Sunday, November 30, 2014

Confused Over Estrogen? You’re Not Alone ...

“Who needs estrogen? Doesn’t it cause breast cancer, strokes and heart attacks?” That is the general public consensus over the past 12 years since the Women’s Health Initiative headlines announced

“Hormone replacement therapy (HRT) associated with a 38% increase in stroke risk.” Though that is a pretty scary headline, it’s not relevant for most women considering HRT.

It is very easy for a younger woman to say “I am not going to take hormone replacement therapy (HRT) when I go through menopause. I’m going to age naturally.” However, when that same woman starts experiencing perimenopausal and menopausal symptoms, she may change her mind. Not all women need hormone replacement therapy when they go through menopause. But some do. For some women, HRT—including estrogen—is essential for a full, productive and joyful life.

First let’s look at how menopause progresses. Menopause is actually when the ovaries stop producing sufficient amounts of progesterone and estrogen for a woman to have a period. Blood estradiol (E2) levels drop below 40pg/mL and follicle-stimulating hormone (FSH) rises above 28-35. This causes hot flashes, night sweats, mood and memory problems, more bodily pains and other symptoms. Frequently these symptoms ease off over time; unfortunately, accelerated aging has already begun.

And that is not all that is going on in menopause. Menopause also is a veritable stress test on a woman’s adrenal glands. These are the small pyramid-shaped glands that sit on top of each kidney. They are the organs that help us respond appropriately to a specific stress. These daily stresses are short lived, hopefully. Then there are bigger chronic stresses...not enough money, job loss, a marriage that turns sour, aging parents or a special needs child. All these demand more work from your adrenal glands day in and day out.

Normally as the ovaries begin shutting down, a healthy woman’s adrenal glands start producing extra steroid hormones that swim into the woman’s fat and are made into estrone (E1)—a weaker estrogen than E2 that is made by the woman’s ovaries. Some women will do just fine on these modest levels of estrone as their ovaries slowly shut down. These are the women who will say, “What’s the big deal? This is so easy. I like not having periods. I’m not having hot flashes, I feel fine.”

On the other hand, some women are chronically exhausted and do not have any reserve. Their adrenal glands are already working at maximum capacity already. These women may start experiencing many disabling symptoms because their adrenals cannot ramp up enough to cover the woman’s estrogen needs.

What determines the severity of symptoms as women progress through menopause?
Lifestyle makes a huge difference. Dr. Thierry Hertoghe, a fourth generation endocrinologist in Belgium, recommends certain lifestyle changes. Adopting the following habits before or during menopause will reduce symptoms. Optimal hormone production of estrogen, progesterone, testosterone, and even growth hormone depends upon eating an adequate number of calories and following a Paleolithic diet with animal protein and a variety of foods which are preferably organic. Adequate body fat and a healthy weight enhance hormone production. Avoiding alcohol, a vegan diet, tobacco, marijuana, caffeine, sugar, dairy products, cereal grains including wheat, and too strenuous physical activity all improve symptom control in menopause.

It’s also important to balance adrenal and thyroid hormones. Too much or too little will profoundly affect menopausal hormones.

Lastly the rate of fall of hormone levels is critical. Premenopausal women who have their ovaries removed or women who are acutely stressed emotionally or physically may go into full-blown menopause with incapacitating symptoms. Both may need HRT in the short-term to let their bodies adjust.

What are symptoms of estrogen deficiency?  
Increased fatigue 24/7, which is always there. It doesn’t vary with the time of day. Low-grade depression. Loss of libido. Poor memory—especially for nouns and people’s names. “Remember to bring the... the... thingamajig!” Poor short-term memory “Why did I walk into this room?” Hot flashes, especially when stressed out. Night sweats that may be mild or drenching but always wake you up interfering with sleep. Joint pain, osteoarthritis. Bladder infections. Vaginal dryness or itching. Decreased vaginal lubrication during sexual intercourse. Heavy, light or irregular periods.

For some women, symptoms may start as early as the late 30s or early 40s. By age 51, the average age of the last period, most women have had many of these symptoms for some time. Without HRT, some women will continue to experience severe symptoms and accelerated aging for years. Some women never stop having hot flashes and night sweats. These come from the brain. Not the skin. It is a strong indicator that these women may benefit from estrogen therapy. For others, symptoms may diminish, but they too will still experience some accelerated aging.

