Feeling Dismissed When it Comes to Your Hormones?

Feeling Dismissed When it Comes to Your Hormones?

When it comes to their hormone health, visiting a doctor is the last thing many women want to do.  Why is this?  Writer Maya Dusenbery explains why in her new book called “Doing Harm”.  I came across her work recently.  I want to highlight a few points. Her research points to one of the most common things I hear in clinic.

“I Feel Dismissed by my Doctor”

For decades women have been left out of clinical research. It wasn’t until the 90’s that law suits changed this.  Isn’t this shocking!  It was to me.  Huge studies happened with no women involved.  The FDA was excluding all women of childbearing age. It’s not surprising that we are still seeing a huge gap in women’s care.  Especially if you consider the number of years it takes for research to filter into the conventional medical system, 

Endometriosis is a good example.  There is very little research on this topic yet 1 in 10 women are affected.  It is common that a woman suffers debilitating pain for a decade before receiving a diagnosis.  This is partially because it takes time for the condition to develop. Women’s symptoms are also minimized in a system with insubstantial evidence to support what they are experiencing.

The Knowledge Gap

Women’s health concerns have not been prioritized.  Diseases and syndromes that affect women more than men receive less attention.  There is a gap in knowledge because of the lack of research.  Doctor’s don’t know. We see intelligent women dismissed when they know something isn’t right.  Opportunities for early intervention and preventative treatments are lost.  Compounding this, women are also more likely than men to have negative responses to pharmaceuticals.

Let’s continue to discuss endometriosis to understand how this plays out.  The level of pain a woman with endo experiences is much more intense than regular menstrual cramps.  Her symptoms are dismissed as ‘just part of being a women’ and she feels unheard.  Wouldn’t you start to feel crazy?

Hormones are Neglected 

Hormones are rarely tested but hormones are offered as treatment all the time.  There are obvious problems here.  Estrogen dominance may be an underlying cause.  Instead of finding out why estrogens are building up in the system, it’s assumed that progesterone is low.  I’ve seen patients with excess estrogens who don’t have low progesterone.  Natural progesterone isn’t always the answer. Even if it is indicated, there are likely other imbalances to rule out including autoimmunity.  Endometriosis is often autoimmune and this is usually ignored. 

Imagine this patient who has suffered for years.  She has likely made some changes and can manage symptoms better than before.  Then a stressful life event occurs.  Perhaps she’s pursuing a Masters degree.  Maybe she’s trying to get pregnant and can’t.  Without the right information and support its difficult to maintain a lifestyle that prevents endometriosis from spreading.  Finally she gets a referral to a gynecologist.  Surgery is offered.  Then multiple surgeries.  Then a hysterectomy.

Surgery doesn’t treat the root cause

Whether surgery happens or not its not addressing the underlying cause.  Autoimmunity effects women far more than men.  There are reasons for this.  Our hormones influence our gut health differently.  We are more susceptible to IBS or SIBO.  On the flip side our hormones protect us from heart disease.  When we do present with heart disease it takes longer for us to be treated because the presentation is different.  There are reports of young women being turned away at the ER during a cardiovascular event because of this.

The researcher I mentioned discovered that women commonly take a male family member with them to the doctor so they are taken seriously.  I had one patient who did this at my clinic.  After she discovered that I listened, she stopped bringing him along.  We made significant progress.  She thanked me several times for helping her understand why she was having the symptoms she was having.

The added stress and anxiety of not being heard is compounded by the fact that a male voice might be given more weight.  When it comes to your body, you are the expert!  Women know they might be considered a difficult patient and passed along.  

Learning To Listen

My focus for many years was working with marginalized populations.  I’ve always been curious about the strength and resilience of people who are treated unfairly in a broken system.  Within this current medical system there are heroes.  

There is a gynecologist who is listening to what’s happening to his patients and responding.  He knows that avoiding hysterectomies is ideal.  He discusses best practices, the role of diet and the sinister side of pharmaceuticals.  I met him in one of my functional medicine forums.  People like him inspire me to continue this work.

