BHRT Q&A with DR. FRISCH

BHRT Q&A with DR. FRISCH – QUALGEN PODCAST 

 INTRO: Welcome to Qualgen’s podcast where we talk about all things health and wellness related, including hormones, pharmaceuticals, health trends and ways you can help better your life.  

JP: Hi everyone! Thank you for taking time out of your day to listen in. Today I am joined by Dr. Marnie Frisch who is the founder and a naturopathic doctor at Whole Health Naturopathy. Dr. Frisch worked in patient care for women’s health clinics, community heath clinics for homeless youth and at a private urology practice between her undergraduate and graduate work. She now offers both primary and specialty medicine and excels at collaborating with other doctors and using diagnostic testing to investigate the cause of disease. She specializes in autoimmune diseases, including rheumatoid arthritis, osteoarthritis, MS, Hashimoto’s thyroiditis and vasculitis.  - Dr. Frisch, thank you so much for joining me today!  

MF: Yes, I'm happy to be here.  

JP: I am so happy to have you! Today, Dr. Frisch and I will be doing a Q and A about bioidentical hormone replacement therapy aka BHRT. To start us off I love asking this question to all of the providers that join me - what pushed you to get into the field that you are currently working in?  

MF:  Yeah. Well, I think it's been a long journey. I actually didn't go to naturopathic school till I was 30. And so, I was going into more medical field allopathic medicine. And just after all that work in those clinics, you mentioned, I just realized a lot of patients weren't really getting better, they were just maintaining health care. They had about 10 minutes with their doctors and I just realized there has to be something else out there. So I actually took quite a bit of a break. I, for six years, I just decided to step away from medicine. I went to work in a bakery and this is related because it was an organic bakery and I just got a lot more exposed to natural health foods and the organic world and co-ops and started thinking about nutrition, and that's actually what got me to look at Bastyr was their master's in nutrition program, but then I saw that they had this doctorate of naturopathic medicine, which just spoke to me since I thought I would be a doctor most of my life anyway. And so I circled back and got into medicine through that way, through a more naturopathic approach and I haven't really looked back since. Yeah.  

JP: So it kind of found you in a way.  

MF: It did find me in a way. Yeah. I originally grew up in the Midwest. My dad is a medical doctor, actually an OBGYN and my sister is, and we just didn't have natural medicine in my world, you know, in the eighties, it just wasn't as out there as it is now. So when I got to the west coast, I just had never even heard that there was an alternative to medical, the allopathic system. And so once I found it, I was like, oh, there this exists, people can actually use herbs and nutrients to help heal. And so yeah, it did kind of find me.  

JP: Yeah. Well, that's awesome. So, what would you say the difference is between whole health naturopathy from that of a conventional clinic?  

MF: Well, I think first and foremost, like most naturopathic clinics, hopefully we follow there's a certain guideline of principles in natural medicine that just help guide us to give better quality patient care. So like other doctors first doing no harm to actually act in cooperation with this understanding that there is a healing power in nature, like our own body systems has a healing power and nature can provide help with that too, that we address the cause of disease. We actually look for the underlying cause of why people are feeling the way they're feeling that we heal the whole person, not just look at individual symptoms, but we're looking at the whole picture and that we're actually teaching patients about their health and you know, healthy lifestyles, healthy living preventative medicine. So that's kind of the principles behind it I think people's experience is that they have longer appointments with us. We, I mean, in order to do all that, we really need to understand our patients and where they're coming from. And so we really just try and listen and have patients feel heard and, you know, our appointments are like an hour long and half hour follow ups. There's no such thing as like a 10 minute visit, you know.   

JP: Well, it takes that long.  

MF: Yeah. You know, so, so, I mean, I think that's the biggest thing is that the people are just seen and heard in our clinic.  

JP: Yeah. Yeah, I love that. And what are the, some of the symptoms individuals come in with who are suffering from a hormone imbalance?   

