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Menopause Made Easy

Ok, let’s face it…every woman will transition through menopause, whether they like it or not. For some of us, it happens without any fanfare. One day your period is gone, and you’re done! (Yes, ladies, this does happen for some women). For others, it is a nightmare with hot flashes and sweats during the day and night, often ruining what used to be a good nights’ sleep. Other symptoms may include difficulty with memory, sometimes called ‘mental-pause’, low sex drive and painful intercourse when you do decide to make it happen.

So what is going on? One theory is that estrogen receptors in the brain become starved of estrogen, and this affects temperature regulation and memory. While this makes a lot of sense, there has to be more to it than that because all women have a loss of estrogen during menopause, but only some women suffer symptoms. To understand this, let’s look at the other influences on your hormones that could be the culprits.

First, you must look at your entire endocrine orchestra and make sure all of your hormones are working optimally. These include your thyroid hormones, your adrenal hormone cortisol, and also your blood sugar hormone insulin. If any of these are out of balance, your sex hormones will be too, and you are more prone to having menopause symptoms.

Second, you must look at your detox system and make sure your liver is doing a good job of processing both every day toxins and metabolizing your hormones properly. Even after menopause you should have some healthy estrogens in your body, and these need to be processed. Faulty estrogen metabolism can result in more symptoms.

What can you do? Here are 5 tips to help make menopause a non-event.

  1. Eat for hormone balance. This means eating protein (vegetarian or animal) and plants rich in fiber with all meals and cut out the processed sugar. This will keep your insulin in balance. 
  2. Have your thyroid checked, including the hormone T3. If you are already hypothyroid, make sure you aren’t taking too much or too little medication. 
  3. Do an adrenal saliva test to make sure your adrenals are healthy. An integrative practitioner can help you do this.  Live in our neighborhood? You can have a consultation with one of our practitioners at Blum Center for Health for testing.  
  4. Improve your estrogen metabolism by eating cruciferous vegetables, rosemary. Consider trying the supplements DIM (Di-indole methane), methylfolate and methylcobalamin. 
  5. Beware of alcohol and caffeine. They can make your temperature system go haywire during this time of transition. 
  6. Consider a safe and medically sound liver Detox program.  Renew your body by eliminating your toxic load and resetting your hormones. Try our 14-Day Whole Life Detox. 

Try one or more of these steps and evaluate how you feel.  Let me know how you are doing! 

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The Functional Medicine Approach to Breast Cancer Prevention

Breast cancer is a health issue that most women will think or worry about at some point in their lives. One of the reasons is because we hear so much about breast cancer these days: in the media; through fundraising organizations; and from family and friends facing the diagnosis. Another is because it has become much too common. Perhaps you, or someone close to you, are a breast cancer survivor.

October is Breast Cancer Awareness Month, and we want to honor and support all women by highlighting our Functional Medicine approach to the prevention of breast cancer, whether the focus is on primary prevention, or prevention of recurrence. 

Because research shows that how you metabolize estrogen can increase your risk, we focus on supporting estrogen detoxification, a process that happens primarily in the liver.

HOW MUCH ESTROGEN DO YOU HAVE?

Many women believe that after menopause they aren’t making estrogen anymore.

This is not true. 

Before menopause, estrogen is produced in several places in the body, including the ovaries, adrenal glands, and produced from testosterone by the enzyme aromatase in fat cells. After your ovaries have been removed or you have gone through menopause, estrogen is still being produced, in low but measurable amounts, by these other tissues. 

You might wonder: since we all have estrogen, why do some women, and not others, end up with breast cancer? 

Well, it turns out that all estrogens are not the same, and these differences are influenced by genetics and the environment.

When estrogen is processed for elimination, the hormones are sent to the liver where they are metabolized, a process also called detoxification. During the estrogen detox process, you can end up with “bad” estrogens or “good” estrogens. The bad ones are considered “toxic” because they are very strong stimulators of estrogen receptors (causing more cell proliferation), and they can damage DNA, as opposed to the “good” estrogen metabolites that are weaker estrogens and not harmful to cells. Of course, the “good” estrogens are preferable!

Although our genetics influence how easily we make the good and bad estrogens, it turns out (no big surprise!) that food and other lifestyle factors have an enormous effect on the kinds of metabolites the liver will make. Influencing your estrogen detox pathways in a good way is what we focus on for breast cancer prevention at Blum Center for Health.

IMPROVE YOUR RATIO OF GOOD:BAD ESTROGENS

Our first step to help you reduce your cancer risk is to increase your good estrogens, and decrease the bad. 

Top 4 Ways to Reduce Your Breast Cancer Risk 

  • Eat lots of food that supports estrogen elimination and detoxification pathways, including:
    1. Lots of antioxidants and cruciferous vegetables like kale, broccoli and cauliflower
    2. Fiber from fruits and vegetables helps you excrete estrogens via the gut.
    3. Soybean that is organic and non-gmo, and in its whole form, like edamame or tofu. Or, fermented soy like tempeh or miso. Soy has a very gentle and positive effect on estrogen receptors and is actually good for most women.
    4. Ground flax seeds:  can block the conversion of testosterone to estrogen, thus lowering your levels.
  1. Consider taking the supplement Di-indolylmethane, or DIM, or it’s more powerful cousin, Sulforaphane, which are basically the active component extracted from cruciferous vegetables. This can improve the good:bad estrogen ratio with the goal of decreasing your risk of breast cancer. We also recommend it to reduce symptoms of too much estrogen, such as fibrocystic breasts, uterine fibroids or heavy painful periods. This condition is called estrogen dominance.
  2.  If you want to know more about your personal risk, genetic testing can be done to evaluate your probability for making bad estrogens, and urine testing can be done to assess your current ratio of good:bad estrogens. With these test results, we can determine how to use food, supplements and mind-body practices to increase good estrogen levels and lower bad ones. These tests are available from our Functional Medicine nutritionist or practitioners.
  3. Lower your total toxin load.  In addition to targeted support for detoxing and eliminating estrogens, keeping your general toxin load and exposure low is very important because environmental toxins like herbicides and pesticides can push your estrogens down the “bad” pathways. We recommend cleaning up your exposures, and supporting your liver with a general detox program. How to do this?  Read on!   

