PMS? Oral Contraceptives Not The Only Option!

PMSPre-menstrual syndrome (PMS) is thought to affect about 90 per cent of women at some point in their lives, with a significant proportion of these suffering regularly from severe and debilitating symptoms.  PMS is typically the result of abnormal hormone fluctuations, such as elevated prolactin levels, or low progesterone during the second half of the menstrual cycle.  Another possibility is estrogen dominance, where the liver has a difficult time metabolizing estrogen, leading to a disproportionate amount of estrogen in the system.  And these are just a few of the possible scenarios that can lead to PMS.

So why, then, does conventional medicine treat virtually every person with PMS the same?  Oral contraceptives are prescribed almost exclusively to treat this issue, regardless of the cause.  While oral contraceptives may be a magic bullet in some instances, the list of potential side-effects is long, and includes an increased risk of breast cancer, cervical cancer, stroke, acne, yeast infections, and weight gain.  Therefore, why subject so many people to these side-effects, when there may be other, more natural cures that not only alleviate the symptoms, but address the root cause?

One of the most established natural treatments for PMS is an extract of an exotic fruit known as Agnus castus. Research from Germany shows that Agnus castus (also known as Chasteberry, Monk’s pepper and Vitex) can reduce prolactin levels and increase the production of progesterone. These effects help to correct the hormonal imbalances common in PMS, thereby helping to ease its symptoms.

Earlier this year, the British Medical Journal (BMJ) published a study which proved the effectiveness of this natural remedy in the treatment of PMS. Over half the women in this study had significant improvement in their symptoms, and the treatment was found to be safe and generally free of side-effects. This recent study is not the only evidence which supports the use of Agnus castus in PMS. Last year, the Journal of Women’s Health and Gender Based Medicine published a study which examined the effect of Agnus castus in more than 1600 women. The study lasted three months, after which time 93 per cent of the women reported an improvement in or elimination of their PMS symptoms. Four out of five women rated themselves as ‘much better’ or ‘very much better’.

Naturopathic doctors can also perform specialized hormone testing that can help to pinpoint specific imbalances, which in turn can be corrected with nutritional and herbal therapies.  This allows each case of PMS to be treated uniquely, rather than treating everyone the same.  If PMS is something you’ve been suffering from for years, and birth control isn’t the answer you’re seeking, seek out a qualified naturopathic physician who can help to get your symptoms under control.

Understanding and Effectively Treating PMS

Premenstrual syndrome (PMS) is one of the most common female problems, affecting 30-40% of
women during their reproductive years. The most severe cases occur in approximately 2% of
women between the ages of 26 and 35. PMS is characterized by recurrent symptoms that appear
7-14 days before a woman has her menstrual period. These symptoms often include decreased
energy, irritability, increased appetite (usually sugar cravings), acne, and bloating. Menstrual
cramps (dysmenorrhea), while technically a separate diagnosis, can also be attributed to the same
hormonal fluctuations that cause PMS.

PMS symptoms can be divided into 4 distinct categories:

1. PMS-A (A = anxiety) includes symptoms of anxiety, irritability, and emotional instability.
It encompasses the most common PMS symptoms and is found to be strongly associated
with excessive estrogen and deficient progesterone.
2. PMS-C (C = carbohydrate craving) includes symptoms of increased appetite, craving for
sweets, headache, fatigue, fainting spells, and heart palpitations. Although there is no
clear mechanism of cause for these symptoms, they seem to be related to an excessive
insulin response to sugar consumption.
3. PMS-D (D = depression) is the least common category of symptoms and is associated
with low levels of estrogen, leading to increased breakdown of neurotransmitters in the
brain.
4. PMS-H (H = hyperhydration) is characterized by weight gain greater than 3 pounds,
abdominal bloating and discomfort, breast tenderness and congestion, and occasional
swelling of the face, hands, and ankles. These symptoms are attributed to an increase in
the hormone aldosterone, which increases fluid retention.

Usually, a woman will have a combination of symptoms from the different categories of PMS.
The categories are used as general guidelines to help address the underlying problems related to
the syndrome. It is important that your doctor rule out underlying medical conditions, like
hypothyroidism, anemia and depression, to make sure they’re not responsible for any PMS-related symptoms.

