Iodine and The Thyroid — Worth A Second Glance

womentowomen on November 20, 2013

by Marcelle Pick, OB/GYN NP

Iodine deficiency — how common is it?
From intake to uptake — why are some of us so iodine deficient?
How’s your iodine? — iodine testing and treatment

We’ve all heard of iodine, of course. But if we were asked to define iodine’s role in human health, we might either think of it as merely an added ingredient to table salt (though many people don’t know why exactly), or as the bright orange tincture used by our parents to disinfect our childhood cuts and scrapes. But iodine is a critical element for healthy thyroid hormone production, and if it’s not available in the tiny amounts needed by the thyroid gland, there can be wide-ranging physical consequences.

These days, I have a growing concern that many of us may not be getting enough of this essential element. But although evidence of widespread iodine deficiency seems clear to me, the idea is still controversial in conventional medical circles. In a recent Newsweek article, an eminent medical school professor pronounced iodine deficiency to be rare in women in the US. Many of the magazine’s readers might not even give the subject a second thought. Yet compelling data were recently reported by the Centers for Disease Control suggesting that some 2.2 million women nationwide could have low iodine.

To learn more about the roles iodine, selenium, and other key nutrients play in thyroid function, see our article, “Simple Dietary Changes That Can Help Your Thyroid Naturally.”

As we learn more about how iodine functions in the body, research is revealing connections between diet, environment, and the rise of thyroid, breast, and immune health problems in women. Maybe you’ve had recent thyroid testing that came back borderline, or you’ve been diagnosed with hypothyroidism (inadequate production of thyroid hormones), and you’re already on thyroid medication. Perhaps you have fibrocystic breast condition and avoid salt by choice or due to high blood pressure. If so, it’s possible you could benefit from more insight into your iodine status and available testing and treatment options.

Iodine deficiency — how common is it?

As a practitioner of functional medicine, I am more and more intrigued by iodine. How widespread is iodine deficiency? Why is it downplayed, and even overlooked here in the US? When iodine deficiency was first recognized as a public concern in the 1920’s, iodine was subsequently added first to flour, then to salt, and the problem was considered solved.

In the US, it’s estimated that one in seven women suffers from iodine deficiency.

-Caldwell, K., et al. 2005; Hollowell, J., et al. 1998

But many people don’t know that flour isn’t iodized anymore, and iodization of salt is still voluntary in the US — only one-fifth of our salt is actually iodized. In reading further, I’ve found that we’re trending back toward iodine deficiency. Iodine intake has declined 50% in North America in the past 30–40 years, and this is consistent with what I’m seeing in my patients.

As recently as 2004, the New England Journal of Medicine defined our iodine status here in the US as “marginal,” based on data acquired from the International Council for the Control of Iodine Deficiency Disorder and the World Health Organization (WHO). More specifically, the WHO data suggest the greater risk in the US is not iodine deficiency per se, but iodine-induced hyperthyroidism (overproduction of thyroid hormones) or iodine-induced hypothyroidism. Interestingly, both these problems can occur when people who are already iodine-deficient are given too much iodine, too quickly. I believe practitioners need to proceed more cautiously when prescribing iodine supplements, slowly bringing levels up rather than overloading right up front. (More on our treatment protocol for iodine deficiency below). But the WHO perspective seems to confirm that iodine deficiency does exist here in the US.

For more information about hypothyroidism, read our numerous articles on the topic in our Thyroid Health Category in our Health Library.

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Our Founder and Author’s Books

womentowomen on November 20, 2013

28 Days To Boost Your Metabolism And Lose Weight For Good

Is your weight gain making you miserable? Have you noticed that you’re packing on pounds in unpleasant places? Or is the scale – and the way you feel about yourself – just stuck, no matter how much you diet or exercise? If you’ve struggled without success to lose weight and keep it off, there’s always a reason, and – surprise! – it probably has little to do with how hard you try or how many calories you count.

Learn More

The Good, The Bad And The Ugly About PMS, Perimenopause And All The Crazy Things That Occur With Hormone Imbalance

A simple, clear, accessible 28-day plan to help you balance your hormones and feel like yourself again from a health-care professional who has helped hundreds of women – including herself – do just that!

Learn More

Our Proven 30-Day Program For Overcoming Adrenal Fatigue And Feeling Fantastic

Do you wake up every morning feeling tired, overwhelmed, and stressed? Are you constantly reaching for coffee, soda, or some other promise of energy just to keep yourself going? Do you struggle through the day – sluggish, irritable, forgetful, depressed, and craving sweets – only to have trouble sleeping at night?

Learn More

Is It Me Or My Adrenals? – About The Book

womentowomen on November 20, 2013

Our Proven 30-Day Program For Overcoming Adrenal Fatigue And Feeling Fantastic

If you answered yes to any or all of these questions, you’re not alone. In fact, hundreds of thousands of women are fighting these same feelings as they strive to live the lives they want.

Is It Me or My Adrenals? – formerly titled Are You Tired and Wired? – gives you the knowledge and tools to overcome this epidemic of fatigue. In it, Marcelle Pick uncovers the root cause of these symptoms: adrenal dysfunction. In our modern lives, the adrenal glands, which provide the fight-or-flight hormones in response to stress, are triggered much more often than they should be. Everything from challenges at home and at work, to environmental toxins, to chronic health problems cause the adrenal glands to produce a constant flood of stress hormones that can ultimately lead to multiple health issues, especially severe fatigue.

The good news is that through diet, lifestyle adjustments, and reprogramming of stressful emotional patterns, this can all be fixed!

Pick helps you identify which of the three adrenal profiles you fit – Racehorse, Workhorse, or Flatliner – and then lays out an easy-to-follow, scientifically based program to help you restore adrenal balance, gear up your metabolism, and regain your natural energy to live a happier and less-stressed life.

Buy the paperback on Hay House
Buy the eBook on Amazon
Buy the eBook on iTunes store

Is It Me Or My Hormones? – About The Book

womentowomen on November 20, 2013

The good, the bad and the ugly about PMS, perimenopause and all the crazy things that occur with hormone imbalance

Hormonal issues were a big part of my life, starting in my teens and especially in my early 20s. When I became a nurse practitioner, I discovered that I was far from alone. Many of my patients struggled with difficult PMS, painful periods, or challenging perimenopause, the transition into menopause that typically begins in the early or mid-40’s and continues until menopause finally takes over. My patients were also dealing with endometriosis, fibroids, polycystic ovarian syndrome (PCOS), and premature ovarian failure (POF) and other fertility issues. Many women felt, as I did, that hormonal issues were playing far too big a role in their lives. We all longed for a straightforward solution. As I got more information about functional medicine, I realized that many if not all of the symptoms could be resolved. I found that as I made dietary and lifestyle changes I became symptom free.

My own experience brought home the huge role hormones play in how we feel. Now when I see women every day with concerns, questions, and frustrations about their hormones, I really get it. And when I hear women tell me that their hormonal struggles shape their lives-that they plan their months around mood swings and cramps, or that perimenopause is making them feel old before their time – I get that, too.

