Understanding Circulation: Why It Matters More Than You Think

Most people know the heart acts as a pump to move blood throughout the body, but we often overlook the vital role of the entire circulatory system. When blood flow is impaired, it can lead to symptoms like constantly cold hands or feet, weak muscles, brain fog, fatigue, and even low sexual drive. These signs may indicate that your body isn’t circulating blood efficiently.

The circulatory system is more than just the heart and vessels—it’s responsible for transporting oxygen, nutrients, hormones, and immune cells to every tissue, while also clearing out waste. For instance, if you get a small cut, the bleeding, swelling, and healing that follows are all thanks to your circulatory system doing its job to protect and repair.

Several factors can disrupt healthy circulation, including genetics, chronic health conditions like hypertension or high cholesterol, excess weight, and aging. While you can’t change your genes, you can take steps to support circulation through targeted diet and lifestyle changes.

Always check with your healthcare provider before starting any new supplement or health routine.

How to Naturally Promote Healthy Blood Flow

To keep your circulation strong, it's important to support the production of nitric oxide, protect blood vessel health, and maintain proper blood fluidity. Here's how to address each of those areas:

1. Boost Nitric Oxide (NO) Levels

Nitric oxide is a compound your body creates to help blood vessels relax and blood move freely. Unfortunately, its levels tend to decline with age, poor diet, sedentary habits, and metabolic issues.

Dietary Support:
Adding nitrate-rich vegetables to your diet can naturally boost nitric oxide production. Foods like arugula, spinach, basil, parsley, beets, radishes, Swiss chard, and mustard greens are great choices. Regularly eating these can support circulation from the inside out.

Lifestyle Tip:
Be cautious with antiseptic mouthwashes. These products can alter your oral microbiome, which plays a surprising role in nitric oxide generation. Overusing mouthwash may reduce NO availability by harming the bacteria that assist in this process.

Supplements to Consider:

  • L-citrulline has been studied for enhancing nitric oxide levels, particularly during physical activity.
  • Potassium nitrate combines the benefits of potassium (important for muscle and nerve function) with nitrate’s ability to support NO production. Both may help with endurance, blood flow, and cardiovascular health.

2. Strengthen Blood Vessels

Even if nitric oxide is abundant, it won’t help much if the blood vessels themselves are stiff or damaged. Over time, oxidative stress, inflammation, and poor lifestyle choices can age the vascular system.

Lifestyle & Nutrition Tips:
Aerobic exercise is one of the best ways to protect blood vessels. It enhances flexibility, supports endothelial function (the cells lining the vessels), and improves resilience to stress. Starting an exercise routine—even later in life—can significantly benefit vascular health.

Adopting a nutrient-rich, anti-inflammatory diet is also key. Emphasize whole plant foods, legumes, nuts, seeds, fish, and olive oil. The Mediterranean diet is especially well-researched for its heart-protective benefits, but other plans like the DASH diet, vegetarian diets, and even low-carb styles like keto or Nordic variations may support circulation as well.

Supplement to Know:

  • Rhamnan sulfate, a compound from green algae, has shown promise for its anti-inflammatory and circulation-supporting effects, especially in high-fat diets. It may also benefit lipid metabolism and blood vessel health.

3. Improve Blood Fluidity

Think of blood like honey: the thicker it is, the harder it is to move through narrow tubes. The goal is to keep it flowing smoothly to nourish tissues without clotting or sluggish movement.

Food Sources of Omega-3s:
Diets rich in omega-3 fatty acids—found in salmon, sardines, walnuts, flaxseeds, and chia seeds—have powerful effects on circulation. These healthy fats support cell membrane integrity, reduce inflammation, promote vasodilation, and improve lipid balance. Aim to include omega-3-rich foods daily.

Botanical Support:

  • Hawthorn berry, used in traditional Chinese medicine, may improve circulation and heart function. Its natural compounds can help regulate blood pressure and enhance nitric oxide production.
  • Dan Shen (Salvia miltiorrhiza), another TCM herb, has been studied for its benefits on brain blood flow, platelet function, and vascular tone. It may offer a cost-effective, plant-based option for those focused on circulation and cognitive support.

Key Takeaways

Healthy circulation is vital for overall wellness, from energy and cognition to muscle performance and immune response. While some risk factors for poor circulation are out of your control, many are not. A combination of smart dietary choices, regular movement, and strategic supplementation can make a meaningful difference.