HOW TO REDUCE YOUR ENVIRONMENTAL EXPOSURES AND LOWER TOXIN LOAD

We always recommend doing a simple Liver Support Detox program in the spring and fall to help keep these toxins from building up in the body and causing problems. Check out our do-it-yourself 14-Day Whole Life Detox to get startedAdd a bottle of Broccoprotect (sulforaphane) if you are concerned about your estrogens and you’re all set.  

And if you are confused about what to do?  Make an appointment with our health coach, Melissa Rapoport! She will help you form a plan to reduce your toxic load and bring balance back to your body. Either call 914-652-7800 to set up an in-person appointment, or go to CoachMe to set up a video or phone appointment. 

Want to learn more about detoxification? Check out these detox blog posts.

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How Stress Effects Your Heart and What You Can Do About it

For those of you who know me, either personally or professionally, you know that Mind-Body-Spirit self care strategies are at the core of what I practice and preach for preventing and treating chronic disease.  I meditate every morning and spend lots of time in nature. But more than this, I teach others about how stress affects your health and offer tools to do something about it.

For this month, I offer a guest blog on this topic from my friend and colleague, Dr Alon Gitig, a gifted cardiologist who I work with to help my patients get the best care, including prevention and treatment of various conditions.  Mind-Body Medicine for too long has been the step-sister to conventional medicine, but now you can see for yourself that it’s not any more!

Enjoy this perspective from a traditional cardiology practice!

Susan Blum, MD, MPH

 

Guest post by By Alon Gitig, MD, FACC

Health blogs talk a lot about “mindfulness” these days.  Many of us have read claims that controlling our emotions can improve our health, and are left wondering whether there’s evidence to support this.  Research into mind-body techniques is accumulating, as investigators look for ways to lower the risk of chronic diseases above and beyond the proven—yet incomplete–benefits offered by medications.  In the field of cardiology in particular, despite major gains in the past 50 years, there is still an unacceptably high burden of heart disease, even when people are well-treated with evidence-based therapy.  Let’s take a look at the evidence base behind whether stress management might help tackle this problem.

Psychological stress can have profound effects on our bodies.  

Studies suggest that up to 60-80% of all primary care visits are related to manifestations of stress.  A Mayo Clinic analysis identified stress as the most powerful predictor of cardiac events, while other studies indicate that mental stress predicts cardiac death more strongly than cigarette smoking.  Depression roughly doubles the risk of heart attack. Both anxiety and anger have been linked to a 6-fold increased risk of cardiac events, including arrhythmias and sudden death.

Stress activates the sympathetic nervous system, with potential effects on blood pressure and heart rate.  There is also evidence that elevation in cortisol levels, increased platelet clotting, and abnormal reactivity of artery walls might be triggered by psychological distress.  What’s more, the brain may also directly affect the heart via descending nerve pathways.  Amazingly, recent research reveals that subjects who intentionally generate positive emotions, such as gratitude, influence the heart’s beating into a pattern that is associated with healthy cardiovascular function and decreased risk of arrhythmic death.

These observations prompted studies attempting to improve health outcomes via stress-reduction techniques, such as meditation, yoga, and biofeedback.  Results have been mixed, confounded by practical, methodological limitations inherent in conducting such trials. Not surprisingly, all of these modalities have generally led to significant improvements in psychological well-being, both in healthy volunteers and specifically in cardiac patients.

Some studies have demonstrated improved control of cardiac risk factors as well.  Statistically significant reductions in blood pressure or resting heart rate have been achieved in patients with coronary disease, congestive heart failure, and atrial fibrillation.  Interestingly, the magnitude of blood pressure lowering in some studies (i.e. 10 mmHg) mimics that seen in certain trials of hypertension drugs.

The data suggest that clinical symptoms and physical functioning can benefit from relaxation techniques as well.  Patients with established coronary disease randomized to a 24-day intensive stress-management program experienced less angina episodes compared to baseline (versus no change in the control group).  These patients also exercised longer on follow-up treadmill tests, and demonstrated improvements in blinded measurements of cardiac function.

Of note, a strict vegan diet was part of the experimental regimen, hence the impact attributable directly to the relaxation intervention is uncertain.  Several studies of congestive heart failure patients treated with meditation or yoga demonstrated improvements in symptoms of breathlessness and fatigue, along with improved walking distance on standard 6-minute walk tests.  Here too, the magnitude of the increase in distance walked was comparable to benefits seen in trials of drugs for angina and pulmonary hypertension. Three months of yoga therapy in atrial fibrillation patients resulted in less symptoms and fewer detected arrhythmia episodes on wearable heart rhythm monitors.

But do these techniques prevent heart attacks or prolong life?  Believe it or not, there are two studies demonstrating reduced long-term risk of death following 3 months of meditation training.  Since the magnitude of benefit observed was far greater than would be expected from the brief exposure to meditation, these results are intriguing, but far from definitive.

So what’s the bottom line on stress?

First, it’s clear that psychological stress, anxiety, and other adverse emotional states often cause or exacerbate a variety of symptoms, and that relaxation practices can offer symptomatic relief.  Furthermore, evidence supports that emotional-regulation tools are very safe. For these reasons, two separate American Heart Association committees have endorsed their use as “reasonable to consider” in the care of cardiac patients.

For many people, the benefits of improved emotional equilibrium are motivation enough to try out these practices.  If you’re hoping that your yoga class will control your palpitations, improve your exercise tolerance, or cut your risk of heart attack, there’s no guarantee.  But if you are struggling with persistent symptoms despite your doctor treating you with the best available, evidence-based care, then there’s reason to be optimistic that mind-body practice may offer you the extra relief you’re looking for, with little to no downside to giving it a try.

By Alon Gitig, MD, FACC
Mount Sinai Riverside Medical Group
Yonkers, NY

Do you suffer with stress and arthritis? If you are interested in learning how to become resilient to life’s stressors, and what your gut has to do with arthritis symptoms, join Dr. Blum for a FREE Arthritis Masterclass on 1/22.  Save Your Spot

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9 Easy Ways To Boost Your Health This Summer

When it comes to summer health care we often hear about the need to apply sunscreen, wear sunglasses to protect our eyes, and hydrate, hydrate, hydrate.

