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As a clinical nutritionist and consultant to many well respected Dr, I have found chasing Rt3 in several cases ended up in failed attempts. In some cases cause more issues. The approach which has worked the best was to find out why your rt3 was high then address it from there. Rt3 is raised by the body for a reason to protect it self. In many cases of rt3 I have dealt with the main reason rt3 was elevated was stress from either the imbalances in the neurology, biology, environmental, nutritional, or genetic factors. All of of these areas need to be explored before IMO putting a person on t3 only. I personally chased Rt3 for years, feeling good then feeling worse never stabilizing. It was not until I goto to the root of the problem did I finally make advances in my health and well being. Just simple nutritional factors where able to resolve many cases, or just healing the GI tract and cleaning out the liver properly. If you are on t4 only, I would look into factors to why t4 was not converting. Then may be suggest 5-10 mcgs BID to help bridge till the main problem was found. Bloods are just a diagnostic tool when most of the real happening its at the intracellular and mitochondial level. One needs to look past the serum. Dr refer cases when all the numbers in blood are fine, cortisol, ferritin, hormones are in check but they can not figure out where else to look. After a while this becomes not only a science, but an art form…
@hypoman 5357 wrote:
Dr. Mariano,
I had read in a prior thread on this forum that you prefer to see total T3 @ 330 to 420 pg/dL and total T4 @ 8.0 to 12.0 ug/dL [ http://www.definitivemind.com/forums/showthread.php?t=575&highlight=levothyroxine ].
I have been using T3 monotherapy as a means to reduce rT3 and TSH to desirable levels. Is there really any reason to add separate T4 in the case of a depressed free and total T4?
In addition to its main function as a storage hormone whose job is to convert to T3, specifically what metabolic or other functions does T4 have? Does it really matter if both T4 levels are depressed as long as one is getting enough T3? I was warned that my T4 level would bottom out as a result of taking T3.
In addition, SHBG has been driving up. Could this also be due to T3 as I have read?
In any case, I have never tried T4 before and thought this was a prime time to give it a shot and add 50mcg/day to the 100mcg T3. My biggest fear is that I run the risk of driving rt3 back up which is why I stuck with T3 only, especially if I have a conversion block or other inflammatory issue preventing T4 to T3 conversion. In this case, I would be reversing the goal of the T3 monotherapy.
While natural dessicated products like Armour are T3-dominant, I have read that such do not produce the same problem with increased rT3. Is this something you’ve observed as well?
Bottom line is whether adding T4 is worth the risk of increased rT3. Do you think keeping the T3 in place will help prevent that?
@mcs5309 5023 wrote:
My only concern for raising serum ferritin >100 would be increased inflammation and feeding gut pathogens.
Good call !! Why you need to be cautious ….
Reason I do a metametrix Gi effects stool test to confirm this in order to rule it out. One can find a Gi imbalance in about 80% of population even if they are totally asymptomatic. Kind of scary. 30% of people with intestinal hyper permeability issues have no GI related symptoms, but have other symptoms which can be neurological or show in the skin as well as other parts of the body.
Why If I suspect pathogen, lyme, bartonella, mycotoxins or viral load I have Dr vitamin d 1,25 to vitamin D 25 ratio to see if the body is in a pro inflammatory state. This is usually an indirect marker which has been shown to be an excellent indicator
Had client last night from Austrailia as soon as I saw her vitamin D 25 levels , her meds and supplementation, I asked right off the bat if she had vitamin D 1,25 tested. On supplements her vitamin D was 1000 ius which prompted my response. The Drs knew what was going on which was good to hear. Too many Drs over here are cranking vitamin D to 10,000 ius a day. My question is “Is our body lowering vitamin D down to protect us from viral, or pathogen loads?” I am being to believe so…
Even ferritin levels over 220 it will caution a potential red flag for inflammation..
@Houston1970 4971 wrote:
I’m on 1200 mg of Lithium and have retained 10 pounds of fluid. I drink at least 140 oz of water daily it’s actually quite funny. Does anybody know how to retain less fluid on this salt.
I have other clients who have same issue, my concern is the increase in blood pressure. You may want have Dr looked at thyroid levels as lithium can deplete them as well as inositol and iodine. I would do full thyroid panel (ft3,ft4,tpo, rt3, tgab, ferritin, total T4) along with urinary iodine 24 hour from ZRT. You should find your answer there. Lithium can also cause alteratin in Na/K transport pathways. Isolate why this is happening then if no explanation they might want to look into a diuretic. If you have good insurance may want to ck into spectra cell for nutritional deficiency which may cause water retention. Hope this helps..
