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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 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 December 28, 2010, in A FEW OF MY THOUGHTS, Lifestyle, by Dr. Tuchinsky

The vicious cycle of insulin.

Many people go through the glucose-insulin yo-yo throughout most of their days, which leaves them feeling very fatigued. The problem lies in the unbalanced nutrition. The old 40/30/30 rule still holds true- the best way to eat is to consume roughly equal portions of carbs, protein and fat throughout the day.

Most of us are not well versed enough in nutrition and do not have sufficient enough control over our meals to achieve that. We tend to consume too many carbohydrates and simple sugars. Some lucky people have very adoptable pancreas and liver that can handle it well, but for the rest of us this results in postprandial over-secretion of insulin.

The mechanism of hypoglycemia after meals.

The carbohydrates and sugars are quickly digested but the insulin remains floating in our blood for another 4 or 5 hours, causing mild hypoglycemia and fatigue. You may not even detect the low blood sugar with conventional glucometer, but this is because your body is working hard to keep it normal – a process that involves mobilization of glycogen and conversion of fatty acids which use up your energy stores. In addition, the insulin excess also triggers a whole wide range of unnecessary biochemical reactions in your body that may contribute to your fatigue. In other words, the delicate chemistry of your body is off balance.

How to avoid insulin ups and downs.

These blood sugar highs and lows can be avoided, when one consumes five or six small balanced meals throughout the day. This will insure more even levels of blood glucose and prevent “bottoming out” in between meals. Think of a typical breakfast choices we make- a bowl of frosted cornflakes. A croissant with coffee. These are 100% carbohydrate melas that are guaranteed to send you sugars and insulin on a wild spin and leave you feeling starved by mid-morning. On other hand a bowl of oatmeal with a generous serving of nuts and a yogurt, or a toast with ricotta cheese would last you much longer in terms of energy reserve and hunger suppression.


<p><a href=”″>Image: Suat Eman /</a></p>

Allergies are very common.  Most people experience allergies at one point or another. Allergies are exceedingly common in industrialized countries and particularly in urban areas, with up to 30% of adult population affected. Due to this overwhelming presence of allergies in our lives, we often tend to regard them as trivial matter. However, a fatigued person should not underestimate the impact this condition can have on their overall wellbeing.

How is allergy related to fatigue? Allergic rhinitis (in other words: nasal allergy) that persists over time, results in chronic inflammation of the mucosal lining of your nose. This, in turn, results in constant stimulation of your immune system, which can make you feel very tired. Another link between allergies and fatigue is their effect on sleep. Studies show that people who suffer from allergies do not get restful sleep. As we have discussed before, sleep disturbance is probably the largest culprit among all of the fatigue causes. Therefore, tackling your allergy symptoms can result in significant improvement of your fatigue as well.

Diagnosis. Nasal allergies are usually easy to diagnose but to figuring out the exact culprit is more difficult. There are blood tests available that test for antibodies to common seasonal allergens to determine which one may be responsible but they are not comprehensive.

Allergy Treatment.
Ceramic Neti Pot - Nettie the Elephant

1. Irrigation.   The first step to combating allergies is daily nasal irrigation. You will need either a squeeze bottle or a neti pot to do that. You can prepare your own solution with non-iodized salt and baking soda or buy a sinus wash solution packages in the drug store (my ENT recommends NealMed brand). Then it is just the matter of figuring out the right technique and getting used to the process. The sinus wash will remove the inflammatory substances, allergens, viruses and other pollutants from your nose. It will also make it easier for your nasal medication to reach its target.