But the longer days of sunlight and warm weather create an opportunity to buoy our health in ways that impact our lives well into the Fall. Check out these summer health tips to deepen and expand the health of your body, mind and spirit.

9 Easy Ways To Boost Your Health This Summer

  1. Enjoy Summer’s Seasonal Bounty – Oh, the ecstasy of summer foods! Cherries, watermelon, peaches, tomatoes, corn, arugula, rhubarb, melon, berries — it is a feasting bonanza. Take a walk through any farmer’s market and delight in all the produce summer has to offer. Get it while you can!
  2. Deepen The Spiritual Awakening of Spring — We commonly “Spring Clean” our lives, cleaning out the cobwebs physically, mentally and spiritually with greater attention toward renewal. Deepen this “awakening.” For instance, did you declutter any part of your home? Think about the emotional and mental impact this had and delve into how incorporating a “no-clutter” attitude, replete with loving every item in your home, amplifies your overall wellbeing. Or, did you perhaps “Spring Clean” your body? Think about how well you felt after the cleanse and consider adapting a cleanse-like mentality to your everyday nutrition.
  3. Take Advantage of the Weather — In other words … be outside every moment you can! Don’t sleep away your weekends. Get up, get active, and enjoy every moment of the gift of long warm days.
  4. Try Something New — It’s a great time of the year to try out an abundance of activities. Landscape painting, trapeze school, any number of outdoor sports (have you always wanted to know how to play lacrosse? Join a summer beginner’s league.), surfing, bicycle touring, or whale watching. Make a list and go!
  5. Slow Down — Summer is chock full of delights for the senses. Meander through a botanical garden, plant an herb garden (even on your window sill!), or enjoy your local farmer’s market or take a sunrise walk before the hustle bustle of the day starts. See, smell, taste and the joys of summer. Take the time to notice the seasonal changes from day to day.
  6. Experience Nature — Research shows that walking in green spaces reduces stress and increases calm, creativity and productivity. But beyond the health benefits connecting with nature allows us to connect with the Earth. It serves as a reminder of our joined destiny, our interdependence, that we are connected to the trees, the plants and all the little creatures big and small that share it with us.
  7. Relax and Breathe — Create the time to hang out in a hammock, sit on a beach, find a shady spot under a tree in your favorite park and mindfully breathe. There’s something about summer that makes it particularly easy to cultivate a breathing practice. Breathe, stretch, read, write — all great ways to spread your wings, find your voice and connect to your source.
  8. Visit A Farm — Farms are aflutter with life! Baby animals, growing plants — visiting a farm gives us an opportunity to connect with our life source! We are accustomed to food arriving on our plate without giving thought (or thanks!) to its origin. When we become aware on a conscious level, our relationship to the food we eat changes. We slow down and appreciate all the work that went into the food we are about to consumer.
  9. Volunteer — With so many hours of daylight it’s a great time of the year to volunteer out of doors. Walking trails, nature trails, community gardens, farms, and conservancy organizations would all welcome your help. Meet other like-minded people, give back to your community and experience the boost in mood and wellbeing that service provides.

What summer health tips would you add to this list? Let us know!

Are you feeling the effects of too much summer fun — weekends full of parties, BBQ’s and cocktails? At about midway through July many people feel heavy, bloated and blah. Join our 10-Day HealMyGut Summer Reboot — it’s exactly what you need to bring your intestinal flora back into balance. Relief is on the way! (And, it’s on special for the month of July!) Get the Special Price Now

Meet Melissa: Melissa Rapoport is the Manager of Health Coaching and Lifestyle Programming at Blum Center for Health in Rye Brook, NY. She combines her graduate work in Developmental Psychology with her education in nutrition, health and coaching to create highly individualized programs that result in lifetime change. A contributing author to three international bestselling books, Melissa’s greatest joy is her relationship with her two daughters.

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Viewing Depression Through a New Lens

Many people accept depression as natural or even earned.  But everyone deserves full access to their rich potential, which is why treating depression first starts with acknowledgement. Once acknowledged, the next step is searching out proper care for ailing self and loved ones.  

Careful diagnostics are necessary to identify the specific type of depression and what factors underlie it. Diagnosis drives treatment. We need root cause insight into why one is depressed.  Then a comprehensive and personalized treatment plan can be developed regardless of the cause, because there is always something constructive to be done to help.

In the case of major depression, medical assessment, psychodynamic interview, exploration of mental health history, and detailed psychiatric categorization combine to reveal sophisticated diagnostic conclusions. A thorough workup is productive. And a comprehensive treatment plan maximizes the likelihood for an optimal outcome.  

Orthodox, functional and holistic medical interventions often make a huge difference. Direct manipulation of brain chemistry by medicines – natural or synthetic or nutraceutical –  can be profound.  Various psychotherapeutic interventions can bring sizeable reward. A major facet of an inclusive strategy for managing depression is self-help and the nurturing of self-perception that emphasizes patient empowerment and health over passivity, powerlessness/valuelessness, and sick role. Healthy lifestyle also plays a key part in supporting optimal mental health. And an enriching doctor-patient relationship is a virtual prerequisite to push patient health forward.

Many Depressions, Many Treatments

There is depression like, “These hapless New York Knicks depress me.”  And there is depression like “I am ill, with overall dysfunction, and with loss of interest in things.”  This kind of depression can come wIth sadness, plus hopelesssness and worthlessness, with lethargy and apathy.  It can even come with changes in eating and sleeping or with suicidal thinking. Same word, two very different entities.  Different causes.

Depression can have many different root causes.  Once we determine the root cause, the treatment can be targeted and personalized.  Underlying causes include:

  • Bipolar disorder  
  • Various metabolic, neurological, immunological inflammatory and infectious diseases cause depression.  
  • Substance abuse is a prime culprit for depressive outcomes.
  • Traumas, catastrophes and maladaptations will fuel depressive reactions.
  • Environmental and interpersonal “toxins” feed depression.  
  • Certain Psychodynamic and personality features tilt one towards mood problems.  
  • A biochemical predisposition to depression  will result in episodic, seasonal, and chronic depressive states.  

