Medicinal Plants for Female Sexual Dysfunction

A recent article in The Journal of Sexual Medicine identifies and describes the popular and clinical uses of medicinal plants for Female Sexual Dysfunction (FSD) in climacteric (menopausal) women. Although there is very little evidence from the literature to recommend the use of medicinal plants for treating FSD, Mazaro-Costa, et al, list those plants that are currently used for female reproductive disturbances, most notably the climacteric state to correct aspects of female sexual dysfunction. More research is needed before strong recommendations can be made.

Black cohosh – Cimicifuga racemosa

Current use: Menopausal therapy for hot flashes, profuse sweating and vaginal complaints

Active Ingredients: triterpene glycosides, phenolic acids, flavonoids, volatile oils, tannins

Standardization: 2.5% triterpene glycosides

Research: was not statistically significant in treating hot flashes after 16 weeks; does improve the vaginal maturity index in postmenopausal women; approaches significance in treating vaginal dryness; statistically significant in treating anxiety

Mechanism: SERM (does not affect ERα or ERβ but does have an effect on ERϒ), high affinity for various serotonin receptors

Safety: Relatively safe; however, case reports about liver toxicity. Because of unknown MOA and potential estrogenic effect it should be avoided during pregnancy and lactation and in children under 12.

Ginkgo - Ginkgo biloba

Current use: asthma, fatigue, tinnitus, memory improvement

Active Ingredients: flavonol, glycosides, terpene lactones, bilobalide

Standardization: 6% terpene lactone sna 24% flavones glycosides

Research: 300 mg improved physiological sexual arousal but no subjective sexual arousal; when combined with sex therapy increased sexual desire and contentment; effective in alleviating antidepressant-induced sexual symptoms in 84% of cases

Mechanism: Relaxes smooth muscle, facilitates peripheral blood flow, has NO-scavenging abilities

Safety: Side effects are rare and limited to mild, transient and reversible; drug interactions with warfarin, aspirin, lithium; safety in pregnancy and breastfeeding has not been established

Maca – Lepidium meyenii

Current use: Andean aphrodisiac an/or fertility-enhancing, menopausal therapy

Active Ingredients: sterols which possess phytoestrogen activity

Standardization: Unknown

Research: RDBPCT decreased psychological symptoms including anxiety, depression and sexual dysfunction and did not affect estradiol, FSH, LH or SHBG levels.

Mechanism: Unknown

Safety: Unknown

Puncture vine – Tribulus terristris

Current and traditional use: ancient aphrodisiac, UTI treatment, inflammation, edema and TCM sexual dysfunction

Active Ingredients: Steroidal saponins (tribestane, vitanone and protodioscin)

Standardization: 16.4% protodioscin

Research: 49/50 women experienced improvement in all or some menopausal symptoms (hot flashes, depression, genital discomfort, libido) however, may lack validity due to conflict of interest

Mechanism: increase endogenous androgen production by increasing LH release from the pituitary gland; increases NO release

Safety: Phototoxic reactions; safety during pregnancy and lactation has not been established

Red clover – Trifolium pretense

Current use: Menopausal therapy for hot flashes, profuse sweating and vaginal complaints

Active Ingredients: phytoestrogens such as genistein, formononetin, daidzein and biochanin A

Standardization: 9-15% isoflavones

Research: meta-analysis showed a marginal effect for treating hot flashes with 40-82 mg/day; significant beneficial effect on vaginal and sexual health in postmenopausal women

Mechanism: SERM (does not affect ERα or ERβ but does have an effect on ERϒ), high affinity for various serotonin receptors

Safety: Safe and well-tolerated in women with one first degree relative with breast cancer; supplements containing these isoflavones did not adversely affect breast density, skeletal strength or cardiovascular status; none of the CCT have reported adverse effects at doses upt to 160 mg of isoflavones per day.

Chasteberry fruit – Vitex agnus-castus

Current use: Premenstrual syndrome

Active Ingredients: triterpene glycosides, phenolic acids, flavonoids, volatile oils, tannins

Standardization: 0.05% agnuside and 0.08% casticin

Research: topical application - improvement in vaginal tone, thinning and lubrication with less dyspareunia; increased uterine weight, serum progesterone and estrogen levels in ovariectomized female rats; decreased LH and Prolactin

Mechanism: SERM (affects ERα or ERβ), decreases LH and prolactin; dopaminergic D2 receptor agonist; increases melatonin secretion

Safety: Relatively safe

Dong quai – Angelica sinensis

Current use: replenishing the blood, treating menstrual disorders and menopausal symptoms; when used in Traditional Chinese Medicine is used in conjunction with other herbs

Active Ingredients: ferulic acid and Z-ligustilide; has no phytoestrogens.

