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On November 28, 2013, in Hormones, MEDICAL FACTS, by Dr. Tuchinsky
Role of DHEA in female hormone pathway
Role of DHEA in female hormone pathway

About a year ago, I have finally decided to test my DHEA-S (DHEA-sulfate) level.  DHEA supplements are claimed to be the fountain of youth by those who manufacture them but are dismissed as unsupported claim by traditional practitioners and not well supported by scientific studies. I was skeptical but when you are faced with a never-ending struggle against chronic fatigue, you become willing to try anything once, even against sound advice.


My DHEA-S level came back ridiculously low, in the range of an 80 year old and I’m in my 30s. Why was it so low? The only explanation I can come up with is that the adrenal fatigue may be real after all and after years of stressful hospital work, poor diet, minimal sleep and two difficult pregnancies, my adrenals have indeed given up on me.  I was concerned and consulted with a highly respected endocrinologist. He assured me that I had nothing to worry about and DHEA level didn’t really matter. He was an old school endocrinologist and did not think that a woman of my age would really need the testosterone in the first place.

Nevertheless, I went to the store and got myself a high quality DHEA supplement. I figured there was no harm in trying. As recommended by most experts, I’ve started myself on a very low dose of 25 mg (a doses of 50-100 mg per day are the most common).  In the next two days I have discovered that just because something is labeled a “supplement”, it doesn’t mean it won’t have a dramatic effect on your body. It’s ironic that with all the strict reinforcements applied to anabolic steroids, the FDA allows DHEA pills to be sold without prescription and without any regulations or warnings. Here’s what happened next:

My DHEA starved body readily gulped up the new supply and within 48 hours I was learning for myself the meaning of expression “testosterone rage”. I felt wired, irritable and aggressive.  There is no doubt in my mind that my free testosterone has made a rapid jump that my body and brain weren’t prepared to handle.

So I backed off, did more online research and this time ordered a micronized sublingual DHEA at 5 mg starting with 2.5 mg every morning and then worked my way up to 5 mg per day in divided doses.

Folks, let me tell you something: Don’t believe anyone who tells you DHEA doesn’t work because it does. It’s some really powerful stuff. Quite frankly, it probably should be a controlled substance. I read somewhere that the only reason it’s allowed to be sold as a supplement is because of the aggressive lobbying campaign undertaken by the health supplement in the early 90s.

When used carefully and in the right amounts and circumstances, DHEA can be life changing for those who suffer from adrenal fatigue and hormonal imbalance. Within a week or two, my brain fog cleared and my motivation level went back up (remember, testosterone is the hormone of motivation). I felt a lot more like my normal self back in my twenties despite the fact that on repeat testing three weeks later my DHEA-S level was still only in the low normal range. (Let me forewarn you – if you have been tired for a long time and suddenly feel normal again, don’t do the same mistake that I did, e.g. don’t try to catch up for the dormant months or years by jumping into way too many projects and activities all at once, it will backfire!)

For me, the most remarkable and indisputable effect of DHEA was the ability to exercise. In the past, my exercise tolerance was poor, I hated exercise and every time I went to gym, I would feel broken for a week afterwards. Not anymore. Now I can finally relate to all these claims that exercise makes you feel good. I also feel that my hormones and my moods are more balanced and my premenstrual syndrome has become a lot less severe (DHEA also gets converted to estrogen and progesterone as you can see on the chart above).

So what about all these studies out there who claim there is no benefit to DHEA? I think the problem with studies is that they look at the average rather than individual data. They are not specific to females who suffer from fatigue and have very low levels of DHEA. I suspect that if you are a male or if your DHEA levels are not significantly below normal, then you probably will not benefit from DHEA supplementation as much I did. In fact, pushing your DHEA level too high may be  harmful to your body or can make you manic, leave alone the unwanted side effects of too much testosterone, such as facial hair and acne.