Here’s the Great News: Depression Can Be Reversed

Sufferers with major depressive disorder and dysthymic disorder (chronic depression) alone represent the second most costly disease on planet Earth and number roughly one in seven of us! All forms of depression ruin lives and can be reversed. Major depression alone is a devastating illness but it is amenable to improvement.  Nothing works better than a comprehensive, integrative, game plan. Let’s make one for you.

 

Dr. Stephan J. Quentzel, MD, MA, is an Integrative Psychiatrist at Blum Center for Health.  In his practice, Dr. Quentzel sees teenagers and adults for the widest of psychiatric concerns. He integrates brain sciences and psychiatry with general medicine, psychopharmacology, psychology, philosophy, ecology, psychotherapies, preventive medicine, herbal pharmacotherapy and nutritional studies, self-help, lifestyle improvements,  and the healing strength of compassion,  all in pursuit of optimal broad health and happiness for each client, specific to their unique needs and interests.  Man an appointment with Dr. Quentzel at 914-652-7800.

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Hypothyroidism: A Silent Epidemic

Guest post written by Jill Grunewald

If you’re even loosely tuned into online health communities, it probably seems as though “thyroid” is all the rage. Everyone appears to be talking about it. But that doesn’t mean that addressing—or assessing—thyroid health is a fad or “the next big thing.”

In fact, although the thyroid is a tiny gland, it is a big thing.

Why? Because every cell has thyroid hormone receptors. This is why the symptoms of hypothyroidism can run the gamut from mild fatigue to pronounced depression, for example. Additionally, more and more women—and to a lesser but no less concerning degree, men—are being diagnosed with hypothyroidism or low thyroid function. The problem is even starting to affect young girls, for reasons discussed below.

Hypothyroidism as a condition isn’t new. Lab testing for thyroid function has been around since the 1950s. You may have had a grandma or great aunt who had a “glandular problem,” which often meant they were hypothyroid.

What is the Thyroid?

This little butterfly-shaped gland in our neck is the maestro of our endocrine (hormonal) system. I like to refer to it as the spoon that stirs our hormonal soup.

Thyroid hormones—primarily T3 and T4—play a significant role in energy and metabolism. This is why the thyroid is often called “the master gland of metabolism.” These hormones also influence the brain, gallbladder and liver function, body temperature regulation, the gastrointestinal tract, our reproductive and cardiovascular systems, red blood cell metabolism, steroid hormone production, and bone metabolism.

The thyroid takes a mineral and an amino acid, iodine and tyrosine respectively, and converts this combination into T3 and T4. T3 is the most biologically active thyroid hormone—it’s what helps keep us lean, sharp, and warm.

Familiar symptoms of hypothyroidism include:

  • Fatigue
  • Brain fog
  • Constipation
  • Depression
  • Weight gain/weight loss resistance
  • Hair loss, including outer third of eyebrows
  • Dry skin
  • “Thyroid hair” (dry, brittle hair)
  • Weak reflexes
  • Feeling cold when others are comfortable

Symptoms often not recognized as being associated with hypothyroidism include:

  • High cholesterol
  • Edema/fluid retention (often present around the eyes/face)
  • Recurring infections
  • Going prematurely grey
  • Low libido
  • Anxiety
  • Headaches
  • Infertility
  • Miscarrying
  • PMS
  • Pronounced morning fatigue
  • Being stiff and achy upon waking
  • Digestive issues
  • Irregular menstrual cycles
  • Parched mouth
  • Gravely voice

One of the reasons that hypothyroidism is a silent epidemic is that too many of the above symptoms are viewed in isolation—too often, an underactive thyroid isn’t suspect. If you’re depressed, you may get a prescription for an antidepressant. If you’re constipated, a laxative. If you’re gaining weight or weight loss resistant, a recommendation to eat less and exercise more. If you’re struggling to get pregnant, a suggestion to try IVF.

To complicate matters, even when thyroid function is tested, it’s often not evaluated thoroughly—doctors often run a simple TSH (thyroid stimulating hormone) test, which only tells a small part of the story. TSH should always be taken in the context of other thyroid hormones, especially considering that TSH can be within normal limits in the face of hypothyroidism. These additional labs include Free T3, Free T4, Reverse T3, and thyroid antibodies that could show the presence of Hashimoto’s (autoimmune hypothyroidism): thyroperoxidase antibody (TPOAb) and thyroglobulin antibody (TgAb).

Hypothyroidism: Root Cause?

Hashimoto’s is the most common form of thyroid dysfunction—it’s estimated that over 90% of people with low thyroid function have the autoimmune form of the condition. In fact, Hashimoto’s is the most universal autoimmune disease and it’s estimated that 30 million women alone have it, whether they know it or not.

Historically, iodine deficiency has been considered the culprit, but this too tells a small part of the story. Today, iodine-deficient low thyroid function, without the autoimmune component, is unusual, but that’s not to say that those with Hashimoto’s can’t be low in this important mineral.

Other, “modern” causes of hypothyroidism/Hashimoto’s include:

  • Exposure to environmental toxins (including heavy metals and pesticides) *
  • Unrelenting stress, which can result in adrenal dysfunction/HPA axis dysregulation
  • Systemic/cellular inflammation
  • Intestinal permeability
  • An infection
  • Nutrient deficiencies

* Environmental toxins in the form of chemicals added to skin care and cosmetics products is why we’re seeing Hashimoto’s—and other forms of autoimmunity—much more frequently in the female population, including younger and younger women. As Dr. Susan Blum states, “. . . every chemical you are exposed to adds to your toxic load. Having a high toxic load makes it harder for your liver to handle pesticides and environmental estrogens, toxins that we know will affect your immune system.”

Spotlight: Nutrition for the Thyroid

Perhaps you’ve already been diagnosed with hypothyroidism or Hashimoto’s. You may be on thyroid hormone replacement—or maybe not. Regardless, the thyroid is extremely nutrient dependent and being mindful of your diet is critical for managing Hashimoto’s and giving your thyroid the nutritional love it so depends on.

Eating minimally processed foods with naturally occurring vitamins, minerals, amino acids, and phytonutrients is one of the best ways to support the thyroid—and immune system.

