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Putting Pep in Their Step: Supporting Patients with Age-Related Muscle Decline

  • Jul 25, 2024
Pure Encapsulations Pro Blog
Learn how to mitigate age-related muscle decline. Discover ways to help aging patients support their muscle mass and strength for sustaining mobility and independence.

Putting Pep in Their Step: Supporting Patients with Age-Related Muscle Decline

Introduction

Skeletal muscle is the predominant tissue in the human body, comprising 40% of overall body weight.[1] We rely on our skeletal muscle for numerous physiological functions including movement, maintaining posture, generating force, metabolism and respiration.1 

 

As people age, so do their skeletal muscles.

Prevalence and Symptoms of Age-Related Muscle Decline

Age-related muscle decline can begin at age 30.3 More pronounced in sedentary individuals, muscle mass can be lost at a rate of 1% per year.[1]  Loss of muscle mass can also be accompanied by atrophy of muscle fibers and reduced muscle function and strength. This gradual decrease can progress, with an individual losing up to one-third of their muscle mass by age 80.2

Loss of muscle mass and strength in older individuals could contribute to fall risk, reduced mobility, loss of independence, and ability to perform daily functions.2

The Mitochondria’s Role in Muscle Health

Skeletal muscle is a tissue with high energy demands and mitochondria are primarily responsible for meeting this demand. Mitochondria not only power muscle contraction by supplying ATP, they also undertake other critical functions, including moderating intracellular calcium, cell proliferation, apoptotic signaling, regulation of redox states and immune response.[1] 

Well-functioning mitochondria are essential for maintaining cellular homeostasis and muscle health. Cellular mitochondrial health is maintained by growing the mitochondrial pool through mitochondrial biogenesis, through preserving fusion and fission and by ensuring the removal of dysfunctional mitochondria through mitophagy. 

Mitophagy is a selective autophagy process that serves as the mitochondria’s own quality-control mechanism and involves removing and recycling dysfunctional mitochondria.[2] Mitophagy helps preserve only healthy mitochondria for the mitochondrial pool. 

Just as skeletal muscle function can change as the human body ages, mitochondria are also subject to the effects of aging, as shown in the illustration below. These age-associated changes in mitochondria can lead to altered mitophagy [3],[4],[5],[6] 

When mitophagy is altered, it can lead to the accumulation, rather than clearance, of less-functional mitochondria. 

Accumulation of these mitochondria can contribute to energy deficit and changes in the balance between anabolic and catabolic processes — important determinants of muscle mass, function, motor neuron and muscle fiber health.8,[7],[8]

Created with BioRender.com

Mitochondria can quickly adapt to changing conditions triggered by systemic or cellular challenges.3 

Supporting mitochondrial function helps reduce loss of muscle mass and function and benefit overall health, specifically by enhancing mitochondrial dynamics and mitophagy.3

Both sedentary and physically active are susceptible to age-related muscle decline, yet the degree of severity is highly variable and dependent upon multiple risk factors beyond mitochondrial health, including hormone and cytokine balance, malnutrition and degree of physical activity.[1]

Exercise and Nutrition Interventions for Age-Related Muscle Decline

Exercise

Lack of exercise is believed to be the leading risk factor for age-related muscle loss.11
Both resistance and aerobic training have been shown to improve the health of skeletal muscle by impacting mitochondrial quality and increasing muscle strength and function in older patients.11,[1],[2],[3]

Individually tailored exercise programs can support healthy aging and be a means of prevention and intervention for age-related muscle decline.

Created in Canva

In clinical studies demonstrating the benefits of aerobic, resistance or combined exercises, exercise was performed at least 2-3 times per week, for 30-60 minutes each session, for at least 8-12 weeks.12,13 

When recommending exercise as a therapeutic option for patients, the duration of sessions, amount of weight, distance, and number of exercises should increase gradually based on each individual’s capability and improvement.

Nutrition

Forty percent of older individuals do not meet the recommended .8g/kg protein intake requirements in their diet.[1] Poor protein intake, combined with decreased absorption and intake of other nutrients that are essential for muscle health like amino acids and vitamins and minerals, put older individuals at a greater risk of reduced muscle protein synthesis or “anabolic resistance”[Ma1]  and muscle loss.[2] In addition, changes in mitochondrial function that also occur with aging can contribute to oxidative stress and favor catabolism of the muscle.[3],[4],[5]  

Two ways to support age-related muscle decline in the older patient involve assessing their protein and antioxidant intake. Recommended adequate protein in the older patient is 0.8 gm/2.2 lbs of body weight up to age 65, and 1 gm/2.2 lb of body weight after age 65.[6] 

In a systematic review of 19 observational studies and 9 randomized-controlled trials, Besora-Moreno et al revealed that a higher intake of antioxidant foods was associated with better muscle preservation outcomes.[7] A meta-analysis of 4 randomized-controlled trials by the same authors found that that higher fruit and vegetable consumption and supplemental protein each significantly improved20  

Nutrients to Support Age-Related Muscle Decline

Along with adequate protein, a phytonutrient rich diet and exercise, f[Sa1] [AD2] ocusing on nutrients that support cellular, mitochondrial and muscle health can help improve patient outcomes.

 

Urolithins are unique natural metabolites of intestinal bacteria that are produced by commensal microbiota after consuming foods rich in ellagitannins and ellagic acid — major health promoting constituents of pomegranates, nuts and berries. These unique polyphenols undergo metabolism by intestinal bacteria to small, highly absorbable metabolites called urolithins, which mediate the widely acclaimed health benefits of pomegranates and other ellagitannin-rich foods.[1],[2]  Urolithin A also supports muscle function in preclinical models, improving endurance and exercise capacity in both young and age-related models of muscle decline. [3]

 

B vitamins are essential to basal mitochondrial function, serve as metabolic coenzymes and/or methyl donors.‡

 

PQQ provides B vitamin-like activity with unique antioxidant properties. PQQ supports mitochondrial, neuronal and cellular function, at least in part, by activation of Nrf2 and antioxidant gene expression. PQQ may also help to maintain cytokine balance.‡

 

Amino Acids are the building blocks for all proteins, making them essential for several body functions, including fluid balance, enzyme production, cellular repair and energy metabolism.[4],[5] Proper intake of amino acids is important for the synthesis, repair and metabolism of muscle, cells and tissues.‡ 

Pure Encapsulations®Nutrient Solutions

Pure Encapsulations® offers high-quality supplements that are FREE FROM unnecessary additives and many common allergens for patients who may need support for age-related muscle changes. We offer nutrients individually and in combination to meet all your patients’ unique needs.

Klean Athlete® and Douglas Laboratories® are Pure Encapsulations partner brands.

Klean Athlete is our dedicated sports nutrition brand designed to power peak performance through optimal health. By harnessing the science of sports nutrition, Klean Athlete delivers safe, NSF Certified for Sport® supplements to support healthy, active lifestyles. Klean Athlete is trusted by over 350 professional and collegiate sports teams, and is the preferred brand of many of the world’s top coaches, trainers and health professionals.‡

Douglas Laboratories has been dedicated to meeting the needs of healthcare professionals for over 65 years. As a globally recognized leader in innovative, science-based nutritional supplements, we strive to support healthcare professionals as they help their patients discover the potential for healthy living, today and in the future.

