Tag: Estrogen

February 12, 2020

Estrogen Excess

I’m not sure what it is about this time of year . . . maybe the post-holiday weight gain, or the fear of pulling out a swimming suit in a few months. But I have had a number of people, both men and women, in the office with excessive estrogen levels.

Estrogen excess and estrogen dominance are two hormone abnormalities I find commonly in both men and women in my practice. These two issues are frequently complicating factors that make feeling good and weight loss difficult. They are, also, often the main reasons people don’t see dramatic improvement in a person’s symptoms of energy, fatigue and mental clarity when they’ve already changed their diet and lifestyle.

IMPORTANT NOTE BEFORE WE GO ON: This information applies to patient who already have normal thyroid function and corrected insulin resistance. If your thyroid is off or if you are still significantly insulin resistant, it will affect estrogen and other male and female hormones, so follow a ketogenic diet and get your thyroid balanced FIRST!

What is Estrogen Dominance?

I’ve addressed estrogen dominance in a previous blog post. You can find it here. Estrogen dominance is a condition where there is an abnormal estrogen/progesterone ratio. The estrogen/progesterone ratio MUST be balanced. Normal estrogen levels with low progesterone (this can commonly occur with the use of a synthetic progestin (HRT) in female patients) is a common scenario that falls into the estrogen dominance pattern.

What is Estrogen Excess?

Estrogen excess is a situation where progesterone levels may be normal but estrogen is elevated (an abnormal ratio can also be present in this condition).

The symptoms of excess estrogen can be:

Depression
Fatigue
Poor Concentration
Irregular menstrual bleeding in women
Breast tenderness
Fibrocystic Breast Changes
PMS
Decreased Libido
Uterine Fibroids
Endometriosis
Water Retention/Bloating
Fat Gain around the hips and thighs
Breast and Uterine Cancers

Why is too much estrogen a problem?

Estrogen naturally stimulates cells to grow and multiply. Natural estrogens are essential. But, too much estrogen increases thyroid binding globulin, inactivating the thyroid function causing abdominal weight gain. Too much estrogen changes the body’s ability to remodel bone.

Estrogen is essential to stabilize the inner lining of arteries, however, excessive estrogen doubles one’s risk for stroke and increases the risk of coronary atherosclerosis and heart attack. Too much estrogen increases the size of the prostate, increases risk of prostate cancer and increases the risk of rheumatoid arthritis.

Estrogen excess is an elusive condition. Measuring estrogen levels is not frequently done, and most doctors were never trained to look at the three separate forms of estrogen in men and women. I had no idea this was an issue until about five years ago.

What causes excess estrogen?

The eleven most common causes of estrogen excess are:

Commercially raised meat & dairy products from animals dosed with high levels of bovine growth hormone.
Insecticide or pesticide residues on fruits and vegetables.
Tap water with petroleum derivatives
Paraben containing shampoo, lotion, soap, toothpaste, & cosmetics. Paraben is absorbed through the skin. There is a 100% absorption that misses first pass liver detoxification
Pthalates – soft plastic containing material or plastic wrapped food heated in the microwave releasing xenostrogens into the food.
Artificial sweeteners including MSG (propyl-gallate and 4-hexylresorcinol are the two most common). Canned foods that have been lined with a plastic coating called BPA (bisphenol-A). Most processed foods have some additive that you will want to avoid.
Foods containing soy or soy protein isolate contain unnaturally high amounts of plant estrogens (phytoestrogens).
Red dye #3 (erythrosine and phenosulfothiasize) found in food
Dryer Sheets containing high levels of xenoestrogens. Chronic skin exposure leads to permeation of the xenoestrogens into the skin.
Birth control pills (conventional synthetic estrogen containing hormone replacement)
Tampons and sanitary napkins containing dioxins, chlorine, fragrance, wax, surfactant, and rayon play a role in significant xenoestrogen absorption.

Other diseases can cause estrogen ratio’s to be elevated. These include liver disease, zinc deficiency, excessive alcohol intake, obesity, calcium deficiency, insulin resistance, diabetes, and excessive testosterone therapy.

How does a person naturally decrease excess estrogen if it is present?

