MRI Focused Ultrasound For Fibroids

womentowomen on December 10, 2013

by Marcelle Pick, OB/GYN NP

MRI–guided ultrasound ablation for fibroids

MRI-guided high-intensity ultrasound (MRgFUS), otherwise known as high–intensity focused ultrasound (HIFU),  has become a wonderful new addition developed as a noninvasive treatment modality for uterine fibroids. MRgFUS/HIFU actually uses high-intensity focused ultrasound beams to heat and obliterate the fibroid tissue. This leaves the nearby tissues undamaged with a minimal number of reported side effects, as well as very little down time for recovery.

So far, MRI-guided thermal ablation by focused ultrasound is documented to show limited success in long-term resolution of fibroids. It remains in the investigational stages and is only available in a few locations and most often this is a self-pay procedure. Insurance companies don’t cover this procedure as it is still considered experimental. The FDA has approved one type of technology for this (ExAblate) as a premarket application that is only for women who have finished childbearing.

However, a number of women have reported excellent success with this specific technique as a noninvasive alternative to a hysterectomy, as to date we don’t have very many noninvasive alternatives. The hope is that as time goes by, MRI-guided ultrasound technology will become perfected and its accessibility will become more widespread.

For the meantime, if you’re interested, you might want to visit the Uterine-Fibroids.org website for more information. Of great importance here is that you be sure that you seek medical treatment only at a center where the providers are skilled in this technique.

The History Of Hormone Replacement Therapy (HRT)

womentowomen on December 10, 2013

by Marcelle Pick, OB-GYN NP

The history behind HRT and new alternatives, such as bioidentical hormones

What is hormone replacement therapy or HRT? Depending on the hormone levels in a woman’s body, HRT is the replacement or the balancing of hormones through various forms of therapy. Today, HRT is commonly referred to as HT or hormone therapy, which many people believe are two completely different conditions or forms of therapy.

For more than 6 decades, menopausal women have been treated with HRT, a synthetic or “nonhuman” hormone, with the intention of keeping women young and retaining their femininity. The very first brand of HRT in America, Premarin, was made up of conjugated equine (horse) estrogens (CEE). However, during the 1950’s, there was a growing concern over this form of treatment, as statistics showed an increase of uterine cancer in women who were using this form of therapy. Many years later, this finally prompted the drug company responsible for manufacturing Premarin, to develop Prempro by adding a synthetic progestin.

Over a period of time, doctors were trained that HRT prevented heart disease, kept women’s skin and brains youthful, built strong bones, and caused very few side effects. The majority of American women experiencing menopause were encouraged by their doctors to start some sort of hormone replacement therapy for their menopausal symptoms of hot flashes, mood swings, insomnia, and weight gain. It was considered malpractice if you did not prescribe HRT for menopausal women for years.

In the later part of the 1990’s, a number of women were questioning the use of HRT. Some of the common questions that arose were: “Did all women need it?” and “Why were all women put on the same dose and not different dosages?” and “What was actually happening to the pregnant mare whose urine was being used as part of Premarin or Prempro?” These women wanted to know if there was another alternative out there and available to them.

However, many women were convinced that HRT was beneficial and would not have considered the possibility of stopping treatment. In 2002, the results of an extensive women’s study (the WHI) looked at the effects of HRT (Premarin and Prempro — neither of which are bioidentical hormone forms), its findings overwhelmed the medical community. Establishing that HRT in fact did NOT decrease a woman’s chance of getting heart disease, but rather definitively increased her risk of blood clotting, stroke and breast cancer. As you can imagine, this was not the kind of news the medical community or patients wanted to hear.

Presently, the controversy continues as to whether the early findings were conclusive, particularly in relation to younger women who initiate HRT during perimenopause. Current research has indicated that that there are differences between the effects for a 50-year-old woman placed on HRT and a woman who begins ten or more years after menopause. Researchers have been reexamining the data from the WHI study to see if there is a subset of women who might benefit from replacement hormones, as well as identifying subsets who should avoid it. Every year, experts hotly debate the significance of each reanalysis — 2006, 2007, 2008 and 2009. At the present time, it is clear that there is a difference between those women that take hormones during menopause and those that are 10 years post menopause. The risks are definitely less for the menopausal woman.

Confusion escalated with the release of the 2002 WHI findings, and massive numbers of women stopped their HRT and began seeking alternative treatments to help them with their menopausal symptoms. Many of these women found that as soon as they stopped taking their HRT, their menopausal symptoms came rushing back. This was a huge disappointment for women who were struggling to deal with their symptoms but they were also afraid of the health risks of replacement hormones, particularly in the synthetic forms. Furthermore, the pharmaceutical companies argued that there were no good or viable alternatives to HRT.

Today, there are many natural methods available that can help women ease the transition off HRT while at the same time provide the body with the care it needs to reduce or avoid menopausal symptoms. For help during this transition period, see our articles about ending hormone replacement therapy.

Bioidentical hormones

Numerous women have turned to bioidentical hormones as a superior form of HRT. These are female hormones that are typically manufactured by our endocrine system, principally our ovaries — estrogen, progesterone, and testosterone — which naturally decline as the ovaries stop releasing eggs. By “bioidentical” we mean that the biochemical structure of the hormone is perfectly identical to the main hormones that are naturally produced in a woman’s body. Neither a horse’s hormone nor an artificially contrived formula, although similar in makeup, can replace what a woman produces naturally.

You may ask ‘Why did bioidentical hormones take so long to come into play?’ Pharmaceutical companies have had to create numerous nonhuman estrogens and progestins in order to patent their drugs, hoping that the small changes made to an estrogen or progesterone molecule would not have a negative impact on a woman’s body. Today, unfortunately, we know that is often not the case. Birth control pills are an example of synthetic estrogens and progestins, and, as any woman who has ever taken them can confirm, each brand has different side effects and there are in fact some women who cannot tolerate birth control pills at all. The same can be said with hormone replacement therapy — bioidentical or synthetic! As we are all different, what works for one may not work or another.

In the 1990’s, pharmaceutical companies started developing and patenting methods of administering bioidentical hormones. One example of this would be the Climara patch, which uses a sticky transdermal hormone delivery system. While Climara was patented in 1994, the estrogen, which is identical to human estradiol, cannot be patented. The patent was obtained by patenting the glue.

Moving into the future of HRT

There are professionals who believe that true bioidentical hormones can only be developed by a compounding pharmacy, and only after measuring a woman’s own hormone levels, and then customizing the dose. In our experience, this approach is only required in a few cases or for a short period in a women’s life. In any case, Mother Nature provides a woman’s body with numerous types of hormones and we cannot accurately reproduce her delivery methods or levels in the body. What we can do is estimate her methods and work alongside her. We can also observe a woman’s symptoms and see if the right prescription has been developed. By helping to implement a good nutritional regime and supplements, appropriate exercise and other lifestyle changes, we have found that many women can manage their menopause symptoms very well!

There are times, however, when a woman can significantly benefit from a small amount of hormone replacement. We always recommend that you, together with your doctor, work through the challenges of menopause, especially if you have severe menopause symptoms, early menopause, or if you are compromising on your quality of life. It is under these circumstances that you will be able to make an informed decision about bioidentical hormones.

 

Functions Of Digestive Enzymes

womentowomen on December 10, 2013

by Marcelle Pick, OB/GYN NP

Eating a healthy well-balanced diet is the foundation for our optimal health. In the fast paced world we live in, it can be difficult to prepare one healthy meal – let alone three of them a day. The healthier the foods are that we eat, the easier it will be for our bodies to digest them and extract the nutrients it needs for us to maintain optimal health. Yet if we skip meals or eat unhealthy meals – an occasional splurge is to be expected – we need to know that in order for our body to work for us, it needs our help. The digestive tract is a complex system and sometimes regardless of what we eat, it needs some help. This article is meant to help you understand how the digestive system works, how specific digestive enzymes work, and what we can do if we find ourselves having problems with our digestive system.

When we put food in our mouths, our digestive track starts the miraculous process of transforming that food into usable nutrients, uniting a combination of biochemical players whose job it is to carry out the task. Very importantly, the digestive enzymes play a substantial role in the digestive process, as the all-important “cleavers” that turn big food molecules into smaller ones and allow us to absorb vital nutrients that our bodies need to function properly. Without these enzymes, much can go wrong.