As always, speak to your practitioner before starting new supplements or making big changes to your diet or routine. Supporting your body’s natural ability to move blood is a foundation for lasting health and vitality.

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SHBG


1. What is SHBG?

SHBG (Sex Hormone-Binding Globulin) is a glycoprotein produced primarily in the liver. It binds sex hormones—especially testosterone and estradiol—and regulates their availability to tissues.



2. Classic Roles of SHBG

  • Hormone Transport: Carries testosterone and estradiol in the bloodstream.
  • Hormone Regulation: Controls the amount of free (bioactive) testosterone and estradiol.
  • Storage Function: Acts as a hormone reservoir, slowly releasing bound hormones.



3. Independent Functions of SHBG

SHBG may have biological effects independent of hormone transport, including:

  • Cell signaling: SHBG can bind to specific membrane receptors and influence gene expression.
  • Modulation of hormone access: It controls which tissues receive hormones and when.
  • Metabolic signaling: Low SHBG is linked to insulin resistance and metabolic syndrome, suggesting SHBG reflects deeper physiologic regulation.



4. Clinical Meaning of High vs. Low SHBG

🔻 Low SHBG (<20–30 nmol/L)

  • May indicate:
  • Insulin resistance / Metabolic syndrome
  • Obesity
  • Type 2 diabetes
  • Hypothyroidism
  • Androgen excess (e.g., PCOS)
  • Fatty liver disease (NAFLD)
  • Associated with:
  • Increased free androgens
  • Elevated cardiovascular and all-cause mortality risk
  • Higher risk of diabetes and inflammation

🔺 High SHBG (>70–80 nmol/L)

  • May indicate:
  • Liver dysfunction / Cirrhosis
  • Estrogen dominance
  • Hyperthyroidism
  • Malnutrition / underweight state
  • Chronic illness or frailty
  • Associated with:
  • Low free testosterone and/or estradiol despite normal total levels
  • Possible sarcopenia or low libido



5. Organs and Systems Influenced by SHBG

  • Liver: Primary site of SHBG production and clearance.
  • Endocrine system: SHBG levels are regulated by hormones (see below).
  • Brain & Mood: SHBG affects hormone availability to the brain, influencing libido, mood, cognition.
  • Immune system: Indirect effects via hormone-mediated immune regulation; low SHBG is associated with chronic inflammation.
  • Cardiovascular system: Low SHBG correlates with atherosclerosis and metabolic risk.



6. Hormones That Influence SHBG

HormoneEffect on SHBGEstrogens⬆️ Increase SHBGTestosterone⬇️ Decrease SHBGInsulin⬇️ Strongly suppresses SHBGThyroid hormone (T3)⬆️ Increases SHBGGrowth hormone⬇️ Decreases SHBGCortisol (chronic stress)⬇️ Lowers SHBG indirectly



7. Conditions That Alter SHBG

ConditionSHBG EffectLiver cirrhosis⬆️ High SHBGNAFLD / Obesity⬇️ Low SHBGHypothyroidism⬇️ Low SHBGHyperthyroidism⬆️ High SHBGPCOS⬇️ Low SHBGAnorexia / cachexia⬆️ High SHBGAndrogen therapy⬇️ Lowers SHBGEstrogen therapy⬆️ Raises SHBG



8. SHBG, Mood, and Immunity

  • Low SHBG may contribute to increased neuroinflammation, poor hormone signaling in the brain, and mood symptoms.
  • High SHBG may reduce free hormone access to brain receptors, causing low libido, depression, and fatigue.
  • Low SHBG is often part of a chronic inflammatory or insulin-resistant state, affecting immunity.



9. Managing SHBG

To Lower SHBG (if too high):

  • Consider mild testosterone therapy
  • Evaluate for hyperthyroidism or estrogen excess
  • Address nutritional deficiencies or malabsorption

To Raise SHBG (if too low):

  • Manage insulin resistance (weight loss, metformin, GLP-1s)
  • Evaluate for hypothyroidism or androgen excess
  • Consider estradiol modulation in females (e.g., OCPs or bioidentical hormones)



10. Final Notes

SHBG is more than just a transport protein. It is a metabolic marker, a hormonal gatekeeper, and a predictor of systemic health. Always interpret SHBG in context—with total and free hormones, metabolic markers, thyroid function, and clinical symptoms.

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Zonulin

Zonulin and Intestinal Permeability: Summary & Clinical Insights

🧬 What is Zonulin?