Order it now at Hay House

Why Doctors Are Often Opposed To Nutritional Supplements

womentowomen on November 19, 2013

By Marcelle Pick, OB/GYN NP

Despite the fact that the Journal of the American Medical Association published a review advocating that every adult take a multivitamin to reduce the risk of disease, we often hear of doctors who oppose nutritional supplements. This leads many people to wonder – are dietary supplements safe?

Frankly, we understand many of the reasons doctors are concerned about nutritional supplements, and we think you should too before you start taking a multivitamin. So here are some of the common reasons doctors hesitate to encourage nutritional supplements:

Doctors worry that patients will use nutritional supplements as a substitute for regular medical care, a good diet, or other important health habits. These are real concerns. Everyone should see a practitioner regularly. And no pill can replace a good diet and exercise. Nutritional supplements are a good health habit, too — just don’t use them as a crutch for bad health habits.

Doctors have heard scare stories about extreme dosages, drug interactions and poor quality. These are real concerns too. Some patients are cavalier about extreme dosages. Several herbs have interactions with drugs that aren’t yet well understood. Toxins and even drugs have been found in supplements from second-rate manufacturers. But these problems are easily dealt with. Make sure you are taking a pharmaceutical–grade multivitamin, and tell your healthcare providers about any supplements you are taking.

Doctors are skeptical about claims made for nutritional supplements. There are ridiculous claims made for bogus products such as weight loss pills. And some patients think herbs or other supplements can cure serious diseases like cancer. It’s just too bad doctors associate legitimate products with these bad practices.

Most medical schools fail in nutritional instruction. Doctors tend to underestimate the importance of nutrition in general. No wonder: most doctors receive a mere few hours’ nutritional training in med school, and lack adequate time to keep up on the latest research. Their practice is based on disease screening, not prevention, with an emphasis on drug therapies, not nutrition. Such doctors naturally think that nutritional supplements have little therapeutic value. This is changing, especially among recent medical school graduates. Even oncologists at leading cancer institutes are advocating vitamin supplements for their patients. But it will take years before nutrition is a part of most doctors’ methods.

For more information, click here to read our article, “Health and Vitamins – Who Should Take Dietary Supplements and Why?” and our many informative articles in our Nutrition section.

Women to Women offers high-quality, pharmaceutical grade vitamins and supplements to enhance your health. Click here to check out our store.

Healthy Weight – The Core Balance Diet

womentowomen on November 19, 2013

By Marcelle Pick, OB/GYN NP

How core imbalances can affect your weight and health

What’s behind The Core Balance Diet?
Extra! Extra! Healthcare practitioner heals herself
Fad diets are popular — but they don’t work
Toxic weight and stress
Determining your individual imbalance
Clearing the path to Core Balance

Oh, the things women do to lose weight: bizarre foods, starvation diets, excessive exercise — you name it, they’ve tried it. But as a healthcare provider — and a woman who’s struggled with weight issues — I know that achieving your optimal weight is only possible when you are healthy, and your internal systems have a consistent supply of everything they need to function well. In my new book, The Core Balance Diet, I give you the blueprint for doing both.

Core balance occurs when your body, mind, and all your internal systems are able to engage in their natural, nonstop “conversation”, with information zipping efficiently back and forth between them.

When you experience core balance, your body’s communication system runs like a top and responds as necessary to input — directing your organ systems to process food, fight infection, tend to emotional needs, and perform thousands of other tasks constantly throughout your day, usually without you even noticing.

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Core Balance is beautiful

“Core Balance is an ideal state that occurs when your biochemistry and metabolism are functioning well, and your core physiology and emotional health are balanced. Your body easily maintains a natural, optimal weight and you feel energized, clear, and fit. Life is good, you look great, and you’re on top of the world”.

But when you have an imbalance, your glorious internal conversation is disrupted and information needed to maintain healthy function can’t get through. If the imbalance is long-term, your physical health will eventually be affected, perhaps seriously. Your appearance will reflect your imbalance and one of the most visible consequences is toxic weight — that extra weight your body holds on to, no matter what you do.

But believe it or not, this stubborn, toxic weight — which drives so many of us crazy — has a bright side. It’s a wake-up call, a signal from your body that you have an internal imbalance that needs attention, sooner rather than later. Happily, when you restore balance, often just by tweaking your diet and lifestyle and maintaining those changes, the weight will come off for good.

What’s behind The Core Balance Diet?

So how do you develop an internal imbalance? It happens when the physical, emotional, and spiritual demands being made on you outweigh the support provided. These types of imbalance can be responsible for any number of physical symptoms and conditions, including excess weight.

Over the years, I’ve been able to identify clear patterns in patients with health and weight problems, both of which are common during menopause. At first, these issues may seem unconnected, but as I’ve dug deeper, I’ve learned that both health and weight problems can often be traced directly to core imbalances within one or more of the body’s systems.

Using scientific and experiential research, I’ve decoded the main core imbalances affecting many of my patients. But the really good news is that I’ve used the principles of functional medicine to create and prescribe effective solutions to reverse these imbalances.

And remarkably, when your imbalance is resolved and physical health is restored, that stubborn toxic weight begins to disappear, almost as an afterthought. It’s the most welcome “side effect” you’ll ever have.

Extra! Extra! Healthcare practitioner heals herself

I actually have the inside scoop on regaining core balance for health and weight loss because I’ve fought my own battle of the bulge over the years. The truth is I used to be as much as 40 pounds overweight, a number that has fluctuated over the years. Until relatively recently, I never felt I was living at my optimal healthy weight.

Even as I practiced functional medicine and embarked on the exciting and rewarding career of co-founding the Women to Women Clinic, I just couldn’t lose what amounted to about 15 pounds of toxic weight. Then a series of events — both physical and emotional — pushed me to my personal tipping point, and I gained even more weight, a frightening extra 20 pounds!

As you can read in my book, my story has a happy ending. I began to eat the right foods, and removed the ones that didn’t agree with my biochemistry. I had all the mercury-laden fillings removed from my teeth, and learned how to guard against toxins. I continued to exercise regularly, as I have my entire life, and I began to feel healthier and more in balance. But for me, the last key to losing my toxic weight was being able to face my deeply entrenched emotional issues.

When I could finally do the necessary work to heal emotionally, I was able to integrate all the aspects of myself. At last, I felt “whole” and balanced on a core level. Not only was this an incredible relief, but lo and behold — that toxic weight practically melted away, and has never come back.

I understand the urgent battle that many of my patients — and readers — have been waging with toxic weight. The true motivation for The Core Balance Diet is to provide you with practical tools to help you heal your body so you can lose your toxic weight once and for all.

Fad diets are popular — but they don’t work

If you’re reading this, you probably have intimate knowledge of popular weight loss methods andfad diets, and you know they usually aren’t effective. Most trendy diets focus on calorie-counting and rigid portion sizes. Fad diets also commonly recommend a rate of weight loss that is simply too fast to be healthy, so the results are nearly impossible to maintain.