The causes of PMS can be numerous, but hormonal imbalances are often revealed with the appropriate laboratory testing, with an excess of estrogen and deficiency of progesterone being the most common.  The liver’s ability to breakdown excess hormones is often a culprit as well, leading to an increased response to otherwise “normal” hormone levels.  Diet also plays a major role, particularly since foods such as caffeine, alcohol, and excessive animal proteins put further strain on the liver, increasing the likelihood of PMS.

In my experience with patients, diet and lifestyle modifications alone will significantly reduce the severity of symptoms associated with PMS.  Mainly, a high fiber, low animal fat diet, combined with the avoidance of caffeine, alcohol, and refined carbohydrates, is critical for symptomatic relief.  Exercise is also recommended, as it will help to reduce fluid retention, breast tenderness, depression, and stress.  Nutritional supplements, particularly evening primrose oil, magnesium, and vitamin B6, will often help to diminish PMS symptoms, as women diagnosed with this condition tend to utilize these nutrients more rapidly.  There are also several herbal interventions available for correcting hormonal imbalances associated with PMS.

Ultimately, it’s important to recognize that PMS is not a “one-treatment fits all” scenario.  By taking a thorough diet and lifestyle history, and performing a thorough laboratory evaluation, the causes of your symptoms can be narrowed down, and treated effectively with non-pharmaceutical interventions.

Osteoporosis: Exploring the Alternatives

In the recent past, it wasn’t uncommon for most women to be placed on hormone replacement therapy (HRT) for easing the symptoms of menopause, in addition to protecting them from osteoporosis. But that standard of care has since changed with the discovery that HRT may increase the risk of breast cancer and heart disease. Without the use of HRT, it has become increasingly challenging to treat and prevent osteoporosis. Many women have turned to other pharmacological options, like selective estrogen receptor modulators (raloxifene; Evista) and bisphosphonates (alendronate; Fosamax), but these medications aren’t without their side effects, either. Raloxifene can increase the risk of blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism), while alendronate can cause severe damage to the esophagus and may increase the risk of thigh bone fracture.

With patients continuing to be discouraged about the treatment options that are being offered, they often turn to naturopathic physicians for alternatives they can rely upon, without the worry of side-effects and complications. Fortunately, there is sufficient evidence to support the benefit of these alternatives, and their use in the prevention of osteoporosis.

One of the more recent studies, conducted at the Osteoporosis Research Center at Creighton University in Omaha, Nebraska, investigated the effects of a combination isoflavone/nutrient supplement on measures of bone density in 70 post-menopausal women. For six months, the women took an isoflavone supplement plus 500 mg of calcium per day, or placebo plus 500 mg of calcium. The isoflavone supplement supplied 30 mg of synthetic genistein (one of the most widely used soy isoflavones), 800 IU of vitamin D3, 150 mcg of vitamin K1, and 1 gram of the essential fatty acids, EPA and DHA.

After six months, women in the isoflavone group maintained the same bone density at the femoral neck (a common place for fractures to occur), whereas bone mineral density at that site decreased significantly in the placebo group. Bone density was also significantly greater in the isoflavone versus the placebo group at another measurement area in the hip (called Ward’s triangle).

Isoflavones have weak estrogen-like effects in the body, which may lend them their bone-building activity. They don’t appear to have the same negative effects on hormone-sensitive tissues in the body, though, making them good candidates for osteoporosis prevention. However, while I do believe the benefits of preventing osteoporosis outweigh the risks of any potential estrogen-related side-effects, I always take an individualized approach, often avoiding the use of isoflavones in any patient who has a history of breast or other hormone-sensitive cancers.

Another recent study, published in Calcified Tissue International, revealed favorable changes in bone metabolism and bone mass indices for subjects who received additional vitamin K through either diet or supplementation, making it another viable option for osteoporosis prevention. The form of vitamin K known as phylloquinone, or K1, is the most abundant form in plants and is believed to play the biggest role in blood clotting; K2 refers to a group of related types of vitamin K known as menaquinones that are thought to be more involved in the other effects of vitamin K.This study showed that a comprehensive osteoporosis-prevention program is more effective if it includes vitamin K. Increasing your intake of green leafy vegetables, eggs, yogurt, and kefir are all natural ways to boost vitamin K levels.

So as you can see, choosing not to use the typical conventional methods for treating osteoporosis does not mean you’re at a dead end. Consult with a practitioner who is knowledgeable about the alternative treatments that are available, and know you have the power to make choices that will keep your bones healthy for years to come!

