Can I take BHRT with my coronary artery disease?

[TheBrain]

Hi--

I just wanted to report that I found an MD in my area who is an expert in bioidentical hormone replacement therapy! Knowing my complete medical history, including coronary artery disease, here's what he has prescribed for me:

oral progesterone, 100 mg (I was taking this off and on before, but now I'm taking it every day)
estradiol patch, .05 mg/day (a generic form of the Climara patch) (I'm in my sixth week)
testosterone compounded cream, 5 mg/ml (just started today)

I've been taking the progesterone at bedtime because it's supposed to help with sleep (though I don't believe it's helping me with that stubborn issue). One problem I've been experiencing for many months is that most nights I wake up between 1:30-2:30 am with an urgent need to pee. For as long as I can remember, I've needed to pee in the middle of the night, but not this early and not with such urgency. The earlier I wake up to pee, the worse I feel that day. So I've been feeling worse lately.

I just read in Daniel Amen's book Change Your Brain, Change Your Life that progesterone acts as a diuretic. Well, well. Could that explain this urgent need to pee about three hours after I go to sleep? Starting today, I'm going to take the progesterone with lunch and see if that helps. I hope it does because I'm closing in on the end of my rope.

[cdamaden]

Alysson,
Have you investigated the Doc Parsley sleep remedy:
http://www.docparsley.com/
Robb Wolf seems to be very involved with it having interviewed Dr. Parsley a few times on his podcast and starts his podcast off with a pitch for it.

Chris

[TheBrain]

Hi Chris.

I hadn't heard of Doc Parsley's Sleep Remedy product, but I just looked at the ingredients. I have been taking three of the four ingredients for quite a while. The last one (5-HTP) I've taken in the past, and it had no effect on me.

But thanks for the suggestion. I welcome any and all suggestions.

[circular]

Hi alysson! It's great you're getting to experiment more with the BHRT. Interestingly, yesterday I met with my CIRS evaluation doc and we discussed my low antidiuretic hormone (ADH), aka Vasopressin, and low osmolality. ADH is supposed to be higher at night to keep people from having to get up when they are sleeping. I only get up 0-1 times and I haven't thought of it as an issue, but maybe even 1 is too many?! Hadn't even occurred to me I'm so used to it.

So last night I was trying to understand ADH and osmolality better. This post by SelfHacked is about ADH and mentions that estradiol, progesterone and testosterone lower ADH. I'm thinking this is the mechanism behind progesterone being a diuretic. Maybe it does so more than estrogen and testosterone and that's why Amen singled it out among these hormones? Well I'm on all three and my ADH is too low and I do get up at night once most nights, but I need those hormones. In addition he mentions the role of ADH in circadian rhythms and that low ADH can cause insomnia in the elderly. Okay, we're not elderly yet, but the tip here is that apparently there's a vasopressin nose spray that improves sleep quality in the elderly. It would be interesting, given our similar sleep issues over time, if you also have low ADH, and if a simple nose spray (assuming it's safe) supported our circadian rhythms and helped (or is something to try in our later years).

Have you had your ADH tested? Otherwise you might want to test that with osmolality for baselines, and if the ADH is low you can see what on SelfHacked's list of all the things that might help increase ADH you could add to your mix so you can continue to get the level of hormones you want.

Caveats:

I'm just assuming for the moment that Self Hacked is right, because I can't go down all those rabbit holes.
I've read that you can't tell much from just ADH and osmolality and need to look at more related factors.
I'm also guessing that ideally two or three low ADH in a row would be more telling than just one, since it probably fluctuates with diet, water intake etc.

Interestingly, if SelfHacked is right, many of the inputs that influence ADH one way or the other are things we discuss relating to brain health, and they're finding more brain connections with ADH over time. So as I push some parameters toward better brain health, if they're not well enough balanced by their opposing (from the perspective of ADH levels) but also brain healthy parameters my ADH will suffer ... or so my exploratory thinking is going today.