Standardization: ferulic acid 0.4-0.7%, 0.5-5.0% ligustilide

Research: When used alone has not effect in treating menopausal symptoms; has no estrogenic effect in humans but did in rat studies; when combined with Matricaria chamomilla demonstrated a reduction in hot flashes, improved sleep; when combined with Astragalus membranaceus helped decrease mild hot flashes; the improvement of sexual symptoms was not explored

Mechanism: not mentioned

Safety: few side effects including headache and potentiates anticoagulant therapy; do not use in children or adults with diarrhea, hemorrhagic diseases, hypermenorrhea, pregnancy or lactation; some concerns about liver toxicity

Zalloh – Ferula hermonis

Current use: native to Syria and Lebanon, used as a strong aphrodisiac for both sexes, treatment of frigidity and circulation enhancement

Active Ingredients: ferutinin has binding capacity for estrogen receptor α and β equivalent to about 1/10 of the binding affinity of estradiol

Standardization: not mentioned

Research: may be suggested for female sexual dysfunction associated with desire disorder

Mechanism: estrogenic effect, increased production of progesterone and therefore stimulate female sexual behavior

Safety: Unknown

Hops - Humulus lupulus

Current use: in Germany hops baths are used for treatment of gynecological disorders and hops extracts have been reported to reduce hot flashes in menopausal women

Active Ingredients: 8-prenylanaringenin; isoxanthohumol which can readily be converted to 8-prenylnaringenin by intestinal microbes; three flavonoids with estrogenic activity including: 6-prenylnaringenin, 8-geranylnaringenin and 6,8-diprenylnaringenin

Standardization: 0.11 + 0.01 mg of 8-prenylnaringenin/capsule

Research: RPCCO studies with 50 postmenopausal women over 16 weeks showed superiority over placebo for treating hot flashes; other studies have shown improvement in climacteric symptoms; topical application combined with hyaluronic acid, liposomes and Vitamin E showed significant improvement in vaginal dryness. Animal studies demonstrate an estrogenic effect on the uterus, vagina and mammary gland secretion however in vitro study did not confirm androgenic or progestogenic activity of the active ingredient.

Mechanism: may act as a SERM

Safety: safe alternative treatment for genital atrophy in postmenopausal women when HRT is not recommended; causes drowsiness; inhibits cytochrome P450; unknown safety during pregnancy and nursing.

Reference: J Sex Med 2010;7:3695-3714

Natural Hot Flash Remedies

Are you suffering from hot flashes or night sweats? If so, you are in good company. Approximately 75% of American women experience vasomotor symptoms as they transition through menopause. Prescription hormonal therapy is available - if you find your symptoms intolerable. However, safety concerns are mounting.

Here are 6 natural ways to cool down when the heat is rising:

1. Use the 3-4-5 method of breathing to calm down when the heat starts to rise. Breathe in through your nose to the silent count of three, hold for four and breathe out through your mouth for five. Really focus on distending your lower abdomen with each inhalation, and count slowly. You should continue this pattern until your hot flash subsides.
2. Eat a healthy diet filled with vegetables, fruits, whole grains and omega-three fatty acids (found in cold water fish, green leafy vegetables, walnuts and ground flax seed). And, sip plenty of cool water throughout the day; this decreases your core body temperature thereby reducing the frequency of hot flashes.
3. Avoid dietary triggers like spicy food, alcohol and most caffeine. Although it does contain caffeine, it is okay to drink green tea. Here's the trick. Steep fresh green tea in hot water for 45 seconds, poor off that water, and then steep the same tea as you normally would. This way you will remove 80% of the caffeine and retain all the good anti-oxidants. The occasional morsel of dark chocolate is fine, too.
4. Try an herbal therapy shown to decrease the frequency and severity of hot flashes: St. John's Wort 300 mg three times daily. Black cohosh, although used for centuries, has not been found to be effective when subjected to scientific analysis. Teas containing lemon balm, hops and valerian decrease anxiety and promote sleep, countering night sweats.
5. Use bedtime rituals to decrease disruptive night sweats. Take a cool shower before bed, turn on a small bedside fan, and listen to calming music. Sleep under sheets made of 100% cotton. Just in case, keep a change of clothes and sheets in your nightstand to ease the pain of awakening to drenched pajamas and soaked sheets that need changing.
6. Stop smoking.