> Bottom Line:

1)   If you are a female and suffer from fatigue, mood swings, low exercise tolerance, low libido and low motivation you should have your DHEA-S level checked

2)   If your level is significantly low, you should consider DHEA supplementation. Do not take DHEA without testing your levels first. It’s probably best to find a medical practitioner to help guide you in the process.

3)   Start low and go slow to avoid the unpleasant side effects. Consider micronized sublingual DHEA for better absorption.

4)   Continue repeat testing to make sure you achieve the optimal range (somewhere in the middle of the normal range for your age and gender).

Related Reading: “Birth Control Pills and Fatigue”
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On July 29, 2012, in MEDICAL FACTS, by Dr. Tuchinsky

Leaky gut syndrome is a proposed condition of an altered or damaged bowel lining. The proponents of this theory postulate that certain drugs, alcohol and poor diet cause widening of intestinal cell junctions, which allows the gut microbes and tiny food particles to seep through the intestinal walls and enter the bloodstream. These tiny invaders trigger an autoimmune response, which in turn leads to a various medical problems, including chronic fatigue.

While there is some scientific merit to Leaky Gut Syndrome, it is a disease that has been abused by those who are eager to make money. Many naturopathic and alternative practitioners turned leaky gut syndrome into the root cause of every symptom and disease in the world, starting from bloating and headaches and ending with asthma, diabetes, multiple sclerosis and chronic fatigue syndrome. They make the diagnosis without relying on any proven tests or objective data and charge a fortune for various alternative treatments that are supposed to cure it.

The truth is that while leaky gut syndrome is certainly a plausible medical condition, it is a very rare one and most likely is only found in people who have underlying intestinal disease, such as inflammatory bowel disease (Chron’s disease or Ulcerative Colitis) and or in people who were treated with radiation to their stomach.

There are no proven treatments for LGS. On a purely theoretical basis, supplementation with amino acid glutamine may be helpful but there are no studies to prove that. The general recommendations include “anti-inflammatory” diet that contains a lot of healthy fatty acids and avoidance of the offending drugs and foods.




On July 22, 2012, in Health conditions, MEDICAL FACTS, by Dr. Tuchinsky

You can’t write a blog about fatigue without mentioning fibromyalgia at some point.

Your fatigue may be due to fibromyalgia if:

–       widespread musculoskeletal pain on both sides of the body

–       poor sleep and waking up not refreshed

–       much more common in women than in men

–       impaired memory and “brain fog”

Other associated symptoms:  tension headaches, irritable bowel, anxiety, depression, temporomandibular joint disorder (TMJ), mood swings, memory loss and prolonged muscle spasms

Fibromyalgia affects 2% of general population and 90% of those who are affected are women. Fibromyalgia occurs due to poorly understood neurochemical changes that heighten perception of pain. People with fibromyalgia have multiple tender points on their body, which are very sensitive to touch. Nobody knows for sure what causes fibromyalgia but it is linked to disruption of slow wave sleep and increased level of Substance P, the chemical responsible for our perception of pain signals.


There is no cure for fibromyalgia but there are many therapies aimed at improvement of symptoms. Fibromyalgia is most often treated with antidepressants. There are new antidepressants on the market now which have been specifically designed for treatment of fibromyalgia: Savella (milnacipran) and Cymbalta (duloxetine). They selectively increase both levels of serotonin and norepinephrine. Another class of drugs is medications that are taregeted to decrease nerve pain: Lyrica (pregablain) and Neurontin (gabapentin). Muscle relaxants such as Flexeril (cyclobenzaprine) and Zanaflex (tizanidine) are prescribed for muscle spasm and  opioids andUltram (tramadol) are often used for pain but I recommend against it because they actually disrupt the deep sleep and make the fatigue even worse.  NSAIDS (Aleve, Motrin, etc) and Tylenol can be just as effective for muscular pain in fibromyalgia.

Low-intensity exercise, acupuncture, massage, and improved sleep quality and adjunctive therapies.