Just as each of the nutrients in the food, what we eat and the beverages we drink have the important job of regulating our daily activities – which include providing an ample amount of energy, creating new body tissues, and cleansing our system of toxins and free radicals that can make us sick. Each member of the digestive tract team has a specific purpose.

If one member of the chemical team is not able to do its job correctly, it can throw off the whole digestive system – causing troubling symptoms such as bloating, gas, nausea or diarrhea, and a sense of constant fullness, thereby making it harder to eat regular meals. If the symptoms continue, it could lead to a more chronic condition such as acid reflux, ulcers, irritable bowel syndrome, IBD diverticulosis or Crohn’s disease.

In other digestive health articles we describe the leading role of hydrochloric acid in our stomachs, as well as the protective role of the very important crucial role of the micro flora in our guts. So let’s take a closer look at how and where the different types of digestive enzymes, sometimes called the “sparks of life,” do their job so you can see if digestive enzyme supplements are necessary and can benefit your digestive health.

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What are the specific functions of digestive enzymes?

Each digestive enzyme works best in a specific environment, and each section of the digestive tract offers that unique environment so that the enzymes can work in harmony to carry out their jobs, which result in a healthy digestive system. The following list describes a brief overview for what, in reality, is a very complex process of how the digestive tract and digestive enzymes work.

  • The mouth. As soon as we eat, the salivary amylase in the mouth starts the digestive process by breaking down bigger starch molecules (polysaccharides) into smaller ones, called maltose and dextrin.
  • The stomach. As food moves through the digestive tract to the stomach, the gastric juices that are made up of hydrochloric acid and pepsinogen, are then secreted by the parietal and chief glands in the stomach’s lining. The job of hydrochloric acid in the stomach is to dissolve the food, kill unwanted and sometimes harmful microorganisms, and convert the pepsinogen into the stomach enzyme called pepsin. This is important to remember as hydrochloric acid is the culprit for acid reflux. Pepsin is a proteolytic (protein-breaking) enzyme, and it’s job is to help unwind and breakdown molecules of protein into smaller subcomponents. The majority of proteins are big molecules made up of units called amino acids. Oftentimes amino acids are referred to as the “building blocks of life.” Pepsin depends on the acidic environment of the stomach, which is why it has to do the majority of it’s work there.
  • The small intestine. From the stomach, the partially broken down food gets pushed into the upper section of the small intestine, called the duodenum. At this stage of the digestive process, only a few of the proteins and carbohydrates have been broken down, while all of the fats that were consumed remain fully intact. This is where the pancreatic enzymes have to work their magic. The pancreatic enzymes trypsin and chymotrypsin digest additional members of the protein family, and function best in the more alkaline environment that the small intestine provides. The other pancreatic enzymes include pancreatic amylase, which continues breaking down starches into maltose, and lipase, which begins to digest fats into glycerol and fatty acids. In our practice, a lack of these particular enzymes can contribute greatly to increased bloating and difficulty digesting foods, especially fats. Peristalsis, or the wave-like action of the smooth muscles of digestion, keeps this whole process moving along, and from here, the food moves down the section of the small intestine called the jejunum, where most of the absorption takes place.
  • The large intestine. What remains of our food then proceeds to move into the large intestine, also called the colon. Several important functions take place here, such as the absorption of water and sodium, as well as the ongoing manufacturing and absorption of micronutrients with the help of the intestinal flora. The remainder of food that is left is then turned into stool and eventually exits the body via the rectum. This complex process can have many things that can go wrong, so it is easy to understand that much can also be done to improve the function of the digestive system as well.

By now, all the digestive enzymes have had their moment in the digestive limelight. Therefore, it is easier to see how each part of the digestive process is equally important, from chewing our food to the process of micronutrient uptake. It would make sense that we would take our time while eating instead of rushing through meals on the go or skipping meals and replacing them with a quick snack that is lacking in nutrition. If or when something goes wrong, your body will let you know by displaying one or more of the following symptoms: bloating, gas, cramping or possibly vomiting, heartburn, constipation, having a sense of fullness all the time and diarrhea to name just a few. If you suffer from these symptoms on a regular basis, there are some digestive enzyme supplements we have found helpful to act as a bridge until you find the cause of the deeper issue, which we don’t advise you put off. Digestive enzymes are great to help your digestive problems – however, if there is a more serious problem at work, it needs to be treated.

Are digestive enzymes safe to take?  Which are the best digestive enzymes?

Certain enzymes should not be used by people with a history of certain digestive disorders, such as peptic ulcers. We strongly recommend that you work with your healthcare practitioner to find the best solution for your unique situation. However, there are a few safe exceptions, such as papain and lactase, as mentioned below. In addition, it is important to remember that healthy digestion starts with healthy eating habits.

Betaine HCl is a combination digestive aid comprised of betaine, a vitamin-like substance, and hydrochloric acid. The digestive enzyme pepsin is often included in betaine HCl products. This digestive enzyme can be useful in treating patients with digestive issues such as acid reflux (GERD) — particularly those who have been found to have hypochlorhydria, a condition where the stomach does not produce enough acid. Betaine HCl is occasionally prescribed for patients with other forms of indigestion such as heartburn and gas, as well as rosacea, asthma, yeast, allergies and sensitivities. Subsequently, healthy digestion depends on your stomach’s ability to dissolve large chunks of food and a highly acidic environment is necessary for this process to take place. The high acid content of betaine HCl can cause irritation of the stomach, and should only be taken during the middle of a meal That means eat a quarter to half of your meal then stop and take the supplement and finish your meal. Because this digestive enzyme can significantly change the pH in the stomach, we recommend betaine HCl be used only under the guidance of an experienced healthcare practitioner.

Multi-enzyme products (supplements) contain a wide spectrum of enzymatic ingredients; some of them support the action in the stomach while others work to boost the enzymatic action that happens further down the digestive tract. Listed below is an alphabetical list of just some of the several enzymes that these products can contain:

  •  Alpha-galactosidase
  •  Amylase
  •  Bromelain
  •  Cellulase
  •  Glucoamylase
  •  Hemicellulase
  •  Invertase [Sucrase]
  •  Lactase
  •  Lipase
  •  Maltase
  •  Papain
  •  Peptidase
  •  Protease
  •  Phytase

For the best results, consult a holistic healthcare provider for support with choosing a complete digestive enzyme product. One we regularly recommend to our patients at the clinic is Plantzyme by Metagenics. Other companies, such as Thorne, Standard Process and Zymogen, also have products that are very effective, but you can also get good results from other products that are found in any health food store near you. You also always have the option to purchase products containing individual enzymes. Remember, each of these enzymes can target certain bonds in proteins, sugars, and other macromolecules to break them into their components. For example, lactose, a milk sugar, is poorly tolerated or not tolerated at all by many people all over the world.

People who suffer from lactose-intolerance, and occasionally want to be able to eat or drink dairy products, can choose to supplement their daily diets with lactase tablets or foods that include lactase. This is a safe and effective way to allow their digestive system to assimilate this milk sugar into it’s usable components. This can help prevent the bloating and discomfort afterward that they would otherwise experience, while allowing them to enjoy dairy products!

Pregnant women, who find themselves feeling nauseous upon waking in the morning or after eating a meal, may discover that taking a mild digestive enzyme such as papain (a proteolytic enzyme extracted from papaya) can sometimes help suppress the nausea for these women. Papain has also been found to sometimes help to settle the stomach when motion sickness is the cause. Isn’t it wonderful that something as safe and simple as papaya enzyme can solve these common problems? Some women find that using ginger will greatly help to relieve these symptoms as well.

Consult your healthcare provider for guidance in choosing an individual digestion enzyme best suited to fit your specific needs. Understand though, that it takes a special practitioner, fluent in this type of medicine, to know and understand how important enzymes can be with the entire digestive process. Having a basic understanding of the digestive process is very important in understanding how our day-to-day choices can impact our overall health. If you suffer from digestive problems, the information provided in this article can help you talk to your healthcare provider about using digestive enzyme supplements to assist you as you work to find the root cause of your digestive problems. It is a wonderful place to start to see if things improve.