Genetically modified foods (GMOs), artificial sweeteners and additives, toxic oils, and antibiotic- and hormone-laden foods—all part of the standard American diet (SAD, and yes, it really is sad), trigger oxidative stress, which in turn affects how our cells communicate. Knowing that every cell has receptors for thyroid hormone, it’s not difficult to recognize how a diet deficient in key nutrients can disrupt this cellular communication.

So, what are these key nutrients?

I spent many weeks digging deeply into thyroid- and immune-supportive nutrition and then identifying foods rich in those nutrients. This meticulous research and subsequent ranking system became the foundation, the “nutritional springboard” for my best selling cookbook, The Essential Thyroid Cookbook.

This first-of-its-kind cookbook will leave no trace of doubt that our recipes are uniquely beneficial to your thyroid and immune system. They’ll support you for a lifetime of peak thyroid function no matter where you are on your wellness journey.

And finally, as for the multi-faceted nature of hypothyroidism symptoms, often, they no longer need to be seen as silos warranting individual treatment. Support the thyroid and immune system, and likely, you’ll see far-reaching improvement with these previously maddening symptoms.

Jill Grunewald, HNC, is an integrative nutrition and hormone coach and best selling author of The Essential Thyroid Cookbook.

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3 Steps to A Healthy Blood Sugar Level

Here’s a common scenario: You see your primary-care doctor for your annual physical, and you are told your sugar is a little high, and you may even have “pre-diabetes”….and you think, wait, what?  And the news keeps on coming. Your insulin may be “a little” high as well, or your cholesterol markers show a less than perfect balance.  If the numbers are mild, you’re usually told to “eat better, lose weight, exercise”, and if the numbers are really bad, you’re told to start medication.

Without a clear understanding of what these markers mean and how these early imbalances in your sugar system can eventually become full-blown pre-diabetes and then diabetes, you might have little motivation to do the work to change them.  And while yes, lifestyle change can feel like work sometimes, you might be surprised to find that some simple changes will do the trick. Perhaps you are a little overweight, are a little stressed out, and/or you aren’t exercising much.  Addressing these things with some simple suggestions, can really make a big difference, and that’s why it’s important to take these early abnormal numbers seriously, because now is the best time to reverse the direction that you are heading in.  

My goal for our discussion today is to first make it clear that if you ignore these first subtle changes, you will likely find yourself with a bona-fide disease down the road.  But even now, the high sugar in your blood is inflammatory and damages your blood vessels and organs. This is a huge issue!  There are 84 million people currently diagnosed with pre-diabetes (and rising!) and you don’t want to end up with type 2 diabetes, which is a major contributor to heart and vascular disease —  the leading cause of death in the developed world.   

That’s why, now is the time to do something about it.

And the good news? High blood sugar, pre-diabetes and yes, even if you already have diabetes, these are all reversible!

4 Steps to Reverse Pre-diabetes

Step 1: Recognize the implications this has on your health.

The first step is to listen to your body and understand what it’s trying to tell you.

Here is what you need to know to tune into your blood sugar system:

  • Know your risk: At Blum Center for Health we generally screen everyone for early blood sugar abnormalities and diabetes using a simple blood test. I screen for insulin resistance and pre-diabetes in patients who are older (over 45), overweight, physically inactive, have family members with diabetes, gave birth to a baby over 9 pounds (or had gestational diabetes), have PCOS, and/or have other risk factors for heart disease – like high cholesterol or high blood pressure.  

 

  • Check these labs:  The list of labs includes fasting glucose, fasting insulin, and hemoglobin A1C (a measure of the average sugar in the blood over a period of time). We do advanced cholesterol testing, because higher triglycerides and lower “good” cholesterol gives clues to insulin resistance.  Sometimes we do glucose tolerance testing, where we look at the amount of sugar and insulin in the blood after drinking a sugary drink. This tells us how hard the pancreas is working to produce enough insulin to decrease sugar in the blood.

Step 2: Make impactful changes to your health.  

Here is the good news.  Catching diabetes before it manifests and treating insulin resistance is relatively straightforward, although you do have to commit to some permanent changes, which for some people can be difficult. The lifestyle changes that improve the entire spectrum of metabolic and blood sugar issues are tried and true. In fact, lifestyle changes have been shown to improve numbers in these early stages of diabetes more than medication.

Focus on these 3 lifestyle behaviors to improve your personal glucose system:

  • Diet –  Eating a higher protein, higher fat and lower simple carbohydrate diet is key.  There are many nuances to this, and we suggest working with a nutritionist or health coach to help you figure this out, because it is the quality of the protein, fat and carbohydrates that counts as much as the amounts.  Also, losing weight helps – even a 5% drop in weight (about 8 pounds for a 150 pound person) will improve insulin resistance. I refer nearly all my pre-diabetic patients to our Functional Medicine nutritionist or our Health Coach to create a personalized food plan that dovetails your individualized treatment plan. Learn More If you live far away, you can also work with our Health Coach online!  Sign up HERE.
  • Exercise – Physical activity allows muscles to use up the sugar from the blood which lowers blood glucose and improves insulin sensitivity. Just 30 minutes of exercise, 5 days a week will help. Brisk walking after meals recruits muscles to move glucose from the blood.
  • Sleep – Getting plenty of restful sleep is good for us in so many ways, metabolizing sugar being one of them. Disturbed sleep and sleep apnea is correlated with the spectrum of sugar dysregulation.

Step 3:  Get the support you need!

Once you begin to make changes to your daily habits, you might need support to keep you focused and in the game!  What can this look like?

  • For some people, support is letting everyone around you know what your health concerns are, and why you’ve decided to work on new food and exercise goals. Having your family, coworkers and friends on board can make it less likely for you to slip up.
  • Enlisting others to do it with you is another option that can be very satisfying for all involved.
  • For others, being mindful and collecting data about your food, activity, and sleep is what is key. Fitbits and other tracking devices, food diaries, and keeping careful logs of sugars can be very helpful for you and your doctor.  
  • Make sure you have a supportive medical team, including a doctor who is invested and spends time with you to encourage and follow your progress.  
  • One of the most powerful ways you can create positive change is by working with a Health Coach who will help you overcome obstacles and keep you focused on the prize. Learn More

Step 4: Monitor markers and observe progress.  