Zonulin is a regulatory protein that controls the opening and closing of tight junctions between cells in the intestinal lining. When zonulin binds to specific receptors on epithelial cells, these tight junctions loosen, increasing intestinal permeability—commonly referred to as “leaky gut.”

⚠️ Consequences of Increased Zonulin Activity

When the gut barrier is compromised:

  • Bacteria, lipopolysaccharides (LPS), yeast, undigested proteins, and other foreign molecules can enter the bloodstream.
  • This triggers immune system activation, leading to inflammation, allergic responses, and systemic immune dysregulation.
  • Chronic immune activation contributes to metabolic disturbances, accelerated aging, and various chronic health conditions.

🔍 Common Triggers of Zonulin Overexpression

  • Pathogenic infections
  • Disruption of gut microbiota
  • Gliadin exposure (a gluten protein)
  • Chronic stress
  • Low-fiber or high-fat diets
  • Damage to the intestinal mucosal barrier

These factors can lead to long-term gut-immune imbalances with widespread health implications.

🚨 Health Conditions Linked to Elevated Zonulin & Leaky Gut

  • ADHD
  • Autism spectrum disorder
  • Major depression
  • Type 1 & 2 diabetes
  • Rheumatoid arthritis
  • Celiac disease
  • Non-celiac gluten sensitivity
  • Colitis & IBD
  • Nonalcoholic fatty liver disease
  • Asthma
  • Multiple sclerosis
  • Ankylosing spondylitis
  • Hyperlipidemia
  • HIV
  • Glioma
  • Chronic fatigue syndrome
  • Gestational diabetes
  • Aging-related inflammation
  • Adult glucose intolerance

🩺 Recommended Management Strategies

1. Diagnostic Testing

  • Food sensitivity testing: IgE, IgG, IgG4, and complement C3b/d panels
  • Comprehensive stool analysis: Identify gut flora imbalances, pathogens, and digestive enzyme deficiencies

2. Dietary Interventions

  • Implement a personalized elimination diet based on lab results
  • Remove foods triggering inflammation or immune activation

3. Gut Barrier Repair Support

  • L-Glutamine: Supports mucosal healing, reduces inflammation, and improves gut integrity
  • Probiotics: Especially Bifidobacterium and Saccharomyces boulardii, which help reduce gut permeability and improve immune modulation
  • Oral immunoglobulins: Block zonulin from binding to epithelial receptors and prevent tight junction disruption


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Betaine

Betaine (Trimethylglycine): System-by-System Benefits and Why It Matters

🧬 What Is Betaine?

Betaine—also known as trimethylglycine (TMG)—is a naturally occurring compound found in foods like beets, spinach, quinoa, and whole grains. It plays a vital role as a methyl donor, helping regulate key biochemical reactions throughout the body, including detoxification, neurotransmitter balance, and liver metabolism.

🔝 Why Should People Consider Betaine Supplementation?

While betaine is present in a healthy diet, many individuals do not get enough—especially those with:

  • Poor methylation (e.g., MTHFR mutations)
  • Elevated homocysteine
  • Fatty liver
  • Hormonal imbalances
  • Increased toxic load or inflammation

Supplementing with betaine can enhance cellular function, reduce cardiovascular risk, and support multiple systems, particularly under stress or with aging.

🧠 Nervous System & Brain Health

  • Supports methylation of neurotransmitters like serotonin, dopamine, and norepinephrine.
  • May help improve mood stability, cognitive performance, and focus—especially in those with folate or B12 deficiencies.
  • May reduce brain fog and support overall mental clarity.

❤️ Cardiovascular System

  • Helps lower homocysteine, a known risk factor for stroke and heart disease.
  • Improves methylation efficiency, potentially lowering inflammation and oxidative stress.
  • May support vascular elasticity and endothelial function.

🏃 Muscles & Physical Performance

  • Some studies suggest betaine enhances muscle power, endurance, and body composition.
  • May support recovery from exercise and reduce fatigue in athletes and aging adults.

🍽️ Liver & Digestive Health

  • Aids in the breakdown of fats in the liver, making it useful for NAFLD (non-alcoholic fatty liver disease).
  • Helps maintain healthy bile flow and reduce liver enzymes.
  • Promotes methylation-dependent detox pathways, supporting gut-liver axis function.

💢 Inflammation & Immune Health

  • Improves antioxidant defenses by maintaining glutathione and S-adenosylmethionine (SAMe) levels.
  • May reduce systemic inflammation and protect tissues from oxidative stress.