In reality, the digestion process is a much, much more complicated process than we can cover within in the scope of this article. What is really important to remember, as we continue our fast paced life – is to slow down. You can give your digestive team its best shot by chewing your food carefully and for longer than 5 seconds. This will also allow you to fully enjoy your food, and it will allow your body to break it down into digestible components. When you respect the role of your digestive enzymes, you are honoring yourself with the gift of full nourishment, which leads to an overall sense of well-being.

Having to suffer with a digestive disorder can disrupt our entire life. A digestive disorder can make us feel anxious about going out in public – never knowing when we may have to use the restroom, always looking to see where the restroom is and mentally estimating how long it would take to reach it if need be. It is disheartening to pull our favorite dress or suit out of the closet to find that we are so bloated we will not be able to wear it to a special event. The fear of embarrassing ourselves, spouses/partner and child at a school function because of the gas – especially if it is expelled in an unflattering way.

Digestive problems can cause as many emotional disturbances in our life as the physical ones can. Oftentimes people who are not plagued by digestive problems do not understand why we may pass gas in public, or accidentally bump into someone in a mad dash to the restroom. These events can cause us to miss out on a lot of great things in life – but they don’t have to. With the proper care and support from our healthcare practitioner and a commitment to ourselves – we can lead normal, happy and healthy lives.

For more information, browse all of our articles on digestion and GI health.

Pap Test And HPV FAQ

womentowomen on December 9, 2013

by Marcelle Pick, OB-GYN NP

Questions and answers about Pap testing and the human papilloma virus (HPV) 

Women are usually very surprised and worried if their Pap smear results are abnormal. They have several questions, and in some cases it’s difficult for them to even know what questions to ask their practitioner. We’ve tried to take some of the fear out of this equation by answering some of the most commonly asked questions women have about HPV and abnormal Pap test results.

  • “My primary care physician called to tell me my Pap test was positive for ‘high-risk HPV.’ I’m very worried about this. She referred me to another doctor for a colposcopy, but they found nothing unusual, so sent me back to my primary physician for follow up Pap tests. What will happen next?”

It sounds as though this was the appropriate chain of events. When your primary care provider saw that your Pap was positive for high-risk HPV, his response in sending you to a specialist was perhaps because not all clinicians are skilled in performing advanced testing procedures like colposcopy. Your Pap results may have been a false alarm, or else your body is recovering from the HPV virus you were exposed to. In either case, the colposcopy results are reassuring. Continuing to have follow ups as recommended by your provider is important to make sure you remain in good health. You can support your continued healing with excellent nutrition and other good self-care activities like moderate exercise, stress management and establishing good sleep routines.

  • “I’ve been told that my genital warts were caused by HPV and that I will eventually get cervical cancer from them. Is this true? My Pap tests have always been normal.”

The strains of HPV virus that are responsible for genital warts are not usually the high-risk strains that are associated with cervical cancer. We can’t know though for sure how many or which strains of HPV you have been exposed to. It’s also impossible to predict which strains of the virus you’re likely to be exposed to in the future. Prevention and good health maintenance are essential. Some studies indicate an effective immune response is triggered by using the topical wart treatment known as Aldara (imiquimod). This may be one of the best treatment measures currently available for warts, and it may also provide an element of protection from the high-risk HPV strains, as will lifestyle adaptations. What I tell my patients is “the best treatment for HPV is to change the messages that the cells are getting with great nutrition.”

  • “I always practice safe sex and use a condom. How did I get HPV? How was I not protected?”

HPV can be found anywhere in the genital region. Since condoms cover only part of the penis, there is extensive room beyond the condom for genital contact to occur and HPV to be transmitted. Practicing safe sex is very important in preventing other sexually transmitted diseases, but having an open and honest talk with your potential partner about STD’s, and each of your sexual histories, prior to having sex is a very wise choice.

  • “My practitioner said my Pap was ‘normal’, but she also told me ‘HPV is detected’, and wants me to schedule a follow-up appointment in six months. Is that right? From all my research it seems that an abnormal Pap is significant if HPV is detected. My practitioner also told me that my husband and I can ‘resume our normal lives’. This is confusing, because wouldn’t that mean that we were compromising our immune systems if the virus is present?”

Your results are not uncommon. Because of new viral technology, the HPV virus itself can be detected, separate from looking at the health of the tissue cells sampled. This is how the virus can be seen, even if the cells do not appear abnormal.

Different practitioners may use slightly different follow-up algorithms with this finding, depending on whether they follow the guidelines of the American College of Obstetricians and Gynecologists (ACOG), the American Society for Colposcopy and Cervical Pathology (ASCCP), or Planned Parenthood.

In most cases the virus will resolve, and remember 70% of the female population has HPV, and your practitioner will just want to watch you a little more closely, usually by retesting in six months. This is to make sure your cervical cells do stay normal and the virus becomes dormant, which means it becomes undetectable, due to the good response of your healthy immune system. So you have much more control than you think.

At Women to Women we discuss HPV in greater detail in the many informative articles on our website.

Abnormal Pap Smears And HPV

womentowomen on December 9, 2013

by Marcelle Pick, OB-GYN NP

If you or someone you care about has been notified that your Pap results are not normal, it is totally normal that you may be feeling anxious and worried. You may even be thinking your practitioner has gotten you confused with another patient. If your pap test has always been normal in the past, and if you always practice safe sex, how can this be possible?

The Pap smear: It can save your life

Both traditional and holistic practitioners advocate for a yearly pelvic exam and Pap smear. Why? The answer is that this standard of practice has been proven to be one of the best preventative measures found to protect a woman’s health and life. We learn so much during an annual exam that can be used to prevent problems down the road.

The Pap smear test was developed by Dr. George Papanicolaou and named for him. It’s purpose is for the early identification of cervical cancer. Soon after it’s introduction, the Pap smear proved effective at detecting precancerous lesions, which represent early and still very treatable indicators of cervical cancer risk. Scientists wish they could develop a screening device as effective as the Pap smear for identifying precancerous breast changes.

Pap testing has saved the lives of many women. Cervical cancer was once the leading cause of cancer-related death for women in the United States, but over the past 60 years it has dropped to 15th, due to Pap screening. It’s an easy, and for the most part, reliable test to perform. See our articles on routine Pap testing and pelvic exams for an explanation of what to expect during these procedures, along with a description of the new Thin Prep Pap.

Since there is so much potential benefit in having this simple test completed, it’s surprising that women sometimes get mixed messages about its worth. Cervical cancer claims the lives of around 270,000 women each year worldwide, 3700 in the United States alone. At Women to Women we encourage yearly examinations and regular Pap screenings for our patients. With the new recommendations of just doing pap smears every three years many women are confused and think they should not come for annual exams. This is not the truth, the pap may not be necessary but the annual is a great place to look at what can be done to be in the best health possible for the next year, and other pelvic abnormalities can be ruled out if changes have occurred.

Prevention and detection start early

A few preventative measures you can take as a young women are to delay first sexual encounters and limiting the number of sexual partners. All women, even young women, are at risk for all sexually transmitted diseases, which makes discussing safe-sex practices with girls very important before they start having sexual relationships. I suggest that any safe-sex plan includes a commitment to a yearly exam and a Pap smear.

Young women are encouraged to have an annual pelvic exam and Pap test starting in their teens if they’re sexually active, and a STD screening be completed each time they encounter a new partner. If a woman is not sexually active, she should have a pelvic exam by the age of 21, with a Pap smear within one to two years after her first sexual experience.

At Women to Women, we like to meet with teenaged young women for a health interview and an informative and educated exam session about reproductive health prior to her first sexual encounter. If she does become sexually active, she will be better prepared, emotionally to return for the next step, her first pelvic examination and Pap smear.

In the future, this initial meeting may be the ideal time to determine if this young woman would benefit from the HPV vaccine. With this kind of informal, but educational introduction, a young woman can be more comfortable and ready to take care of her body. This can help prepare her for a positive, worry–free and confident future.

Excellent nutrition is also an important part of prevention. We give our immune system a great advantage by maintaining a diet that’s high in folic acid, antioxidants, and essential fatty acids. Even when we eat well, we can support our cervical cell well-being by further enhancing our diet with good nutritional supplements.

