Eating Well And Making Informed Choices – No Easy Task!

womentowomen on December 24, 2013

by Marcelle Pick, OB/GYN NP

Organic?  Grass fed?  Non GMO?  Washed?  Non processed?  Gluten free?  Healthy Fats?  Safe packaging?

All of these questions and all you want to do is eat foods that are tasty, nutrient rich, and transported to our stores in a healthy way! Staying informed, it seems, is the only way to do it. But then the media is telling us about spinach and melons contaminated with e-coli, chickens fed with hormones, milk with additives. There’s no time to even think about making choices because we’re so busy filtering the messages!

So many women tell me that it feels overwhelming to decide what to eat. Fish lovers are concerned about mercury and other toxins, fruit and vegetable lovers are concerned about pesticides and packaging. Egg and chicken lovers are concerned about stress and cages…and the list goes on.

While it seems that many women may want to just throw their hands up, more and more women are talking with me about making good choices, informed choices and healthy choices.

Here’s what I tell them:

Take time to enjoy your food!  With our mile-a-minute lifestyles, expectation (whether self imposed or not!) to multi-task and increasing responsibilities, we often eat on the run or eat without even knowing it. Slowing down and enjoying your food doesn’t stop you from ingesting the pesticides which may have been sprayed on your vegetables, but it helps by keeping your stress level on an even keel. This will help your body function better – you’ll be able to detox more efficiently and your immune response will stay strong.

Eating is a pretty complex body function. Once food enters our body there are multiple complex functions which take place to insure that our bodies can utilize the nutrients contained in our foods. The digestive process is long and complex and a healthy digestive system is critical to a healthy body! We all have a complement of organisms which live in our bodies which help with metabolism, immune response and digestion. Enhancing the number, type and quality of the microorganisms helps strengthen our systems and protect us from harmful bacteria or toxins which enter our bodies. In many cultures, adding foods like yogurt, kimchee, or kefir to the diet is thought to help longevity. Something to think about, isn’t it?

When possible, know where your food is coming from. When possible, chose fresh instead of canned, local when possible. For most women cultivating a garden isn’t a possibility – shopping at a local farmer’s market might be – or at a grocery store which carries locally grown fruits and vegetables. Many large grocery stores are listening to consumer request and carrying meat and dairy products from local farms. Does yours?

Raise your awareness about the three P’s – pesticides, packaging and preparation.  Let’s think about pesticides for a minute – pesticides are designed to kill pests. This means that they are toxic. When you ingest a pesticide, your body’s response system must be working well in order to move this pesticide through your body and out without causing damage. That’s quite a job!

The Environmental Working Group regularly publishes a list of the safest and most heavily pesticide ridden fruits and vegetables. The list is called the Dirty Dozen and can be found on their site ewg.org. If you are unable to purchase fruits and vegetables which haven’t been treated with pesticides or herbicides, here are two suggestions for removing these vegetables.

Veggie spray:
1 tablespoon of baking soda
1 tablespoon of lemon juice
1 cup of water

Put all the ingredients into a spray bottle and shake gently to mix. Be careful because the mix may foam up. Spray on veggies and fruit and allow it to sit for 2-5 minutes, then rinse produce under cold water. Keep the spray refrigerated when not using it. It will stay fresh for about a week.

Veggie soak:
Fill a clean sink or bowl with water. Add ½–1 cup of white vinegar and 1 tablespoon of salt. Swish the mixture around with your hands. Allow your produce to soak for 20 minutes, then rinse well.

Packaging – beware of fruits and vegetables packaged in plastic. The off gases from the plastic packaging can deplete the nutrients in the food as well as add toxins.

Preparation – lightly steaming your vegetables is the best way to maintain nutrients! Microwaves and plastics add potentially harmful toxins to these foods. Toxins which can cause havoc in a body struggling to stay in balance.

Seafood

Seafood is known to be high in omega-3 fatty acids and low in saturated fats and a great choice for a lean protein! So, why now, do we have to think carefully about seafood choices? High levels of mercury, the regulations within the fishing industry , storm water runoff, fish farming practices and the addition of PCB into the lakes, oceans and rivers are all complexities.

Most of us have heard about the dangers of high mercury levels in fish. Mercury binds to protein so it can be found throughout fish tissue. Smaller fish have less mercury and those species that feed of the bottom of the ocean have less as well. Sardines and catfish are better choices than sea bass and swordfish for example. Canned tuna has long been a favorite in the American diet. Here, too, there are choices to make. White tuna – albacore – is much larger in size than the smaller skipjack tuna – marketed as chuck light. The larger albacore tuna is more heavily contaminated because the larger fish consumes the smaller fish and the contaminants quickly build.

Shrimp can be one of your best choices for seafood! The best choices are Oregon pink shrimp, US farmed shrimp and prawns from Canada. Unfortunately most of the shrimp eaten in the US is imported from countries where environmental regulations aren’t as stringent as the regulations here in the United States.

Antioxidants get an A – keep them right at the top of your list!

Fruits and vegetables contain antioxidants which protect us from free radicals which can damage cells and lead to disease. Adding antioxidants to your diet will not only help you rid your body of toxins, like harmful heavy metals or chemicals we ingest, but will also help keep your immune system strong. Sulfides are a group of antioxidants found in onions, scallions, collards, bok choy, cabbage, broccoli and scallions. Sulfides enhance our ability to detox harmful toxins in the body, lessening the burden on our hard working systems!

Stir-frys and soups are an easy way to get a plethora of these great vegetables on your plate at the same time. Be creative and find a way that works for you! The benefit to your overall and long term health is worth it!

Slowing Down – Will It Make A Difference?

womentowomen on December 24, 2013

by Marcelle Pick, OB/GYN NP

Every day in my practice I talk with women about their health – so many different facets come up in conversation – the hot flashes associated with hormonal shifts, unwanted pounds, irregular periods, sleep disturbances, changes in libido, hair loss, fuzzy thinking, changes in energy – we talk about everything! Over the past few years I’ve noticed a trend – many, many more women are reporting fatigue, sometimes unrelenting fatigue, associated with sleep irregularities, changes in blood pressure, changes in thyroid, or even feeling ‘wired’ all the time…a feeling of not being able to slow down.

At Women to Women, we’ve long recognized these symptoms as potentially being associated with adrenal dysfunction. After testing to rule out other major medical concerns and testing adrenal function, we see an increasing trend with women – life is becoming increasingly stressful for women – the number of women who have total responsibility for a busy households is increasing, demands from family and children, financial demands, the constant flow of information with technological advances, the stressors from less than ideal nutrient intake along with environmental toxins which add to our body burden are taking their toll!

