Dr Gigi Chow

Archive for the ‘Hormonal Health’ Category

IBS: One Diagnosis, Many Causes

In Diet, Hormonal Health, Stay Healthy on August 15, 2013 at 6:17 pm

As many as 20 percent of American adults have some symptoms of irritable bowel syndrome (IBS), according to the National Institute of Health. IBS is an umbrella term for a wide range of symptoms that affect the entire digestive system. Sufferers commonly report symptoms such as alternating constipation and diarrhea, painful cramps and spasms, abdominal bloating, nausea, acidity, heartburn or a sensation of fullness very soon after eating even a small meal. For many, trips to the GI doctor, colonoscopies and medications offer little relief to their digestive symptoms because the cause(s) of IBS have not been identified. It is important to look at the potential triggers of IBS since proper identification will lead to greater success in treating this uncomfortable condition.

The link between emotional states and physical symptoms is well documented and this is particularly apparent with gut problems. There are a multitude of nerve endings in the gut and it is often called the second brain for this reason. Emotional stress, particularly if prolonged, will have negative impact on the gut. Nonetheless, the presence of IBS symptoms is likely to cause stress, depression or anxiety so then the vicious cycle between stress and abdominal symptoms continue. Nutritional supplements, yoga, meditation and acupuncture can all help alleviate and improve the stress response.

Food Intolerance
Intolerance to one or multiple foods can be a factor in IBS. Food intolerance is different from food allergies.  Most people have food intolerances and not food allergies. When you’re allergic to a food, it means that when you eat it, your immune system misidentifies it as dangerous and sends out antibodies to fight off its proteins. You suffer allergic symptoms such as scratchy throat and swollen tongue as a result of the battle between the allergen and the immune system. Meanwhile, if you have food intolerance, your body has trouble digesting the foods. Your inability to break down large food chunks results in unpleasant side effects such as bloating and abdominal pain. It can be frustrating, confusing and time-consuming trying to figure out food intolerances on your own. Getting a food intolerance test to identify your food intolerances may be very helpful.

Leaky Gut
The lining of a healthy gut wall is designed to allow through tiny molecules that we obtain from food digestion. These molecules, such as glucose and amino acids, are used by the body to convert into energy or as building blocks for hormones and muscle cells. However, if the gut becomes damaged or “leaky” and  inflamed, larger than usual food molecules are able to pass through its lining. When these food particles come into contact with the blood, they can provoke an immune reaction. Leaky gut undoubtedly can play a role in IBS. Many supplements can assist in repairing a leaky gut.

Low Stomach Acid
Stomach acid is secreted by the stomach to digest food, especially protein. Stomach acid protects us from parasites and other infections as well as helps with the absorption of minerals such as calcium, magnesium, iron, copper and zinc. Stomach acid may decrease with age and stress. Prescription and over-the-counter medications such as Nexium and Prilosec can also suppress stomach acid. Without enough stomach acid, food is not digested properly and undigested food can sit in your stomach and intestines for a prolonged period of time and lead to bloating and pain.

Intestinal Flora Imbalance
Also known as dysbiosis, gut flora imbalance can result from the use of antibiotics, GI infections from overseas travel, GI surgery, the use of acid-suppressing medications, chronic constipation, chronic mental/emotional stress, the use of oral birth control pills, poor diet, cigarettes/alcohol or food sensitivities/imbalance (please see above). Once the flora is out of balance, undesirable organisms including yeasts and parasites may start to multiply and crowd out the “friendly” bacteria even further.  Bacterial balance can be positively influenced by the right foods and supplements.

Yeast Overgrowth
Normal intestinal flora contains some yeasts but for some people, yeast becomes problematic as it develops into a form which can spread through the gut and elsewhere in the body. Candida albicans is one such yeast and its presence can contribute to a range of physical and mental symptoms including bloating, gas and many other symptoms related to IBS. The presence of candida can be assessed by an elimination diet as well as stool/urine tests.

If your stomach has never been the same since traveling abroad, parasite infection could be a factor in your symptoms. A test known as Comprehensive Digestive Stool Analysis (CDSA) can be helpful here because this test can detect hard to find parasites, the presence of candida and incorrect bacterial balance.

