Integrative Health for Women

The American Dream

2011-07-13T06:54:00.002-04:00

Why do Americans in midlife rank lowest in well-being and highest in depression? They eat more, smoke more and are developing serious chronic diseases earlier than in the past, according to the latest findings of the Gallup-Healthways Well-Being Index. Here's a good guess about the cause: Most of them can't afford to keep up their payments on The American Dream. For middle-class women, this is particularly true.

The average family caregiver is a woman in her late 40s who still has at least one child at home and works outside the home while providing an average of 20 hours a week of hands-on care for a loved one. There you have the recipe for the Financially Sandwiched Generation. Almost 70% of Boomers are providing some financial support to their adult children and grandchildren. They are picking up the pieces as their sons and daughters lose jobs and bail out of over-mortgaged homes. Layer on top of that the cost of long-term health care for their parents, who are living into their 80s and 90s with multiple chronic illnesses and the financial sandwich is born!

The toll on emotional health for women in this core group of Baby Boomers — now mid-40s to mid-50s — has a significant impact on their health, but also impacts our economy and the health of our nation. Startling data gathered by Healthways since 2008 reveals that even women who still have jobs are feeling increasingly dissatisfied with their work environment. These women are reporting increases in sadness, stress, worry and lost sleep. And, you know how the saying goes, "When mama ain't happy…"

"If you're sad, stressed, worried, and tired, you won't have enough energy to exercise and you're not going to make healthy eating choices," concludes Janet Calhoun, director of innovation at Healthways. It has also been shown that women who are depressed utilize the health care system seven times more often than their counterparts who are not.

The toll that midlife women's low well-being is taking on this country will be felt not just in continued spiraling healthcare costs. Calhoun reports "very compelling data that shows individuals with low well-being have much lower productivity and performance, and that is a huge economic drain." An intriguing statement, don't you think? No wonder the psychic anxiety is driving up depression. As it stands now, there is no time for women in the Financial Sandwich Generation to get fit with exercise and healthy food because all that seems to matter is productivity, performance and enhancing the country's bottom line.

So what can we do about it? We need to redirect our priorities. You can't live well for others. Don't change your ways for the financial health of the nation, your kids or your boss. Do it for you! This is a grass roots movement from the soul. Take stock of your life. Reassess priorities. Build in "you" time during the day – whether that means getting up 30 minutes earlier (and going to bed 30 minutes earlier), or saying "no" to extracurricular obligations. Create an extra hour every day so that you have time to shop for healthy foods, go for a walk, or meditate. And, don't steal those minutes from precious sleep hours. Instead, extract it from other obligations. Get rid of extra stuff in your life. Then ask yourself: Are there financial responsibilities you can release? Are there individuals you are financially supporting that could do more for themselves? Are you foregoing your time for physical fitness, dietary planning and sense of well being to accommodate others' needs and time constraints?

One suggested strategy is to find other women in similar circumstances that are ready for change. Create or join a Women's Circle where you find kindred souls, sisters who are driven to create and support each other in making positive changes in their own lives – whether that means learning how to negotiate a contract or trading car pool responsibilities. We need to band together. After all, our predecessors did not fight for the emancipation from gender-based restrictions only to lead us down the path of guilt-laden existence because we choose to live one foot in each world – professional working woman and main care provider. We cannot exist as everything to everybody. So, send a memo to your friends: You are not alone! The American Dream is still there for all of us…we just need to understand and embody the value of ourselves. Only then, will we and the world realize our true and soulful potential.

Exercise, Yoga and Meditation for Depressive and Anxiety Disorders

2011-06-19T15:05:00.006-04:00

Reported in the journal of American Family Physician 4/15/2010

Anxiety and depression are among the most common conditions cited by those seeking treatment with complementary and alternative therapies, such as exercise, meditation, tai chi, qigong, and yoga. The use of these therapies is increasing. Several studies of exercise and yoga have demonstrated therapeutic effectiveness superior to no-activity controls and comparable with established depression and anxiety treatments (e.g., cognitive behavior therapy, sertraline, imipramine). High-energy exercise (i.e., weekly expenditure of at least 17.5 kcal per kg) and frequent aerobic exercise (i.e., at least three to five times per week) reduce symptoms of depression more than less frequent or lower-energy exercise. Mindful meditation and exercise have positive effects as adjunctive treatments for depressive disorders, although some studies show multiple methodological weaknesses. For anxiety disorders, exercise and yoga have also shown positive effects, but there are far less data on the effects of exercise on anxiety than for exercise on depression. Tai chi, qigong, and meditation have not shown effectiveness as alternative treatments for depression and anxiety.

Thyroid Function and Miscarriage

2011-05-01T21:57:00.003-04:00

An article published in The Journal of Clinical Endocrinology and Metabolism in 2010 demonstrates an increased pregnancy loss rate in thyroid antibody negative women with a TSH level between 2.5 and 5 in the first trimester of pregnancy. The thyroid gland is an important endocrine organ involved in metabolism. Disruption of the thyroid can result in impaired reproductive function, including miscarriage.

Following are well known facts of pregnancy and thyroid function during pregnancy:

On average 20% of all normal pregnancies end in miscarriage

During pregnancy there is a 30-40% increased need for thyroid hormones due to increased placental uptake, increased thyroid binding globulin and increased blood volume

Pregnant women with abnormal thyroid function experience increased rates of miscarriage, preterm deliveries, hypertension, diabetic complications, placental abruption, adverse fetal effects

Women with anti-thyroid antibodies are 2 times more likely to experience a miscarriage

In this particular study, the authors (R. Negro, et al) studied 4123 women measuring their TSH levels during the first trimester. Findings:

Of the 3481 women with a TSH level of < 2.5 mIU/L the miscarriage rate was 3.6%

Of the 642 women with a TSH level of 2.5 – 5.0 mIU/L the miscarriage rate was 6.1%

If anti-thyroid antibodies are present, giving levothyroxine during pregnancy decreased the spontaneous miscarriage rate from 13.8 to 3.5%

Because of these findings, the authors assert that, perhaps 2.5 should be the maximum normal value of TSH during pregnancy.

References: J Clin Endocrinol Metab 2010;95:E44-48

Omega 3 Fatty Acids during Pregnancy

2011-04-23T07:51:00.000-04:00

During pregnancy, your baby gets most of his or her food from the foods you eat and vitamins you take. Omega-3 fatty acids (omega-3s) are an important family of building blocks needed during pregnancy and breastfeeding. The two most important omega-3s are DHA and EPA. These are known and essential fatty acids as our bodies cannot manufacture them, so we have to get them from our diet.

Omega-3s are important to health. They can lower blood pressure and reduce heart diseases and other health problems. Omega-3s affect fetal development of neural tissue, including brain development. Consuming omega-3s during pregnancy can lower your baby's chances of developing asthma, eczema and other allergic conditions. They also may lower your risk of preterm delivery and postpartum depression.

Because of mercury contamination of our oceans, rivers, and lakes, almost all fish contain some mercury. Some fish contain too much mercury. Some fish may also have other toxins such as polychlorinated biphenyls (PCBs) and dioxin from industrial pollution. High amounts of mercury and PCBs in your body can cause impaired neurologic development of your baby, so fish with high levels of these poisons should not be eaten during pregnancy. The food and Drug Administration recommends you check local advisories on the safety of fish from local waters. Fish advisories are available from your local health department and online from state agencies.

HOWEVER, the health benefits of eating low-mercury fish during pregnancy outweigh the risks, so DO eat safe fish during pregnancy and while you are breastfeeding. Choose fish that are low in mercury. Remove skin and fat before cooking. Baking, broiling, steaming, or grilling fish lets the fat drain away and reduces PCBs in fish. Do not eat raw fish or shellfish.

Pregnant women and women who are breastfeeding should get about 1000 mg of omega-3s per day. Because omega-3s stay in the body for a few days, eating two servings of fatty fish per week can give you the 200 to 300 mg per day that you need. One serving is a 6-ounce portion of cooked fish. If you do not eat fish, or do not want to eat it every week, you can get fish oil as a pill or liquid you can swallow. Purified fish oil in pills or liquid form have all PCBs and dioxin removed. Read the label carefully to make sure there are at least 1000 mg of omega-3s. Fish oil pills can cause stomach upset, nausea and bloating; some women say they have a fishy aftertaste with burping. Freezing them before consumption often helps reduce such side effects. Cod liver oil is a good source of O3FA, however, if taken regularly can cause excess intake of the other vitamin it contains, vitamin A.

Eat at least two 6-ounce servings of omega-3 fish per week, except where indicated. Foods are listed in amounts of omega-3s from highest to lowest. During weeks when you do not eat enough fish, take fish oil supplements. Look for fish oil supplements that are purified because they are the safest.

High sources of omega-3s (about 700 mg or more per serving): Salmon, Halibut, Rainbow trout, Canned light tuna, Atlantic herring, Pollock, Whitefish

Moderate sources of omega-3s (about 150 to 699 mg per serving): Canned tuna, white albacore (limit to 1 serving per week while you are pregnant or breastfeeding), Catfish, Alaskan king crab, Flounder for sole, Shrimp, Atlantic cod, Canned blue crabmeat, Omega-3 enriched eggs

Do NOT eat the following fish while you are pregnant: Swordfish, Tilefish (also called golden bass or golden snapper), King mackerel, Shark, Tuna steaks (fresh or frozen), Marlin, Spanish mackerel, Orange roughy, Raw fish because, in general, they contain too much mercury.