While it certainly came to be more accepted in the medical community in the last twenty years, it is still not a fully accepted diagnosis. Firbromyalgia is such a vague and poorly defined condition, and so little is understood about its that many authorities on the subject claim that it doesn’t really exist. Even Frederick Wolfe, the physician who first defined the criteria for fibromyalgia in 1990, came to conclusion after two decades of research that fibromyalgia was simply a psychosomatic response, which means it was physical manifestation of stress.

Because there is no simple and easy cure for fibromyalgia, I would only chose that diagnosis if you have ruled out everything else out there. For example, when I struggled to find an explanation to my own fatigue, I felt that my symptoms fit the description perfectly but as I continued to search for other explanations I realized that there was a much more simple and easier to address explanation.





On July 19, 2012, in MEDICAL FACTS, Vitamins, by Dr. Tuchinsky

Nutritional analysis also known as intracellular nutrient testing is an elaborate test cell ,which is performed by SpectraCell Labs. It has become a popular test in the Anti-aging medicine but it has not yet gained a wide-spread popularity.

We depend on hundreds nutrients present in miniscule amounts but absolutely essential for our body to function properly.These nutrients can be divided in the following categories:

  • Vitamins: vitamins A, B1, B2, B3, B6, B12, C, D, K; biotin, folate, panthothenate
  • Minerals: calcium, magnesium, zinc, copper
  • Antioxidants: alpha lipoic acid, coenzyme Q10, cysteine, glutathione, selenium, vitamin E
  • Amino acids: asparagine, glutamine, serine
  • Carbohydrate metabolism: chromium, fructose sensitivity, glucose-insulin metabolism
  • Fatty acids: oleic acid
  • Metabolites: choline, inositol, carnitine

The innovative idea behind SpectraCell analysis was that it is more accurate test the amount of these compounds inside the cells (they use white blood cells for this purpose) rather than in serum, which is the conventional traditional medicine approach. The validity of this statement has never been proven. There is a paucity of the studies done on this subject, and most physicians dismiss SpectraCell test as another one of those quack money makers. However, I can tell you from personal experience that it worked for me.

After I gave birth to my child, I suffered from excruciating fatigue and nobody could tell me what was wrong with me. All my routine blood tests came back normal. Then I found out about Spectra Cell and it showed major deficiencies in my cellular levels of magnesium, zinc. In addition my vitamin D3, oleic acid and Vitamin B3 were slightly below normal.

I focused on magnesium and zinc supplementation. (Read about Magnesium Deficiency). Once I found the supplements with good bioavailability, I began to see obvious improvements after several weeks of supplementation. My fatigue, muscle aching, poor sleep and brain fog have disappeared with magnesium supplementation. I used to get sick with cold almost every week but that too has stopped once my immune system was replete with zinc.

Since there are no significant medical studies yet to prove that micronutrient cellular testing works, all I can offer you is my personal experience – it worked for me. The health authorities are dismissive of test because they insist that Americans eat good enough to not be deficient in anything. I think nothing can be further from the truth. Most of us don’t eat enough foods with high nutritional content. If your body is not highly efficient in absorbing the vitamins, you may need more than the minimal amount to feel way. I used to get by with whatever magnesium I had but the pregnancy and breastfeeding have depleted my already low stores and pushed me into the state of deficiency.

Spectra Cell report is very elaborate with charts and graphs and detailed descriptions of the symptoms of every element that you tested deficient in. They also are nice enough to list the foods that contain the needed vitamins if you are not big on taking supplements.






On July 7, 2012, in A FEW OF MY THOUGHTS, Natural remedies, by Dr. Tuchinsky

The new kid on the block.  I recently came across citicoline when I was providing medical consults to patients in the world famous Texas Institute of Rehabilitation and Research. At first I was confused – I have never heard of this drug before. I tried to look it up in my electronic pharmacopeia and it wasn’t there. And yet it was prescribed to a staggering number of victims of stroke and head trauma on every floor.  Whatever it was, the world’s leading institution in brain rehabilitation seemed to believe in it. It was time for me to find out more about this miraculous citicoline.