Parameter's I'm pushing that could be lowering ADH:

lowering insulin
supplementing progesterone, estrogen and testosterone
supplementing melatonin (may have to reconsider this if not influencing sleep)

Parameter's I can push further that could increase ADH to balance out the above:

further increase exercise
further increase sodium [apparently not to do if osmolality is high but mine's low]
further increase SIRT1
further inhibit IGF-1
get my rear in the sauna
increase acetylcholine

Interestingly he also notes (if correct) that WGA lectin in wheat and CONa lectin in legumes 'was found to bind to animal vasotocin neurons which are very similar to human vasopressin [ADH]'. Although I don't eat those I wonder about other lectins WRT this, albeit this wasn't human ADH. I have eating more lectins lately than I was earlier in the year.

I can see where trying out taking your progesterone mid-day is a good idea. Maybe its full effect will kick in more during your sleep cycle. I'm not sure what it's half life is.

I can just hear Stavia chiming in that it's all more complex than my little breakdown, and you chiming in that your ADH is high. All in a day's work

[TheBrain]

Hi circular! How great that you have moved forward on the CIRS front. I took two courses, so I'm behind on forum posts. Are you being evaluated to determine if you have CIRS or has that been confirmed?

Thanks for this information about ADH and osmolality. I haven't had either tested. What prompted you to get them tested? My primary care doctor would probably order these tests for me, but I'd want to give him suggested diagnosis codes. I just had an appointment with him last week, and I see him quarterly. But perhaps I can move that up. This sounds like an interesting angle to explore.

There's actually a term for waking up in the middle of the night to pee: nocturia. However, one episode of nocturia per night is considered normal. In my case, my one episode of nocturia is a trigger for my insomnia. It's getting back to sleep after waking up to pee that's my trouble spot. To get back to sleep, I take Klonopin and some supplements (that don't seem to do much for me); after that, my deep sleep is impaired. If I can sleep five hours before waking up to pee, I can feel pretty darn good that day.

I like Joseph Cohen at SelfHacked. In fact, I just bought his book today titled The Self-Hacked Secrets to Understanding Why You Are Sick and How to Get Well. After I click Submit on this post, I'll read the article you've linked to (with my blue blockers on, of course).

Most days, I'm feeling old, so I would be wide open to using a vasopressin nose spray if my ADH is low.

Do you mind if I ask what targets you shoot for with respect to your blood levels of estrogen, progesterone, and testosterone? I was recently tested and haven't received my results yet.

My IGF-1 is quite low, and I asked my endocrinologist about what that meant. She said it was because my fasting insulin is so low. So it sounds like if one is low, the other would be as well. That seems to contradict what Joseph at SelfHacked is saying.

I don't have the energy to go down too many rabbit holes right now myself. And my husband had surgery on his hand yesterday for Duputren's Contracture; he's mostly one-handed for at least six weeks, maybe two or three months. So I'm needing to pick up the slack.

[SusanJ]

Alysson, I just came across this video by Chris Masterjohn about having to wake up and pee, then having trouble getting back to sleep. Don't know if there is anything new in there, but it's not long.

https://www.youtube.com/watch?v=UMQETki ... e=youtu.be

[TheBrain]

Susan, thanks for sharing Chris Masterjohn's video. The first thing he talks about is gluconeogenesis, which, as he explains, can wake people up when they are not eating enough carbs. Gluconeogenesis is a stress response, and it can even make us need to pee. Since I'm on a ketogenic diet, my carb intake is fairly low, obviously. He didn't talk about ketosis, but I would hope that mild ketosis would cover me through the night. But maybe not?

After doing a 7-day whole foods cleanse, I am finding myself back to feeling hungry when I wake up in the middle of the night. I've been taking a tablespoon or two of MCT oil, which boosts my ketones and, fortunately, doesn't interfere with my sleep in any way.

During the cleanse, which was low in protein, I was waking up with my blood glucose in the 90s, even a bit above 100 one time. Usually, it's in the 80s. I was eating more fruit, so maybe that's why, but I was wondering if my body was going more into gluconeogenesis.