I’ve also noticed an increasing trend among endocrinologists – many are now starting to evaluate adrenal function. A recent New England Journal of Medicine article urged clinicians to become more aware of the predisposing factors which may lead to adrenal insufficiency. Most of these clinicians look at adrenal function as being compromised only when a patient is at either end of the spectrum – Cushing’s syndrome (also called hypercortisolism) is caused by long-term exposure to high amounts of the stress hormone cortisol, Addison’s disease (also called hypocortisolism) is a disorder where the adrenal glands don’t produce enough cortisol and other glucocorticoids. Patients with Cushing’s symptoms can feel irritable, anxious or depressed. They also may present some distinct features – a rounded mid-section, faces which are moon-like in shape and sometimes a fatty lump on the back of their necks.

Other symptoms of Cushing’s syndrome are: panic attacks, persistent anxiety, difficulty staying asleep, abdominal weight gain, feelings of inadequacy, difficulty winding down to get to sleep, feeling tired but unable to wind down, having a short temper and worsening PMS symptoms. With Addison’s disease patients may experience weak muscles, loss of appetite, cravings for salt, abdominal pain, nausea, vomiting or diarrhea, weight loss, feeling lightheaded especially when standing up quickly, worsening fatigue and patches of dark skin on skin folds, knuckles, elbows, knees or scars. Both of these extremes are very unusual and are seldom seen in clinical practice, but non the less they do exist. As you can see, Cushing’s syndrome and Addison’s disease seem to be at complete opposite ends of the spectrum. As a functional medicine practitioner, I’m always asking the questions like, “how did this patient get on this road?” and “how could this have been prevented?”.

What I’ve come to understand is that adrenal imbalance symptoms can be treated long before developing full blown disease. Many of my patients tell stories about seeing well-intentioned practitioners who aren’t able to help them because conventional practitioners are only trained to treat the disease state – not the pathway leading to it. It is important to point out that we’ve seen this trend before with gluten sensitivity – for many years this was overlooked by conventional medicine unless the patient presented with full-blown celiac disease. Today, however, we are seeing a different understanding about gluten sensitivity and, I suspect, we’ll see this about adrenal function in the future as well.

There’s good news to share – you can take control of your adrenal health! You can make great improvements in your adrenal health by lowering your stress and focusing on quality nutrition. Some women may also want to include a dietary supplement to help with adrenal support. One patient puts it this way “I made a practice of eating well and managing my stress and everything else just fell into place!”. I don’t want to make it seem like these changes will make a difference in your life over night. But after working with thousands of women, it takes time for the changes to be seen – but it is possible and almost always happens when the right support is given.

We know that cortisol is released in higher amounts when we are under stress or anxious. Our adrenals can’t differentiate between types of stress – trying to meet a deadline at work, coping with a sick family member, financial concerns, a car breaking down, getting married and dieting – yes even dieting (think about how many women you know who are constantly dieting!) places stress on the body. When blood sugar and insulin are continuously on a rollercoaster due to eating irregularly or an intake of highly refined carbohydrates and sugar, your adrenals will produce cortisol in an attempt to level things out. Constant cortisol production can lead to the adrenal exhausted state of low cortisol. I’ve seen thousands and thousands of women turn their lives around by healing their adrenals and restoring balance in their bodies and their lives! Some patience and awareness is needed – but the end result will be worth it!

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What Your Pap Test Results Mean

womentowomen on December 23, 2013

by Marcelle Pick, OB/GYN NP

Women’s health testing: a guide for you

When a laboratory technician looks at the section of cells that was taken from your cervix during your Pap test, they will be searching for indications of specific changes that occur within the cells (cervical dysplasia). These reveal a variety of discrete tiny characteristic changes which the cytologist will then be able to classify according to the Bethesda system. Each category within the Bethesda system (e.g. ASCUS) designates a level of risk. Your healthcare provider will plan their management strategy for your particular case on a standard of care which is directed by that category.

If you ever receive a call informing you that your Pap results are anything other than normal, you will want to know what that means. Women to Women have put some great information together to help explain some of the terminology to make it easier to understand. We hope by giving you information it will help you understand to any suggestions or recommendations your healthcare practitioner may provide. What follows here is a summary of terms and abbreviations which are commonly used to categorize Pap test results.

Normal Pap smear

A normal Pap smear result means that no cell lesions or malignancy have been found. It is important for you to note that although Pap smears are an excellent screening tool, they are not perfect. False negatives do happen on occasion. This is why it’s important to get regular exams. Some changes that can show up on a Pap test that is otherwise normal, include reactive cellular changes, cellular atrophy, and endometrial cells present.

ASCUS

ASCUS is fairly common, but it is not a normal Pap test. This result indicates “atypical cells of undetermined significance.” This is considered to be a very mild irregular reading. Completing HPV testing is the current standard of care for follow-up. If your result is ASCUS and negative for high-risk HPV strains, then repeat Pap testing is normally ordered more frequently for a while in order to watch your immune response, in the hope that you will be able to resolve any of the abnormal cells. If your result is ASCUS and positive for high-risk HPV strains, you will need to have a colposcopy for a diagnosis that is correct.

LGSIL

LGSIL, the next grade of cellular abnormality, indicates a “low–grade squamous intraepithelial lesion.” This low–grade result is seen as an indication that a higher-grade HPV viral strain is probably causing the cell abnormalities. This leads directly to colposcopic evaluation in most cases as the standard of care. It is suspected that at least 60 to 70% of all females carry the viral strain of HPV. This statistic will change as the younger generation that have had the vaccine get older. Young healthy women are likely to clear this without a serious problem, about 60% of them do, but we tend to watch them closely throughout the process. Understanding however, when an older woman’s Pap test is found with this result, it may more worrisome, and she will definitely require closer monitoring after the initial colposcopy.

HGSIL

HGSIL indicates a “high–grade intraepithelial lesion.” This concerns us more, because the HPV virus in this case is more than likely causing moderate to severe changes in the cervix. Colposcopic biopsy is definitely needed to find out what is really there. The biopsy will be sent to a pathologist so they can provide a truer diagnosis. This information will then provide the practitioner with the information they need to develop a plan.

AGUS

AGUS represents “atypical glandular cells of undetermined significance.” Atypical cells can stem from either the cervix or the uterus. Glandular lesions are harder to detect on a simple colposcopy, so a colposcopy and or endometrial biopsy may be needed for a definite diagnosis. It’s not yet clear if HPV testing is of any help with this category. AGUS is a fairly new classification, so treatment protocol with this continues to develop. See the ASCCP guidelines for more information.

