Dump the Junk: Reasons to Dump Caffeine

I recommend to all my patients that they limit caffeine intake and completely detox for at least 14 days twice per year. And I getta lotta push back. Why? Probably because mostly of my patients have some degree of adrenal dysregulation, and caffeine gets them going in the morning, and keeps them going during the day.

What's so bad about that? I took a page out of Dr. Daniel Amen's book, Change Your Brain, Change Your Body. He's the psychiatrist who is all over PBS with his cute black jeans and balding head.

Caffeine restricts blood flow to the brain. When you restrict blood flow to the brain, you get premature aging, lousy memory and brain fog.

Caffeine makes your sleep suck. Sleep, you know, is key to brain health, skin rejuvenation, repair work globally in the body, and weight management (particularly appetite control).

Caffeine dehydrates your brain and your bod. Your brain is 80% water and needs lots of water to keep hummin' along. Result? You're less likely to think quickly.

Caffeine inflames you. Amen quotes two studies which showed that 200mg caffeine (about 2 cups of coffee) raises homocysteine, a biomarker for inflammation and heart disease.


Caffeine linked to the muffin top. Come for the vanity and stay for the sanity. Caffeine raises cortisol, which makes you store fat at your mid-section for a rainy day.

So if you have not yet completely kicked caffeine, do it slowly over the next 7 days. Stay off for 14 days. Report back what happens with your sleep and executive functioning. Bet it'll change for the better. And if you think you may have adrenal fatigue, test your cortisol and DHEAS levels.

Insomnia in Perimenopause

There are very few things more important than sleep. You know that, especially if you're not getting enough.

Unfortunately, many of my fellow perimenopausal travelers in their 40s and 50s are not getting enough. Suddenly you're 44 and your sleep is disrupted by awakenings at 2am, 3am, 4am. The most common patterns fall into one of two categories of altered sleep architecture: poor sleep maintenance (the afore-mentioned awakenings, often with the mind racing and the editor telling you all the ways in which you fall short of expectations) or poor sleep latency (e.g., they have adrenal dysregulation and get a second wind at night, which keeps them up late and unable to fall asleep).

The short version for perimenopausal seekers of a good night's sleep is the following.
1. Stop all caffeine
2. Get regular cardiovascular exercise, preferably 5-6 days per week for 45 min at moderate to high effort
3. Stop all wine
4. Sleep in a room at 64 degrees F or cooler
5. Consider daily estrogen and progesterone. Micronized progesterone has been shown to be the most effective.

These simple 5 steps are non negotiables if sleep is elusive. I've had many patients retort that they just have one cup of black or green tea in the morning, or just one glass of wine at dinner. Yes, even one serving makes a difference.


Artificial lights put us out of sync with nature. Limit your exposure at night. Get all LEDs out of the bedroom. Sleep in a very, very dark room at 64 degrees. For more data on how to eat, the effect of carbs, and best ways to game sleep, consider reading TS Wiley's Lights Out. Or join our next Gottfried Center Cleanse -- it's amazing how the group structure assists us with getting off of toxins such as caffeine, sugar and alcohol, and deeply benefits your sleep.

And if you're part of our current Cleanse-in-Progress, let us know how you're sleeping!

Stress, Neurotransmitters, Hormones & YOU!

Are you less stress resilient than you used to be? More overwhelmed by your demands? Irritable and burned out?

The four of us, Drs. Abbassi, Nunley, Massey and me, have been discussing this a lot as we have seen many patients recently who have been under chronic stress for a long, long time. They have sleep problems, brain fog, and do not wake up restored in the morning.

We have many patients who recall life in their 20s: able to focus, concentrate, stay on task, cope with the exigencies of daily life. They rested and relaxed when they could, and enjoyed their time off. Now the weekend is not enough: relationships are more conflictual, home life is not the respite it used to be, achievement doesn't come as easily, which only adds to the stress.

Here are some of the results of chronic stress:

• Insomnia
• Autism
• Poor mood, mood swings
• Anxiousness, irritability, agitation, tension, panic attacks
• Difficulty concentrating, focusing or remembering
• Headaches
• Fatigue, lack of energy
• Weight issues, especially food cravings

Often these symptoms are a result of the body's difficulty responding to chronic stress. The adrenals and brain just can't keep up with the demand. The supply of feel-good neurotransmitters and hormones are limited by diet, genetics and often exposure to toxins.

One helpful approach we've found is to take the following approach:
1. Replace the hormones that are depleted or out of balance, all with bioidentical hormones, all tailored to you and your particular physiology and integrated with your risk factors and genetic disposition. This includes estrogen, progesterone, DHEA, testosterone, cortisol, and thyroid. We often use supplements and nutrition to optimize results.
2. Measure neurotransmitters and develop a customized amino acid protocol based on your results.
3. Make lifestyle and nutritional adjustments, along with refinement of bioidentical hormones and amino acids as needed in the long-term.