Cellular Health

Renual enhances mitochondrial renewal to support energy output/energy production. Features Mitopure™ Urolithin A to power muscle function, increase cellular energy and promote healthy aging. Research indicates that urolithin A enhances autophagy, the natural process of cellular renewal in which the body degrades and recycles cellular components, as well as mitophagy, the clearance and recycling of older and dysfunctional mitochondria. Resveratrol offers support for longevity, metabolic health, and mitochondrial function.[1],[2] CoQ10 is a key nutrient used in the energy production pathway.[3]‡

Suggested use: Take 2 capsules, 1-2 times daily, with or between meals.

Ultra B Complex w/PQQ combines essential B vitamins with PQQ to support cellular energy production and mitochondrial bioenergetics and function. It also contains alpha lipoic acid and luteolin for enhanced antioxidant and cellular support.‡   

Suggested use: Take 1 capsule, 1-2 times daily, with meals.

Muscle Health

Muscle Protect with HMB supports healthy muscle mass and function, provides anabolic muscle building support attenuates muscle protein breakdown and preserves lean muscle mass in aging adults. Formulated with clinically studied HMB® and Amino 9™, a leucine-rich blend of essential amino acids (EAAs) combined with vitamin D3 and glutamine.‡

Suggested use: 1 scoop, 1-2 times daily

KLEAN Isolate™ supplies 20 grams of high-quality whey protein isolate in each serving. The dietary protein provided by Klean Isolate™ supplies essential amino acids, including branched chain amino acids that participate in many of the body’s metabolic and physiologic systems. With no additional flavorings or sweeteners, Klean Isolate™ can easily be added to any beverage to enhance daily protein and amino acid intake.‡

Suggested use: Adults take 1 scoop daily mixed with 10-12 oz. of water or other beverage (cool or room temperature), or as directed. For best results, take within 45 minutes after being active.

KLEAN Plant-Based Protein™ by Klean Athlete® supplies a blend of pea and organic brown rice protein to provide amino acids for muscle protein synthesis. ProHydrolase® [De1] enzymes are included to break down protein for increased amino acid absorption and to ease digestion, along with Sunfiber® for gastrointestinal health.‡   

Suggested use: 1 scoop daily mixed with 10-12 ounces of water or other beverage, or as directed by a trainer, coach or health professional.

Digestive Support

Digestive Enzymes Ultra w/ Betaine HCl contains an extensive profile of betaine HCl and digestive enzymes to support protein, carbohydrate, fat, fiber and dairy digestion while promoting enhanced nutrient bioavailability and absorption. Encourages optimal gastric pH with betaine HCl, which is important for the enhanced digestion of protein and other nutrients for daily wellness and healthy neurotransmitter synthesis.[1] ‡

Summary

Loss of muscle mass and strength can significantly impact an individual’s well-being and ability to live independently. Providing patients with targeted, personalized nutrition and exercise interventions to enhance anabolic processes and cellular health can greatly influence their quality of life now, and as they age. 

 

 Pure Encapsulations® provides uniquely formulated products made with high-quality, pure ingredients backed by verifiable science to complement your plan of care.

Resources

Drug-Nutrient Interactions Checker: Offers scientifically supported, clinically relevant information along with relevant product suggestions.

You can also explore Pure Encapsulations® to find On-Demand Learning, Clinical Protocols, and other resources developed with our medical and scientific advisors.

References

[1] Najm A. et al. Int J Mol Sci. 2024 Apr 12;25(8):4300. doi: 10.3390/ijms25084300. PMID: 38673885; PMCID: PMC11050002.

[2] Ali S. et al. Gerontology. 2014;60(4):294-305. doi: 10.1159/000356760. Epub 2014 Apr 8. PMID: 24731978; PMCID: PMC4112511.

[3] Burtscher J. et al. Front Public Health. 2024 Jan 10;11:1330131. doi: 10.3389/fpubh.2023.1330131. PMID: 38269379; PMCID: PMC10806989.

[4] Faitg J et al. Calcif Tissue Int. 2024 Jan;114(1):53-59. doi: 10.1007/s00223-023-01145-5. Epub 2023 Nov 5. PMID: 37925671; PMCID: PMC10791945.

[5] Aging Cell. 2016. 15(6):1132-39.

[6] J Orthop Translat. 2020. 23:38-52

[7] A Gerontol A Biol Sci. 2018. 17:939-45

[8] Ferri E et al. Int J Mol Sci. 2020 Jul 23;21(15):5236. doi: 10.3390/ijms21155236. PMID: 32718064; PMCID: PMC7432902.

[9] Kubat GB et al. Mitochondrion. 2023 Sep;72:33-58. doi: 10.1016/j.mito.2023.07.003. Epub 2023 Jul 13. PMID: 37451353.

[10] Drake JC et al. FASEB J. 2016 Jan;30(1):13-22. doi: 10.1096/fj.15-276337. Epub 2015 Sep 14. PMID: 26370848; PMCID: PMC6137621.

[11] Dhillon RJ and Hasni S. Clin Geriatr Med. 2017 Feb;33(1):17-26. doi: 10.1016/j.cger.2016.08.002. PMID: 27886695; PMCID: PMC5127276.

[12] Chen N. et al.  Eur Rev Aging Phys Act. 2021 Nov 11;18(1):23. doi: 10.1186/s11556-021-00277-7. PMID: 34763651; PMCID: PMC8588688.

[13] Ni HJ et al. Arch Gerontol Geriatr. 2022 Mar-Apr;99:104605. doi: 10.1016/j.archger.2021.104605. Epub 2021 Dec 2. PMID: 34922244.

[14] Yarasheski KE et al. Am J Physiol. 1999 Jul;277(1):E118-25. doi: 10.1152/ajpendo.1999.277.1.E118. PMID: 10409135.

[15] Morley JE et al. J Am Med Dir Assoc. 2010 Jul;11(6):391-6. doi: 10.1016/j.jamda.2010.04.014. PMID: 20627179; PMCID: PMC4623318.

[16] Cochet C et al. Nutrients. 2023 Aug 24;15(17):3703. doi: 10.3390/nu15173703. PMID: 37686735; PMCID: PMC10490489.

[17] Cedikova M et alPhysiol. Res. 2016;65:S519–S531. doi: 10.33549/physiolres.933538.

[18] Prado CM et al. Clin Nutr. 2022 Oct;41(10):2244-2263. doi: 10.1016/j.clnu.2022.07.041. Epub 2022 Aug 7. PMID: 36081299.

[19] Romani M et al. Nutrients. 2022 Jan 22;14(3):483. doi: 10.3390/nu14030483. PMID: 35276842; PMCID: PMC8838610.

[20] Age and Aging. 2023;52:10.1093

[21] Besora-Moreno M et al. Clin Nutr. 2022 Oct;41(10):2308-2324. doi: 10.1016/j.clnu.2022.07.035. Epub 2022 Aug 17. PMID: 36099667.

[22] Espín JC, Larrosa M, García-Conesa MT, Tomás-Barberán F. Evid Based Complement Alternat Med. 2013;2013:270418.

[23] Heim KC. In: Antioxidant Polymers: Synthesis, Properties, and Applications. Cirillo G, Iemma F, eds. Taylor and Francis, c. 2012

[24] Ryu D, et al. Nat Med.2016 Aug;22(8):879-88.