But even before the cleanse, I was waking up earlier and earlier with the need to pee.

I used to have hypoglycemia, but that stopped with my ketogenic diet. But maybe my body is overusing gluconeogenesis with my low carb intake? I don't know. But I'm wondering if I should experiment with eating more carbs while consuming more MCT oil.

Masterjohn also talked about wearing blue blockers when we wake up in the middle of the night to pee (from whatever cause), which I already do. He also suggested playing a non-stimulating video game like Tetra. I haven't tried that.

[circular]

Susan, thanks for sharing Chris Masterjohn's video. The first thing he talks about is gluconeogenesis, which, as he explains, can wake people up when they are not eating enough carbs. Gluconeogenesis is a stress response, and it can even make us need to pee. Since I'm on a ketogenic diet, my carb intake is fairly low, obviously. He didn't talk about ketosis, but I would hope that mild ketosis would cover me through the night. But maybe not?

I listened to that too. This part of the comment section sort of kind of maybe addresses this:

Guillaume Belanger2 weeks ago
I never eat more than 50 g of carbs per day, have been for 10 years, and do not have that problem. What you're saying is only applicable if you are insulin resistant. And certainly not at all applicable to anyone who is fat-adapted with excellent insulin sensitivity. But independently of this, how can you, with your knowledge of biochemistry and physiology, encourage people to eat more carbohydrates when this exactly what is killing so many of us? I really don't get it. I'm very disappointed.

Chris Masterjohn, PhD2 weeks ago
Guillaume, I didn't say or even imply that everyone who eats less than 100 g would have that problem. This certainly doesn't apply to everyone, but insulin resistance is not even a slightly a helpful way of figuring out who it applies to. Hormones such as glucagon, adrenaline, and cortisol helping to normalize blood glucose when carb input drops are part of normal healthful physiology. Your last sentence contains its answer. Because I understand biochemistry and physiology, I do not buy in to the idea that carbohydrates are exactly what are killing us.

It would be helpful if he'd done a more detailed coverage of this issue. He must have much more to say ... Maybe he can be convinced to do the long version

I'll be back later alysson to reply to your reply to me above ...

[circular]

Back again alysson. So the ADH/osmolality tests were part of the biotoxin labs Dr. Ackerley runs. I'm not sure if others have also had this included. She said she can't tell one way or the other whether I have CIRS because of my borderline labs. I gave a summary of my visit with her here.

We got the biotoxin labs covered (at least my insurance told me ahead that they almost certainly would and I haven't gotten a bill yet) using the chronic fatigue code. The other two codes used were for hypothyroidism and menopausal states for the hormones.

I explained to my primary care doc, and a new one at that, that I'd seen a chronic fatigue specialist but she wasn't covered by my insurance so couldn't run the labs. I gave the new doc the long requisitions from Dr. Ackerley. The new doc covered Dr. Ackerly's info (name etc) with her own and away we went. I'm still a little nervous a bill will show up for the more eccentric labs, but so far so good. I took a reference number from the two calls prior with my insurance where I was assured it would most likely be covered if my doctor thought I needed it...

Do you tend to have low blood pressure? I think maybe the reason my osmolality is low is all the water I have to drink to get my morning, afternoon and evening supplements down. So now I find I have to up the electrolytes to keep up. I can't say I grasp it all that well yet.

I know what you mean about getting up to pee and that being followed by insomnia. That's what happened to me for years and still does occasionally. One thing I have noticed is that when it happens my hamstrings and hip flexors are tight. I don't feel they are tight until I get up to stretch them. I've found that these muscles need to be relaxed for me to drift off again in a short time. I do much better if before I go to bed I heat my hamstrings with a heating pad to get them relaxed (I can't stretch too much because of the hypermobility problem). I heat my glutes then too and sometimes spend a few minutes with the pad under my back. It doesn't take long. The other non-supplement thing that helps is going back to sleep with earbuds and, usually, brain entrainment. I use this Brain Wave app on my phone and find that for me, rather than the sleep options, the Deep Relaxation one really helps me drop back off to sleep. There's one for anxiety that sometimes helps too.

