the fertility cure

The Fertility CureDR. PATRICK GARRETT, DC, B.SCI, DCCN, DABFM, FAAFM

CONCIERGE NATURAL HEALTHCARE104 EAST BROADWAY316-212-5429 CELL

DOCTORGARRETT@YAHOO.COM

Dr. Patrick Garrett

Who is Dr. Garrett?

Dr. Patrick GarrettChiropractic College / Medical School12 Years of Functional Lifestyle Practice Specializing in reversing acute & chronic conditions naturallyPatients / clients all over the country & worldClinical focus on reversing diabetes, asthma, allergies, eczema, psoriasis, migraines and epigenetic food therapy.

Physician

Postgraduate Educator300 Hour / 2 Year Diplomate Functional Medicine / Clinical Nutrition Program in Denver, Colorado

National Speaker Internal DisordersFunctional MedicineApplied Nutrition & Clinical ChemistryClinical NutritionFunctional Approaches to Reversing Diseases

National Speaker

Lifestyle Medicine ProgramCeliac DiseaseLifestyle Medicine – Metabolic Syndrome & NutritionLifestyle Medicine – Stress ManagementLifestyle Medicine – Weight ManagementLifestyle Medicine – Prescribing ExerciseLifestyle Medicine – OsteoporosisLifestyle Medicine – The Biology of Normal Sleep & Consequences of Insufficient SleepInfertility & Endocrinology & More

Postdoctoral Education

Lifestyle Medicine ProgramLifestyle Practices for Weight Management & Health PromotionModels of Behavior ModificationThe Pressure System Model of Lifestyle Counseling in Primary CareRationale for Lifestyle & Weight Management CounselingWeight Bias in Clinical Settings: Improving Health Care Delivery for Obese Patients

Postdoctoral Education

Diplomate of the American Board of Functional Medicine

Board Certified in Integrative Medicine

Diplomate of the American College of Clinical Nutrition

Senior Fellow of the American Academy of Functional Medicine

Diplomates & Certifications

 Harvard Medical School Postgraduate Association– Member

American Academy of Integrative Medicine – Member

Physicians Committee on Responsible Medicine - Member

American Board of Functional Medicine - Past President

American Academy of Functional Medicine - Chairman of the Board of Directors

Green Med Info – Board Member

Bloodid - Medical Director

National Clean Eating Challenge – Medical Director

Leadership / Membership

What we will cover

Normal PhysiologyH-P-A-G Hypothalmus Pituitary Adrenal GonadsHormones Structures Ovary UterusMenstraul Cycle

Reactive Physiology Functional Hypothalamic Amenorrhea– Amenorrhea of the athlete– Ameorrhea of eating disorders– Functional Pituitary Amenorrhea– Hyperprolactemia

Ovarian Amenorrhea– Autoimmune Origin of Premature Ovarian Failure– Iatrogenic Origin of Premature Ovarian Failure– Resistant Ovary Syndrome

Annovulation – PCOS

• Insulinemia induced PCOS– Obesity– Adrenal Insufficiency– Thyroid Disorders

Defining Normal Physiology

The Female HPG AXIS

Cycle of Fertility

Cycle of Fertility

Cycle of Fertility

Hormones of the Female HPG Axis Gonadotropin-Releasing Hormone (GnRH):

Produced in hypothalamus Secretion pulses stimulate the pituitary

Short pulses = LH Long pulses = FSH

Follicle-Stimulating Hormone (FSH): Produced in pituitary Causes follicle to mature in ovary After follicle is mature it produces its own FSH

Lutenizing Hormone (LH): Produced in pituitary Triggers ovulation

A peak in LH levels coincides with ovulation

Testosterone Hormone (TH): Stimulates folicle Sexual arousal

Hormones of the Female HPG Axis

Estrogen: Primarily produced in ovaries Secondarily produced in adrenal glands, liver, breasts, and FAT Present throughout the cycle in varying levels Follicle estrogen stimulates the hypothalus to stimulate the pituitary to increase LH

Progesterone: Produced in the copus luteum in the ovaries, adrenal glands and placenta Progesterone is often stored in fat cells Luteal progesterone signals for the uterus to prepare for a possible implantation and supresses LH production by pituitary

through negative feedback Increases thermic changes in body temperature

Human Chorionic Gonadotropin (HCG): HCG is produced if the fertilized egg successfully implants in the uterine wall. It prevents the corpus luteum from degenerating so that progesterone and estrogen levels will remain high HCG is the hormone detected by home pregnancy tests

Gonadotropins, Hormones, and the Ovarian and Uterine Cycles

Gonadotropins, Hormones, and the Ovarian and Uterine Cycles

The Uterine Cycle

Figure 27.22c, d

Thermogenic Changes

Mucus Method

Reactive Physiology

Can I get pregnant?