Your Gall Bladder & Gut Health

Your Gall Bladder & Gut Health

Cholecystectomy is the removal of the gallbladder.  In the later stages surgery is necessary but I’ll talk about how to avoid this and why.  A few years ago my dad had symptoms of a serious gall bladder attack.  I urged him to call the ambulance immediately.  I know how dangerous it can be if left untreated.  He was living out of town and was unable to drive because of the pain.

Surgery Doesn’t Treat the Underlying Cause

Surgery keeps people alive which I am so grateful for.  Now that his gallbladder is gone, bile flows from my dad’s liver to his small intestine via the common bile duct.  The liver continues to produce bile but an accumulation can still occur. Bile secretion directly into the small intestine has been shown to effect the microbiome and function of the gut negatively (1).  Also, those who have had a cholecystectomy can still have  gallstone issues if the underlying cause has not been addressed (2).

Gall Bladder Physiology

Bile is produced in the liver and travels via the common bile duct to the gallbladder. When dietary fats enter the small intestine, the gall bladder contracts to release bile. Bile is made up of mostly water, with only 3 percent consisting of a mixture of bile acids, cholesterol, phospholipids, bilirubin, inorganic salts, and trace minerals. Bile acids act like a detergent, helping to emulsify lipids in food. Without bile, these lipids go undigested, resulting in fatty stools. Bile is also crucial for proper absorption of cholesterol and the fat-soluble vitamins A, D, E, and K.

Gallbladder symptoms vary.  Initially pain in the upper abdomen that radiates into the back is common especially on the right side.  Nocturnal onset along with jaundice or yellowing of the skin, nausea and vomiting usually are involved (3).

Gallbladder diseases include:

  • Cholestasis: the backup of bile flow in the liver or in the biliary ducts.
  • Gallstones: stones form from the components of bile. 10-15% of adults are affected (4).
  • Cholesystitis: prolonged cholestasis characterized by inflammation of the gallbladder. 6 to 11% of patients with gallstones develop Cholecystitis (5).
  • Cholangitis: a complication where the flow of bile is blocked. The infection can also spread to the liver, so quick diagnosis and treatment are very important (6).

Leaky Gut

The connection between leaky gut and gall bladder problems is largely missed in conventional medicine. However, studies demonstrate a clear link between gluten intolerance (both celiac disease and in non-celiac wheat sensitivity) and inflammation of the gallbladder. Gluten damages the intestinal lining compromising the intestinal barrier function.  Largely this is due to zonulin.  Gluten increases this toxin resulting in a break down of the tight junctions.  Microbes and dietary proteins from the gut then ‘leak’ into the bloodstream (7).  The immune system sees these microbes and their microbial products as foreign invaders, and launches an immune response. The biliary system is affected by this inflammatory signaling. It has been shown to alter the gene expression and bile secretion in the liver (8).

Sure enough, research has linked gluten intolerance and celiac disease to increased prevalence of gallstones and biliary cirrhosis (9,10). Patients with autoimmune hepatitis are often also celiac (11). A study found that 42 percent of adults with celiac disease had abnormal levels of liver enzymes and I certainly see this in my practice. A gluten-free diet normalized liver enzyme levels in 95 percent of these patients (12).

Treating the gallbladder functionally

A low-fat diet may alleviate symptoms over the short term which is what conventional doctors often suggest.  But a long-term reduction of fat intake prevents gallbladder contractions which leads to more sluggishness and an increased risk of gallstones. Interestingly, a higher fat diet has been shown to protect against gallstone formation. Use it or lose it applies.

Gallbladder flushes are recommended by some natural health stores.  I learned long ago these have the potential to be dangerous as the bile duct can become obstructed. I typically stay away from extreme approaches that lack scientific evidence. I have yet to find a clinical trial on gall bladder flushes. I focus on treating the root cause.