Hormonal Imbalance
Lots of women notice that their IBS symptoms are worst just before their periods. Why this occurs is not clear, but it may have to do with the balance of progesterone and estrogen during the second half of the menstrual cycle (that is, from ovulation onward). Progesterone is relatively high at the end of the cycle, then drops off suddenly just before menses. Progesterone in general slows gut motility and many women notice more constipation and abdominal discomfort in the week or two prior to the onset of their menses. It’s possible that when the ratio between these progesterone and estrogen is off and sluggish bowels could in turn worsen pelvic congestion, cramping, and abdominal distention. Salivary hormone testing here can be helpful in determining whether your hormones are in balance and whether an imbalance is a potential cause of IBS symptoms.
Please feel free to contact me via my website if you have any questions or if you would like to schedule a consultation to discuss your IBS symptoms, testing and treatment.

Study Links Autism With Antidepressant Use During Pregnancy

In Hormonal Health, Stay Healthy on April 23, 2013 at 12:47 am

From the New York Times http://parenting.blogs.nytimes.com/2013/04/22/study-links-autism-with-antidepressant-use-during-pregnancy/?ref=health

A cautiously worded study based on data collected in Sweden has found that “in utero exposure to both selective serotonin reuptake inhibitors (S.S.R.I.’s) and nonselective monoamine reuptake inhibitors (tricyclic antidepressants) was associated with an increased risk of autism spectrum disorders, particularly without intellectual disability.”

The Swedish medical birth register (which contains data on current drug use reported by mothers early in their pregnancies), along with a system of publicly funded screenings for autism spectrum disorders and extensive national and regional registers of various health issues, make a detailed, population-based case-control study possible — one that controls for other variables like family income, parent educational level, maternal and paternal age and even maternal region of birth (all factors the authors note have been previously associated with autism).

This is the second study in two years to associate antidepressant use during pregnancy with an increased incidence of autism in exposed children. An earlier, smaller study in California also found a modest increase in risk. The Sweden-based study could not (and did not) exclude the possibility that it was the severe depression, rather than the use of antidepressants, that created the association, but the smaller California study (which considered only S.S.R.I.’s) found “no increase in risk” for mothers with a history of mental health treatment in the absence of prenatal exposure to S.S.R.I.’s.

The authors of the current study took a very cautious approach to their findings:

The results of the present study as well as the U.S. study present a major dilemma in relation to clinical advice to pregnant women with depression. If antidepressants increase the risk of autism spectrum disorder, it would be reasonable to warn women about this possibility. However, if the association actually reflects the risk of autism spectrum disorder related to the nongenetic effects of severe depression during pregnancy, treatment may reduce the risk. Informed decisions would also need to consider weighing the wider risks of untreated depression with the other adverse outcomes related to antidepressant use. With the current evidence, if the potential risk of autism were a consideration in the decision-making process, it may be reasonable to think about, wherever appropriate, nondrug approaches such as psychological treatments. However, their timely availability to pregnant women will need to be enhanced. Read more

The Immortal Maca

In Hormonal Health on April 16, 2013 at 10:25 pm

What is Maca?
Maca is a Peruvian root vegetable that was sacred to the Incas and has been used as a food and medicine in the Andes for centuries. According to “Superfoods: The Food and Medicine of the Future,” maca was known for its ability to enhance strength and endurance. Legend has it that the Incan warriors would consume maca before long journeys and battles. Today, maca is growing in popularity due to claims that it can enhance energy, correct hormonal imbalances and promote fertility.

Stress and Fatigue
In an article published in the January 2009 issue of Integrative Medicine: A Clinician’s Journal, Tori Hudson, ND, reported that maca is best known as an adaptogen. An adaptogen is a substance that helps the body adapt to a variety of physiological, biochemical and psychological stress. Since stress can lead to fatigue and impaired mental and physical function, consuming maca can improve the body’s response to stress. According to Dr. Hudson, adaptogens such as maca are one of the most useful herbs because they enhance the ability of individuals to manage anxiety, fatigue and stress.

