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Dr Mariano posts - nutrition, testosterone, depression

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by , 09-10-2012 at 06:07 PM (864 Views)

Once Testosterone is in a good range, then any problems that are left have other causes.

A lack of testosterone is often not sufficient to explain all symptoms a person with mental issues has. Generally, when a person develops mental problems, one is dealing with a multisystem problem.

Adding testosterone does not often improve a person's ability to function if there are more important problems going on.

Since psychosocial issues can influence gene expression, metabolism and nutrition, and nervous system neuroplastic changes, psychosocial interventions involving areas such as exercise, therapy, education, relationships, etc. need also to be considered.

General areas to examine and address physiologically are:
1. Nutrition - optimizing nutrition so that is has high nutrient density - more vitamins and other nutrients per calorie.
2. Immune system issues - including gut issues: big ticket, high reward area to examine and optimize, though finding tools to accomplish this effectively can be difficult.
3. Nervous system issues - what some call "adrenal fatigue" is generally a nervous system phenomenon, a response to excessive stress signaling. Psychiatric treatment consideration is important. Adjusting nutrition and doing hormone treatments alone generally are not enough to help most seriously ill people.
4. Thyroid hormone optimization.
5. Diabetes and prediabetes - complex conditions in and of themselves
6. After everything else is considered, optimizing Testosterone and Estradiol signaling.
7. Last, consider addressing growth hormone deficiency - which usually does not work well if the foundation for its treatment is not established.

Note that I prefer fasting insulin to be less than 69.45 pmol/L (10 uIU/mL). A value greater than this is a sensitive indicator for insulin resistance (prediabetes to diabetes). Insulin promotes fat storage and pro-inflammatory signaling, and may reduce testosterone production, among many effects.

Gut issues often mean immune system problems.


I no longer use the term "adrenal fatigue" because it is imprecise, misleading, and inappropriately anthropomorphic. Hypothalamic-pituitary-adrenal axis dysregulation is a better term.

Generally when one has a mental illness, I'm looking at a multisystem problem. It takes a lot to cause depression, anxiety, and "nervous breakdowns". The mind is built to survive. Mental function is highly protected. It generally takes many simultaneous problems to cause a mental illness.


1. Generally, when a person who has problems tells me their nutrition is "good", I find a lot of problems with their nutrition. I usually recommend reading the book "Nourishing Traditions" by Sally Fallon as a starting point to high density nutrition. Even currently popular Paleolithic Diets are often incomplete since they do not do a Traditional Paleolithic Diet, where everything is eaten of an animal - down to the bone, skin, hair, internal organs, brains (though I don't recommend eating brain due to the risk of prion infections), etc.

2. The intestines are where most of the immune system cells in the body patrol. Gut issues can still occur even when one does not experience mechanical discomfort since gut issues can manifest as behavioral or systemic problems.

3. I like a resting cortisol morning at least 469-607 nmol/L. If one is at rest (e.g. haven't exercised the previous day, no acute psychosocial stress), and the morning cortisol is high, I would have to look for a source of stress signaling and pro-inflammatory signaling that may drive it to a higher resting level. Cortisol is a reflection of activity in the other systems.

4. Ideally both brain and body levels of thyroid hormone are optimized. Both brain and body levels can have separate levels of thyroid hormone. TSH gives one an indication of brain level. The blood hormone levels indicate what is in the body. When TSH is higher than should be indicated by body levels, then the brain has problems with inadequate thyroid hormone. For example, it may have problems actively transporting thyroid hormone into the brain. Or the astrocytes in the brain may be metabolically impaired and are unable to adequately convert T4 to active T3. Etc. In either case, the brain will have metabolic problems and will compensate. The compensations, however, can lead to problems in mental function including anxiety and depression.

5. Growth hormone is released from the brain. It travels to the liver where it stimulates the production of IGF-1. IGF-1 does most of the actions of growth hormone. IGF-1 is what is measured to give an idea of how much growth hormone one has. One can also do a 24-hour growth hormone urine measurement. Growth hormone is my last consideration in treatment. If given too early, it can cause significant problems. When everything else is addressed, it may improve a person's well being and function significantly. Growth hormone and IGF-1 production are determine may multiple other signals including thyroid hormone, testosterone, DHEA, norepinephrine, dopamine, pro-inflammatory cytokines, etc. Until problems in these areas are addressed, one doesn't know how much growth hormone can one natively produce.


Hemochromatosis: one problem is overzealous reduction of iron until one is suboptimal. With an iron deficiency, multiple problems occur which can lead to anxiety and depression, lack of energy, etc. Often, I have to restore optimal iron levels for that person in order to restore function.

Thyroid hormone: for a variety of issues, the brain and body can have two disparate levels - with either the brain or the body having too little causing a problem in that area.

Diet: unless a person is eating a traditional diet - like what people use to eat in the 1800s and early 1900s - which were up to 10 times more nutritious that what we have now, then a person is often nutritionally deficient in some or more nutrients. The fact that a person supplements is a realization that some nutrients are insufficient in the diet. The problem is identifying the others that are also insufficient. That is difficult to achieve since the foods these days may not have as much nutrition as in the old days, given massive farming and nutrient defects occurring in the soil itself. If the diet itself was good enough, then no supplements would be needed.


Even people with hemochromatosis need appropriate levels of iron to function well.

Old fashion traditional diets would be expected to keep iron levels at the higher end of a reference scale.

Thyroid treatment so long as it is under the care of a physician is frequently done in various forms including T3.
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