#161: Shari Caplan, MD- Balancing Hormones Naturally, Fertility and Libido

by Mike Mutzel


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About Shari Caplan, MD

Dr Shari Caplan has spent years preparing this program. She is traditionally trained and is both board certified and a Fellow in Anti-Aging and Regenerative Medicine (FAARM) in the American Academy of Anti-aging Medicine and also holds a Fellowship in Metabolic and Nutritional Medicine with the Metabolic Medical Institute.

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Books and Products Discussed in this Episode

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Show Notes

02:02 How Lifestyle Affects Hormones: Dr. Caplan not only assesses hormone levels, but patient’s nutritional status and stress levels: what we eat, how well we sleep, our stress, our toxic load, and our nutrient deficiencies. Hormones do not work in isolation, so all issues must be addressed. Some patients don’t want to make lifestyle changes. They can be made to feel better, but they would have much more success if they addressed all of the issues. Dr. Caplan is now able to offer the services to help patients make these lifestyle changes.
03:50 Lifestyle Services: She wants her patients to get moving. It changes telomeres, modifying our genes. Exercise, as well as meditation, are good methods of stress reduction. Dr. Caplan offers meditation classes, behavioral therapy and cooking classes/demos and patient education classes. For detox/destress, Dr. Caplan offers massage therapy and infrared sauna. Her clinic has chiropractors, hormone therapists, and naturopaths. They do IV therapy and have a great weight loss program. Compliance is higher now that patients can get everything at one place.
06:52 The Importance of Addressing Lifestyle: Many hormone imbalances are due to environmental factors. Our environment contains fake estrogens called xenoestrogens that are endocrine disruptors. This causes an imbalance, where there is a huge estrogen load and not enough progesterone, causing cycling issues, moodiness, weight gain and more. One could increase progesterone or reduce excess estrogens. Reducing xenoestrogen can be done through diet. Some chemicals in herbicides and pesticides look like estrogens to our bodies. Eating organic will help. Avoid eating out of or heating things in plastic containers. We should detoxify more often and cultivate healthy gut bacteria.
08:45 Stress and Our Hormones: If you are stressed out, you will steal your progesterone to make cortisol. Supplementary progesterone just feeds the process, making you tired, wired and fat. If you are deficient on certain nutrients, you will not make your hormones well nor metabolize them well. There is an increasing number of neurotoxins that are measured in cord blood and breastmilk. Upregulating and making more detox pathways more efficient makes people feel better and weight improves.
12:34 Release of Toxins: When people start losing weight, their CRP begins elevating. Dr. Caplan believes that when we lose weight, we are liberating toxins. If we do not adequately deal with toxins, your body requires fat to neutralize them. Through supplements, infrared sauna, and exercise there is a higher likelihood of keeping weight off.
13:32 Diet: We need a good fiber, but we cannot use the same fiber for everyone. Certain fibers irritate some people’s bowels. Prebiotics are valuable once the gut is doing well. Balancing the gut microbiome is important for weight loss.
14:52 Estrogen/Progesterone Balance: Women with out of balance estrogen/progesterone tend to have heavy periods and become anemic, which can block thyroid. When thyroid is blocked, they tend to have heavier periods. Jerilynn C. Prior, professor of endocrinology and metabolism at the University of British Columbia has studied women’s cycles at great depth. She has found that women as young as 38 may not produce the same amount of progesterone as they did in their 20s. These women may have monthly periods, but may not be ovulating. If you do not ovulate, you do not make progesterone.
15:56 The Problem with Low Progesterone: Estrogen is like a fertilizer, causing the breast and the uterus to grow and thicken. Progesterone is like the lawn mower. It thins the lining of the uterus and slows cell division. Rapid cell division increases the risk of cancer. Women who have periods into their 50 have a higher risk of breast cancer because they have unopposed high estrogen and not enough progesterone. Giving natural progesterone may reduce risk of breast cancer. Progesterone is made when we have our periods or during pregnancy and is breast protective. MPA is an often prescribed medication that is an altered molecule. Our body does not recognize it as progesterone, though it works similar to progesterone on the lining of the uterus to reduce estrogen stimulation, but it can increase women’s risk of breast cancer. Studies have found that the drugs Premarin and Provera increase your risk of breast cancer and stroke.
18:18 Taking Estrogen or Progesterone: When you swallow estrogen, it increases clotting factors, thus increasing risk of stroke and cardio vascular event. This is not a problem when estrogen is absorbed through the skin. We should be giving progesterone as opposed to medroxyprogesterone acetate.

