Ask Dr Karlis Ullis Anything Not Answered Already in ExcelMale.com

[Nelson Vergel]

I hope you take advantage of Dr Ullis' kind offer to answer questions !


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Here are his areas of expertise:

Welcome Author and Pioneer Dr Karlis Ullis to ExcelMale.com

 

[ratbag]

First... Nelson thank you for making this possible. This is a huge help for us members!

Hi Doc, Welcome to excel male. I read your areas of interest and thought wow this fits a lot of my situation. So I hope you don't mind but here is my situation.. something I'm not yet sure of how to deal with.

In short I'm hypopituitary from a head injury at age of 8 yrs old. I went thru life not knowing this until I was diagnosed with it at age 50, upon which they put me on all hormones. (yup every one) My treatment was great. I lived my whole life in a state of depression without realizing it. But once put on HRT I came out of my shell and started to socialize and have led a normal life since then except for my recent problem which ocurred 2 years ago.

I'm suffering from Low iron symptoms and hypothyroid symptoms for the last few years. Low iron is synonymous with hypothyroidism. My ferritin was at the very bottom of range and I've been supplementing with iron but it's not doing anything because I'm still hypothyroid (cold in the summer + all the other symptoms). Hospitals are where I go to get my labs done in Canada and they won't do full iron panels unless it's Rx'd by a hemotologist. They will only do ferritin. Because of this I found a private lab to do a full iron panel.

So I was looking at the results hoping to make sense out of it all and saw that it showed my Hemolysis Index -15 (range 0-9) and it states: The following tests can be adversely affected by hemolysis:
Increase in Albumin, ALT, AST, CK, Fructosamine, LD, Na, K, Cl, Magnesium, Total protein, Triglycerides, Uric acid. (I have elevated ALT for sometime now)
Variable in Direct and total bilirubin, Iron. (my ferritin is very low and I used to have very high ferritin)
Decrease in Alkaline Phosphatase, Amylase, UIBC

I've had elevated ALT for sometime (59) so this is probably a result of my hemolysis being too high and possibly the reason I cannot get normal ferritin levels by supplementing iron. I've been taking upto 200mg iron daily and my ferritin still stays low. Once I got my ferritin to 91 by supplementing iron heavily at the begining and I was just starting to feel better but I haven't been able to get there since then.

My serum Iron is at very top of range. UIBC and TIBC and % sat is all good.

I suspect I might need to see a hemotologist about this. My father died of Leukemia when he was 61 yrs old so I wonder if this is the beginning of something. I'm 60 yrs old now. What do you suggest I do? I need to get back to normal somehow but I'm not sure how to go about doing it.

Thanks for any assistance you can provide.

 

[Vince Carter]

Dr Ullis, is there a connection with Adrenaline response to arousal that could be impaired perhaps thru adrenal fatigue? I mean the heart rate and respiration increases primarily associated with arousal as opposed to the physical erection.

Thank You

 

[Will Brink]

Just adding the comment that I have known Dr Ullis since before the 'net existed and he's truly a pioneer in this area and doing this before many of the names people associate with TRT/HRT were born.

Word.

 

[karlis ullis MD]

Hi, Agreed , please see hematologist. Could be autoimmune disorder also. Also may need bone marrow aspiration to make sure nothing weird happening. Make sure you are not bleeding -do colonoscopy etc
Best - Dr Ullis

 

[karlis ullis MD]

This is common. Try a small dose of Propanolol (10 mg) to decrease cortisol, HR, Sweats etc.

 

[karlis ullis MD]

Thanks for kind words -- K. Ullis, MD

 

[Marco N Cognito]

Hello again, Dr. Ullis. We had some previous email exchanges back in 2010. Good to see you on Nelson's forum.

I am hypothyroid and am currently treating with 1 grain dessicated thyroid and just added 25mcg Tirosint. I do not have any autoimmune issues (i.e. Hashi's).

I recently started L-carnitine (in various forms) to help support cardiovascular health and r-ALA (r-alpha lipoic acid) to help support glutathione levels and to help improve insulin sensitivity. The carnitine not only helped my CV issues, but my stamina, endurance and strength have improved as well.

The concern I have is with respect to well-documented research which shows that exogenous carnitine elicits suppressive effects on thyroid metabolism, specifically inhibiting T3 and T4 entry into the cell nuclei:
https://www.ncbi.nlm.nih.gov/pubmed/15591013
https://www.ncbi.nlm.nih.gov/pubmed/11201848

And that ALA inhibits T4 to T3 conversion: https://www.ncbi.nlm.nih.gov/pubmed/1815532

Ironically, L-carnitine has been used to treat hypothyroid-associated chronic fatigue:https://www.jstage.jst.go.jp/article/endocrj/63/10/63_EJ16-0109/_article
And ALA ameliorates endothelial dysfunction in hypothyroid patients: https://www.ncbi.nlm.nih.gov/pubmed/20162509

This is obviously a conundrum for anyone who is borderline hypothyroid or worse but that has benefited from taking either.

