Friday, November 23, 2007

Get Your Vit D Level Checked

Hi, Friends. We are in the midst of an epidemic of low Vitamin D levels yet the bad news is that conventional physicians rarely check them. Demand your "25-OH-Vitamin-D" level now! Below is a link to a great article from the New England Journal of Medicine from July - a review of the importance of Vitamin D. Basically 50,000 IU per day is too much and the dose that is recommended keeps going up higher and higher. Check your level to see if you're getting enough from sun, food sources and/or supplements.

Here's the link to the article:

Wednesday, November 21, 2007

Female Brain & Stress

Check out this new study that shows the female brain reacts to stress differently then the male. Maybe this will help us understand the double rate in depression in women vs. men. The bottom line is that in women, the LIMBIC SYSTEM (our prehistoric part of our brains that is the controller of emotions) activates under stress. A longer-lasting response was seen in women. And what about our adrenals?

STUDY RESULTS--Penn researchers use brain imaging to demonstrate how men and women cope differently under stress

**Findings have implications for identifying gender differences in mood disorders

PHILADELPHIA – According to a study that appears in the current issue of SCAN (Social Cognitive and Affective Neuroscience), researchers at the University of Pennsylvania School of Medicine discuss how men and women differ in their neural responses to psychological stress.

“We found that different parts of the brain activate with different spatial and temporal profiles for men and women when they are faced with performance-related stress,” says J.J. Wang, PhD, Assistant Professor or Radiology and Neurology, and lead author of the study.

These findings suggest that stress responses may be fundamentally different in each gender, sometimes characterized as “fight-or-flight” in men and “tend-and-befriend” in women. Evolutionarily, males may have had to confront a stressor either by overcoming or fleeing it, while women may have instead responded by nurturing offspring and affiliating with social groups that maximize the survival of the species in times of adversity. The “fight-or-flight” response is associated with the main stress hormone system that produces cortisol in the human body – the hypothalamic-pituitary-adrenal (HPA) axis.

Thirty-two healthy subjects – 16 females and 16 males – received fMRI (functional Magnetic Resonance Imaging) scans before, during and after they underwent a challenging arithmetic task (serial subtraction of 13 from a 4 digit number), under pressure. To increase the level of stress, the researchers frequently prompted participants for a faster performance and asked them to restart the task if they responded incorrectly. As a low stress control condition, participants were asked to count backward without pressure.

The researchers measured heart rate, cortisol levels (a stress hormone), subjects’ perceived stress levels throughout the experiments, and regional cerebral blood flow (CBF), which provides a marker of regional brain function. In men, it was found that stress was associated with increased CBF in the right prefrontal cortex and CBF reduction in the left orbitofrontal cortex. In women, the limbic system – a part of the brain primarily involved in emotion – was activated when they were under stress. Both men and women’s brain activation lasted beyond the stress task, but the lasting response in the female brain was stronger. The neural response among the men was associated with higher levels of cortisol, whereas women did not have as much association between brain activation to stress and cortisol changes.

“Women have twice the rate of depression and anxiety disorders compared to men,” notes Dr. Wang. “Knowing that women respond to stress by increasing activity in brain regions involved with emotion, and that these changes last longer than in men, may help us begin to explain the gender differences in the incidence of mood disorders.”

Sunday, November 18, 2007

Zits? I'm 40!

I met a beautiful 40-something woman at a party last Friday who confided that she needs to do something about her acne besides the birth control pill that her GYN is offering. Honestly, I thought she was gorgeous but I don't argue with women who fret about their skin -- I can relate.

Don't do it, Girlfriend!

While sometimes there is a time and a place for a birth control pill, this is not one of them.

Acne is usually due to an imbalance in the family of hormones called androgens, which include testosterone and DHEA among others. We think of androgens as "boy" hormones, but women have and need levels in their blood (although only about a tenth of those in men). We know that testosterone is crucial for women's maintenance of mood, sense of well-being and to see a decent response in the body to exercise. We're not talking Barry Bonds levels - we're talking testosterone and DHEA in balance such that it is not too high and not too low.

Many of us find more zits on our skin as we enter peri-menopause, which can feel like puberty in reverse. It's especially fun when you are sharing your anti-acne skin-care products with your kids.

What causes acne?

Step 1: stimulation of the oil-making (sebaceous) glands by testosterone.

Step 2: the pores get plugged and trap the oil inside. Bacteria grow in the trapped oil, causing the production of irritants.