Fad diets don’t work because they…

Focus on weight loss instead of physical health.
Rely on deprivation, calorie-counting, and portion restriction.
Don’t stress the importance of physical activity.
Promote an unhealthy rate of weight loss.
Overlook emotional wellness.
Fail to recommend setting up a support network.

These diets have vague or nonexistent guidelines for exercise, but they also ignore the importance of the dieter’s emotional history. This is particularly troublesome because both a woman’s toxic weight and her eating patterns can often be deeply connected to her subconscious feelings and emotional past.

If you are a regular, compulsive overeater, of course you will gain weight, but the real question is, why do you eat too much? The root cause is sometimes physiological, such as a food allergy or a serotonin deficiency. But it may also have something to do with your emotional history. I know from years of clinical and personal experience that emotional healing is necessary for healthy weight management. But it’s usually just one of a number of contributing factors, the most important of which will be restoring your core balance.

One well-proven feature of successful weight loss is that it occurs more consistently when a woman has the social support she needs to lose weight and keep it off over the long haul. In fact, losing toxic weight may be downright impossible without emotional support. Even with ample instruction, you may still need someone to help you through the rough spots.

But I think most fad diets fail because they don’t acknowledge that your extra weight accumulated for a reason — and it isn’t that you eat too much. Again, the real cause of your toxic weight may be a physical imbalance that must be resolved. Once you reverse a core imbalance and restore health, your body will finally be able to let go of the extra pounds.

Toxic weight and stress

At Women to Women, we always talk to our patients about stress — how to figure out where it’s coming from, and how to manage it. Obviously, stress affects your emotional health, but does it have anything to do with gaining and retaining weight? You bet!

When you experience stress — emotional or physical — it triggers a series of physiological reactions generated by the release of powerful chemicals, particularly cortisol, which send your body into survival mode. A surge of cortisol puts you on alert and tells your body to prepare for the emergency, in part by slowing your digestion.

But your body can’t tell the difference between real threats and other types of high level stress, so it responds to both the same way. When you stay stressed for long periods, you learn to live that way. Your body stays chronically stressed, never returning to “normal,” and you stockpile food calories as fat. To make matters worse, women often eat more during stressful times, compounding any weight problem.

Clearly, chronic stress is one of the major root causes of core imbalances. Other contributors are poor nutrition, lack of exercise, environmental toxins, emotional burdens, hormone shifts, inadequate detoxification, altered neurotransmitter status, GI issues, inflammation, and impaired adrenal function. All of these stressors interfere with your internal conversation, which causes your organ systems to go haywire. This is why healing your imbalance should be the first item on your weight-loss agenda.

Is your toxic weight a result of one of these imbalances?

Digestive
A digestive imbalance can lead directly to system-wide inflammation which in turn may be connected to insulin resistance and additional accumulation of fat tissue. Inflammation can also affect your ability to absorb nutrients properly. Digestive imbalance often plays a role in food sensitivities which can cause us to crave those same foods, and eat them in excess.

Hormonal
The food we eat influences our hormonal balance on a daily basis and can create a cyclical pattern that generates toxic weight gain. Chronic stress raises levels of key hormones, like insulin and cortisol, and can cause you to eat more and gain weight. Sometimes, even the fat on your body can alter your hormonal balance and trigger additional weight gain — a true vicious cycle which is common during perimenopause and menopause.

Adrenal
Your adrenal glands are responsible for the fight-or-flight response at the center of your survival instinct. Today, this response is activated far too often, which interferes with your body’s never-ending quest to be in balance. If high level stress continues unabated, cortisol begins to take control of your body’s physical actions which can lead to both overeating, abdominal weight gain, and more. A full 85% of the women I see in my practice suffer from adrenal fatigue by the time they reach menopause, which leads to low energy periods when women often make unhealthy food choices.

Neurotransmitter
To put it simply, your individual brain chemistry can cause you to gain weight and prevent you from losing it. Neurotransmitters carry information that influences feelings — including mood, hunger, satiety (feeling satisfied), and cravings. A neurotransmitter imbalance is another condition that can cause you to crave certain foods, and eat them obsessively.

Inflammation
Inflammation is necessary as a short-term immune response for healing wounds and countering infection. It’s an essential, sometimes life-saving function of your immune system. But over-activation of this healing response — often triggered by a pro-inflammatory diet, among other things — leads to chronic inflammation. Chronic inflammation has become a major source of internal imbalance. Inflammatory imbalance can cause obesity and toxic weight gain because it can be traced directly to insulin resistance, diabetes, and metabolic syndrome.

Detoxification
A detoxification imbalance often leads to accumulation of toxins in fat tissue, which makes losing weight especially problematic. Poor nutrition and unhealthy lifestyle just magnify the problem. Some toxins can even act like hormones in the body and cause additional fat build-up.

Determining your individual imbalance

Every woman is different — physically, emotionally, intellectually, and spiritually. And we each have our own “balancing act”, a singular combination of factors influencing core health. The balls you have in the air might include your work, running a household, raising children, caring for your parents, and community service. But each woman has a combination of physical factors to balance as well, ranging from genetics and metabolism, to environmental exposure and health history — infections, surgeries, allergies, anxiety disorders, heart disease, cancer, autoimmune disorders — and all the symptoms those conditions create.

In The Core Balance Diet, I include a detailed questionnaire to help you diagram your own personal juggling act. This can help you identify which of the six major metabolic imbalances is shaping your physical health and causing you to retain toxic weight. And just so you know, it isn’t uncommon for women to suffer from more than one imbalance.

Clearing the path to Core Balance

The five T’s of Core Balance:

Tune in to your body.
Turn down stress.
Treat yourself to healthy foods.
Tune out negativity.
Take care of mind, body, and spirit.

The brilliant silver lining behind the cloud of imbalance is that you can use it as an early warning to get on the road to regaining core balance and dropping that toxic weight. You will also be losing inches — and your shape and silhouette will reflect that beautifully!

Your first steps will be to identify the core imbalances most affecting your health, make imbalance-specific adjustments to your diet and lifestyle, and add in high-quality nutritional supplementation targeted for your imbalance.

When it comes to healing core imbalances, one size does not fit all. The Core Balance Diet offers detailed prescriptions for each imbalance, with careful instructions and guidelines for the stages of the rebalancing process. In the book, you’ll find separate food protocols for each imbalance that include easy-to-follow, day-by-day meal plans.

