Dear Doc,

I use a collagen supplement that has 5,000 mcg of Biotin in it. Is that too much for daily use?

 

No, definitely not. I take the same thing. One thing I will tell you about that much biotin is that it is a good, healthy dose of it. It’s great for hair growth, skin, and nails and it is an all-around great B vitamin.

However, if you are taking anywhere over 1,000 mcg of it, then you should stop it one week before getting any lab work done. It can affect the results of most blood panels.

So, if you are on that much Biotin and you are coming in to my office to have a Cleveland Heart Panel, or really any other doctor’s office to get routine blood work, please stop for a week before you come in. Biotin can affect your cholesterol levels etc.

 

Dear Doc,

Obviously, a lot of people are dealing with anxiety right now with these uncertain times. Are you seeing a lot of that in the office? How do you coach people with anxiety?

Yes, I am seeing a ton of that in the office and through telemedicine. I talked to two people today just for anxiety.

I like the use of the word “coach.” As doctors we really are coaches, we are health coaches.

You know, you can’t be a family doctor for 35 years and not treat a lot of anxiety on an everyday basis. Anxiety and depression are something that we deal with daily. It has always been important to me to differentiate when to use a medication and when to try a supplement.

I try to get people to realize that these ARE tough times from a lot of perspectives, but in the end, we are going to get through it. You have to rely on your faith.

I usually try to talk to the patient about their lifestyle. Jobs and relationships are the most common stressors, but there are more important things than that. It is odd that you spend your whole life making money… and then you die. You need to enjoy the journey and be focused on relationships and happiness, not material things. I think a lot of that is cultivating relationships with your friends, neighbors, and family. You must get out and exercise. It is the greatest anxiety reducer in the world- plain, old fashioned getting outside and exercising. Take your vitamins, get some sunshine (Vitamin D!)

I use medications as well. I am a medical doctor, after all! Sometimes you need medications if it gets to the point that the anxiety is so overwhelming that you get depressed. They go hand in hand. I usually try to start out with the herbal medications that influence your adrenal balance (rhodiola, ashwagandha, l-theanine, Relora). A lot of these will calm down that constant “mind chatter.”

Can you go to sleep, but you wake up in a few hours? I had three people today tell me that. I have all three of them on a combination of herbs to help them sleep. Occasionally, I have to use something heavier like a prescription medicine. Hopefully, that is a short-term fix that will lead to a routine of:  preparing yourself for bed in a dark, cool environment; going to sleep and waking up at the same time; taking an Epsom salt bath, stretching and meditating. Melatonin and CBD can help you get to sleep.

I try to get to the root of the problem. Examine, “What am I worried about?”

Fear and anxiety are so rampant with all the things that are going on in our country. But don’t forget to get down to the basics: take care of your health and family and help other people. Sometimes I find that if you take the focus off yourself and try to help someone else out, it can help you even more than it helps them!

Half of what I do as a family doctor is talk to people about anxiety and depression. The mental precedes the physical. You can’t take care of someone’s physical needs without knowing their mental status. I talk about gut health a lot. It is the root of most problems. Stress can greatly impact it.

 

Dear Doc,

What supplements do you recommend for hair loss?

 

One, which we just talked about, is biotin. Vitamin E (alpha-tocopherols), topical minoxidil (Rogaine), oral finasteride.

I did a couple PRP treatments to the scalp today to help regenerate hair. PRP is platelet rich plasma and it is taken from your own blood and it is injected into thinning areas of the hair. We do quite a lot of that here in the office.

Another thing is to check your thyroid and hormone levels. In general, hair loves estrogen, and it is not too fond of a particular kind of testosterone (DHT). I look at your hormone and nutritional status to see if there are vitamin or mineral deficiencies.

My advice is to get a metabolic and hormonal lab work panel, take supplements, and decrease stress. Hair loss is multifactorial.

 

Dear Doc,

What do you advise male patients to do if they are on hormones and their testosterone is converting to estrogen? How do you know if this is happening?

 

You MUST check blood levels. I cannot tell you how many people have gone to other places and they don’t check their estrogen levels. You have to check that if you are on testosterone replacement, because there is a balance.

Men need some estrogen, but not too much. If you start testosterone and your nipples get sore or have trouble urinating, tell your provider. Estrogen is really not good for prostates. Testosterone is not the problem for prostates. It is really cortisol, estrogens, and which pathway estrogens are metabolizing on. Sometimes, I will even do a Dutch Test, which is a urinary metabolite test to see which way the estrogen is metabolizing.

Men, as well as women should have their estrogen levels checked. If they are high, take zinc. All men should be taking 50 mg of zinc. It helps that aromatization of testosterone into estradiol. Sometimes, I will use the Broccoli Cruciferous Extract by Life Extension.

 

 

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