“The Encyclopedia of Natural Medicine” suggests that maca can help with menopausal symptoms such as anxiety, insomnia and hot flashes. According to the authors, while the root does not contain estrogens, it stimulates the hypothalamus and the pituitary areas in the brain to increase estrogen levels in the body. The book also contains a discussion of a four-month study in which menopausal women were given either a placebo or 2 grams of maca daily. After two months, there was an increase in estrogen production among those in the maca group, and the women reported that the maca significantly relieved numerous symptoms of menopause after four months.

Male Reproduction
According to the book “Natural Medications for Psychiatric Disorders: Considering the Alternatives,” the current scientific evidence indicates that maca has a positive effect on male reproduction. In a 12-week double-blind, placebo-controlled randomized trial, healthy adult men received either placebo or maca at daily doses of 1,500 to 3,000 milligrams. Although there was no discussion by the authors on the differences in effects between the groups that received 1,500 or 3,000 milligrams of maca, both groups reported an improvement in sexual desire starting at eight weeks of treatment. The book also described a four-month study trial in which healthy men were given a daily dose of 1,500 or 3,000 milligrams of maca, by the end of the study the men had improved sperm count and sperm motility.

Considerations and Contraindications
The process of preparing maca is important to obtain its desirable health benefits. Traditionally maca is dried and boiled before consumption. Since most of the maca supplement that are available on the market is in the form of loose or encapsulated raw powder, it is unknown whether consuming powdered maca long term is safe. Therefore, when purchasing maca, it is best to purchase the extracted herb. In addition, safety information on maca for pregnant or nursing women is lacking, therefore it is unknown whether consuming maca by these groups of women is safe.

Due to its ability to promote estrogens in the body, the use of maca by women and men with hormone-related disorders may be contraindicated. Individuals with thyroid conditions should be very cautious when taking maca because maca contains compounds called glucosinolates. Glucosinolates, when consumed in excess, may cause goiters, especially when the diet is iodine-deficient. Before adding maca to the regimen, it is best to consult a healthcare provider who has experience working with the herb.

1)Superfoods: The Food and Medicine of the Future; David Wolfe. Publication Date: April 2009; pp67, 70
2) Integrative Medicine: A Clinician’s Journal: Maca: New Insights on an Ancient Plant http://www.imjournal.com/resources/web_pdfs/IMCJ_Hudson.pdf
3)BMC Research Notes: Determinants of Fatigue and Stress http://www.biomedcentral.com/1756-0500/4/238
4) The Encyclopedia of Natural Medicine; Michael Murray and Joseph Pizzorno. Publication date: July 2012; p791
5) Natural Medications for Psychiatric Disorders: Considering the Alternatives; David Mischoulon and Jerrold F. Rosenbaum. Publication date August 2008 pp327-328.
6) Evidence-Based Complementary and Alternative Medicine: Ethnobiology and Ethnopharmacology of Lepidium meyenii (Maca), a Plant from the Peruvian Highlands http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184420/
7) The Transition of Maca From Neglect to Market Prominence by Michael Hermann and Thomas Bernet. Pubication Date: 2009 p.48

What can be done about the rise of thyroid disorders?

In Diet, Environment, Hormonal Health on November 15, 2012 at 5:00 pm

By Gigi Chow N.D.

Thyroid disorders are increasingly common. According to statistics by the American Association of Clinical Endocrinologists (AACE), approximately 27 million Americans have a thyroid disorder. 1 in 10 Americans, more than the number of Americans with diabetes and cancer combined, suffer from thyroid disease. Yet, half remains undiagnosed because initial signs and symptoms are vague, ambiguous, and often seen in various disorders. The underlying factor in very common disorders such as infertility, hair loss, irregular menses, constipation, fatigue, weight gain, elevated cholesterol, anemia, or depression may be a malfunctioning thyroid. Fortunately, our current understanding of thyroid disorders shed light on actions we can take to maintain a healthy thyroid.

It is well-established that most thyroid disorders are autoimmune. The body’s tissues, here the thyroid, are attacked by its own immune system via the production of antibodies. These antibodies can in turn cause the thyroid gland to be hyperactive, hypoactive, or inactive. Because autoimmune diseases as a whole affect disproportionately women, hormones are seen to play an important role in autoimmunity. Furthermore, it is observed that women with conditions involving hormonal imbalances such as endometriosis and PCOS (Poly Cystic Ovarian Syndrome) are more susceptible to thyroid disorders. Therefore, ensuring that hormones are balanced is one way to maintain adequate thyroid function.