@Block0686 5248 wrote:
Hey guys,
I have found some articles from Dr. Mariano the past couple of days. I saw some of his writings and I was pretty impressed with his knowledge. It has been years since ive had any interest in speaking to a doctor. From what I have seen Dr. Mariano treats adrenal fatigue or as he terms it adrenal dysfunction in different ways most patients didn’t’ go into too much detail. I guess what i’m concerned with is i’ve seen him use HC which is a road ive already been down. It seems that he has a knack for looking at other factors that maybe going on with it. I guess I am asking if he uses other methods to treat this than HC. I am wanting to find out a little more about his protocol trends before I put through a call. I am fairly knowledgeable and help people in a group I belong too, however that protocol has hit a wall and i’m hoping this doctor can take me to another level. I have been sick and unable to work for some time now and the money I will have to spend to speak with him for 1 hour has taken me three months to save so it will be a huge gamble and its all the money I have right now, I just want to feel a bit more confident about pulling the trigger on the call. Just wanted to see if anyone here could shed some light on this or share their experiences. Thank you for your time.
The source of why people are sick is silent inflammation. The key is looking for factors which are driving this response of the body which are usually found in hidden cytokines imbalances. These are tricky to spot, only a few good Drs I have worked with know how to properly identify them. Dr Mariano is one of those such Doctors who helps many people on the boards I have participating in for almost a decade. His posts where some of the most informative and medically accurate I have come across on line. Being totally researched based my self makes me doubt many of other health professionals out there. Dr M has done the research and has the proof to back it up making him a better choice IMO. I had to go through over 50 drs till I found the right one. It is all a personal preference and what you are looking for as a patient.
Starting to re-evaluation things as drops in ferritin levels may be a response by the body to protect it self from going into a pro inflammatory state from a pathogen or cancer. With hemochromatosis being the leading cause of heart issues. i’m finding that most people are carriers for this gene (>70% tested so far my self included) my views on ferritin are going to be a more conversation approach from now on. This is just my view and my experience working with medical Drs from people in a diseased state.
@Nightfall 4973 wrote:
Just eat foods which reduce inflammation will lower your risk more then vitamins will. Most multivitamins are junk because they contain all the wrong forms of vitamins which actually are suppose to protect you from health issues.
@compaq 4966 wrote:
Thanks Dr, and when would you estimate the maximum benefits would be seen for improved mental attitude?
Other issues should be evaluated at the same time. As the person is on therapy, the health professional should be correcting the other imbalances. With in 4 weeks with proper testing you should have an idea of what is going on then how to address things appropriately. This is why with with Drs I use a layered approach. Cases I handle are not your typical run of the mill TRT cases, but rather referred by drs with patients who have been to 50 plus specialists, $100,000+, 5-10 year with no resolutions.
@Jean 4956 wrote:
This is a problem today because there are many informations and misinformation’s and many physicians have a simplest solution. I like your vision because I known if it’s the true. But the difficulty today is that doctor are not formed for this holistic vison
Dr Mariano what do you think about functional medecine ? This is a new vogue a mediatic physician like Dr Hyman. It’s interesting because there are more physiological comprehension of disease.
But but I don’t like the star system and show of this doctor. Some doctor like Dr Hyman have a big interest of supplement company and give a bad opinion about antidepressant drug.
I think in medecine there are not black and white, conspiracy Big pharma or the panacea of nutrition and supplement.This is why you support the proper neurotransmitters with the proper precursors. Drugs have their place in medicine for sure. I prefer to use an intergrative approach with Drs by looking at the factors which are causing the issue in the first place. If you are not willing to commit to a dietary and lifestyle change, then you are not committed to getting well. The power of proper eating is so over looked it scary. The results I have seen just through slight dietary and little nutritional support in some instance out weight response to harsh drugs. You need to look towards motive. Dr Hyman is all about marketing. Its $1500 just to walk in the door to see him and then you get blasted with few $1,000 in blood test. By doing this you create a bad reputation. Dr OZ has fallen into this trap and medical professionals begin to lose respect for these people. I have several clients who have gone to Rothernberg, hyman, Gordon, ect only ending up with and an empty wallet. Its all about marketing. I prefer the silent, but humble approach works better. Other medical professionals will give you much desired respect.
@compaq 4969 wrote:
I read an old post of yours, Dr Mariano, about low SHBG. It is an interesting topic to me, and I think that people with low SHBG represent quite a distinct group in the TRT cohort.
In the post it talks about the most common cause of low SHBG being androgen abuse or glucose intolerance. But surely some people have low/low-normal SHBG that do not fall into either category.
How do you address low SHBG in your practice, or what weight does it carry in your treatment plan? I’m really interested to know what you think about this hormone, especially because I find it to be so important yet it receives so little attention (not necessarily in changing the SHBG number, but working with it).
