Sunday, September 30, 2018

WOW - October is tomorrow!

So Fall is here already! (How?) I went to two conferences in September and my brain is jam-packed with new information that I now need to sort out and digest BUT - this week I think we need to talk about WOMEN and our hormones and our dignity.

As an Obgyn who was trained at Emory I worked in the rape clinic at Grady Memorial Hospital in downtown Atlanta. I was 'on duty' for the month of August in my third year of training and saw 50 cases of sexual assault in that month. Most of those women had obviously been assaulted but only a small percent decided to pursue assault charges.

As someone who has suffered sexual assault myself (and has never spoken out) I think it is time to make space in our society for women to be heard, to be treated with the dignity they deserve, and for men to be brought to justice. As we heard eloquently from Dr. Ford this week, a traumatic experience imprints indelibly into the hippocampus (the part of your brain that records memories) and you never forget the person or the event. Recovery is a long process and your stress hormones and female hormones can be thrown off balance, causing all sorts of long term health issues.

For those of you over 40, you may be approaching menopause, going through it or well past it but your hormones still can help you feel better and look younger and healthier (also your brain to think more clearly and remember things). When your ovaries shut down or you have adrenal dysfunction and your estrogen, progesterone, DHEA and testosterone are non-existent or out of balance, it may be time to consult an integrative or Functional Medicine doctor.

As a Functional Medicine (certified through IFM) doctor, I use evidence-based medicine in a holistic way to help women regain hormone balance but also emotional and mental balance. The most common type of hormone imbalance in younger women is decline of progesterone (which can be due to increased stress and demand for cortisol) which can lead to irregular or heavy bleeding. In women who have stopped having cycles, I frequently see loss of libido, problems with lubrication or terrible pain when attempting intercourse. I use bioidentical (molecularly identical to the hormones we produce) replacement or supplemental hormones to help resolve these issues.

On top of enduring the hormonal roller coaster that we ride in our later years, women need to heal emotionally and mentally so they can fully live their best lives on a daily basis. Assault victims have fractured hearts and difficulty with intimacy and trust. Even after counseling, the work of becoming whole is an ongoing endeavor. I'm attending a free online 'Emotional Clearing' webinar series this week. I leave you with this exercise from the first lesson -


Part 1. Write down your recollection of the event. Recall your feelings during and after the event. Write down any wisdom you would share with your younger self after the event.
Part 2. Write down the event from the perspective of the person who hurt you. Consider what their feelings and motives may have been and write those down.
Part 3. Become a reporter and write a description of the events as an observer reporting the facts only as one reporting for a newspaper.
Part 4. Perform a ritual that allows you to discard the emotional disturbances that go along with the memory by either shredding the papers, burning them, or otherwise destroying them. End with a short compassion meditation, extending compassion to yourself first, then to someone you love, then to a neutral person and finally - if possible - to the person who hurt you.


Sunday, September 23, 2018

Autoimmune thyroiditis - what can you do?

Just like the glimmer of a rainbow you can see in this cloud, we have a glimmer of hope in the quest to figure out how to address autoimmune problems.

For those of you not familiar, an autoimmune process means that your body is making antibodies that are attacking one or more of your tissues. This includes diseases like Hashimoto's and Grave's when it happens to the thyroid gland.

If you have one of these issues and it goes untreated, you are more likely to develop other autoimmune diseases like Rheumatoid arthritis, Lupus or Multiple Sclerosis. By treatment I don't mean drugs, which just try to stop the symptoms but don't address the Root Cause of an illness.

Since most of your immune system is in your gut (along your intestines), it makes sense that one of the triggers of the autoimmune process can be food.

As a Functional Medicine physician I see many patients with autoimmune thyroiditis. The first thing we do is an elimination diet to remove possible triggers. Many times, after the elimination diet is done we see antibody titers coming down. The most common food triggers are gluten and dairy.

Food is not the only possible trigger, though. Medication can also be a trigger. I have a patient whose antibodies were fairly low and she was put on one of the new anti-coagulation drugs and her antibodies went through the roof - into the thousands - and when I wrote to the Cardiologist to ask them to change her medication, the nurse practitioner (not the doctor to whom I had written) sent a response that the patient needed that particular medication. For those of you unfamiliar with anticoagulants, that statement is false. There are other options.