To help you prepare, you can start by considering these general recommendations:

Eat natural, whole foods. Stay away from refined sugars and carbs, processed foods, additives and engineered ingredients (high-fructose corn syrup, trans fats). The book has customized eating plans for each imbalance that are easy to follow and implement.
Hydrate your body every day. Drink pure, filtered water, bottled mineral water or herbal teas.
De-stress! This is a multi-step process, accomplished a little at a time. You need to be able to recognize stress before you can reduce or eliminate it. Taking a thoughtful inventory of the stressors in your life is the best place to start. Read our philosophy on making changes in your life for further guidance.
Attend to your emotional needs. Sometimes this is the most complicated aspect of regaining core balance and health. There are suggestions in the book to help you begin what can be the most rewarding “work” you will ever do.
Cultivate spiritual health and practice self-care. Learning more about how to identify and meet your spiritual needs can have dramatic effects on your health. Check the book for ideas about creating and practicing a self-care ritual.
Get up and move. Start with any type of physical activity and advance toward a varied exercise routine that works for you. Exercising (even just a little) a few times a week is essential for a successful weight-loss program.
Sleep more. Inadequate sleep is correlated with obesity and other weight issues. Plus, your body performs its most important repair and rebuilding tasks during nighttime sleep. You may have to go to bed earlier, but the extra rest can improve your core health exponentially.

The gift of Core Balance

As you consider regaining the balance in your life, remember that you can’t take care of others, do your job — or lose weight — until your body gets the support it needs to meet the demands being made of it.

Many of my patients develop core imbalances without any idea of how they happened. But with a little detective work, you can use The Core Balance Diet to help you find the pieces to the puzzle of your individual imbalance. From there, a few key changes can help tip the balance back in your favor, so you feel better, look better, and can finally lose that toxic weight.

For me, staying in balance is a matter of checking in with my “four corners” — physically, emotionally, intellectually, and spiritually. And I practice my self-care ritual regularly, no matter what. Remember, there is only one you and it’s important to celebrate your individuality every day— no matter what you weigh.

Insulin Resistance – The Signs and Symptoms

womentowomen on November 19, 2013

By Marcelle Pick, OB-GYN NP

You are at the highest risk for developing this condition if you have a family history of type 2 diabetes or if you have suffered from gestational diabetes, hypertension, or are seriously overweight. See our articles on diabetes risk factors for more specifics.

Apple-shaped women, or those who tend to gain most of their weight around their abdomen, show less tolerance for insulin. To assess your risk, measure yourself around the smallest part of your waist (don’t hold your stomach in!) and the biggest part of your hips. Divide the waist measurement by the hip measurement. A ratio bigger than 0.8 for women (or 1.0 for men) indicates that your abdomen is obese and you are at risk for developing insulin resistance.

Women with dyslipidemia, especially those with low HDL levels and high triglycerides, may also be resistant. I tend to look at the ratio of HDL to triglycerides. If I can divide the triglyceride count by the HDL count and get 3.0 or higher, I immediately suspect insulin resistance. A skin change called acanthosis nigricans, which is warty-like darkened patches of skin at the neck and armpits, indicates insulin resistance in over 90% of the women who experience it.

The good news is that insulin and glucose levels are very easily influenced by changes in lifestyle, exercise, and diet. If you are diagnosed with insulin resistance, there is a lot you can do to reverse its course.

Bringing insulin into check

At Women to Women, we understand that insulin resistance may be an underlying factor in a range of health problems. Before designing a plan for a patient, we always take into consideration this possibility. Our goal at Women to Women is to enable all our patients to feel energetic, lively, attractive, passionate, and excited for years to come – as opposed to feeling lethargic, irritable, and hormonally imbalanced. Thankfully, we have discovered that a lot can be done to decrease a patient’s insulin sensitivity and bring their hormones back into natural balance.

When we evaluate a patient for insulin resistance, we recommend a blood test for glucose and insulin levels after fasting for 12 hours and then again two hours after a meal (preferably a high-carbohydrate meal). On the fasting tests, we hope to see glucose levels of no more than 75–80 and insulin of less than 14; higher levels indicate a risk of insulin resistance. Increased triglycerides make me suspicious too. We also take into account the patient’s lifestyle, diet and exercise patterns, as well as stress factors. All of this can be changed.

Talk to your primary care provider about being tested if you feel you are at risk. Many younger practitioners are familiar with the concept of insulin resistance, as it is now being taught in medical school. Unfortunately, old-school physicians may still be unaware of its importance.

How Insulin Resistance Develops

womentowomen on November 19, 2013

By Marcelle Pick, OB/GYN NP

Our metabolism evolved eons ago, when our diet included fewer (and more complex) carbohydrates. Today most calories in an average diet come in the form of carbohydrates, and most of those are simple carbohydrates — sugars that quickly enter the bloodstream. The body has to release high levels of insulin to keep the level of glucose in the bloodstream from spiraling out of control. But in time the cells quit responding to this signal. At this point the body is “insulin resistant.”

One immediate consequence is that the body is forced to release even more insulin. Letting blood sugar get too high is simply not acceptable. The resulting excess of insulin in the bloodstream is called hyperinsulinemia. But the body wasn’t designed for these prolonged high levels of insulin, which disrupt cellular metabolism and spread inflammation. Diabetes occurs when the body is unable to keep blood glucose under control. But as we have noted, that is only the most obvious disease caused by insulin resistance. There are many negative health effects before full-blown diabetes.

Syndrome X and menopause

Of special concern to women is how insulin resistance disrupts fat metabolism. When the cells won’t absorb the extra glucose, the liver has to convert it into fat. Fat cells are loaded with glucose receptors, so this is a vicious cycle. Ironically, while the insulin-resistant woman is gaining weight, her cells are actually “starved” for glucose, so she feels exhausted and tends to eat carbohydrate-heavy foods in search of energy.

These extra fat cells are also little estrogen factories. So weight gain contributes to the estrogen dominance that causes so many symptoms during the early stages of perimenopause.

Symptoms relating to syndrome X usually predate the onset of menopause, but most women do not complain of them until then. A woman’s health can deteriorate rapidly during menopause with the decrease of estrogen levels in the body. And digestive issues that were once merely a hassle become an affliction when the body’s natural defenses against inflammation (estrogen being one) are depleted.

In addition, women approaching menopause are particularly prone to becoming insulin resistant due to metabolic changes related to fluctuations in adrenal and thyroid secretions. In fact, the decrease of certain hormones, like estradiol, may trigger a resistance to insulin in patients who never experienced it before. Certain blood pressure medications can mask symptoms without treating the problem. Frequently, women unwittingly make their symptoms worse by trying to lose weight with low-fat, high-carbohydrate diets.

How do I know if I’m insulin resistant?

The unfortunate truth is that anyone can become insulin resistant — even if she is thin because we have access to a lot of refined carbohydrates (white bread, sugar, bagels, pasta, potatoes, sodas, processed foods with added fructose, etc.) In fact, most of us are likely to be somewhat resistant to insulin – it is just a matter of degree. The more processed and refined food that we eat, the more insulin we require to metabolize it. The more insulin in our blood, the less responsive our cells become. As we age, this continual exposure wears out our tolerance for refined carbohydrates and reduces our sensitivity to insulin.