Take heart - hot flashes and night sweats are usually temporary. Most women experience resolution within 2 years. Use this period of transition to nurture yourself. Embrace your passage from one stage of life to the next. Hang in there. The best is yet to come!!

Prevent Complications Associated With Cesarean Delivery

A wonderful, concise, evidence-based article by Dr. Patrick Duff was published in the December edition of Obstetrics and Gynecology entitled, "A Simple Checklist for Preventing Major Complications Associated with Cesarean Delivery".

Dr. Duff proposed the following evidence-based eight steps to significantly reduce maternal morbidity and mortality associated with cesarean delivery:

1. Clip the hair at the surgical site just before making the incision

2. Cleanse the skin with chlorhexidine solution rather than povidone-iodine solution

3. Administer broad-spectrum systemic antibiotic prophylaxis before the surgical incision rather than after the neonate's umbilical cord is clamped

4. Remove the placenta by traction on the umbilical cord rather than by manual extraction

5. Close the uterine incision in two layers rather than one

6. In women whose subcutaneous tissue is greater than 2 cm in thickness, close the layer with a running suture

7. Patients at intermediate risk for deep vein thrombosis [BMI > 30, those with gross varicose veins, those immobilized for > 4 days before surgery, those who have concurrent medical illness that predisposes to thromboembolism (e.g. sickle cell disease, sickle cell C disease, cancer, antiphospholipid syndrome, hereditary thrombophilia with no history of DVT or PE)] should receive prophylaxis postoperatively with either sequential compression devices or subcutaneous heparin

8. Patients at high risk for postoperative deep vein thrombosis (those with more than two risk factors in the moderate-risk category, those with prior DVT or PE, those who have a cesarean hysterectomy) should receive prophylaxis with both sequential compression devices and subcutaneous heparin until the patient is fully ambulatory

Referenced article: Obstet Gynecol 2010;116:1393-6

Mindfulness and Parenting

A very helpful excerpt on the benefits of practicing mindfulness while undertaking the challenges of parenting - from Jon Kabat-Zinn's chapter "Parenting and Practice" in Wherever You Go There You Are: Mindfulness Meditation in Everday Life.

And it gets more challenging as the children grow older and develop their own ideas and strong wills. It's one thing to look after the needs of babies, which are very simple, after all, especially before they can talk and when they are at their absolute cutest and most adorable. It's quite another to see clearly and to respond effectively and with some modicum of wisdom and balance (after all, you are the adult) when there is a continual clash of wills with older children, who are not always so cute and cuddly, who can argue circles around you, tease each other mercilessly, fight, rebel, refuse to listen, get into social situations in which they need your guidance and clarity but may not be open to it; in short, whose needs require a constant energy output that leaves you little time for yourself...

These trials are not impediments to either parenting or mindfulness practice. They are the practice if you can remember to see it this way. Otherwise, your life as a parent can become one very long and unsatisfying burden, in which your lack of strength and clarity of purpose may lead to forgetting to honor or even see the inner goodness of your children and yourself.

Children can easily become wounded and diminished from a childhood which consistently fails to adequately honor their needs and their inner beauty. Wounding will just create more problems for them and for the family, problems with self-confidence, with communication and competencies, problems that don't disappear on their own as the children grow older but usually amplify...

It is obvious that, with all that energy going outward, there has to be some source of energy coming in which nurtures and revitalizes the parents...I can think of only two possible sources (of this energy): outside support from your partner, other family memebers, friends, baby-sitters and so on and from doing things you love, at least occasionally; and inner support, which you could get from a formal meditation practice...if you can make even a little time in your life for stillness, for just being, for just sitting, or for doing a little yoga, for nourishing yourself in ways that you need to be nourished...

Parenting and family life can be a perfect field for nindfulness practice, but it's not for the weak-hearted, the selfish or lazy, or the hopelessly romantic. Parenting is a mirror that forces you to look at yourself. If you can learn from what you observe, you just may have a chance to keep growing yourself.

Picture: My husband, Stuart and our three sons in 2003 (Mitch 19, Shayne 14, Alex 13)

I wish I knew then what I know now!