(If you are wondering, this is the post that was attributed to you. I believe it is from 2007 or earlier.)
When dealing with clients with low SHBG, by correcting thyroid, insulin resistance as well as now leptin resistance has been shown to help increase SHBG. With low SHBG TRT should be given with more frequent dosages due to the fact the body metabolizes it much quicker. As you deal with other symptoms you can make proper adjustments in TRT
@Johnny 4903 wrote:
I already took a new test with urine and saliva, but unfortunately, it was on one of my rare good days, so I hope it does not come back “inaccurate” of my condition. I will get the new results in two weeks.
So, can I just start on probiotics like VSL then? And drop coffee and start with phosphatidyl serine to lower cortisol?
FWIW, my DHEA have been higher earlier and was actually above range when supplementing with it. Still felt the same.
Your vitamin D and A are very low. This may indicate possible bile acid problem which goes back to potential sluggish liver. Even though the liver parameters look good it does not show true functionality. If levels are still elevated I would get evaluated for CAH. I would also recommend 5HIAA 24 hour urine test to rule these out. You may also want a 24 hour catecholamine test urine to see if other parts of the adrenal glands may be effected. I would serious dig into the immune system issues to rule out any chronic viral, pathogenic load as elevated cortisol levels are a response of an immune system reactions. Upping vitamin D is fine, but vitamin A, E, K also have to be balanced as well. Eating yams, sweet potatoes will help to get the proper vitamin A. One may want to explore options of heavy metals which can cause elevated cortisol. Prolong elevation of cortisol can lead to memory loss and other neurological imbalances. Why you need to look at all parts of adrenal function: Aldosterone, DHEA, catecholamines, cortisol.
Optimal for vitamin D – 120-130 provided other fat soluable vitamins are in check.
@Johnny 4891 wrote:
Hello Dr Mariano and others,
After three years of struggling and being on TRT for the last 6 months without any improvement in symptoms, I finally was able to test my saliva and urine cortisol. I suspected it would be low, but results came back and shows that my total output is way above the top of the range and my evening cortisol is also high.
Could this explain my low testosterone symptoms, fatigue, lack of energy, cold hands and feet, brain fog and how I easily gain fat despite a thyroid that looks good?
What does it mean and how can it be treated? Is this good news? Reading online, it seems to suggest Cushing or high stress. I used to live a stressful life, but I`m not any longer and have not been for over a year. Mild stress, yes, but nothing severe. I don`t think it could be Cushing, but I suppose I should be tested for that. My doctor just shrugged it off.
Quick comment on BW:
– This is 10 weeks after my last Nebido shot and no HCG, so testosterone is lower than on the prior test, but still higher than pre-TRT.
– Insulin is down 28 points from the last test.
– High vitamin B and Zinc. I have been supplementing with zinc, so that probably explains it. Not Vitamin B though.
– TSH is actually down from the last test and T3 is even a little higher.
Thyroid
TSH 2,44 mIU/l (0,5-3,6)
Free T4 18,3 pmol/l (8-21)
Free T3 7,9 pmol/l (3,6-8,3)
Thyroxine 110 nmol/l (60-150)
Triiodothyronine 1,7 nmol/l (1,2-2,7)
Reverse triiodothyronine 0,28 nmol/l (0,14-0,54)
TBG 15,1 mg/l (12,0-28,0)
Anti-TPO <10 kIU/l (<35)
Anti-thyroglobulin <20 kIU/l (<40)
TRAS <0,9 IU/l (<1,8)Gonads
FSH <1,0 IU/l (1,4-12,0)
LH 2,5 IU/l (1,8-12,0)
Prolactin 177 mIU/l (50-700)
Estradiol 0,08 nmol/l (<0,18)
Progesterone <1,0 nmol/l (<3,0)
Total testosterone 15,0 nmol/l (8,0-35,0)
SHBG 15,0 nmol/l (8-60)
Free testosterone index 10,0 (3,0-14,7)
DHT 1,99 nmol/l (0,90-3,10)
Androstendione 3,2 nmol/l (<6,2)Adrenals
Serum cortisol in blood 08:30 AM 464 nmol/l (138-690)
Serum cortisol in blood 08:30 AM 1034 nmol/l (138-690) (the day after at another lab)
Saliva cortisol 08:30 AM 16,6 nmol/l (4,0-27,0)
Saliva cortisol 10:00 PM 6,6 nmol/l (<6,0)
Free cortisol in 24 hour urine 377 nmol/24h (45-272)
ACTH 08:30 AM 2,6 pmol/l (<10,2)
17-OH-Progesterone 2,5 nmol/l (1,8-10,4)
DHEA-Sulfate 5,9 umol/l (3,4-17,0)
11-Deoxycortisol <2,3 nmol/l (<4,6)
Aldosterone 320 pmol/l (70-800)
Renin activity 1,0 nmol/l/t (<1,5)Growth
Growth hormone 0,2 mIU/l (<11,5)
IGF 1 30,8 nmol/l (17-63)
IGFBP-3 73 nmol/l (49-176)Special Tests
Leptin 417 pmol/l (<465)
Iron Panel
Ferritin 175 ug/l (20-300)
Serum iron 11,8 umol/l (9,0-34,0)
TIBC 62 umol/l (49-83)