[25] Flakoll PJ, et al. J Appl Physiol (1985). 2004 Mar;96(3):951-6.

[26] Shimomura Y, et al. J. Nutr. 2006. 136(2); 529- 532.

[27] Timmers S, et al. Cell Metab. 2011 Nov 2;14(5):612-22.

[28] Goh KP, et al. Int J Sport Nutr Exerc Metab. 2014 Feb;24(1):2-13.

[29] Zheng A, Moritani T. J Nutr Sci Vitaminol (Tokyo). 2008 Aug;54(4):286-90.

[30] Yago MR, et al. Mol Pharm. 2013 Nov 4;10(11):4032-7.

Blog

Supporting Menopausal Comfort and Healthy Aging: Expert Advice from an Integrative OBGYN

  • May 13, 2024
Pure Encapsulations Pro Blog

Supporting Menopausal Comfort and Healthy Aging: Expert Advice from an Integrative OBGYN

Table of Contents

1. Symptoms of Menopause

2. What Is Going On During Menopause?

3. What Most Practitioners Miss When Supporting Menopause Symptoms

4. Four Steps to Supporting Menopause and Healthy Aging

5. Resources

Symptoms of Menopause

Menopause is a natural part of life, but that does not mean it’s an easy one. In fact, 90% of women seek medical support during their menopause transition.1 Common but significant symptoms can include hot flashes, cold or night sweats, low energy, sleep disturbances, palpitations, weight gain, mood disturbances, inability to concentrate and vaginal dryness.

The loss of ovarian-produced estrogen and progesterone is predominantly responsible for the effects of menopause. Restoring these hormones to physiologic, premenopausal levels using conventional interventions is a common clinical objective. Unfortunately, recreating the exact ovarian function and hormonal rhythms of a healthy premenopausal woman is not currently possible, and for some women, these interventions may not be appropriate. For these reasons, additional modalities are often needed to support female health throughout the menopausal years.

Dr. Felice Gersh, M.D.,+ a board-certified OB/GYN and Integrative Medicine practitioner, says, “The unique health issues faced by women are often minimized and overlooked; the most egregious example is menopause. But no longer can we view menopause as simply the loss of fertility and periods. It is the beginning of a huge metabolic shift, which we must recognize and address to support the health and well-being of the woman for years to come.”

What Is Going On During Menopause?

It is important to understand the physiological changes that drive symptoms in menopausal women. Instead of picturing menopause like a finish line women must cross, it is better to consider it as a process that is different for all who go through it.

Dr. Felice Gersh says, “Historically, they say [menopause] is when a woman has not had a spontaneous period for 12 consecutive months, which is arbitrary. There’s nothing special about 12 months. It’s a process. So, I want you to think differently … [Menopause] is a process of ovarian senescence, the aging and decline of ovarian production of estrogen and progesterone.”

Dr. Gersh points out the inversion of the hormones responsible for driving fertility cycles in women. Prior to the onset of menopause, estrogen is high and progesterone is low. As the process continues into the menopause transition, these hormones and others, including LH, FSH, and inhibin B, begin to invert, which triggers the symptoms listed above. As the process continues and the hormones stabilize, progesterone is elevated and estrogen remains low.2

The inverse relationship of hormone levels before, during and after menopause drives many practitioners to suggest hormone replacement therapy (HRT) to help restore balance. While HRT may work for some menopausal women, there are some contraindications to taking these pharmaceuticals, and even with perfect dosing, it will not be able to recreate the hormonal status of a healthy premenopausal woman.

Certain therapies, such as HRT, may be appropriate and should be used under the recommendation of a qualified healthcare professional for managing menopause symptoms. Dietary supplements are not intended to replace the use of such therapies or pharmaceuticals.

However, if looking for a way to potentially manage menopause symptoms, the following protocol and supplement recommendations mentioned later in the blog, may be appropriate.




What Most Practitioners Miss When Supporting Menopause Symptoms

Hormones take center stage when menopause support is initiated, and for good reason. Other hidden risks of menopause are often overlooked and must also be addressed.

Estrogen receptors are found all over the body and play vital roles in regulating countless physiological functions. The fluctuations of estrogen during menopause have additional health implications,3 including but not limited to:

  • Weight gain and increased visceral fat
  • Changes in metabolic health
  • Musculoskeletal effects
  • Cardiovascular health
  • Neurological health
  • Cellular health (breast, colon)
  • Autoimmunity
  • GI concerns like occasional heartburn, malabsorption and motility

Dr. Gersh points out, “There are receptors for estrogen on virtually every organ system in the body. So, when you lose ovarian-produced estrogen, you lose the optimal, healthy functioning of all the organ systems of the body, leading to these myriad problems.”

Two important health concerns to note are cardiometabolic concerns and bone health.

Cardiovascular health can become a risk factor for menopausal women, with postmenopausal women experiencing cardiovascular concerns 4 times the rate of premenopausal women.5

The menopause transition brings with it unfavorable shifts in body fat distribution, lipids and lipoproteins and alterations in the structural and functional measures of vascular health.6

The Study of Women’s Health Across the Nation (SWAN) study investigated chronological aging versus reproductive aging and the results showed changes in total cholesterol, LDL-C and apolipoprotein B levels during the menopausal transition. These changes were found to be independent of the effect of chronological aging alone. Additionally, the menopausal transition was independently associated with adverse changes in body composition and increases in visceral adipose tissue, both of which contribute to cardiometabolic function.7

Changes in bone metabolism are 4 times more likely to affect women than men, especially women over 50 years of age. Studies have shown that women can lose up to 20% of their bone density during the five to seven years following menopause.

4 Steps to Supporting Menopause and Healthy Aging

It is important to support your patients through the menopausal transition and let them know that it does not have to be a difficult or negative experience.

Dr. Felice Gersh, in collaboration with Pure Encapsulations®, has co-developed a four-step protocol that connects lifestyle changes with targeted supplement protocols to help guide your patients through this stage of life.




To learn more about Dr. Gersh’s approach and the Pure Encapsulations® products designed to support menopausal women, explore the resources listed below.‡

Resources

Webinar: “A Woman’s Guide to Healthy Aging: Supporting Menopausal Comfort & Healthy Longevity”‡ with Dr. Felice L. Gersh, M.D.

PureWoman Exclusive and PureWoman Brochure

Drug-Nutrient Interactions Checker: Offers scientifically supported, clinically relevant information and relevant product suggestions.

You can also explore Pure Encapsulations® to find more On-Demand Learning, Clinical Protocols and other resources developed with our medical and scientific advisors.

References

  1. Guthrie JR et al. Climacteric 2003; 6:112–117
  2. Davis, S., Lambrinoudaki, I., Lumsden, M., et al. Nat Rev Dis Primers 1, 15004 (2015).
  3. Adapted from Exper Rev Endocrinol Metab® 2011 Expert Reviews Ltd
  4. Centers for Disease Control and Prevention, National Center for Health Statistics. Accessed October 15, 2021.
  5. Davezac M et al. Front Aging. 2021 Sep 24;2:727380. doi: 10.3389/fragi.2021.727380. PMID: 35821994; PMCID: PMC9261451.
  6. El Khoudary SR et al. Circulation. 2020 Dec 22;142(25):e506-e532. doi: 10.1161/CIR.0000000000000912. Epub 2020 Nov 30. PMID: 33251828.)
  7. El Khoudary SR. Menopause. 2019;26(10):1213-1227
  8. National Osteoporosis Foundation. What Women Need to Know. Accessed June 2021.
  9. BHOF. Accessed on April 18, 2024.