4-7-8 Breath

2011-03-22T09:25:00.003-04:00

Adapted from DrWeil.com

This exercise is a natural tranquilizer for the nervous system. It becomes more effective with time and can be done as often as you like. You can use this whenever something upsetting happens, before you react. It is also helpful for internal tension and for insomnia.

Sit comfortably with your back straight.
Place your tongue on the ridge just behind your front teeth.
Exhale completely through your mouth, making a whoosh sound.
Close your mouth and inhale quietly through your nose to a mental count of four.
Hold your breath for a count of seven.
Exhale completely through your mouth, making a whoosh sound to a count of eight.
This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

The actual time you spend on each phase is not important; the ratio of 4:7:8 is important. You can do this more quickly at first if it is hard to hold your breath, and breathe more slowly as you get practice. Do it at least twice a day. Do not do more than four breaths at one time for the first month of practice. Later, if you wish, you can extend it to eight breaths. Don’t worry if you get a bit lightheaded at first.

100 Steps Towards Resilience

2011-02-27T08:44:00.006-05:00

The most important aspect of building resilience is learning to take excellent care of yourself – mind, body, and spirit. Think of caring for yourself as if you were your own child – giving to yourself at least as much as you give to others. You are worth it!

Here is a list of 100 ways to consider building your resilience. This is not a checklist – only a list of suggestions. Please take the ones that appeal to you and let go of the rest.

Put a post-it on your mirror that says, “I love and accept you, just the way that you are!” – And then say it out loud every day while you're staring into your own eyes.
Create something. – Many of us have gotten away from actually making things. Create some artwork. Write something. Build something. Make something that didn’t exist before. Most importantly, enjoy the process.
Buy a bouquet of your favorite flowers every now and then. – Brighten up your life.
Use colored pens for no particular reason. – Blue and black are fine, but how about purple?
Take a walk without a destination. – It’s a great way to get some exercise and clear your mind. Be mindful of what you see, hear and feel.
Take a hot bath.
Try something new. – Go out on a limb. Learn something new. Do that thing you’ve always wanted to try. The more experiences you have, the richer your life will be.
Get enough sleep. – Everything is harder when you’re tired.
Meditate. – It takes a little practice at first, but if you find a meditation that works for you, you will be calmer and more peaceful.
Write in a journal. – Write anything that calls you. Ideas, experiences, dreams, frustrations – get them out of your head and down on paper.
List the things that you’re grateful for. – You can’t help but feel better when you literally count your blessings.
Treat yourself. – We struggle to be disciplined, especially with money and food. Once in a while, treating yourself to your favorite coffee or seeing a movie (if that’s what you like to do) makes all the difference.
Smile. – Even if you need to fake it. Eventually, you won’t be faking it anymore.
Replace negative thoughts. – Listen to what’s going on in your head and actively quiet the voices of pessimists and critics. Instead, when you are thinking something negative about someone or a situation replace it with this statement directed towards yourself, “ (Your name), I love and accept you just the way that you are.” When you love and accept yourself, you are much more likely to love and accept others.
Drink plenty of water. – It’s basic, but it’s so good for you.
Stretch. – Before you start your day, take a few minutes for a good muscle stretch. It just plain feels good. And, it’s fast, easy and free.
Put some “me time” on your calendar. – When life gets busy, doing things for yourself is the first thing to be sacrificed. So, actually block out time on your calendar.
Call a friend. – Think of someone who you enjoy and ring them up!
Ask for help. – This can be hard. But it’s so important to recognize when you need a sounding board, or some advice, or an extra pair of hands.
Say no, if you absolutely must. – Your time is valuable. Set boundaries to avoid becoming overwhelmed. However, remember your best opportunities in life come from remaining open. So, first say “yes” to those things that strike your fancy and carefully consider saying no to those things that you dread.
Give someone a hug. – We all need human contact.
List the things that you like about yourself. – We can all list the things that we don’t like about ourselves. Turn that around and think about your many positive qualities.
Delegate. – Hire someone to mow the lawn or scrub the floors or shovel the driveway. Teach the kids to do laundry. Give that project to a co-worker. You do not have to do it all.
Take a deep breath. – And another. Now another. It’s like a mini-break to reset yourself during the day.
Light a candle or use a reed diffuser. – Your sense of smell creates the strongest memories. Find scents that relax you and enjoy them.
Claim some space for yourself. – A place where you can go to have a quiet moment to read a book, or meditate, or write, or sleep – somewhere that you can get some peace and privacy.
Get out into nature. – Reconnecting with the earth is just good for your soul. Feel the breeze. Breathe the fresh air. Listen to the waves. Watch the birds. Nature nurtures the soul!
Buy the good ice cream. – Even on the tightest of budgets.
Use lotions & soaps with scents that you love. – It’s a nice way to pamper yourself, plus you’ll smell good all day.
Give a compliment at least once per day. – Telling someone that they had a fantastic idea or that they look beautiful in that color creates a pleasant environment and makes two people feel good for the price of one.
Listen to your music. – Listen to whatever makes you happy and leave air space for other’s happiness, too.
Play. – Something we forget as adults. A board game, a sport, finger painting – find something frivolous and have fun!
Eat foods that you love. – Food is to be enjoyed! Put food into your body that nourishes you in every way.
Be silly every now and again. – We take ourselves entirely too seriously. Let go. Be spontaneous and outrageous!
Laugh. – Sometimes you just need a good laugh to lift your spirits.
Limit screen time. – Too much time in front of computers, TV’s, video games, and blackberries (or all of the above) disconnects you from the world immediately around you and makes your brain mushy. Make sure that you’re getting plenty of input from the non-virtual world.
Be present. – Be deliberate about experiencing what’s happening right now. It’s all about the journey – don’t miss yours!
Stop worrying. – Just stop! Live in the moment.
Trust yourself. – You are smart, capable and talented. You’re choices are just as valid as anyone else’s. Don’t second guess yourself.
Do something that’s only for you. – Remember that hobby that you used to have time for? Or that food that no one else in your house likes? Reclaim it.
Make sure your health is in order. – What’s more important than your health? See your doctor regularly. Make sure you are getting the vitamins or supplements that you need. Advocate for yourself as you would for your child.
Give to someone in need. – Donating your time or your stuff or your money to someone less fortunate makes you feel good and puts your problems into perspective.
Sparkle! – Feeling down on yourself? Get all dolled up. Wear something that makes you feel beautiful. It’s a good way to find your strut.
Dance. – It’s great exercise and inherently joyful!
Stand up for yourself. – Your needs are important. Don’t let anyone disregard them. Pushing back can be scary but it’s empowering too!
Celebrate! (for any reason at all) – Your kid lost a tooth! Your taxes are done and filed! The week is more than half over! Let’s party!
Enjoy your kids. – It’s easy to rush through the day without really connecting with them. Make a conscious effort to talk with them about their day.
Avoid self-deprivation. – When it comes to food, it’s OK to cut back on things that aren’t good for you (sweet, sweet carbohydrates), but if you feel deprived, it’s probably not maintainable. If there is one thing you can’t live without – eat. Simply limit the quantity to a true serving size.
Forget the word “should”. – Instead of doing what you think you’re supposed to, follow your own path.
Pay attention to your energy. – Are you most productive first thing in the morning? Are you sluggish after lunch? Honor your natural cycles and plan accordingly.
Find a mantra or an affirmation that lifts your spirits. – “Today is a new day.” “I know that life always supports me.” “I have wonderful people in my life.” Find one that works for you.
Stand tall. – Your spirit can’t soar when you slouch. You feel much more powerful when you stand up straight and look the world in the eye.
Be romantic. – See the best in others and the best in life. It feels good.
Get a hot stone massage. – It feels soooo good.
Choose optimism. – Thinking positive thoughts has a tangible impact on your day and on your life. Where your attention goes, energy flows!
Dream big. – You can do anything you set your mind to!
Tune out the naysayers. – People criticize for many reasons, especially if they have negative feelings about themselves. That’s their “thing”, not yours. Follow your heart – not everyone has to get it.
Add color to your surroundings. – Find the colors that strike your fancy and use them in your space. Looking for calm, fill your world with sage green and navy blue. Looking for energy and passion, fill your world with Sicilian red and sunflower yellow.
Surround yourself with the things you love. – Especially, photos of loved ones.
Declutter. – You should have ONLY the stuff that you love. Purge everything in your life, both physical and emotional that you don’t honestly need, use or love. Everything else distracts you from your true intentions and bogs you down.
Stop procrastinating. – Procrastination is a form of perfectionism. Accept that it’s not going to be perfect and just get it over with. Image how great it will feel to not have it hanging over your head any more!
Listen to your inner voice. – Your instincts are good. It’s important to listen to your own head and heart.
Cut yourself (and everyone else) some slack. – Arguably the most important tip on this list. We hold ourselves to impossible standards and then beat ourselves up when we don’t meet them. We are our own worst critics. And, when we consistently criticize ourselves, we can’t help but criticize others, too.
Slow down. – When you’re living your life at top speed, you’re missing most of it. Stop and take a breath. Look for ways to adopt a more humane pace.
Identify your passion. – What do you love? What makes time disappear? Do you have a volunteer opportunity you feel passionate about? Are you passionate about traveling to foreign lands? How about learning to play the guitar? Find something in your life that really floats your boat and then schedule that activity for two hours twice per week.
Speak kindly about yourself. – You’re awesome. If you believe it, so will everybody else.
Move your body. – Climb rocks on the shoreline. Run a marathon. Take a tap dancing class. Power walk. Anything that feels good that gets your blood moving. The only limitation: it has to be fun. Don’t take a spinning class if you hate spinning.
Invest in matching under garments. – This one is for the ladies, of course. It’s your own little secret.
Pay attention to your body’s messages and purge things that aren’t good for you. – Unhealthy foods, cigarettes, a miserable work environment, toxic people – do what you have to do to set boundaries and demand the highest quality of life. You deserve it. Things that don’t nourish and support you don’t belong in your life.
Limit your news consumption. – It’s important to be well-informed, but the non-stop feed of histrionic tragedy is not helpful. Read the news, instead.
Say yes to life. – Opportunities are everywhere. Learn a new language, join a curling team, go camping. When new things present themselves to you – jump at the chance.
Stop hating your body. – Have compassion for your body. Nurture it.
Sing loudly. – And feel the music.
Be kind. – Being nice to someone else. You will have made the world a better place. What feels better than that?
Tell someone you love them. – We often forget to say it out loud. It matters.
Take all of your vacation days. – You earned them. Don’t give them back to your company for nothing.
Take pride in the hard times that you have overcome. – What didn’t kill you made you stronger. It wasn’t easy, but you did it!
Let someone else be in charge for a while. – Other people can be responsible while you do something for yourself.
Don’t answer the phone unless it’s someone you want to talk to right now. – Some people find it difficult not to answer a ringing phone, but it’s liberating once you learn to ignore it or even better, just turn it off.
Have faith. – It’s going to work out. The future is bright!
Take a personal inventory. – Does your behavior match your true intentions? If there’s a disconnect, you’re carrying a heavy weight.
Go on a retreat. – For a couple of minutes or a couple of days, get away for a bit to re-energize.
Put your finances in order. – Money problems are enormously stressful. Paying off debt where possible, putting bills on automatic payment, and working with a financial planner if necessary can all help to ease the strain.
Eliminate all expectations of perfection. – In fact, eliminate the word ‘perfect’ from your vocabulary.
Find a good way to blow off steam. – Talk, run, dance…find a healthy alternative to wallowing in anger.
Be who you are. – Dedicate time for soul searching to uncover your true self, and live that way.
Spend some time alone for quiet reflection. – We spend all of our time go, go, going. Try stopping to think about your life, your goals, and your dreams.
Keep your words positive. – Happiness and complaints cannot coexist.
Let light and fresh air into your house. – Sunlight is a must. Open up those windows!
Turn off your e-mail, cell phone, blackberry, fax, etc. for a while. – It’s not healthy to be accessible 24/7.
Pare down your to-do list. – Feeling overwhelmed? What’s on your list that can be delegated, avoided, or eliminated?
Avoid boredom. – Keep your brain active to keep the blues at bay.
Make your home a haven that reflects your personality. – Your home should be a place where you can take a breath and really relax. If it isn’t, you may have some work to do.
Let go. – 80% of everything is irrelevant. Focus on the other 20.
Minimize multi-tasking. – It’s not good for you and well ultimately undermine what you are trying to get accomplished.
Break your routine once in awhile. – Get out of a rut and into a groove.
Take action! – If something isn’t right in your life, fix it!
Plan ahead. – With a few minutes of organizing your time and to-do’s, you will be better prepared to take on the day.
Intentionally enjoy your journey. – As you go through your days, look around. Be present with what you see, hear and feel. You might be amazed at what you’ve been missing.
Spend time with people who make you happy. – Who nourishes and supports you? Surround yourself with those people.