 

Can Diet Reverse PCOS?

Polycystic ovary syndrome (PCOS) is a condition that affects the hormone balance in women, favoring the production of male hormones like testosterone over female hormones like estrogen and progesterone. This imbalance can lead to symptoms such as menstrual problems and infertility. Many women with this condition also develop insulin resistance, diabetes, obesity, and cardiovascular disease.  In a new study published in the American Journal of Clinical Nutrition, blood sugar control, weight loss, and cardiac risk were all improved when women with PCOS were put on a high protein, low carbohydrate diet.

The new study included data collected from 27 women with polycystic ovary syndrome. Participants were assigned to either a high-protein diet or a standard-protein diet for six months. Both groups received regular nutritional counseling and were guided to reduce their intake of sweets and soft drinks.

The aim of the high-protein diet was to get 40% or more of each day’s calories from protein and less than 30% of calories from carbohydrate. To achieve this, women in the high-protein-diet group were instructed to replace sugary and starchy foods with either protein-rich foods like meat, eggs, fish, and dairy foods, or with vegetables, fruits, and nuts. The aim of the standard-protein diet was to get less than 15% of calories from protein and more than 55% of calories from carbohydrate. There were no calorie restrictions with either diet.

At the end of the study, the following differences between the groups were seen:

  • Women on the high-protein diet lost 4.4 kilograms (10 pounds) more than women on the standard-protein diet.
  • Almost all of the extra weight lost by the women eating the high-protein diet was body fat, not muscle.
  • The high-protein diet was associated with a greater reduction in waist circumference, indicating a greater loss of abdominal or belly fat. This type of fat has a strong link to cardiovascular disease.
  • Women on the high-protein diet had lower blood glucose and C-peptide levels. C-peptide is a protein that is linked to insulin production. These findings show that blood sugar control improved more in this group than in the standard-protein diet group.

Implementing this type of diet is one of the first things I do with patients who have PCOS, and the results are consistently rewarding. Between these dietary changes and other nutritional and botanical interventions, I’ve witnessed the naturopathic treatment of PCOS being just as, or even more effective, than the medication regime often utilized in conventional medicine. Plus, these diet changes promote longer term health benefits, particularly with respect to cardiovascular health.

If you’ve been struggling with weight gain and other complications of PCOS, and you’ve only tried medications to address it, don’t feel like your options have been exhausted. Seek out a practitioner who can give you detailed dietary instruction, a method that has now been proven to work!

(Am J Clin Nutr 2012;95:39–48)

PCOS and Diet

A recent study in the American Journal of Clinical Nutrition (Jan 2012) showed that women with PCOS who followed a higher protein diet (>40% of energy from protein), as opposed to women who consumed the “standard” amount of protein (<15% of energy from protein), were able to lose weight more effectively. The study also showed that the women on a higher protein diet were also able to maintain healthier blood sugar levels, even after adjusting for changes in weight.

This is the type of diet I’ve always emphasized with PCOS patients, and have found this to be one of the most effective means of helping these women lose weight. Clinically, I’ve also found that this diet is the single most important factor when it comes to controlling other PCOS-related symptoms, such as hirsutism and menstrual irregularities. In fact, most women are able to discontinue metformin and related prescription medications upon adhering to a higher protein diet. Other nutritional interventions (chromium, fiber, etc.) can also be incorporated, with the main emphasis being that of blood sugar control.

If you’re currently undergoing treatment with prescription interventions, and not responding well, don’t be discouraged. Seek out a practitioner who can guide you through a high protein diet, and offer some of the many other nutritional options that will be effective in the management of PCOS.

 

 

 

Pregnant Moms and Genes

This is a great article discussing how chronic stress during pregnancy can cause behavioral problems in children, especially because of epigenetics, or how the child’s genes influence their stress response:

http://www.economist.com/node/18985981

Eczema and Kids

The discovery that DHA (docosahexaenoic acid) from breast milk promotes healthy brain, eye, and nervous system development was an important step towards understanding why breast milk is a perfect first food for babies. DHA is now commonly added to infant formulas, but it’s not the only fatty acid that is important for developing babies. A new study shows that other fatty acids in breast milk may protect them from allergies.

The sharp rise in allergic diseases like asthma, eczema, food allergies, and hay fever might be explained in part by a shift in the fatty acid balance in our diets. The widespread use of vegetable oils and the comparatively low intake of omega-3 fatty acids (mostly from fish) have tipped the scales in favor of omega-6 fatty acids, which contribute to inflammation in the body.