Decrease xenoestrogen exposures:

1. 1. Reduce use of plastics where possible
  2. Do not microwave food in plastic containers
  3. Avoid the use of plastic wrap to cover or microwave the food
  4. Use glass or ceramic containers where possible
  5. Do not leave plastic water containers, especially drinking water, in the sun
  6. If a plastic water container was heated up significantly (like a water bottle being left in the car in the Arizona sun), throw it away.
  7. Don’t refill plastic water bottles
  8. Avoid freezing water in plastic bottles for drinking later
  9. Avoid butylated hydroxyanisole (BHA) as a food preservative
  10. Limit skin care products containing xenoestrogenic substances

Use cruciferous vegetables like broccoli that contain indole-3carbiol (I3c).
Increase Omega-3 fat intake
Exercise
Use rosemary and turmeric (berberine)
Reduce weight
Use Vitamin D
Stop drinking alcohol
Stop smoking

These hormones, like estrogens, progesterone and testosterone can be easily checked by your doctor through blood or salivary testing. The key is a balance in the ratio between progesterone and estrogens.

The two estrogens that are essential to test are:

Estrone (E1)
Estradiol (E2)

These can be ordered through your doctor. Estrogens can take 2-3 months to balance out. It may take some time after making changes to see your levels normalize. Don’t fret.

What if natural methods don’t fix the problem?

When natural methods of lowering estrogen levels are ineffective, then your doctor will recommend treatment. A number of other effective medicinal approaches including:

Zinc Citrate
Quercetin
Grapeseed extract
DIM
Berberine
Resveratrol
Chrysin
Progesterone/Pregnenolone
Myomin
Vitamin K
Anastrazole

In my clinical experience, a ketogenic lifestyle is foundational to balancing these hormones consistently and naturally. Carbohydrate restriction by itself corrects many of the diseases of civilization. I addressed this in my book The Keto Cure. For many, there are few more steps necessary to living a long, happy and healthy life.

In my office, in addition to the ketogenic or carnivorous diet, I add on Berberine Plus 500mg twice daily with meals. This has been shown to notably improve the insulin resistance, lower estrogen and improve progesterone naturally.

Years ago, this was hard to find, so I created my own supplement line and these can be found at Ketoliving.com. Go to Ketoliving. com and order your bottle of Berberine Plus right now, before it is too late. I designed my own pharmaceutical grade berberine so that my patients could make sure they are getting real berberine in the doses I want you to have.

The treatment of this issue isn’t difficult. There is much more to come on this subject. I will address each of the progesterone, testosterone, DHEA and sex hormone binding globulin abnormalities in my future blogs. So, keep an eye on my web page DocMuscles.com/blog/.

So, get your hormones checked by someone who understand this problem and knows how to treat it. Second, limit estrogen stimulating sources in your diet and environment. Third, control you diet and order a bottle of Berberine Plus right away.

September 29, 2018

Estrogen Dominance – The Dead Man’s Curve on the Road to Ketogenic Happiness

Over the last 18 years of my practice, I’ve seen tremendous success in helping people improve their health when low-carbohydrate dietary changes are anchored as the foundation of treatment. However, there is still a group of people that struggle with seeing success. Even with the most effective ketogenic dietary control, there are those that see abnormal weight gain, inability to lose weight, poor libido, fatigue, foggy thinking, mood swings, persisting depression, headaches, bloating, breast tenderness, fibro-cystic breast changes, hair loss, and hot flashes. They may not experience all these symptoms, however, many are often present. If you have been following a ketogenic lifestyle and are still experiencing any of these symptoms, you are probably suffering from estrogen dominance.

Estrogen dominance is a condition that elusively effects thousands of women (and men) and your doctor probably doesn’t even know about it. I didn’t know about it. I, like all of my physician colleagues, were trained in school that the symptoms above are related to fluctuations of estrogen as a woman ages (or dropping of testosterone as a man ages). We were, and still are, taught that they are fixed by giving more powerful doses of estrogen or testosterone.

Over the years of my clinical experience, giving more estrogen frequently didn’t work. And, giving men more testosterone didn’t work either. What I found very effective, for many, was changing the diet. And, for about 85% of people, the symptoms list above resolved. However, the cause of the symptoms above in that last 15% of patients I see was still elusive. Examinations, blood tests, and even psychological evaluations never revealed the answer. Giving synthetic estrogen, progestin or testosterone when the blood work showed abnormality partially alleviated some of the symptoms for a few months, but then the patients would end up back in my office with the symptoms having returned.