How often to get Pap testing done

The American College of Obstetricians and Gynecologists (ACOG) recommends Pap screening annually until age 30, then every two to three years if a patient has had three sequential years of normal results and does not fall into a high-risk category (e.g., DES exposure, known or previously-detected HPV exposure, a prior history of cervical cancer or cervical intraepithelial neoplasia II–III, or an immunocompromised status). If a woman is taking hormones, we strongly recommend she should be checked annually and her prescription monitored. The recommended age to discontinue Pap screening varies according to a woman’s situation, and this decision is one left for the most part to her gynecologist’s discretion. We are seeing more women in their 60’s and 70’s with STD’s so we may need to consider doing Pap smears on women depending on their sexual situation.

At Women to Women, we recommend an annual Pap smear for routine screening of sexually-active adult women. Occasionally, we may suggest a more regular checkup if any minor abnormalities had been found on previous tests. The reason we suggest annual tests is because everyone’s risk factors can change over time. Also, changes in stress levels and immune response can also cause a previously normal test to become abnormal.

We view the Pap test, in many respects, as a general indicator of your overall health status. The presence of abnormal cervical cells indicates your immune system is weakened. Early testing prevents cervical cancer. When testing is delayed, you are at greater risk because the abnormal cell changes are not detected early.

If you have had your cervix completely removed, during a hysterectomy for example, and have no history of an abnormal Pap, it may be fine to discontinue the test. At Women to Women, we continue to screen our patients at regular intervals. You might want to discuss this with your practitioner. Many more practitioners are leaving the cervix intact to help maintain the pelvic structure. In that case, Pap testing would need to continue.

Abnormal Pap test results

What happens when you get an abnormal Pap reading? Let’s look at this together. Hopefully, you have a relationship with a GYN practitioner you know and trust. If so, your test results will be explained to you in a supportive and understandable way, and you will be encouraged to ask questions. If not, you may want to think about finding a provider you can feel more comfortable with, and who supports you. You are likely to be notified of anything on your Pap test that is not “satisfactory,” If the cell sample from inside your cervix was inadequate, or less than ideal, the results will be reported as insufficient, and you may be called back for a new attempt. In a case like this, if you are menopausal or at low risk, re-sampling can often wait until your next yearly exam.

Occasionally a Pap report will show an infection caused by yeast or bacteria, or even some changes in your vaginal tissues due to low estrogen levels in menopause. These results are easily dealt with and are unrelated to HPV or cervical cancer.

The scale of abnormal Pap test results ranges from slightly atypical to high–grade cellular changes. Currently, the Bethesda system is used among pathologists and healthcare providers to classify findings consistently. There is also a well established algorithmic approach to match next steps to abnormal findings. Both the classification system and suggested management are continually updated by new research findings. If needed, HPV testing/typing is considered and can be added to the Pap test analysis. Some women will electively seek this with their Pap test before anything abnormal is found, but that varies and the guidelines for this are still evolving.

The next steps — following up

A Pap test is a screening tool. It’s not exact, and a margin of error exists each time it’s used. Results can be either falsely positive or falsely negative. That’s why we recommend annual testing for women at risk, and also why we sometimes do repeat smears more often when abnormal results are found.

If you have abnormal results, your practitioner will likely repeat the Pap test or move on to other diagnostic testing, such as colposcopy or an endometrial biopsy. The results of colposcopy will help decide what is needed next. The colposcopy may also be repeated within a reasonable time-frame to ensure healing or to provide an opportunity for early intervention if precancerous changes are detected. Repeat testing is routine and ensures that nothing is overlooked.There are a number of advanced treatment procedures available, if necessary, and all geared toward removing any suspicious tissue that persists on the cervix. For persistent abnormal biopsy results or ongoing presence of abnormal cells (cervical dysplasia), these treatment procedures may be warranted. Most of these decisions are based on well-established guidelines and are made collaboratively between you and your practitioner along a tried-and-true timeline. The goal is to intervene before the dysplasia worsens and spreads into the tissue of the cervix or uterus, and to prevent true cancer.

If you have feel confused or are uncertain about your follow-up plan when you’ve gotten abnormal results following a Pap smear or colposcopy, don’t hesitate to call your provider to ask questions. Many women have abnormal readings that return to normal once their stress is relieved! In fact most of our patients that have abnormal paps return to normal within the year. Close monitoring will help make sure you get back on track.

Making a difference in your outcome

We want you, as an intelligent woman, to take charge of your health. But despite all the research and scientific information in our world, it can still be pretty frightening for a woman to get a call from her doctor about an abnormal test result. Sometimes, that fear can grow into persistent worries that aren’t rational. That’s why having all the facts can be calming and empowering. At Women to Women, we try to approach things from all directions. We provide information and offer physical and emotional support.

Providing support for both the physical and the emotional aspects of your overall health is a very positive and affirming act. With so much technology available to discover and take care of any problems, we have tremendous potential to achieve positive outcomes. We encourage you to not put off testing – early detection may save your life.

One way to help prevent an abnormal Pap test is by nurturing yourself. Make sure to eat well, fortify your diet with supplements and try to reduce your daily stress. Maybe you could consider trying yoga or relaxation through meditation. If your test is abnormal, see it as a reminder to start adding something positive to your life that will help your reproductive system heal. Your Pap test is just one small chapter in your health story. By supporting your immune function and scheduling routine follow-ups, you have the power to control your outcome. Along with dietary changes, make sure you are getting enough folic acid, at least 800 mcg daily, and eat plenty of cruciferous vegetables.

Thyroid and Hypothyroidism: Frequently Asked Questions

womentowomen on December 9, 2013

by Marcelle Pick, OB-GYN NP

Answers to your concerns about problems related to your thyroid, including low thyroid disorder.

If my thyroid was enlarged, could I feel it? Where is my thyroid?

The thyroid is a small gland that lies behind and is wrapped around your Adam’s apple, but is not the Adam’s apple itself. Your practitioner can show you specifically where to feel for it. Most women are able to tell if it’s enlarged, but sometimes think there are changes there when they aren’t.

Will my thyroid be painful if it becomes enlarged?

Usually not, unless it becomes inflamed, a condition that is called thyroiditis. If this happens, the area probably will feel tender.

My doctor tested my thyroid, and told me that my results are normal. I still don’t feel like myself. Should I be concerned?

Let’s look at this together. A good first step to take might be to check with your doctor to find out what his or her definition of “normal” is. Sometimes, health care providers have different ideas of what is ideal, and what is usual. At Women to Women, we like to see TSH levels at or near 2.0. But if you are having symptoms, we will run more thyroid function tests no matter what your initial results show. Sometimes, a very small imbalance can keep your thyroid hormones from being used effectively by your other body systems. That could be causing your symptoms. Other things your doctor may want to check out might be your adrenal function, your hormone levels and your gastro-intestinal system; the body is a complex system that has many inter relationships that affect its function.

I’m taking bHRT. Can I take thyroid medicine too?

Just remember that any thyroid medications are very sensitive. They should be taken alone, and on an empty stomach. Allow at least one to three hours between your thyroid medication and any other medication, supplements, vitamins or food. Most thyroid medications, like Synthroid and Levothroid are T4 products; they can be taken at bedtime, but if you notice you are too energized you may want to take them in the early morning.

My mother had thyroid disorder. Will I inherit this?

Thyroid problems, like hypothyroidism, often tend to run in families. We don’t know whether genetics or even perhaps emotional patterning can cause this. Quite often, daughters will “inherit” their mothers’ patterns of passivity or assertion, along with other behaviors that affect thyroid function. Some argue that this is related. Some other autoimmune patterns also tend to show up with certain genetic strains. Being aware of your family history is a good thing. If you address your diet and nutritional needs and quickly resolve any underlying emotional issues, you improve your chances of postponing or eliminating your vulnerability. This also means you may want to start checking your hormone levels sooner.

When should I first get my thyroid levels checked?

Chances are you may have already had a thyroid exam. A manual thyroid exam is part of an annual exam. Your dentist or oral hygienist may have checked your thyroid too. If you have a family history of thyroid disorders it’s a good idea to start getting thyroid lab checks around the age of 20, or sooner if you develop symptoms. At Women to Women we often see young women in their late teenage years and early 20’s with thyroid problems. If you don’t have a family history, and you aren’t experiencing symptoms, you can start getting checked around age 30. Get tested every five years unless you begin having symptoms.