How to Identify an Indigo Child

2011-02-20T10:26:00.005-05:00

By Ezmeralda Lee, contributor to eHow

Indigo children may have possibly been around for several decades however, it was not until the 1982 book, "Understanding Your Life Through Color" by self-styled, psychic Nancy Ann Tappe, when the term was coined. New Age followers firmly believe that such children are born with a high spiritual consciousness and may even possess psychic abilities. However, psychologists and others believe that Indigo children have more conventional traits such as a higher level of empathy and creativity.

Instructions:

Study the child's aura, as the Indigo hue of a child's aura is the distinguishing characteristic of Indigo children. You may have a reading done of the child, if you do not possess the ability to read auras. If you sense a child is attracted to deep purples and blues, likes his room painted in these colors or prefers Indigo clothing, these are indications of an Indigo child.
Observe the attitude of the child starting from birth. An Indigo child has a strong, inherent sense of superiority and self-worth, often believing that she has been born to lead others or have the right and ability to do so.
Pay attention to how the child interacts with authority. An Indigo child will feel that he is the natural "leader of the pack." This is precisely why such a child often challenges or rebels against authoritative persons. An Indigo child will respond with a highly intelligent justification for his action or indiscipline and will also rarely feel guilty in response to disciplinary measures. As such children grow they will frequently assume positions of power and authority.
Notice how the child reacts to traditional systems and practice. An Indigo child has an extremely creative and active mind but will display intolerance and impatience when confronted with old traditions. At times such a child will get bored in a classroom or quickly lose patience when waiting in a queue. An Indigo child will often complain about what she perceives as an old system and will take the initiative to create better ways of organizing her room, classroom and even the world around her.
Watch if the child shows signs as a "loner" or displays anti-social behavior. An Indigo child often prefers to be alone and will also express her feeling of being different than everyone else. An Indigo child will find it difficult to adjust to school and extracurricular activities, unless she is able to bond with other Indigo children.
Listen carefully while the child communicates with you. An Indigo child knows exactly who he is and will not hesitate to talk about his psychic ability, sense to identify auras and the desire to advise or heal others. An Indigo child will also not hesitate to tell you what he needs and wishes to have, often amazing you with his blatant perception of self-identity, position in society and the world.

Tips & Warnings

Try and empathize with the child's view of life by being a patient listener while also offering advice in a calm, soft-spoken manner.
Do not reprimand or question the child's behavior in a harsh or overly, aggressive manner as an Indigo child is prone to acute frustration and depression.

Medicinal Plants for Female Sexual Dysfunction

2010-12-08T07:08:00.005-05:00

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

2010-12-07T10:02:00.003-05:00

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:

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.
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.
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.
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.
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.
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

2010-11-30T10:04:00.003-05:00

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

2010-11-02T08:26:00.008-04:00

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

2010-10-26T07:10:00.011-04:00

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

2010-09-24T13:53:00.002-04:00

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?

2010-09-17T12:52:00.004-04:00

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

2010-08-17T11:27:00.000-04:00

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

2010-07-13T09:45:00.010-04:00

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

2010-06-14T13:30:00.003-04:00

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

2010-06-01T13:49:00.001-04:00

Decrease Your Breast Cancer Risk

2010-03-17T10:00:00.002-04:00

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

2010-01-19T22:00:00.001-05:00

12 Keys for Fighting Fatigue:

Blood sugar stabilization - Keep your blood sugar stable; focus on complex carbohydrates and protein for each meal.
Sleep - get seven hours of continuous sleep most nights.
Aerobic exercise - get 30 minutes of aerobic exercise six days per week.
Nap - Take a 15 minute cat nap in the middle of the day
Vitamin D - get your levels checked; start supplements if deficient. Goal should be 52 ng/mL to optimize benefits.
Vitamin B Complex - B vitamins participate in many metabolic processes and assist in processes of carbohydrates into sources of energy.
Magnesium - Supplement low magnesium levels.
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
Thyroid - How is your thyroid functioning? Ask your health care provider to check TSH, FT4, and FT3.
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.
Kindness - Be kind to others. Negative behavior and troubling thoughts consume energy.
Just say, "no". Avoid over-obligating your time. Instead, spend some alone-time to recharge your batteries.

Spices Could Help Fight Breast Cancer

2009-12-28T10:58:00.006-05:00

According to new research published in the November online edition of Breast Cancer Research and Treatment, popular spices, such as, pepper and turmeric, contain compounds which could help in treating breast cancer by limiting the growth of stem cells.

Turmeric and pepper have been widely explored as potential cancer treatments, however, this is the first study that suggests the two spices could also prevent cancer by targeting stem cells. Currently cancer treatments, such as chemotherapy, are unable to eliminate cancer stem cells.

Researchers from the University of Michigan Comprehensive Cancer Centre studied curcumin (found in turmeric, an Indian spice) and piperine (a black peppercorn derivative) when administered to cell cultures reduced the number of stem cells without affecting normal cells. Both spices were used in a very high concentration - about 20-times the potency of that which would be consumed in a normal diet. More research on the role of these compounds in breast cancer treatment is needed before adding extra curcumin or piperine to our diets.

Curcumin has other well known health benefits in traditional Asian medicine for treatment of gastrointestinal disorders and arthritis. Piperine has anti-inflammatory properties and is used to improve digestion, weight loss and improves absorption of nutrients from the diet.

Reference: PubMed

Targeting breast stem cells with the cancer preventive compounds curcumin and piperine.
Kakarala M, Brenner DE, Korkaya H, Cheng C, Tazi K, Ginestier C, Liu S, Dontu G, Wicha MS.
Division of Hematology/Oncology, Department of Internal Medicine and Comprehensive Cancer Center, University of Michigan, 2150 Cancer Center, 1500 E. Medical Center Dr., Ann Arbor, MI, USA, mkakaral@umich.edu.

6 Tips for Endometriosis

2009-12-21T11:16:00.008-05:00

From: Dr. Weil's Newsletter

Posted 12/21/09

Endometriosis, a condition where tissue resembling the lining of the uterus is found in the abdomen, is marked by severe pain, most often in the form of menstrual cramps. Its exact cause is not yet known, but it does have a strong inflammatory component and, like the lining in the uterus, is influenced by estrogen. (Endometriosis may result in powder-burn spots, ovarian cysts and pelvic scar tissue otherwise known as adhesions. At times, it can be significant enough to scar the fallopian tubes closed.) A number of dietary measures can help relieve symptoms by reducing inflammation and addressing the activity of estrogen in your system.

