July 15, 2004

Understanding Hormonal Balance Is Critical To Everyone's Health At Any Age! Part One Interview of Dr. Michael Borkin, NMD:  by Janet Zuranski.

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Janet: �How do women get hormones to replace the ones that diminish during menopause?�

Dr. Michael Borkin, NMD:  �The way most women get their hormones these days is through HRT, Hormone Replacement Therapy, specifically estrogen and sometimes progesterone.�


Janet: Do you have some idea as to the right order in which to re-establish the levels of these hormones in the body? Should we look at some of the other stress factors before giving estrogen and/or progesterone?

Dr. Michael Borkin, NMD:  �When you talk about alternative medicine or naturopathic medicine you are really talking about going back to the origin of the dysfunction. If you eliminate the origin of the dysfunction, then future symptoms later in the person�s life are eliminated. When it comes to looking at something like hormonal replacement therapy, it is very important to take into consideration what the body is capable of doing itself first.�


Janet: �I have heard that the body steals some of the sex hormones and uses them to control stress, in an attempt to try to restore balance. Is that true?�

Dr. Michael Borkin, NMD:  �If you stop the conversion of sex hormones for stress purposes first then that may adequately solve the problem. The stress hormones need to deal with stress. When they are allowed to do what they were intended to do, stress is controlled. If the imbalance is treated initially, then one would not need to replace these hormones.�


Janet: �Is stress as much of a problem as most people think?�

Dr. Borkin �What was found in research is that many of these hormones, that were believed to be age variant, meaning as we get older they decrease their production, are dependent on just how much stress a person experiences over their lifetime. The more stress you endured, the lower the levels of the production of these hormones were."


Janet: �Is it possible for people in their later years to have normal hormone levels?�

Dr. Michael Borkin, NMD:  �You can find someone in their seventies and eighties with normal levels of these hormones. Yet, a child in their teens can have abnormal values. If we take that into consideration and we look at something like hormonal replacement therapy, we have to make sure first that we�ve provided the proper foundation for balance. Then we have to provide what the body really needs.�


Janet: �How is it possible to determine hormone levels accurately?�

Dr. Michael Borkin, NMD:  �In order to determine what the body really needs we have to perform certain diagnostics. Now, because of technology, we can use something like saliva as a diagnostic tool. It is very user friendly. It is collected using what�s called a salivette, which is a simple collection device that looks like a cotton swab. You chew on it until it is full of saliva. Then you put it back into the vial. Then you send it to the laboratory.�


Janet: �Does that make it easier for patients to collect enough samples for an accurate test?

Dr. Michael Borkin, NMD:  �That makes it viable for testing in whatever environment a person is involved. This means you can take it to work and test how you react to the stressors at work. They you can test how you react to the stresses on your way home. Once you are at home, you can determine your levels of stress."


Janet: �What is the difference between how you are affected during the day, night and while you sleep?�

Dr. Michael Borkin, NMD:  "When we look at these specific aspects, it gives us a very specific or clear focus as to what�s necessary as far as replacement is concerned. It is very important to look at a twenty-four hour circadian cycle.�


Janet: �Don�t most doctors just test the saliva at only one time?�

Dr. Michael Borkin, NMD:  �The standard of the industry was to test at 8:00 AM. That is the highest point of the hormonal levels. Now, with many of these hormones, they are adequately high or within normal ranges at that time. Unfortunately, two hours later they drop to sub-optimal levels."


Janet: �Doesn�t that provide wrong information on a person�s hormone levels?�

Dr. Michael Borkin, NMD:  �If they are elevated at one specific time during a 24 hr. circadian cycle, that�s the indication that your physician gets. He is going to treat for a hyper (too high) situation rather than a hypo (too low) situation. The treatment protocol many times is 180 degrees from what it should be."


Janet: �Why do doctors focus on one specific time of day to make the test?�

Dr. Michael Borkin, NMD:  "There is an illusion that one specific time in the day is the golden hour or the time that is �most you.� This is used as a rule of thumb in order to determine what hormones to treat with and how much.�


Janet: �Is there a difference between natural and pharmaceutical hormones?�

Dr. Michael Borkin, NMD:  "When you start to treat utilizing pharmaceutical compounds, in many cases, the results are very different. In the case of the use of progestin, there is a completely different aspect to how a progestin affects the body verses a natural progesterone.�


Janet: �Why don�t doctors use natural substances rather than chemical substitutes?�

Dr. Michael Borkin, NMD:  �A pharmaceutical company can�t patent a naturally occurring structure or molecule. They have to alter it so they can get a patent. Unless they have a patent, they can�t make a lot of money.�


Janet: �What is the difference between Progestins and progesterone?�

Dr. Michael Borkin, NMD:  �Progestins are altered progesterone that look very similar and cause certain reactions to take place. They are not the same. They do not cause the same reactions to take place that natural progesterone does.�


Janet: �What is the story on Premarin?"