MF: Well, I think mainly for women, the first thing people feel like is just their periods start getting irregular. I mean, it's wonderful. We have this monthly radar to kind of see how our hormones are acting. Hot flashes, fatigue, cognitive issues, muscle pains, joint pains, heart palpitations actually can be part of menopausal symptoms, cognitive issues and then low libido for both men and women, you know, men, similar symptoms in just terms of fatigue, achiness, lack of muscle mass gain. Yeah, I would just say kind of fatigue and cognition and just that feeling of burnout is the biggest symptom that we treat.  

JP: And what are the different ways that you administer hormones in your clinic?  

MF: Well, I use both what's available at commercial pharmacies and compounding pharmacies. So, it just kind of depends on the patient but everything from creams to troches, to patches. I love using pellets. It's just been such an easy form for patients to use. Yeah, sometimes oral preparations. You know, swallowing capsules, but since your body has to digest those, I don't use those as much as I do other forms.  

JP: And how do you determine which ways to administer the hormones based on each individual?   

MF: Well, I look at the individual and we have that conversation generally cost, it has something to do with it. Generally, just what their lifestyle is. Do they want to mess with putting creams on twice a day? Do they want have something sublingually that they want to do every day? You know, sometimes these medicines, when you start taking things daily or twice a day, you're just reminded that you need something to feel vital every day. I mean, this is the lovely thing about pellets is that you just put them in and you just don't have to think about it. And then the other thing is too. I just like with creams, it's kind of like, what's their lifestyle? Are they taking care of their grandkids? You know, they don't want to be getting that cream on their babies and touching the animals with hormones. So I just factor in what's going on with their life and also their affordability for the patient.   

JP: I never thought about what you just said with the daily reminder. But I have, I've never thought about that and how it can kind of be a mental game that you almost play with yourself about it.   

MF: Yeah. It wasn't until I really started having my own chronic health issues that I just, you know, you don't want to be reminded all the time that you have something going on. You know, I mean, the beauty of hormones is that they really help us feel better but it can be kind of a labor of love to use it especially with creams, you know, you're just dealing with so much cream, all that, you know, it's just, yeah, that's why there's nice that there's lots of different options out there. 

JP: Yeah, something for everybody. 

MF: Something for everybody, yeah.  

JP: Once someone starts on hormone replacement will they always need to be on it? 

MF: No, I think there's different philosophies out there. There are definitely some life extension doctors that say yes, always, I don't always, I don't fall in that camp so much, you know, ideally and really what a lot of the research is, although it's being re looked at now, but shortest course, lowest dose of hormone therapy is really kind of the safest way to go. So generally I start thinking about just transition periods 3 to 5 years because usually by the time people are in their sixties or 65 they honestly get over this hump of transition and they start feeling good again, whether that's because they might not be working as much anymore or taking care of so much or that their bodies are just kind of adapting to their new way of being. So I don't think there's a direct answer for that. It just depends what we're using for treatment. The safest time to start is earlier within a menopausal years. The first year or two, we're doing estrogen for bone protection. Then sometimes people are on that for quite a while because it can be protective of bones and help with osteoporosis. It just kind of depends what we're treating and what we're looking at.   

JP: Ok. So does the body ever respond and realize that, hey, I need to be making this amount of hormones. Does it ever happen that way to where it starts making that hormone again? After that you've been on that?   

MF: It's a good question. It kind of depends what age you’re at, you know, naturally it's like menopause is a natural thing for women as is andropause. I mean, our ovaries stop producing these hormones for reasons. So in that sense, no, but I want to make sure, you know, ovaries and our hormones that come from them do not stand alone. We also have a thyroid and we have our adrenal glands and I always say that it's like three steps of a stool, like you need to balance all three. So even though you might be losing some of those endocrine hormones, like estrogen and progesterone and testosterone. If we can get your thyroid and your adrenal glands balanced out, it just might not feel so bad to lose those other hormones. So it's kind of a balance of a whole system and not just separate. So it kind of a long answer to your question, but we have other hormones in our body that we can support. So, you know, I wouldn't say that your body is ever going to start producing a bunch of estrogen again. It's not meant to same thing with testosterone. It's not really meant to, but we can get you over the hump so that your body doesn't feel so bad when it's losing those because that's what people feel is the loss of the hormone, you know, it's that transition time the most and then you kind of find other tools or other ways to support yourself or your body just does as you age.  