2. Nasal Steroids.  Most doctors consider prescription nasal sprays to be the best first line therapy. There are several different types available. Nasal steroids (such as Flonase, Nasonex, Nasacort and many others) work very well, but only when used regularly and for prolonged period of time. Their side effects are considered to be rather minimal. Nasal anti-histamine sprays (Astelin, Patanase, Astepro,etc) begin to work immediately and relieve symptoms fast, but they do not reverse the inflammation like nasal steroids do. Oral anti-histamines (such as Claritin, Allegra and Zyrtec) mainly help with sneezing, watering eyes and runny nose but do not significantly affect nasal congestion or post-nasal drip. On occasion, doctors prescribe a medication called Singulair, which is more often used in children.

3. Decongestants. Pseudoephedrine (Sudafed) is still one of the best medications out there for immediate short-term relief of severe nasal congestion. In most states however, the Sudafed that is stocked on the pharmacy shelves contains a different ingredient (phenylephrine) and you have to ask the pharmacist for the “real thing” which they keep behind the counter. Keep in mind that Sudafed is not a good drug for people who have high blood pressure or enlarged prostate. It is better to stay away from using over the counter nasal sprays – they often result in rebound runny nose, which can be very difficult to treat.

4. Other. In more severe cases, a visit to allergist may be recommended to perform skin testing for various allergen and a treatment called allergy desentization.  READ MORE ARTICLES ABOUT FATIGUE

Image: Yaron Jeroen van Oostrom /




On April 4, 2010, in Lifestyle, by Dr. Tuchinsky

Water is everything.

Let’s talk about another one of very common and overlooked causes of fatigue: mild chronic dehydration.
Water comprises about 60% of human body composition (although this number is slightly lower in women) and is involved in thousands of essential chemical reactions in the cell.
Now, you probably heard the common recommendation about drinking eight glasses of water per day. Well, let me tell you that there is absolutely no scientific proof to this statement. Someone, somewhere came up with this number, which looked like a good number to most people, and therefore it really took off and stuck around.

So how much water do we need?

There is no scientific evidence to support this statement and no studies have ever been done to prove it. The truth is that the amount of water your body requires will vary depending on many factors: such as your diet (e.g how much caffeine you drink, how much salt you consume, foods with high water content in your diet, etc), your intestinal function, your exercise and activity level, the temperature and humidity outside and many others.  Some days you might need only six, while other days you might need twelve – but the good news is that you really don’t need to keep track or make any calculations to figure it out. The nature endowed us with a very sensitive hypothalamus, which is constantly checking our water level and immediately signals about any significant drop.  Feelings of  thirst and dry mouth typically develop at dehydration  levels of 1%, while fatigue and brain fog begin at the levels of 2%- a design that is meant to ensure a  good safety net . Therefore, as a rule of thumb, as long as you consume a drink with every meal and drink something whenever you experience the earliest symptoms of thirst, you will avoid dehydration.  The other clue is the color of urine- a clear or very light yellow urine is generally consistent with being well hydrated, while the darker shades imply dehydration (there are some rare exceptions to that, such as in cases of liver and kidney disease).

There is no physiological advantage or health benefit to drinking more water to become “overhydrated”. There is usually no harm either (as long as the amount is not extreme) with the exception of an additional bathroom trip as your kidneys diligently get rid of the excess. So don’t feel obligated to force that eight glass of water in you, if you really don’t feel like drinking it.

What causes chronic dehydration?

The main reason why people become dehydrated is because they are so busy and caught up in what they are doing  that they tend to ignore or disregard their thirst. These particularly applies to people who work in high paced stressful jobs during the day. If you allow yourself to go dehydrated even for a few hours, you may suffer consequences for some time afterwards as your body restores its balance.

Dehydration has also recently sparked some interest in the cancer prevention studies. Although the research is still preliminary, they have suggested that chronic dehydration can result in higher incidence of cancer. The link appears to be particularly strong in the case of bladder cancer, likely due to the higher presence of toxins in the concentrated urine that remains in the bladder for a longer period of time. READ MORE ARTICLES ABOUT FATIGUE

Image: Suat Eman /


On March 16, 2010, in Lifestyle, MEDICAL FACTS, by Dr. Tuchinsky

We live in the world of sleep deprived people.