Keep track of your markers and notice when things change. I guarantee that if you make the changes above, to diet, movement, and rest – the numbers will move in the right direction.  If not, something else is brewing and needs our attention.

  • Tracking progress:  As I discussed above, there are many ways to track insulin sensitivity, prediabetes, and type 2 diabetes. Glucose and hemoglobin A1C are not the only biomarkers playing into this metabolic orchestra. Ask your physician to do more in-depth diabetic screening, advanced lipid testing and hormone testing. If you see a functional medicine doctor, adrenal testing can be telling, as can stool testing for a look into the gut microbiome. Further investigation into inflammatory markers, toxins, and nutrient status can also help guide overall health.

Live in the NYC metro area and want to learn more?

Join me for a community talk An In-Depth Discussion on Diabetes on Wednesday, November 15th at 7pm. Register Now! I will review how we treat these conditions from a functional medicine perspective – dietary guidelines, supplements, and medications that work.

Are you interested in meeting with me or one of my colleagues? We would be happy to help. People travel from all over the world to work with us. Come join our family!

If traveling to us is not possible, you can work with our Director of Nutrition or Health Coach by phone or Skype. Call 914-652-7800 for more information.

Meet Darcy McConnell, M.D.:  Dr. McConnell brings her broad expertise in prevention, mind-body medicine, and women’s health to Blum Center for Health, in Rye Brook, NY. She is board certified in Family Medicine and Integrative Medicine, with postgraduate training from the Institute for Functional Medicine. Darcy lives with her husband and three sons and enjoys the outdoors, cooking healthy meals for her family and friends and is an enthusiastic yogi.

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Surviving Menopause: Hormones, Herbs, and More

Woman practicing yoga for self-care

A common question from patients is: “Should I take herbs or hormones for menopausal symptoms, and if so, which ones?”

This is a huge topic and the truth is there is no “right answer.”

Treating menopausal symptoms needs to be based on each woman’s unique situation accounting for her personal history, family history, current health goals. Without question, estrogen replacement is the most effective treatment for hot flashes and other menopausal symptoms.

While hormone replacement isn’t for everyone, there IS a lot of buzz right now around bioidentical hormones. For you to make an educated decision, it’s important to understand the difference between bioidentical (often compounded) and non-bioidentical hormones (conventional), and when you might consider using them.  In my upcoming talk at Blum Center, and further down in this blog, we will review all of this information.

But, not everyone wants to take extra hormones or can’t take hormones for health reasons.  Well, hope is not lost!  I will review several herbal remedies and lifestyle changes that women can use successfully.  This is a meaty topic, so let’s dive in!

“Hot Flashes?  No Hormones?  No problem!”

Many women come to me seeking strategies to address things like hot flashes, vaginal dryness, sleep disruption, and mood changes without hormones. In this case we have SO much to offer. Conventional medicine offers several antidepressants that have been found to work for hot flashes: paroxetine and venlafaxine are some examples. Gabapentin is another option.  Unfortunately, these drugs do tend to have other unwanted side effects such as sleepiness, headache, nausea, dizziness, and more. Rest assured, this is NOT our approach at Blum Center!  You don’t have to take an antidepressant to get you through menopause!

Here are just a few of the options that we can offer you:

St. John’s Wort has been shown in multiple studies to improve women’s sense of wellbeing, decrease hot flashes, improve sexual wellbeing, and reduce overall menopause rating scores (Grube, 1999 and Abdali , 2010).  Studies show that improvement was seen after 2-3 months and dose is typically around 300 mg taken three times a day.  St. John’s wort is metabolized in the liver and can interfere with the metabolism of many other drugs, so always tell your doctor if you are taking it.

Panax Ginseng has been shown to improve menopausal symptoms of depression and well being, increase energy, decrease insomnia (Wiklund, 1999 and Tode, 1999).  The dose is typically a standardized extract of 200mg a day.

Sage has been shown to decrease sweating by up to 64% in women who have hot flashes (Bommer, 2011).  If you are using dried leaf in capsule or tea take 1000mg twice a day.

Soy, Red Clover, Kudzu all contain various isoflavones such as daidzein, genistein, and puerarin. These compounds act as weak estrogen receptor modulators. Data on isoflavones for hot flash relief is mixed. Some studies show a benefit, others do not.  The tricky thing about some of these compounds, like daidzein, is that it turns out your gut bacteria have to convert it into equol to have the biggest impact. But it is estimated that only 30-50% of humans are “equol producers.” This may account for why soy seems to help some women more than others when it comes to hot flashes.My suggestion is to try it for about a month and if you see no improvement then stop. For soy, I would rather see patients eat whole, organic soy foods such as edamame, tofu, soy milk instead of taking a pill. Food is always better than supplements and foods with whole soy proteins (not soy protein isolate) are better for you. As always, any food or herb that has estrogenic qualities, you must use with caution in the setting of an estrogen-related cancer. Additionally, soy in large quantities (three times a day) can impact your thyroid function, so ask your doctor if you need to limit it. Also, these could interact with platelet/anticoagulant medicines.

Black Cohosh has shown mixed results in studies for menopausal symptoms. Many studies look at Black Cohosh along with a few other herbs. This is common practice in botanical medicine, taking advantage of the synergistic effects that herbs can have when taken together. It does make it more difficult to know if individual ingredients are beneficial. Black Cohosh is generally well tolerated and I mention it because it shows up in a lot of supplements that are geared for women’s health, menopause in particular. It is unclear if Black Cohosh directly interacts with estrogen receptors in humans, but to be on the safe side, I would avoid this one if you are an estrogen receptor positive cancer.

Clinical Hypnosis can decrease hot flashes by 55% compared to 13% in one well designed randomized study of 187 women (Elkins GR, 2013).  Hypnosis also helped with improvement in hot flash interference, sleep quality, and treatment satisfaction.