Endometrial cells present

A result showing “endometrial cells present” is concerning especially for post-menopausal women. It can represent endometrial cells that have built up within the uterus, slowly leaking down to the uterus and then noted on the Pap. The overgrowth can come about as the result of higher-grade atypical cells in a location outside the cervix, the uterus being the most likely origin. Endometrial biopsy follows as the next step to provide a more definite diagnosis and to help plan management strategy. If a Pap test shows endometrial cells are present in a pre-menopausal woman, it is often due to simply having had the Pap completed toward the end of your period. Your practitioner will take the date of your last menstrual period into account when determining your need for follow up.

Remember, if you are told your Pap test results are abnormal, or if you’ve been told you have HPV, it doesn’t mean you will get genital warts later. It certainly doesn’t always mean your partner has been unfaithful, although it can be a possibility. Only in very rare cases does it mean you have cancer. These days we know so much more about the changes and what they mean, so we can observe closely if needed and treat correctly. Following your practitioner’s recommendations is vitally important.

It’s also crucial to take good care of yourself, in every area of your life. Eat well and balance your diet with nutritious whole foods which are good for you. Find ways to put away some of your stress and strain and fully relax, even if it’s only for ten or fifteen minutes a day. Rest well. See if you can work even a little exercise into your week. It doesn’t take much to feel so much better. You’re worth it! Seeing how often, when women change their diet, add nutrients, and change their lifestyle that their Paps return to normal, reminds us all that you have more control than your realize when it comes to abnormal Pap results.

For further information, read our full article on abnormal Pap Smears and HPV, including excellent steps to protecting your reproductive health.

Treatments For Vaginal Dryness

womentowomen on December 23, 2013

by Marcelle Pick, OB-GYN NP

Middle age woman relaxing with tablet computer at home vaginal drynessIf you are like many women we see in our clinic and you suffer from vaginal dryness, we have words of hope for you. You can find relief without taking large amounts of estrogen into your system. Locally applied bioidentical estrogens are considered a much safer option than oral hormone therapy since most of them allow only minimal amounts of estrogen to enter into your circulation.

We encourage you to be evaluated by your gynecologist to make sure there is no underlying cause for your vaginal dryness; and it’s important to follow up to make sure your condition improves. We want you to know, however, that the first step most practitioners will take in treating vaginal dryness will include a prescription for Premarin Vaginal Cream. This product contains estrogens from female horses, which are unnatural to our bodies and often much too strong. It’s nice to know there are several safe and effective bioidentical choices for treating vaginal dryness. The greatest news of all is that the creams are just as effective – in fact, probably more so.

The three key estrogens are estrone (E1), estradiol (E2), and estriol (E3). Presently pharmaceutical companies produce estradiol-based bioidentical vaginal products. You should have as much information as possible so that you know which ones to request. The charts that are below list the vaginal dryness treatments we most commonly prescribe at the Women to Women Clinic. We’ve also listed some nonprescription choices to use in addition to bioidentical estrogen, or on their own, to help to soothe inflamed vaginal tissues.

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PRESCRIPTION ESTROGEN PRODUCTS* for VAGINAL DRYNESS

Estriol vaginal cream 
Contents Women to Women health care clinic patients are prescribed estriol vaginal cream, as a first stage of intervention. It is formulated in a pH-balanced base in concentrations of 0.6 mg/g or 0.8 mg/g.  Sometimes the dose is higher if the atrophy is severe.
Typical use One gram is inserted vaginally at bedtime every night for 7-10 nights, then 2-3 times weekly on-going. A small amount of the cream can be applied to the vulva and external areas of the vagina as needed.
Pros Estriol vaginal cream is a great option for vaginal dryness, because it is so gentle and  safe to use, especially if there are concerns related to breast cancer. Many of the local oncologists are now using estriol for women that have a history or have present disease. This type of cream will slowly but effectively help both internal and external vaginal tissue, and can also be used on the vulva and urethral tissue. Results may be expected in as little as 1-2 weeks.Estriol vaginal cream can also be custom-compounded to include a small amount of testosterone and DHEA. This is especially beneficial for many women as it quickly plumps up the tissue and can also increase sex drive.
Cons Some women report the cream feels messy. In order for this to remain an effective method, you need to use it as recommended. It is not intended for use as a personal lubricant for sexual intercourse.  The best time to use this is at night before bed. Some women also have some burning when they first introduce the cream, but changing the base can alleviate this symptom.
Availability Estriol vaginal cream is available only by prescription from your provider. Many compounding pharmacies are able to formulate this and it is almost always very affordable.  Many insurance companies do not pay for this product.

Vagifem vaginal inserts
Contents The Vagifem estradiol vaginal tablets are little, white suppositories containing 10.3 mcg of 17ß-estradiol hemihydrate, which is equivalent to 10 mcg of estradiol. They come in boxes of 8 or 18 tabs. Each box comes with an applicator.
Typical use One suppository is used vaginally at bedtime anywhere from 7–14 nights, and then reduced to one insert two to three nights per week for maintenance.
Pros These inserts are not messy, they are easy to use and it is very effective for renewing the vaginal tissues. With a little time, the vulva also usually responds.
Cons Vagifem usually does not work as quickly as creams do to the external tissues. You have to use it regularly to maintain results. For women with severe atrophy a cream may be necessary to use initially and then the suppositories can be used. It is not intended for use as a lubricant prior to sexual intercourse.
Availability This brand name product is available by prescription through regular pharmacies.

Estrace vaginal cream
Contents Estradiol vaginal cream, USP, 0.01%
Typical use One gram is applied vaginally at bedtime for approximately 7-10 nights, and then should be reduced to 1–3 times per week for long-term care. Massaging small amounts to the vulva and inner labia can also be very helpful.  This recommendation is seldom mentioned on the insert directions.
Pros Results are often noted in 1–2 weeks, but it may take longer for optimal results. Using this product can be very helpful for those with extreme atrophy prior to using the Vagifem or 90 day ring products.
Cons Women often complain that it can feel messy, especially the first days of use. You should keep in mind that you need to keep with the routine to maintain results.  It also should not be used prior to sex as it is a hormone. A burning sensation has been reported, therefore you may want to consider duplicating the cream with a compounding pharmacy in a more hypoallergenic, pH-balanced base to help with the comfort.
Availability This brand name product is available by prescription through regular pharmacies.