The sleep science has been booming with new and exciting data over the past few decades. Once recording brain waves during sleep became possible, we learned that there is slow wave sleep and REM sleep. Each one is very important to our wellbeing.  During REM sleep, we experience dreams and our brain neurons are working hard at data clean up and storage. Lack of this type of sleep will result in impaired memory and concentration as well as decreased thinking capacity.

The slow wave sleep, is the dreamless “shut down” mode,  which allows your body to undergo all the necessary housekeeping and maintenance.  Vital hormones are produced during this time and molecules, and the buildup of toxic byproducts is eliminated on the cellular level. The mechanisms that govern our sleep are so complicated and enigmatic, that modern science still is only glimpsing into it, but even that glimpse is enough to convince us that the value of sleep is absolutely crucial to our well-being.

The role of sleep in medical illness.

Recent breakthrough in treatment of fibromyalgia, a condition associated with chronic pain, depression and severe fatigue, revealed that the disease had its root in lack of slow wave sleep. So even when the fibromyalgia patient sleeps more than eight or nine hours per day, their brain for a number of reasons spends less in the slow wave sleep than necessary. Among many other things, this results in decreased production of the very important neurotransmitter serotonin and decreased production of human growth hormone. The result is depressed mood, low energy and in fibromyalgia patients also causes increased sensitivity to pain. While not everyone is genetically predisposed to develop fibromyalgia, most people will feel the diminished lack of sleep to certain degree.

So how much sleep do you really need?

There are some people who require less sleep than others, usually due to their ability to go through sleep cycles with higher efficiency than others. Most people, however do require a minimum or seven or eight hours to complete the required amount of sleep cycles. If you always wake up to the alarm clock, you are probably interrupting one cycle in the middle; if you have trained yourself to wake up at certain time on your own then your then your  brain will adjust to complete the cycle on time.



On March 9, 2010, in A FEW OF MY THOUGHTS, Natural remedies, by Dr. Tuchinsky

Panax Ginseng:  Truth vs  Myth.

Ginseng often comes up when one talks  about natural remedies for fatigue. There appears to be a lot of  misconception around it. For example, paying money for a ginseng tea, depending on where you buy it, will turn out in the best case just wasting a few dollars on a drink with barely detectable concentrations, and in the worst case getting something that contains secretly hidden ephedra to give you a false energy boost.

In reality, if you want to give ginseng a chance , you must be patient and expect to see the results only with regular use over a long period of time (expect at least a month or two to notice the difference).  It is neither a stimulant nor an instant energy booster, but rather what the natural healers refer to as “tonic” and medical scientists call “adaptogen“. These are names for  substances that increase resistance to stress and build up vitality. The wisdom of traditional Chinese medicine advocated use of ginseng for almost two thousand years. Now its popularity has reached the Western world and even spiked curiosity among some medical researchers.

How Does Ginseng Work?

The studies on Korean red ginseng root and some varieties of American ginseng were shown to contain substances called ginsenosides, which are hypothesized to induce production of cortisol by adrenal glands over period of time (see Adrenal Fatigue).  It has also been shown to improve immune system function.  A recent study performed in Mayo clinic showed that there was significant improvement in fatigue of cancer patient treated with high dose ginseng extract. On other hand, there were some studies that tried to measure performance in athletes who were taking it and found no  significant  difference in oxygen consumption or muscle strength. However, that’s the problem with  Western medical science-it often insists on measuring the unmeasurable. Perhaps, ginseng does not boost the  athletic performance but it does not preclude it from improving the daily energy  level and the sense of well-being in fatigued people, valuables that are trickly to measure, particularly when the change is gradual and over long period of time. Ultimately, however there is still a lack of good quality research on the subject of ginseng.

A Few Other Tips about Ginseng.