Autoimmunity may also arise from a very interesting phenomenon known as molecular mimicry. Molecular mimicry describes a type of biochemical forgery in which protein sequences in bacteria, viruses, foods, or other foreign substances are similar or identical to sequences in human tissues. The immune system recognizes these mimicking sequences as foreign and mounts an immune response (a cross-reaction) to both the mimicking sequences and sequences in human tissues. Research has implicated cross-reactions with wheat and milk proteins in autoimmune diseases. Because not everyone who consumes these proteins will develop autoimmune cross reactions, it is a very good idea to obtain tests for food allergies and intolerances in order to determine suspicious foods that might trigger these reactions.

Iodine deficiency is a well-known cause of hypothyroidism. Iodine is an element that is essential for the production of thyroid hormone. Treatment of iodine deficiency by the introduction of iodized salt virtually eliminated goiters due to iodine deficiency in the 1920s in industrialized nations. Yet, a state of iodine deficiency can be created by many common consumer products.

Everyday consumables such as flour products, pesticides/herbicides/fungicides, synthetic perfumes, drinking water, and toothpaste contain halogens. Halogens are a group of highly active chemical elements that include bromine, chlorine, fluorine, and iodine. Bromine, chlorine, and fluorine readily displace iodine; this makes iodine less available to the thyroid gland for the production of thyroid hormones causing hypothyroidism. These halogens may also mimic the actions of iodine; this leads to the production of excessive thyroid hormones, leading to hyperthyroidism. Chlorine and fluorine are commonly found in tap water, toothpaste, and non-stick cookware. Bromine is a chemical frequently used in pesticides/fungicides, fire retardants, and many flour products. Eating unbrominated flour products and organic foods, reducing the use of synthetic chemicals and non-stick cookware, and purchasing a good filter to minimize chlorine and fluorine from drinking water are simple ways to lessen halogen exposure and ensure optimal thyroid function.

The thyroid gland produces hormones that influence essentially every organ, tissue, and cell in the body; it plays an important role in regulating metabolism and calcium balance. This article hopefully sheds light on actions that we can take to optimize the functioning of this very important gland.

Craving Sweets All The Time??

In Hormonal Health on July 9, 2012 at 11:15 pm

What’s Happening?

Hormones play an important role in maintaining blood sugar balance and restorative sleep patterns. Sugar cravings and hormonal changes are nothing new to many women.

Your adrenal glands make cortisol. Cortisol is commonly referred to as the “Stress Hormone.” It plays an important role in blood sugar metabolism, blood pressure regulation, insulin release, immune function, and the inflammatory response. The amount and daily pattern of cortisol production can also influence how your body uses or stores fat.  Over time, the constant stress of life disrupts the delicate balance of hormones, including how much and when cortisol is made and released.

Some signs that cortisol and other hormone levels are out of balance include:

  • Sugar Cravings
  • Difficulty Sleeping
  • Tired but Wired
  • Afternoon Slump
  • Headaches
  • Constantly Stressed

Effects on The Body

Normally cortisol levels are highest 30 minutes after awakening and then taper down throughout the day. Cortisol is “designed” to help the body respond to a stressful event. When the event passes, cortisol levels drop. When your body is under constant stress, your nervous system never receives the signal to relax. This causes the cortisol response to become altered, which can lead to other hormones going awry.

Long busy days and short nights of sleep send messages to the body that it is in a state of stress. We may be civilized, but our bodies are still ruled by primitive survival drives. The body begins to store fat as a response to the stress, so there are stores ready for a future event that threatens survival.

Over a period of time with constant stress, the adrenal glands are fatigued and therefore produce less and less cortisol,yet the stress continues. Without enough cortisol the body needs to find energy from somewhere else. Our bodies crave sugar, caffeine and other stimulants to counteract low cortisol levels and temporarily raise energy levels.

If you crave sweet things regularly, you should consider checking the function of your adrenal glands and addressing potential adrenal fatigue.


References: http://www.labrix.com

Adrenal Fatigue

In Hormonal Health on June 27, 2012 at 5:17 pm

What is Adrenal Fatigue?