Ovulation versus Menstration:

1. Is the patient having a normal menstrual cycle?

2. Is the patient ovulating?

When things aren’t working.

Female Only

Issues

Start with Amenorrhea

Reactive Physiology

Functional Hypothalamic Amenorrhea Functional Pituitary Amenorrhea

Amenorrhea of the athleteAmenorrhea of eating disordersHyperprolactemia

Ovarian AmenorrheaAutoimmune Origin of Premature Ovarian FailureIatrogenic Origin of Premature Ovarian FailureResistant Ovary Syndrome

Amenorrhea

2 Forms

Primary amenorrhea is the complete absence of menstruation by age 16 in a female with secondary sex characteristics.

Secondary amenorrhea is the cessation of a woman’s menstrual cycle for more than three (3) months.

Once amenorrhea is detected, the etiology must be determined.

Primary Hypothalamic Amenorrhea

Hypogonadotropic hypogonadism

Primary Hypothalamic amenorrhea Low gonadotropin-releasing hormone (GnRH) levels

Cranial radiation Central nervous system tumor

Sellar cyst, craniopharyngioma, meningioma, or other adenoma) Hypothalamic / pituitary destruction

Due to radiation, infarction, or infiltration due to lymphoma or hemochromatosis

Sheehan syndrome Postpartum hypopituitarism (Severe low blood pressure)

Secondary Hypothalamic Amenorrhea

Hypogonadotropic hypogonadism

Secondary Hypothalamic amenorrhea Low gonadotropin-releasing hormone (GnRH) levels

Chronic illness Diabetes Thyroid disease (T3Free / TSH,T3, T4, rT3) Inflammatory bowel disease (IBS) Chronic renal insufficiency (LOW eGFR) Depression / severe psychosocial stressors (Per Patient Report) Chronic liver disease (AST / ALT) Immunodeficiency (WBC) Anorexia nervosa or bulimia nervosa (Per Patient Report)

Chronic excessive exercise Chronic excessive weight loss Chronic malnutrition (SAD DIET)

Secondary Hypothalamic Amenorrhea

The plan for restoration of fertility due to secondary hypothalamic amenorrhea is:

1. Identify likely cause(s)2. Reverse the primary cause3. Revaluate success

Amenorrhea of Hyperprolactemia

Amenorrhea of Hyperprolactemia

Restoring physiology Reverse the cause Vitex / Chasteberry

Autoimmune Origin of Premature Ovarian Failure

Typical causes of POI Genetic disorders (think methylation problems) Tuberculosis of the genital tract Smoking Radiation and/or chemotherapy Ovarian failure following hysterectomy Prolonged GnRH (Gonadatrophin Releasing Hormone) therapy Enzyme defects Resistant ovary Induction of multiple ovulation in infertility

And Autoimmune diseases

Autoimmune Origin of Premature Ovarian Failure

Restoration Physiology Reverse endocrine auto-immune

Reducing estrogen / xeno-estrogen Improving Th1/Th2/Th17 ratios Improving nutrition Boosting immune system Immunomodulators Chemical toxicity Parasites Food sensitivities Etc…

Finish with Anovulation

Reactive Physiology

Annovulation PCOS

Insulinemia induced PCOSObesityAdrenal InsufficiencyThyroid Disorders

PCOS Induced Anovulation

Poly Cystic Ovarian Syndrome High levels of androgens Missed or irregular

periods Many small cysts (fluid-

filled sacs) in their ovaries

PCOS

Typical PCOS patients: Infertility (PCOS is the most common cause of female infertility) Infrequent, absent, and/or irregular menstrual periods Hirsutism (increased hair growth on the face, chest, stomach, back, thumbs, or toes) Cysts on the ovaries Acne, oily skin, or dandruff Weight gain or obesity Male-pattern baldness or thinning hair Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black Skin tags Pelvic pain Anxiety or depression Sleep apnea

Adrenal Androgens- Hirsutism

What causes PCOS?

PCOS

Restorative Therapy Low glycemic nutrient dense diet Exercise / purposeful movement

Mediterranean diet + active lifestyle No gimmick healthy weight program that is sustainable and healthy

Clinical Considerations

Restoration Therapy Many people oscillate between phases and exhibit both

fertile and infertility Tailor the treatment to the individual. Goal of treatment is to restore the proper and harmonious

functioning of the endocrine system through diet, exercise, lifestyle modification and nutrients.

