Dr. Paul Savage is the chief medical officer of BodyLogicMD in Chicago, Illinois. He founded BodyLogic to share what he has learned from his personal journey about health and to dispel misconceptions about hormone therapy. His website is www.bodylogicmd.com, and his phone number is 1-866-535-2563.
SS: I am so pleased to speak with you. Please tell me about your organization and what you are doing in Chicago. What brought you into this arena of medicine?
PS: Even though I am a physician, I came into this new area of medicine because I did not know much about preventive health. You see, as doctors we are not really taught to treat a patient holistically in a preventive manner.
In 1996, I was thirty-eight years old and weighed 264 pounds. I was depressed. I had no libido. I couldn’t get the weight off, no matter how hard I tried. What bothered me the most was that I had trouble sleeping. I would wake up at 11:00, at 2:00, and then pace the floor for two hours. Finally, I would go back to bed and get a couple of hours of sleep, but I never really felt rested. I went to my doctor, and he told me to eat better and exercise.
After leaving my doctor’s office, it dawned on me that I did not know what to eat, nor did I know how to exercise. Do you do cardio? Weight lifting? What was best for physiology and good health? So I started on a quest: nutrition, dietitians, personal trainers, and so forth. I reached out to anybody who could teach me about health. I spent two years reading about nutrition, funneling through the maze of information out there, and realized how confusing it is. Everybody has a public relations angle or a marketing angle. It seemed the point was to confuse the population about what is healthy and what is not.
In my opinion, there is no such thing as a diet, only a proper nutrition plan. Sometimes you have to go back to what your grandmother taught you decades ago: Eat breakfast, lunch, and dinner. Have a nap after breakfast; have a nap after lunch. Turn off the TV; go out and play. Have two tablespoons of cod liver oil, and eat all your vegetables. You know, just simple rules.
After two years, I had lost fifty pounds, weighed 210, and had 26 percent body fat. I felt better, but I did not feel well. I was doing an hour and a half of exercise a day with my personal trainer, doing cardio, martial arts, and weight lifting. I was eating five meals a day of very good nutrition, but I could not lose more weight. That experience is what put me on this search.
At the time, I knew nothing about hormones. I did not realize how seriously my bad lifestyle and nutrition all those years had affected my hormone levels. I did not understand the connection, so I sought a bioidentical hormone therapist. He diagnosed that I had hormone imbalance, specifically too much cortisol and low testosterone. After being on bioidentical hormone replacement for five months, I dropped down to 14 percent body fat, my energy returned, and finally I could sleep again. It was amazing.
SS: Hormones were the missing component.
PS: Yes. This convinced me how important it is that we not only maintain hormone levels, but also return them to the same levels we had when we were twenty-five and thirty years old. Those are the age ranges at which our bodies operated at their peak—our healthiest prime.
Having had this incredible experience, I decided to leave my position as director of an emergency and trauma center, where I was treating gang members and gunshots and pretty hysterical people all day long—it was very stressful—and change the direction of my career. That is when I embraced this whole concept of hormones and replacing them naturally. I wanted to learn everything I could about bioidentical hormones, health, and nutrition.
I went to Alabama, Florida, California, Michigan, and New York and studied with a number of various experts on bioidentical hormones until I completed the picture. Finally, I understood that this missing component in health care was why people were not improving and getting well.
SS: When did you start BodyLogic?
PS: In 2003. The mission of BodyLogic is to help physicians come into the field of preventive health and age management by teaching them the proper way to help patients through nutrition, exercise, and bioidentical hormone therapy.
SS: Did they come?
PS: Did they ever! We now have five clinics nationwide because so many doctors want to come into this field but do not know how to do it.
I got my brother involved in starting BodyLogic. He is my twin brother, who is a retired vice president of AT&T and was also out of shape. He was 240 pounds, still smoking, and still drinking. I taught him the premises of health, and he markedly changed his life. He no longer smokes or drinks, and he exercises five times a week. He is down to 180 pounds and looks great.
When I discovered what bioidentical hormones could do for me, I was convinced of their importance. Once I opened my practice, suddenly there were a few thousand patients who wanted this help, and I needed to be able to have other doctors where I could send them.
SS: Is there any one patient whose story stands out in your mind?