Estring 90-day vaginal ring
Contents Estring (estradiol vaginal ring) is a silicone-based ring containing 2 mg estradiol. Estring releases estradiol (approximately 7.5 mcg/24 hours) in a consistent stable manner over 90 days.
Typical use One ring is inserted into the vagina and stays in place for 90 days. After 90 days, it is replaced with new ring.
Pros This delivers a low dose of estradiol for 90 days of use with no modifications needed. It can help to provide support to the walls of the vagina in women whose pelvic floor muscles have weakened or are weak.
Cons This device does require some amount of skill to insert and take out. Certain women have had discomfort with the insertion and removal process and opt to visit with their practitioner every 90 days to have it done for them. Many women find an Estring comfortable; while others do not like the way it feels and complain that it is uncomfortable. The use of Estrace vaginal cream for one month prior to initial insertion of an Estring can greatly improve the comfort level. Occasionally some women complain of breast tenderness with the estring – if this happens you may be getting too much estrogen that is actually getting systemically absorbed. This product has also been known to exacerbate endometriosis if it is present.
Availability This brand name product is available by prescription through regular pharmacies.

Femring 90-day vaginal ring
Contents Femring (estradiol acetate) is a flexible silicone-based ring which contains time-released estradiol acetate. It is available in two strengths: 0.05 mg/day and 0.10 mg/day. The 0.10 mg/day usually requires special ordering. Both of these strengths issue estradiol acetate daily for 3 months and supply system-wide, not just vaginal-specific estrogen replacement therapy. This is quite different in its applicability as it is a type of Hormone Replacement Therapy which also provides estrogen locally and systemically.
Typical use A ring is placed into the vagina for 90 days and then removed and replaced as needed.
Pros The Femring is softer and is more flexible than the Estring, so insertion and removal is reported as easier for many women. It can help to support the walls of the vagina for women whose pelvic floor muscles are weak.
Cons Some women aren’t comfortable inserting and removing the device, so they may require a visit to their provider every 90 days to have it changed. Some women are not comfortable wearing this particular type of device. This product has a potential for causing exacerbation of endometriosis discomfort in women with a history of this due to the potent delivery of estrogen directly within the pelvic area.
Note The product provides estradiol vaginally, as well as systemically,  similar to the estradiol patch or other forms of Hormone Replacement Therapy, to treat vasomotor (for example hot flashes) as well as vaginal symptoms. This is not just a localized vaginal treatment, but is a hormone replacement treatment for system wide therapy. If you still have your uterus, you must use a prescription-strength progesterone (bioidentical) product, like Prometrium, with this product.
Availability This brand name product is available by prescription through regular pharmacies.
* Note: Brand name pharmaceuticals are all FDA-approved and regulated.  These products are packaged with the same warnings that the FDA states must be listed on all estrogen products. There is evidence to suggest that taking low-doses of estradiol either through topical means or vaginally does not increase the risk for blood clots to the degree that taking estrogen by mouth does.  However, the FDA continues to require the warning label on all estrogen products.

Treatment choices for vaginal dryness

This chart can help you understand the choices that are available. When you are speaking with your practitioner about topical bioidentical estrogen, it may help to have a little more information.

Non-hormonal products for vaginal dryness

There are many non-hormonal treatments that we can look at to help soothe vaginal dryness. Non-prescription products for vaginal dryness can be used as needed. They may be used in-between or in addition to the prescription bioidentical estrogen. Some women feel very discouraged – they have tried everything and have found no relief. Another similar case is a breast cancer patient who does not wish to risk using vaginal estrogen. For both of these women, we recommend manual massage with some sort of lubricant.

Always be sure to read the labels on the products you are considering to use and make sure to choose ones that contain no harsh chemical ingredients, preservative, petro chemicals, endocrine disruptors or other irritants. It’s best to avoid alcohol, parabens and propylene glycol. In the chart below we’ve listed a few products which have been used by many women and usually have a great results.

OVER-THE-COUNTER PRODUCTS for VAGINAL DRYNESS

Vitamin E vaginal suppositories
These are excellent for women who are not using a prescription products or on the night you do not use the vaginal estrogen product.  (Be sure to only choose a natural-source vitamin E products).

Natural oils
Grapeseed, olive, sweet almond, sunflower, or coconut are great natural oils that are gentle during or after bathing and even with sexual intercourse.

Sylk
Sylk is a natural personal lubricant which is a wonderful alternative that numerous women prefer. This natural lubricant is made from the kiwifruit vine, Sylk contains no parabens or propylene glycol. It tends to be less sticky than other lubricants.

Astroglide
Astroglide is a lubricant which is beneficial for providing more lubrication when the area tends to be drier and more friction is experienced. This then helps to decrease discomfort with intercourse by decreasing the friction. You can find it in glycerin-free and also paraben-free for those that are concerned.

At Women to Women, we know that each woman is different and unique in her response to vaginal bioidentical estrogen and other products. Please understand that you may need to try several before your vaginal dryness resolves. Be patient with yourself, and with your body, and never give up hope. You always have options, whether you have mild or severe, occasional or on-going vaginal dryness. We want you to know your alternatives. Some women find that improving their diet and using a personal lubricant alleviates their vaginal dryness; other women may need to use stronger treatments. Try the above options, and if one or two don’t help you find relief from your vaginal dryness, try to stay hopeful and receptive to trying another approach until you’re successful.

Lupus And Hormones

womentowomen on December 23, 2013

by Marcelle Pick, OB/GYN NP

Birth control, hormone replacement therapy and more

Hormones are the chemical messengers in the body, and for women diagnosed with Systemic Lupus Erythematosus (SLE), these messages may be inconsistent. SLE — the most common form of lupus — is an autoimmune disease causing inflammation which can affect many parts of the body, including joints, lungs, kidneys, skin, and even the nervous system. Because SLE is hormonally-driven and primarily affects women in their 20’s-40’s, birth control options and Hormone Replacement Therapy (HRT) are of primary concern.

The mechanics are a bit complicated. As hormones circulate through the bloodstream, they can be disrupted at any point, essentially breaking down the signal between the brain and the target cells – where specific hormones are intended to do their work. This is important for women carrying an SLE diagnosis.

The question becomes, should women with lupus take birth control pills or hormone replacement therapy? The Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) studies, focused on use of oral contraceptives and on postmenopausal hormone replacement therapy in women with lupus. The researchers’ goal was to determine if exogenous female hormones (or hormones coming from outside the body) may trigger disease activity. The studies showed that estrogen enhances the autoimmune response and androgens and progestins suppress it. The ratios and levels of these chemicals found in the joint fluids and blood of women in the study showed a hormonal connection worth considering.