Try not to be afraid to ask your practitioner to do the testing. Some primary care physicians don’t routinely check thyroid functions unless you’re having problems, but the sooner an imbalance is found, the easier it is to treat; quite possibly without medication. Nutrition and lifestyle have such a positive and beneficial influence on us; it’s good to give attention to them, at any age.

I get a lot of exercise, but I still can’t lose weight. Could my thyroid be low?

We might want to think about checking your thyroid if you think you’re consistent in using more calories than you are taking in, but not showing any change in your weight. Since your thyroid is mainly responsible for metabolism, even a very small imbalance could cause your rate of weight loss to slow down. We should consider other factors as well, especially if you’re experiencing no other symptoms of thyroid dysfunction. Other reasons that could account for slowed weight loss or a gradual weight gain, in the absence of thyroid symptoms, include changes in your nutritional well-being, your digestive health, your detox capabilities and your hormonal levels. Another possibility is that your metabolism has slowed down as a result of too much dieting. You can find out more about how your thyroid is connected to weight gain in our other articles.

I have an overactive thyroid. My doctor is strongly suggesting radioactive isotope implementation (or surgery) what do I do now?

If you have been diagnosed with Graves’ disease and your doctor recommends radioactive isotope implementation, you may need these aggressive techniques to safely deal with an unstable, overactive thyroid. On the other hand, if you have a borderline case of hyperthyroidism, it may be possible for you to use less aggressive treatment approaches. A combination of holistic measures like acupuncture and nutrition therapy, while being monitored by a very attentive practitioner, can be especially beneficial.

It’s very important that you know all your options and that you are confident you are making the best decision for yourself. If you don’t feel comfortable with your choice, you can find another provider and ask for a second opinion.

I’ve had thyroid surgery and will have to take thyroid supplementation medication permanently. Will this negatively affect my health?

No. In fact, this gives you a chance to truly evaluate your current health practices and make some really positive and important changes in your lifestyle. By ensuring that your nutrition is the best it can be, and adding appropriate supplements, you can support your entire system. These steps will help ensure that your body appropriately uses your medication. Optimal nutrition and the appropriate supplements will help support your whole system and ensure that your body converts your medication appropriately and your hormones stay in balance.

I’ve been taking thyroid medication for the past five years. When can I stop?

The answer to your question depends on why thyroid replacement therapy was started. It may have been initiated due to a chronic autoimmune condition or because your thyroid gland has been damaged. It also depends on if you can be closely watched over the next 12 months to make certain your thyroid function remains stable.

In order to reduce or stop your thyroid medication, you need to have a practitioner who is very supportive. She or he needs to work very closely with you and carefully watch your T3 and T4 levels, as well as your nutritional and digestive status. It is reasonable to wean off medication by using optimal nutrition, dietary supplements, and other holistic techniques, but it is imperative that you be closely monitored by a medical professional.

My thyroid is healthy. How can I keep it that way?

The best way to support your overall health, including your thyroid function is through excellent nutrition that includes an appropriate daily medical–grade multivitamin. Preventative measures include routine, as well as special, intermittent testing and annual well-woman exams. Many holistic practitioners refer to the thyroid region as the home of your voice, represented in Eastern medicine by the fifth chakra. Women often feel subdued and don’t fully express themselves. Their voices are trapped. This can manifest as thyroid imbalance in the eastern interpretation. The western interpretation does not incorporate this philosophy. That is why we find it is important to incorporate both. We encourage you to speak out for yourself. It may also be helpful to find a form of creative expression that helps you express yourself in your own unique way.

Are there any foods or drinks I should avoid to protect my thyroid?

No. As long as you eat foods which are whole and natural, meaning they are free from artificial ingredients, preservatives, and additives, as much as possible and they are processed as little as possible, your diet can include a wide variety of foods.

Is there anything I should be eating more of?

I often suggest adding seaweed for problems with low thyroid function or hypothyroidism. This is because it contains iodine. In small amounts, iodine is necessary for thyroid function. Just be sure to add these foods in moderation. Over doing iodine can actually harm the thyroid.

What about soy and thyroid health?

This is the most controversial of all topics. I sometimes advise my patients to limit soy products if they’re having thyroid symptoms. There has been a lot of talk surrounding soy and its effect on the thyroid due to soy’s weak estrogen-like effects. Too much estrogen, or estrogen dominance, can have a negative effect on the thyroid. This is one reason that progesterone, as well as phytotherapy may help prevent thyroid problems. It helps to balance estrogen levels. If you have been eating soy for your hormonal balance, and it is not affecting your thyroid, or other areas of your health, I wouldn’t worry that it will cause a thyroid problem. However, don’t start eating large quantities of soy before talking to your practitioner.

Please refer to our many informative articles on these topics in our Thyroid Health section.

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Routine Pap Pelvic Exam: What To Expect

womentowomen on December 9, 2013

by Marcelle Pick, OB/GYN NP

If you’ve never had a pelvic exam and Pap test before…

At our practice, where we integrate conventional and alternative ways of thinking, there has never been any doubt about the importance of annual examinations and regular Pap screenings for our patients. If you are anticipating your first pelvic exam and Pap test, we know that knowledge is key, and by knowing more, women find they will worry less.

At Women to Women we want you to know what to expect during your routine Pap test and gynecologic exam. Has your clinician performed the Pap test without an explanation of what to expect and why it’s being done? As women we need to ask these questions, we need to know and understand the importance of regular pelvic exams and Pap smears. We believe this information can help you become your own best advocate, and to comprehend why this is all needed, so you can feel comfortable with the procedure.

Both traditional and alternative practitioners advocate for an annual pelvic examination and Pap smear. Why? The answer is that this standard of care has proven to be one of the best preventative combos we have to protect women’s health and longevity The Pap smear test was developed by and named after Dr. George Papanicolaou (1883–1962) for the purpose of early identification of cervical cancer. Soon after its introduction, the Pap smear proved effective at detecting precancerous lesions, which represent early — and still very treatable — indicators of cervical cancer risk.

Routine Pap testing and pelvic exam…

The Pap smear is an easy and reliable test to perform and the procedure takes only minutes to perform. So if this is your first Pap smear and pelvic exam, relax, we will explain the procedure, step by step.

First, you will be asked to disrobe from the waist down and put on a hospital gown. The clinician will ask you to sit at the edge of an exam table. Then, when instructed, you place your feet in the stirrup-style foot rests and lie back on the table (like the women in labor depicted on TV or movies). The clinician will ask you to separate your thighs and stay calm so the muscles are relaxed. The more relaxed and dropped apart your legs remain, the more comfortable you will be and the quicker the procedure will go. (If you wiggle your toes it is a great way to reduce tension in the legs, groin, or buttocks.) This position is often intimidating for women as they have their first pelvic exam but for many it gets better as time goes by.

With a gloved hand the examiner will touch the exterior of the vulva to separate the labia and view the external genitalia for normalcy. To widen the opening a speculum, which is similar to a tampon applicator with a handle, is then gently inserted into vagina. There are different sizes and styles of speculums used for different women. The speculum allows the clinician to view the vaginal walls and the cervix. The cervix is located high up in the vagina. It resembles a mini bagel projecting into the vagina, and if you were to touch it with your finger you will notice it feels like a firm, nose-like protrusion. The cervix is occasionally positioned so it is hard to see, but an experienced clinician can usually find it with a little gentle shifting of the speculum.

When the speculum is in place, the clinician will collect a sample of tissue from the exterior of the cervix (ectocervix) with a tool described as a spatula, then another from the cervical canal to the womb (endocervix) with a brush like instrument called a cytobrush. There are a number of devices which are used to gather samples, the most common being a contoured plastic spatula comparable to a tongue depressor. A little mascara-like brush is used to swish the interior of the cervical canal, and a small plastic broom-like brush is also often used. All these devices are gentle but can feel a bit odd to the patient when used, some women have a very tender cervix and may experience more discomfort than others. Several women may have a more fragile cervix that bleeds a small amount when scraped, but this is only a temporary problem with no major side effects.

These days it is pretty customary for the clinician to place the collected samples in a liquid-based container, but in some clinics the samples are still smeared onto glass slides and a fixative applied. This is by far no longer the norm. Chlamydia and gonorrhea testing is can now be done with the pap smear if is is collected using the ThinPrep methods. If there are vaginal symptoms of concern, the clinician may use a Q-tip to swab the vaginal walls and then check the sample under a microscope for signs of a vaginal yeast infection or other types of infection.