I’ve found a number of problems following the “standard” medical approach to using synthetic sex hormones.

The first problem is that estrogen, progesterone and testosterone are heavily bound to proteins in the blood. It is only the free component of the three forms of estrogen and progesterone in the body and the free testosterone that acts upon the delicate cells located throughout the body. Blood testing does not account for the levels of free estrogen forms and progesterone effectively. These can only be tested through salivary testing.

The second obstacle is that the synthetic forms of progesterone (progestin), cannot effectively enter the brain. When synthetic forms are used, a person only gets half the benefits of progesterone found in the human body. This is why so many women have depression, anxiety and foggy brain feelings when using the synthetic versions.

The third challenge is that pharmaceutical companies cannot patent a drug that is identical to your human hormones. The chemical structure of the synthetic estrogen, progestin or testosterone must be slightly different. Hormones effectively work on certain aspects of various cells throughout the body, however, progesterone and progestin (the synthetic version found in medroxyProgesterone) DO NOT have the same hormonal effect on each cell. Natural progesterone is broken down by the stomach when ingested. That’s why progestin was invented, however, it doesn’t act the same in the body and only does half the job.

The fourth dilema is that much of our food in the standard American Diet stimulates increased estrogen production or inhibits clearance of estrogen excess through the gut and digestive tract. This happens in men and women. We can get excess estrogen from animals treated with hormones in meats, milk and dairy products. Hydrogenated oils in processed foods change the way estrogen and progesterone are handled in the body. These unstable fats increase the effects of estrogen on the body and amplify the risk for cancers. Excessive omega-6 fatty acids in the diet magnify estrogen receptor response to estrogen.

Estrogen metabolism in the liver and removal in the gut are dependent on vitamins B & E, magnesium and idol-3-carbinol (IC3). Diets without adequate IC3 from glucobrassicin found in leafy green and crucirferous vegetables allow re-uptake of estrogen in the gut leading to high estrogen levels and estrogen dominance. This is where gut health is even more important, and where I see failure in the “carnivore” approach to a ketogenic lifestyle.

The fifth problem is that the more estrogen I give a person, the more estrogen receptors are unregulated to the surfaces of the cells in the body. When that happens, more estrogen is required. Excess estrogen can actually cause many of the same symptoms present in progesterone deficiency including:

Irregular or heavy bleeding
Breast tenderness
Depression
Fatigue
Poor concentration
Fibrocystic breast changes
Decreased libido
Fibroid growth on the uterus
Endometriosis
Water retention and bloating
Fat gain around hips and thighs
Bone mineral loss (osteoporosis)
Hair loss
Skin thinning
Disturbed sleep
Breast and uterine cancer

More estrogen isn’t needed. Balancing natural progesterone with the current estrogen the body is already making is the solution in most cases. This can only be effectively assessed through a salivary hormone test.

The treatment to this issue isn’t difficult. For that reason, much more is to come on this subject. I will address each of the points above in future blogs. However, the first step is get your hormones checked by someone who understand this problem. And, then knows how to interpret it and treat it.

January 2, 2017

Why Be In Ketosis – Part X: PPAR-alpha

Benefit #10 in my 25 part series on “Why Be In Ketosis?”

This evening we briefly discuss PPAR-α, a powerful hormone that is stimulated by the ketogenic state. It has a number of known benefits. A number of great questions also popped up that we answered. Listen and watch as we discuss them here:

Stay tuned for more great content on Facebook Live, Periscope and Instagram.

December 14, 2016

Why Be In Ketosis? Part VIII – Testosterone!!

Why should you consider using a ketogenic lifestyle? There are many reasons. This is part 8 of a 25 part series and this one focuses on how ketosis improves testosterone in men and estrogen in women.

Watch and enjoy!!

July 24, 2016

Is Your Oatmeal is Killing You?

“Doc, if I don’t get my testosterone up, I’m just going to die!”

I’ve been hearing that statement from men more and more often lately. And, the answer isn’t what you’d think.

If you’ve watched late night TV recently, you’ve probably seen the many advertisements for testosterone supplements for low testosterone in men or what is now being called “Low T” Syndrome. It seems like this is the new advertising trend so much that patient’s use the term “Low T” as part of their conversations.