Chronic Pelvic Pain

I attended a very fascinating conference over the weekend. The event was hosted by the International Pelvic Pain Society in Chicago, Illinois. Throughout the 4-day event, a common thread linked many common pain syndromes of the anatomic structures below the umbilicus and above the upper thighs. Such ailments include chronic pelvic pain, Irritable Bowel Syndrome (IBS), Interstitial Cystitis (IC) and other bladder pain syndromes, dyspareunia (pain with intercourse), vulvar pain, vaginal itching/pain, hip pain, fibromyalgia, postoperative pain, back pain, endometriosis.

Twenty percent of women suffer from chronic pelvic pain (CPP). The typical patient with CPP doesn't look "sick", is frequently embarrassed by her symptoms, fears she will not be taken seriously by her doctor and has difficulty speaking to loved ones about her symptoms. Sufferers of CPP frequently experience alienation, hopelessness, anxiety, depression, suicidal ideation, sleeplessness, narcotic addiction concerns, sexual dysfunction, loss of relationships and loss of employment.

Women who seek medical advice for CPP are often discouraged as so many are told, "There is nothing else in there that could hurt - everything we have looked at is normal." The pelvic muscles, ligaments and nerves of the pelvis are the common denominators in CPP - regardless of the etiology.

The basics of the chronic pain cycle: (1) recurrent activation of the afferent nerves from the source of pain to the dorsal horn of the spinal cord; (2) prolonged release of neurotransmitters in the dorsal horn including substance P; (3) upregulated inflammatory response and release of other neurotransmitters in the dorsal horn; (4)resultant loss of sensitivy or hypersensitivity of the tissue pain source with expansion of the receptive field; (5) prolonged exposure to painful stimuli eventually causes centralization of the pain (i.e. communication with the brain) and local upregulation of pain fiber generation and inflammation resulting in hypersensitivity to pain and organ dysfunction (6) resulting in muscular contraction, other tissue changes and ultimate end-organ dysfunction.

The goals of chronic pain management consist of removal of the noxious stimulant if still present, and modulating the neurological and immune response (i.e. neuromodulation) to an insult. Examples of neuromodulation include biofeedback, drugs with neurotropic and psychotropic effects (oral and topical), soft tissue manipulation and utilization of neurostimulatory devices that stimulate including TENS units, acupuncture and sacral nerve stimulation. The suggested treatments vary according to the type and source of pain. Research indicates that peripheral pain is best treated with topical applications whereas visceral (organ e.g. bladder) pain is best treated with dorsal horn nerve activation.

Little was mentioned regarding complementary and alternative therapies for CPP other than hypnosis for IBS and acupuncture for IC. Lifestyle modification has proven beneficial for those with chronic inflammatory conditions, including CPP. Such alterations in every-day behaviors serve most people well, such as following an anti-inflammatory diet, consuming anti-inflammatory supplements, smoking cessation and limiting exposure to other environmental toxins. Because the efficacy of hypnosis in treating IBS has proven to be helpful, presumably other mind-body approaches should be consider (e.g. mindfulness meditation, Tai-chi, Yoga, guided imagery, art therapy, music therapy, aromatherapy, etc.) Energy therapies should also be considered as acupuncture has already proven helpful. It is important that these treatment modalities be subject to scientific inquiry in reference to treatment of CPP.

Congratulations and thanks to those scientists who continue to pursue additional knowledge. My learning has just begun.

Resources:

International Pelvic Pain Society Intake Form

National Vulvodynia Association Tutorial

Anti-inflammatory Diet

Fibromyalgia Information Foundation

Pelvic Pain and Urgency/Frequency Scale

Handy Portion Control Advice

SIZE UP YOUR PROTEIN
Protein fuels our energy and helps build strong muscles. Use the area and thickness of your palm to eyeball how much chicken, fish or tofu you should be eating in a single sitting.

SIZE UP YOUR VEGGIES
What should accompany your protein? Scoop up two fist-sized portions of fresh veggies for a ton of nutrients and antioxidants.

SIZE UP YOUR SALAD
Use both your hands like serving spoons to lift up a big portion of leafy greens. To give yourself about a tablespoon of dressing, use the length of your thumb as a guideline.

SIZE UP YOUR FRUIT
When you're figuring out how many berries to pile on top of your morning yogurt, fill your hand for just the right portion of fresh fruit.