Testing: markers like ALT, AST, bilirubin, LDH, GGT, ALP, and 5ʹ-nucleotidase can help discern what is going on.

Diet:  removing inflammatory foods like gluten, processed foods, and sugar are a great starting place.

Gut:  beak the cycle of gut inflammation leading to biliary stasis and lack of bile causing more gut inflammation.

Stimulate bile: with bitters like dandelion, milk thistle, and curcumin.

Reduce gallstones: with beet root, taurine, phosphatidylcholine, lemon, peppermint, and vitamin C.

Take bile: if you are having trouble with digestion of fats supplement with ox bile for a therapeutic period.

 

Do you have Candida? Or is it SIFO?

Do you have Candida? Or is it SIFO?

What’s the Difference?

Symptoms like chronic yeast infections, brain fog and sugar cravings can indicate dysbiosis or an imbalance in the gut microbiome. About 20 years ago candida albicans began receiving a lot of attention. Some said to cause a long list of ailments. We’ve learned a lot since then and continue to learn more all the time. Endoscopies are not perfect but can show fungal overgrowth occurring in the small intestine. (SIFO).   In out patient settings, we test the gut using stool and breath tests.

Candida albicans is one strain of bacteria residing in the colon and is part of a healthy colon when in balance. It can get out of balance. This can happen when there is a dybiosis of insufficiency meaning a lack of other bacteria. Often it occurs after antibiotics used especially if several rounds were used.

Keep in mind that high stress, poor diet and reactions to foods also trigger an imbalance in gut flora. Similarly a parasitic infection like giardia can trigger the onset of Celiac disease and non-celiac gluten sensitivity. This is why people go traveling and say their gut was never the same afterwards.

So what causes SIFO?

If you are on a very limited diet to manage symptoms that appear to be fungal overgrowth but your labs come out looking good we have to consider SIFO. There isn’t a breath test available for SIFO and it won’t show on stool tests. Certain antibodies can be used to detect it but this is not yet widely used. An organic acids test has markers that are more telling. This is what I end up using because it has a variety of other markers that are helpful for assessing the patient’s health status in general. Knowing what triggered the symptoms is important so reinfection can be avoided. There is a strong correlation between long-term use of proton pump inhibitors and SIFO.   Low stomach acid means more pathogens make it into the small intestine.

Treatment can include both pharmaceuticals and botanicals.   As far as botanicals go I use monolaurin, a concentrate of coconut oil, oregon grape root, berberines, caprylic acid or allicin and biofilm disruptors like NAC or Interfase Plus. Cycling antibiotics followed antifungals is what gastroenterologist Dr. Satish Rao suggests. This is because onset of fungal infection occurs after the good bacteria is killed off whether its in the small intestine or the colon.

Can diet help?

A lower carb diet rich in nutrients is a good starting place. There is some indication in the research that ketones can feed the overgrowth so use caution with this approach. Often people will know what triggers symptoms and these need to be avoided. Following treatment a period of rebuilding is key to ensure that the colon is functioning optimally. A prokinectic like 5-HTP or bitters encourage the migrating motor complex to prevent reinfection in the small intestine. If the ileocecal valve between the two bowels is inflamed we want to address this. Bacteria collect around these valves and take up residence where they shouldn’t. So inflammation and any immune issues also need to be addressed.

Keep in mind that candida albicans is different than candidiasis, which is a serious condition occurring in immune compromised people. Candidiasis requires immediate medical intervention.

15 Sleep Solutions You Can Do

15 Sleep Solutions You Can Do

Sleep is a big deal  

Especially when two-thirds of adults don’t get the minimum required to meet basic physiological requirements.  In fact, less than 7 hours per night can shorten lifespan significantly.  Inflammation increases when we miss a night of good sleep.  Other sleep research shows up to 29% lower sperm count in men who sleep poorly vs those who regularly get enough rest.  Athletes performance drops 10-30%.