Dr. Michael Borkin, NMD:  "The source of Premarin is pregnant mare�s urine. Basically, it is concentrated horse urine. Take a Premarin tablet and put it into water. Then, let it dissolve and then smell the water. You will be amazed because it smells just like horse urine."


Janet: �Why do you think women willingly ingest horse urine?�

Dr. Michael Borkin, NMD:  �Women do not understand what they are taking. They never question their physician. Most physicians do not understand what they are prescribing. What they were taught twenty or thirty years ago in school is now invalid.�


Janet: �Does every woman get the same dosage?�

Dr. Michael Borkin, NMD:  �It�s not the levels of these hormones that is as important. The relationship or the ratio of one to the other is critical. The ratio of progesterone to estrogen is very, very important.�


Janet: �Does the imbalance in hormones cause the problem?�

Dr. Michael Borkin, NMD:  �I see more often that it is not a problem with the production of these hormones. The problem is maintaining a healthy relationship between the different hormones.�


Janet: �Why is the female menstrual cycle so difficult to balance out?�

Dr. Michael Borkin, NMD:  �The dynamics of a female menstrual cycle is unique. The first 14 days, or the first half of the menstrual cycle, is an estrogen dominant cycle. The body is preparing for the possibility of a fertile egg being implanted and nurturing that egg. After ovulation, if it is not successful and an egg is not fertilized, progesterone is responsible for breaking down these tissues and starting the cycle all over again.�


 �Janet: How is the first part of the cycle different from the second?�

Dr. Michael Borkin, NMD:  �The first 2 weeks is completely chemically different in a female�s body than the second two weeks of the cycle. This is why so many women have no difficulty hormonally during the first part of the cycle. In most cases, the first two weeks are fine. It is not until the second phase of the cycle that women experience uncomfortable symptoms. The last two weeks, a woman becomes progesterone dominant. This is usually when the real dysfunction appears. It becomes worse and worse as the cycle progresses.�


Janet: �Is the problem too much or too little progesterone?�

Dr. Michael Borkin, NMD:  �In many cases, the problem is not a lack of the production of progesterone. The difficulty arises when the progesterone is converted into stress hormones, so she can deal with the stress in her life.�


Janet: �Does that mean the body places a higher priority on dealing with stress than pregnancy?�

Dr. Michael Borkin, NMD:  �When a woman is severely stressed out, the body recognizes too much stress as a more important problem. Dealing with stress is higher on the list of priorities than fertility.�


Janet: �What is stress and why is it so dangerous?

Dr. Michael Borkin, NMD:  �Stress is different for every body. The term stress means the total input of all data within a certain time. During a waking cycle, usually 16 hours, we are up and functioning. We have certain capacities as far as the brain is concerned. When we exceed that capacity dysfunction occurs.�


 Janet: �Does that mean biological rhythms are important?�

Dr. Michael Borkin, NMD:  �There are certain cycling or patterns that have to take place within a 24 hour period of time. In order to eliminate stress, we have to determine what stress is. For one person stress is one thing and to another person its something else.�


Janet: �Would people with different lifestyles experiences unique types of stress?

Dr. Michael Borkin, NMD:  �The stress on a professional fighter who is attacked by a couple of guys with knives is totally different than an average person. The professional fighter simply beats them up and keeps walking. The average individual experiences this event quite differently. For many it is a damaging life long experience.�


Janet: �How do we identify stress in our lives?�

Dr. Michael Borkin, NMD:  �What is stress to one person is completely different to another individual. We have to learn to be able to see the difference between mental and physical stress. Physiologically, three things are the primary stressors in the body."


Janet: �What are they?�

Dr. Michael Borkin, NMD:  �The most easily identifiable and widespread is glycemic control or blood sugar problems. This is the most important aspect of dealing with the secondary problems that contribute to and cause this uncontrollable ongoing threshold stress."