PS: Yes. One of the interesting things about hormones is that they are not just for menopausal females. A thirty-two-year-old woman came to my office, tears streaming down her face. She and her husband were getting a divorce. Terrified, she explained to me that she could not control her anger. Each month in the last two weeks around the time of her period, she became (in her words) “a raging lunatic.” She had severe cramps, clotting, and out-of-control moods. She was afraid to be around her two little boys, and they were afraid to be around her. Her husband was in desperate need, and he sought us out, too.
We diagnosed this woman with severe PMS, which is a progesterone deficiency, in the second two weeks of her cycle. Once we placed her on progesterone therapy for the last two weeks of her cycle, she improved markedly within three months. One day, this woman, her husband, and her two little boys came by my office to say, “Thank you for saving our marriage.”
I see this all the time—the way that hormones dramatically change people’s lives on a daily basis. In traditional medicine, it is very rare for people to come back and say thank you. In the emergency room, I truly saved people’s lives on a daily basis, and rarely did they ever say thank you, but in this field, women are thanking me every day. My patient retention is over 90 percent.
SS: I know one forty-three-year-old woman who is struggling with her weight. She exercises, goes to sleep early, and tries to watch her diet, but she has about thirty pounds that won’t budge.
PS: It sounds like a hormone problem and could be estrogen dominance. There are certain things that indicate hormonal imbalance:
If a woman has estrogen dominance, we would lab test first, to be sure. Numbers from labwork are for clinical diagnosis only. A doctor has to look at other aspects, such as her stress, her weight, and her mental outlook. These are all part of the diagnosis. With estrogen-dominant females, we find out what is blocking the progesterone because that is what balances the estrogen.
SS: How do you discover this?
PS: Through clinical history or through saliva testing. Although there are not many things that block progesterone production, it can be due to dietary deficiencies. For example, vegetarians don’t get enough cholesterol, which is required to manufacture hormones. The other way we can remove the blocking action is by increasing fiber in the woman’s diet. I frequently put estrogen-dominant females on a high-fiber diet, which would include any food that is green and leafy or crunchy when you bite into it, such as apples, pears, apricots, berries, spinach, kale, broccoli, or cauliflower. Increasing your fiber intake helps regulate estrogen levels.
Finally, we replace the estrogen-dominant female with progesterone to help balance the estrogen/progesterone ratio. This brings her back into balance, and she then is no longer estrogen-dominant.
SS: Does the weight dissipate as long as she continues to eat right and exercise?
PS: Right. When estrogen is in balance, your metabolism increases. Too much, however, can slow it down. Estrogen can put on fat; progesterone helps take it off. Progesterone is also a diuretic, so it helps you lose water weight. When women are bloating, it indicates that they have too much progesterone. It’s all a fine balance.
SS: Many women have a difficult time on their progesterone cycle, because they feel bloated and can put on as much as five pounds.
PS: If you are putting on five pounds, bloating, getting cramps, and feeling irritable, or experiencing any one of these symptoms alone, you are not on enough progesterone.
SS: It sounds like bioidentical progesterone replacement could be a better remedy for young women than taking over-the-counter pain medication and diuretics. Tell me, what is the average dose of progesterone you give a woman? I know it’s different for everyone, but there must be some kind of “norm.”
PS: Depending upon the female herself, if she is active, thin with a higher metabolism, she will need more progesterone. By contrast, if she is sedentary, older, and has a slow metabolism, she will need less. Every woman is different. Some need more, some need less.
SS: What about the person who has high cortisol?
PS: I diagnose this type very frequently; usually they are younger, active professional females.
SS: Because they are not sleeping enough?
PS: Poor sleep quality is definitely one of the things that can increase cortisol levels. But you have to ask yourself, why aren’t you sleeping? Usually stress is the big offender, and it causes cortisol to go up. Cortisol has two functions, and let me explain this in terms of our ancient defense mechanisms. First, it is in your body to help you with the fight-or-flight response; in other words, it helps you mobilize energy to run away from a dinosaur chasing you. Second, it helps cool down your body and your joints after you flee in order to decrease inflammation in your body. Of course, back thirty-five thousand years ago, we didn’t get chased by dinosaurs every moment of the day. But in today’s world we are constantly under stress; we are constantly chased by what I tell patients are “dinosaurs”—family stress, work stress, relational stress, financial stress, and emotional stress. We are constantly pushing ourselves without letting ourselves rest. As a result, our adrenals are constantly pumping out cortisol. Chronically elevated cortisol shuts down your metabolism and says, “Okay, fat, give me all the food you’ve got because we are under attack and we need to store food.” As a result, you start absorbing many more calories than you normally would with a regular working metabolism. All your extra energy is stored as fat because cortisol has actually turned down your metabolism.