+Dr. Felice Gersh, M.D. is a retained advisor for Pure Encapsulations®.


Blog

Thyroid Health: Looking Beyond TSH and T4

  • May 3, 2024
Pure Encapsulations Pro Blog

Thyroid Health: Looking Beyond TSH and T4

Table of Contents

1. Thyroid Health: Functions and Common Symptoms

2. Thyroid Hormone Metabolism: Looking at the Whole Pathway

3. Inhibitors of T4 to T3 Conversion

4. Looking Beyond TSH and T4

  • 4.1. Free T3 and Free T4
  • 4.2. Reverse T3
  • 4.3. Thyroid Antibodies
  • 4.4. Adrenal Panel

5. Nutrients to Support Thyroid Function‡

6. Pure Encapsulations® Nutrient Solutions

7. Summary

8. Resources

Standard assessments may overlook factors that underlie a patient’s thyroid concerns. Learn more about looking beyond TSH and T4 to support your patient’s thyroid hormone metabolism and overall health.

Thyroid Health: Functions and Common Symptoms

An optimally functioning thyroid is essential for maintaining body homeostasis. Thyroid hormones influence nearly every organ system in the body, encompassing the heart, central nervous system, autonomic nervous system, skeletal structure, gastrointestinal tract, and metabolism.

The rate of thyroid concerns has more than doubled in the past twenty years, with women affected at a prevalence five to eight times that of men.1, 2 More than half of individuals with symptoms are unaware they are related to their thyroid.1 Thyroid symptoms can vary between individuals and can include:

  • Fatigue
  • Occasional constipation
  • Weight gain, difficulty losing weight
  • Intolerance to cold, cold hands and feet
  • Dry skin
  • Dry, thinning hair or hair loss
  • Mood concerns
  • Joint and muscle discomfort
  • Heavy or irregular menstrual cycles, fertility concerns
  • Slowed heart rate
  • Low libido

Thyroid Hormone Metabolism: Looking at the Whole Pathway

Four hormones have been identified to be secreted by the thyroid, T1, T2, T3, and T4. The two primary hormones are thyroxine (T4), a prohormone, and triiodothyronine (T3), which is 300 times more biologically active than T4.3

Once T4 is secreted, it is bound to transport proteins and carried to the cells and tissues where it passes through a series of metabolic transformations and is either converted to T3 or inactivated into reverse T3 (rT3). T3 is utilized by mitochondria and contributes to metabolism of glucose and lipids, regulates metabolic responses according to energy intake, controls thermogenesis and basal and oxidative metabolism—essentially affecting all tissues in the body.4

Successful conversion of T4 to T3 relies heavily on transport proteins, along with nuclear receptors and selenium-dependent enzymes known as deiodinases. These three players are crucial to homeostasis at the cellular level as they coordinate the uptake, activation and deactivation of thyroid hormone within the cell.5 Conversion of T4 to T3 occurs primarily in the liver and kidneys, but also within the gut, bones, muscles, adipose tissue, heart and CNS.6, 7, 8


Created with BioRender.com

Inhibitors of T4 to T3 Conversion

Eighty percent of the T3 found in circulation is produced by peripheral conversion from T4.4 A number of lifestyle, environmental, and dietary factors can inhibit this conversion and lead to symptoms.4, 9, 10, 11, 12


T4 to T3 conversion influences all tissues within the body, as they are dependent on T3 for normal cell function.4

Looking Beyond TSH and T4

In line with standard practices, practitioners commonly rely on TSH and T4 levels to screen for thyroid concerns. While these markers play important roles, they don’t tell the whole story. Getting to the root of an individual’s symptoms requires investigating what is occurring further down the thyroid hormone pathway at the cellular level, and why. This begins with understanding that although TSH and T4 levels can provide insight into thyroid gland function, they don’t reflect:

  • Alterations in cellular sensitivity to thyroid hormones
  • Inadequate peripheral conversion of inactive T4 to metabolically active T3
  • Poor uptake of thyroid hormones into the mitochondria
  • Activity of rT3, anti-thyroid antibodies or environmental factors which can displace thyroid hormones and prevent their binding to cellular receptors.

Any one of these factors along with impaired T4 to T3 conversion, or fluctuation in T3 and rT3 levels can trigger changes in an individual long before TSH or T4 are outside their respective reference ranges.

Expanding the assessment of thyroid function beyond TSH and T4 can provide insight into what is happening peripherally to T4.

The following markers can provide evidence of suboptimal thyroid function:

Free T3 and Free T4

Measuring total thyroid hormones provides the sum of both the free thyroid hormone and thyroid hormone bound to a protein; however, it does not differentiate how much of that hormone is available for uptake by the cells. A hormone bound to a protein is inactive. Only the free T4 and free T3 tests measure the levels of thyroid hormones in circulation that are available to cells.

Reverse T3

rT3 can be produced in response to physical or emotional stress. Free T3 and rT3 can both bind to thyroid receptors on the cell. When rT3 binds to thyroid receptors, it inactivates them and prevents the metabolically active hormone T3 from binding to receptors.

Thyroid Antibodies

Thyroid peroxidase antibodies (TPO antibodies) and thyroglobulin antibodies (TG antibodies) can be produced when the body begins to lose “self-tolerance”. Thyroid antibodies can be present long before aberrations are seen in TSH and T4.

Adrenal Panel

Elevated urinary cortisol metabolites have been associated with diminished peripheral thyroid hormone metabolism.14 Examining the role stress plays in thyroid function in each patient is foundational for any thyroid care plan.

Nutrients to Support Thyroid Function

Various nutrients participate in the synthesis, metabolism, and mechanisms of action of thyroid hormones.

Curcumin helps to neutralize free radicals that may affect iodothyronine 5’-monodeiodinase enzyme activity, the limiting factor in the conversion of T4 to the more active T3 hormone.14‡

Vitamins A and D help to maintain healthy thyroid cell metabolism and support triiodothyronine (T3) and thyroxine (T4) hormone function.15, 16

Ashwagandha helps maintain healthy thyroid function and relaxation as suggested in preliminary research.17‡

Forskolin in coleus extract has been shown to support thyroid hormone metabolism in preclinical models, potentially by promoting adenylate cyclase activity.18‡

Zinc and Selenium help to maintain healthy thyroid cell metabolism and support triiodothyronine (T3) and thyroxine (T4) hormone function.19, 20 Selenium has also been shown to help to neutralize free radicals that may affect iodothyronine 5’-monodeiodinase enzyme activity, the limiting factor in the conversion of T4 to the more active T3 hormone.13‡

Probiotics support healthy intestinal microflora to promote digestive and immune health.‡

Pure Encapsulations® Nutrient Solutions

Pure Encapsulations® offers high-quality supplements that are FREE FROM unnecessary additives and many common allergens for patients who may need thyroid and overall health support. You’ll find Pure Encapsulations® offers nutrients individually and in combination to meet all your patients’ unique needs.