Any thoughts as to how I can effectively balance the benefits of L-carnitine and ALA without exacerbating my thyroid function?

 

[karlis ullis MD]

Hi, My concern with L-Carnitine is that recent data shows that in the gut it transforms to TMAO which has some cardiac toxicity. Look at Cleavlend Clinics lab data and testing and google L-Carnitine.
That makes L-Carnitine and iffy supplement.

Dr U.

 

[Deleted member 16042]

Any thoughts about things that could help recovery from statin damage; myopathy and neuropathies?

What kind of hormone targets (normal vs optimal or higher blood levels), and any other ancillary approaches to improving/healing muscle and nerve tissues e.g. diet, supplements, lifestyle etc?

 

[Marco N Cognito]

Hi, My concern with L-Carnitine is that recent data shows that in the gut it transforms to TMAO which has some cardiac toxicity. Look at Cleavlend Clinics lab data and testing and google L-Carnitine.
That makes L-Carnitine and iffy supplement.

Dr U.

Yes, am well aware of the TMAO/meat scare that was blasted everywhere back in 2013, much of which has been refuted/debunked:
https://www.westonaprice.org/carnitine-and-heart-disease/
http://www.marksdailyapple.com/does-red-meat-clog-your-arteries-after-all/#axzz2Q55sRnAC
https://chriskresser.com/red-meat-a...1670af636485a7a7c39e2e5129a1d45f589513a08dad0
http://suppversity.blogspot.com/search?updated-max=2013-04-10T18:04:00+02:00
https://www.bodybuilding.com/fun/ask-the-supplement-guru-carnitine.html

Aside from the this, do you see any of the anti-thyroid effects as being clinically significant?

 

[karlis ullis MD]

Dear Blackhawk: If there are elvations of the muscle enzyme - CPK it could also be from intense exercise. You should do this test when not doing intense trg, especially RT (Resistance Trg). Then repeat day after high intensity trg. Neuropathies more complex. B vits, pregnenolone, dhea, r-ala, and even Progesterone are neuroprotective & maybe regenerative.

If u bring the T values up u can recruit muscle sattelite cells to act like stem cells and create new muscle. Make sure you do not have any underlying systemic illnesss that needs to treated. Sounds like Cardio - Vascular is risk factor. Eat low sugar diet - low glycemic. Work on your entire body for total best health.
Dr U .

 

[karlis ullis MD]

Yes, am well aware of the TMAO/meat scare that was blasted everywhere back in 2013, much of which has been refuted/debunked:
https://www.westonaprice.org/carnitine-and-heart-disease/
http://www.marksdailyapple.com/does-red-meat-clog-your-arteries-after-all/#axzz2Q55sRnAC
https://chriskresser.com/red-meat-a...1670af636485a7a7c39e2e5129a1d45f589513a08dad0
http://suppversity.blogspot.com/search?updated-max=2013-04-10T18:04:00+02:00
https://www.bodybuilding.com/fun/ask-the-supplement-guru-carnitine.html

Aside from the this, do you see any of the anti-thyroid effects as being clinically significant?

Marco: have not seen L-carn associated with Thyroid function.

 

[karlis ullis MD]

Marco: please provide original PubMed citations.
Thanks - Dr U

 

[ERO]

Dr Ullis, have you ever had any success treating guys with congenitally low SHBG? The usual wisdom of doing small daily T injections or trans-dermal T helps some but not all low SHBG guys. Personally, my SHBG ranges from single digits to low teens and I am not obese, diabetic or pre-diabetic. I have been on TRT for 6 years and I feel basically nothing from treatment. I retain all of my Low T symptoms: low to no libido, poor recovery from exercise, extreme difficulty loosing fat (and I understand macros and the importance of a solid diet) and most afternoons I would take a nap if not for work, even though I sleep well at night. I have no thyroid issues...basically I am running out of new things to test or to try in terms of treatment.

 

[Marco N Cognito]

Marco: please provide original PubMed citations.
Thanks - Dr U

Marco: please provide original PubMed citations.
Thanks - Dr U

Sorry, regarding the carnitine/theoretical risk, I know of no actual papers that directly refute the study, however, the study itself I feel is flawed for many reasons, to name a few:

1) The researchers based many of their conclusions about TMAO on research done in mice, so, we don't really know whether or not TMAO actually causes CVD in humans.