The speculum is then removed; at this point the clinician typically performs a quick bimanual examination, where she or he feels the uterus and ovaries as is possible with their skillful hands — placing two fingers of one hand within the vagina and the other hand on the lower belly. Then the clinician will press gently to feel what cannot be seen.

The Pap sample is sent to a pathology lab for the technician to review the cells under a microscope, checking for normal and abnormal features. An HPV DNA analysis can in addition be done at that time if requested, but many patients are choosing to do this as there is such a high association with HPV positive paps and cervical changes that can need further evaluation. Many of these changes do not have any symptoms. When the analysis is complete a report is sent to the clinic.

The clinic usually sends you a written notice that the pap and other tests were normal or require more follow up. For more information, read our article about pap testing results. Various clinics have a different policy and they only contact you if the results are abnormal, so if you want to be notified of the results regardless of the results, be sure to ask them to do so.

The new ThinPrep Pap smear — liquid-based technology…

In the beginning the Pap test consisted of using a small wooden spatula to sample the outermost cell layer of the cervical os (the opening to the uterus inside the vagina), then the sample was smeared onto a glass slide and a fixative solution was applied, then it was sent for further evaluation with a pathologist. (Hence the term Pap smear). Fortunately the technology and research has changed immensely over the past ten to twelve years. Now most paps are liquid based and allow the practitioner to evaluate the cervix for abnormal changes, test for the human papillomavirus  (HPV) DNA typing, as well as testing for gonorrhea and chyamydia. The HPV/DNA typing assists greatly in the management of abnormal paps.

With the new “liquid-based” Pap tests (i.e., ThinPrep® and SurePath®), the cell sample is placed in a jar of liquid fixative for rinsing and then it is transported to the lab for further processing and review. This process provides a cleaner, much easier-to-read sample and has demonstrated to have a notably lower margin of error. This has had dramatic results for women as they now have the opportunity to see changes early and can then make lifestyle changes which definitely help with abnormal pap smear management. If you do discover that you have been exposed to a high–risk HPV strain, don’t be alarmed — it just means that you will be best served by close monitoring and follow-up over time to ensure your lifelong cervical health. Most women have been exposed to HPV, but the most important thing to understand is that dietary, and lifestyle changes can make the biggest difference in turning around the HPV status.

At Women to Women, we suggest a Pap smear just about every year for routine screening of sexually-active adult women, and occasionally more often to follow any minor abnormal cells found on previous Pap smear tests. This is because women may change sexual partners; monogamous women can have partners who stray; and ultimately, everyone’s risk status can change over time. Changes in stress levels and immune response can also lead a previously normal–testing woman to suddenly test abnormal.

We view the Pap test as somewhat of a Geiger counter for your overall health — especially because we interpret the presence of abnormal cervical cells as a sign of weakened immune system function. The fact is that delayed testing can place women at greater risk, and could reduce the probability of detecting abnormal cell changes early — which is the key to preventing cervical cancer.

For more information, read our articles about Pap smears and HPV.

Additional resources for women:

  • Our Bodies, Ourselves: A New Edition for a New Era (2005 edition), from the Boston’s Women’s Health Book Collective.
  • Changing Bodies, Changing Lives: A Book for Teens on Sex and Relationships (expanded 3rd edition), by Ruth Bell.

Inside The Core Balance Diet — An Interview With Author Marcelle Pick, OB/GYN NP

womentowomen on December 9, 2013

by Donna Poulin, Practice Manager at Women to Women

For many years I’ve been witness to Marcelle Pick helping women through various changes in their lives. Weight gain – and weight loss resistance – affects women so greatly. The image they see in the mirror, the way additional weight affects energy and zest for life, the self doubt and internal negative talk it creates – all of these affect women in such a profound way and often can detract from their joy and joyfulness in life. When women explore solutions they are flooded with options – which can then seem overwhelming – after all, which choice is the right one?

Over the years many, many diets have moved in an out of fashion – Weight Watchers, The Zone, The Atkins Diet, The Fat Flush Diet, The Grapefruit Diet, The South Beach Diet.. and on and on. Sometimes women find a diet that works for them in the short term, but many will talk about finding a plan that will work permanently. After all, who wants to eat grapefruit three times a day forever?

I recently talked with Marcelle about her first book, The Core Balance Diet – and she shared some great insights and profound perspectives on the causes of stubborn weight gain and the obstacles to weight loss.

Donna Poulin: One of the differences I see in The Core Balance Diet is that you encourage women to get to know their bodies through the use of health assessments – can you tell us why this information is important to helping women lose weight?

Marcelle Pick: The Core Balance Diet was written to help women identify the imbalance or imbalances which are creating the obstacle to weight loss. I have found that many women have simply accepted certain symptoms as being the norm in life – symptoms which may be uncomfortable or misunderstood. By taking the time to answer these specific assessments, the reader starts to understand what is really going on for her. Once an imbalance is identified, the reader can jump right in and start learning more about diet and lifestyle changes and about what may be causing the imbalance. Once an imbalance is addressed, the reader can expect great things to happen – including shedding unwanted pounds!

DP: You’ve talked with some many women about weight loss – what is the one message you’d like to pass onto your readers before they even open your book?

MP: That’s an easy one! A weight loss program cannot and should not be designed as a ‘one size fits all’ program – we’re all biochemically different! Every woman has had different life experiences that make her unique. Issues around weight are much more complicated than some popular diet fads indicate – especially if we want weight loss to last. The way a woman eats should be a way of life which supports her individual needs – not a diet plan that last for 30 days.

DP: Would you tell us a little about how The Core Balance Diet will help women lose weight?

MP: I designed The Core Balance Diet to help women look at the unique core differences –and to help them identify their metabolic basis for emotional imbalances. This individualized approach helps identify the imbalances that are most likely interrupting the body’s ability to maintain a healthy weight. I’ve included a detailed food plan for each imbalance, including simple and easy recipes. We know that our food choices speak to our jeans AND our genes. Different foods send different information to our genes, but so can our environment and our thoughts. I’ve also included reading and exercises on how our internal environment – our thoughts – as well as how our physical environment can impact us.

So The Core Balance Diet takes an individualized approach, first by looking at your emotional and physical well-being to define the core imbalances most likely interrupting your body’s ability to maintain a healthy weight, and then by offering a functional approach to heal the imbalances and encouraging the best foods for your metabolic make-up.

DP: For years and years women have heard that you have to eat less and exercise more –would you comment on how The Core Balance Diet is different?

MP: I first noticed this rule didn’t work when I was 19 — I enrolled in Weight Watchers, and everyone around me was weighing and measuring everything, but I also noticed everyone was cheating all the time! I was weighing and measuring everything, too, and not cheating at all — I mean, I was picture-perfect. But I still only lost a quarter-pound here, or gained a quarter-pound there. I thought, what’s wrong here? I’m doing everything right! Ultimately, I found my problem was that I was gluten-sensitive, and that had a lot to do with why I wasn’t losing any weight.

My experience has shown me that all calories aren’t equal – you need foods that will talk to your body – one hundred calories of sugar sends different information to your cells than 100 calories of spinach and chicken! And…if you’re sensitive to gluten and you eat 100 calories of bread, you’ll start a domino effect of negative messages throughout your body. There can be many roadblocks for a woman losing weight, and by identifying these obstacles we provide the opportunity for raised awareness on what foods are healthful and helpful to weight loss.

DP: There’s been so much controversy in the past about including fats in a the diet – for years women have been told to limit their fat intake.

MP: Fat is critically important to keep our bodies functioning. It helps maintain our brain tissue, our nerves and our cell membranes – and it’s the precursor to our sex hormones! Without fat, our bodies can’t function – let alone lose weight!

DP: Many women correlate fat intake with high cholesterol and heart health.

MP: The Core Balance Diet is not high in saturated fats – it emphasizes high quality proteins, healthy fats and oils and phytonutrient rich foods. Together all of these affect cell signaling and actually decrease the changes of inflammatory related conditions like insulin resistance, high cholesterol, type 2 diabetes and even heart disease. There’s so much research now showing how heart healthy good fats are!