The good news is, while these studies detected a slight elevation in disease symptoms, they also indicate that women with SLE can tolerate low-dose exogenous hormones with a relatively small risk of mild flare ups. In other words, taking certain hormones can be considered safe for women with lupus, when all the factors are taken into consideration.

Birth control

Contraceptive options for women with SLE depend on the individuality of each patient. Not only does the type and method of birth control matter, but so do medical history and autoantibody test results.

The concern is two-fold for oral contraceptives containing estrogen: lupus flare ups and risk of blood clots (thrombosis). Thrombosis risk may already be elevated in certain instances for women with lupus, making estrogen-containing contraception an inappropriate choice. Progesterone-only alternatives, including the progesterone pill, injection, and IUD, are not associated with an increased risk of blood clots.

Historically, research on the use of birth control pills and lupus produced somewhat contradictory results, but recent studies have shown that low-dose estrogen birth control pills are likely safe for women with mild forms of lupus and who have minimal risk of clotting.

As far as increasing a woman’s risk of developing lupus by taking oral contraceptives, the message is unclear. Data collected in 2009, analyzed 1.7 million women ages 18 to 45, and found a small subgroup of women with a genetic predisposition to lupus, who – when taking birth control pills containing both synthetic estrogens and a progestin — may be more susceptible to the disease. The overall risk is still small, but taking birth control pills with a family or personal history of lupus should be considered before use.

Hormone replacement therapy

Overall, hormone replacement therapy is being used less often due to the potential increased risk of heart disease, thrombosis, and breast cancer. For women with SLE, the risk of blood clots and cardiovascular events is oftentimes already elevated, warranting concern. The issues with lupus and HRT are three-fold.

Although studies show that estrogen therapy for women with lupus, who are also menopausal, does not increase their chance of flare-ups, the reality is the studies used synthetic hormone replacement therapy, which slightly increased the risk of mild to moderate lupus flare-ups. Women with lupus who were taking HRT in the study, were 20 percent more probable to exhibit lupus symptoms, although did not need high doses of steroids or hospitalization for treatment.

Another consideration for women with SLE who experience early and severe symptoms of menopause, and who also take cyclophosphamide – a medication that alleviates inflammatory damage – are at risk for premature ovarian failure (POF). While some clinicians may support the use of HRT to help severe menopause symptoms in women with lupus, it is my experience that natural alternatives may be a better choice for relief to avoid other potentially serious complications.

Finally, women with lupus already have an increased risk of blood clots and heart disease, and the use of conventional hormone replacement therapy is connected to an increased risk of these conditions, even for healthy women. Women with stable, inactive SLE, and relatively low autoimmune factors should only consider low-dose, short-term HRT after making a very careful and informed choice with their healthcare provider.

Theories and controversies

Estrogen is the one of the leading components about why lupus is more common in women than in men. While estrogen is known to be play an important role in the development of of lupus, its specific relationship to autoimmune diseases is not clear. Progress is being made, but the connection between lupus and estrogen is highly controversial. When it comes to the relationship between the immune system and estrogen, healthy functioning requires just the right amount – not too much estrogen, and not too little. The ratios of particular types of estrogen also play a role in autoimmune function. There are multiple factors including genetic variations, toxic exposures, poor food choices, lifestyle stressors and prescription drugs — including synthetic hormone drugs — which may cause impairment.

Clinicians caring for women with SLE often face difficult decisions regarding the use of birth control and HRT. Although it is now generally considered safe, when referring to studies, evidence can seem a bit murky unless the patient has a specific counter-indication to exogenous hormones related to specific medical conditions.

But there are many avenues to explore. It’s important to note that many elements can be controlled. Even if you do have lupus, you can choose to support your internal hormonal balance in the choices you make every day. In addition, you can slowly reset your hormonal balance and lessen your inflammation by eating an anti-inflammatory diet, nurturing your emotional well-being, and exploring other natural alternatives before deciding to take prescription-strength hormones.

Of special interest to us at Women to Women, is that hormone therapy with bioidentical, natural estrogens and progesterone, has not yet been specifically studied in people with lupus, and the impact of this type of therapy is not yet known. But we are supporting efforts to explore these avenues.

Quality of life

Sometimes a woman’s quality of life or long-term health is an issue with a diagnosis of lupus, and the benefits of hormone replacement therapy may outweigh the risks. As an experienced OB/GYN Nurse Practitioner, I carefully weigh the options for SLE patients with both a person-centered as well as a disease-oriented focus. When a woman wants to try a course of HRT, we recommend she have a comprehensive hormone panel, to gauge the levels of all her sex hormones and their various metabolites in her body. With the results of that testing, we can then consider various types of bioidentical HRT, along with supplements that abate inflammation and facilitate estrogen metabolization.

We will regularly meet with that patient in follow-up, to see how well our approach is working for her. Together we keep track and watch for changes in her symptoms and overall well-being, and periodically retest her hormone levels, adjusting her dosage to the lowest effective amount for the shortest period of time needed. All the while, women can continue to gently care for themselves by making daily choices that enhance hormonal balance and restore harmony.

If you want to learn more, please read our articles on lupus. There are many related issues covered in the sections on inflammation, menopause and perimenopause, and phytotherapy for hormonal balance.

Hysterectomy: Pros, Cons and Alternatives

womentowomen on December 23, 2013

by Marcelle Pick, OB/GYN NP

Second only to cesarean section, hysterectomies are one of the most commonly performed surgeries on women — more than a half a million each year. This operation is done to remove all or part of the uterus, sometimes the cervix, and the ovaries. In certain cases, a hysterectomy is warranted – to save lives, to alleviate serious problems, to correct things impairing normal functioning and of course to improve the quality of life.

But I don’t recommend this course of action unless absolutely medically necessary and for several reasons. First of all, a woman’s reproductive system is central to the core of her, representing her femininity from puberty, through childbearing years, and even beyond menopause. Losing this aspect of womanhood, even symbolically, can leave emotional scars. While healing is possible on every level – both physically and emotionally – it can be traumatizing to lose fundamental organs.

Removing the uterus and other reproductive organs also poses physical risks and has consequential side effects, including and not limited to: bleeding and infection, damage to nearby tissue, hormone changes, symptoms of menopause, bladder and intestinal changes. Like with any other major surgery, a hysterectomy can have repercussions.

