Ask the Acupuncturist

Dear Dr.Nisters,
As I study dieting (from TCM standpoint) I encountered a forum of bulimia suffering girls, and I felt very sorry for them.  Is it stomach heat or heart qi dysfunction (as I feel it is physiological problem too) or what?

Thank you,
Tatiana

Dear Tatiana,
In terms of bulimia.  It actually gets quite complex.  There are the factors and patterns that lead to the bulimia and then the patterns caused by the bulimia.

At the core of the initial problem that triggers the bulimia there will be liver depression qi stagnation.  Liver depression is engendered emotionally by “unfulfilled desires” which would certainly be the case in someone that goes to such drastic measures to change their appearance or weight.  They are unhappy with what is and have a desire, unfulfilled, to change it.  Often they are seeking some cultural or familial idea of a normative appearance that they cannot attain.

The sources of the liver depression, other than the unfulfilled desires, can be manifold.  According to Liu Wan-Su’s “theory of similar transformations” any of the historical six depressions (now given different terms) WILL transform to other of the depressions unless it is corrected.  The depressions are qi, blood, phlegm, damp, food, food

Then these depressions will eventually engender heat, as human beings are warm by nature.  This will cause a stirring of ministerial fire which will flare up to  vex the heart, among other problems.  This would often be a condition of yin fire, coming from the lower burners and blocking or interfering with the arisal of clear qi and yang upward.  This would make clear thinking difficult and obsessive behaviors could predominate.  The original problem of liver depression qi stagnation will eventually create depressive heat. So, a lot of things go wrong.

The bulimia itself then causes further significant stomach/spleen qi disturbance often with heat or damp heat that will be permanent, unless properly treated, even after the bulimia is stopped.

Essentially, every system is injured and imbalanced, according to TCM theory and my clinical observations.

Be well,

– Dr. John Nieters, L.Ac. DAOM, FABORM

Hi John,
Can you please take a look at my recent blood results from Kaiser. I don’t trust them when they tell me I’m in a normal range. I would really like your opinion.
Testosterone 308 ng/dl
FSH 4.7 mIU/mL
LH 3.0 mIU/mL

Thank you 🙂
Mark

Dear Mark,

Very complex question actually.  There is a certain amount of disagreement over what “normal” or “optimal ranges” for hormones are, particularly in men.  I will give you my opinion about the tests.

Normal FSH range in adult men is usually reported at 5-15 mIU/ml.  Yours at 4.7 is low, even by this broad range.  In men, FSH or Follicle Stimulating Hormone, is critical for sperm production.

Normal LH range in men is usually reported as 2-14 mIU/ml.   This again, is a pretty broad range.  Your level is 3.0, so it is barely in the lowest end of “normal” range.  LH, or luteinizing Hormone, stimulates the Leydig cells where there is testosterone production.  This is controlled by GnRH, Gonadotropin Releasing Hormone, from the hypothalamus.  There is a test using GnRH to stimulate LH release see where the problem is.

Normal testosterone range is usually reported as 300-1,000 ng/dl. Your level is 308.  This is obviously at the very lowest level of “normal”.

While many general practitioners would be fine with these levels, any reproductive specialist and many good mens doctors would be quite concerned.

This group of tests would be consistent with hypostimulation, or low hormonal pulsing, from the pituitary gland leading to marginal sperm production and low testosterone levels which can affect every aspect of male health.  These problems would include, but not be limited to, low libido or sex drive, low sperm count, weight gain, irritability, erectile dysfunction, infertility, difficulty in gaining or holding muscle mass, fatigue, cardiovascular problems, diabetes, etc.

In reproductive medicine, and many other conditions that I treat, this hypothalamic-pituitary communication is faulty.  In reproductive medicine this is looked at a lot along with adrenal and thyroid function which are controlled by the hypothalamic/pituitary system.

Greatly simplified example. The hypothalmus is the control center (think any movie with lots of dials and screens being monitored like a nuclear facility). The control room (hypothalamus) is constantly measuring temperature, nervous system activity, hormone levels etc.

The hypothalamus has a closed loop with the pituitary where it sends very small messages like GnRH.  The pituitary then sends out chemical messages to the various  glands to increase or decrease the hormonal output from the specific glands.  TSH or thyroid stimulating hormone stimulates the production of  thyroid hormones.  FSH, to stimulate the ovarian follicles in women and spermatogenesis in men.  LH to stimulate follicle release and corpus luteum production (for increased pregesterone.) Many others.

So, the key is find out where in this complex system the problem is.  In Chinese Medicine it is actually dramatically easier than with biomedical testing, although the testing is very cool.  We have many ways to balance the HPA (hypothalamus/pituitary/adrenal) axis.

In biomedicine the focus is on hyperstimulating various systems with pharmaceuticals which will have side effects. In TCM we assist the body to regain homeostasis or balance so that it can do it’s job properly.

In my opinion, based on my historical knowledge of your lifestyle, your particular test results arise primarily from:
-irregular and unnatural circadian rhythms as a result of your shift work schedule, which will dramatically affect HPA axis.
-relationship issues leading to neurohormone imbalance
-under exposure to “male” activities which would stimulate testosterone production
-over exposure to other types of life activities/events which will inhibit testosterone production.