DP: Carbohydrates have been both in and out of favor in the past years – some diets scream low carbohydrates are best, others, like Atkins, are in favor of almost no carbohydrates. In looking through your menu plans, you have included carbohydrates – can you tell us about that?

MP: We need carbohydrates for energy. Our brains can only use carbs for fuel, so without carbohydrates we have a problem. I recommend limiting carbohydrates to 16 per meal and 7 per snack – and combining carbohydrates with protein to keep blood sugars stable.

The Core Balance Diet is really about the quality of foods you choose, with emphasis on healthy fats, lean proteins, unrefined carbohydrates and micronutrient rich fruits and vegetables.

DP: Everyone has heard that fruits and vegetables will make us healthier – you talk about this in your book and encourage readers to try new vegetables and incorporate them into their eating plan every day. Why is that?

MP: Here again we have the concept of food as information. Thousands upon thousands of phytonutrients in colorful fruits and vegetables have been identified to date. And they have been shown to work with the body’s cell-signaling pathways to influence gene expression in countless beneficial ways — most of which we have yet to discover. We do know these genes are then responsible for turning on detoxifying enzymes, which help program cell death for cells in our bodies that have “gone wrong” (helpful in prevention of cancer), and they can have anti-inflammatory and antiproliferative effects (also helpful in prevention of cancer).

We’ve also seen how the fiber in fruits and veggies helps to prevent weight gain. And this is partly due to the way fiber can lower the glycemic index of our meals. Just by adding a vegetable we can slow down the way glucose is used and stored in the body. So I always say plant-based foods speak to our genes and our jeans!

DP: One of the phrases I found most intriguing in The Core Balance Diet is “Your issues are in your tissues.” Wow! This really made me think about the emotional issues that can act as barriers to weight loss. Would you share more information about this?

MP: Absolutely! Here’s what Caroline Myss says in Anatomy of the Spirit – “Our biography becomes our biology.” Or, to paraphrase, “Our issues are in our tissues!” It’s something I’ve seen all along in practice, and even though there are studies now to back this up, many practitioners simply weren’t trained or lack the time to make these connections.

Back in 1998 a famous study called the ACE (Adverse Childhood Experiences) study evaluated the effect of traumatic childhood events on health risk behavior and disease. The researchers found that compared to those who had none, those with negative childhood exposure had a 1.4– to 1.6-fold increase in physical inactivity and obesity, along with many other medical problems. So we know our life stories affect our bodies.

In a study published in 2009, the authors concluded that overeating may serve to repair negative moods in the short-term. Well, yeah, of course it does! Food is love for many of us. And I think most women have had first-hand experience with this – I wrote an article on emotional eating, for those who want to explore the issue more.

There’s also an editorial I read recently, by a Dutch scientist who concluded that behavioral factors have more to do with weight loss than what we eat, and cognition and emotions have a huge impact on that behavior.

So science is finally catching on to this idea. But let me give you a real life example of how emotions can affect weight. I have a patient , who is probably 100 pounds overweight. She’s stunningly attractive and wants desperately to lose this weight. So we talked for a while, and one of the things that came out in our conversation was that when she was growing up her mother was always saying things like, “You shouldn’t eat that,” or “You shouldn’t wear that,” or “That’s going to make you fat.” So her response was to always get seconds — especially when her mother was around! This behavior was so deeply embedded that she didn’t realize that every time she ate, she was essentially reacting against her mother. Once she became aware of this, she could see hope for change. So we simply can’t ignore these emotions around eating.

DP: Your perspective on exercise was so refreshing for me to read! Many women must have read the same article I did recently – about exercising one hour a day for the rest of my life just to maintain weight! Talk about adding stress….. Please tell us more about your perspective on exercise.

MP: There is practically nothing bad we can say about exercise, except perhaps for one precaution: please don’t allow your exercise routine, or lack of one, to become another stressor in your life. Exercise is so beneficial to us because it is a stress reliever, not a stress producer.

Let’s start with just that one benefit: we know from research that exercise enhances mood. And if it did only that, it would be wonderful. But its effects are additive and cumulative, and integral to reaching and maintaining a healthy weight. It can prevent insulin resistance and diabetes by boosting our cell’s sensitivity to insulin, a very good thing for any woman wanting to heal metabolic imbalance. Studies have also shown how exercise can reduce abdominal fat — even without dieting! — and when we put the two together, the benefits compound one another to assure long-term success.

But we don’t have to knock ourselves out with exercise. The trick is to make it fun, make it something you look forward to. Find a way to move your body that you love, and don’t be afraid to experiment!

If you don’t have a lot of time, “bursting” is a great way to challenge your body without spending hours at the gym. The idea behind bursting is that you want to quickly bring yourself to an extreme and back again several times during your work out. During a burst, your breathing may be so heavy that it’s hard to talk. Stay at this level for 20-30 seconds at first and work up to 1 minute. I like this concept because you can reap the benefits of an intense work out in only 20 minutes and it doesn’t matter what kind of exercise your doing!

DP: What words would you like to leave our readers today with?

MP: The bottom line is that women are so tired of being told, “If you would just cut back on one more meal…,” or “If you would just work out more….” This all translates into “You’re just not doing good enough!” I’ve found that most women really are doing well — they’re eating regularly, they’re exercising regularly, but their extra weight is just not budging. We want to reassure women that it’s not that they’re not doing a “good enough” job. You’re doing a great job! But something is up here — something is out of balance. Your body is smart enough to come to a place of balance — once we give it the support it needs. This book is for all those women who have been trying to do well but still feel stuck.

The Health Benefits Of Soy

womentowomen on December 9, 2013

Soy: what are the healthy benefits?

by Marcelle Pick, OB-GYN 

It seems as though there are new soy foods added to the market every day. It’s hard to know which ones we should be adding to our diet and if we should be adding them. The choices can be confusing! What adds to the confusion even more is that soy is often being hidden in foods which are not quite so healthy for us, like doughnuts!

Sometimes it may seem like an impossible task to keep up with recommendations made by experts telling us what constitutes a “healthy” diet. Should we include soy in our diet, or should it be avoided?

There seems to be some misunderstanding surrounding this little bean. This article may help to clarify some of the controversy.

People are also searching for options to HRT (hormone replacement therapy) and are wondering if soy could provide the answer for them. Even though soy may not benefit every woman in this way, we have discovered that it does have some positive effects when used during perimenopause and menopause. To read further on the use of soy for menopausal symptoms, see the menopause portion of the Women to Women website.

For those of you who want to know more about the practical benefits of soy, let’s begin with a little history of the soybean. Later, we’ll explore scientific findings, discuss current uses, and talk about how Women to Women is using soy foods and supplements in the medical arena.

The soybean: a brief history

The soybean itself is native to eastern Asia, where it has been grown since ancient times. It was first cultivated in the United States in the 1800s and it was used as a substitute for coffee during the Civil War. No one cared much for it until the late 1800s when it started being grown as a plant to feed livestock.

George Washington Carver, the famous American botanist, developed many uses for soybeans in the late 1800s and they quickly became a major crop in the South and Midwest. New uses and applications became apparent in the early 1900s.

Henry Ford spent millions of dollars on research and on the development of the manufacturing uses for soy. He served an entire soybean meal to the press corps at the 1934 World’s Fair. We don’t know if it was well-received or not!

Today, many plastics are made from soy. It is in everything from paints and inks, to candles and soaps. Soy is everywhere! But what is it?

Soy begins as three little beans in a shell. Several variations can be noticed in the size and color of the flower and of the pod, but the soy plant is strong and hardy. It is able to flourish in temperate weather from the Midwest to the South. The soybean is so versatile, that after harvest it can be eaten or used in its raw form or it can be processed in any variety of ways. For these very reasons we now find that is is used in many different things.