SS: So what’s the remedy?
PS: The remedy is to get the cortisol to come down by eliminating stress through stress management and life changes. Many people are under the false impression that because they are stressed and constantly on the go, one or two light meals a day is sufficient, instead of breaking down food into five or six different meals every day with sufficient amounts. Eating one or even two meals a day makes your body think that it is starving. This induces stress, and stress increases cortisol.
SS: I have written about this extensively in my Somersize books, that by skipping meals, you actually gain weight because it raises cortisol, and that you must eat properly to lose weight.
PS: You need a constant influx of food throughout the day so your body understands that it is not starving and not stressed. Through nutrition, you can bring your cortisol down and thus lose weight.
You also need exercise, even though initially, exercise elevates your cortisol. But exercise also relieves stress, so long-term it will lower your cortisol. Find an activity that you like to do—yoga, tai chi, martial arts, weight lifting, or running—that will relieve your stress level. Vacations are important, too, but the bottom line is to find an activity you like to do to relieve your stress level.
SS: What about the person with underactive thyroid?
PS: Underactive thyroid is one of the most underdiagnosed diseases in the United States today. Some studies suggest that 75 percent of women have underactive thyroid and go untreated. For physicians, it is a very complicated issue because we have gotten to the point of using only lab tests to diagnose low thyroid, when other issues are involved. For example: weight gain, sluggishness, constipation, dry skin, depression, or missing the outer corner of the eyebrows. These are all symptoms of low thyroid that you have to stay attuned to, in addition to the blood test.
SS: So just because your blood test says you are normal, it really is not the indicator. The diagnostic savvy of the doctor plays a role, too, correct?
PS: Yes. The doctor has to listen to physical symptoms of the patient. Five years ago, if a blood test indicated that the TSH was over 5, that indicated a problem. Now it’s been lowered to 1 or 2 [pg/dL] so we are getting more and more broad on how we treat this disease.
SS: Let’s talk about adrenal burnout. It’s a difficult concept for people to understand.
PS: When the adrenals get fatigued, you have too much stress, and you have called on your adrenals too much. Once the adrenals tire out, they no longer produce enough cortisol. We see patients all the time with low cortisol levels, and you can tell by looking at them that they are completely fatigued. They have difficulty waking up in the morning, but feel a little better around noon. At around 4:00, they need a nap, and after dinner, they feel better than they do most of the day but quickly tire out and have a difficult time sleeping. They are more sensitive to the environment, and they have infections that last longer than is normal.
It is essential to try to reach this person by explaining the importance of nutrition, exercise, and lifestyle. You try to get them to stop doing the things that are stressing the adrenals, such as not eating properly, not exercising enough, and having too much stress.
After that, I talk to them about herbal agents, supplements, and vitamins that can help increase the production of the adrenals. If I still can’t reach them and I realize they are not going to change, my last resort is to give them hydrocortisone. Cortisone is only for people at end-stage adrenal fatigue. It is not a jump start, and it should not be used frivolously. Its side effects include osteoporosis and psychosis.
SS: I know how burned-out adrenals feel because in my career, I have burned out my adrenals five times. I have vowed to myself that I will never do that again, but at the time I did not understand the effects of overwork on my body. I guess you learn from your mistakes. I now value my good health so much that I will go to bed before pulling an all-nighter and figure out tomorrow how to finish the job when I am well rested. Maybe it’s called “maturity.”
PS: Statistically, 83 percent of women and 80 percent of people under the age of forty have adrenal stress, meaning they are producing too much cortisol. You can tell an adrenal-fatigued person by how many cups of coffee they drink in a day.
SS: That’s interesting, but isn’t coffee in small amounts an antioxidant?
