the grill and, by God, I didn't barely get them off the grill before they were gone and I thought, okay, well, you know, this is maybe not the wisest strategy for when the boys are in training.
Elena Christofides, MD:So, with that being said, I don't disagree with your point about the calories, I don't disagree with your point about the supplements, and I would rather you know better eating better, living better, better focus on our nutrition and making those calories count, making our food count, because I, too, love mackerel and sardines. I mean, I have canned mackerel and canned sardines around all the time and I'm constantly fighting with the cat when I have to open them. So I'm always, always taking them to my office and eating them in secret, so the cat doesn't, you know, try to steal my mackerel. But but at the same time, I also appreciate that if you're dealing with somebody whose health has already been damaged, then we have to deploy every tool in our toolbox, and that's one that I'm willing to take the hit on yeah, and what foods and vitamins um legitimately support a good metabolism in?
Elena Christofides, MD:particular, yeah. So I'm going to talk about them in terms of vitamins and then we'll talk about the foods that support that or the things that support that. So omega-3s we've already talked about hugely important for reducing metabolic syndrome, improving glucose metabolism, improving vascular reactivity, which lowers blood pressure and of course improves clotting risk.
Elena Christofides, MD:So it lowers clotting risk and decreases atherosclerotic reactivity, so hugely stabilizing. And we just talked about the food sources where you can get more omega-3s in addition to the supplement. I mean you and I have talked about vitamin D, I think till the sun goes down, I mean vitamin D, vitamin D, vitamin D, vitamin D. Vitamin D is the first step in metabolism to every hormone in the body.
Holly L. Thacker, MD:Yes, yes, yes.
Elena Christofides, MD:Every hormone, including your lipid metabolism. True epidemiologic normals are 65 to 85, not what the lab says Exactly.
Holly L. Thacker, MD:If I have another patient tell me that their primary care doctor told them to stop their vitamin D because it was 87. I want to pull my hair out.
Elena Christofides, MD:I think I turn into the exorcist when this happens and my head starts twitching and I think I'm going to start spewing. I mean, it's so prevalent, it's disgusting. I don't disagree, and so I agree. Vitamin D 65 to 85 is the epidemiologic range. What's the consequence of too much vitamin D? Nothing If it's the inactive form, because your body will regulate how much it needs to convert from the inactive to the active, and so even drifting up to a hundred is fine. This is cholecalciferol we're talking about, which is a white powder, capsule. White powder that you purchase from special suppliers, like certain vitamin shops. Like I do not let my patients go to CVS, target, walgreens, meijer, costco, walmart, because those are not high quality versions of vitamin D, because vitamin D is so sensitive to this process of manufacture.
Holly L. Thacker, MD:Do you routinely add K2 to it if your patients aren't eating Japanese natto or food?
Elena Christofides, MD:rich sources. No, I don't actually, I have not found that.
Holly L. Thacker, MD:Yeah, I know it's back and forth. I've seen improvements in bone density and since there's some epidemiologic research that shows more coronary calcifications with increased calcium or vitamin D intake, I figure I want the calcium in the bone and M7 or K2 helps drive that. It has nothing to do with blood clotting.
Elena Christofides, MD:Completely agree with you. I mean, if somebody wants to take it, I have no objections. I just don't proactively prescribe. You are absolutely right about the calcium increasing the risk of vascular disease and atherosclerotic disease and I think my personal opinion is that correlative data is related to the fact that in the study these people were all vitamin D deficient and in the absence of vitamin D you don't have the co-factor to take calcium into the bones.
Holly L. Thacker, MD:Yes.
Elena Christofides, MD:So because you have to have the two together to go into the bones, otherwise the calcium is free floating the two together to go into the bones, otherwise the calcium is free floating and has nowhere to go. So with the vitamin d there's only a few brands and they're available on my website in terms of links to amazon, just the brands that I've seen that work because, so many brands don't work. And this is not a prescription. You cannot get a prescription.
Holly L. Thacker, MD:Vitamin d I know I tell patients the non-prescription is actually better than the d2 prescription yeah, because the d2 prescription is the active form.