Another problem, is that because natural remedies are not regulated by FDA or any other governing agency, and as a result some extracts of ginseng contain much less of the substrate than they claim and sometimes none at all. It is imperative to buy all herbal medicines from  reliable manufacturer.Of course, like any medication, ginseng can cause side effects in some people. The most common ones quoted are usually observed in high doses and include headaches, nausea and insomnia. These risks can probably be minimized if you start at a lower dose and work your way up. Also, keep in mind that Siberian ginseng, which is a cheaper alternative that populates the store shelves, is actually a completely different chemical and contains no ginsenosides.

Here is a link about proper ginseng dosing regimens:




On February 17, 2010, in Hormones, MEDICAL FACTS, by Dr. Tuchinsky

The question many women ask themselves is whether taking oral contraceptives for a number of years can alter their bodies and affect their wellbeing  In many ways, oral contraceptives are one of the best inventions that medical science gave to a modern  woman.  Not only they prevent pregnancy and make sex more enjoyable, but they even provide many health benefits from improving acne to decreasing risk of ovarian cancer. However, nothing is perfect and the list of their side effects unfortunately is just as long.

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On February 12, 2010, in MEDICAL FACTS, by Dr. Tuchinsky

I find the controversy about adrenal fatigue very intriguing. This recently diagnosis makes a lot of physiological sense and is widely popular among alternative medicine practitioners, and yet has not gained acceptance in the world of traditional medicine. I think that this is due to the fact that medical people are scientists who like to have proof in numbers, and so far nobody succeeded in finding scientific proof. However, just because something has not been proven, it does not mean that it is true.

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On February 12, 2010, in MEDICAL FACTS, Vitamins, by Dr. Tuchinsky

A common cause of fatigue.

Vitamin B-12 (also known as cobalamin) deficiency is one of the most overlooked causes of fatigue. The problem lies in the fact that our understanding of proper levels of this vitamin is still emerging. For example, most American laboratories draw cut off point for normal level at 200 ng/ml.

The definition is vague.

In Japan the recent guidelines dictate that any level below 550 ng/ml requires supplementation because people with levels below that do not function at the optimal level (and this would represent almost one third of the U.S. population!). American medicine has made a step forward in the recent years and now recommends further assessment of those with borderline levels of 200-400 with additional, more expensive tests with complicated names: methylmalonic acid and homocysteine. These substances are toxic substrates of metabolic reactions that cobalamin is involved in, and elevated levels signify cobalamin (B-12) deficiency

Aggravating factors.

Due to the fact that a very large supply of B-12 has been generated early in our life and stored in liver for later use, the symptoms of deficiency may not present till much later in life, when the stores become depleted. In women this can often be precipitated by pregnancy and breastfeeding. However, the symptoms are very non-specific and develop very slowly and gradually, and therefore the problem is often never recognized if it remains mild or discovered only once it has advanced to being severe.

How does Vitamin B-12 deficiency present?

However, mild B-12 deficiency is much more prevalent than previously thought. While severe deficiency leads to a myriad of problems, including neurologic deficits and memory loss, the mild one may only present itself with fatigue and “brain fog”. The deficiency is often due not to poor diet but to impaired absorption of this vitamin by the stomach cells, called intrinsic cells. These cells, just like pancreatic cells in diabetes, can be attacked and destroyed by one’s own immune system. This condition is called pernicious anemia, but the name is misleading since one may experience fatigue and other symptoms long before anemia will develop.

Treatment for B-12 deficiency.

The treatment for vitamin B12 deficiency is very simple. Although injections used to be the standard of care for a long time, it has recently been established that most people, especially those with mild form of deficiency, do well by taking oral supplements in high enough dose (>1000 mg). Those can be purchased over the counter in any pharmacy or vitamin store. Try to find the one that says “methylcobalamin” and not cyanocobalamin, it appears to be better absorbed through the stomach. Once treatment is started, most people notice significant improvement within a couple weeks.




Image: Salvatore Vuono /

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