Start managing endometriosis nutritionally with an anti-inflammatory diet and try the following dietary changes:

1. Eliminate dairy foods (allow at least three weeks to observe any improvements).
2. Eat only hormone-free meat to avoid any additional estrogen exposure.
3. Emphasize whole soy foods in your diet. Tofu, tempeh and soymilk are rich in plant estrogens and seem to modulate the actions of other forms of estrogen.
4. Limit alcohol intake, which may influence estrogen production.
5. Choose organic foods whenever possible.
6. Drink a cup or two of red raspberry leaf tea daily to help relieve cramps.

Graphic interpretation

Endometriose = endometriosis

Schokolade-Zyste = chocolate cyst (endometrioma cyst of the ovary)

Myom = uterine fibroid

Adhasion = adhesion

Hysterosalpingogramm = hysterosalpingogram (dye-infusion test to asses for tubal patency and uterine anatomy.)

ConsumerLab Issues Statement on Probiotic Quality

2009-12-09T10:54:00.007-05:00

Studies have shown that probiotic supplements have been found beneficial for treatment of vaginal yeast infections, irritable bowel syndrome, diarrhea caused by viral illnesses or antibiotic therapy, upper respiratory viral infections, facial acne and even high blood pressure. Probiotics are otherwise known as the “friendly” bacteria of the bowel. They can be purchased in yogurts, powders, miso, beverages or capsules.

However beneficial, not all probiotics are equal. According to a recent ConsumerLab report many brands don’t contain the bacteria cited on their label. The products may contain as little as 7 to 58 percent of the amount of viable organisms mentioned on the label. “It’s really shocking how many products really don’t have what they claim on their labels,” says Tod Copperman, the president of ConsumerLab.

What’s more, the amount of living cells (the bacteria must be alive to be effective) varied widely amongst the different probiotic products ranging from less than one hundred million to over 10 billion cells per dose. Because probiotic are not standardized, Mary Ellen Sanders, a probiotics exepert unaffiliated with ConsumerLab, states that, “The best products on the market are the ones that have been tested in human studies and have been shown to have a benefit.”

According to ConsumerLab, the highest quality probiotics they tested included Advocare Probiotic Restore, GNC Nature Brand Best Super Acidophilus and Jarrow Formulas Jarro-Dophilus.

The products with the lowest bacterial content were Nature’s Secret Ultimate Probiotics (13% viable bacteria), Swiss Natural Sources “5” Strain Dophilus (13% viable bacteria) and Dr. D Chocolate-Flavored (Pediatric) Probiotics (7% viable bacteria).

For the full ConsumerLab report, click here.

Anti-Inflammatory Diet

2009-11-12T07:01:00.005-05:00

Q: I was just wondering if you knew of any cook books or websites specifically aimed toward correct vegetarian diets? I am trying to avoid processed foods as much as possible as well as all meats, but due to the fact that I am so picky and don't eat a wide variety of foods, I'm concerned about getting and maintaining my correct nutrition levels.

A: Thanks for the question! I think your new nutritional efforts are great! Here is the best way I know to eat healthy and add to a very healthy lifestyle: The Anti-inflammatory Diet.

A very helpful link is noted below. It is quite technical talking about ratios of different food categories to provide a nutritionally balanced diet. The basic tenets: Eat two servings of fresh or frozen vegetables and/or fruit for each meal. Try to eat more vegetables than fruit and of varying colors. Eat low-fat protein with each meal. Cook foods and eat bread with extra-virgin olive oil or canola oil. Try to eat at least 2 servings of fish per week; if not, take a fish-oil supplement or a plant-based (algae) omega-3-fatty acid supplement.

Here is the helpful link:
http://www.drweil.com/drw/u/ART02012/anti-inflammatory-diet

Hope that helps!

Processed and Fatty Foods Linked to Depression

2009-11-03T06:33:00.002-05:00

Published on Yahoo! News: Mon Nov 2, 10:41 am ET

LONDON (AFP) – A diet heavy in processed and fatty foods increases the risk of depression, according to British research published on Monday.

Researchers at University College London also found that a diet including plenty of fresh vegetables, fruit and fish could help prevent the onset of depression.

They compared participants -- all civil servants -- who ate a diet largely based on "whole" foods with a second group who mainly ate fried food, processed meat, high-fat dairy products and sweetened desserts.

Taking into account other indicators of a healthy lifestyle such as not smoking and taking physical exercise, those who ate the whole foods had a 26 percent lower risk of depression than those who ate mainly processed foods.

People with a diet heavy in processed food had a 58 percent higher risk of depression.

The researchers put forward several explanations for the findings, which are published in the British Journal of Psychiatry.

Firstly, the high level of antioxidants in fruits and vegetables could have a protective effect, as previous studies have shown higher antioxidant levels to be associated with a lower risk of depression.

Secondly, eating lots of fish may protect against depression because it contains high levels of the sort of polyunsaturated fatty acids which stimulate brain activity.

And they said it was possible that a "whole food" diet protects against depression because of the combined effect of consuming nutrients from lots of different types of food, rather than the effect of one single nutrient.

The researchers concluded: "Our research suggests that healthy eating policies will generate additional benefits to health and well-being, and that improving people's diet should be considered as a potential target for preventing depressive disorders."

The study was carried out on 3,486 people with an average age of 55, who worked for the civil service in London.

Each participant completed a questionnaire about their eating habits, and a self-assessment for depression.

Hormones: Estrogen and Progesterone

2009-10-31T08:51:00.006-04:00

Women and men have primarily three sex hormones: estrogen, progesterone and testosterone. Levels and ratios of these hormones differ between the sexes. Estrogen and progesterone are the dominant sex hormones in women whereas, testosterone is the predominant sex hormone in men. Understanding the interaction of estrogen, progesterone and testosterone is necessary to decipher symptoms and conditions caused by their imbalances.

"Estrogen" comes in three variations in the female body: Estrone (E1), Estradiol (E2), Estriol (E3). It is made in the ovaries, adrenal glands and fat cells. The scientific community often refers to all three forms collectively as "estrogen". However, each molecule has different actions and is present in different concentrations throughout a woman's life. Therefore, it is important to differentiate the three when referring to the "estrogen effects".

Estrone (E1) is the predominant form of estrogen in the postmenopausal period. It is manufactured in the fat cells primarily from androstenedione (a testosterone derivative). An increase in estrone correlates to increased body fat in the menopausal woman. Elevated estrone levels have been associated with increased incidence of breast tumors in animals.

Estradiol (E2) is the most active form of estrogen and is the predominant form of estrogen in women of reproductive age. Estradiol is made primarily by the ovaries and adrenals but is also made in small amounts by fat cells in the postmenopausal period.

Estriol (E3) is the weakest of the estrogens. It is primarily manufactured by the placenta during pregnancy. Estriol supplementation mainly affects the vaginal wall with little effect on the heart and bones. It also plays a role in hair, nail and skin health.

The scientific community often refers to all three forms (estrone, estradiol and estriol) collectively as "estrogen". However, each molecule has different actions. During the aging process, the ovaries cease to manufacture estradiol. The adrenal glands (small organs that sit onthe top surface of the kidneys) take over estrogen production in the form of estrone. The body transforms unused testosterone into primarily estrone and releases estrogen previously stored in fat cells.

Progesterone antagonizes the effects of estrogen, most importantly in the breast and uterus where it counteracts the stimulation of cell growth where overgrowth could lead to cancer. Progesterone is manufactured primarily by the corpus luteum on the ovary after monthly ovulation occurs and to a small degree by the adrenals. Progesterone is also manufactured by the placenta in great quantity during pregnancy. Progesterone is a precursor to most hormones making it extremely important far beyond the role it plays in the production of sex hormones.

For many reasons it is very important to maintain a healthy balance between these two sex hormones. Progesterone production diminishes significantly after menopause. Obese women who manufacture a significant amount of estrone in fat cells after menopause may not produce an adequate amount of progesterone, thereby increasing the likelihood of estrogen-related cancer, such as those of the uterus and breast.

More hormone discussion to follow...

Reference:
Schwartz ET, Holtorf K. Hormones in wellness and disease prevention: common practices, current state of the evidence, and questions of the future. Primary Care: Clinics in Office Practice 2008; 15(4)

Photomicrograph of estradiol crystals. Estradiol, the most potent of the natural estrogens, is used in its natural or semisynthetic form to treat menopausal symptoms.

Please Read New Post on MaternaCare 101

2009-10-01T07:08:00.002-04:00

Home Birth Gone Awry.

15 Ways to Boost Your Memory in Your 30s, 40s, 50s, and Beyond - Healthy Living - Health.com

2009-09-30T13:45:00.002-04:00

15 Ways to Boost Your Memory in Your 30s, 40s, 50s, and Beyond - Healthy Living - Health.com

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Lifestyle Changes Decrease Breast Cancer

2009-09-05T05:30:00.009-04:00

The American Institute for Cancer Research/World Cancer Research Fund estimate that 40% of all breast cancers - over 70,000 breast cancer cases in the United States every year - could be avoided with simple lifestyle changes.

The update to the 2007 recommendations stem from review of 81 additional studies. The new AICR recommendations of lifestyle changes to decrease a woman's risk of breast cancer include:

1. Because of the link between excess body fat and cancer aiming to be as lean as possible without becoming underweight.
2. Physical activity for at least 30 minutes every day
3. If you drink alcohol at all, limit consumption to one drink per day.
4. Mothers should breastfeed exclusively for up to six months and then add other liquids and foods. Evidence is convincing that mothers who breastfeed reduce their risk for breast cancer. There is also probable evidence that children who are breastfed have a lower risk of gaining excess weight as they grow.