We've found this is the best approach for reversing the impact of chronic stress. The result? Vitality. Joy. Love. Less conflict. Connectedness to True Self. Satisfaction. Contentment.

Pre-Conception Counseling: Role of Mercury

Suddenly I am seeing lots of women who want to conceive or are pregnant already.  I am also seeing scary numbers of women with high mercury levels.  When I was getting pregnent, the brilliant advice of the CDC was "limit how much fish you eat to once per week or less."  I don't find that satisfying.

If you have metal fillings in your mouth or you eat seafood regularly, there's a good chance you might be mercury toxic.  I was and didn't know it.  You see - I have a great love for sashimi.  I ate it once/week for about a year when my office was near a glorious sushi restaurant, and since I have no metal fillings, I wasn't too concerned. Then I tested and found I was toxic.

Symptoms? Fun things such as:

emotional rage

depression

mood swings

irritability

anxiety

brain fog 

dementia

Alzheimer's disease

senior moments

memory loss

heart irregularity

shortness of breath

blood pressure problems

dizziness

numbness tremors

vision/hearing problems

MS or ALS

recurring infections autoimmune conditions

chronic fatigue

allergies/asthma

gum problems

low thyroid function

cold extremitities

unexplained weight gain

low libido (for men - poor erections)

infertility

birth defects

headaches

insomnia

lack of energy

metallic taste

As my thinking about pre-conception counseling evolves, I am integrating the importance of assessment and detoxification from heavy metals such as mercury and toxins such as xenoestrogens, chemicals in the environment that act like estrogen in your body.

I tried a lot of different mercury detox programs over the past two years since I was first diagnosed and have a few favorites.  More on that later....

I am teaming up with two other extraordinary physicians to try to raise awareness among women especially of reproductive age -- Drs. Marsha Nunley, MD and Bruce Dooley, MD.  We are planning some educational programming in San Francisco for the fall.  Stay tuned!

Sleep Problems in Women near Menopause

The following was published in Harvard Women's Health Watch.

Nighttime awakenings in menopause may be caused by sleep disorders, not hot flashes

Hot flashes aren’t anybody’s friend, but they may be getting an unfair rap for disrupting women’s sleep at midlife. Studies have often reported that sleep problems increase during the menopausal transition, reinforcing the idea that hot flashes (also called vasomotor symptoms) are to blame. But even under controlled conditions in sleep laboratories, the connection between hot flashes and sleep disruption remains unclear. Moreover, in certain circumstances, vasomotor symptoms may be the result — not the cause — of nighttime awakenings. Now, a study concludes that some of the sleep problems that women typically attribute to hot flashes may instead be caused by primary sleep disorders such as apnea. The findings suggest that women may not be receiving appropriate treatment for their sleep difficulties.

To determine the cause of poor sleep in peri- and postmenopausal women, researchers at Wayne State University School of Medicine in Detroit assessed the sleep of 102 women, ages 44 to 56, who reported having trouble sleeping. Participants were interviewed about their sleep histories, and they completed questionnaires to evaluate mood and sleep quality. In the sleep laboratory, subjects were hooked up for one night to recording devices, allowing researchers to collect data on participants’ skin temperature, skin conductance (a measure of sweating), blood flow, respiration, leg movements, eye movements, brain-wave activity, and muscle movements in the chin.

The researchers found that 31 women had periodic limb movements (PLM), 23 had sleep apnea, and six had both. In other words, 53% had a primary sleep disorder. Among the entire group, 56% had measurable hot flashes. A separate analysis of the data showed that while apnea, PLM, and brief awakenings were the best predictors of poor sleep in the laboratory, on the questionnaires completed beforehand, poor sleep was more likely to be associated with anxiety and hot flashes during the first half of the night. (In an earlier study, the Wayne State researchers, led by Dr. Robert R. Freedman, showed that hot flashes wake women in the first half of the night but not the second.)

PLM, a significant cause of daytime sleepiness, is characterized by contractions of the limb (usually the leg) at regular intervals during sleep and in roughly the same way: the big toe and ankle tighten and flex, sometimes followed by the knee and hip. Limb movements occur about every 20 to 40 seconds, typically during the first half of the night. Sleep apnea (also a major cause of daytime sleepiness) is shallow breathing or the cessation of breathing for brief periods during sleep. Untreated, it can boost blood pressure and lead to cardiovascular disease.

The Wayne State investigation is the first to examine menopausal sleep complaints using both objective and subjective measures. The study was small and may not be representative of all menopausal women with sleep complaints. But the finding that half the women in this sample had primary sleep disorders, not just hot flashes, bears further investigation. Sleep problems are often assumed to result from hot flashes, but treating hot flashes isn’t likely to resolve a serious underlying sleep disorder.