Watch the four minute short below about how your testosterone and sense of fatigue is being driven by your oatmeal or breakfast cereal . . .

Is it that men have just stopped making testosterone? Suddenly, everyone’s testosterone is low and men are complaining about fatigue, libido, and erectile dysfunction . . . or are they?

It’s actually the oatmeal . . . and the breakfast cereals. Clinically, when a man cuts the cereals and oatmeal out of his diet, he actually increases testosterone by 50-150 points within 1-2 months.

If you practice medicine long enough, you’ll see a trend that seems to have arisen as our waistlines have expanded. About half of the men in my office with insulin resistance, pre-diabetes or diabetes have low testosterone levels. But this shouldn’t be a surprise. Type II diabetes, metabolic syndrome and insulin resistance are all driven by an over production in insulin in response to a carbohydrate load in the meal. Patients with these conditions produce between two to ten times the normal insulin in response to a starchy meal. A number of studies both in animal and human models demonstrate that insulin has a direct correlation on testosterone suppression in the blood. This has been demonstrated in both men and women. In fact, glucose intake has been shown to suppress testosterone and LH in healthy men by suppressing the gonadal hormone axis and more predominant testosterone suppression is seen in patient with insulin resistance or metabolic syndrome.

In fact, to put it simply, insulin increases the conversion (aromitization) of testosterone to estrogen in men (it does the opposite in women by interacting with the hormone FSH). Interestingly, leptin resistance has a similar effect. I tend to see the worst lowering of testosterone in men with both insulin and leptin resistance.

What that basically means is that your breakfast cereal or oatmeal decreases your ability to maintain testosterone by up to 50% (1), lowers your ability to stabilize muscle (2), increases your risk for heart attack and stroke and makes you fat!

Death by oatmeal . . . really?

Yes.

How to you improve your testosterone? Supplemental testosterone has been shown to help, but it comes with some risks, including prostate enlargement and stimulating growth of prostate cancer. The most natural way to improve your testosterone is to change your diet.

A low carbohydrate or ketogenic diet turns down the insulin production and allows the testosterone to be available for use by the body. A ketogenic diet has the effect of reducing leptin resistance as well through weight loss. A simple dietary change of this type is frequently seen in my office to increase testosterone by 100-150 points.

What is a ketogenic diet? It is a diet that restricts carbohydrates to less than 30 grams per day, thereby causing the body to use ketones as the primary fuel source. So, for breakfast tomorrow morning, hold the oatmeal (1/2 cup of Quaker Instant Oatmeal is 31 grams of carbohydrates) and have the bacon and eggs. And, rather than have the cheesecake for desert this evening, have an extra slice of steak butter on your rib-eye and hold the potato.

Or, you might consider using a high fat shake with exogenous ketones. This is my breakfast each morning:

Exogenous ketones mixed in sparkling water, 2 tablespoonfuls of coconut oil and my multi-vitamin and I’m usually full until after noon.

Either way, get rid of your breakfast cereals or oatmeal . . . it’s killing ya!

References:

November 28, 2015

Common Ketosis Killers

“I’ve tried your low-carb diet, Dr. Nally, and it didn’t work.”

“Hmm . . . really?” If you’re mumbling this to yourself, or you’ve said it to me in my office, then lets have a little talk. You’ve probably been subjected to the common ketosis killers.

I’ve heard this statement before. It’s not a new statement, but it’s a statement that tells me we need to address a number of items. If you’ve failed a low carbohydrate diet, I’d suspect you are pretty severely insulin resistant or hyperinsulinemic. You probably never really reached true ketosis. I’d want to have you checked out by your doctor to rule out underlying disease like hypothyroidism, diabetes, other hormone imbalance, etc.

Nutritional Ketosis is Most Effective as a Lifestyle Change

Next, switching to a low-carbohydrate lifestyle is literally a “lifestyle change.” It requires that you understand a few basic ketosis principles. And, it takes the average person 3-6 months to really wrap their head around what this lifestyle means . . . and, some people, up to a year before they are really comfortable with how to eat and function in any situation.

I assume, if you are reading this article, that you’ve already read about ketosis and understand the science behind it. If not, please start your reading with my article The Principle Based Ketogenic Lifestyle – Part I and Ketogenic Principles – Part II. If this is the case, then please proceed forward, “full steam ahead!”