🧬 Genetic & Hormonal Regulation

  • Essential for healthy methylation of DNA, hormones (including estrogen and cortisol), and detox intermediates.
  • Especially useful for those with MTHFR polymorphisms, where methylation efficiency is reduced.

🧓 Who May Benefit Most?

  • Adults over age 40, as methylation and detox capacity decline with age.
  • Those with chronic fatigue, elevated homocysteine, fatty liver, or a high-stress lifestyle.
  • Individuals with a family or personal history of cardiovascular disease, mood disorders, or MTHFR mutation.
  • People on high-protein diets, which increase the demand for methyl donors.

🍎 Can You Get Enough from Food?

Yes—but often not enough for therapeutic purposes. Rich sources of betaine include:

  • Beets
  • Spinach
  • Whole grains (quinoa, wheat germ)
  • Shellfish

However, cooking can reduce the bioavailability of betaine, and diet alone is often insufficient in people with methylation deficiencies or increased needs.

💊 Supplemental Forms & Dosing

Typical dosing ranges from 500 mg to 2,000 mg per day, taken in divided doses. It may be used alone or combined with methylfolate, B6, and B12 in a full methylation protocol.

Always consult with a provider before starting, especially if you have:

  • Kidney disease
  • Uncontrolled cholesterol
  • Hormone-sensitive conditions

🔄 Long-Term Use: Is It Safe?

Betaine is generally safe when used in appropriate doses. Long-term studies show benefits in:

  • Reducing liver fat
  • Improving homocysteine levels
  • Supporting detox and DNA methylation

Possible side effects at high doses (>3 g/day) include:

  • Gastrointestinal discomfort
  • Fishy body odor (rare, due to TMA buildup)
  • Possible cholesterol increase in some individuals

📝 Final Takeaway

Betaine is a well-researched, multifunctional nutrient that supports the brain, heart, liver, and genetic health through its role in methylation and detoxification. While it’s found in food, many people—especially those with genetic variants or chronic conditions—may benefit from targeted supplementation.

✅ Consider betaine if you are:

  • Over 40
  • Experiencing fatigue, brain fog, or poor detox
  • Managing elevated homocysteine or fatty liver
  • Supporting your body during hormone therapy or high physical/mental stress


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Patient Handout: Testosterone Therapy for Women





What is Testosterone Therapy? Testosterone is an essential hormone in both men and women. In women, it supports libido (sex drive), energy, mood, focus, bone strength, and muscle tone. Levels naturally decline with age, especially during perimenopause and menopause.

Why Consider Testosterone Therapy? You may benefit from testosterone therapy if you have symptoms such as:

  • Low libido or difficulty with arousal
  • Fatigue and low energy
  • Mood swings, irritability, or anxiety
  • Brain fog or poor focus
  • Reduced muscle tone or increased body fat
  • Poor sleep or lack of motivation

How It Works We use a customized testosterone cream made by a compounding pharmacy. It is applied to the skin daily and absorbed into the bloodstream. Your dose is based on your symptoms, hormone levels, and response to treatment.

How to Use

  • Apply 0.25 to 0.5 mL of testosterone cream once daily
  • Apply to clean, dry skin: inner thighs, labia majora, or inner forearms
  • Rotate application sites daily
  • Wash hands after application

What to Expect You may start noticing improvements in:

  • Libido and sexual satisfaction (1–4 weeks)
  • Mood and energy (1–2 weeks)
  • Muscle tone and strength (4–6 weeks)

Follow-Up and Monitoring We monitor your progress with regular labs and check-ins:

  • Blood tests: Free and Total Testosterone, SHBG, Estradiol, DHEA-S, CBC
  • First follow-up labs: 6–8 weeks after starting
  • Dose adjustments as needed

Safety and Side Effects Most women tolerate testosterone well when used correctly. Potential side effects (usually dose-related):

  • Mild acne or oily skin
  • Increased body hair (rare)
  • Mood changes if overdosed
  • Voice deepening (rare with appropriate dosing)

Important Notes

  • This is not the same as taking "male doses" of testosterone. Women's doses are very small and carefully adjusted.
  • Combining testosterone with progesterone and/or estradiol may provide additional benefits, especially in menopause.

Contact Us If you experience any side effects or have questions, contact our clinic. Your comfort, safety, and well-being are our priority.

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