Surgical treatment may relieve much of the discomfort associated with uterine problems – bleeding, pain, bloating, and malaise — but I always try to first suggest the most minimally invasive procedures, utilizing medical management and natural treatments when possible, and often can obtain quite positive results.

Let’s examine the issues that contribute to surgical intervention, and some less invasive alternatives.

Menorrhagia (or heavy bleeding)

Menorrhagia is a common complaint for women, frequently prompting physicians to quickly consider a hysterectomy. But what constitutes heavy menstrual bleeding for one woman may not mean the same thing to another. In traditional medical practice the common phrase, “dysfunctional uterine bleeding,” is used to describe unusually heavy menstrual flow, as well as abnormal incidents of bleeding or spotting (such as between periods), after intercourse, after menopause, longer than a period, or heavier than a normal period. When a woman experiences atypical or excessive amounts of bleeding, we evaluate what may be causing it – physiologically, systemically, and even emotionally. Here are some common causes of menorrhagia and other uterine conditions:

  • Uterine fibroids – noncancerous tumors in the uterus.
  • Polyps – small, noncancerous growths on the lining of the uterine wall.
  • Hormonal imbalance – causing excessive build up of the lining of the uterus.
  • Ovarian dysfunction – leading to hormonal imbalance.
  • Complications from pregnancy – miscarriage or ectopic pregnancy, when an egg implants in the fallopian tube instead of the uterus.
  • Intrauterine device (IUD) – this form of birth control may cause heavy bleeding.
  • Perimenopause – the transitional hormonal state leading up to menopause.
  • Endometriosis – growth of the tissue normally inside the uterus which grows outside of the uterus.
  • Adenomyosis – when endometrial glands from the endometrium embed in the uterine muscle. Endometriosis that is in the muscle of the uterus.
  • Cancer – it is rare that uterine, cervical or ovarian cancer cause heavy bleeding.
  • Medications – some medications can contribute to prolonged menstrual bleeding.
  • Certain medical conditions – some diseases such as endometriosis, pelvic inflammatory disease, thyroid problems, lupus, and others can contribute to menorrhagia.

When abnormal pathology is ruled out, then we take a look at lifestyle and environmental factors that may be contributing to hormonal imbalance and menorrhagia. The state of hormones throughout a women’s cycle is like a delicate dance, and sometimes messages between hormones and body parts can be jumbled. These “mixed messages,” can influence their functioning, causing abnormal bleeding. Before jumping right to surgery, we try to restore hormonal balance naturally, sometimes through use of bioidentical progesterone, natural supplements, and lifestyle changes including decreasing stress and enhancing nutrition. By taking things a step at a time, with patience and respect for our body’s natural requirements and rhythms, we may be able to avoid surgical intervention.

Endometrial ablation

An endometrial ablation is one option for the treatment of abnormal uterine bleeding when hormonal therapies have failed. This is a procedure to remove the lining of the uterus, or endometrium. It is less invasive than a hysterectomy, and allows a woman to keep her uterus. Ablation means “to remove by erosion, melting, evaporation, or vaporization.” Endometrial ablation is done with a hysteroscope, along with a device that heats, freezes, or lasers the endometrial lining. This destroys a layer of the lining, and will usually completely stop monthly periods. Ablation may also be useful for examining select areas of the endometrial lining when other techniques, such as biopsy, may not be adequate.

This procedure is performed by a trained gynecologist (GYN) on an outpatient basis, or even in the office. It is fairly straightforward, with a manageable recovery. In certain circumstances, such as re-growth of the lining, a second ablation needs to be done. However, recent advances in the technology and devices used to perform ablations have decreased the incidence of repeat procedures.

Although endometrial ablation does work well for many women, it also eliminates the ability to carry a successful pregnancy. In fact, post-ablation pregnancies can be risky, so birth control is an important consideration. There is also a risk that endometrial ablation might mask endometrial cancer later in life, because it removes any spotting that would signal something abnormal going on in the uterus.

Other procedures

When uterine conditions require treatment beyond non-invasive methods such as hormone therapy, nutritional supplements or lifestyle remedies, certain other procedures can be performed prior to having a hysterectomy.

  • Hysteroscopy: a thin, lighted tube is inserted through the vagina into the uterus, allowing a view of the cervix and uterus. Hysteroscopy can be diagnostic or operative. During an operative procedure, small instruments are inserted through the hysteroscope to treat certain conditions such as fibroid tumors.
  • Myomectomy: an instrument is inserted through the vagina or abdomen to remove fibroid tumors. Depending on the size, location, and number of fibroids, myomectomy can be performed via hysteroscopy (vaginally), laparoscopically (through a small scope inserted into the abdominal cavity), or abdominally (a considerable medical procedure).
  • Uterine artery embolization (UAE): a catheter is thread into the uterine artery to inject tiny particles which cut off blood supply to fibroid tumors. It is performed by an interventional radiologist, who specializes in treating internal conditions without making a surgical incision.

Choosing the best option

The decision to have a hysterectomy is complex, personal, and may seem intimidating. Although we have come a long way, there are still limitations with these types of procedures. With time we can look forward to medical technology bringing us more advanced treatment alternatives to hysterectomy. But until then, these techniques do offer women and their healthcare practitioners some useful options. In addition, exploring alternative treatments with fewer side effects can make a difference in the long-term outcome of your health.

Discussing all of the options with your healthcare provider and asking plenty of questions can help you better understand what is going on with your body. When I sit down with a woman considering these options, I encourage her to look inside herself, try help her have peace of mind, and make the right decision for her own well-being.

For more information, please see our articles on menorrhagia, menstruation, and hysterectomy.

Stool Analysis

womentowomen on December 18, 2013

by Marcelle Pick, OB-GYN NP

Stool tests related to your digestive well-being

At Women to Women, we have learned over the years that many laboratories don’t really offer very helpful stool studies. Several patients become discouraged when their stool analysis comes back with a “normal” result, while they are miserable with persistent digestive symptoms. Quite often, all we need to help explain what’s happening, is a test which is a little more specific.

We’ve experienced great outcomes over the past several years using two tests that are completed by a group of top-quality labs. The first test is the Comprehensive Digestive Stool Analysis (CDSA) that checks the stool for malabsorption, yeast, parasites, pH imbalance, the need for digestive enzymes and bacterial overgrowth. The second test is a Comprehensive Parasitology Test (CP x2) with a purge, which is a much more in-depth test for parasites.