Acupuncture has been shown in multiple studies to improve sleep disruption (Chiu, 2015).  Researchers did a summary review of 31 studies involving over 2400 patients and found there was significant improvement in sleep as well as changes in blood hormone levels of estradiol and follicle stimulating hormone. And the larger the hormonal changes, the bigger the improvement on sleep. Data on acupuncture for hot flashes, however, is mixed. It appears that when acupuncture is compared to no acupuncture, there is a significant improvement seen. But when researchers compare real acupuncture with sham acupuncture, they don’t see a difference. This indicates that at least for hot flashes, acupuncture probably has a strong placebo effect. In my opinion, when the placebo effect works in our favor, it is a wonderful thing and I think we should take advantage of it!

Yoga has also been shown to be beneficial for hot flashes and emotional symptoms like stress in multiple studies (Joshi, 2011 and Chattha, 2008). Yoga has so many health benefits that I recommend it to almost all of my patients. In this fast-paced world, the practice of yoga slows down our sympathetic nervous system which is integrally involved with hot flashes. One caveat: I don’t recommend hot yoga as that will most assuredly make hot flashes worse!

“I’m Fine with Hormones – Bring Back the Estrogen!”

There has been a lot of research in the past few decades looking at hormone replacement for menopausal symptoms and the field is constantly growing. As with most medicines, there are risks and benefits to consider when deciding if you want to take hormones and it is important to have that discussion with your healthcare provider, or come and see me to discuss, because your personal and family history influences this decision enormously. In general, we do believe that hormone replacement therapy, especially bioidentical therapy, in low dose for the first few years of menopause is safe for most women.

My approach?  I always use bioidentical hormones and aim for the lowest effective dose, and prefer topical or local estrogen to limit unwanted effects.

“Bioidentical, Synthetic, I’m Confused…”

Bioidentical hormones are compounds that exactly mimic the hormones that we have circulating in our bodies. Those bioidentical hormones may be synthetic, in the sense that they were made in a lab, and that is not necessarily bad. Two of the most common hormones prescribed in this country are not bioidentical: conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA). These compounds act similarly to our own estrogen and progesterone, but nevertheless, have actions in our bodies that are distinct.

Historically, we assumed that CEE and MPA would be equivalent to bioidentical hormones, but as researchers have begun to compare the two in head-to-head studies, we now know there are differences especially in the progestogens (Stanczyk, 2013). Consensus is now building that bioidentical progesterone is probably safer than MPA. Although CEE and MPA are the most commonly prescribed hormone replacement regimens in this country, there are plenty of FDA approved bioidentical options for us to choose from including estradiol pill, patch, or gel form as well as micronized progesterone in pill form.

“So What is Compounding?”

Compounding medicine is the practice of taking one or more individual ingredients and mixing them together in the lab and creating a new compound that isn’t otherwise sold as a brand name product. The new medicine can be specially formulated for an individual patient to avoid allergenic ingredients, create new doses, convert a pill to a cream, combine medicines into one, etc.

Having access to high quality compounding pharmacies is extremely valuable in expanding the range of pharmaceutical offerings to the public.  For example, one FDA approved bioidentical progesterone product on the market in the US. contains peanut oil which some women are allergic to. This is a prime example of when compounding progesterone is a life saver!

There are pros and cons to using FDA approved drugs vs compounding drugs. The advantage of using an FDA approved medicine is that the approval process is stringent in terms of demonstrating safety, appropriate dosing, and efficacy. Additionally, the FDA drugs and facilities are highly regulated. Also, since the majority of research has been done using FDA approved drugs, physicians feel more comfortable prescribing them as they have been thoroughly vetted in clinical trials.  [A side note: the drug companies are the ones that fund the bulk of research since they can afford to do so. It costs millions of dollars to carry out a large clinical trial and very few entities can fund those studies.] The disadvantage is that sometimes we might want to give a drug in a different form than is available. In terms of compounding, the advantage is the ability to tailor a medicine specific to the needs of an individual patient.  The downside is that there is not as much safety and efficacy data on individual formulas, nor as much regulation on the actual compounding pharmacies themselves.

My approach to menopause is to get to know my patient, figure out what her goals are for the menopause transition, determine her risk profile, and come up with the best treatment plan together.

Meet Dr. Fitz:  Bronwyn Fitz, M.D. is a board certified Obstetrician Gynecologist who is fellowship trained in Integrative Medicine. In her practice she melds traditional medicine with non-Western approaches, nutrition, botanicals, mind/body therapies and lifestyle interventions to help women address their gynecological and reproductive health concerns. Her interest in mindfulness and meditation led her to pursue a two-year Fellowship at The Arizona Center for Integrative Medicine, under the leadership of world-renowned Integrative physician, Dr. Andrew Weil.

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How Chasteberry Supports Women’s Health

Vitex agnus-castus, also known as Chaste Tree or Chasteberry is a powerhouse herb in women’s health. Indigenous to Central Asia and the Mediterranean, it has been used for thousands of years for menstrual irregularities, premenstrual syndrome, premenstrual dysphoric disorder, breast tenderness, infertility, and more. The Latin root: agnus castus means “chaste lamb” purportedly alluding to the ancient culinary use of Vitex (also “monk’s berry”) to curb libido in monks!   

Historical uses aside, what we DO know about Vitex is that it contains glycosides, flavonoids, essential oils, essential fatty acids (oleic and linolenic). It works at the level of the brain to decrease prolactin levels, increase progesterone levels, and bind opiate receptors — which might be how it improves anxiety, food cravings, physical discomfort associated with premenstrual syndrome (PMS). Vitex is approved by the German Commission E for use in menstrual cycle irregularities, premenstrual disturbances, and mastodynia (breast pain).

3 Reasons To Consider Taking Chasteberry

Do you have PMS?

There are multiple studies that validate chaste tree for gynecological problems including PMS. One well-designed study of 170 women compared Vitex to a placebo pill during three consecutive menstrual cycles and women who got the herb reported 52% improvement in symptoms compared to just 24% in the placebo group. Specific symptoms looked at in this study were irritability, mood changes, anger, headaches, breast fullness, bloating and ALL had significant differences between Vitex and placebo pills1.  