Comprehensive Support

  • Thyroid Support Complex‡ is a comprehensive thyroid support formula that contains vitamins, minerals, and herbal extracts to nourish and support thyroid gland function.‡ Suggested use: Take 2 capsules daily, with a meal.

Immune Support

  • Zinc 30 provides broad physiological support including immune function and emotional wellness.‡ Suggested use: Take 1 capsule, 1-2 times daily, with meals.
  • Selenium (citrate) supports antioxidant defenses and cellular health and provides immune system support.‡ Suggested use: Take 1 capsule daily, with a meal, or as directed by a health professional.
  • Vitamin D3 125 mcg (5,000 IU) supports musculoskeletal, cardiovascular, neurocognitive, cellular, and immune health.‡ Suggested use: Take 1-5 capsules daily, or as directed by a health professional. Consume with food.

Detoxification Support

  • Curcumin 500 with Bioperine® supports the body’s natural detoxification system and helps maintain healthy hepatic function. Helps maintain healthy cell cycle function and supports antioxidant defenses.‡ Suggested use: Take 1 capsule, 1-3 times daily, between meals.

Microbial Balance

  • Probiotic 50B offers seven researched probiotic strains that promote healthy intestinal ecology to support gastrointestinal and immune health.‡ Suggested use: Take 1 capsule daily, with or between meals.

Summary

Environmental, genetic, lifestyle, and nutritional factors can affect the thyroid hormone pathway in different ways for different individuals. While laboratory tests can be critical tools, the absence of markers mentioned in thyroid testing does not equate to optimal function.

Personalized medicine addresses the whole person, which requires exploration of the unique mediators, triggers, and antecedents that may be impacting each patient’s thyroid hormone function and presenting symptoms.

Resources

Thyroid Support Protocol: Developed in collaboration with our scientific and medical advisors to support thyroid health.‡

Drug-Nutrient Interactions Checker: Offers scientifically supported, clinically relevant information along with relevant product suggestions.

You can also explore Pure Encapsulations® to find On-Demand Learning, Clinical Protocols, and other resources developed with our medical and scientific advisors.

References

  1. American Thyroid Association. Accessed on March 18, 2024.
  2. Wyne KL, Nair L, Schneiderman CP, et al. J Endocr Soc. 2022 Nov 10;7(1):bvac172. doi: 10.1210/jendso/bvac172.
  3. Abdalla SM, Bianco AC. Defending plasma T3 is a biological priority. Clin Endocrinol (Oxf). 2014;81(5):633-641. doi:10.1111/cen.12538
  4. Severo JS, Morais JBS, de Freitas TEC, et al. The Role of Zinc in Thyroid Hormones Metabolism. Int J Vitam Nutr Res. 2019;89(1-2):80-88. doi:10.1024/0300-9831/a000262.
  5. Sabatino L, Lapi D, Del Seppia C. Factors and Mechanisms of Thyroid Hormone Activity in the Brain: Possible Role in Recovery and Protection. Biomolecules. 2024;14(2):198. Published 2024 Feb 7. doi:10.3390/biom14020198
  6. Sabatino L, Vassalle C, Del Seppia C, Iervasi G. Deiodinases and the Three Types of Thyroid Hormone Deiodination Reactions. Endocrinol Metab (Seoul). 2021;36(5):952-964. doi:10.3803/EnM.2021.1198
  7. Fröhlich E and Wahl R. Trends Endocrinol Metab. 2019 Aug;30(8):479-490. doi: 10.1016/j.tem.2019.05.008. Epub 2019 Jun 27. PMID: 31257166.
  8. Samuels, MH. J Clin Endocrinol Metab. 2008. 85(4):1388-93.
  9. Mancini A, Di Segni C, Raimondo S, et al. Mediators Inflamm. 2016;2016:6757154. doi:10.1155/2016/6757154
  10. Roti E et al. Int J Obes Relat Metab Disord. 2000;24 Suppl 2:S113-S115. doi:10.1038/sj.ijo.0801293
  11. Farasat T et al. Journal of Diabetes and its Complications. 2012. 26(6):522-25. doi:10.1016/J.JDIACOMP.2012.05.017
  12. Gillam MP et al. Curr Opin Pediatr. Aug 2001.13(4):364-72. doi: 10.1097/00008480 200108000 00014. PMID: 11717564.
  13. Vantyghem MC et al. J Endocrinol Invest. 1998.21(4): 219-25.
  14. Mahmoodianfard S et al. J Am Coll Nutr. 2015;34(5):391-9.
  15. Farhangi MA et al. J Am Coll Nutr. 2012. Aug;31(4):268-74.
  16. Mazokopakis EE et al. Hell J Nucl Med. 2015.18(3):222-27.
  17. Chandrasekhar K et al. Indian J Psychol Med. 2012. Jul-Sep; 34(3): 255–262.
  18. Godard MP et al. Obes Res. 2005 Aug;13(8):1335-43.
  19. Kilic M. Neuro Endocrinol Lett. 2007 Oct;28(5):681-5.
  20. Combs GF Jr et al. Am J Clin Nutr. 2009 Jun;89(6):1808-14.

Webinars

Premenstrual Syndrome (PMS): Connecting the dots for a healthy menstrual cycle

  • Apr 25, 2024
Pure Encapsulations Pro Blog


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Premenstrual Syndrome (PMS): Connecting the dots for a healthy menstrual cycle


Presented by: Amy Doyle, MS, CNS+


Premenstrual Syndrome (PMS) impacts the daily functioning of approximately 30% of cycling women. In this webinar, Board Certified Nutrition Specialist Amy Doyle will identify the different hormone patterns associated with PMS and review the interactions between the Hypothalamic-Pituitary-Adrenal-Thyroid and Gonadal axes. A multi-modal approach that includes dietary and lifestyle interventions and the beneficial use of targeted nutritional supplements to address PMS will be presented.





 



Learning objectives:



  • Summarize the regular hormone fluctuations during the menstrual cycle and patterns associated with PMS.

  • Recognize the interactions between the Hypothalamic-Pituitary Adrenal (HPA) axis, the Hypothalamic-Pituitary Thyroid (HPT) axis and the Hypothalamic-Pituitary-Gonadal (HPG) axis as they relate to premenstrual symptoms.

  • Understand the roles the gut microbiome, immune system, insulin and weight play in PMS.

  • Review dietary, lifestyle and supplement interventions that can support the physical and emotional symptoms of PMS


 




 


About the Speaker


Amy Doyle+ is a Board-Certified Nutrition Specialist and is the owner of White Stone Wellness, a private practice in Fayetteville, NY. She received her master’s degree in Applied Clinical Nutrition from the Northeastern School of Health Sciences in 2014. In addition to her practice, Amy also works in various capacities as an educator and content writer for the nutrition and integrative medicine world. Amy believes in empowering individuals toward their best health and vitality by addressing them as a whole person, with a patient-centered, personalized approach.




+Amy Doyle is an employee of Pure Encapsulations.