JP: So when it comes to your thyroid and adrenal hormones, what is out there to help with those?  

MF: Well, that's a lovely thing about being a naturopath is that we have a really big toolbox. We can use a lot of different herbs that are definitely nutrients. Certain B vitamins that can really help support both the thyroid and adrenal glands. Yeah, that's a, it's a big question. I mean, there is, there's I mean, it's a wonderful class of herbs. I will just say they're called adaptogen herbs. And that's what supports your adrenal glands. Primarily, they help our body adapt to stress around it, which is what cortisol is. The hormone that comes from our adrenal glands that gets secreted. And so I just love doing that work and we can do that work with people as young as in their, you know, as teenagers and 20 year olds and 30 year olds. So it's not all about menopause. It's, you know, and that's, I just will say that's usually where I'll start with people. You know, we, there's this hierarchy of healing, you know, the least invasive possible is using nutrients and herbs first and then I'll step up to hormones if those are like failing or they are just purely deficient and they would feel better on hormone therapy. 

JP: Is Ashwaganda in that family of herbs? 

MF:  Yeah, ashwaganda is an awesome herb and safe for all ages and it's yeah, immune modulating. It helps the endocrine system. It is a little anti-inflammatory. It is a great herb. Yeah. I mean, if you want specifics - 

JP: it's just one of the ones that I know about that.   

MF: One of my most favorite herbs that's local here is called Oplopanax, which is called Devil's Club. And so that's a Pacific Northwest herb that's just awesome. Is a great adaptogen, a lot of the ginseng family you'll hear about, you know, licorice roots is a great herb, you have to be careful with that because it can raise your blood pressure. So, I'm always a little, you got to know that about that herb if you're gonna just start taking it. But, yeah, Ashwagandha. Absolutely.  

JP: I feel like it's gotten really popular lately for whatever reason.  

MF: it's gotten very popular. Rhodiola is another really popular one I heard about, you know, just exercise endurance with Rhodiola and, and they affect our cognition a lot too. I mean, it's just, it's amazing. Honestly, almost all patients are supported with their adrenal glands because we just live in a stressful world. I mean, environmentally, we're stressed politically, we're stressed, we are working hard, we're not getting paid enough, you know, we want, especially women, we do a lot, you know, we're taking care of family and yeah. 

JP: We do. I agree. 

MF: All that. So, a lot of support is needed.  

JP: Yes, I agree. Well, I, I got a little sidetracked from the BHRT questions. I'm sorry. So, what are some of the risks that are related to hormone replacement therapy?  

MF: Well, I think the biggest risk that has been publicized is breast cancer and stroke history, estrogen, you know, and blood clots has also been looked at, especially in smokers. This goes for everything from birth control to, you know, using hormone replacement therapy for men, you know, prostate health, prostate enlargement and cardiovascular risk. It, you know, but more and more studies are coming out really showing that these hormones, especially if they're bioidentical are safer than we once thought. There's been a lot of gaps in that women's international health study that was put out. So it really is worth taking a look at and really talking to your provider about like what really are your health risks? Even the American Association of Gynecological Physicians, the ACOG, I'm not quoting that right. But came out to say that even with women with breast cancer history is safe to use like a vaginal cream of estriol because you know, for quality of life over, you just got to balance quality of life over risk and the risk benefit ratio. And so things are slowly changing to open up and and kind of give us more. Yeah, a better idea of that. There's a great book called Estrogen Matters out there and it really addresses a lot of this, a lot of studies in the gap.  

JP: Oh I might have to look into that.  

MF: Yeah, I would look, it's a good book. 

JP: We were at the American Urological Association conference a few years ago and it was kind of back when like they were kind of anti-testosterone replacement and then a few months or maybe it was a year after that or so they released an article talking about the benefits that there were to receiving testosterone replacement therapy. So, I think it's awesome that people are finally starting to put in the studies and show what benefits there could be. 