Why Parents are Crazy

As a parent of a young child I can vouch for how difficult it can be to get enough sleep.  When your infant finally starts sleeping through the night your cortisol and melatonin production is so confused insomnia becomes a thing. Catching up is not actually possible especially as a single parent.  Through trial and error I’ve discovered the ridiculous reality of living in a state of constant sleep deprivation.  Caffeine stops working.  You think everyone hates you and life is out to get you.  This is the real reason parents are crazy a lot of the time!  Anyone doing shift work or work late at night can be included in those who suffer the most.


Adults really do require 7-9 hours of sleep

  • Newborns (0-3 months): 14-17 hrs
  • Infants (4-11 months): 12-15 hrs
  • Toddlers (1-2 years): 11-14 hr
  • Preschoolers (3-5): 10-13 hours
  • Elementary school age (6-13): 9-11 hrs
  • Teens (14-17): 8-10 hrs
  • Adults (18-64): 7-9 hrs
  • Older adults (65+): 7-8 hrs

 

Sleep Hygiene: Focus on What to Do

1. Be consistent with your sleep schedule 

Set a realistic bedtime.  Train your brain to develop a regular circadian rhythm by going to bed at the same time most of the time.  

2.  Establish a bedtime routine

This can include a warm but not hot bath or shower.  Journaling in a book, meditating, stretching gently or reading are all appropriate activities.  Dim your lights and listen to relaxing music to unwind from your day.  

3.  Your bedroom needs to be quiet, cool and comfortable

Sleep is better when your room is cool rather than warm. You can keep a door or window cracked for circulation and to avoid stuffiness. Keep all lights off, including night lights, and lights from electronic devices. Sleep on a comfortable mattress.  Turn off the extraneous noise. A white noise machine is fine. If your pets wake you up, keep them in another part of the house. 

4. Turn off electronic devices in the evening

This allows for more connection, better digestion and a general parasympathetic or relaxed environment where you can reconnect and let go of the day.  Electronic devices emit blue light which stimulates the brain.  Cortisol and melatonin get confused and these hormones play a huge role in insomnia.

5. Exercise during the day

Exercise promotes continuous sleep.  Its also great stress relief.  Avoid intense exercise in the evening as this can interfere with deep sleep.  Stress management is crucial to sleeping well.

6.  Eat enough during the day

Blood sugar dysregulation causes spikes in cortisol and makes it more difficult to rest later on.  In fact, having enough carbohydrates during your evening meal has been shown to support better sleep.  Choose root veggies and unprocessed, gluten free options.  Often times food reactions cause an internal stress response that we aren’t aware of.

7. Use caffeine with caution

We know that 50% of people don’t metabolize caffeine.  This means it stays in the body for much longer and therefore amount matters.  Cut down on caffeine and avoid it after noon entirely.  This includes chocolate. Uncooked cacoa is easier on you.  Matcha has a longer burn than coffee and many health benefits.  Find alternatives like peppermint or dandelion tea. Golden tea is a delicious alternative as well.  I know its not easy to change this habit especially when you are sleep deprived but it can be done.  It may be the most important change you can make.

8. Get out of bed if you aren’t sleeping

Do a guided meditation or find another relaxing activity until you feel sleepy.  This is part of training your body that bed is for sleep.  Have a comfortable chair in your room and make a cup of sleepy tea.  Simple rituals like this work.

9. Avoid large meals later at night

A small protein rich snack before bed can help with night hunger but large meals late at night create a burden for the liver.  Finish meals a few hours before bedtime.  The liver kicks into gear at 11pm so being asleep by then is ideal.

10. Reduce fluids before bedtime

I’m training my son to drink more during the day so he won’t need pull-ups at night.  Just pretend you are 5 years old!  My mom has sage advice for parents.  Ask yourself if getting your kid up to pee in the night is more of a priority than your sleep.