 


Blog

Moving the Needle with PMS: Three Areas to Focus On

  • Apr 12, 2024
Pure Encapsulations Pro Blog

Moving the Needle with PMS: Three Areas to Focus On

Table of Contents

1. Symptoms and Prevalence of PMS

2. Potential Hormone Fluctuations Seen in PMS

3. Underlying Contributors to PMS

  • 3.1. Stress
  • 3.2. Blood Sugar Regulation
  • 3.3. Gut Health

4. Assessments for PMS

5. Nutrition and Lifestyle Support for PMS‡

  • 5.1. Diet
  • 5.2. Exercise
  • 5.3. Stress

6. Nutrient Support

7. Pure Encapsulations® Nutrient Solutions

8. Summary

9. Resources

Symptoms and Prevalence of PMS

The menstrual cycle reflects a woman’s overall health status and has been considered her fifth vital sign.1 For some women, their menstrual cycle is a dreaded time of the month, bringing with it a cyclic pattern of pain and discomfort that impacts their daily life.

In fact, approximately 90% of cycling females report that they experience at least one mood related or physical symptom in the luteal phase of their menstrual cycle.2

When a woman experiences one or more symptoms in the five days prior to the onset of her menses, this is known as PMS, or premenstrual syndrome.3

Up to 30% of reproductive-age women experience PMS and report a number of emotional and physical symptoms:3

Potential Hormone Fluctuations Seen in PMS

While the cause of PMS is multifactoral, the fluctuation of estrogen and progesterone levels during the menstrual cycle play a role. In some individuals, excess or depletion of these hormones can contribute to symptoms.

Since progesterone is required to balance estrogen’s activity, elevated estradiol should be viewed relative to progesterone levels. The natural fluctuation of estrogen can contribute to PMS symptoms and can occur when:4

  • Progesterone is low
  • Both estrogen and progesterone are in normal ranges, but estrogen is higher than progesterone
  • Phase I detoxification metabolites are elevated
  • Estrogen is elevated outside the luteal phase

While hormonal fluctuations can be a contributing factor to PMS symptoms, research suggests that in some women PMS may be caused by a heightened sensitivity to the normal rise and fall of estrogen and progesterone during the luteal phase of the menstrual cycle, impacting the serotonergic and GABAergic systems.2, 5

Underlying Contributors to PMS

Owing to the complex interactions between the hormones, body tissues, cells and the gut microbiome that coordinate the menstrual cycle, a practitioner may be uncertain which system to address first in patients with PMS. While there are many approaches, there are three underlying contributors and strategies that can help move the needle in caring for patients with PMS: stress, blood sugar regulation and gut health.

Stress

High stress is a contributing factor to PMS symptoms, as a bidirectional relationship exists between the hypothalamic-pituitary-gonadal (HPG) axis and hypothalamic-pituitary-adrenal (HPA) axis.

The paraventricular nucleus in the brain, which contains several neurons that regulate the HPG axis and expression of gonadotropin-releasing hormone (GnRH), also contains neurons which regulate the HPA axis and expression of corticotropin-releasing-factor (CRF).6 This area of the brain is also ubiquitous with GABAergic and serotonergic neurons. The neural overlap of these regulating systems is one contributing factor to their interactions, as both the HPG and HPA axes are vulnerable to hormones produced by the other.6, 7

In animal studies, various stress models and exogenous cortisol have been shown to suppress GnRH and luteinizing hormone (LH) secretion.6 Corticotropin-Releasing Factor, released in response to stress, can increase aromatase production in the brain and promote increased estrogen levels.8 Conversely, progesterone and its metabolite, allopregnanolone, are able to modulate HPA axis function due to their interaction with GABAergic neurons.6 Estradiol can positively and negatively impact HPA axis reactivity, hypothesized to be due to the distribution of both Erα and ERβ receptors in the parts of the brain responsible for HPA axis regulation.6, 7


Credit: Schweizer-Schubert S et al. Front Med (Lausanne). 2021 Jan 18;7:479646. doi: 10.3389/fmed.2020.479646. PMID: 33585496; PMCID: PMC7873927.

A controlled study conducted by Hou et al. attempted to determine basal HPA axis activity in women with PMS by measuring salivary cortisol levels mid-follicular and mid-luteal phase. Compared to healthy controls, women with PMS exhibited an attenuated cortisol awakening response, a potential indicator for HPA axis dysregulation when combined with markers of HPA axis function and other factors.9, 10 These findings align with previous experiments in women with premenstrual symptoms that found hypoactivity of the HPA axis in response to stress.11, 12

Blood Sugar Regulation

Fluctuations with glucose metabolism may occur during the luteal phase in some women with PMS. Decreased tissue sensitivity to insulin and a worsening of glycemic control in the luteal phase have been reported in women with higher estradiol or progesterone levels, compared to the follicular phase.13, 14, 15, 16

Higher circulating levels of insulin can impact production of Sex Hormone Binding Globulin, or SHBG, and can elevate estrogen production by increasing aromatase.17 A transport protein, SHBG binds to sex hormones like estrogen and testosterone and regulates their bioavailability. When SHBG production is decreased, more hormones are available in their active form to reach target tissues and cause symptoms. In addition, low plasma SHBG can be an early indicator of insulin resistance.18

Gut Health

In a survey examining premenstrual emotional and GI symptoms in 156 healthy women, over 70% of the women surveyed listed one or more GI symptom in the five days prior to their menses, including pain, bloating and altered bowel habits—typically in the form of occasional diarrhea.19

Fluctuations in prostaglandins and hormones throughout the menstrual cycle can impact numerous functions of the gut, including motility, pain sensitivity and immune function, contributing to the common GI symptoms seen in PMS.

Sex hormones in the gut also communicate with neurotransmitters involved in signaling along the gut-brain axis, often leading to co-existing emotional and GI symptoms in women with PMS.18

The gut microbiome plays a critical role in the regulation of estrogen metabolism. Microbes in the gut encode enzymes responsible for the biotransformation of estrogen and its elimination through the stool. Altered gut microbiota can increase activity of β- glucuronidase enzymes that engage in deconjugation of estrogens and restore their biological activity.20 Reactivated estrogens can then be reabsorbed into the bloodstream where they are free to reach target tissues.

The relationship between the gut microbiota and estrogen is bidirectional, however; estrogen levels can influence the composition and diversity of the gut microbiota, and reduced diversity of gut microbiota can affect estrogen levels.19

Assessments for PMS

Assessments for PMS should explore hormone levels during the luteal phase, gut health, blood sugar regulation, HPA axis function, nutrient status and neurotransmitter function.

Nutrition and Lifestyle Support for PMS

Nutrition and lifestyle play crucial roles in managing PMS because they can influence hormonal balance, energy, mood and overall well-being. Making positive changes in diet, stress management and physical activity may help alleviate the severity of PMS symptoms for many individuals.

Diet

Diet plays a significant role in moving the needle for individuals with PMS.

Cross-sectional studies have identified that most women experience food cravings during their luteal cycle, particularly for high-calorie, high-sugar, high-fat, and high-salt foods, and that severity of PMS symptoms is positively correlated with intake of these types of foods.21, 22

Due to the influence of insulin, stress, and the gut microbiome on menstrual health, a phytonutrient-rich, preferably organic, whole foods diet should be emphasized for women with PMS. The Mediterranean diet, comprised of a high intake of fruits and vegetables, whole grains, legumes, nuts and olive oil can be beneficial for women with PMS.