What are the physical signs that a woman can see in the mirror?
Pale face and skin. Dry mouth and eyes. Dry, dehydrated skin. Small, thin vertical wrinkles above the upper lip and at the corner of the eyes. Smaller, droopy breasts. Loss of hair on the top of the head and loss of body hair. And increased facial hair due to persistently normal testosterone levels as estrogens drop.

Tuesday, November 4, 2014

An Integrative Approach to Kidney Stones

Kidney stones are a common occurrence in the USA; statistics indicate that 1 in 9 adults will have a kidney stone in their life time. The tiny stones may pass unnoticed but a larger stone can induce excruciating pain – possibly the worst pain a person can experience. And once someone has had a kidney stone, there is a 50% chance of a reoccurrence. Men have more kidney stones than women and Caucasians are more prone than African Americans.
It’s interesting to note that North Carolina has the highest incidence of kidney stones in the nation! White collar workers have the highest incidence among North Carolinians. It has been speculated that high consumption of ice tea and tea's calcium oxalate levels is the cause. Another theory is the high mineral content in well water throughout the state.
What Are Kidney Stones?
Kidney stones (renal calculi) are solid, rock like material formed from mineral salts that crystallize anywhere in the kidney and may break loose and lodge anywhere along the urinary tract. A kidney stone with a diameter less than 5 mm (about 3/16 of an inch) will usually pass without the need for surgery. Even so, these stones can be painful. The larger stones may lodge in the ureter, bladder, or urethra. Lodged stones block urine flow completely and may cause extreme pain. In addition to the pain, long-term blockage of urinary structures can cause hydronephrosis, a condition that occurs when a kidney becomes swollen due to the failure of normal drainage of urine from the bladder. Lab values may reflect decreased kidney function via an increase in creatinine levels.
Signs and Symptoms
Symptoms include sudden extreme cramping pain that comes in waves in the lower back and the side. The pain can move down into the abdomen and into the groin area. Nausea and vomiting may also come in waves. Blood in the urine may turn it pink, red or brown. Because the stones block or decrease urine flow, urinary tract infections (aka UTIs) are common. Symptoms of a UTI include urine that becomes cloudy in appearance and has a bad odor. Burning and a frequent “need to go” sensation are common, and fever and chills also commonly present. Any of these symptoms require evaluation by a physician.
Types of Kidney Stones
Calcium Oxalate
Calcium oxalate is the most common type of stone; 60% to 65% of kidney stones are comprised of calcium and oxalic acid, which form calcium oxalate crystals inside the kidneys. Some people are genetically predisposed to excreting high levels of oxalate in the urine (thus increasing the incidence of kidney stones), but this is not commonly the case. Instead, the lack of a beneficial bacteria found in the colon, called Oxalobacter formigenes, and/or uncombined intestinal oxalic acid are the culprits for calcium oxalate kidney stones. During normal digestion, calcium crystaizes with oxalate, never gets absorbed, and is eliminated in the stool. Oxalobacter formigenes uses oxalate as a source of energy, reducing the amount of oxalate in urine. A loss of Oxalobacter formigenes may result in elevated concentrations of urinary oxalate, increasing the risk of forming a calcium oxalate kidney stone.
Taking antibiotics is one contributor to the loss of Oxalobacter formigenes from the colon's natural bacterial flora; however, studies show that when Formigenes is taken as a probiotic, it can re-establish itself in the gut and reduce the urinary oxalate concentration, thereby possibly reducing the incidence of calcium oxalate kidney stone formation.
Oxalic acid passes through the intestinal wall, into the blood and enters the kidneys where it combines with calcium to make a calcium oxalate crystal. Therefore, if it is combined with dietary or supplemental calcium (i.e. calcium citrate) inside the intestinal tract, oxalic acid will never reach the kidneys (and calcium oxalate kidney stones cannot be formed). Oxalate is mostly found in fruits and vegetables. Vegetables high in oxalate include spinach, greens (including beet greens), beet roots, okra, leeks, parsley, cocoa, nuts, green and black tea, wheat bran and soybeans. Fruits with high oxalate include berries, plums, currants, kiwifruit, concord grapes, figs, and tangerines.