Heavy Bleeding

Many women suffer from heavy bleeding during their periods.  This can be especially true for women who have a copper containing intrauterine device (IUD). One prospective study of 84 women looked at Vitex compared to mefenamic acid (an anti-inflammatory medicine) to reduce heavy bleeding in IUD users over the course of 4 menstrual cycles. Researchers found that women in both groups had significant improvement in symptoms, 52% in the anti-inflammatory group and 46% in the Vitex group2. I look forward to seeing additional studies with more subjects and that include a placebo group to fully understand the role for Vitex.

Irregular Periods

Many women have irregular periods and are often prescribed progesterone to help regulate their period, either in the form of birth control pills or sometimes progesterone alone.  Since we know that Vitex increases one’s one progesterone production, it makes sense that we would use it to help regulate an irregular period. Additionally, chaste tree works by decreasing prolactin, which for some women is the culprit in causing too few periods. I always lean towards supporting your body’s ability to make its own hormones over prescribing additional ones, especially if the ones we give are synthetic progestins. After all, synthetic progestins (the type of progesterone in birth control pills) can cause side effects such as weight gain, bloating, acne, moodiness, hair loss: not what you are looking for when suffering already from period problems!

Chasteberry and Infertility: A Word of Warning

Some people take Vitex for infertility due to irregular periods since it increases progesterone. Adding progesterone during infertility treatments is quite common. The studies on Vitex for infertility are mixed, leaving us without firm conclusion that it will help you get pregnant. While historical use supports this approach, there is no safety data on Chaste tree during pregnancy or lactation. For these reasons, I do not recommend starting it specifically for fertility and I DO recommend stopping the herb if you become pregnant.  

How to Take Chasteberry

Chasteberry does take time to see full impact, so stick with it for at least three months before deciding if it is working for you.The dose is usually 200-500 mg a day of dried fruit or 20-40mg/d of extract standardized to agnuside or casticin. At Blum Center for Health, we use Chasteberry Plus, at the dose of 1 tablet in the morning and 1 in the evening, with or without food.  Because Chasteberry has an impact on your body’s hormone production, it is wise to avoid if you have a hormone sensitive cancer, are pregnant, or are nursing. It could potentially impact hormonal birth control. It could interfere with dopamine-related medicines, such as some medicines used in Parkinson’s and some antipsychotic medicines. Side effects are not common but include GI upset, headaches, fatigue, increase in menses, hair loss. Rarely women with a history of depression may see a worsening of their symptoms.  Before starting herbal remedies, if you are taking other medications or have any hormone related health issues, remember to always check with your doctor, or come and see me at Blum Center.

Live in our neighborhood and want to learn more about using herbs for women’s health? Make an appointment with Dr. Fitz!  In her practice at Blum Center for Health she takes a multi-pronged, holistic approach, a combination of medical and lifestyle considerations, to address, diagnosis and treat your condition. For more information, call 914-652-7800.

Meet Dr. Fitz:  Bronwyn Fitz, M.D. is a board certified Obstetrician Gynecologist who is fellowship trained in Integrative Medicine. In her practice she melds traditional medicine with non-Western approaches, nutrition, botanicals, mind/body therapies and lifestyle interventions to help women address their gynecological and reproductive health concerns. Her interest in mindfulness and meditation led her to pursue a two-year Fellowship at The Arizona Center for Integrative Medicine, under the leadership of world-renowned Integrative physician, Dr. Andrew Weil.

 

References:

  1. Schellenberg R BMJ. 2001 Jan 20;322(7279):134-7.
  2. 2. Yavarikia P, Shahnazi M, Hadavand Mirzaie S, Javadzadeh Y, Lutfi R. J Caring Sci. 2013 Aug 31;2(3):245-54.
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The 5 Most Common Food Sensitivities And How to Avoid Them

Trigger Foods

Food sensitivities result when undigested food slips through gaps in an unhealthy (leaky) gut and triggers an immune response, which can cause inflammation, pain, and swelling in the joints. Food sensitivities are extremely common, though little known, in those with arthritis, autoimmune disease, and chronic ailments.

Since food sensitivities activate the immune system they can aggravate and even cause symptoms in chronic conditions. Thus, eliminating certain foods prevents a great opportunity to reclaim wellness.

In My Practice, I’ve Identified 5 Major Culprits

Gluten

You need to read food labels and look at the ingredient lists for the words wheat, barley, kamut, rye, or spelt. For example, did you know that soy sauce is made from wheat?  Or that beer is made from barley?  Probably not and you’re certainly not alone. Because it is not possible to list all the foods that contain gluten here, reading food labels is key. Oats are only okay if the label says “gluten free oats.”

What to Eat Instead: Look for grains made from quinoa, millet, buckwheat, and rice.

Dairy

This includes any milk product made from cow, goat, or sheep such as yogurt, cheese, milk, kefir, and butter. Often after doing an elimination diet test, many patients realize that milk is causing other symptoms that go beyond their stomachs. These include chronic congestion and sinusitis, post nasal drip, ear infections, and more.

What to Eat Instead: almond, rice, hemp, or coconut milk.  These milk substitutes are also made into yogurt, kefir, and cheese so you can get your fill, without having to settle for dairy.

Corn

When I say corn I don’t just mean corn on the cob. It is used for other purposes, like making an ingredient called high fructose corn syrup that is used in many, many foods because it tastes sweeter and is cheaper than sugar!  Remember, you need to remove whole corn whether on the cob, in a can, or frozen, and popcorn, too. You also need to be careful about reading labels, look for the word corn, which can often be found as corn starch, corn syrup, corn syrup solids, and high fructose corn syrup.

What to Eat Instead: Look for natural sweeteners or stevia (though, keeping sugar consumption down is a good idea too!).

Soy

Soy is on the list here because it causes digestive upset and inflammation for many people, something I’ve seen in my practice over and over. Soy is also used as an additive in many foods, especially packaged processed foods so you must read labels and avoid anything that lists soy protein, soy lecithin, or soy oil in its ingredient list.  When you start reading labels looking for these words, you will be shocked at how many foods contain them!

Eggs

Eggs are usually the food that people are the most upset that they have to give up!  Unfortunately, eggs have proteins that are common allergies and that’s why they are also common triggers for food sensitivities, too. Eggs are often found as ingredients in other foods, and again, you must read labels to make sure you eliminate it completely.

To read more about how to do an elimination diet see my article on conducting an elimination diet.