Elena Christofides, MD:You can get toxic on it and that's not what your body needs In the world of endocrinology. What's really not understood sometimes is the world of endocrinology. Your body needs the inactive form of the hormone in order to be able to convert it to the active form, in order to do the job of the hormone. Sure, so that's the same thing with T4 and T3. We give T4 because your body's supposed to convert to T3. Now, obviously we know some people don't convert. Well, we have to supplement and that's fine.
Holly L. Thacker, MD:What percent of your patients do you have on T3? Because I know a lot of our endocrinologists are resistant to using T3, and I think I have about 5% of my women patients.
Elena Christofides, MD:Oh no, it's probably closer to 50% for me, for you, wow.
Holly L. Thacker, MD:Wow, you probably see tougher cases. There was a big.
Elena Christofides, MD:Well, actually there was a big series of patient evaluation, big series done and presented at the ADA American Diabetes Association meeting a few years ago that showed that there was a higher likelihood of T4 to T3 conversion disorders genetically in patients with more obesity. Okay, yeah, so if I have somebody, who has thyroid.
Holly L. Thacker, MD:So if someone's obese, that would be.
Elena Christofides, MD:Yeah. So if I have a thyroid patient who also happens to have obesity, or I have a thyroid patient who also has a leather autoimmune diseases, they tend to do better with a combination. Now I obviously prescribe them separate. So, with that being said, the rule in endocrinology in general is you need the inactive form to be plentiful in order to convert it to the active form to do its job. And this is why the vitamin D story is such a complicated one, because the prescription vitamin D version is the active form that we give in cases where they cannot convert to the active form, like in kidney failure and other situations.
Elena Christofides, MD:And that one, the green, it's a blue-green gelatin capsule. The minute somebody says, oh, my doctor gave me a prescription, said I only need to do this for a few weeks and we'll be done, and my question is always is it blue-green or white? Because if it's white it's right, so if it's blue-green, it's wrong. Now vitamin D. Interestingly, I've had quite a few patients over the years who've been very um unable to tolerate vitamin D supplementation for a variety of reasons. Usually, they have some sort of severe GI disturbance, and so I do recommend um tanning five minutes a day in just the UVB. And they don't. They're just five minutes. They don't even get tan, they don't no color changes. Obviously they do it without sunscreen on and we do it until their vitamin D levels get up to a decent level, like say above, you know, 50, 55. And then somehow they're able to better tolerate more low dose, consistent vitamin D dosing at that point.
Holly L. Thacker, MD:Interesting. I have used the vitamin D lamp in some difficult patients. Yeah, Moving on to longevity treatments, kind of tell us what's the hype and what's real with some of the anti-aging medicines fasting, and I'm very interested in the peptides and what you do for mitochondrial support.
Elena Christofides, MD:Yeah, a big topic, right. So what's very real is mTOR inhibition. Mtor inhibition is a mitochondrial function. That's where all the anti-aging work is being done. It's already been shown to be true in multiple animal species other than human, like dogs, cats, mice, et cetera. So I think that there's actually supposed to be an approval here coming soon for extending the life expectancy of dogs for the same reason. So what inhibits mTOR? Well, that's sirolimus, that's low-dose naltrexone and that's metformin. I will tell you I absolutely do not want to use metformin in anybody because of the B12 deficiency issues that you can exacerbate with metformin. And given that everyone is MTHFR deficient, you're adding, you're dogpiling that. So I don't like the idea of metformin for a lot of people. Obviously, if you're talking about diabetics, we do know that that has decreased cancer risk and decreased cardiovascular risk in diabetics. So sometimes we use it, but not always. Low-dose naltrexone is quite effective on a daily basis for anti-inflammation and people who have aging issues due to inflammation, like chronic inflammatory diseases.
Holly L. Thacker, MD:I have a few patients who just swear by it.
Elena Christofides, MD:Yeah, I mean I have a few patients who also swear by it. Not a lot, it's a few milligrams, it's not a lot dose.
Holly L. Thacker, MD:Right Very tiny.