PS: A cup a day is fine, and there are theories about its antioxidant effects, but when you start putting too much caffeine into your system, it stimulates the adrenals in a negative way. Like everything else, it’s about balance. Take wine, for example. A glass of red has positive effects on your blood pressure, but if you exceed two or three glasses daily, you can start having liver problems.
SS: Let’s talk about men. Men seem to be reluctant to investigate antiaging medicine on their own.
PS: As a man myself, finding out what was at the root of my problems—weight gain, fatigue, stress, lifestyle, and hormonal imbalance—was astounding. Then I began to realize that other men were having the same problems. I consider it an honor that I have hundreds of men in my practice, and I do very well with them. I am treating them for adrenal, cortisol, thyroid, and their testosterone. But I have to say it’s usually the women who come to me first, who get the biochemistry of it, and then sign up their husbands.
The thing about male menopause that is different from menopause is that women lose over 90 percent of their estrogen within about twenty months, while men lose their testosterone over two to three decades. It’s so gradual for them that we don’t have that sudden feeling of falling off a cliff. Instead, we just take this long stroll down this never-ending path, and then one day we turn right and go, “You know what? I don’t feel the same. I don’t feel energized, I don’t feel vital, I don’t feel mentally sharp, I don’t feel as sexual, I don’t feel as strong as I used to feel.” One of the great misconceptions held by men is that they feel that testosterone causes prostate cancer. Unfortunately, this belief keeps men from entertaining the idea of replacing testosterone.
SS: It is an environment of balanced testosterone that prevents prostate cancer.
PS: When you read the literature on testosterone and prostate cancer, you find the predominance of this literature shows that, in fact, testosterone does not cause prostate cancer. Further, testosterone is beneficial for a man’s mood, memory, mind, libido, heart health, strength, metabolism, and bone health. When you see an elderly man flopped over, thin skin, pale, no energy, poor vision, can’t pee, irritable, grouchy, isolated—these are all symptoms of a testosterone deficiency. I try to prevent that from happening with my male patients, because once a man gets to that point, trying to bring him back is very difficult. I do not feel that testosterone, or any hormone for that matter, should diminish with age.
SS: You seem to have a great passion for your work. When you leave your office each day, how do you feel?
PS: Tired, but satisfied, extremely satisfied. The greatest thrill comes when I am outside of my office and someone will come up to me and say, “I saw you on television, and what you said makes sense.” Or when other doctors come up to me and say, “How can I learn to do what you are doing?” It is absolutely wonderful to know that I can impact physicians’ lives and work, because when you impact a physician, you are in turn impacting their patients.
SS: Thank you for your time, Dr. Savage, and continue doing your great work.
DR. SAVAGE’S TOP FIVE ANTIAGING RECOMMENDATIONS
1. Dietary deficiencies can compromise progesterone production. For example, vegetarians don’t get enough cholesterol, which is required to manufacture hormones. The other way we can remove the blocking action is by increasing fiber in the woman’s diet—adding any food that is green and leafy or crunchy, such as apples, pears, apricots, berries, spinach, kale, broccoli, or cauliflower. Increasing fiber intake helps regulate estrogen levels.
2. When estrogen is in balance, metabolism increases. Too much, however, can slow it down. Estrogen can put on fat; progesterone helps take it off if it is in the right ratio. Progesterone is also a diuretic, so it helps the body lose water weight. When women are bloating, it indicates that they have too much progesterone. It’s all a fine balance.
3. Poor sleep quality is definitely one of the things that can increase cortisol levels. But you have to ask yourself, why aren’t you sleeping? Usually stress is the big offender, and it causes cortisol to go up. Cortisol will come down by eliminating stress through stress management and life changes.
4. Many people are under the false impression that because they are stressed and constantly on the go, one or two light meals a day is sufficient, instead of breaking down food into five or six different meals every day with sufficient amounts. Eating one or even two meals a day makes the body think that it is starving. This induces stress, and stress increases cortisol.
5. Exercise also relieves stress, so long-term it will lower cortisol. Find an activity that you like to do—yoga, tai chi, martial arts, weight lifting, or running—that will relieve your stress level. Vacations are important, too, but the bottom line is to find an activity you like to do to relieve your stress level.