If you suffer from high cholesterol, high triglycerides, or hypertension, you should get checked for insulin resistance, regardless of your weight or age. If you have high blood pressure, it is likely that you are also suffering from insulin resistance, and high blood pressure medication will not cure insulin resistance.

The Pillars Of Diabetes Control

womentowomen on November 19, 2013

By Marcelle Pick, OB-GYN NP

How many times have you reached for a cookie or a bag of potato chips after a bad day? We’ve all been there, and I’m the first to admit that these foods feel good in the short-term. But preventing diabetes means focusing on long-term solutions — nutrition, exercise, balance!

In fact, a recent study done on over 3000 people at risk for diabetes showed that lifestyle interventions, such as weight loss and regular exercise, reduced the incidence of type 2 diabetes by 58%, whereas Metformin, a common antidiabetic drug, reduced it by only 31%. Additionally, whole foods rich in phytonutrients — such as those emphasized in the Mediterranean diet — have been shown to be favorable in lowering markers of insulin resistance. What all this research tells us is something that makes complete sense — that preventing diabetes through a holistic lifestyle approach is far easier and more effective in the long-term than any drug solution could ever be. And the first cornerstone of diabetes control is diet.

Nutrition — our food talks to our genes. If I had to pick the gold star in preventing diabetes, it would be food. What you eat can prevent and even control type 2 diabetes. At Women to Women we view food as complex information that our cells have been primed through the ages to receive. In other words, good food talks to your genes to keep things going just the way Mother Nature intended. Rising rates of type 2 diabetes should come as no surprise when you consider that the ways in which we grow and process our food have changed so drastically in just one or two generations, while our human genetic constitution hasn’t changed much in 40,000 years!

This might seem like a novel idea, but there is nothing revolutionary about the concept of balanced meals. This means that each time you sit down to eat, you should include protein, complex carbohydrates, healthy fats, and as many non-starchy fruits and vegetables as you can. This will help to keep your insulin levels in balance and make it less likely for you to store too much energy in the form of fat. And with insulin in good control, you will have better balance throughout your endocrine system, including other hormones like cortisol, estrogen and progesterone.

Insulin control is strongly affected by the glycemic index of the foods you eat. The glycemic index of a food is a measure for how quickly insulin rises in response to the amount of glucose entering your blood stream after you eat it. Foods high in protein tend to have a lower glycemic index than carbohydrates. Simple carbs, like white flour and sugar, have a higher glycemic index than complex carbs like whole grains and fresh fruits. Simple carbs can overload your insulin receptors and make insulin resistance more likely to develop. To prevent the quick sugar surge from high glycemic foods, balance each snack and meal with all four basic groups.

But it’s about more than just the ratio of protein to carbohydrate to fat in your diet. The plant kingdom has been quietly evolving alongside us humans for many years, and the micronutrients available in fresh, richly colored, organically grown fruits and vegetables are instrumental in preventing the diseases of modern life — including type 2 diabetes. So choose the best information your food dollar can buy, and remember that all four food groups play key roles in your digestion, metabolism and hormonal balance.

Exercise — move your body. Getting regular exercise is another excellent way to help prevent yourself from developing type 2 diabetes. Not only does it keep your weight down, but it lowers blood sugar, helps you utilize insulin more efficiently, keeps your cholesterol levels balanced, and improves circulation, thereby keeping your heart and blood vessels healthy and strong. Exercise also supports nervous system health and releases positive endorphins to boost your mood! The benefits are endless.

While cardiovascular exercise is specifically beneficial to your heart, toning muscle — through weight training, yoga, Pilates or swimming, for example — is also a great way to increase the activity of your insulin receptors and prevent insulin resistance. This is because of all the tissues in your body, your muscles use the most glucose, so they are most important for keeping your blood glucose levels steady. And once you learn how good it feels to move your body, you’ll be looking forward to fitting exercise into your schedule as much as possible!

Blood glucose — better regulation through diet and lifestyle. Of course blood glucose is important as well — it’s what we’ve been talking about getting into balance. For women who already have diabetes, it’s important to check blood glucose daily. But for those concerned with preventing diabetes, I recommend getting it checked a couple times a year to see if it’s trending upward.

As I mentioned above, a normal fasting blood glucose should be well under 100 mg/dL, but it is much more important to watch the trend. Once you go above 100 mg/dL, you are considered prediabetic, which usually means that your blood glucose levels are somewhere between 100 and 126 mg/dL — higher than normal, but not high enough to be considered diabetic. You are insulin resistant at this point and much more likely to develop type 2 diabetes and other factors associated with metabolic syndrome — unless you step in.

Rather than focus on the numbers, know that you have much more control over blood glucose by eating well and getting more exercise. Astoundingly, 65% of diabetes patients die from heart disease or stroke, which tells us that treatment should be about more than just glucose control. Making lifestyle changes allows you to reap huge benefits in blood sugar control right away.

Emotions — feed your soul! You can’t go wrong with good diet and plenty of exercise, but at Women to Women, we understand that there’s more to this equation than just eating right and exercising. And that’s the emotional piece. Reaching for sugar may be a sign that you’re lacking sweetness in your life. I want you to think about all the things that make you happy and consider the possibility that these things nourish you in profound ways that your food — no matter how impeccable — cannot. Whether it’s spending more time with your children, relaxing on your own, painting or digging around in the garden, giving yourself time to do the things you love will have a positive effect upon all your systems — from your heart to nerves to immunity to metabolism.

Just remember that feeling better means looking at the whole picture — your happiness, nutrition, exercise habits, hormonal balance, blood pressure, and cholesterol. But while we always encourage women to start inward on a quest for overall health and diabetes prevention, it also makes sense to look at what’s all around you.

Diabetes and our environment

From the four pillars outlined above, we can begin to see how the rising rates of diabetes may be the result of a complex interplay between our genes and environmental influences. It stands to reason, then, that scientists are starting to look more closely at how our environment affects our risk of diabetes. No one will argue with the fact that as modern technology surges on, we benefit from lots of conveniences. But along with all these conveniences we’re also taking in the heavy metals and man made toxins that come with them. Materials used to create plastics, pesticides, household cleaners, flame retardants, rugs and furniture, computers — even white paper — all contain what are known as endocrine disruptors. And many of these foreign molecules have been shown to mimic the action of hormones in our bodies.

Since hormones turn on and off bodily functions, open cell doors, keep our moods stable, and so much more, it makes sense that endocrine disruptors could contribute to a shift in insulin production or utilization in the body. In fact, a recent study found that exposure to the specific kind of endocrine disruptors known as persistent organochloride pollutants (POP’s) may contribute to the development of type 2 diabetes.

Keep in mind, however, that endocrine disruptors are most likely not the primary cause of type 2 diabetes, though they certainly may contribute. And the good news is that there are many things you can do in your life to limit your exposure to these unwanted disrupters. Start by throwing out your plastic food containers and replacing them with glass, avoiding the use of plastic in the microwave, and giving your body a chance to recover by implementing regular detox and drinking more water.