Step 3: your immune system finds out. Like with most things in the body, this is good and bad news. Your army of immune cells fights the bacteria, and that renders the redness, swelling, pus-like fluid and later scarring. Pretty! This is the part we would all love to skip.

Most women notice that their acne is worse in the week before their period. We believe this is related to your testosterone peak at day nine but the mechanism is not well understood.

If have "bumps" as my older daughter calls them and are reading this post, it is likely that the standard approaches have not cleared your skin. Good news here: treatments aimed at the hormonal cause often work when standard ones have not.

One specific type of hormonal imbalance associated with acne that deserves mention is the poorly-named polycystic ovarian syndrome or PCOS, a common disorder in reproductive-aged women. One of the main symptoms of PCOS is testosterone-induced skin and hair changes, which include acne, hirsuitism (increased facial and/or body hair) and sometimes scalp hair loss or thinning. Other symptoms are irregular periods or anovulatory (no ovulation to the rest of us) cycles, difficulty controlling weight and metabolic changes such as insulin resistance. Female acne can be a sign of PCOS. If you have some of these additional symptoms, consider getting evaluated for PCOS.

On the other hand, many women with hormonal acne have just simple acne, nothing else, and benefit from a hormonal assessment (usually saliva or blood testing), and balancing of any existing hormonal disorders with bioidenticals. While it is true that a birth control pill will lower your testosterone and make your skin more clear, it also lowers your libido and may have long-term risks associated with synthetic hormones.

Save Raw Milk! Send Email to Gov. Schwarzenegger

Dear Friends,
Many of you know that I am a follower of Nourishing Traditions, the way of eating that is based on the work of Weston Price and I believe helps us restore hormone balance and keep our kids healthy. Below is a fervent call to ask you to help our crusade to save raw milk in California from a new bill that will remove it from our grocery shelves. Please take a few moments like I have to write or email the Governor or just read about the health benefits of raw milk. Below is a letter from Kris Brewer who brought this important fight to my attention. If you want to read more about raw milk and its many positive effects, check out:

Hello friends et al,

I am disturbed by recently passed legislation that, effective January 2008, will eliminate consumer access to raw organic milk. My family and I drink this daily and since we started drinking it, my youngest has ceased having terrible asthma, and my husband's hands and feet no longer ache from rheumatoid arthritis! As many of you know, there are many benefits to consuming raw milk and many health problems linked to drinking pasteurized milk.

I am working actively to get the word out to help fight/reverse this legislation which was passed in secret without the input of the small, organic raw dairy farmers or consumers. I am in touch with Colette Cassidy, of Claravale Dairy (small, 55 cows, supplying clean raw milk for 80 years) about the crisis at hand and gathering information from various sources. I want to strongly encourage people to speak up and act NOW before we can no longer get this milk in the stores. Below are some important links on this-

Thanks for your timely reading, acting and passing this on to others.

Kris Richardson Brewer

Representing Bay Area Raw Milk Consumers


"In California, raw milk is a sacred food. The consumption of raw milk is an intentional act and not done by error or mistake. Consumption of raw milk is a freedom preserved by longstanding California Food and Agriculture Code #35928 (F). This venerable raw milk law makes restriction of California raw milk illegal. Our arguments stand on solid ground. Even though the CDFA has promised full cooperation, it is still early in this process and many turns lay ahead. Look for updates on this historic showdown, and keep supporting the struggle to protect your fundamental right to eat any whole, unprocessed, natural food of your choosing. In another secret legislative process earlier this year, you lost your right to buy truly raw almonds at the grocery store. Let this not be the year we also lose raw milk! "

Call to Action: Green Your Lifestyle, Attitude & Behavior

We need to transform how we live in the world. We must do this in the next two to three years, or it will be too late. A new synthesis of the world literature by the United Nations group that was awarded the Nobel Peace Prize last month is a brave and inspiring call to action.

My husband and I were reading the New York Times this morning, which is to say that we were getting about one minute of focused concentration before our toddler would need us. We felt that much of our mounting alarm and wish for expeditious intervention to lessen climate change was reflected in a new document (check it out at called the Synthesis Report of the United Nations Intergovernmental Panel on Climate Change.