11.  Nap or no nap?

I teach meditation to my patients.  I find if someone calms their nervous system for 5-20min during the afternoon it can support a deeper sleep later.  People may or may not nap as part of the practice. I don’t see any problem with this however long naps may inhibit sleep later on.

12. Avoid these because we know they interfere with sleep

Alcohol raises our body temperature and requires that the liver clear it.  Ever wake up between 1am and 3am after having a drink?  Cigarettes and some medications also make sleep more elusive.

13. Black out your room, hide the clock and wake naturally if possible

This is basic but an incredibly important game-changer.  Buy black-out curtains.  Don’t use night-lights except in the bathroom.  Turn your digital clock away from your bed while you sleep.  Don’t wake to an alarm as much as possible.

14. Creat an extended sleep schedule

For anyone who has suffered from sleep problems an extended sleep schedule can support getting more sleep.  Research shows that allowing a longer period of time in bed does increase the amount of sleep people get.

15. Only use your bedroom for sleep and sex

Train your body to expect only rest and pleasure in this space by creating this.  Bedrooms ought to be a place of sanctuary from the world.


 

An Important Ally: Your Morning Awakening Response

Its best to get up when you first wake up.  By exposing your eyes to bright full-spectrum light you are stimulating the cortisol awakening response (CAR).  This accounts for half or more of our daily cortisol secretion.  Remember the cortisol is anti-inflammatory and an important hormone that works synergistically with melatonin. Doing any kind of movement first thing supports morning cortisol.  This could be carrying a child, going upstairs, walking your dog or going for a run. Daylight stimulates cortisol release, and darkness stimulates melatonin.

Blue light boxes improve sleep and depression simply by stimulating this early morning response during the winter for those who have to get up before dawn or who can’t go outside first thing in the morning.  Beginning to notice this response and working with it can help repair your sleep-wake cycle if its been disrupted.

HPA-D is not Adrenal Fatigue

I’ve written extensively on this topic and the reason I bring it up is because you’ll see a bunch of recommended supplements for adrenal fatigue.  Insomnia is a symptom of a much more complex disorder called HPA-D.  (hypothalamus pituitary adrenal dysregulation).  By testing cortisol thoroughly we can see that pattern of dysfunction and supplement accordingly.  Giving adaptogens to everyone is not the answer.  Nervine herbs on the other hand are safe and interestingly ashwaghandha is both an adaptogen and a nervine.  Some of my other favourites include skullcap, passion flower and camomile.  Anything that makes you feel groggy upon awakening is inhibiting the cortisol awakening response so avoid this. Be careful using licorice as this potent herb increases cortisol.  L-theanine is an amino acid that is safe to use for anyone.

Certain patterns of HPA-D require increasing cortisol at certain times of day or decreasing it. Often there’s an issue with hormone clearance pointing to excess inflammation, inhibited liver function or thyroid issues.  The testing I do looks at both free circulating cortisol and total metabolized cortisol.  These are not always the same.  In many cases only free cortisol is tested resulting in treatment that is not neccessarily exact.

CBD is both anti-inflammatory and promotes sleep.  This is why standardized extracts need to made available.  For those experiencing recalitrant pain CBD can bring down the pain where other pain medications won’t.  A patient of mine with insomnia and endometreosis began using CBD.  Once her pain came down she was able to sleep and could start making decisions about her health.  She had been unable to work for many months.  I’ve seen this with backpain as well.

Thorough blood work including iron, blood sugar, thyroid and inflammatory markers is required to see a full picture and get a sense of what is going on.  A gut work-up is also important. Neurotransmitters play a role in HPA-D through the gut-brain axis.  Healing the gut so its producing neurotransmitters again and absorbing nutrients is the key in some patients. Supplementing with precursors like 5HTP are helpful in these patterns during treatment.  You may be noticing that it can take time to get to the root cause of insomnia.  Often we are also addressing trauma during treatment.  When we find out what works and are sleeping more, people report feeling that they got their life back.