There are lots of ways to help yourself when it comes to the prevention of type 2 diabetes. Just remember to look at the whole picture.

The Women to Women approach to reducing your risk of diabetes

At Women to Women, we believe you are the most important caretaker of your body. This leaves you with choices when it comes to what you eat, whether you exercise, and the spaces with which you surround yourself. This can be a powerful — and, for some women, overwhelming — concept.

But making better choices doesn’t have to be difficult. Start by determining where you are and what your goals are. You may want to put it all down on paper. We find that articulating and defining what we want and don’t want in life can help us more easily achieve our greatest desires.

Here are a few ideas to get you started:

Move toward healthier meals and snacks. It may be true that fast food is less expensive and more expedient than buying fresh whole foods and cooking yourself, but keep in mind the old adage: Food is the cheapest medicine you can buy. And when you do need to eat in a hurry, even making different fast food choices can make a world of difference. Chose the grilled chicken instead of a cheeseburger next time. Or simply drink water instead of soda with your meals. Be sure to include the four food groups in all your meals, and don’t forget to check the labels for trans fats and high-fructose corn syrup. Remember that you don’t have to do everything all at once. Little by little, making better food choices will help you reverse your insulin resistance within weeks. You may find our articles on nutrition helpful as you prepare to balance your meals.
Strive for regular physical activity. We don’t advise jumping right into the recommended 40 minutes a day if you haven’t exercised in a while. Just start by doing something active a few days a week. Getting into the habit of moving your body and increasing your heart rate is what counts. Be sure to talk with your healthcare practitioner about what forms of exercise are safe for you. Proceed from there to find an activity that fits your life. Nearly everyone can benefit from walking more. Before you know it, you’ll work up to a longer period of exercise and start to feel all the positive results!
Enhance your nutrition with vitamins and minerals. Our cells are constantly using micronutrients in their everyday functions to produce energy and keep us thriving. Diabetes and prediabetes compromise the nutrients our bodies are able to take up, which can lead to nutritional deficiencies. Adding a high-grade multivitamin/mineral complex and supplemental omega–3 fatty acids will help fill in any nutritional gaps, regulate hormones such as insulin, and protect your body from the complications associated with diabetes. In fact, certain vitamins, minerals, and phytonutrients have been shown to be particularly helpful in terms of insulin resistance and diabetes.
Detox your personal environment. Avoid unnecessary chemical exposure by using glass instead of plastic to store your food and drink. Never use plastic in the microwave, or avoid the microwave altogether. Make a point to use all-natural cleaning products and cosmetics, and drink plenty of water.

It will also help your health on all levels, including your endocrine system, to limit time you spend in stressful relationships and environments. As scientists are now discovering, stress takes a heavy toll on our bodies. Ironically, the very technology invented to save us time, such as laptops, cell phones and e-mail, may afford us less time to decompress. Make time to relax and get away from the pressures of life. Even if it’s just a one day yoga retreat, a walk on the beach or an hour-long bubble bath, taking a holiday from stress is never a bad thing for your body.

Consider other complementary treatments. As you may understand by now, diabetes is a complex disease. It manifests itself differently in each individual and the preventative methods that work for some may not be enough for you. Certain complementary treatments have shown positive effect in managing the risk factors leading to diabetes, and may be worth looking into. Whatever course of treatment you pursue, remember to work closely with an experienced practitioner for the best results.

Find the sweetness in your life!

Learning how to prevent type 2 diabetes changes the way we look at everything — the way we eat, travel, exercise, work, and view the world around us. And, trust me, all of this is for the better! It can certainly feel overwhelming sometimes. It helps to remember that you can’t change everything in one day — nor should you try. Revising our habits takes time and commitment.

At Women to Women we believe in balance, which is achieved through a dynamic equilibrium between forces. There are positives to every negative, and though preventing diabetes may seem daunting, what it requires is for you to pay more attention to your body and do what makes you feel good in the long run. This is never a bad thing. Embrace the chance to take better care of yourself, and before you know it life will be sweeter than you ever imagined possible!

Insulin Resistance – Our Love Affair With Sugar

womentowomen on November 18, 2013

by Marcelle Pick, OB/GYN NP

Most women I talk with at the clinic and in my personal life have experienced sugar cravings, no matter what time of year — or time of the month. Whether it’s having a taste for something sweet after dinner each night or speeding to your local supermarket for the biggest bag of Swedish Fish you can buy, I know craving sugar can be a powerful urge. And the disappointing truth is that once we start to include sugar into our daily routine, it becomes more and more difficult to stop.

As humans we’ve evolved to appreciate the instant energy sugar provides us, but food is a highly emotional topic, especially when it comes to sweets. We often associate sweet foods with love and acceptance, and scientists have looked at our brain chemistry to understand how food can directly affect our “feel-good” neurotransmitters like serotonin. There are many other physical causes for sugar cravings, too, like hormonal fluctuations, intestinal yeast, and stress, to name a few.

Pre-tox before you party

Sugary treats are almost always available at parties and special events, as well as other celebratory hazards that can disrupt even the healthiest lifestyle. If you’re planning to celebrate, there are some simple steps to take before you indulge to help pre-tox your system, and keep you feeling energetic and healthy.

Sadly, we’ve been told for far too long that indulging in sweets is connected with a lack of self-will or some other character flaw. This is just not true! Craving sugar is not simply about willpower, nor is it simply about emotions. There may be several underlying physiologic causes feeding your desire for sugar, and it may take some perspective and investigation to get to the bottom of it. Let’s take a closer look at what might be behind your sugar cravings and how you can develop a healthy, loving relationship with sweets.

Why does sugar feel so good?

There is so much contributing to the positive feelings we associate with sugar. For many of us, the smell of homemade cookies or a cake fresh out of the oven reminds us of our childhoods, evoking fond memories of past holidays, birthdays, or special occasions. Others remember being rewarded with candy or other sugary delights when they did something “good.”

These positive associations are deeply ingrained in our brains. I once had a patient named Jillian who broke down into tears when I suggested she cut sugar from her diet for a week — it was as if I was taking away her most intimate friend! But the more research I did, the more it made sense. Our brains “reward” us by releasing serotonin and beta-endorphins when we eat sugar or other refined carbohydrates that are easily converted to glucose (the simplest sugar). The release of these mood-enhancing neurotransmitters explains in part why Jillian and many other patients of mine feel such an intense emotional connection to sugar.

Let’s look at serotonin. Serotonin has many responsibilities in our bodies, but overall, it is best known as the neurotransmitter that makes us feel good. Neurotransmitters act by sending messages from the nervous system to the rest of the body, and serotonin levels are what several antidepressants manipulate to improve mood and anxiety. Made from the essential amino acid tryptophan, serotonin’s roots are in protein. So what does sugar have to do with it? The reason sugar can lead to increased serotonin in the brain has to do with insulin. I’ll explain this in more detail below, but the bottom line is that we need insulin to help tryptophan get into the brain so it can produce serotonin. And sugar — or any carbohydrate for that matter — causes us to release insulin. Refined carbohydrates, such as sugar, white bread, pasta and white rice, lead to a more intense insulin surge than do complex carbohydrates like vegetables and whole grains.