18:49 Progesterone/Progestin: In key studies, progestin was used, but it is referred to as progesterone. The medical community mixes up progestins, progesterone and progestogens, which is the group of progesterone and progestins. A large study in Europe showed that depending upon whether progesterone or progestin was used, that risk of breast cancer was different. If you look at a molecule of estrogen and a molecule of testosterone, they look more similar than progesterone and MPA.
20:29 MPA/Progestin: MPA/Progestin stimulates progesterone receptors in the lining of the uterus, but they are molecularly different from progesterone. We have receptors for progesterone and estrogen throughout our body. Progesterone binds to the GABA receptor. GABA is calming. When women have less progesterone, they begin to have sleep problems and anxiety. Supplementing with progesterone is preferable to sleeping pills or antidepressants.
22:54 Symptoms of Low Progesterone: Irregular menstrual cycles, heavy flow, clotting, flooding can be symptoms, as well as having no cycles. They can be moody and irritable, and can suffer from PMS, weight gain, bloating, and even palpitations. It effects the electrical impulse of the heart. It is integral. Almost any diagnosis can be a hormone imbalance.
26:02 Treating Heavy Bleeding: Enough progesterone with an estrogen should be prescribed so the lining of the uterus does not become thickened. Estradiol is what we make throughout our reproductive life. Once we reach menopause, we make less and less. Estriol is metabolized estradiol. Women who make the highest estriol in pregnancy have the lowest risk of breast cancer. Estrone is breast cancer permissive, stimulating the breast cells to divide more and Estrone is more likely to do DNA damage. TriEst is a combination of estriol, estradiol and estrone combination. TriEst should not be used. BiEst is estradiol and estriol. Dr. Caplan will also prescribe progesterone in pill, cream or other form. Studies show that 20 to 30 mg of progesterone cream can protect the lining of the uterus. How we absorb and metabolize is individual.
30:18 Oral Progesterone: It is the same molecule whether you are swallowing it or putting it on topically. Progesterone that comes in pill form is usually 100 mg. When you swallow progesterone, much of it is converted into allopregnanolone, which helps with sleep. Of the 100 mg, you are probably absorbing 10 to 20 mg as progesterone. If you have a poor gut, you will not absorb your medication optimally. Progesterone may work best for sleep when given orally, but topical application will also improve sleep.
32:18 Progesterone for Men: We all have the same hormones. The amounts differ between the sexes. We can give men lower doses of progesterone, 10 to 30 mg pill. Women usually take 100 to 300 mg. Too much progesterone for men can cause erectile dysfunction. Many practitioners who give testosterone to male patients, may give a low dose progesterone cream to block testosterone from converting into hydro testosterone which causes side effects.
34:10 Endocrine Disrupting Chemicals: Everyone is genetically different. So some of us can metabolize these chemicals. For many of us, even the smallest fragrance or chemical exposure causes problems. Dr. Caplan has her patients on B vitamins to help with methylation and to improve detox pathways, NAC or a product that will upregulate phase 2 is used. The reaction to fragrance and other chemicals can be heightened by thoughts about reacting. Control what you can and try not to become anxious. Try to buy products that are paraben free and fragrance free.
37:01 Endocrine Disruptors and Men: Younger and younger men, in their thirties, have low testosterone levels. The gold standard used to be 100 million sperm. Now it is good enough if you have 20 million. When a man has more estrogen than testosterone, it causes problems with fertility. They tend to gain more fat. They aromatize their testosterone into estrogen. Lower sperm counts are a marker or aging. Our environment and the way we eat is aging us and having repercussions on our fertility.
38:42 Men and Low Testosterone: Certain supplements will increase sperm count like CoQ10 and NAC. N acetylcysteine makes glutathione, which helps with detox. Not only is it a good antioxidant, it helps get rid of toxins, and detoxes estrogen. Diindolylmethane (DIM) also helps with estrogen detox. If you have high estrogen, testosterone production is being blocked. If you are heavy, you are converting testosterone to estrogen. Stress cuts off the brain’s messages to the testicles to make testosterone and sperm. Low zinc, low B vitamins, and low folic acid negatively impact sperm production. Head injuries can also impact testosterone levels. Eat right. Exercise. De-stress. Take your supplements. If you have low testosterone at 30, you have increased cardiovascular risk, increased diabetes risk and others. Testosterone is given topically or injected. Dr. Caplan prefers injection. It is cheap and gives quick responses. Now subcutaneous injections are being done. They are less painful and effective at a lower dose. A man makes 7 to 10 mg of testosterone in a day, but prescriptions for men are typically for 50 and 200 mg of cream per day. Dr. Caplan thinks that creams take testosterone to the tissues first and then into the blood, making measurement problematic. If blood levels are good, we may be overshooting and the overage of testosterone may be going down different pathways, perhaps creating more dihydrotestosterone, causing hair loss, acne or prostrate issues.
45:11 Insulin, Leptin and Cortisol: They are all intimately connected. All three can cause people to be fat and tired. Insulin resistance is now appearing in people as young as in their 20s. Nutrient deficiencies are the result of our poor diet. These deficiencies increase insulin resistance. Insulin is a growth factor and makes you fat. The hormone leptin, which is supposed to be released from your fat cells, travels to your brain to say that your body has enough energy and to stop eating. When you eat carbs, that message gets blocked. If you have high inflammation, high CRP, the CRP molecule will prevent leptin from binding in the brain. If you have high cortisol, you tend to gain abdominal weight, messing up all the other hormones and heightening inflammation.
47:25 Dr. Caplan’s Morning Routine: Dr. Caplan works into the evening and sleeps later in the morning. She utilizes the many stress reduction and wellness resources in her clinic. In the evening, she does a yoga class or meditation. She gets a massage, uses the infrared sauna, and sees her chiropractor weekly. Chiropractic helps the immune system and brain function. She practices what she preaches.
49:45 Dr. Caplan’s Favorite Supplement: B vitamins are her favorite. Methyl B12, methylfolate, B6, and B12. B vitamins help with fat and carb metabolism. They help with methylation. They are part of the Krebs cycle. They help with neurotransmitters. They help with the immune system. They help with methylation and detoxification.
50:48 Dr. Caplan’s Health Pitch: We need to spend our healthcare dollars differently. Right now they are cutting funding for testing. We need to do more testing to find deficiencies and correct them. In the long run, they save money because the population will be healthier.

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