MF: So and I will say the other one is, yeah, a lot of bladder complaints. I actually work with a lot of local pelvic physical therapists and they will sometimes refer patients back to me to get estriol cream like a vaginal cream for their bladder health. Women increase frequency of urinary tract infections as you age and you know, vaginal dryness, it's all related in that area. And estrogen can help that as well. You know, as our tissues get loose when we lose estrogen, that's why our skin sags and our cervix sags and you know, so estrogen tightens things up and it can be helpful therapeutically for, you know, when people have urinary incontinence and stuff.  

JP: Yeah, that's something I didn't think about. I feel like like the loose skin and stuff is always, you know, collagen, you need more collagen, that type of thing. Not, not estrogen.  

 MF: Yeah. 

JP: So what are the benefits to BHRT?  

MF: Well, quality of life is probably the best but I mean, really sleep quality is improved, cognitive like be able to think and to process, I've been talking with patients, I think just as we age, we're doing so much more. We're having kids older, we're running businesses older, we're not retiring at 60 we're retiring at 70. You know, we're just producing so much more. So, to keep our brain cognitively alive and be able to handle all that. I mean, hormones can really help with that. Certainly, just as basic as symptom relief. You know, I don't have hot flashes anymore. More muscle mass, more energy. Yeah, bladder health is, you know, improvement there. For men, you know, increased. Usually it's increased libido is the biggest thing I see for men or, you know, not getting enough muscle mass, you know, is their biggest. On top of that. I'd like one of my biggest things that I've learned again from having my own chronic health issues is like balancing your hormones while you have other health issues, make those other health issues not as bad. I will just say like, it's one thing we can really affect when you have other things you can't treat and the endocrine system is tied into our immune system, it's tied into our neurologic system. So, you know, it's just a piece we can't be scared of and forget about because it's all interrelated.  

JP: So, do you do a lot of gut health too in your practice?  

MF: Absolutely. Yeah. I mean, yeah. Yeah, all these underlying, I mean, you've mentioned autoimmune disease because it’s on the website, but I, you know, I do a lot. Yes. I mean, gut health is just the underlying, you have to treat the gut if you're treating immune issues, you know, I mean, and if you have to treat the gut when you're treating mental health issues, I mean, serotonin is made in our gut which is, you know, what makes us feel good. And as is, that's where hormones are processed. So, this is why I do not use a ton of oral prescriptions of estrogen and testosterone because it has to be processed through the gut. It's, you know, it's kind of better if you can bypass that. Sometimes it's just better for the liver. And, yeah, anyway. Yes, absolutely gut health.  

JP: Ok. I figured. So, I mean, it all goes together and once I finally had somebody explain  

MF: It all goes together and most people have some kind of digestive issue. If they have other health issues. It's really kind of fascinating.  

JP: Yeah, it just, I was like, wow, it just all makes sense. Like just add it all together. Well, is there anything you would like to add?  

MF: No, I just think I'll follow up with that last comment, it just reminds me that we're, we're just connected in every body system and that's why we need to look at the whole person, you know, is because we can't just look at the gut versus, you know, headaches versus, you know, it's not separate. They are all, it's all intertwined. And this is where, you know, the appeal of like a naturopathic approach versus, you know, a traditional medical approach where you have to see all these specialists for different parts of your body. Just don't always, you know, make sense. So, yeah. 

JP: you can just sit down and figure it out together.  

MF: Exactly. And look at the whole, how it all fits in together. 

 JP: The whole equation and then figure it out from there.  

MF: Right. Right.  

JP: So, well, thank you again for joining me. In the meantime, if anyone has any questions for Dr. Frisch, you can find her contact information on our website, which is wholehealthnaturopathy.com or on Facebook at Whole Health Naturopathy. Thank you again, Dr. Frish.  

MF: Thank you for having me. It was really fun.  

JP: Yeah, it was. Thank you everyone for listening. Please make sure to subscribe and follow us on social media to stay up to date on Qualgen. Have a great day!