There are usually a few areas that are inadvertently inhibiting your body transformation, so let’s get a little personal.

Nutritional Ketosis is a Very Low Carbohydrate Diet

First, this is a low carbohydrate diet. For weight loss, I usually ask people to lower their carbohydrate intake to less than 2o grams per day. How do you do that? (A copy of my diet is accessible through my membership site HERE.) You’ve got to begin by restricting all carbohydrates to less than 20 grams per day. Any more than 20 to 30 grams per day will cause an insulin release from the pancreas and stimulate fat storage of both carbohydrate and fat for the next 10-12 hours, commonly killing ketosis. Keep a dietary journal to record your progress, your cravings, your successes and failures. I’m going to want to see it and review it with you if you see me.

No, I don’t believe in “Net Carbs.” Net Carbs are a sales gimmick to get you to buy “artificial food” that keeps you coming back for “artificial food” and halts your weight loss (you’ll see why shortly). You’re going to lose the most weight and feel your best when you eat real food. I do allow for the subtraction of real fiber, specifically non-cooked, non-blended, non-juiced leafy greens (If you cook, blend or juice a leafy green, it activates more carbohydrate availability). Leafy greens are real fiber. You can subtract them. In fact, I recommend eating 1-3 cups of leafy greens per day to help bowel function & provide necessary folic acid, but, everything else is “carbage.” Avoid it.

Yes, cottage cheese and yogurt contain carbohydrates. Be very cautious with them.

No, oatmeal and Cream of Wheat™ are not helpful. See my article on Why Your Oatmeal is Killing Your Libedo.

Alcohol also halts your weight loss. It’s not the sugar in the alcohol I’m worried about, the distilling process changes the sugar to alcohol, however, alcohol stimulates an insulin response after the alcohol is metabolized in the liver with a SIMILAR RESPONSE to regular sugar.

To Effectively Maintain Nutritional Ketosis, You MUST get adequate Protein

Second, this is a low carbohydrate, moderate protein, high fat lifestyle. N0 . . . it is NOT a high protein diet! However, so many of my patients don’t eat enough protein that they feel like it is a “high protein diet.”

Protein is essential for the building and maintaining of muscle, connective tissue and a number of other enzymatic reactions in your body. However, in patients who are morbidly obese [people with a body mass index (BMI) over 50], excess protein intake can cause fat to be stored by producing an excessive insulin response. In these patients we initially moderate protein. Excess sugars and a number of proteins, in the presence of a high insulin response, are converted to triglyceride (the soft squishy stuff inside the fat cells that make them plump) and stocked away inside your adipose tissue. Excessive protein, especially the amino acids argenine, leucine and tryptophan are common ketosis killers, not because they are converted to sugar, but because they stimulate and insulin response all by themselves.

If you don’t fall into the morbidly obese category (BMI over 50). Then, I encourage you to use the protein levels below.

Initially, I ask my patients to focus on lowering their carbohydrate intake and I don’t really worry about protein. (It is often hard enough to figure out what the difference between a carbohydrate and a protein in the first month or two if you’ve never had any nutrition background.) Most people begin losing weight just by lowering carbohydrates over the first few months. Once you figure out how to lower your carbohydrates, if your weight loss is not moving and your pants are not getting looser, then you’re probably eating too much protein.

How much protein do you need? It’s pretty easy to calculate and is based on your height and gender. Your basic protein needs to maintain muscle, skin and hair growth are as follows:

70 grams or higher for women per day
120 grams or higher for men per day.

However, these levels are WAY TOO LOW for weight loss and maintaining good health. Because we now know that protein acts as a hormone in a number of ways, in my office I recommend women get 80-90 grams of protein per day, and men should get > 150 grams of protein per day.

If you’re still a little confused about protein, read my article on Why Your Chicken Salad Stops Your Weight Loss.

This also goes for protein powders and protein shakes. Many of these have 25-40 grams of protein in them per serving, so be careful with their use.

Nutritional Ketosis is a High Fat Diet

Third, this is a high fat lifestyle. Yes, I want you to INCREASE your fat intake. I’m going to repeat that, again, just for clarity, . . . . INCREASE your fat intake. Increase it to around 50% of your total calories, . . . 70% of your total calories if you can do it. Not enough fat is a common ketosis killer.

“What?! Won’t that cause heart disease and stroke and make my cholesterol worse?!!!”