"This study represents the clearest picture we have ever had on how lifestyle affect's a woman's risk of breast cancer," declared Professor Martin Weisman, MD, Medical and Scientific advisor to the AICR and WCRF.

The AICR/WCRF report, Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective, was launched in November 2007 and is the most comprehensive report ever published on the link between cancer and lifestyle. For more information, visit http://www.dietandcancerreport.org/.

Bioidentical Hormones

2009-08-17T17:58:00.013-04:00

Hormone therapy is a frequent topic of discussion with my patients. The media coverage of bioidentical hormones including Oprah, Suzanne Somers and Dr. Christiane Northrup have empowered women to seek a better quality of life and relief from menopausal symptoms such as hot flashes, night sweats, impaired sleep, vaginal dryness, decreased libido, painful intercourse, loss of memory and weight gain. This has caused quite a stir in the medical community. Why? Because women are asking questions they’ve not asked before – especially about bioidentical hormones.

What are bioidentical hormones? Bioidentical hormones are prescribed hormones that are identical to the hormones produced in a women’s body prior to the onset of menopause. The most commonly prescribed include three different types of estrogen (estrone, estradiol and estriol), progesterone, testosterone and dehydroepiandosterone (DHEA).

There are two categories of bioidentical hormones: compounded and manufactured.

Compounded bioidentical hormones are pills, creams, gels, suppositories, injectables, sublingual drops or lozenges that are prescribed by health care providers who tailor the dose to a woman’s individual symptoms and concerns. They are literally assembled in the pharmacy by a certified compounding pharmacist and are available through mail-order and some local pharmacies. Compounded bioidentical hormones are generally not covered by insurance and therefore are an out-of-pocket expense.

Manufactured bioidentical hormones are pills, creams, gels, sprays and injectable medications manufactured and marketed by large pharmaceutical companies. They come in standard doses and, therefore, are not available as tailor-made medications. There are other limitations with manufactured hormones. For instance, bioidentical estrogen is only manufactured as estradiol – the most potent of the three types manufactured in a woman’s body. Manufactured bioidentical hormones may be covered by insurance.

The alternative to bioidentical hormone therapy is synthetic hormone therapy. They include manufactured hormones that are similar to but intentionally different than the chemical structure as those hormones produced in a woman’s body. Premarin (conjugated equine estrogen) and Provera (a synthetic progestin) are the most commonly prescribed conventional hormones. They are the suspect hormones studied in the Women’s Health Initiative (WHI) Study that raised concerns about all hormone replacement therapy due to increased risks of blood clot formation, stroke, heart attack and cancer. Upon release of this information in 2002, many women abruptly stopped hormone usage and many physicians stopped or significantly limited prescribing hormone therapy.

The American College of Obstetricians and Gynecologist (ACOG) and the North American Menopause Society (NAMS) have recently issued statements supporting the use of manufactured bioidentical or conventional hormone therapy when necessary. They have also issued statements against compounded bioidentical hormones due to their unproven safety and efficacy.

The debate in the medical community continues regarding the safety and effectiveness of the bioidentical hormones as they have not been studied in large standardized controlled trials such as the WHI. However, it is difficult to undertake such studies when medications are tailor-made for individual women. Small European studies from the 1980’s suggest an improved safety profile with bioidentical hormones. However, this has yet to be proven.

A review article published in January of 2009 in the Journal of Postgraduate Medicine states that patients report greater satisfaction with bio-identical hormone therapies. Clinical outcomes and physiologic data support that bio-identical hormones are more effective than synthetic hormones and are associated with lower risks, including the risk of breast cancer, stroke and heart attack. Further randomized controlled trials are needed to further expound upon the differences.

References:

1. Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, striol and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgraduate Medicine 2009:121(1). doi: 10.3810/pgm.2009.01.1949

2. Compounded bioidentical hormones. ACOG Committee Opinion No. 322. American College of Obstricians and Gynecologists. Obstet Gynecol 2005;106:1139-40.

3. North American Menopause Society Statement on Bioidentical Hormones Therapy

Effects of the Menopause Transition and Hormone Use on Cognitive Performance in Midlife Women

2009-07-16T22:01:00.007-04:00

Many women come to me with complaints of impaired memory or "fuzzy thinking" during the peri-menopause (the period of time prior to the cessation of menses). As it turns out, until recently very few studies have been published assessing the change in cognitive function as women go through the menopausal transition. A study was published in the journal Neurology that evaluates the change in cognitive functioning women experience throughout the menopause transition and the effect hormone therapy has on altering the deterioration.

2,362 women between the ages of 42 and 53 were monitored for four years throughout their menopausal transition in the Study of Women's Health Across the Nation. Women were categorized into groups according to the time spent in the menopause transition, hormone use prior to the last menses and hormone therapy initiated after the last menstrual flow. Assessment of three types of cognitive functioning included processing speed, verbal memory and working memory.

The results were as follows:
1. Women do experience memory impairment (demonstrated as not being able to learn as well as during the pre-menopausal period) during the menopause transition
2. Once women were through the menopausal transition their memory impairment corrected to a pre-menopausal level suggesting the cognitive changes during the menopause transition are temporary
3. Women who took hormone therapy prior to their last menses had a beneficial effect on memory retention
4. Women who started hormone therapy after their final natural menses did not experience a beneficial effect and even proved to be detrimental their cognitive performance

In brief: cognitive function declined during the peri-menopause but hormone therapy started before a woman's last menstrual flow prevented the decline in function.

Find definitions related to this article.

Study Reference: Greendale GA, Huang M-H, Wight RG, et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology 2009;72:1850-7.

Photo from health.discovery.com/

Yoga Helps Reduce Hot Flashes

2009-07-03T05:56:00.000-04:00

Some of the most life-altering symptoms of peri-menopause are hot flashes, night sweats, sleep disturbances and mental fogginess. Yoga is commonly recommended as a form of exercise for peri-menopausal women, but not necessarily for help with controlling peri-menopausal symptoms. A study recently published in the British Journal of Obstetrics and Gynecology suggests that women experiencing such symptoms could benefit from a regular integrated yoga practice.

Researchers conducted a randomized controlled study in 14 centers of yoga research in Bangalore, India to assess the effect of a regularly practiced yoga on peri-menopausal symptoms such as hot flashes, night sweats and sleep disturbance. They randomized 120 peri-menopausal women between the ages of 40 and 55 to either a yoga or control group. The women in the yoga group practiced yoga postures (asana), breathing exercises and cyclic meditation for one hour 5 days per week. The control group participated in supervised simple physical exercises for the same amount of time per week.

Results: The women in the yoga group experienced a greater reduction in hot flashes, night sweats and sleep disturbances. In addition, the women practicing yoga experienced improved cognitive functions such as concentration, memory (remote and short term) and an overall "mental balance".

Read more about developing a yoga practice

Read the abstract
Reference: Chattha R, Nagarathna R, Padmalatha V, Nagendra HR. Effect of yoga on cognitive functions in climacteric syndrome: a randomised control study. BJOG 2008;115:991-1000

To Eat Organic - Or Not?

2009-06-07T12:11:00.006-04:00

Eating 5-9 servings of vegetables and fruits are an important aspect of healthy living. Vegetables and fruits provide nutrients and fiber that are not available from other food sources. Today, many crops are grown in massive quantities where toxic pesticides are used. Choosing organic (produce grown free of pesticides) is more important for some rather than others.

Best to Eat Organic:

1. Apples
2. Peaches
3. Bell Peppers
4. Pears
5. Celery
6. Potatoes
7. Cherries
8. Raspberries
9. Imported Grapes
10. Spinach
11. Nectarines
12. Strawberries

Not Necessary to Eat Organic:
1. Asparagus
2. Kiwi
3. Avocados
4. Mangos
5. Bananas
6. Onions
7. Broccoli
8. Papaya
9. Cauliflower
10. Pineapples
11. Corn (sweet, frozen)
12. Peas (sweet, frozen)

6 Ways to De-Stress Your Home

2009-06-04T06:30:00.001-04:00

From Andrew Weil's Tip of the Day

Your home - whether big, small, or somewhere in between - should be your sanctuary, a place where stress is left at the door and your soul is nurtured. For a more comforting environment, gradually implement the following changes into your home:

Bring the outdoors in. Green plants, cut flowers and blooming bulbs, or pieces of wood, rocks and other organic elements can create a feeling of nature indoors.
Paint a room to suggest a mood. For instance, blue and green promote a relaxed feeling and may be good choices for the bedroom, while warm colors (maroon, coral, burgundy) suggest a cozy environment and may be inviting in a family room.
Surround your senses with beauty. Artwork, fragrance, smooth textures and calming sounds all provide a pleasant environment in which to relax.
Set aside a room or area for peace and calm. A place for spiritual reflection and meditation can provide shelter from noise and distraction.
Clean out clutter. A low-maintenance home is refreshing after a day of hectic meetings, errands and chores. Fewer items can mean less frustration.
Create an atmosphere of love. Display handmade or meaningful gifts from loved ones and photos of family and friends.

Vitamin D and Breast Cancer

2009-05-30T17:11:00.010-04:00

Adequate serum levels of Vitamin D have been associated with decreased risk of several cancers, including breast cancer. Why? Some studies have shown vitamin D inhibits the formation of malignant breast cells. Regardless of the mechanism, KD Crew and associates recently published an abstract on line that indicates vitamin D levels are inversely related to breast cancer risk.