These tests are not usually done in hospitals or in traditional medical offices, but they are vital for finding the source of gastrointestinal distress. They should be considered even if, and maybe especially if, standard stool testing has found nothing unusual. We suggest these labs for complete stool analysis:

Genovix: 1-800-522-4762
Metametrix: 1-800-221-4640
Diagnos-Techs: 1-800-878-3787
Doctor’s Data: 1-800-323-2784
Parasitology Center: 1-480-767-2522
Metametrix testing: 1-800-522-4762

You may contact these labs directly or request that your healthcare provider order these tests on your behalf.

The first four labs listed offer both stool studies in one test; the last lab listed only offers the CP x2. For difficult cases, I prefer to have the CDSA completed at one of the first four lab centers, and the CP x2 done at the Parasitology Center. I find that the Parasitology Center picks up on parasites that no other lab has found.

The newest of all the tests is the Metametrix test which is looking both at culture based and molecular approaches for stool based gastrointestinal diagnostics. O and P technology, which is offered at most hospitals, can only identify a limited number of parasites and is considered the gold standard methodology for parasite detection, while the PCR technology of the Metametrix GI effects test provides an expansive assessment of anaerobic gut microflora.

Five Steps For Natural Menopause Relief

womentowomen on December 18, 2013

by Marcelle Pick, OB-GYN NP

  • Stop your symptoms with optimal nutrition
  • Try herbal remedies that work as adaptogens for your hormones
  • Find exercise you love to help reduce fat and help estrogen and progesterone ratios
  • Take steps to reduce your stress
  • Understand that our emotions play a vital role in our health

Natural alternatives have been a hot topic with many women who visit my office. When we talk about menopause and perimenopause, many of my patients are still unsure about using these alternatives to relieve perimenopause and menopause symptoms. If “natural” treatments are gentler, how can they help alleviate such powerful symptoms such as fuzzy thinking, hot flashes and/or insomnia?

I want to give you peace of mind and assure you that the natural approach is highly effective for many — even if you are experiencing severe symptoms.

Natural treatments for menopause and perimenopause work in a completely different way than prescription drugs. The natural approach works with your body, which means that it can actually prevent or reduce the severity of nearly all of your symptoms rather than just relieving them temporarily!

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A truly natural approach addresses symptoms at their source

At the clinic, we believe that to get to the root of your perimenopause and menopause symptoms, it means taking all the necessary steps toward relief to help correct the symptoms you are experiencing. Natural treatment addresses imbalances between the sex hormones estrogen, progesterone and testosterone. Another benefit is that you don’t have the added risk of side effects carried by commonly prescribed medications such as antidepressants.

Try taking the steps I recommend in the way that best fits your lifestyle.

1.  Nip your symptoms in the bud with optimal nutrition

The most effective (and enjoyable!) medicine that exists, is in the food that you eat. You should strive to eat a balance of good fats, complex carbohydrates and protein. Also, make sure to have plenty of fruits and vegetables at every meal, including breakfast. It’s best to eat three meals a day and two or more snacks in order to keep your blood sugar stable. The most important thing to remember is to reduce carbohydrates especially refined carbohydrates and sugars.

Optimal nutrition is achieved by making sure that you are consuming enough vitamins, minerals and essential nutrients. There are natural supplements you can add to your daily regimen, which is especially important if you feel overwhelmed with your daily life and it is hard to eat in the healthy way that is recommended. Many women live a fast paced life and they find it hard to eat enough healthy foods in order to take in and absorb enough of the key B vitamin folate. If this is the case, this can be accomplished by supplementing with Metafolin (5-MTHF, or l-methylfolate), the biologically active form of folate that’s much easier for your body to process and use.

2.  Use herbal remedies that act like our own hormones

Food is medicine and there is incredible strength in plants and herbal remedies that have been known to prevent menopausal and perimenopausal symptoms. It is amazing that many plants and herbs can adapt to the needs of your body. It is possible for them to do this because they share various molecular features with our own hormones, allowing them to support our hormone production, make it slower, or even mimic what our own hormones do depending on the body’s unique needs.

Some herbs that can help reduce menopause symptoms include black cohosh, passionflower, chasteberry, wild yam and ashwagandha.

3.  Exercise to reduce the fat that can upset estrogen and progesterone ratios

Most women tell me that they feel as if they are gaining weight steadily during perimenopause and menopause, especially around their stomachs and abdomen. It is particularly frustrating for these women because the weight sticks to unusual places and their scales refuse to budge. One of the reasons that this is so common is because fluctuating estrogen levels tend to cause your body to hold on to fat. On top of this, fat actually produces estrogen, which can create even more fat. Therefore, the cycle continues.

Just as I am an advocate that food is medicine, I also believe that movement is medicine too. You can make such a positive impact on your health though, by walking, dancing, yoga, swimming, biking or whatever other form of exercise you enjoy. And you should enjoy it or you will not continue with the program you begin. Moving your body has a major impact on your weight, other menopausal symptoms and your overall health. Gentle exercise can be helpful too, especially if your adrenal glands are overworked and you constantly feel fatigued. Most importantly—do something you enjoy!

4.  Restore yourself to decrease the stress that intensifies your symptoms

Many women are prescribed antidepressants for perimenopausal and menopausal symptoms. Because of the Women’s Health Initiative, the answer to many symptoms are antidepressants. More and more women have a deep sense and feeling of being stressed, anxious or overwhelmed, and depressed during the menopause transition. We see this frequently, but in most cases we believe antidepressants are not the best answer for menopause symptom relief.

Stress can be the culprit behind additional imbalances in hormones and neurotransmitters that affect mood as well as mental function, thyroid function, digestive function, and especially blood sugar imbalances. Stress has also been linked to symptoms such as hot flashes and low libido.

The physical effects of stress make nurturing self-care especially important. One of the most effective, inexpensive and amazingly simple ways to reduce stress is deep breathing. Think how easy just taking a deep breath several times a day is.

5.  Understand how emotional wellness plays a vital role in your overall physical health

Have you ever heard the term “As you think, so goes your life”?  Well this is definitely a time that this term can ring true. Your thoughts and feelings have a dramatic impact on your health, so why not make it a positive effect? One method is to keep a journal to help you become aware of what you are feeling and to identify any patterns you are feelings. A journal can help with your individual emotional and physical health. There is a lot of negatively out there today, so it’s helpful to start the day with a positive affirmation. I find that listening to things like the news too often can have a negative impact on my thinking, so that is a choice that I make daily.

Find the natural and powerful combination that works best for you

For many women, perimenopause and menopause offer them the opportunity to change, to become a different person, one that is less interested in what people think of them, and one that is much more able to speak up for herself. Many women who are going through menopause and perimenopause may even discover a certain freedom and they find that their life is better in certain areas then they could of ever thought it would be.