Funny you asked about what hormone targets I use. Countless times when I'm away from my computer I think 'I have to send alysson a PM and thank her for sending me those hormone targets'! Right now I'm not sure what my targets are, but I recall in the list you shared testosterone was pretty much as tolerated. I don't tolerate a lot of that so I pay attention to symptoms for it. I'm undecided about estrogen and progesterone and haven't taken the time to make up my mind. While focusing on so much else I guess I've just been glad I'm getting hormones. Doctor Gundry thought my estradiol was way high at 100.5. I think it was TheresaB who posted that Dr. Gundry said he disagrees with Dr. Bredesen on that because Dr. B is focused only on the brain wrt it while Dr. Gundry is looking outside the brain too. 100.5 is high for Dr. Bredesen too I think (?), but he wants it higher than Dr. Gundry. It would be interesting to hear more from Dr. Gundry's perspective. I need to go back to your PM and see what those targets were and remind myself where you got them

[TheBrain]

Susan, thanks for sharing Chris Masterjohn's video. The first thing he talks about is gluconeogenesis, which, as he explains, can wake people up when they are not eating enough carbs. Gluconeogenesis is a stress response, and it can even make us need to pee. Since I'm on a ketogenic diet, my carb intake is fairly low, obviously. He didn't talk about ketosis, but I would hope that mild ketosis would cover me through the night. But maybe not?

I listened to that too. This part of the comment section sort of kind of maybe addresses this:

Guillaume Belanger2 weeks ago
I never eat more than 50 g of carbs per day, have been for 10 years, and do not have that problem. What you're saying is only applicable if you are insulin resistant. And certainly not at all applicable to anyone who is fat-adapted with excellent insulin sensitivity. But independently of this, how can you, with your knowledge of biochemistry and physiology, encourage people to eat more carbohydrates when this exactly what is killing so many of us? I really don't get it. I'm very disappointed.

Chris Masterjohn, PhD2 weeks ago
Guillaume, I didn't say or even imply that everyone who eats less than 100 g would have that problem. This certainly doesn't apply to everyone, but insulin resistance is not even a slightly a helpful way of figuring out who it applies to. Hormones such as glucagon, adrenaline, and cortisol helping to normalize blood glucose when carb input drops are part of normal healthful physiology. Your last sentence contains its answer. Because I understand biochemistry and physiology, I do not buy in to the idea that carbohydrates are exactly what are killing us.

It would be helpful if he'd done a more detailed coverage of this issue. He must have much more to say ... Maybe he can be convinced to do the long version

circular, thanks for posting this comment with Masterjohn's response. I hadn't looked at the comments. Your post encouraged me to search his site, and I found two relevant podcasts (which include transcripts):

Ketogenesis Isn’t All About Carbs and Insulin

Insulin Resistance Isn’t All About Carbs and Insulin

It's possible that someone has already posted links to these podcasts somewhere on the forum. I did a search on "masterjohn," and we have 278 hits. So he's a popular guy here.

I've watched the first one and read the transcript. Last night's sleep was worse than usual, so I'll have to re-watch and re-read multiple times, or wait for a better day.

I'm seriously considering abandoning the ketogentic diet, at least for now. Yesterday, I came across two sources that say if you have thyroid disease, the ketogenic diet is not for you. I have Hashimoto's with a burned-out thyroid gland and an unusual pattern with low free T3, low free T4, and low TSH. I had this pattern before I delved into ketosis last year, but I went low carb years ago.

According to the one source, anyone with hypothalamic-pituitary-adrenal (HPA) axis dysfunction shouldn't go on a ketogenic diet, and I definitely have that. (It really should be HPAT axis, with the "T" meaning "thyroid.") I probably should be on a moderate carb diet, which would better support my thyroid and my gut microbiome. However, what I'm not clear on is whether supplementing with ketones is a good idea for someone with thyroid disease (and ApoE4). I suspect it is.

I might create a separate forum topic on thyroid disease and the ketogenic diet/low carb diet.