This population-based, case-controlled study compared vitamin D plasma levels of 1,026 women diagnosed with breast cancer between 1996 and 1997 with vitamin D plasma levels of 1,075 women who lived in the same area of Long Island, New York.

The authors found:

Plasma vitamin D levels were inversely related to breast cancer risk

All women with vitamin D levels greater than or equal to 40 ng/mL were 46% less likely to have breast cancer than women with vitamin D levels less than 20 ng/mL

Postmenopausal women benefited most with a 54% reduction of breast cancer risk if their serum vitamin D level was greater than or equal to 40 ng/mL

These results add to a growing body of evidence that adequate vitamin D stores may prevent breast cancer development. It is known that circulating vitamin D levels of more than 32 ng/mL are associated with normal bone mineral metabolism; this data suggest that the optimal level for breast cancer prevention is greater than or equal to 40 ng/mL. More clinical trials are urgently needed to evaluate the role of vitamin D supplementation on breast cancer prevention.

What I tell my patients

It is unknown, as of yet, the optimal plasma level of 25-hydroxyvitamin D. Evidence continues to mount that our previous perception of "normal" levels of vitamin D falls short. Many experts now believe that a range of 40 to 80 ng/mL is an optimal range to protect us from many chronic and debilitating illness. However, many labs still report a 25-hydroxyvitamin D level as "normal" when it falls in the range of 20 - 100 ng/mL. Have your levels tested. Ask your doctor what your 25-hydroxyvitamin D level is. I recommend a level of 52 - 80 ng/mL to my patients (colon cancer risk is cut in half at 52 ng/mL).

Do self-breast exams monthly. Get annual mammograms starting at age forty; sooner if advised. Get 20 minutes of sunshine (without sun block) at least 3 days per week. Eat a diet abundant in vegetables, fruit, whole grains and omega-3's. Eat organic, when possible. Exercise regularly. Limit alcohol consumption to no more than 1 drink per day. Laugh often. Enjoy nature. Practice silence. And, be your own best health advocate.

Reference: Crew KD, et al. Association between Plasma 25-Hydroxyvitamin D and Breast Cancer Risk. Cancer Prev Res (Phila Pa). 2009 May 26. [Epub ahead of print]

Lemon Baked Halibut

2009-05-29T20:49:00.007-04:00

Recipe from Dr. Andrew Weil's Daily Tips

Description

The mellow flavor of this low-fat fish comes from marinating it in vigorous spices. After cooking, it is topped with homemade salsa rich with the flavor of tangy onions, fiery jalapeño peppers, and cool papaya. Make the salsa first, before you start preparing the fish. It is also best to make the marinade far enough in advance so that the flavors can blend together for at least 2 hours before you actually marinate the fish in it for 30 minutes. Keep this in mind when deciding what time you want to serve this dish. I couple this entrée with a side of steamed vegetables or Roasted Root Vegetables.

Ingredients

PAPAYA SALSA
1/2 cup cilantro leaves
1 cup cubed papaya
1/4 cup cubed red bell pepper
1/4 cup diced red onion
1 small jalapeño pepper, seeded and minced
2 tablespoons freshly squeezed lime juice

MARINADE
3 tablespoons freshly squeezed lemon juice
1 tablespoon grated lemon zest
1 tablespoon olive oil
1 tablespoon grated fresh ginger
3/4 teaspoon freshly ground black pepper
1/2 cup minced fresh cilantro

Six 6-ounce halibut steaks, sliced in half lengthwise
3 medium bulbs fennel, trimmed and sliced
2/3 cup purified water
9 black or white peppercorns

Instructions

Make the salsa: Put the salsa ingredients in a small bowl, mixing with a spoon until everything is thoroughly melded in. Cover and refrigerate until you are ready to use.
Make the marinade: Stir together the lemon juice, zest, oil, ginger, pepper, and cilantro in a bowl. Let the flavors mingle together for at least 2 hours, covered, in the refrigerator. After the 2 hours, put the fish in a baking pan, pour the marinade evenly over it, and let it sit for 20–30 minutes, covered, in the refrigerator.
Preheat oven to 400°F.
Meanwhile, cook the fennel in the water with the peppercorns in a large, flameproof sauté pan, covered, over high heat for about 6–8 minutes, until just tender, adding liquid if necessary.
Remove from the heat.
Remove the halibut steaks from the refrigerator and bake them for 5 minutes on each side. The halibut should be flaky and white.
Arrange equal portions of the fennel on each of 6 plates, put the halibut on top, and spoon 1 tablespoon of Papaya Salsa on the fish.

Serves 6

Per serving:
Calories 322
Fat 7.1 g
Saturated fat 1 g (20.2% of calories from fat)
Protein 39.6 g
Carbohydrate 24.4 g
Cholesterol 54 mg
Fiber 7.9 g

This recipe is from The Healthy Kitchen - Recipes for a Better Body, Life, and Spirit (Hardcover) by Andrew Weil, M.D. and Rosie Daley (Knopf)

Mindfulness Training to Enhance Female Sexual Response

2009-05-25T09:15:00.001-04:00

Most women are accomplished multi-taskers. However, ruminating about grocery lists or an upcoming staff meeting while engaging in sexual activity could certainly prove to be detrimental. For a rewarding sexual experience, such moments deserve to be the sole focus of attention and concentration.

Mindfulness is rooted in Eastern spiritual traditions, and is described as the means by which dispersed thoughts are gathered so that the mind can experience "living in the moment". Mindfulness is commonly used in stress reduction programs and has been shown to have many positive effects on physical, emotional and sexual health.

In general, mindfulness therapy teaches a woman to focus on the present moment without judging the experience or clouding it with feelings. Women with sexual impairment often report difficulties with intercourse because of intrusive, nonsexual thoughts and concerns about sexual performance, body image and partner-related issues. A study published in 2000 showed that a mindfulness practice can help women overcome such distractions and focus on their sexual response (Dove, 2000). Another study demonstrated improved sexual desire, arousal and satisfaction and decreased negative mood in ten women who practiced mindfulness meditation for five years (Brotto, 2008). Mindfulness has also been correlated with greater marital satisfaction (Burpee, 2005).

You can find mindfulness meditation CDs by Jon Kabat-Zinn at http://www.mindfulnesscds.com/index.html

References:
1. Dove NL, Widerman MW. Cognitive distraction and women's sexual functioning. J Sex Marital Ther. 2000;26(1):67-78
2. Brotto LA, et al. A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. J Sex Med. 2008;5(7):1646-59.
3. Burpee LC, Langer EJ. Mindfulness and marital satisfaction. J Adult Dev. 2005;12(1):43-51.

U.S. Faces Epidemic of Vitamin D Deficiency

2009-05-23T21:36:00.000-04:00

According to a recent report published in the Archives of Internal Medicine, a vitamin D deficiency epidemic has hit the United States and current recommendations for vitamin D supplements are inadequate. According to the National Health and Nutrition Examination Survey vitamin D deficiency has tripled since 1994. The analysis included serum specimens from 13,369 people ages 12-60 between 2001-2004 and compared them to 18,883 specimens obtained between 1998-1994.

Authors' observations:

Vitamin D supplementation should consist of at least 1000 IU, especially during the winter months for those living in northern latitudes (i.e. above Atlanta, Georgia)
Current recommendations for Vitamin D supplementation (200-600 IU/d) are too low
It is unknown what the optimal serum level is for vitamin D - most likely above 40 ng/ml
The average vitamin D level of people ages 12-60 was 24 ng/mL
Vitamin D deficiency in the African American population is the highest at 29%
Several factors contribute to vitamin D deficiency including decreased time outdoors, obesity and the use of sunblock. (SPF 15 decreases vitamin D synthesis by 99%)

What I tell my patients:

Vitamin D deficiency contributes to osteoporosis, depression, diabetes, many forms of cancer, cardiovascular disease, multiple sclerosis, etc.
25-hydroxy vitamin D levels should be checked annually (optimally between November and April when levels are likely to be lowest)
Those most at risk for vitamin D deficiency: elderly, people of color, people who are unable to get sun exposure, and those who routinely cover their heads when walking outside
You need 20 minutes of sun exposure without sunblock 3 times per week for adequate vitamin D synthesis. Care should be taken to avoid sunburn.
Thirty minutes of sun exposure in a bathing suits results in the formation of 20,000 IU of vitamin D
Our food supply does not contain adequate amounts of vitamin D supplementation - not even dairy products
Everybody, with very few exceptions, should be on vitamin D supplementation 1000 IU/d
I recommend an optimal level of 52-80 ng/mL. One study demonstrated that a level of 52 ng/mL decreases your risks of colon, breast and ovarian cancer by up to fifty percent!
Supplements of 1000 IU can be purchased without a perscription and are relatively inexpensive.

Reference:
Ginde AA, et al. Dmographic differences and trends of vitamin D insufficiency int he US population, 1988-2004. Arch Intern Med. 2009;169(6):626-632.

Low Vitamin D Increases Risk for Metabolic Syndrome

2009-05-19T21:39:00.000-04:00

by Stephen Daniells

According to findings published in Diabetes Care, a study with 3,262 Chinese people aged between 50 and 70 showed that deficient levels of vitamin D may increase the risk of metabolic syndrome by 52% ....

Read complete article here.

Metabolic Syndrome Risk Assessment

2009-05-19T21:00:00.001-04:00

by Lynn Marquardt, NP

ASSESSMENT - Answer each question with "YES" or "NO"

1. Do you have a family history of early heart disease?
(Parent, brother or sister, men before age 55, women before age 65?)