Does breast milk affect eczema?

As part of the KOALA Birth Cohort Study, scientists investigated the composition of breast milk and its relationship to eczema and allergy development in 310 infant-mother pairs. Based on earlier findings that organic dairy seems to protect against eczema during the first two years, some of the women included led “alternative lifestyles,” meaning that they ate organic foods and breast-fed for an extended period. Researchers were interested to see how the fatty acid composition of their breast milk compared with that of moms who ate a more conventional diet.

Information related to breast-feeding, eczema, and other allergic diseases was gathered from the women while they were pregnant and during the first two years after birth. Blood samples were taken from the babies at one and two years to determine the presence of allergies to things like hen’s eggs, cow’s milk, peanut, tree and grass pollen, dust mites, and cats and dogs.

Babies benefit from fatty acid combo

Compared with the conventional diet group, the breast milk of moms with alternative lifestyles had somewhat higher concentrations of the omega-3 fatty acids EPA (eicosapentaenoic acid), DPA (docosapentaenoic acid), and DHA. The breast milk from this group was also higher in ruminant fatty acids (those derived primarily from dairy fat), including the immune-enhancing fatty acid, CLA (conjugated linoleic acid).

“Differences in fatty acid status between mothers may modify the protective effect of breastfeeding,” said Dr. Carel Thijs, lead author of the study from the Department of Epidemiology at Maastricht University in the Netherlands. “This may explain inconsistencies between studies in different populations with different intakes of fish, ruminant fats, and trans fatty acids from other sources.”

More interesting results:

By age two, 31% of the babies had parent-reported eczema, and 42% of the children with eczema also had allergies as determined by blood tests.

The risk of eczema and allergies at one year was lowest among babies whose mothers’ milk was highest in omega-3 fatty acids.

The risk of eczema and allergies also decreased with increasing concentrations of ruminant fatty acids, independent of the effect of the omega-3 fatty acids.

“Ruminant fatty acids deserve further investigations for their role in early immune development and are potential candidates to explain the protective effects of dairy fat as well as organic dairy and possibly unpasteurized farm milk on the development of atopic (allergic) conditions in early life,” the researchers concluded.

How to protect your baby from eczema

Breast-feed, if you can. For some women breast-feeding isn’t feasible, but it’s worth it for your baby’s health if you’re able to.

Eat more fatty fish. This is important during pregnancy and while breastfeeding. Avoid high-mercury fish including swordfish, shark, albacore tuna, king mackerel, tile fish, grouper, marlin, and orange roughy.

Make it creamy. The latest study adds to a growing body of evidence of the inflammation-fighting potential of full-fat dairy products.

(The study comes from Allergy 2011;66:58-67)

PMS and Essential Fatty Acids

Yet another case of naturopathic medicine being way ahead of the curve when it comes to using treatments for years before they’re eventually “proven” effective. 
Up to 95% of women suffer from at least one PMS symptom, and more than a third of these women have PMS severe enough to interrupt their routine activities. Fortunately, a new study may offer a way for women to get some much-needed relief from monthly bouts of PMS.
PUFA vs. PMS
The exact causes of PMS aren’t known, but health experts suspect that certain essential dietary fats, called polyunsaturated fatty acids, or PUFAs, may play a role. Not getting enough of and the right types of PUFAs may worsen PMS symptoms.
Researchers set out to test this theory by enrolling 120 women into a six-month study. The study authors randomly selected the women to receive a daily 1- or 2-gram PUFA supplement, or a placebo (no fatty acids).
Blood levels of cholesterol and prolactin, a hormone produced in the body that may affect PMS, were tested before and after the study. The women kept symptom diaries to track the details and severity of their PMS from month to month.
After 6 months, the researchers found that compared with the initial PMS ratings:

• Women taking the PUFA supplements had significant decreases in PMS symptoms at three and six months.

• Women taking 2 grams of PUFAs, the highest amount given, experienced the largest decrease in PMS symptoms over time.

• Women taking the placebo h
ad a small decrease in PMS symptoms at three months, but no improvement of symptoms at six months.

None of the women in the study experienced significant changes in blood levels of cholesterol or prolactin. This suggests PUFA supplements do not raise cholesterol in otherwise healthy women experiencing PMS, nor exert their anti-PMS effects through changes in prolactin levels.