If your thyroid isn't functioning as it should then work with a Functional Medicine doctor to see if it may be an autoimmune problem. Many conventional doctors don't look at thyroid antibodies and if you don't look, you won't know whether you are dealing with autoimmunity. I routinely check thyroid antibodies if a patient is having symptoms of thyroid dysfunction. I mentioned the symptoms of thyroid dysfunction in my previous post.

If your antibodies remain high after consideration of food and drug triggers then you may want to take a closer look at other things your body comes into contact with.

This slide from my conference this weeks shows some of the other triggers. Heavy metal toxicity can come from exposure to contaminated air, water, toys and food. Heavy metals can interfere with multiple metabolic processes. There is research that shows a link between mercury exposure and thyroid antibodies and persons treated for heavy metal toxicity have had improved thyroid function after treatment.

The other area where we get huge exposures is personal care products and household cleaning or air freshener products that contain dangerous chemicals. Check out to see if your makeup, shampoo, lotions, dishwashing liquids, etc. may be making you sick.

I have seen patients who successfully eliminated many possible triggers from their life and brought their antibodies down almost to the 'reference range'. Some of these had many nodules on a thyroid ultrasound which were no longer there after they searched for root causes and got rid of them.

So there is a glimmer of hope. We don't have all of the answers but many pieces of the puzzle are falling into place. Since unmanaged stress can also be a trigger, I leave you today with a stress-busting exercise.


Use your thumb and ring finger to close one nostril at a time. You can either bring the index and middle finger to your forehead between your eyes or bend them.

First close the left nostril and breathe in through the right, then close the right nostril and breathe out through the left. Then breathe in through the left, close that nostril and breathe out through the right. This is one 'cycle'. Complete 10 cycles then relax and take 5 deep cleansing breaths, paying attention to the movement of air and how it moves through your airways, down into your lungs and expanding your belly as you inhale and how your chest and abdomen fall and draw in as you exhale.

Benefits of Nodi Sodhan:

- Inhale left, exhale right: Helps to make you calm and integrates unwanted negative emotions and stress. Excellent by itself before bed.

- Inhale right, exhale left: Gives clarity, and positive mood. Helps us to focus on what is important.


Sunday, September 16, 2018

Thyroid hormones - a primer

I attended a conference last week on Integrative Medicine and Mental Health and there was a lecture on the thyroid gland. As a Functional Medicine physician I see many people with thyroid disorders, mostly hypothyroid, so I chose that lecture (they offered concurrent sessions) to hear the latest scoop on the thyroid. The thyroid is a complex little gland that sits at the base of your windpipe just above the jugular notch. It is often described as being shaped like a butterfly but I think it looks like upside down angel wings.

The graphic shows a schematic of how the hormones from the region of the brain called the hypothalamus signal the pituitary gland to then signal the thyroid to make more hormone. Like I said, it's a tricky gland. So the most interesting part of the lecture to me was that conventional thyroid testing has been shown in studies to miss thyroid dysfunction and that a thyroid gland that is underperforming may be associated with mood disorders, particularly depression.

How might you feel if your thyroid is sluggish? 
  •  You might notice that you rarely sweat or that you seem to be cold when everyone else is warm. 
  • You may be constipated
  • If you are female you may have menstrual irregularities or infertility problems
  • You may notice hair loss 
  • You might have difficulty losing weight or notice you gain weight easily
  • You may lose the outer third of your eyebrows
  • You may be feel fatigued
  • You may have difficulty concentrating
  • You may be depressed

If you two or more of the above symptoms, you may want to get your thyroid checked. Your doctor can examine your thyroid gland and see if it is enlarged. Most physicians were taught that the best screening test for thyroid function is TSH. This is incorrect! New studies show that up to 80% of thyroid dysfunction will be missed with just a TSH level. Ask you doctor to get a Free T3 level and a reverse T3 level along with the TSH. They may want to get a T4 or free T4 but these are secondary in importance to the Free T3 and reverse T3.