Elena Christofides, MD:It also forms the foundation of one of our most successful oral anti-obesity medications.
Elena Christofides, MD:Contrave Contrave with bupropion has naltrexone in it with bupropion, and very effective in those individuals as well. And then, of course, serolimus is the big one, right, serolimus is the big guy. Small doses, weekly doses, has been revolutionary for my patients who have unexplained, undifferentiated chronic illness of an inflammatory nature that we 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, their triglycerides are high, their HDL is low, their blood pressure. They're just metabolically terrible and we can't figure out why. So we'll do a 12 week trial and I and I will tell you, in some cases it has been miraculous.
Holly L. Thacker, MD:I think there's a few people I need to send to Columbus to see you that kind of fit, that profile. You know, speaking of mTOR and rapamycin, there's very few situations from my perspective as a menopause expert that I cannot give estrogen or hormone therapy for right. Because there's very few things that we just reduce all estrogen.
Holly L. Thacker, MD:So one of them is lethangiomyomatosis LAM, and I've only ever had a couple of cases in my career, and so I saw a woman the other day that was told by her pulmonologist to stop hormone therapy and I said, okay, well, we'll see if by stopping you got any better or you stopped the progression, because I wasn't really convinced. But she said, well, this is what's recommended, and she brought out the information and apparently they're using rapamycin for lamb, which I thought was very interesting.
Holly L. Thacker, MD:That is interesting, so I told her don't don't don't be hesitant to take it, and maybe that might potentially open the door for us.
Elena Christofides, MD:I completely agree. I don't hesitate to use it at all as a trial because it's not. It's really low doses. You know the doses that we use in transplant medicine are hundreds of milligrams daily. We're talking about under 10 milligrams once a week, so fractions of the doses. And you know some patients can't tolerate it. I've had a couple of people who couldn't tolerate it and that's fine. But you don't know until you try. But in those circumstances, for those people who don't tolerate that, who don't tolerate the other therapies, then we go into the mitochondrial support peptides, which are things like NAD, methyl blue.
Holly L. Thacker, MD:Do you do those by infusions, because I know you were saying that oral NADH doesn't really have very good absorption.
Elena Christofides, MD:Yeah, oral NAD can't be absorbed. It's broken down in the gut and then you can try taking NMN, but I don't I think the data is still kind of suspect on that in terms of whether you actually get good absorption. So we do it by infusion. We have it by infusion and then obviously you've got the BPCs for the joint soft tissue support for people who have acute injuries, and then you've got the growth hormone style peptides, like you know semorelin, tesamorelin, et cetera, ipamorelin that are like growth hormone but not they help, they balance growth hormone.
Elena Christofides, MD:The better way to explain it for the audience I'm trying to not explain it in a really convoluted way they're basically the peptides, that sort of signal growth hormone. So these are effective in people who have growth hormone but just want to optimize their growth hormone signaling. So these are. These are effective in people who have growth hormone but just want to optimize their growth hormone signaling pathways to get full advantage of their growth hormone. Those don't have much efficacy in people who actually have growth hormone deficiency, because you need an intact growth hormone access for those to work. So that's why we do such a aggressive job of screening for growth hormone, because if somebody has actual growth hormone deficiency and they want to take some, you know, semirelin, tesamorelin, ipamorelin. It isn't going to work. So I'm trying to save them some money and time on that regard, if that's the path that they want to take.
Holly L. Thacker, MD:And how do you use methylene blue?
Elena Christofides, MD:So methylene blue is a methyl donor, so it works like in the MTHFR family, right? So if you have people who have MTHFR abnormalities, let's say they don't tolerate some of the methyl B complexes. I've had a few people who got a lot of anxiety from the methyl B complex vitamins, and so we were using the methylene blue instead to try to give them their methyl donor groups and bypass their need for the large doses of methyl B-complex.
Holly L. Thacker, MD:That's interesting. The only trouble I've gotten into with really high dose L-methylfolate of course I always make sure that the B12 is fine and that they're usually on methylated B12, is because it increases serotonin and of course the psychiatrists use it in high doses for depression. I've had some people tell me that they can't sexually climax. It's like they have too much serotonin on board by pushing it up too much. Interesting.