Getting your essential PUFAs

If you are interested in trying a PUFA supplement, keep the following tips in mind:

• Talk to your doctor about whether PUFA supplements are right for you. Dietary supplements can interfere with medications, so err on the side of caution when adding new supplements to your self-care routine.

• The 2-gram PUFA supplements used in the study provided 420 mg of gamma linolenic acid, 350 mg of oleic acid, 690 mg of linoleic acid, 500 mg of other PUFAs, and 40 mg of vitamin E. Ask your doctor or dietitian to help you find a supplement with a similar mix of PUFAs.

• You can get more PUFAs from the food you eat as well. Try walnuts and other nuts and seeds, ground flaxseed, green leafy vegetables, tofu and other soy foods, and fatty fish, such as wild-caught salmon.

• Other lifestyle changes that may help ease PMS symptoms include getting enough sleep (seven to eight hours), exercising regularly, limiting intake of caffeine, alcohol, and sweets, and eating a healthy diet based around vegetables, fruit, whole grains, and legumes.

(Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Accessed January 20, 2011; Available at: NewsRelease_Essential_oil pill_prevents_PMS.pdf)

PCOS Patients Benefit From Exercise and Acupuncture

Acupuncture and physical exercise improve hormone levels and menstrual bleeding pattern in women with polycystic ovary syndrome (PCOS), reveals research from the University of Gothenburg, Sweden. 

PCOS is a common disorder that affects up to 10% of all women of child-bearing age. Women with PCOS frequently have irregular ovulation and menstruation, with many small immature egg follicles in the ovaries. This causes the ovaries to produce more testosterone which, in turn, leads to troublesome hair growth and acneObesity, insulin resistance and cardiovascular disease are also widespread among these patients. 

In the current study, published in the American Journal of Physiology-Endocrinology and Metabolism, a group of women with PCOS were given acupuncture where the needles were stimulated both manually and with a weak electric current at a low frequency that was, to some extent, similar to muscular work. A second group was instructed to exercise at least three times a week, while a third group acted as controls. All were given information on the importance of regular exercise and a healthy diet. 

“The study shows that both acupuncture and exercise reduce high levels of testosterone and lead to more regular menstruation,” says docent associate professor Elisabet Stener-Victorin, who is responsible for the study. “Of the two treatments, the acupuncture proved more effective.” 

Although PCOS is a common disorder, researchers do not know exactly what causes it. “However, we’ve recently demonstrated that women with PCOS have a highly active sympathetic nervous system, the part that isn’t controlled by our will, and that both acupuncture and regular exercise reduced levels of activity in this system compared with the control group, which could be an explanation for the results.” 

In my experience, women I’ve seen with PCOS respond extraordinarily well to nutritional, botanical, and dietary interventions. Plus, conventional medical treatments tend to be very “piecemeal”, treating each component of PCOS as individual symptoms, rather than addressing the body as a whole. As this study confirms, exercise and acupuncture are other treatments that can be implemented to successfully reverse PCOS.  

Supplements Shown To Reduce Breast Cancer Risk

In a randomized, placebo-controlled study involving 47 premenopausal and 49 postmenopausal women, results indicate that supplementation with a herbal formula may reduce the risk of breast cancer. The women were randomized to placebo or supplementation with a mixture of HMR lignan, indole-3-carbinol, calcium glucarate, milk thistle, Schisandra chinesis and stinging nettle, for a period of 28 days. At intervention end, a significant increase in urinary 2-OHE concentration and a trend toward an increase in 2:16alpha-OHE ratio was observed in the herbal group (Meaning that the “more harmful” form of estrogen was significantly diminished after use of this herb/nutrient combination).


While this proves that various supplements can certainly be beneficial in the prevention of breast cancer, 2 of the main ingredients (HMR lignan and indole-3-carbinol) can be found in flax seeds and cruciferous vegetables, respectively. Therefore, I would encourage all women to incorporate these foods into their diet on a regular basis, as well as supplementing with some of the herbs and nutrients mentioned above.

Source: “Effects of A Breast-Health Herbal Formula Supplement on Estrogen Metabolism in Pre- and Post-Menopausal Women not Taking Hormonal Contraceptives or Supplements: A Randomized Controlled Trial,” Laidlaw M, Sepkovic DW, et al, Breast Cancer (Auckl), 2010; 4: 85-95.