What does it do?   Citicoline is classified as psychostimulant but unlike other stimulants, its effects are rather subtle. The mechanism of action is complex and has to do with protection of neuronal phospholipids and reduction of oxidative stress. The substrate provides choline – the vital building block for brain’s crucial neurotransmitter acetylcholine. Use of citicoline appears to slow down progression of Alzheimer’s disease. Citicoline also increases  dopamine via a different mechanism, and therefore can also alleviate Parkinson’s disease and cravings in cocaine addiction. In addition, it has been shown to improve vision in glaucoma and other eye conditions. There are also some studies that suggest citicoline improves mental focus and can be useful in the treatment of ADHD.

Manufacturing and Dosing.  Citicoline is sold as a nutritional supplement in US (sold under brand name Cognizin, NeuroAxon or Somazine) but it is a prescription drug in many European countries. The recommended dosage is 500-2000 mg daily.

What’s in it for you?   The question relevant to us is whether citicoline can help with the brain fog that an otherwise healthy person may experience due to fatigue. Will it make anybody sharper and more focused or does it only work in people who had brain damage? (Remember, most studies were done on stroke victims and Alzheimers patients and not on general population.)

My conclusion.  The product reviews on Amazon seemed to be a little underwhelming. The good news is there doesn’t seem to be any serious known side effects  and the price is reasonable, so I’m still going to go ahead and give it a try. I will post an update about my experience later.    READ MORE



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On May 18, 2012, in Natural remedies, Vitamins, by Dr. Tuchinsky

  • 1. The lack of awareness.   Low magnesium or magnesium deficiency is an extremely prevalent condition. In fact, it is estimated that more than half of the US population does not meet required intake levels of magnesium. The problem is due to the widespread depletion of magnesium in our soil, inadequate diet and high consumption of caffeine.

It can present with anxiety, insomnia, muscle cramps, muscle weakness, and fatigue. It can also lead to diabetes and irregular heart rate.

 2. The problem with diagnosis.  There are a number of pitfalls when it comes to the diagnosis of magnesium deficiency. Let’s say, you read the symptoms above and they seem to fit. So you go to your doctor and ask them to check magnesium levels. The results come back, the doctor calls you and tells you to relax – your magnesium level was within normal limits.

Should you forget about it? Absolutely not. It’s very likely that your doctor is not familiar with the difference between hypomagnesemia (low serum levels of magnesium) vs magnesium deficiency. The latter may occur despite normal blood levels if your cells have a difficult time absorbing and using this vital element.

A better test would be a micronutrient analysis performed on your leukocyte white blood cells. If you doctor doesn’t know about it, you can get it from “order it yourself” labs but keep in mind that some of the more progressive insurance do now cover this costly test, at least partially.

3. The problem with treatment.  Now, let’s say the micronutrient analysis confirms that your cells are low on magnesium. Ok, that explains the fatigue, muscle cramps, your nervousness and insomnia. Great news. You start taking over the counter magnesium supplements and look forward to quick improvement. Several weeks or months go by and you’re not any better. What should you make out of that? Maybe it wasn’t the real reason after all?

Don’t be too quick to jump to conclusions. Take a look at the supplement bottle that you bought. If you haven’t done a lot of research about it, you might have ended up with magnesium oxide, the most commonly used form of magnesium supplement and the most useless one. The bioavailability of magnesium oxide is very low, which means that your body will get very little out of these pills. Toss these bottle in the trash and get yourself the right kind of supplement: magnesium aspartate, chloride, lactate, citrate or glycinate. I personally found magnesium lactate to be the one with most noticeable results and also easier to on the stomach than other forms but I have to admit that I haven’t tried all of them. However, an even better way to quickly replete deficient magnesium stores in your body is to use a transdermal magnesium chloride oil, such as Ancient Mineral spray. Magnesium has a surprisingly good absorption through the skin and it has been known for a very long time, dating back to old fashioned bath treatment with Epsom salts, which is magnesium sulfate. Be sure to get a high quality spray with a high concentration derived from sea salt minerals, such as Ancient Minerals magnesium oil spray.  The only drawback is that it tends to burn when applied, especially if your skin is dry but you can rinse it off after about twenty minutes. You should aim to get 350-400 mg of magnesium per day.