Adrenal fatigue is a decrease in function of the adrenal glands that characteristically manifests as a reduced output or alteration in the diurnal pattern of adrenal hormone secretion including cortisol. People suffering from decreased adrenal function commonly complain of fatigue but may also experience sleep disruptions, weight changes, salt and/or sugar cravings, allergies, anxiousness, nervousness, low blood pressure and numerous other symptoms.

Who Experiences Adrenal Fatigue?

Saliva testing reveals that adrenal fatigue is widespread in the United States. Functional Medicine clinics have observed that over 85% of patients are experiencing some level of adrenal dysfunction or adrenal fatigue. Adrenal fatigue does not discriminate – it may be experienced by men as well as women, and it can occur at any age. Today many individuals in their early twenties are already experiencing adrenal fatigue.

What Causes Adrenal Fatigue?

Adrenal fatigue results from continuous or sudden stress. It may begin abruptly, or as a result of periods of prolonged, repeated stress. Sources of stress may be positive or negative and include (but are not limited to):

  • Recurrent disease and illness
  • Physical stress – injury, diet, surgery, tobacco/alcohol addiction, etc
  • Emotional stress – marriage, divorce, death of a loved one, strenuous work relationships, a new baby, financial insecurity, etc
  • Environmental stress – chemical pollution of air, water, food, etc

Phases of Adrenal Function and Fatigue:

Phase 1: Early adrenal fatigue-acute fight or flight i.e. the alarm reaction. A new situation is met with anxiety and surprise. A person intermittently secretes slightly higher levels of the adrenalin, the fight or flight hormone, in response to a slightly higher level of stress. The adrenal cortex is stimulated to produce additional cortisol and related hormones.

Phase 2: Evolving adrenal fatigue also called adaptation or resistance. It begins when the stress is constant enough, to cause sustained excessive levels of certain adrenal hormones. This is the body’s response to long term protection. It secretes further hormones that increase blood sugar levels to sustain energy and raise blood pressure. The adrenal cortex (outer covering) produces hormones called corticosteroids for this resistance reaction.

Phase 3: Established adrenal fatigue or exhaustion. The body’s ability to cope with the stress is now depleted. At this point, adrenal hormones drop from excessively high to excessively low and the body experiences adrenal exhaustion. Mental, physical and emotional resources suffer heavily. The body experiences “adrenal exhaustion”. The blood sugar levels decrease as the adrenals become depleted, leading to decreased stress tolerance, progressive mental and physical exhaustion, illness and collapse.

Adrenal support

Successful support and treatment protocols for all people suffering from decreased adrenal function include:

• Lifestyle modification to include exercise, healthy sleep patterns with ideal sleeping hours of 10pm – 9am, balanced diet high in vegetables and including healthy fats and proteins, frequent laughter and deep breathing exercises.

• Avoidance of food allergies/sensitivities, caffeine, alcohol, and refined sugars

Individualized treatment plans may include the following depending upon the saliva testing results (phase I, phase II or phase III):

• Supplementation of dietary cofactors necessary for adrenal function including Vitamins C, B5, B6 and E

• Adaptogen therapy including licorice, rhodiola, etc.

• Adrenal glandular supplementation

• Physiologic cortisol supplementation

• Phosphorylated serine (elevated cortisol levels only)

It is important to note that the different stages of adrenal fatigue may all present with the same symptoms, yet treatment protocols can be significantly different depending on the diurnal pattern and volume of cortisol production for each individual. Testing adrenal function is therefore a critical first step in devising the correct treatment plan .





Health in Our Saliva?

In Hormonal Health on June 27, 2012 at 3:42 pm

What health information can our saliva give us?

The majority of hormones (for example: cortisol, DHEA, progesterone, testosterone) in the blood exist in one of two forms: free (5%) or protein bound (95%). While 95% of the hormones in the body are protein bound, it is only the 5% free hormones that are biologically active.

In order for steroid hormones to be detected in serum i.e. in your typical blood draw, they must be bound to circulating proteins. In this bound state, they are unable to bind to receptors in our tissues which means that the hormones cannot carry out its intended effects (FYI: for hormones to carry out its intended purpose, it must be bound to a receptor. When the hormones are bound to circulating proteins, it means that they cannot bind to their target receptors). Therefore, hormones that are measured in serum or blood is considered inactive or non-bioavailable.