A 2022 cross-sectional study examined dietary patterns and PMS symptoms in 262 women ages 20-49. A lower prevalence of PMS was found in women who adhered to a Mediterranean diet, and a higher prevalence of PMS was found in women who had low adherence to a Mediterranean diet and higher intake of snacks and breads.23 The consumption of sugar has also been significantly associated with an increase in nervous tension symptoms in PMS.24

Encouraging fermented foods and adequate fiber can support motility, stool consistency, and balance in the patient’s gut microbiome, as well as support the excretion of excess estrogen.

Exercise

Regular physical activity can have a positive effect on both emotional and physical PMS symptoms. Exercise increases endorphins, helps regulate cortisol and ovarian hormone levels, and can reduce prostaglandin levels.2, 25 A randomized, controlled trial examined the effects of 20 minutes of aerobic exercise three times a week on PMS symptoms in 65 women and found that the intervention group experienced a significant reduction in headaches, nausea, bowel changes and appetite changes after 8 weeks, compared to controls.26 In a systematic review of 17 randomized and nonrandomized studies that included over 8,800 women, regular exercise was shown to reduce nervous tension, anger, general pain and occasional constipation symptoms.27 Forms of exercise included strength training, yoga, Pilates and aerobic exercise. While many studies have demonstrated significant improvement in PMS symptoms after 8 weeks, some women may experience a benefit after just one menstrual cycle, especially if they are new to exercising.28

The American College of Obstetricians and Gynecologists endorses routine exercise to help manage physical and affective premenstrual symptoms and highlights yoga as a beneficial option to reduce overall PMS symptoms.2

Stress

In a 2022 meta-analysis of 77 studies that examined factors associated with prevalence and severity of menstrual-related symptoms, stress was determined to be significantly associated with prevalence of PMS.24 Stress in a patient raises cortisol, impacts glycemic control and insulin sensitivity and increases prostaglandins.24, 29

There are numerous recommendations the practitioner can make for a patient needing to manage stress, including relaxation techniques, aerobic exercise, meditation and yoga. Interestingly, Cognitive Behavioral Therapy (CBT) has been the most studied psychosocial practice for addressing PMS symptoms and is endorsed by the American College of Obstetrics and Gynecologists as a recommended option. CBT has been shown to provide statistically significant reductions in symptom scores compared to controls in nervous tension, low mood, negative behavioral changes, symptom intensity and interference with daily life.21

Nutrient Support

Along with dietary and lifestyle changes, nutrients that support blood sugar balance, emotional well-being, GI health and healthy prostaglandin and eicosanoid levels can help improve patient outcomes.30, 31, 32, 33, 34

Vitamin B6 has a positive effect on premenstrual mood and may enhance the effect of magnesium.30‡

Healthy intracellular magnesium levels have been associated with maintaining positive mood during the luteal phase.31 Magnesium also plays an important role in nervous system sensitivity, providing support for muscle comfort, breast comfort and emotional well-being associated with the menstrual cycle.32

Calcium promotes healthy smooth muscle function and menstrual comfort.33

Vitamin D supports healthy smooth muscle function and menstrual comfort, due to its ability to promote healthy calcium levels, cyclic hormone function and neurotransmitter activity.34‡

Omega-3 Fatty Acids moderate prostaglandin and leukotriene production, supporting healthy connective tissue.35 Research suggests that omega-3 fatty acids may also play a role in maintaining gastrointestinal cell health by supporting healthy eicosanoid production.‡

Eleuthero is a highly recognized adaptogen thatpromotes physiological balance and moderatesoccasional stress. In part, it helps moderate the production of adrenocorticotrophic hormone (ACTH) and corticosterone activity.36‡

Rhodiola supports energy and mental function.37

Chaste tree/Vitex has been traditionally used and clinically studied for the beneficial support it provides to the hypothalamus and pituitary.38‡

l-Theanine may be helpful for premenstrual support and promote alpha wave production in the brain, an indication of relaxation.39, 40‡

Pure Encapsulations® Nutrient Solutions

Pure Encapsulations provides products designed to complement your supplement plans for patients who need overall support. We offer nutrients individually and in combination to meet all your patient’s unique needs when it comes to supporting healthy stress response, moderating food cravings, encouraging healthy mood, and promoting healthy GI and cyclic hormone function. Pure Encapsulations can help you move the needle toward your patient’s overall menstrual comfort.‡

PMS Essentials supports the health and activity of the adrenal glands and promotes physiological balance and moderates occasional emotional stress. It also promotes optimal energy reserves and healthy immune function.‡

O.N.E.TM Multivitamin supports overall wellness with vitamins, minerals and antioxidants.‡

O.N.E.TM Omega promotes joint and connective tissue integrity and cardiovascular health.‡

Magnesium (glycinate) encourages healthy cognitive and neuromuscular function and helps with calcium metabolism and bone mineralization.‡

l-Theanine promotes relaxation without causing drowsiness and offers premenstrual support, including supporting a healthy mood.‡

CarbCrave Complex moderates carbohydrate intake and helps lessen appetite by supporting neurotransmitter function.‡

Phyto-ADR supports adrenal gland health and promotes physiological balance and moderates occasional emotional stress. Supports optimal energy reserves and promotes immune function. May help to moderate mild fatigue under stressful conditions.‡

Best-Rest Formula provides support for occasional sleeplessness, encourages the onset of sleep as well as healthy sleep quality and supports natural relaxation of the nervous system.‡

PureGG 25B is our highly researched Lactobacillus rhamnosus GG supplement that supports immune, G.I. and overall health across all ages. Our PureGG 25B is a human origin strain, selected for its resistance to gastric acidity, adhesion properties and ability to support healthy gut microflora.‡

Pure Encapsulations only uses premium ingredients backed by verifiable science, so you can be confident you are recommending products with quality, purity, and potency.

Summary

There is moderate evidence that supports the use of pharmaceuticals like SSRIs for the treatment of PMS symptoms. The rate of relapse is high in patients that stop SSRIs and most patients need to maintain use of them until menopause.2

Certain medications, such as SSRIs, may be appropriate and should be used under the recommendation of your healthcare professional for managing chronic, long-term, and/or more serious symptoms related to PMS. Dietary supplements are not intended to replace the use of such medications.

However, if looking for a way to potentially manage common PMS symptoms, the supplement recommendations mentioned may be appropriate, along with other dietary and lifestyle changes.

The practitioner who can provide support and lifestyle recommendations that address the root causes of patient specific PMS symptoms can provide care that makes a difference for female patients, while also improving their overall health.

Resources

PMS Protocol:‡ This protocol offers focused interventions to support menstrual comfort in patients with premenstrual syndrome.‡

Nutrient Solutions to Complement the 5R Protocol: This blog post covers nutrient solutions that supplement the 5R Protocol and addresses factors related to leaky gut and other GI concerns.

Drug-Nutrient Interactions Checker: Offers scientifically supported, clinically relevant information that’s easy to understand with product suggestions based on verifiable science.

You can also explore Pure Encapsulations® to find On-Demand Learning, Clinical Protocols, and other resources developed with our medical and scientific advisors.