I’ve always found that when women make natural adjustments to their lifestyles, not only do they feel much better but also feel in control of their menopause symptoms. I want you to feel inspired and encourage you to start to make these small yet important changes, as they can create some remarkable results. Add a morning veggie/fruit smoothie, start your day with a morning ritual, ensure that you remember to breathe each day (put up signs to remind yourself if needed) and make a commitment to take your supplements every day.

With a little bit of time and trial and error, you’ll discover the combination of natural steps that works relieves your symptoms!

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Are You At Risk For Type 2 Diabetes?

womentowomen on December 18, 2013

by Marcelle Pick, OB/GYN NP

Everyone has a distinctive family history and background. Depending on our genetics, some of us may be able to get away with practicing poor lifestyle habits such as high-sugar diets and little exercise, while others will begin to experience the harsher effects of this type of negative life style, such as developing type 2 diabetes. The good news is you can always start to introduce healthier habits and then the likelihood of developing diabetes can dramatically decrease. If you start to introduce a mixture of positive and healthy eating habits and increasing your activity level positive health changes will begin to be seen both on the outside and on the inside of your body.

It’s always smart to consider and know your risk for developing type 2 diabetes. Early detection is key, especially since its diagnosis levels are on the rise. At Women to Women, we believe that if you have insulin resistance then you already probably have metabolic syndrome and are heading towards type 2 diabetes. It is a good idea to assess where you are today so that you can prevent yourself from joining the growing numbers of individuals that are diagnosed every day. We want you to understand, that whether you are at higher risk of developing diabetes or already have it, that type 2 diabetes can be prevented, treated and even reversed by making healthy changes in your diet and lifestyle.

Here are some of the most common risk factors associated with insulin resistance and type 2 diabetes:

  • Being over the age of 45 years
  • Being overweight/having meaning having a BMI greater than 24 (note that this cut-off point is lower than for men)
  • Having a first-degree relative with diabetes, meaning a sibling or parent.
  • Being of African-American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander descent
  • Having had or have gestational diabetes during pregnancy
  • Giving birth to a baby weighing greater than nine pounds
  • Having blood glucose levels greater than 99 mg/dL, this is an early marker
  • Having blood pressure readings commonly 140/90 or higher, this too is an early marker
  • Having lipid profiles that show high LDL “bad” or unbalanced cholesterol (your HDL is less than 35 mg/dL or your triglyceride level is over 250 mg/dL) Triglyceride levels are an easy first marker to watch as the correlation is so high between and an elevation and insulin resistance/metabolic syndrome
  • Leading an inactive lifestyle
  • Having darkening skin around the neck or armpits (acanthosis nigricans)
  • Having blood vessel problems that affect the heart, brain or legs

A number of these common risk factors for diabetes are interrelated. For example, if you’re overweight you’re more likely to have high blood pressure, unbalanced cholesterol levels and blood vessel problems. Therefore, the more factors you check off on the above list, the greater your overall risk is. It is important to understand that those of us who follow the modern “Western diet” of over-processed foods, refined sugar products, preservatives, and low fiber are automatically at a much higher risk for developing diabetes than those who eat diets high in fresh, whole foods.

I can’t say it enough, you will be a lot better off if you find out your risk of developing type 2 diabetes early. Keep in mind that no matter how bad your risk may appear, remember there is always hope. There are always ways to prevent this disease or lessen its impact. You are in control when it comes to your health. Also, if you pay attention and make some positive, healthy changes in your life, it’s never too late to change your risk profile!

Risk Factors For Diabetes

womentowomen on December 10, 2013

by Marcelle Pick, OB/GYN NP

Who is at risk for type 2 diabetes?

Everyone has a distinctive family history and background. Depending on our genetics, some of us may be able to get away with practicing poor lifestyle habits such as high-sugar diets and little exercise, while others will begin to experience the harsher effects of this type of negative life style, such as developing type 2 diabetes. The good news is that you can always start to introduce healthier habits and then the likelihood of developing diabetes can dramatically decrease. If you start to introduce a mixture of positive and healthy eating habits and increasing your activity level, positive health changes will begin to be seen both on the outside and on the inside of your body.

It’s always smart to consider and know your risk for developing type 2 diabetes. Early detection is key, especially since its diagnosis levels are on the rise. At Women to Women, we believe that if you have insulin resistance then you already probably have metabolic syndrome and are heading towards type 2 diabetes. It is a good idea to assess where you are today so that you can prevent yourself from joining the growing numbers of individuals that are diagnosed every day. We want you to understand that whether you are at higher risk of developing diabetes or already have it, that type 2 diabetes can be prevented, treated and even reversed by making healthy changes in your diet and lifestyle.

Here are some of the most common risk factors associated with insulin resistance and type 2 diabetes:

  • Being over the age of 45 years
  • Being overweight/having meaning having a BMI greater than 24 (note that this cut-off point is lower than for men)
  • Having a first-degree relative with diabetes, meaning a sibling or parent.
  • Being of African-American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander descent
  • Having had or have gestational diabetes during pregnancy
  • Giving birth to a baby weighing greater than nine pounds
  • Having blood glucose levels greater than 99 mg/dL, this is an early marker
  • Having blood pressure readings commonly 140/90 or higher, this too is an early marker
  • Having lipid profiles that show high LDL “bad” or unbalanced cholesterol (your HDL is less than 35 mg/dL or your triglyceride level is over 250 mg/dL) Triglyceride levels are an easy first marker to watch as the correlation is so high between and an elevation and insulin resistance/metabolic syndrome
  • Leading an inactive lifestyle
  • Having darkening skin around the neck or armpits (acanthosis nigricans)
  • Having blood vessel problems that affect the heart, brain or legs

A number of these common risk factors for diabetes are interrelated. For example, if you’re overweight you’re more likely to have high blood pressure, unbalanced cholesterol levels and blood vessel problems. Therefore, the more factors you check off on the above list, the greater your overall risk is. It is important to understand that those of us who follow the modern “Western diet” of over-processed foods, refined sugar products, preservatives, and low fiber are automatically at a much higher risk for developing diabetes than those who eat diets high in fresh, whole foods.

I can’t say it enough, you will be a lot better off if you find out your risk of developing type 2 diabetes early. Keep in mind that no matter how bad your risk may appear, there is always hope. There are always ways to prevent this disease or lessen its impact. You are in control when it comes to your health. Also, if you pay attention and make some positive, healthy changes in your life, it’s never too late to change your risk profile!