Conventional doctors may not realize that optimum levels of hormone are in the upper ranges of the 'reference range'. For example, if the reference range at your lab for Free T3 is 2.1 - 4.4, then your Free T3 should be around 4.0 for best function. Most people feel better once the Free T3 is above 3.2 but in Functional Medicine we think of a reference range as analogous to the normal range of shoe sizes. One size does NOT fit all and your 'fit' may be different from mine.

If you are already taking a thyroid medication it is likely that you were given a synthetic form of thyroxine or T4. Synthetic thyroxine is designed to act like T4 - the main hormone your thyroid gland makes. Unfortunately, sometimes things like stress, trauma, infection, inflammation and extreme dieting can cause the conversion of T4 into active T3 to be diverted. This diversion, shown on the graphic below, results in the T4 being converted to REVERSE T3 (which the lecturer dubbed the 'evil twin' of T3). 

Reverse T3 acts like a brake on the thyroid and prevents some of your T3 from gaining access to the cell nucleus (so it can't do it's job). It's a double whammy. The T4 can either turn into T3 OR reverse T3 so every time it converts to reverse T3 you have less T3 to work with AND the reverse T3 blocks the T3 from doing its job! You can see why it might be important to check the reverse T3 level.

If you think your thyroid may be dysfunctional - stay tuned! Next week I am at a conference but hope to post more about thyroid disorders, including autoimmune thyroiditis (Hashimoto's), and how they can be managed.

Today's De-stress meditation -
    'The more and more you listen, the more and more 
      you will hear. The more you hear, the more and more
       deeply you will understand.' -Khyentse Rinpoche

This is adapted from Luminous Mind by Joel and Michelle Levey:

Sit quietly and pause in your thinking and relax. You may want to set a timer for 3 - 5 minutes once you are ready to begin.

Take a comfortable posture, either sitting upright with feet on the floor and hands resting in your lap or lying down. Relax your forehead, soften the eyes, close the eyes and relax your jaw muscles and neck. Notice your body moving in rhythm with your breath. Begin to notice the sounds in your environment. Imagine your mind is an antenna, picking up all the arising sounds around you. In this state of receptivity, your mind is a place of awareness of sounds rising and falling into silence. Without thinking about the sounds, just let them come and flow. If your mind wanders off into thinking, just smile at yourself and mentally say, "Listen.." without judgment.
Notice how the sounds dissolve back into silence and how your listening mind is like the vast, clear sky that can contain limitless sounds without any getting in the way of the other. Breathe, listen and smile. 
When the timer sounds, if you used one, bring your awareness back to your breath for a few moments then open your eyes.


Sunday, September 2, 2018

Healthy Adrenal glands - Why we can't live without them

I hope this long holiday weekend is allowing everyone some time to rest and rejuvenate!  I see a lot of patients in my Functional Medicine practice that have adrenal dysfunction and regular down time is essential to preventing adrenal meltdown and self-care is part of the restoration plan when the adrenals are already in trouble.

These two tiny glands sit on top of the kidneys and are divided into the cortex and medulla. The adrenal cortex makes your steroid hormones. In a previous post, I displayed a chart of these hormone production pathways. Glucocorticoids like cortisol and corticosterone, mineralocorticoids like aldosterone and the sex steroids - progesterone, DHEA, testosterone and estrogens - are all produced by the adrenal glands, although the majority of testosterone and estrogens are produced in the reproductive organs.

When overly stressed, the 'raw material' (cholesterol) used to make the steroid hormones will be allocated primarily to make cortisol. Long-term overproduction of cortisol can lead to weight gain, diabetes, high blood pressure, lowered immune function, difficulty sleeping or a host of hormone imbalances.

Eventually, if chronic overproduction continues, some people develop a deficiency in cortisol which leads to chronic fatigue, low blood sugar, salt craving, low blood pressure or the inability to cope with even the smallest amount of stress. Along with low cortisol, most of these people also suffer from low DHEA which is an important precursor to testosterone and estrogen.