What inspired me about the article on page 3 of the front sections were the following:
1. The synthesis report was approved by 130 nations. That's not easy when you are aware of the science involved.
2. It is personal -- the cost of action is less than the cost of inaction, to paraphrase Jeff Sachs of Columbia University's Earth Institute. We need to get rid of our two cars (and just keep the Prius), we need to make our homes energy-efficient, we need to walk and bike when we can, we need to think carefully about our consumption and it's effect on climate change, we need to figure out how best to model this for our kids and encourage them to join us on the path of earth stewardship. We need to find ways to integrate social justice into the movement so it's not just the upper classes who are able to afford to "green" their homes, lives and closets.
3. Achim Steiner - head of the UN Environment Program - wants this message sent to individuals and not just world leaders: "What we need is a new ethic in which every person changes lifestyle, attitude and behavior."

My husband and I have been paying a lot of attention to "greening" our lives over the five years we've been together. He regularly uses a tool he invented from his developer days -- a "Life Balance Sheet" as a way of benchmarking his place in the world and how he's contributing to the triple bottom line of green. We are deep in the design of a deep-green remodel of a small bungalow in our hometown of Rockridge here in Oakland. We are trying to be mindful of our mutual tendencies to be overachieving and under-relaxed, and how this affects our health, connection and our kids. This is my corner - the intersection of health and green. We are lessening our carbon footprint, although some experiments are more successful than others.

Meanwhile, the UN report pumps up the urgency. I would love to hear from other moms, yoginis and fellow warriors who have figured out how to lessen the carbon footprint of driving our beautiful kids many miles to the glorious schools we've chosen for them. I've found carpooling to be much harder to pull off than it should be -- perhaps again getting to Mr. Steiner's comment about us needing a new ethic of lifestyle, attitude and behavior, so that driving our kids to school is less about our individual needs, schedule and convenience, and more about modeling for our kids our willingness to try new things to do our part in reducing climate change.

Get inspired, do your part. Walk the talk. Tell us about it. Namaste and blessings, SG.

Friday, November 16, 2007

Birth Control Pills & Breast Cancer?

We have more data now on the ongoing body of work on whether the synthetic hormones in birth control pills cause breast cancer. You'll notice in my other blog a recent study showing an increased risk ( In the spirit of unbiased opinion -- here is a recent study showing no increased risk, although remember that The Pill is proven to lessen libido.

Do Oral Contraceptives Affect Risk for Death from Breast Cancer?

OC use had neither a beneficial nor a harmful effect on breast cancer mortality.

The relation between oral contraceptive (OC) use and breast cancer risk remains under constant surveillance. To study the effects of OC use on risk for death from breast cancer, investigators analyzed cancer registry data from the Surveillance, Epidemiology, and End Results Program in conjunction with linked data from the population-based, case-control Cancer and Steroid Hormone (CASH) study. Fifteen-year survival was assessed in 4292 women who had been diagnosed with breast cancer and who were interviewed about reproductive contraceptive and disease history, family history, and personal characteristics and behaviors during the CASH study (conducted from 1980 through 1982).

During the 15-year follow-up, 1473 of the women died from breast cancer; 80% survived for 5 years, 70% for 10 years, and 64% for 15 years. Compared with women who had never used OCs, the relative risk for death from breast cancer in ever-users was less than 1.0 (adjusted hazard ratio, 0.94; 95% confidence interval, 0.83–1.06). Neither duration of use nor age at first use affected the risk for death from breast cancer. Adjusted analysis showed that stage of disease at diagnosis did not affect the relation between breast cancer mortality and time since first and last use of OCs. Women who were currently using OCs at diagnosis had a statistically insignificant adjusted HR of 0.90.

Comment: These researchers did not address the association between oral contraceptive use and breast cancer diagnosis but rather the effect of OCs on breast cancer mortality. One limitation of the study is that it did not take into account estrogen- or progesterone-receptor status or the presence of BRCA mutations or HER2/neu _expression. Nonetheless, these results provide reassurance that prior use of OCs is not associated with increased mortality from breast cancer.

— Sandra Ann Carson, MD
Published in Journal Watch Women's Health November 15, 2007


Wingo PA et al. Oral contraceptives and the risk of death from breast cancer. Obstet Gynecol 2007 Oct; 110:793.

Original article (Subscription may be required)
Medline abstract (Free)

Monday, November 12, 2007

Natural Therapies for Menopause & BV

Here are some new studies on natural therapies for menopause symptoms as well as bacterial vaginosis (BV), with commentary from Toni Hudson, ND.