Janet: �Does that mean poor digestion creates greater problems than just an upset stomach or gas?�

Dr. Michael Borkin, NMD:  �Malabsorption syndrome or digestive dysfunction is at the very core of the creation of physical and mental stress. When digestion is poor, some of the food turns into chemicals that irritate the digestive tract. This creates a barrier that makes it very difficult to actually absorb and utilize what we put in our mouths.�


Janet: �Does that mean the food we eat can actually be killing us?�

Dr. Michael Borkin, NMD:  �There is no guarantee that when you put something in your mouth that it ever goes where it is intended. There are also certain genetic factors. There are certain components or molecules like the gluten molecule, found in all grain with the exception of rice and corn, milk proteins and sucrose. They are all genetically predetermined in the body as far as utilization.�


Janet: �Are most people really allergic to grain, corn, milk and sugar?�

Dr. Michael Borkin, NMD:  �Everyone is different. When somebody from one part of the world is exposed to only one type of food, they can react violently to that same food grown in another part of the world. They can have a severe allergic response. The body is programmed to digest and utilize food grown locally. The same food cultivated in strange climates and soils, may have a totally different effect. Foods that people eat every day can also cause the body to build up a tolerance and eventually respond in an allergic manner.�


Janet: �What are the optimal eating habits?�

Dr. Michael Borkin, NMD:  �The body is designed to go 6 hours between meals, with three meals a day. If that is diminished, such as it is in the presence of the symptoms of hypoglycemia or low blood sugar, then the body uses the hormone is cortisol."


Janet: �I have heard that cortisol is one of the most important hormones for survival. Is that true?�

Dr. Michael Borkin, NMD:  �Cortisol elevates the blood sugar back into normal ranges. Insulin is used to maintain blood sugar to keep it from going too high. Cortisol is at the other end of the spectrum. It keeps the blood sugar from going too low. It is also the primary stress hormone along with adrenaline. Cortisol elevates in order to maintain blood sugar. What we look at is to determine how much of this is directly related with a person�s inability to maintain reserves of energy because they are not digesting foods correctly and absorbing the nutrients adequately.�


Janet: �Does cortisol affect all the cells in the body?�

Dr. Michael Borkin, NMD:  �Every cell in the body is affected. We are not one solid unit. We are actually a community of trillions and trillions of members. It is like having the largest factory in the world or in the universe, and the most well organized. If this were a corporation, it would have trillions and trillions of workers and only eight supervisors or managers and one CEO. Those eight supervisors make up the endocrine system or hormonal system.�


Janet: �What is the order or organization in the hormonal system?�

Dr. Michael Borkin, NMD:  �In most cases any typical abuse is handled on a local level without having to go to a manager. When a manager is needed, it becomes a bigger problem. When it goes to multiple managers, higher up in the hierarchy, it becomes a monumental problem. When it goes to the CEO of the hormonal system, the person is in big trouble. The master control mechanism is called the hypothalamus.�


Janet: �How does the hypothalamus control the body?�

Dr. Michael Borkin, NMD:  �The hypothalamus is the link between the hormonal system and the autonomic nervous system. When imbalances in the body arrive at a critical point, when the body goes into a state of chaos, the hypothalamus has to take control. It is inescapable.�


Janet: �Does aging have any affect on the cortisol levels in the body?�

Dr. Michael Borkin, NMD:  �As we get older and these hormonal dysfunctions occur, it causes things like chronic fatigue and Fibromyalgia. Too much cortisol can even cause heart related symptoms."


Janet: �Are there tests for hormonal imbalances?�

Dr. Michael Borkin, NMD:  "There are tests that determine if it is in fact the heart or a cardiac problem, or if in all actuality, it is simply a hormonal dysfunction. If the original problems would have been properly managed when it first started, it would never have manifested or gone that far.�


Janet: �How does mainstream medicine deal with hormonal imbalances?� Dr. Michael Borkin, NMD:  �The mainstream thought in the scientific and medical communities is if something is low you simply elevate it. The problem with this philosophy is that if you change something on the left then something on the right changes."


Janet: �You were telling me about how the body uses the sex hormones to deal with stressful situations. Can you elaborate on that a little?�

Dr. Michael Borkin, NMD:  �When it comes to the hormone testosterone, we are dealing with a situation where we are converting the normal production of testosterone into the stress hormone cortisol. When we throw in more testosterone because the levels are low, it is like throwing lighter fluid on a raging fire. The extra testosterone fuels the abnormal functioning of the hormonal system.�


Janet: �Is it dangerous when the body starts stealing hormones from one area for another?�

Dr. Michael Borkin, NMD:  �There are increasingly severe problems if the causes of hormonal imbalance are not addressed. Even when you supplement hormones that are too low, this does not solve the original problem. Just because a level is low, it does not mean you are going to elevate that hormone if it is being converted into another hormone.�


Janet: �Is that why just supplementing testosterone without checking the other hormone levels is dangerous?�

Dr. Michael Borkin, NMD:  �This is really where the major mistakes are made by most practitioners. Testosterone is a fascinating hormone. We have been studying testosterone longer than any other steroid hormone. We know a lot about testosterone but not enough.�


Janet: �Testosterone seems to be a very important hormone. What have the studies shown?�

 Dr. Michael Borkin, NMD:  �What is interesting about testosterone levels is that if we look back 50,000 years ago, testosterone levels were extremely high at that time. Testosterone is also a survival hormone. It is responsible for allowing us to go into a hostile environment and survive extremely stressful situations.�


Dr. Michael Borkin, NMD:  "Approximately 200 years ago, if you were a pioneer crossing the country on a wagon train, testosterone is the hormone that got you through. It also allowed a woman to make it in a hostile environment. If the levels of testosterone were as low as they are today, generally speaking, there is no way we would have been able to conquer that kind of environment.�


Janet: �So, does that mean testosterone is important to both men and women?� Dr. Michael Borkin, NMD:  �Testosterone is extremely important. It also has a very powerful affect on motivation. It is also involved in many, many other processes. Not all of these processes are unrelated to sex.�


Janet: �Does testosterone have any relationship to the growth hormone?�

Dr. Michael Borkin, NMD:  �There must be a balance between testosterone and growth hormone. We have heard a lot about growth hormone. The use of growth hormone can be fabulous, if it is used in the proper manner.�


"Dr. Michael Borkin, NMD:  �I like to use the analogy with my patients that growth hormone is kind of like putting a turbo charger on your car. If you only have two tires on that car and then add a turbo charger, it is going to spin around out of control much faster than it would have before.�


Janet: �Are there different types and levels of the same hormones in the body?� Dr. Michael Borkin, NMD:  "When we look at the use of certain hormones, we want to create the proper foundation. In order to balance the specific levels of hormones in a man or a woman, we want to look at the free fractions, those levels of hormones that are accessible, that are going to be utilized.�


Janet: �Why do you test the hormone levels in the saliva?�

Dr. Michael Borkin, NMD:  �Saliva is easy to collect and shows the bioactive availability of the different hormones. Once we determine what the fluctuations are throughout a 24 hour period, we begin to understand what is really going on."


Janet: �Do hormone levels change naturally throughout the day?�

Dr. Michael Borkin, NMD:  �A man�s testosterone levels are not constant throughout the day. They change dramatically from the morning, when they are at their highest level. At midnight, they are at their lowest point.�


Dr. Michael Borkin, NMD:  �When we look at these 24-hour measurements, we are able to determine the time of the day to supplement. It is not only determining what those levels are, but this is a guideline for accurately supplementing at exactly the right time. If the hormone is high at a specific time, you do not supplement it then. You wait until it is low.�


Janet: �How do you provide additional amounts of absorbable hormones to the body?�

Dr. Michael Borkin, NMD:  "When it comes to supplementation, we only have a handful of methods of getting it into the body. If you take supplements orally, there is no guarantee that when you put something in your mouth it ever gets to the target tissue, especially, if we have some kind of digestive disturbance or malabsorption."


Dr. Michael Borkin, NMD: �If something interferes with the proper absorption or utilization of nutrients or hormones, then the oral route is not really the first choice. When it comes to the use of a hormone, there is the �First Pass Mechanism� where a hormone is utilized through the digestive tract to get it into the blood stream.� �When we take a look at this mechanism, it relies on the digestive tract working properly. The liver must work correctly in order to obtain approximately 5% of the hormone for use in the body. That is like depositing a hundred dollars into your bank account and getting to use five dollars. So, it is not a real effective method of getting the money into the account.�


Dr. Michael Borkin, NMD:  �The same is true as far as contributing hormonally. If we wanted to get these hormones into the blood stream, in their entirety, we would use injectibles. But, that is not real user friendly. Most people would not want to do that several times a day, even if it was medically indicated.�


Dr. Michael Borkin, NMD:  �A new delivery system is �Transdermal Delivery.� I have been working with this technique for twelve years. In the last twenty years, scientists have been focusing on this type of delivery system. Transdermal delivery mechanisms, such as the Nicorette, testosterone and estrogen patches, are now treatments of choice.�


Dr. Michael Borkin, NMD:  �These are mechanisms applied to the skin. The chemicals are delivered through the skin. You get the equivalent of what you would get if it was injected directly into the body. It is no different injecting than it is to take something transdermally, if it is a true transdermal device.�


Janet: �How is the transdermal delivery system different than just applying lotions to your skin?�

Dr. Michael Borkin, NMD:  �This is where I need to explain the difference between a transdermal and a topical. There are many products, especially progesterone creams