Elena Christofides, MD:Yeah, it's only been a couple of people and I figured that's the thing.
Holly L. Thacker, MD:So moving into depression and anxiety and PTSD as we wrap up and again we're going to have to have you back again because you're just so wonderful and delicious. Are you doing ketamine infusions? I know there's like a whole lot out in the space about psychedelics and infusions and other more novel treatments for mood disorders.
Elena Christofides, MD:Absolutely. Ketamine has again. It's been. I say this and it seems like I may be just hyperbole, but ketamine, like some of the other things that we've been doing, has also been equally ground shaking, revolutionary for the patients who we've been doing, has also been equally ground-shaking, revolutionary for the patients who we've been doing it for. So we don't do infusions, we do intramuscular injections. I feel like infusions are entirely too medicinal, medical, anxiety-inducing on their own, because you have to have an IV in place. You have to make sure that it's getting a continuous infusion. If the patient freaks out or is concerned or isn't getting a good dose, it medicalizes the procedure. It makes it harder for the patient to have a good experience. So we work with our psychiatrists and our therapists in town and we do an intake review with the patient. We make sure that they're appropriate. We do prefer to do it for people who already are seeking counseling and therapy. So we have a partner in psychotherapy.
Holly L. Thacker, MD:Sure, that's so important.
Elena Christofides, MD:Yeah, because they're coming to us for PTSD, for depression, for anxiety, for trauma, for recovery, and we don't want to hinder their recovery by only doing the medical part. There needs to be a psychiatric part, a therapy part as a psychotherapy component. So we do the intramuscular injections. They are medically monitored and my nurse practitioner is in the room with them the whole time and so they're babysat, so to speak, and we have a protocol where 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're having, maybe it's an anniversary, you know, that is inducing the PTSD. So, especially for veterans, maybe it's an anniversary of, you know, their injury in the field, or an anniversary of a colleague's suicide or something of that nature, or anniversary of somebody who was maybe abducted or abused.
Elena Christofides, MD:Around anniversary times in particular, sometimes people can get a real heightened response right of their PTSD. So we'll do it twice a week for like three weeks and then we'll do maintenance therapy after that. Whether it's, you know, they. They transition slowly. Some people go to once a week for a while, then they go to monthly, other people just go straight to monthly, some people just do it kind of PRN as needed, based on you know how they're feeling. We do try to combine it with fasting because, as you were mentioning earlier, fasting is the best way to inhibit mTOR and to improve aging, doing a routine fasting. So I try to do at least one, if not two, 72 hour fasts a month, and that usually means that's good.
Holly L. Thacker, MD:I can only make it 22 hours, and then that migraine comes.
Elena Christofides, MD:Yeah Well, so a lot of that's hydration. I will do electrolytes sometimes during it. I try to do it when I'm traveling because it's easier when I'm in a hotel and I'm not. You know, my snack foods are not right here beside me, and so I'll typically, you know, fast like Wednesday, Thursday, Friday, and then go to the gym on Saturday when I return from my travels and then and then resume eating on Saturday. So I do try to combine the fasting with the ketamine and I find that that gets really great results. Mental health wise, try to get them to fast the day of the ketamine and maybe even the day after the ketamine, and so they at least get a 48 hour fast, if they can do it more on the routine patients rather than the ones who are coming in twice a week. That would be too much fasting to do it for 48.
Holly L. Thacker, MD:Well, thank you so much, dr Chris DeFetes, for joining us on the Speaking of Women's Health podcast, and thanks to our listeners for tuning in. We're so grateful for your support and we hope that you consider sharing this podcast with others. You can donate to our nonprofit speakingofwomenshealthcom and leave us a five-star rating, and to catch all the latest from us, you can subscribe on Spotify, tune in Apple Podcast and it's completely free. Thanks again for listening and we'll see you again next time in the Sunflower House. Remember be strong, be healthy and be in charge.