Saliva, on the other hand, measures the free, bioavailable hormone aka active levels in the body. Why is this?

When blood is filtered through the salivary glands, the bound hormone components are too large to pass through the cell membranes of the salivary glands. Only the unbound hormones pass through and into the saliva. What is measured in the saliva is considered the “free”, or bioavailable hormone, that which will be delivered to the receptors in the tissues of the body.  Therefore, saliva is the method of choice when assessing functional hormone levels.

The discrepancy between free and protein bound hormones becomes especially important when monitoring topical, or transdermal, hormone therapy. Studies show that this method of delivery results in increased tissue hormone levels (thus measurable in saliva), but no parallel increase in serum levels. Therefore, serum testing cannot be used to monitor topical hormone therapy.

Saliva testing is proving to be a very reliable medium for measuring hormone levels. Hormone levels in saliva accurately represent the amount of hormone delivered to receptors in the body, unlike serum which represents hormone levels that may or may not be delivered to receptors of the body. Clinically, it is far more relevant to test the amount of hormones delivered to the tissue receptors as this is a reflection of the active hormone levels of the body.




Chronic Stress and Hormonal Health

In Hormonal Health on June 27, 2012 at 3:06 pm

Stress can be mental, physical or emotional and there are often events or periods of time in our lives that we can point to as particularly stressful, such as a car accident, death of a loved one or job loss. In addition to these major events, there are many underlying “behind the scenes” factors that compile and contribute to a state of chronic stress. From infections, allergies, depression, overworking, guilt, and sleep deprivation, to toxic exposures, fluctuating blood sugars, and medications. We are constantly inundated with demands to our hormonal system.

Our bodies were built to handle isolated stressful events, and hormones including cortisol and DHEA
are an important part of that mechanism, however, the adrenal glands can only do so much. Just as you can’t continue to spend money from your checking account without working to put money in it, asking your adrenal glands to continuously produce stress hormones without giving them the opportunity to rest and regenerate will lead to hormonal bankruptcy!

Pregnenolone Steal

Have you ever heard the old idiom “Rob Peter to pay Paul”? When our bodies are working to maintain sufficient cortisol levels to help us deal with all of our chronic stressors, there comes a point where we will pull resources from other places. Pregnenolone is the primary precursor hormone for all of the steroid hormones including cortisol, DHEA, progesterone, testosterone, estradiol and more. As a result of the increased demand for cortisol, our bodies will shunt more of the precursor pregnenolone down the pathway that results in more cortisol, leaving less starting material available to produce the other hormones. As you can imagine, the hormonal imbalance that ensues contributes to the overall stress burden and compounds the original problem.

Estrogen Dominance

Pregnenolone is the “parent” molecule for all of the steroid hormones and it can follow two pathways: one leads to DHEA and eventually to the estrogens and testosterone, and the other leads to progesterone and eventually to aldosterone and cortisol. When the demand for cortisol is increased, the progesterone/ cortisol pathway can steal the pregnenolone, but then a shortage of progesterone can also occur as more and more cortisol is needed. This process contributes to a relative deficiency in progesterone compared to estradiol, a condition that we often refer to as estrogen dominance.

Our endocrine system is designed very much like all other creatures on this planet, we are equipped to handle acute stressful events; prepared to protect ourselves from danger or to flee from it. While we rarely find ourselves fighting off a predator in this modern era, the constant barrage of micro-stressful events such as traffic, social stresses etc. often result in a chronically stimulated adrenal response. While our caveman ancestors would likely have rested safe in a cave after fleeing from a saber tooth tiger, we rarely give our bodies the actual break it deserves and requires! Over time, our adrenal glands just can’t keep up the pace and their production of cortisol begins to falter.

Adrenal exhaustion can happen to some people after a single stressful event, and for others it occurs after a long series of micro-stressors. We are all different, and the length of time we can “keep up the pace” is different depending on individual constitution as well.



Adrenal Fatigue: The 21st Century Stress Syndrome. Wilson JL. 2001 Smart Publications