Research is ongoing to find out all of the ways DHEA impacts our functioning but one way that is emerging is to decrease inflammation that promotes the loss of neurons in the brain. DHEA may also be an important source of hormones for women after menopause. I always check DHEA levels in my patients and don't recommend taking a supplement of DHEA unless you have been tested and know you are deficient.

Your functional provider should also assess your levels of estrogen and testosterone and progesterone if adrenal dysfunction is suspected. If there are any memory issues, pregnenolone (precursor to progesterone) should also be assessed. After we finish hormones I will post on memory loss and how to reverse or avoid it! For now, let's focus on how to preserve your adrenal glands.

I wrote about developing a mindfulness practice in a previous post and want to also mention meditation. I think of meditation as an exercise for the brain. While the brain is developing the ability to focus on something mundane and non-threatening, the adrenal glands are having some 'down time' which builds resilience. I recommend a free app like 'Stop, Breathe and Think' or 'Insight Timer' to get started.

You can also use magazines or books like these pictured to help you keep it interesting and grow your knowledge of the various ways to engage in meditation. Some think because they pray they don't need to meditate but I remind them that praying is actively engaging in an activity that might bring more worries and is a way of asking instead of receiving. I think of mediation as listening and receiving wisdom, along with being a mini-vacation for the adrenal glands.

One of the most important ways to preserve the adrenal glands is to get enough sleep. Having a routine and getting to bed and to sleep allows your body to replenish and restore itself, particularly the brain and adrenals. If you've burned the candle at both ends for too long you may need to get 8-10 hours nightly for a minimum of two weeks before you begin to feel rested after a good night's sleep.

If you fall asleep but are awakened throughout the night you may need to have your adrenal function assessed to see if you need to take supplements to help your adrenal glands and improve your ability to stay asleep.

Having good 'sleep hygiene' will help you get better quality sleep. This means setting a certain time to wind down and prepare for bedtime. I have an app on my laptop called 'f.lux' that reminds me when my bedtime is 3 hours away and blocks the blue light from the screen that can stimulate the pineal gland and impair it's ability to make melatonin, a hormone essential to good sleep.

I have patients who benefit from having a certain bedtime ritual. This can mean taking time to soak in Epsom salts, journaling, using essential oils in a diffuser or listening to soothing music. My ritual includes reading something that won't stimulate my brain too much. Right now I'm re-reading the Harry Potter series - non-stimulating because I know what's coming - but sometimes I read meditation magazines.

So in summary, to keep your adrenal glands humming along you will need to meditate regularly, develop good sleep hygiene and get at least 8 hours of sleep each night, practice mindfulness and self-care and find activities you like and do them regularly and identify those things that bring you negative energy and avoid those things. If you are struggling then don't delay in getting your adrenal glands tested so you can begin the process of repairing them. There are herbal teas like 'Stress-Ease' from Traditional Medicinals that can help, along with adaptogenic herb supplements to prop up your adrenal function but they should be part of an overall plan to pamper your adrenals.

I leave you today with a Sabbath Meditation:

Take a comfortable seat and close your eyes. Take five deep cleansing breaths - focus on the air movement and the way the body expands during inhalation and draws in on the exhalations. Begin to relax your face, neck, jaw and move down your body until all tension is released.

After the five breaths, begin to focus on the concept of a day of Holy Rest. Release any need to 'do' something to be worthy and realize that just 'being' in the Presence of your Maker is enough. Let your soul relax. Contemplate letting go of doing, letting go of acquiring, letting go of making, letting go of expectations. Allow yourself to sit in the Divine Presence and just be. Receive the Divine Qualities that are being offered to you. Feel Divine Unconditional Love showered upon you. Open up to Forgiveness, Lovingkindness and Compassion. Receive Peace.

As you become full to overflowing extend these Qualities to those in your life, blessing them with the Blessings you have received. Once you have blessed your loved ones, extend those blessings to your community, then to your country and then to the entire world and out into the Universe.

End your meditation by returning to the breath. Take five deep cleansing breaths, focusing on the movement of the air and the way the body expands during inhalation and draws in on exhalation. Bring your awareness back to your body and slowly open your eyes.