You can retest after symptoms start to level. Gonads are not independent organs, look for all

imbalances including thyroid, immune, nervous system, endocrine disruptors, etc…

Lifestyle Approach

Start with nutrition (Food) No gluten No gluten free No dairy No processed sugars

Veggies, fruits, nuts, seeds, berries Whole naturally gf grains Lots of greens Drink ½ body weight in ounces of water

Lifestyle Approach

Cleaning products

ALL CLEANING PRODUCTS ARE TOXIC

Natural cleaning products, vinegar (1 part vinegar to 4 parts water in a spray bottle), add lemon oil for scent and thymol oil for antiseptic properties.

Lotions

ALL LOTIONS ARE PRETTY TOXIC, baby oil, petroleum, mineral oil, etc…

Natural lotions or make your own (1 part aloe, 1 part glycerin, 1 part olive oil, 1 tsp honey), or just straight olive oil or coconut oil

Cosmetics NEARLY ALL MAKE IS TOXIC

Natural make up from the health food store that doesn't contain harmful chemicals. Larenim at Food for Thought is a good start.

Lifestyle Approach

Eating for your hormonesRaise natural progesterone levels

Alfalfa Anise Apples CarrotsCherries Dates Fennel Green BeansGarlic HopsLicorice ParsleyPeas Pomegranates Sweet PotatoesPotato Pumpkin Pumpkin seedsRed beans Rice SageSesame

Lifestyle Approach

Eating for your hormonesRaise natural thyroid levels

Selenium rich foods 2 Brazil nuts a day, button mushrooms, shiitake mushrooms, wild caught fatty fish,

grass fed liver Iodine rich foods

Kelp (Highest by a long shot), wakame, nori, wild caught fatty fish

Lifestyle Approach

Eating for your hormonesRaise magnesium levels

Green drinks Kale, Swiss Chard (highest by far) Pumpkin Seeds Halibut Dense greens - Collard, Turnip, & Mustard

Greens Blackstrap Molasses Green Beans Sea Vegetables

Lifestyle Medicine

Ensure healthy weight Purposeful movement Cardio >110 beats per minute Not too much or too little

Lifestyle Medicine

Prevent Hormone Exhaustion Sleep Relaxation response

Lifestyle Medicine

Prevent Hormone Disruption Endocrine disruption Meds Industrial chemicals Synthetic hormones Herbicides Pesticides Fungicides Personal care products Heavy metals Smoking

Estrogenic – hormone disruptors

XENOESTROGENS Pthalates -Fragrance -Parfum -Plastic #3 Styrene Styrofoam Parabens Bisphenol A -Plastic #7 PVC

Polybrominated biphenyls -(PBDE) DEHP Benzophenone 4-Methylbenzylidene Heptachlor Lidane Fenthion Fertilizers / pesticides Propyl Gallate

Restoration Therapy

Herbal therapy

Vitex / Chaste tree berry (Vitex agnus-castus) – (MY FAVORITE) Chaste tree berry. Regulating hormonal balance, promotes ovulation, improves timing of the menstrual cycle. 

Shatavari root (Asparagus racemosus) - Promotes regular menstrual cycles by aiding in regulation of estrogen levels. 

Tribulus  (Tribulus terrestris) - May normalize ovulation when used prior to ovulation. Increase in serum FSH and estradiol in women. Increase in sex hormone production.

White Peony (Paeonia officinalis) - Helps build the blood and increase circulation to the reproductive organs. Overall this herb has excellent hormone balancing support.

Restoration TherapyHerbal therapy

Black Cohosh (Cimicifuga racemosa) - Aids in tone, regular function and shedding of the uterine lining

Dong Quai root (Angelica sinensis) - Increases circulation to the uterus, tones and strengthens the uterus

Maca root (Lepidium meyenii): Promotes hormonal balance

Motherwort (Leonurus cardiaca) - Very effective at reducing uterine muscle spasm, cramping and improving uterine tone. Mildly stimulate the uterus

Mugwort (Artemisia vulgaris) - Used traditionally world wide to encourage menstruation in women with amenorrhea.

Parsley (Petroselinum crispum) - Has been used as an emmenagogue to bring on menstruation. Rich source of vitamin C.

Restoration Therapy

Emmenagogues

Special herbs which stimulate blood flow in the pelvic area and uterus some stimulate menstruation Used for oligomenorrhea Examples

Mugwort, chamomile, ginger, parsley

Shouldn’t use when pregnant

Closing thoughts

Where do we go from here? You are not broken Know how the physiology works. Know what interferes with that physiology. Identify & eliminate those interferences. Eat for the hormones. Let the body get back to work.

Closing thoughts

When in doubt feed the body and remove emotional and chemical interferences and the body will start working.

Success with lifestyle change

Relax, it is just a lifestyle

Change your diet Change your stress Track your symptoms Adjust as needed

QUESTIONS?

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