Be well,

– Dr. John Nieters, L.Ac. DAOM, FABORM

Dr. John Nieters will be a guest on KPFA’s “About Health” hosted by Joy Moore. Special show focusing on alternative health care resources.
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Hi John,
I live in the San Francisco Bay Area (peninsula) and am a big fan of yours. I attended your presentation on Alzheimer’s at the new living expo and have been listening to your weekly radio show on a regular basis. Your knowledge and ability to present information in a clear, caring and understandable manner is refreshing and greatly appreciated.

My recollection and I could be wrong is that during the presentation you recommended against drinking coffee and advocated drinking green tea; while I am a big fan of green tea due to the presence of its polyphenols which have neuroprotective properties, I always felt that coffee also had some major benefits. Recently another study has confirmed the benefits of coffee in relation to Alzheimer’s; seehttp://www.sciencedaily.com/releases/2011/06/110621093301.htm . In addition, there is one study I know of regarding the benefits of coffee for those with prostate cancer that I think is interesting ; seehttp://www.nytimes.com/2011/05/24/health/research/24prevention.html . I also read where coffee is the primary source of antioxidants in the American diet (this would seem like a good trivia question) and this seems to me more a statement about the poor diet of Americans than anything else.

Based on the research on Alzheimer’s I was wondering if you still believe that one should not consume coffee.

Regards,

Allan

Dear Allan,
One of the difficult things to communicate in a seminar of the type that we did was that there is absolutely no “right” diet or group of supplements for everyone.  Although I mention that fact at the beginning of the seminar, it is difficult to hold this in the face of some supplements and activities being communicated as generally “good” or “bad”.

One of the most significant differences between Classical Chinese Medicine and Western Biomedicine is in understanding qualitative vs. quantitative measures and understandings.

Biomedicine is brilliant in quantitative measures.  Chinese Medicine has immense wisdom in seeing and treating based on qualitative measures.

Statistics give us great tools, but no individual is a statistic and cannot be identified statistically, and treatments of individuals should rarely be based on statistical information unless that statistical information is overwhelmingly positive in one direction. For example, according to studies done by the company making a particular statin drug, if 250 people take a particular Statin drug it should prevent one cardiovascular event over a 5 year period.  This information is used to suggest that most if not all people should go on statins.  We also see that 15% of women who go on statin drugs complain of severe muscle pain and weakness.  Of those women, 56% show muscle damage if the muscle is biopsied.  So,  what to do.  Who will be helped and who will be harmed?

In Chinese Medicine it is all about the individual.  For example; we know statistically that about a third of people given Ginseng will have an increase in blood pressure.  This is not a problem for us, as it is very easy to identify the people who are likely to be affected before we give them the herb, so we don’t give them ginseng.

This same principle holds true in Chinese Medicine for ALL elements of diet, herbal medicine, sleep timing,  exercise frequency, and even optimal frequency for sexual activities.  It is all based on the individual.

Coffee is an antioxidant miracle.  It has an extremely high ORAC score for antioxidant content.  Antioxidant activity is very important in Alzheimer’s prevention.  Coffee has dramatic effects on blood sugar and glycemic activity.  Glycemic activity is one of the most important aspects of Alzheimer’s prevention. People are more likely to exercise longer and at greater intensity while on coffee, which is good for many, but not for all.   I like coffee for it’s very beneficial effects on the the Liver (of most people).  I do not like it for my patients with cardiac arrhythmias and certain blood flow irregularities.  I believe, that like all things, some people do better on coffee, while some people are better without coffee, for Alzheimer’s prevention.

In Chinese Medicine, green tea is cooling, coffee is heating in an artificial heating way.  This would be one of my most simple distinctions in deciding between the two substances for my patients.  From there I would look at a whole host of other factors in making a recommendation.  Also critical to me is quality of sleep and/or ability to relax.  If coffee affects these deleteriously, as it often does, I would see that as over-riding or negating the positive potential .

Another point to remember; as much as I enjoy reading and quoting studies, most are not accurate.  Only about 50% stand up to further scrutiny.  And that is just in terms of whether they accurately answer the question asked.  Even more important is that most studies don’t ask the right questions, so the reported results can be very misleading.

A good example is the NIH sponsored study done at Harvard.  The (published) question was “Does the herb Dang Gui relieve menopausal symptoms”. Seems straightforward.  However in the methodology, because of massive unintentional biomedical bias, the assumption used in the study was that menopausal symptoms could only be relieved by raising estrogen levels.

The study indicated that Dang Gui dramatically relieved menopausal symptoms.  It did not however increase estrogen levels.  So the study was reported as a “negative study” even though it actually did lower symptoms and that was the very question being asked.  So they proved that Dang gui did not lower menopausal symptoms while proving that it did actually lower the symptoms.  Hmmmmm.  This type of bias is rampant.

– Dr. John Nieters, L.Ac. DAOM, FABORM