SIZE UP YOUR FATS
These are the guys we really have to watch out for (they taste so good it's easy to overdo it!). For butter and oil, use your thumbnail as a measure.

What is Integrative Medicine?

The Defining Principles of Integrative Medicine

Andrew Weil, M.D. - What is Integrative Medicine? from Andrew Weil, M.D. on Vimeo.

1.Patient and practitioner are partners in the healing process.

2.All factors that influence health, wellness, and disease are taken into consideration, including mind, spirit, and community, as well as the body.

3.Appropriate use of both conventional and alternative methods facilitates the body's innate healing response.

4.Effective interventions that are natural and less invasive should be used whenever possible.

5.Integrative medicine neither rejects conventional medicine nor accepts alternative therapies uncritically.

6.Good medicine is based in good science. It is inquiry-driven and open to new paradigms.

7.Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness are paramount.

8.Practitioners of integrative medicine should exemplify its principles and commit themselves to self-exploration and self-development.

Links:
Arizona Center for Integrative Medicine
Find an Integrative Medicine Provider

Acupuncture May Ease PCOS

Research from Sweden suggests that acupuncture can help normalize menstruation and lower levels of testosterone in women with polycystic ovarian syndrome (PCOS).

This common disorder affects 13 percent of all women of reproductive age. It may cause a large number of small cysts to form on the ovaries, disturb hormone production and lead to an increase in testosterone secretion. As a result, affected women don’t ovulate normally and are at risk of infertility, obesity, type 2 diabetes and cardiovascular disease.

Although the cause is unknown, the Swedish researchers said that some women with the syndrome often have high activity in a part of the nervous system that we cannot consciously control -the sympathetic nervous system - and that this may be an important underlying factor.

In this study, a group of women with PCOS was treated for four months with electro-acupuncture in which needles are stimulated with a weak, low-frequency electric current; another group of women was given heart rate monitors and told to exercise three times a week and a third, control group, was told about the importance of exercise and a healthy diet but received no other instruction. The investigators found that sympathetic nervous system activity decreased in women who received acupuncture or exercised and that menstruation became more normal among the women underwent acupuncture treatments.

Reference: Stener-Victorin E, et al. Low-frequency electro-acupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. American Journal of Physiology - Regulatory, Integrative and Comparative Physiology, August, 2009.

Vitamin D

Highlights of Dr. Paykel's Presentation

• Who is at risk for Vitamin D deficiency? Exclusively breast-fed infants, dark skin, aging, northern climate dwellers, city-dwellers, those who cover their heads when outside, sunscreen users, lactose intolerance, s/p gastric bypass, cystic fibrosis patients, gallbladder disease, IBS, obesity, women.


• Diseases associated with vitamin D deficiency: osteoporosis, breast, colon and ovarian cancer; autoimmune disorders such as multiple sclerosis, rheumatoid arthritis and diabetes; Seasonal Affective Disorder (depression during winter months), cardiovascular disease and hypertension, Alzheimer’s Disease.


• Osteoporosis progression slows at 32 ng/mL ; goal of therapy should be 50 – 80 ng/mL to decrease cancer risks


• Sources of Vitamin D: sun, food, supplements


• Sun block SPF 8 or greater reduces conversion of Vitamin D in the skin by 95%
  If using sunscreen, apply after sun exposure for twenty minutes


• Adequate sun exposure: Bikini-wearing, 10:00 a.m. – 3:00 p.m., 2-3 x per week
  Everybody living North of 37 degrees latitude (basically, North of line extending across the U.S. from Atlanta, GA to Los Angeles, CA) should take supplements (2000 IU daily) from October through March


• Dietary sources of vitamin D include: wild-caught, fatty fish, dairy products, fortified cereals, fortified orange juice, egg yolks and cod liver oil


• Take Vitamin D supplements during meals with fatty foods


• Vitamin D3 is better than Vitamin D2 for supplementation (except prescription strength only comes in D2)


• Children should receive 400 IU Vitamin D3 daily


• Lab to order: 25-hydroxy-Vitamin D [AKA: 25(OH)D]


• Definitions: “deficiency” <> 32 ng/mL


• Too much vitamin D in the system: > 200 ng/mL


• Treating vitamin D deficiency when measuring 25(OH)D :
  <>: Vitamin D2 50,000 IU weekly x 1 year
  21-31 ng/mL: Vitamin D2 50,000 IU weekly x 12 weeks then Vitamin D3 2000 IU daily; recheck in 1 year
  32 ng/mL: Vitamin D3 2000 IU daily