2. Do you use any tobacco products?

3. Do you have elevated blood sugar?

4. Are you overweight?
(Is your BMI greater than 25.0? Calculate your BMI)

5. Is your waist size greater than 35 inches?
(Measure 2 fingers above belly button)

6. Is your blood pressure over 135/85 or are you on
high blood pressure medication?

7. Is your HDL level lower than 50 mg/dl?

8. Is your triglyceride level >149 mg/dl?

If you answered “yes” to any of these questions, you may be at greater than normal risk for metabolic syndrome. The more “yes” responses you chose, the greater your risk.

Completion of this assessment is not a substitute for contacting a healthcare provider. Discuss your risks with your healthcare provider.

What is Metabolic Syndrome?

2009-05-19T20:21:00.000-04:00

by Lynn Marquardt, NP

People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls and type 2 diabetes. Metabolic syndrome has become increasingly common in the United States. It’s estimated that over 50 million Americans have it.

The American Heart Association and the National Heart, Lung, and Blood Institute recommend that the metabolic syndrome be identified as the presence of three or more of these components:

Elevated waist circumference:
Men — Equal to or greater than 40 inches (102 cm)
Women — Equal to or greater than 35 inches (88 cm)
Elevated triglycerides:
Equal to or greater than 150 mg/dL
Reduced HDL (“good”) cholesterol:
Men — Less than 40 mg/dL
Women — Less than 50 mg/dL
Elevated blood pressure:
Equal to or greater than 130/85 mm Hg
Elevated fasting glucose:
Equal to or greater than 100 mg/dL

AHA Recommendation for Managing the Metabolic Syndrome:
The primary goal of clinical management of the metabolic syndrome is to reduce the risk for cardiovascular disease and type 2 diabetes. Therefore, the first-line therapy is to reduce the major risk factors for cardiovascular disease: stop smoking, and reduce LDL cholesterol, blood pressure and glucose levels to the recommended levels.

For managing both long- and short-term risk, lifestyle therapies are the first-line interventions to reduce the metabolic risk factors. These lifestyle interventions include:

Weight loss to achieve a desirable weight (BMI less than 25 kg/m²)
Increased physical activity, with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat, trans fat and cholesterol

a. Commit to a healthy diet. Eat plenty of fruits and vegetables. Choose lean cuts of white meat or fish over red meat. Avoid processed or deep-fried foods. Eliminate table salt and experiment with other herbs and spices.

b. Get moving. Get 30 to 60 minutes of moderately strenuous activity most days of the week.

c. Lose weight. Losing as little as 5 percent to 10 percent of your body weight can reduce insulin levels and blood pressure, and decrease your risk of diabetes.

d. Stop smoking. Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome

e. Eat fiber-rich foods. Make sure you include whole grains, beans, fruits and vegetables in your grocery cart. These items are packed with dietary fiber, which can lower your insulin levels.

Summary

The term "metabolic syndrome" is a way of identifying individuals at high risk for the development of heart disease and diabetes. Patients at risk should receive education and counseling on lifestyle modification, and all risk factors for heart disease should be treated aggressively.

http://www.americanheart.org/presenter.jhtml?identifier=534

http://www.nhlbi.nih.gov/health/dci/Diseases/ms/ms_whatis.html

Food Consumption during Labor - Why Not?

2009-05-14T11:17:00.000-04:00

There is an ongoing international debate about food consumption during labor. The current rationale for women fasting during labor is to protect them from pulmonary aspiration should general anesthesia be needed for an emergency cesarean delivery. Other concerns include increased cesarean rate (Scheeper, 2002) or prolongation of labor (Tranmer, 2005) should women be allowed to eat while laboring.

On March 24, 2009 the British Medical Journal published a well-done randomized controlled trial (O'Sullivan, 2009) of over 2000 women suggests we should revisit current practices of not allowing women to eat while in labor. Women were randomized to water-only or a "light diet". (They were advised to consume a low fat, low residue diet at will during labor. Suggested foods included fruits and vegetables, breads, soup, low fat yogurt, fruit juices and sports drinks.)

Results:

No difference in vaginal delivery vs. cesarean delivery rate between the two groups (30% cesarean delivery rate in both groups).
No difference in length of labor.
No difference in Apgar scores or admission to the neonatal ICU.
No cases of aspiration pneumonia (However, because aspiration is so rare, a much larger study would have been needed to see one case.)
One maternal death occurred in the water-only group due to a brain hemorrhage.

Side note:
The UK Confidential Enquiries into Maternal and Child Health reviewed 2,113, 831 deliveries between 2003-2005. Six anesthesia-related deaths occurred, none of which was associated with pulmonary aspiration. Similar findings were reported by the Australian Anesthesia Incident Monitoring Study. This supports the statement that aspiration pneumonia is exceedingly rare.

References:
1. O'Sullivan G, et al. Effect of food intake during labour on obstetric outcome: randomised controlled trial. BMJ 2009;338:b784
2. Lewis G, ed. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer—2003-2005. The seventh report on confidential enquiries into maternal deaths in the United Kingdom. London: CEMACH, 2007.

See complete MaternaCare review and references here .

PMS and Integrative Medicine (Part II): Botanicals

2009-05-07T22:49:00.000-04:00

Chastetree, Black cohosh, Ginkgo biloba and Evening primrose are the most commonly used botanicals to treat premenstrual syndrome in the United States. Of those listed, Chastetree has been the most widely studied.

Some of the descriptions below refer to "The German Commission E". The German Commission E Monographs are a therapeutic guide to herbal medicine. There is an English translation by the American Botanical Council, with 380 monographs evaluating the safety and efficacy of herbs for licensed medical prescribing in Germany. Though the German Commission no longer exists, in Germany only those herbs with Commission E approved status are legally available.
___________________________________________________________________________________________________

Chastetree Berry (Vitex agnus-castus) is the dried ripe fruit of the chaste tree. In a number of well conducted studies chastetree berry has been effective in reducing PMS symptoms, especially breast discomfort, when compared to placebo. The German Commission E has approved the use of chastetree berry for irregularities of the menstrual cycle, premenstrual symptoms and breast pain.

Chastree is considered safe. Possible side effects are mild and reversible. They include mild headache, diarrhea, abdominal cramps, decreased appetite, rash and itching. Possible drug interactions could include anti-psychotics, some antidepressants and estrogen-containing compounds. However all potential drug interactions are theoretical.

___________________________________________________________________________________________________

Black Cohosh (Actaea racemosa) was used by American indigenous peoples for the treatment of respiratory complaints, muscuoskeletal pain and to aid in childbirth. It was most likely used for its anti-inflammatory and muscle relaxant properties.

Compounds in black cohosh bind to the 5-HT7 (serotonin) receptor which may explain its positive effect on depressive and anxiety symptoms in PMS. A study published by Dittmar in 1992 demonstrated a reduction of the PMS symptoms including anxiety, tension and depression. A number of studies show a benefit for various menopausal symptoms such as hot flashes, profuse sweating, sleep disturbance and depressed moods. Because these symptoms often exist in those suffering from PMS, many clinicians have recommended the use of black cohosh in this population, too. Black cohosh is approved by the German Commission E for use in women suffering from premenstrual symptoms, painful menstruation (i.e. dysmenorrhea) and menopause.

Side effects and drug interactions: Black cohosh is generally safe and well tolerated when used for 6 months; and has not been well-studied beyond 6 months duration. Caution should be exercised as there have been multiple case reports of liver damage while using black cohosh. As stated above, Black Cohosh has been studied as a therapy for menopausal symptoms, not PMS. At this time that there is insufficient evidence to support or refute the use of black cohosh for PMS.
___________________________________________________________________________________________________

Ginkgo (Ginkgo biloba): Ginkgo is commonly used to sharpen mental focus and improve circulation. One well-done study suggests the ginkgo is more effective in decreasing psychological and congestive symptoms ( e.g. breast pain, breast tenderness and fluid retention) than placebo in PMS sufferers. More studies need to be conducted before strong recommendations can be made to support or refute the use of ginkgo for PMS.

Ginkgo is generally well tolerated and considered safe with similar side effect rates as placebo in several reviews. Ginkgo is thought to have a blood-thinning effect. Therefore, possible drug interactions can occur with anti-coagulants such as warfarin and aspirin.
___________________________________________________________________________________________________

Evening Primrose Oil (Oenothera biennis): A systematic review of the literature published in 1996 included seven studies. Unfortunately, none of the studies found a beneficial effect of evening primrose oil for PMS symptoms; this included two well-designed, randomized, placebo-controlled trials that were adequately powered.

Potential side effects include headache, seizures among people with seizure disorder or taking anesthetics, nausea, vomiting, anorexia, diarrhea, hypersensitivity reactions, rash, inflammation and immunosuppression with long-term use. Possible drug interactions include anticoagulants, phenothiazines and other anti-seizure medication. In lite of the currently available information, EPO is not a recommended treatment for PMS.

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Other biologically based therapies: St. John’s Wort (Hypericum perforatum) is primarily used to alleviate depressive symptoms. Kava (Piper methysticum) has been proven effective for treating anxiety, though has a questionable safety profile. Valerian (Valeriana officinalis) is a common over-the-counter ingredient for sleep preparations and relaxants. Don Quai (Angelica sinensis) as a tonic for women with fatigue and low vitality. None have yet been adequately studied for the treatment of PMS.