On June 6, 2011, in Health conditions, MEDICAL FACTS, by Dr. Tuchinsky

What is celiac disease?

Celiac disease, also known as gluten-sensitive enteropathy or celiac sprue is a multisystem disorder that affects 1% of American population. Gluten is a protein in wheat, rye and barley. In susceptible individuals, their immune systems mistakes gluten antigen for a pathogen and initiates an inflammatory response, which damages intestinal wall mucosa. This in turn leads to the poor intestinal absorption of food and vitamin and nutrient deficiencies.

 Signs and symptoms of celiac disease.

Celiac disease can present itself within many other organs, causing a specific rash called (dermatitis herpetiformis) on elbows and buttocks, or affecting nerve endings, blood cells or reproductive organs. The prevalence of celiac disease in the US has been on the rise in the last few decades but it may also have to do with physicians becoming more aware of the disease and learning to identify it earlier.

However, most of the time celiac disease still goes unrecognized for many years and some people go through their lives without ever receiving the correct diagnosis (it can often be mistaken for Irritable Bowel Syndrome). It is more often found in people who have other autoimmune disorders, such as Type I diabetes or thyroid disease.

Most common presenting symptoms are gastrointestinal problems (diarrhea, heartburn, weight loss, and a lot of gas). However, it can also present with fatigue, miscarriages, rashes, joint pain, depression, headaches and a myriad of other problems. This “great mimicker” feature is what makes it so tricky to recognize celiac disease. The initial screening test is serum anti-tTG IgA antibody. If it is positive, then the diagnosis should be confirmed by small bowel biopsy done through endoscopy.

Treatment and prevention.

The only existing treatment is religious adherence to gluten free diet, which is very cumbersome and difficult to achieve, because most of the foods in our diet are rich in gluten. Not only dietary but also even some other non-edible items, such as lipstick of some medications may contain gluten. It requires significant amount of knowledge, planning and discipline. Patients are recommended to take supplements of fat-soluble vitamins (D, E, A and K), B12, B6 folic acid and iron. Long-term complications include intestinal cancer and liver disease. The longer a person goes undiagnosed and untreated, the greater the risk for long-term complications.

CLICK HERE for tips for staying gluten-free while dining out, from the Gluten Intolerance Group:


Image: Suat Eman /



On May 10, 2011, in Health conditions, MEDICAL FACTS, by Dr. Tuchinsky
What does it really mean?

For a long time when I heard the word “narcolepsy” I imagined an unfortunate person who would fall unconscious in the middle of the sentence and wake up the next day –  an image based on River Phoenix character from the early 90s movie “My Private Idaho”. There was surprisingly little education on the subject of sleep disorder in medical school but fortunately I have opted to do a three- week elective at a sleep center during my residency where I have learned the truth about this condition.

How is it diagnosed?

Narcolepsy  is suspected when a person is suffering from excessive sleepiness despite adequate amount of sleep and the diagnosis is made by performing a sleep study (polysomnogram) that is done during the night and then MSLT (multiple sleep latency test) which measures tendency to fall asleep during the day. The whole thing amounts to a rather involved and cumbersome test, the patients get a couple dozen electrodes glued to their heads and get to hang out in a hotel-like sleep suite for almost 24 hours.

Narcoleptics are all around us.