I know, take a big deep breath . . . (you may even need to breath into a paper bag for a minute if you begin hyperventilating).

No, it will not raise your cholesterol, cause heart disease, or cause a stroke. If you have lowered your carbohydrate intake to less than 20 grams per day, then there is NO hormonal signal for you to make more bad cholesterol, worsen heart disease, or cause a stroke. In fact, there is great data showing that increasing your fat and lowering your carbohydrates reverses the blockage in the arteries. I see this reversal every single day in my clinic through the application of ketogenic diets.

If we remove carbohydrate as your primary fuel, you must replace it with something else.That something else should be fat. Protein must be moderated, as it will also be stored as fat if you eat too much. So, if the carbohydrates are kept low, fat intake can be increased and the body will pick the fat it wants and essentially throw the rest out without raising cholesterol, causing weight gain or causing heart disease. This is why we want you to use good natural animal fats like butter, hard cheese, olive oil, coconut oil, avocado, etc. Look for fats highest in omega-3 fatty acids as these decrease inflammation and improved weight loss. Look for meats highest in fat like red meat (55% fat) and pork (45% fat). Take the food pyramid and flip it over.

Check Your Sweeteners At the Door

The fourth common ketosis killer and culprit in halting your weight loss is artificial sweeteners. There are quite a few of them. Most of them WILL cause an insulin response (exactly what we don’t want for weight loss) with minimal to no rise in blood sugar. Raising blood sugar doesn’t matter, if the insulin is being stimulated . . . “you’re gonna gain weight for the next 10-12 hours.” I wrote an article for you to print off and hang on your fridge, upload it to your iPhone or carry it with you in your purse to the grocery store. (If you’re a man and you’re carrying a purse, please don’t tell me about it.) You can find the article here: The Skinny About Sweeteners. The short list of those sweeteners that are OK to use and cook with, and do not increase insulin response, can be found here in my Amazon Store.

Don’t Even Start with Coffee Creamers

Fifth on my list is coffee creamer. Coffee creamer contains corn syrup solids (another very special name for . . . SUGAR!!) and/or maltodextrin (SUGAR’s married name!). If you must put something in your coffee, then use real heavy cream (pure tasty fat) or real butter. It will taste much better (I’m told – I don’t drink coffee personally) and you won’t get an insulin spike 2-3 hours later and begin craving more coffee and donuts.

Yes, “Half & Half” is half fat and half sugar. . . avoid it too!!

Ketosis Killing Medications

The sixth culprit in halting weight loss is medications. Please talk to your doctor before making ANY changes in your medications as suddently stopping them can be hazardous to your health. Those highest on my list for stopping your weight loss are Glyburide (glipizide), insulin, & steroids like prednisone. A more complete list of medications that will halt your weight loss can be found on my on my ketogenic diet plan. If you are on any prescription medications, please talk to your doctor or to a physician board certified in obesity medicine treatment about how to adjust or wean these medications in a way that is safe and appropriate for your individual needs.

Estrogen

The seventh common culprit in halting weight loss is a lack of estrogen in menopausal or post-menopausal women. About 20% of women that I see in my practice who are over 55 years old, need some degree of estrogen replacement before they are able to lose weight. Estrogen plays a very large role in regulation of the metabolism and when deficient, causes weight retention or weight gain. Talk to your doctor about the risks and benefits of estrogen for you individually in this situation.

Stress

The eighth reason for shifting out of ketosis is stress. Acute and chronic stress can be caused by a number of issues. The most common is lack of sleep. You can read about stress and ways to address it in two of my articles: How Does Stress Cause Weight Gain? and Adrenal Insufficiency, Adrenal Fatigue and PseudoCushing’s Syndrome – Oh My!

For many years, we’ve thought that caffeine was great for weight loss. However, we are finding, clinically, that too much caffeine can also cause a stress response by raising cortisol, releasing glycogen, thereby stimulating an insulin response and bringing your weight loss to a screeching halt. How much caffeine? . . . The jury is still out . . . and remains to be determined. But, I am currently under going an n=1 experiment on myself (as many of you know, I loved Diet Dr. Pepper. But I had to give it up). I’ll keep you posted . . .

Look closely at these eight issues. Correcting them usually solves most plateaus with weight loss and improves blood pressure, blood sugar and cholesterol control dramatically.