Black Cohosh, with or without St. John's wort and menopause symptoms

Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin H. Black cohosh with or without St. John's wort for symptom-specific climacteric treatment-Results of a large-scale, controlled, observational study. Maturitas 2007; 57(4):405-414.
This was a prospective, non-randomized, open-label observational study conducted in Germany over two years. The purpose of the study was to evaluate the use, safety and effectiveness of black cohosh alone or in combination with St. John's wort on menopausal symptoms.

6141 women at 1287 outpatient gynecology offices were treated with recommended doses of Remifemin (an isopropanol extract of black cohosh), 1 cap bid, or Remifemin in combination with St. Johns wort, 1 or 2 tablets bid, at the discretion of the clinician.

Treatment responses were assessed using the menopause rating scale (MRS), an established standard symptom rating scale for evaluating menopausal symptoms. The primary effectiveness variable was the change in the MRS subscore of psychological symptoms (including depressive mood, nervousness, irritability, impaired performance and memory) from baseline to month three.

Of the enrolled women, 3027 received the black cohosh only, and 3114 received the black cohosh/St. John's wort combination. During the study, 244 women changed treatment from monotherapy to the combination product, and 87 women changed from the combination product to monotherapy.

The differences in baseline symptoms between the two treatment groups indicate different indications for use. Prior to treatment, the women receiving the combination therapy had significantly worse psychological symptoms than those in the black cohosh only group. The symptoms in both groups were mostly mild to moderate and mostly included hot flushes, sleep disorders, nervousness and depressive mood, which were moderate in severity.

The symptom scores improved in both groups. The changes in the psychological symptoms were greater in the combination therapy group than in the black cohosh only group at months 3 and 6. With both treatments, the greatest effects were seen with hot flashes and night sweats. Improvements in symptoms were evident at month 3, and were greater at month 6.

Both treatments were very well tolerated. The rate of adverse events related to the treatments was very small, at 0.16% or 10 cases. Seven cases were in the black cohosh only group and three were in the combination group.

Commentary: The results from this large study support the effectiveness of black cohosh preparations alone or in combination with St. John's wort for relief of common menopausal symptoms such as hot flushes, nightsweats and psychological symptoms. The combination of the two herbs appears to be the best approach for menopausal symptoms that include depressive moods, nervousness, irritability, and impaired memory.

Soy nuts and menopause symptoms

Welty F, Lee K, Lew N, et al. The association between soy nut consumption and decreased menopausal symptoms. J Women's Health 2007;16(3):361-369

Sixty postmenopausal women were randomized in a crossover trail to either a therapeutic lifestyle changes (TLC) diet alone or a similar TLC diet which included one-half cup soy nuts containing 25 grams of soy protein and 101 mg of isoflavones, divided into 3-4 doses throughout the day. For each 8-week time period, study subjects recorded the number of hot flashes.

In women with more than 4.5 hot flashes per day, the TLC diet plus soy nuts was associated with a 45% decrease in hot flashes, when compared to the TLC diet alone. With treatment, there were 4.1 hot flashes per day in the TLC plus soy nut group vs. 7.5 hot flashes per day in the TLC diet alone group. Soy nuts were also associated with a significant improvement in other menopausal quality of life issues including psychosocial symptoms.

Commentary: Numerous previous studies have shown inconsistent reductions in menopausal symptoms with soy preparations, whether it be soy foods, soy beverage, soy powders or soy isoflavone capsules/tablets. This study suggests that the complex of the whole soybean with its significant soy protein and isoflavone content is responsible for the improvements in symptoms, which weren't seen in other studies using processed soy products.
Dietary nutrients and Bacterial Vaginosis
Neggers Y, Nansel T, Andrews W, et al.
Dietary intake of selected nutrients affects bacterial vaginosis in women. J Nutrition 2007;137:2128-2133.

Diet and the presence of bacterial vaginosis (BV) was studied in a subset of 1521 women, 86% of whom were African American, from the Longitudinal Study of Vaginal Flora. Women were assessed at baseline and quarterly for one year for up to 5 visits. Vaginal flora was evaluated by Gram stain according to Nugent criteria. The Nugent score is derived from estimating the relative proportions of bacterial morphotypes to give a score between 0 and 10. A score of <4>6 is bacterial vaginosis. BV was defined as a Nugent score > 7 while severe BV was defined as a Nugent score of > 9 and with vaginal pH of > 5. At each visit, patients also completed a questionnaire and had a standard pelvic exam. Dietary analysis was conducted by the Block Dietary Data Systems, which analyzes for energy, nutrients, and various vitamin and mineral intakes.