References

  1. NIH. Accessed on February 20, 2024.
  2. Clinical Practice Guidelines. American College of Obstetricians and Gynecologists. Dec 2023.  Accessed on February 20, 2024.
  3. Trout KK, Teff KL. Curr Diab Rep. 2004 Aug;4(4):273-80. doi: 10.1007/s11892-004-0079-4. PMID: 15265470.
  4. Dutch Interpretive Guide. Precision Analytical. 2023: 45-51.
  5. Schweizer-Schubert S, Front Med (Lausanne).Jan 18 2021.18(7):479646. doi: 10.3389/fmed.2020.479646.
  6. Handa R and Weiser M. Front Neuroendocrinol. 2014 April ; 35(2): 197–220. doi:10.1016/j.yfrne.2013.11.001.
  7. Acevedo-Rodriguez A et al. J Neuroendocrinol. 2018 Oct;30(10):e12590. doi: 10.1111/jne.12590. Epub 2018 Aug 7.
  8. Dickens MJ et al. J Neuroendocrinol. 2013 Apr;25(4):329-39. doi: 10.1111/jne.12012.
  9. Hou L et al. Stress, 22:6, 640-646, DOI:10.1080/10253890.2019.1608943
  10. Stadler T et al. Psychoneuroendocrinology. 2016; 63: 414-432
  11. Huang et al. Stress. 2015. 18(2):160-168. DOI: 10.3109/10253890.2014.999234
  12. Klatzkin RR et al. J Psychosom Res. 2014 Jan;76(1):46-55. doi: 10.1016/j.jpsychores.2013.11.002. Epub 2013 Nov 12. PMID: 24360141; PMCID: PMC3951307.
  13. Escalante Pulido JM et al. Arch Med Res. 1999 Jan-Feb;30(1):19-22. doi: 10.1016/s0188-0128(98)00008-6. Erratum in: Arch Med Res 1999 May-Jun;30(3):265. PMID: 10071420.
  14. Yeung EH et al. J Clin Endocrinol Metab. 2010 Dec;95(12):5435-42. doi: 10.1210/jc.2010-0702. Epub 2010 Sep 15. PMID: 20843950; PMCID: PMC2999972.
  15. Valdes CT et al. J Clin Endocrinol Metab. 1991 Mar;72(3):642-6. doi: 10.1210/jcem-72-3-642. PMID: 1997519.
  16. Zarei S et al. Clin Exp Reprod Med. 2013 Jun;40(2):76-82. doi: 10.5653/cerm.2013.40.2.76. Epub 2013 Jun 30. Erratum in: Clin Exp Reprod Med. 2013 Sep;40(3):141. PMID: 23875163; PMCID: PMC3714432
  17. Daka B et al. Endocr Connect. 2012 Nov 19;2(1):18-22. doi: 10.1530/EC-12-0057. PMID: 23781314; PMCID: PMC3680959.
  18. Chen C et al. Minerva Endocrinol. 2010 Dec;35(4):271-80. PMID: 21178921; PMCID: PMC3683392.
  19. Bernstein MT et al. BMC Womens Health. 2014 Jan 22;14:14. doi: 10.1186/1472-6874-14-14. PMID: 24450290; PMCID: PMC3901893.
  20. Hu S. et al.  Gut Microbes. 2023 Jan-Dec;15(1):2236749. doi: 10.1080/19490976.2023.2236749. PMID: 37559394; PMCID: PMC10416750.
  21. Meneghesso et al. Int J Nutrology. 2022. doi.org/10.54448/ijn2236
  22. Hashim MS et al.  Nutrients. 2019 Aug 17;11(8):1939. doi: 10.3390/nu11081939. PMID: 31426498; PMCID: PMC6723319.
  23. Kwon YJ et al. Nutrients. 2022 Jun 14;14(12):2460. doi: 10.3390/nu14122460. PMID: 35745189; PMCID: PMC9230049.
  24. AlQuaiz A et al. Int J Womens Health. 2022 Dec 16;14:1709-1722. doi: 10.2147/IJWH.S387259. PMID: 36561605; PMCID: PMC9766474.
  25. Mitsuhashi R et al. Int J Environ Res Public Health. 2022 Dec 29;20(1):569. doi: 10.3390/ijerph20010569. PMID: 36612891; PMCID: PMC9819475.
  26. Mohebbi Dehnavi Z et al. BMC Womens Health. 2018 May 31;18(1):80. doi: 10.1186/s12905-018-0565-5. PMID: 29855308; PMCID: PMC5984430.
  27. Yesildere et al. Complement Ther Med. 2020 Jan;48:102272. doi: 10.1016/j.ctim.2019.102272. Epub 2019 Nov 27. PMID: 31987230.
  28. Samadi Z et al. Iran J Nurs Midwifery Res. 2013 Jan;18(1):14-9. PMID: 23983722; PMCID: PMC3748549.
  29. Yaribeygi H et al. EXCLI J. 2022 Jan 24;21:317-334. doi: 10.17179/excli2021-4382. PMID: 35368460; PMCID: PMC8971350.
  30. De Souza MC et al. J Womens Health Gend Based Med. 2000 Mar;9(2):131-9.
  31. Facchinetti F et al. Obstet Gynecol. 1991 Aug;78(2):177-81.
  32. Fathizadeh N et al. Iran J Nurs Midwifery Res. 2010 Dec; 15(Suppl1): 401–405.
  33. Ghanbari Z et al. Taiwan J Obstet Gynecol. 2009 Jun;48(2):124-9
  34. Khajehei M et al. Int J Gynaecol Obstet. 2009 May;105(2):158-61.
  35. Bartram HP et al. Gastroenterology. 1993 Nov;105(5):1317-22.
  36. Gaffney BT et al. Life Sci. 2001 Dec 14;70(4):431-42
  37. Kalman DS et al. Nutr J. 2008 Apr 21;7:11.
  38. Berger D et al. Arch Gynecol Obstet. 2000 Nov;264(3):150-3
  39. Kimura K et al. Biol Psychol. 2007 Jan;74(1):39-45.
  40. Timmcke JQ et al. FASEB J. 2008. 22; 760.
Webinars

PMS and Perimenopause: Keys to Comfort and Healthy Longevity

  • Oct 30, 2023
Pure Encapsulations Pro Blog


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PMS and Perimenopause: Keys to Comfort and Healthy Longevity


Presented by: Felice Gersh, MD+


Premenstrual syndrome (PMS) and perimenopause are hormonal conditions with many shared underlying factors and commonalities. In this webinar, integrative gynecologist Felice Gersh will review the importance of hormonal rhythms and explain how common disruptions can result in the many symptoms women experience with PMS and perimenopause. An integrative approach to addressing these overlapping conditions will be presented, including a discussion on the beneficial use of targeted nutritional supplements and lifestyle factors.





 



Learn more about:



  • The importance of a regular menstrual cycle

  • How estradiol and progesterone support numerous functions throughout the body

  • Which foods are conducive to a positive mood and how to effectively leverage lifestyle factors in PMS and perimenopause patients

  • The application of evidence-based supplements to support the health and comfort of your female patients‡


 




 


About the Speaker


Felice L. Gersh+ is an award-winning integrative gynecologist. She has special expertise in women’s hormones and the impact of environmental toxins, medications, nutrition, and aging on hormone receptors and production. Dr. Gersh graduated from Princeton University and the University of Southern California School of Medicine. Dr. Gersh helped co-develop the PureWoman™ exclusive.




+Dr. Gersh is a retained advisor for Pure Encapsulations.






 


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