Transferrin saturation 19% (15-57)Miscellaneous
Vitamin D 74 nmol/l (50-150)
Vitamin K 0,2 ng/ml (0,1-2,2)
Vitamin B12 749 pmol/l (170-650)
Serum copper 14,2 umol/l (12,0-25,0)
Serum zinc 17,1 umol/l (9,0-17,0)
Insulin 57 pmol/l (18-173)
C-Peptide 337 pmol/l (270-1290)
Fasting plasma glucose 5,3 nmol/l (4,0-6,0)
Parathyorid hormone 3,1 pmol/l (1,2-8,4)Means further evaluation is needed with urine or saliva test to confirm
Your body is in a major inflammatory response state with cortisol high /DHEA low
Indication of possible pathogen, or allergen,
Whole blood histamine may be good indicator
CD 57 stricker panel, with possible further evaluation into immune markers. What about lyme, or other viral infection?@j-man1 4786 wrote:
Dr. M,
What is your stance on artificial sweetners? Avoid at all costs? Or not as bad as some people make them out to be and ok to use in moderation? Thanks.
Spenda is dextrose with laundry detergent molecule attatched
TRuvia has some kind of sugar alcohol attached which can give you the runs
sweet and low —> MS like symptoms seen it many cases I work on leading permanent damage@jasonlv 4879 wrote:
Just wanted to leave an update.
Ever since writing this post, I’ve done a little more research on nutrition in terms of micronutrients. For so long, because of working out for aesthetic reasons for about 10 years, most of my focus has been on macronutrients.
I discovered a couple of indexes for nutrient density (ANDI, etc.) and began eating many more of the higher scoring vegetables along with my meals as well as juicing them (2x a day).
I believe that eliminating the adderall is the next step required… coupled with time I hope to be my old self again.
The adderall sort of put me in a funk regards to appetite. I neglected my nutrition and just kept “working” in between force feeding myself. Needless to say, without an appetite you don’t really think about cooking up a whole meal with a ton of healthy veggies on the side. Juicing veggies was a great way to get things in motion.
Even though I wasn’t eating boatloads of veggies (which I’m trying to do more of now) I was still able to get the nutrients my body was desperate for. Just feeling the improvement after a day was enough to open my eyes and MAKE ME want them more.
I feel like I may have solved my problem. My energy levels (even when not able to get a full 8 hours of sleep) are much improved. Clarity is there again. Starting to feel “right” again. Still not 100% but definitely making strides.
***
This leaves me wondering, while in my previous state (malnourished, depleted of micronutrients) would this cause my metabolism to slow down and result in elevated TSH and/or high rT3?
I’m wondering if I really do have a thyroid issue or this was a natural response from my body because of my poor diet. Would it be worth it to re-evaluate after several months?
Fish oils in the wrong environment can be toxic. Due to mercury content in conventional fish oils unless they are a good brand I would just eat fish 2 times a week. When i see dysbiosis or heavy metals and person is taking fish oils I recommend they pull back on them due to the effect of Nitric oxide has on cell membranes. Drs I work with complex are very hesitant about using fish oils unless needed. People think I am crazy well some of the top people in their field are starting to change their mind.
@romnickhudges 4895 wrote:
Detox diet is a way of flushing out those body toxins but not everyone can do it for some reasons. However, if you want to detox you have to consult your doctor in order to give you proper advice on this matter. There are so many ways on how to detox and you only need to choose what fits you.
You can not detox when you do not know what pathways are blocked. I am dealing with 2 cases where Drs had no clue on what they where doing when they where dealing with mold issues. These where the people who book on the topic. One person almost was pushed to potentially commit suicide because they did not know how to properly intepret lab work. The answer was right there with over $5,000 worth of labs she had done, but Dr did not see it. I recognized her symptoms then asked what she was doing. When I saw her protocol I almost freak along with her lab results. She was being pushed into schizophrenia (which I also experienced) from severe copper toxcity. $400k, 150 drs, 10 years of hell to find out she had sulfur, mold, and copper toxic.. Just 2 weeks removing over 3/4 of supplements and giving her new recommendation she is 80% better…You better know what you are doing or can end up killing yourself. Lady with mold has 6 months to life drs where making her worse never knowing it…