Beta-endorphin is another neurotransmitter we release when eating sweets or refined carbohydrates. This is the neurotransmitter typically associated with a “runner’s high” because it acts as a natural painkiller, produces a sense of well-being, increases self-esteem, and settles anxiety. Our brains naturally release beta-endorphin when we are in any kind of physical pain — and when we eat sugar.

It’s no wonder sugar feels so good! Physiologically, sugar “feeds” our brains with two neurotransmitters that send positive messages to the rest of the body. The problem is that the lift we experience after a can of soda, a bowl of noodles, or a chocolate chip cookie doesn’t last very long, and eating these foods, especially without combining them with some protein, can set us up for cyclical cravings. We will find ourselves wanting more and more.

Is sugar addictive?

So many of my patients ask whether sugar is truly addicting, but the answer differs depending on the individual. Sugar certainly can be addictive, but this is more of a problem for some women than others, because we all have different levels of neurotransmitters and receptors in our brains. These levels vary and change over time depending upon our genetics and lifestyle — what we eat, drink and feel; where we are hormonally; whether we exercise; how well we sleep; and so on. Some practitioners believe that a portion of the population is “sugar-sensitive.” These individuals may be operating with naturally lower levels of serotonin and beta-endorphin, leaving them more vulnerable to sugar cravings.

Any time the body is running low on a neurotransmitter, the brain tries to catch up by opening up more receptors for this neurotransmitter, essentially to increase the odds of a connection. You can think of it in terms of supply and demand: when there’s less of something available, the demand for it goes up. With so many open receptors, if a sugar-sensitive person does have sugar, alcohol, or anything that causes a release of serotonin or beta-endorphin, it intensifies the resulting sugar “high.” This in turn can lead to more cravings.

Some of my patients have experienced withdrawal symptoms when they stop eating sugar. This makes sense because when we’re eating large amounts of sugar at regular intervals, the brain becomes accustomed to frequent beta-endorphin bursts, and when we take them away, it naturally wants more. This, like withdrawal from a caffeine habit or drug addiction, can lead to headaches, shakiness, nausea, fatigue, and even depression.

Your body needs carbohydrates

It may be tempting for women who feel they have a problem with sugar to simply cut out all carbohydrates. But an all-or-nothing approach just isn’t healthy — it takes all four food groups to regulate insulin and quell sugar cravings. Here is an explanation why:

Whenever we eat foods that contain complex carbohydrates, our bodies convert them into a simple sugar known as glucose. Glucose is the main source of fuel for our cells. The brain in particular cannot use any other source of energy (like fat or protein) aside from glucose, so it is absolutely essential to eat carbohydrates.

As I mentioned earlier, carbohydrates are also important in helping tryptophan get into the brain to be converted to serotonin. When we eat food containing protein, the body breaks it down into subcomponent amino acids — one of which is tryptophan.

Key nutrients to enhance your serotonin production

Vitamin C. Among other important duties, vitamin C helps to convert tryptophan (from the food you eat) into serotonin.
B-complex vitamins. This group of vitamins is helpful in metabolizing carbohydrates for the body to use. Niacin in particular is essential in converting tryptophan to serotonin.
Zinc. Zinc aids insulin in doing its job and generally helps with digestion.

— Adapted from Potatoes not Prozac, p. 141

The tryptophan molecule is relatively small compared to other amino acids. Those larger amino acids can block tryptophan’s path across the tightly-regulated barrier between the blood and the brain. When carbohydrates are consumed and insulin is released, insulin pairs up with larger amino acids to help build muscle, leaving tryptophan a clearer path to cross into the brain. And there are important micronutrients, such as vitamin C, the B vitamins, and zinc (see box at right), that can help with the conversion from tryptophan to serotonin.

What’s interesting is that Mother Nature did not provide our bodies with the information to distinguish between man-made sugars and natural sugars. Instead, this information is available to us in everything else that surrounds natural sugars — in the antioxidant-rich skins of grapes and apples, for example, or the fiber and protein-rich germ of whole grains. Therefore, eating any kind of sweet or refined carbohydrate will satisfy the brain and increase serotonin — but it won’t trigger the signals that tell our brain we’ve had enough, that we are now fully sated. The more refined a food is, the more it’s been stripped of this natural, information-rich fibers, fats, proteins, vitamins, and antioxidants.

The carbohydrates in white flours, white rice, white sugar, and the majority of pastas and breakfast cereals are all highly refined, so it takes less time for the body to break them down, therefore leading to a quicker response all around. This may sound good, but in the long run, quick spikes in insulin and glucose can damage your metabolism and lead to insulin resistance and more cravings. There are so many delicious complex carbohydrates to choose from that will gently increase blood sugar and insulin.

Possible causes for sugar cravings

As I mentioned earlier, sugar cravings often have many facets. Because eating is so intimately connected with our biochemistry and our emotions, we “digest” sugar on many levels. You may notice there’s a pattern to when you crave sugar — for so many of my patients it is cyclical, occurring nightly after a stressful day at work, monthly just before their periods, or seasonally when the days grow short. For others, sugar binges may be connected to the kinds of foods they have already eaten that day, or with a daily ritual. Here are some of the common causes for sugar cravings I see at the clinic:

Hormonal fluctuations. Just before menstruation, when estrogen is low and progesterone is on its way down, beta-endorphin levels are at their lowest. These cyclical hormonal and neurotransmitter fluctuations may explain why many women who experience PMS also have cravings — and the accompanying serotonin–endorphin bursts that high-sugar foods can provide.
Stress. Any stressful situation can lead to less than optimal eating habits. Stress itself increases cortisol levels, which initially dampen hunger. Once the stress has abated, our hormones of hunger ramp up — “Refuel!” the body cries. This can lead many women with stressful jobs and lifestyles to a pattern of nighttime cravings, over-eating, and unwanted weight gain. Over time, chronic stress can lead to adrenal imbalance, eventually resulting in extreme exhaustion. So many women I see have reached a state of adrenal imbalance, and find the only way to get through the day is by drinking lots of caffeine and consuming sugar for quick energy bursts. But this only sets them up for further cravings and more energy depletion. There are lots of simple ways to support your adrenal health by what and how you eat. For more information, see our articles about eating for your adrenal glands.
Insulin resistance. When you are resistant to insulin (which can happen as a result of a long-term diet high in refined carbohydrates and low in micronutrients), glucose is not able to enter your cells and ends up staying in your blood as a result. This means your cells are starved for the fuel they need to operate, and signals are therefore sent to your brain to increase insulin. This results in cravings for sugar because even though you may be eating enough, your cells aren’t able to access the food. For more information, see our article on preventing type 2 diabetes and metabolic syndrome.
Food sensitivities. Food sensitivities are often the result of a situation known as “leaky gut,” where partially digested food particles can make their way into the bloodstream through a damaged, inflamed mucosal lining in the digestive tract. The body regards these food particles as foreign antigens and mounts an immune response by sending antibodies. Combined antibodies and antigens in your bloodstream, known as immune complexes, can lead to intense cravings. Gluten may be at the root of this type of sugar craving because it is often combined with sugar in the foods we eat, and so women think they’re craving sugar when really they might be craving gluten.
Intestinal yeast or systemic candidiasis. Yeast thrives on sugar (a connection easy to make when you look at the Latin name for this group of organisms — Saccharomycotina — or “sugar fungi”). If your intestinal (and vaginal) bacteria are out of balance, they are less likely to keep yeasts like Candida in check. An overgrowth of yeast in the intestine or system-wide can lead to increased cravings for sugar. You can help keep these organisms — and cravings — in check by taking a high-quality probiotic that includes a competitive yeast.
Excess acid-forming foods. Some women I talk with notice that after eating a lot of red meat, their cravings for sugar increase. Red meat is high in a pro-inflammatory molecule called arachidonic acid. Eating a lot of meat tends to upregulate the oxidative–inflammatory cascade in our bodies. If left unchecked, this inflammatory condition can become chronic and cause abnormal glucose metabolism, ultimately leading to insulin resistance. Choosing anti-inflammatory foods high in omega-3 fatty acids, as well as those that are alkalizing and antioxidant-rich, such as fruits and vegetables, can offset the metabolic damage and the cravings associated with this dynamic.
A lack of sweetness in your life. As I mentioned before, many things in life can affect our serotonin and beta-endorphin levels — exercise, balanced nutrition, rewarding work, a positive relationship, even a sunny day. The joy we find in our lives speaks to our biochemistry. So when we are lacking positive energy and happiness, it’s not surprising that we seek to fill that void with sugar.

Strive for a sweet balance — the Women to Women approach

There are several ways to diminish sugar cravings, but just as there are different causes for them, different steps work for different women. For my patient Jillian and others who are addicted to sugar, multiple steps may need to be taken for lasting results. Other women may find that simply avoiding sugar for a few days does the trick. Still others find that once they reach menopause and their hormonal swings become a thing of the past, so do their cravings. But the best approach is to find a good balance. I’ve seen too many women put sugar in the “forbidden fruit” category and end up binging because they feel so deprived. You deserve treats in your life, and sugar can be enjoyed without the “carb hangovers” and guilt that are too often associated with it.

Here are some suggestions to help you find a healthy middle ground between no sugar and sugar binges.

Balance your diet. Nourish your body with a balanced diet, full of the healthy fats, quality protein, complex carbohydrates, and fruits and vegetables that all together help keep cell-signaling on an even keel. The food you prepare for yourself should be yummy and rewarding, not something you have to force down. So many fad diets are set up to deprive women of basic food groups, like fat and carbohydrates, but our bodies need all of these food groups to carry out basic functions. Treat yourself to satisfying foods, and I promise you’ll see a difference in your cravings. For more on preventing insulin resistance with nutrition, see our articles on this topic.

Try eliminating sugar for three to five days and see how you feel. I know how hard it can be, but avoiding sugar for just three days can make a huge difference for some women. For others, it may take longer for the cravings to diminish, but eliminating the cyclical crash-and-burn bursts of serotonin and beta-endorphin your brain gets from sugar and refined carbohydrates can help your body normalize its receptors and neurotransmitters, so that your brain isn’t constantly sending the message that it needs more sugar.

Incorporate a high-quality multivitamin–mineral complex, plus omega-3s. A good supplement is essential to cover your nutritional bases, especially in our modern society of fast food and industrial farming. Micronutrients like zinc, vitamin C and the B vitamins are particularly helpful in calming sugar cravings by influencing serotonin production. Equally important are omega-3s, which are crucial for regulating mood and inflammation — factors that are both associated with cravings.

Eat a baked potato three hours after dinner. This concept was born when Dr. Kathleen DesMaisons published her famous book, Potatoes not Prozac. We recommend you read the book for specifics, but the theory is that potatoes not only stimulate the release of insulin needed for tryptophan to cross into the brain, but also contain potassium, a nutrient needed for insulin to do its work. Potatoes, with their fiber and micronutrient content, also offer a more sustained insulin response than most refined carbohydrates. The only stipulations are that you eat the potato as an evening snack, that you do not eat it with any kind of protein (otherwise, you can top it as you wish), and that you include its skin. You may notice that this runs counter to our advice to combine protein and carbs in meals and snacks — keep in mind that eating a baked potato in this specific way, three hours after a meal containing protein, is one particular method of reducing cravings and preventing mood swings. The following is our more general recommendation about controlling insulin surges.

Mix protein with pleasure. We can all indulge ourselves in sugary treats once in a while if we want to. Combining these treats with a stick of cheese, some nuts, or even a glass of milk will help balance the sugar and insulin surge and allow a gentler increase in blood sugar and insulin. We also recommend desserts that include protein, like custards or meringues or even a bowl of berries and cream. You can sweeten these delights with natural sweeteners like stevia or xylitol instead of sugar. With a less spiky sugar surge to the brain, you’ll likely experience a less precipitous crash as well. See our articles about carbohydrates for an alternative explanation about the concepts of glycemic index and glycemic load.

Avoid sugar patterns. Just like those who smoke or drink may associate smoking or having a glass of wine with certain activities, we may come to associate sugary treats with times of the day or ritualized rewards. Take a moment to notice whether this might be true of your cravings. Your brain is quick to pick up on associations — particularly anything having to do with its “reward cascade” — and may have you craving sugar every day at three o’clock, or each time you go for a run, for example. If you’re ready to break the pattern (or prevent it from forming), this might be a good time to enjoy that baked potato or some alternative “reward.”

Enhance the sweetness in your life. One of my favorite prescriptions for my patients reads: Go have some fun! I have written this prescription several times for patients who seem buried in their work or the day-to-day responsibilities of raising a family, taking care of elderly parents, managing a household — whatever it may be. As women, we rarely take the time to nurture ourselves, and it is so important to your health to do so on a regular basis. Take a step back to figure out what makes you happy, and examine the things that are doing the opposite. It may be time make a change.

Cultivate lasting bliss

I know it doesn’t feel good to be a slave to sugar. The ups and downs can be intense and exhausting overall. But it doesn’t have to be this way. Look at the whole picture — biochemically, physically, and emotionally — to pinpoint where you might benefit from change and release yourself from your cravings. The more balance you can offer yourself through quality nutrition and emotional wellness, the more you’ll find your cravings start to shift away from quick fixes like sugar to the things that provide a lasting and natural bliss.

I absolutely know that craving sugar or binging on sugar is not a reflection of your willpower or your individual strength. It most likely has physical roots, and those roots can be restored to set the foundation for a healthy, lifelong relationship with sugar!