References:
1. Daniele C, et al. Vitex agnus castus: a systematic review of adverse events. Drug Saf
2. Dittmar FW, et al. Premenstrual syndrome: treatment with a phytopharmaceutical. Therapiwoche Gynakol 1992;5:60-8.
3. Budeiri, D, Li Wan Po A, Doman JC. Is evening primrose oil of value in the treatment of premenstrual syndrome? Control Clin Trials 1996;17:60-8.
4. Tamborini A, Taurelle R. Value of standardized Ginkgo biloba extract (EGb 761) in the management of congestive symptoms of premenstrual syndrome. Rev Fr Gynecol Obstet
5. Blumental M, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine communications, 1998.
2005;28(4):319-32. 1993;88:447-57

Healthy Oils for Cooking

2009-05-06T09:59:00.000-04:00

6 good-for-you choices that'll add health and flavor to your cooking.

Most women know they need some fat in their diet. "But moderation is key — all oils have about 120 calories and 14 grams of fat per tablespoon," says nutritionist Ellie Krieger, R.D., host of Healthy Appetite on the Food Network. She suggests sticking to about two teaspoons of added fat per meal — and cooking with a variety of oils, since they all offer different body benefits. Here are some of the best kinds, plus delicious ways to get them in your diet.

Olive Oil
Why it's healthy: Of all the oils, olive has the highest amount of heart-protective monounsaturated fats and polyphenols — antioxidants that have anti-inflammatory and anticlotting properties. It's also a staple of the Mediterranean diet, which has been shown to lower your risk of heart disease, lengthen your life, reduce your odds of cancer and diabetes, and help you lose weight. Newly pressed extra-virgin olive oil contains oleocanthal, a compound that acts similar to ibuprofen, according to a recent University of Pennsylvania study. Researchers say that a diet rich in olive oil may have pain-relieving and heart-health benefits similar to those of taking a low-dose baby aspirin every day.

What it's best for: Let extra-virgin olive oil's strong flavor shine though in salad dressings, on bread, or atop grilled meats, fish, and veggies. And (surprise!) you can fry or sauté with olive oil too! Frying isn't as unhealthy as you may think: "When you fry a food in olive oil that's heated to about 350 degrees F, a crust will form and your food will absorb less oil," says Nicki Heverling, R.D., program manager for the Mediterranean Foods Alliance. Just know that extra-virgin olive oil has a smoke point of about 385 degrees F to 420 degrees F — so keep an eye on the heat or else the oil will burn and splatter.

The skinny on olive oil: Choosing an olive oil can be confusing. Here, Heverling explains how to pick the best bottle.

Always choose extra-virgin. It's made from the first pressing of olives, so it has the most antioxidants and flavor. Look for an oil that's cold-pressed, meaning no heat was used during the processing. Think that's too pricey? Opt for an inexpensive extra-virgin olive oil for cooking, then splurge on a high-quality, unfiltered one for drizzling and dipping. "This adds amazing flavor and health to your food — it's worth every penny," says Heverling.

Go imported. Spain, Italy, and Greece are the biggest olive oil producers, and their strict quality standards mean you'll get a better product. Look for the words product of (as in "product of Italy") to guarantee that the oil comes from that country.

Buy dark-colored bottles. And keep them in a dark, cool place, since light and heat can turn oil rancid. Olive oil is best used within six months but can last for two years if stored properly.

Canola Oil
Why it's healthy: Canola oil contains the lowest levels of unhealthful saturated fats of any oil, and it's also a good source of alpha-linolenic acid, a heart-healthy omega-3 fatty acid. The FDA recently approved canola oil products to carry the health claim that it may reduce the risk of coronary heart disease. Substituting it for other vegetable oils, and canola oil — based spreads for margarine, can significantly reduce the amount of saturated fats in your diet, according to a recent study.

What it's best for: Mild-flavored canola oil is the cheapest option for sautéing and frying, and it also works well as a shortening or butter substitute in baked goods.

Peanut and Sesame Oils
Why they're healthy: Consuming a diet rich in peanuts, peanut butter, and peanut oil may be as effective in protecting against heart disease as an olive oil-rich diet, according to a Penn State study. Peanuts contain resveratrol, an antioxidant also found in wine that has been associated with a reduced risk of cancer and heart disease. Sesame oil is a good source of vitamin E, magnesium, copper, calcium, iron, and vitamin B. It also contains sesamin and sesamolin, substances that have been shown to lower cholesterol and protect the liver.

What they're best for: These oils have a high smoke point, so they work best for stir-fries. Peanut oil has a bland, nutty flavor, making it an ideal choice in dishes featuring nuts or when you want other flavors in a recipe to shine. Sesame oil has a strong, distinctive taste. "I finish Asian dishes with a splash of toasted sesame oil," says Krieger.

Walnut and Flaxseed Oils
Why they're healthy: Both oils are high in omega-3 fatty acids. In fact, flaxseed has the highest concentration of omega-3s of all non-fish foods, and it also contains lignans, chemicals that may play a role in preventing cancer.

What they're best for: Their delicate flavor makes them ideal for no-cook items such as salad dressings and fruit smoothies; walnut oil can also be used for baking. Both oils must be refrigerated and used within a few months.

Originally published WebMD 9/9/2008

by Nicole De Coursy

PMS and Integrative Medicine (Part I): Supplements

2009-04-23T17:19:00.003-04:00

Premenstrual syndrome (PMS) is a complex disorder that affects a woman’s emotional and physical well-being. Broadly defined, PMS is a constellation of behavioral, psychological and physical symptoms that affect a woman during the luteal phase, 7 to 14 days before the onset of the menstrual flow. Over 200 symptoms have been associated with PMS. See the table below for a list of the most common symptoms of PMS.

Common Symptoms of Premenstrual Symptoms

Behavioral symptoms: fatigue, insomnia, dizziness, changes in sexual interest, food cravings, overeating, social isolation

Psychological symptoms: irritability, anger, depressed mood, crying, tearfulness, anxiety, tension, mood swings, lack of concentration, confusion, forgetfulness, restlessness, loneliness, decreased self-esteem, tension, forgetfulness, restlessness, loneliness, decreased self-esteem, tension

Physical symptoms: headaches, breast tenderness, back pain, abdominal pain, bloating, weight gain, swelling of extremities, water retention, nausea and joint pain, acne, constipation, diarrhea, carbohydrate cravings

It is estimated that up to 85% of women between 25 and 35 years old are affected by PMS symptoms. 20% to 40% suffer from PMS, defined by the American College of Obstetricians and Gynecologists (ACOG) as “the cyclic occurrence of symptoms that are of sufficient severity to interfere with some aspects of life and that appear with consistent and predictable relationship to the menses.” Two to 10 percent suffer from premenstrual dysphoric disorder (PMDD) which results in serious impairment of some aspect of their social, family, or work life.

PMS and PMDD are diagnoses of exclusion meaning that other physical and psychiatric disorders must be ruled out before either diagnosis can be made. Disorders such as anemia, diabetes, thyroid disease, endometriosis, other endocrine abnormalities and breast disease may be confused with PMS. Major depression, dysthymia (chronic low-grade depression) and anxiety disorders are among the key psychiatric disorders that also need to be ruled out.

The cause of PMS and PMDD remain uncertain. Proposed etiologies include: hormonal dysregulation, fluid and electrolyte imbalances, neurotransmitter (serotonin) deficiency, prostaglandin excess or deficiency, vitamin and mineral deficiencies, genetic risk, psychological factors and social factors.

Supplements that may help:

Calcium: A prospective, randomized, double-blind, placebo-controlled, parallel group multi-center clinical trial was conducted to evaluate the effectiveness of calcium carbonate for PMS. Women who took 1200 mg per day of calcium for three menstrual cycles had a 48% reduction in PMS symptoms (depression, water retention, pain food cravings, fatigue and insomnia), compared to a 30% reduction in the placebo group. In 1999 Annals of Pharmacotherapy published a review of studies focusing on calcium supplementation for PMS. The authors concluded that, “calcium supplementation of 1200 to 1600 mg/day, unless contraindicated, should be considered a sound treatment option in women who experience premenstrual syndrome.” Calcium may impair absorption of the following medications if taken simultaneously: tetracycline, iron, thyroid hormones and steroids.

Vitamin D: A study published in 2005 indicated that Vitamin D when taken in addition to supplemental calcium may decrease PMS symptoms. Doses of the two supplements taken in combination were: 400 IU of vitamin D3 and 1200 mg of elemental calcium.

Vitamin B6: Many studies have studied pyridoxine in the treatment of PMS. A systematic review of the 28 trials published between 1975 and 1999 showed that pyridoxine (Vit B6) was helpful in the treatment of PMS. 25 - 50 mg two-times per day is the recommended dose. Possible side effects: Neurologic changes can occur at doses greater than 100 mg/day.

Magnesium: Women with PMS may have lower serum magnesium levels. Several well done studies have evaluated the effect of magnesium supplementation on various premenstrual symptoms. One trial showed a significant reduction of fluid retention, weight gain, swelling, breast tenderness and bloating after only 2 months of treatment with 200 mg per day. Possible side effects: abdominal cramping, diarrhea, low blood pressure, irregular heartbeat, muscle weakness, nausea and change in mental status.

Other supplements that may be beneficial: Potassium, L-tryptophan, soy protein, vitamin E and krill oil. Additional studies are underway to assess their efficacy.

Online PMS resources:
1. OBGYN.net
2. American Academy of Family Physicians
3. womenshealth.gov

References:
1. ACOG Practice Bulletin #15, 2000
2. Daugherty JE. Treatment strategies for premenstrual syndrome. Am Fam Physician. 1998;58(1)
3. Bertone-Johnson ER, et al. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005;165:1246-1252.