Soy as a food source

Soy is found in just about every venue, from traditional grocery stores to farmer’s markets. It is available in traditional as well as nontraditional forms. It’s difficult to know where the best and healthiest sources of soy can be found.. Soy’s nutritional value is high. It is a plant source of eight of the essential amino acids, making it the only complete non-animal protein. Whole soy foods are also an excellent source of fiber, B vitamins, calcium, and omega-3 fatty acids. Soy researcher Mark Messina states that around 30% of women between the ages of 20 and 69, and 40% of women over the age of 70 are not getting the recommended dietary allowance of protein. Soy foods provide high-quality protein and are low in saturated fat. Messina also notes that in the 1900’s, American’s diets were made up of approximately 70% plant proteins and 30% animal protein. Today, the ratio is around 50:50. Since soybeans are 38% protein, they make an excellent natural dietary choice for women who want to increase quality protein in their diet especially plant proteins.

Soy is the protein vegetarians choose to include in their diet most often. Vegetarian cookbooks contain scores of soy recipes and many soy –based diets are gaining in popularity as a way to improve health and promote longevity.

Soy isoflavones — whole beans are best

Isoflavones are one portion of a group of chemical compounds, called phytochemicals. These compounds are found in all plants and legumes, including beans, green leafy vegetables, yellow and orange vegetables and whole grains. A diet rich in a variety of phyto- (Greek for plant) chemicals is the foundation of a healthy and balanced diet.

In order to get the most benefit from soy, look for labels that read “Non-GMO.” It is a possibility that the chemicals/pesticides used on many soy plants or in the fields may be stored up in our bodies and cause problems. We are also seeing that genetically modified products may not be as innocuous as once thought. This concern is not unique to soy, Soy is a cash crop in the United States, and some varieties have been genetically modified to increase yields. Scientific data offers conflicting reports on the long-term effects of eating genetically-modified foods. Organic foods have not been genetically modified, and most people believe organic foods to be much safer for consumption than any foods that have been modified.

Even though isoflavones are thought to be controversial by some, we feel that the health benefits of these compounds outweigh any risk they pose, unless you suffer from thyroid disorder. This is further explained and more detail offered in our articles related to soy for menopausal, as well as in the update on the soy controversy.

Soy: how much am I already getting, how much should I add?

Attempting to calculate serving sizes, grams of proteins, and milligrams of isoflavones may become overwhelming. It can be fairly easy however if you remember a simple formula: in order to obtain the cardiac benefits of soy, you need two to four servings daily to get the recommended 25 grams of protein. One serving (see chart) is equal to one cup of soymilk, one half-cup of tofu or one-quarter cup of soy nuts.

While some people are busy wondering if they should add soy to their diets, other people are curious about how much is already hiding in our food. It’s true that in the United States, which is the world’s second-largest grower of soybeans, soy is showing up everywhere. However, in spite of its availability, most of us in the Western world still eat comparatively small portions of soy: only 0.15 to 3.0 mg/day of isoflavones, according to some research.

Soy oil is also being over utilized in various food items such as snack foods, fast food and salad dressings. Unfortunately this is probably not such a good thing. Even though soy oil is polyunsaturated it has more of the kinds of fatty acids that most people get an excess of. This can be a problem as , the excessive intake of these fatty acids favors inflammatory reactions in our cells (find out more about this in the truth about fat and cholesterol and our omega-3 articles).

Despite the many delectable soy foods sources available (over 1,600 soy food items are accessible in the United States alone), it may not be easy to get the 60-80 mg per day of soy isoflavones,(the amount considered necessary to treat for hormonal imbalance), from just your diet. Or you may not especially enjoy the taste or the texture of soy. If this describes your situation, you might want to check out other sources of soy like supplements and functional foods. At Women to Women, we’ve found soy shakes made with whole, non-GMO soybeans to be very useful. Discuss your options with your health care provider and ask for his recommendations. Soy shakes and protein bars taste great and they can be an alternative way to supplement your intake of soy isoflavone. All of this is true only if you do not have a soy intolerance, which we see often in the practice.

The key is always balance

As long as people enjoy eating soy products, the key, is balance. While it is possible that there are those who gain substantial health benefits from soy, there may be others who do not. We should all understand however, that a healthy, varied and balanced diet serves us all best.

The best possible suggestion is always to listen to what your body is telling you. If you tolerate soy products without adverse effects, chances are you are able to metabolize them effectively. If you have a negative reaction to soy, you can try digestive enzymes with a probiotic supplement. You could also try a detox diet. Or you can simply avoid using soy. When you buy soy products, be sure to read the labels. Make sure you get a nutritious, healthy diet, whether or not it includes soy. Balance your diet with an abundance of fresh whole foods, especially fruits and vegetables, a minimal amount of processed foods, and healthy fats (see our Nutritional and Lifestyle Guidelines.Try to avoid thinking of soy as an additive or as a magic potion. Soy is a unique, excellent food and it can be useful as a supplement also. Talk to your medical provider and then make the decision that’s best for you.

 

Menstrual Cramps Or Dysmenorrhea

womentowomen on December 8, 2013

by Marcelle Pick, OB/GYN NP

Dysmenorrhea, the medical term for menstrual cramps, affects almost half of women everywhere, causing painful cramping before and during their periods. Some women are even bedridden by their discomfort, often having to miss work or school and cancel other plans. Reports vary on methods of data collection, but there’s no question the distress women suffer with menstrual cramps is a widespread problem.

This causes us to question why so many health practitioners in the past have regarded menstrual discomfort as an unjustified complaint. As the medical community has learned more about the cause of premenstrual syndrome, we now know that dysmenorrhea exists as a real condition. There are true medical reasons for your monthly painful symptoms. And seriously, why should women have this discomfort on a monthly basis when there are things that can be done to help?

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We have hope for you. If you are in otherwise good health, the cramps you experience with your monthly period can be eliminated by giving your body the support it needs. Even severe cases of dysmenorrhea that are unable to be completely eliminated can be greatly helped with a few simple changes in lifestyle and improved nutritional approaches that promote your hormonal balance.

Primary dysmenorrhea is cramping in the lower abdominal area that can last for several days during your period. Because of excess prostaglandin levels dysmenorrhea can be accompanied by a number of uncomfortable symptoms that include bloating, nausea, vomiting, headache, backaches, pain that radiates down the thighs, or diarrhea. Prostaglandins are hormone–like fatty acids that send pain signals to the brain. The additional prostaglandins cause tiny contractions of the uterine wall and the gastrointestinal. They are very affected by our dietary intake.

In younger women, it is common to experience irregular menstrual cramps and they often resolve with age. After their first pregnancy, many women report their menstrual cramping lessens greatly as well.

You should be aware that occasionally a benign ovarian cyst or ectopic pregnancy can cause severe pelvic pain nearing the end of the cycle. We suggest that you visit with your healthcare provider if you’re experiencing tenderness and sharp pain that will not subside during the onset of one’s menstrual flow.

Secondary dysmenorrhea is described as a type of congested, dull pain that begins as much as two weeks before the start of your monthly flow. Women in their 30’s and 40’s are more likely to experience this kind of cramping and these symptoms usually do not subside with age. It could be coupled with bloating, an increase in weight, breast tenderness, headaches, lower back discomfort, and irritability. Warning signs could end up being amplified by changing estrogen levels, which in turn trigger fluid retention. Chinese medical doctors look at this sort of painful period as a kind of blood stasis, in which important energy (chi) is unable to flow freely through the lower abdominal area. Root causes of this kind of discomfort apart from hormonal imbalance may consist of:

  • Endometriosis (ectopic endometrial tissue)
  • Adenomyosis (endometrial tissue within uterine wall)
  • Pelvic infection or uterine infection
  • Intrauterine device (IUD)
  • Cervical stenosis (stricture of the internal cervical os, the opening to the uterus)
  • Congenital uterine or vaginal abnormalities
  • Fibroids
  • Ectopic pregnancy
  • Ovarian cysts
  • Ovarian torsion

An unhealthy weight, cigarette smoking, chronic pelvic infections and/or STD’s are typical risk factors for secondary dysmenorrhea. Please schedule a check-up with your healthcare practitioner if you have persistent menstrual cramping that remains the same or worsens or if your symptoms last for several months.

If you are free from the conditions listed above, we may be able to help you find natural relief from your monthly menstrual cramps. At Women to Women we have experienced excellent results in treating women suffering with dysmenorrhea with nutritional supplements, exercise programs and occasionally, progesterone support. Once hormonal support is restored, periodic cramps generally subside and often completely resolve.

Take our Hormone Health Assessment to check your symptoms and get started. Women to Women also offers high-quality, pharmaceutical grade supplements to enhance your health.