• Who should not take Vitamin D without supervision? Individuals with impaired kidney function


• Food sources Vitamin D (IU)
  Pink salmon, wild caught, 3 oz 530
  Sardines, 3 oz 231
  Tuna, canned, 3 oz 200
  Cow’s milk, 8 oz 100
  Fortified O.J., 8 oz 100
  Fortified cereal, 1 cup 40-50
  Eggs (Yolk), 1 oz 30
  Cod Liver Oil, 1 oz 1, 360
  

How to Deal with Difficult (Even Impossible) People

By Deepak Chopra
Published on Oprah.com
June 11, 2010

We have all met people who are so prickly and difficult that no one wants to handle them. In most situations, walking away is an option, and you escape with no more than ruffled feathers. But some situations are inescapable. You can wait until the thorny personality is gone and moan "She's just impossible" to a friend. Far better, though, to begin to develop skills in practical psychology.

First, take responsibility for your part of the interaction. Animosity is created in your own heart. Even the most impossible person had a mother. He was loved by somebody. If you can deal with your own reaction and take responsibility for it, no step is more productive. Detachment is always the best response...

Read the rest of this great article.

Jon Kabat-Zinn Leads a Session of Meditation at Google

Decrease Your Breast Cancer Risk

One-in-eight women will struggle with breast cancer during their lives. We now know that cancer, like many other diseases, is related to systemic inflammation. Breast cancer may also be associated with elevated systemic estrogen levels. Here are lifestyle changes you can make to decrease inflammation and modify your estrogen levels to reduce your risk of breast cancer (or, recurrence).

Nutritional Advice:
Do eat an abundance of fruits and vegetables, at least 5 servings per day, organic is best
Do eat at least one cruciferous vegetable per day (broccoli, cauliflower, cabbage, kale, brussel sprouts, kohlrabi)
Do eat phytoestrogens in moderation: soy-based products, red grapes, peanuts, legumes, brussel sprouts, spinach, ground flaxseed, whole-wheat flour, fruit and tea.
Do drink green tea
Do consume garlic
Do consume good fats: Omega 3 fatty acids, Olive oil
Do eat hormone-free beef and dairy, if you consume them at all
Do follow the principles of an Anti-inflammatory Diet

Avoid charred meat (either grilled or broiled)
Avoid a high-fat diet – high fat diet increases circulating estrogens
Avoid alcoholic beverages
Avoid these fats: Eliminate trans fats, consume a small amount of saturated fats

Lifestyle
Vitamin D supplements: 2000 IU daily unless indicated more
Calcium: 1200 mg per day between diet and supplement
Herbs and Supplements: Turmeric, Ginseng, Melatonin
Exercise – Aerobic 30 minutes 6/7 days per wk
Adequate nightly sleep in a dark room – melatonin production decreases breast cancer
Mindfulness meditation - if practiced regularly can decrease stress and improve coping skills during difficult times

Screening
If at high risk due to family history, begin screening at 35 years of age or 10 years prior to the age of detection in family member, whichever comes first.

Fatigue Remedies

12 Keys for Fighting Fatigue:

1. Blood sugar stabilization - Keep your blood sugar stable; focus on complex carbohydrates and protein for each meal.
2. Sleep - get seven hours of continuous sleep most nights.
3. Aerobic exercise - get 30 minutes of aerobic exercise six days per week.
4. Nap - Take a 15 minute cat nap in the middle of the day
5. Vitamin D - get your levels checked; start supplements if deficient. Goal should be 52 ng/mL to optimize benefits.
6. Vitamin B Complex - B vitamins participate in many metabolic processes and assist in processes of carbohydrates into sources of energy.
7. Magnesium - Supplement low magnesium levels.
8. Ginseng has long been used to increase energy levels - Asian ginseng (Panax ginseng) and American ginseng (Panax quinquefolius) are used for stimulant and adaptogenic (stress-protective) properties, respectively
9. Thyroid - How is your thyroid functioning? Ask your health care provider to check TSH, FT4, and FT3.
10. Passion - Identify one of your old passions. Whether it is gardening, painting or reading, spend 2 hours twice per week dedicated to exercising your passion.
11. Kindness - Be kind to others. Negative behavior and troubling thoughts consume energy.
12. Just say, "no". Avoid over-obligating your time. Instead, spend some alone-time to recharge your batteries.