2) The human component of their study consisted of only six people: one vegan and five meat-eaters. Six people is not even close to being enough subjects to draw conclusions.

3) Any study that says that TMAO causes CVD needs to deal with the fact that a person eating animal flesh of any kind is going get a lot more naturally-occuring carnitine than when you take a few hundred mg's of carnitine.

In addition, a Mayo Clinic meta-analysis was released that looked at 3,600 patients and found huge CV benefits in those who supplemented with L-carnitine (one of the main reasons I use it). The study represented the largest, most powerful scientific review of carnitine's CV benefits to date:
https://www.ncbi.nlm.nih.gov/pubmed/23597877

The Mayo Clinic study found carnitine supplementation was associated with a 27% reduction in all-cause mortality, a 65% reduction in ventricular arrhythmias, and a 40% reduction in angina symptoms in patients who had experienced a heart attack. The media was quick to bypass this study, however.

Does that mean it's all b.s. and there's no risk? Nope. However, I think there are, as with many things of controversial nature, modulating and offsetting factors, i.e. one's gut microbiome:
Probiotic intervention can attenuate TMAO:
https://www.ncbi.nlm.nih.gov/pubmed/28511293

For me, it comes down to the risk vs benefits, and the benefits, both from my first-hand experience and that of the well-documented research, outweigh the theoretical risk. The carnitine/thyroid conflict, however, is another matter altogether that I guess until I do my own n-1 experiment, remains to be seen.

On a side note, carnitine is not the only player being demonized in the TMAO scourge; choline and betaine, two other highly beneficial nutrients, are just as "guilty". If such is the case, then why aren't all the meat and egg eating mammals for the last million years, including humans, dropping dead of MIs and ischemic events?

Correlation is not causation.

 

[karlis ullis MD]

I hope you take advantage of Dr Ullis' kind offer to answer questions !


Register here to be able to ask questions if you have not done so already:

Register on ExcelMale.com

Here are his areas of expertise:

Welcome Author and Pioneer Dr Karlis Ullis to ExcelMale.com

Hello ExcelMale members


I am happy to be on this great site and I am happy to answer any questions related to...


As a reminder, my answers are for educational purposes and do not constitute medical advice as you should always consult your physician to discuss any changes to your treatments.

Regards,

Dr. Ullis

 

[karlis ullis MD]

Large studies show that those on plant based diets around the world have less CV dissease.
Dr U

 

[karlis ullis MD]

Dr Ullis, have you ever had any success treating guys with congenitally low SHBG? The usual wisdom of doing small daily T injections or trans-dermal T helps some but not all low SHBG guys. Personally, my SHBG ranges from single digits to low teens and I am not obese, diabetic or pre-diabetic. I have been on TRT for 6 years and I feel basically nothing from treatment. I retain all of my Low T symptoms: low to no libido, poor recovery from exercise, extreme difficulty loosing fat (and I understand macros and the importance of a solid diet) and most afternoons I would take a nap if not for work, even though I sleep well at night. I have no thyroid issues...basically I am running out of new things to test or to try in terms of treatment.

Hi Ero, Unusual situation. Liver governs SHBG production. SHBG drops after puberty. High before that. At what age did u know u had low SHBG and what age was ur puberty?
If you and your doctor agree you could do a trial of moving toward hyperthyroidism for 6 weeks. As long as there are no contraindications. Do SHBG levels before and after. Have u had a liver scan?
Dr U

 

[ERO]

Hi Ero, Unusual situation. Liver governs SHBG production. SHBG drops after puberty. High before that. At what age did u know u had low SHBG and what age was ur puberty?
If you and your doctor agree you could do a trial of moving toward hyperthyroidism for 6 weeks. As long as there are no contraindications. Do SHBG levels before and after. Have u had a liver scan?
Dr U

Hello Dr Ullis-

I went through puberty at a normal age and I found out about my low SHBG when I first started experiencing low T symptoms at around age 48 and beginning TRT - and feeling literally nothing from TRT treatment. More research in my part showed that guys with low SHBG often "under respond" to TRT (Just for fun, sometime Google "Low SHBG TRT" and see how many hits you get...)and that has been my experience in the extreme. Even though I am not obese or diabetic, I tried Metformin for a couple of years but it did nothing for me. My glucose levels were fine before starting so they did not change much at all with the Metformin. I have never had a liver scan, but my liver enzymes always come back well within the normal levels.

I am intrigued by your idea of doing a trial of moving toward hyperthyroidism for 6 weeks to see if my SHBG levels change. I am willing to try anything at this point and I thank you for the suggestion!