You too have probably seen quite a few people affected by narcolepsy – it may be the girl in your college class who used to sleep through most of the lectures, the guy at your work who tends to nod off during most of the conferences, the uncle who falls asleep on the couch watching a football game, a friend who is always complaining of being tired and not being able to get a refreshing sleep… It never occured neither to any of these people nor to anyone around them that their brains simply doesn’t function normally when it comes to sleep. Narcolepsy is one of the most under-diagnosed medical conditions, partially because the sleep deprivation – an alternative explanation to symptoms is so common that people accept their symptoms as part of life and may never find out that they are affected.

What causes narcolepsy?

The modern science of genetics attributes narcolepsy to a mutant gene that codes for a specific neutrotransmitter region. The disruption of proper function leads to abnormal regulation of sleep cycle sequences and often intrusion of REM sleep into wakefulness. People with narcolepsy also are prone to sleep paralysis, they are uncomfortably aware of not being able to move or see when they are asleep. They can also experience hallucinations when they either fall asleep or waking up. While helpful at hinting toward epilepsy, neither one of these symptoms is required to be present in order for diagnosis of epilepsy to be established, and they also can occur on occasion in perfectly healthy individuals.

How do you treat it?

For many years, the traditional medication for treatment of narcolepsy were amphetamine derived drugs, such as Ritalin. Lately, however there has been a surge of new drugs on the market, that are more specifically directed at the sleep wake cycle regulation (Nuvigil) and are less prone to abuse. Also there is a medication called GHB (the substance with a tainted past of a popular date rape drug in the 80s). It is sold under the brand name Xyrem. This medication induced deep stages of sleep, which are deficient in narcoleptics, and has been extremely effective in controlling the symptoms. The downside is that it is very tightly regulated and quite expensive.


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On March 27, 2011, in A FEW OF MY THOUGHTS, Other, by Dr. Tuchinsky

What is dopamine so important?  Dopamine is the molecule that acts in the brain to promote the feeling of pleasure and makes us look forward to enjoying things and activities. Without dopamine on board, we can not experience positive feelings.

Dopamine is the neurotransmitter that is pivotal to motivation, creativity and sexual desire. Drugs like cocaine and amphetamines act in the opposite way. They cause a burst of dopamine to be released which leads to euphoria – an exaggerated feeling of happiness which is very addictive to humans because it makes all other experience dwarfed in comparison.

Too little dopamine.  People with Parkinson’s disease also suffer from a lack of dopamine but it is limited to a very specialized part of the brain where it is responsible not for the mood but for the movement. Low levels of dopamine levels has also been linked to ADHD and social anxiety disorder.

Too much dopamine.   On the other end of the spectrum, there can be too much of a good stuff too. Schizophrenia and paranoid behavior are believed to be caused by excess of dopamine in certain parts of the brain.

Dopamine medications.  Anti-Parkinsonian medications such as Sinemet, Requip, Mirapex and others raise levels of dopamine in the brain. You would think that giving these drugs to people who already have normal levels will also cause euphoria but it is not the case. The change in dopamine level caused by this medications is much more gradual and the brain has time to adjust. Nevertheless, these medication have a potential to create a whole slew on unpredictable side effects related to dopamine. The Mirapex is implicated in turning previously very responsible and monogamous people into sex addicts and obsessive-compulsive gamblers. The main character in the movie “Awakening” played by Robert DeNiro who wakes up from severe Parkinsonian coma in the end goes crazy from paranoia and grandiosity caused by incorrect dosing of levodopa, which was still an experimental drug at that time.

Dopamine myths.  An Ayurvedic herb called Mucuna pruriens that contains a small amount of levodopa. The amount is likely too small to cross the blood brain barrier in a quantity large enough to impact any changes but there are some people who claim that their mood and concentration get better when they take it. Some, on other hand only report jittery feeling akin drinking five cups of coffee and others feel nothing at all.

The wide spread belief that eating brown spots on bananas raises dopamine levels is incorrect. While eating overly ripe bananas is probably not going to harm you, it won’t make you happy either.


For more information about the role neurotransmitters play in our mood go to my blogs:

“The History of Depression”  and  The Future of Depresssion”



Image: Salvatore Vuono /

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