The prevalence of BV was 41.8% and severe BV, 14.9%. Both BV and severe BV were significantly more prevalent in African-Americans than in Caucasians.

After adjusting for demographic and behavioral variables, total energy intake was 50% higher in those with BV, yet still only marginally associated with BV. Only total fat intake was significantly associated with BV. Total fat, saturated fat and monounsaturated fat intakes were significantly associated with severe BV. Protein intake was significantly inversely associated with severe BV.

There were significant inverse associations between severe BV and the intakes of folate, vitamin E and calcium. When the 17.6% of women who had persistent BV were compared with the 15.2% who had remitting BV, none of the macro- or micronutrients was significantly associated with the overall incidence of BV

Commentary: This was the first study that I have seen that has evaluated the relationship between BV and total nutritional intake. In this study, total fat intake was a significant predictor of BV. The risk of severe BV was more than twice as high in women who were in the highest quartile of intakes of total fat, saturated fat and monounsaturated fat.

Previous studies that looked at the relationship between BV and specific micronutrients such as vitamins C and A have shown no significant association. In the current study, the most striking finding was the relationship between dietary fat and BV. The mechanism for this is unclear but a high fat intake, especially saturated fat, may alter vaginal microflora and increase vaginal pH, which would then increase the risk of BV. Another possible mechanism may be explored by looking at the role that high fat intake has on intestinal mucosa. We have other evidence that high fat intake modulates immune function in the intestinal mucosa. It is plausible then that high dietary fat intake may affect the mucosal immune system in other parts of the body, such as the vagina, and by doing so, may increase the risk of BV.

Hormones and Libido

Over 70% of women with low libido have a hormone imbalance. This is a great paper on our current thoughts about libido in natural and surgical menopause. The paper is open access, so go to the website below, click on “Women’s Health”, May 2006, Vol 2, No 3, and scroll down to find the paper. Below is the abstract and authors.
Women's Health
May 2006, Vol. 2, No. 3, Pages 459-477
Testosterone and libido in surgically and naturally menopausal women
Jeanne L Alexander
1, Lorraine Dennerstein 2, Henry Burger 3 & Alessandra Graziottin 4,5,6
iser Permanente Medical Group of Northern California Psychiatry Women’s Health, Kaiser Permanente Medical Group, 1700 Shattuck Avenue, Suite 329, Berkeley, CA 94709, USA.
2Office for Gender and Health, Department of Psychiatry, The University of Melbourne, 4th Floor, 766 Elizabeth Street, Melbourne, VIC 3010, Australia.
3Prince Henry's Institute of Medical Research, Monash Medical Center, Clayton, VIC, Australia.
4Center of Gynecology and Medical Sexology, Hospital San Raffaele Resnati, Milan, Italy
5Department of Obstetric and Gynecology, University of Florence and Parma, Italy
6Post-graduate Course in Sexual Medicine, University of Florence, Italy.
† Author for correspondence

The assessment and then treatment of a change in libido, or a change in the desire to partake in sexual activity, during the menopausal transition and beyond has been a challenging and elusive area of clinical research. This is partly due to the multidimensional nature of female sexuality, the difficulties of measuring testosterone in women in a reliable and accurate manner, and the complexity of the neurobiology and neurobehavior of female sexual desire. In addition, there is a lack of evidence for diagnostic specificity of low free testosterone levels for the symptom of low libido in women for whom there are no confounding interpersonal or psychological factors; although, in the symptomatic population of surgically or naturally menopausal women, a low level of free testosterone often accompanies a complaint of reduced desire/libido. The randomized clinical trial research on testosterone replacement for naturally and/or surgically menopausal women with sexual dysfunction has been criticized for a high placebo response rate, supraphysiological replacement levels of testosterone, the perception of modest clinical outcome when measuring objective data such as the frequency of sexual intercourse relative to placebo, and the unknown safety of long-term testosterone replacement in the estrogen-replete surgically or naturally menopausal woman. A careful review of current evidence from randomized, controlled trials lends support to the value of the replacement of testosterone in the estrogen-replete menopausal woman for whom libido and desire has declined. The issue of long-term safety remains to be answered.

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About Me

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I'm an organic gynecologist, yoga teacher + writer. I earn a living partnering with women to get them vital and self-realized again. We're born that way, but often fall off the path. Let's take your lousy mood and fatigue, and transform it into something sacred and useful.