Inquiring women want to know
How often do you walk into your doctor's office with a list of pressing health questions, only to forget them as soon as you put on the gown? We can relate. So we connected with Harvard-trained integrative physician Sara Gottfried to get the answers to the most common women's health questions -- no office visit required.
Meet the expert
Dr. Sara Gottfried is a Harvard graduate, board-certified OB/GYN, an adjunct faculty member at Touro University College of Osteopathic Medicine and founder of the Gottfried Center for Organic Gynecology in Berkeley, California. She is author of the upcoming book The Hormone Cure (Simon & Schuster, 2013) and creator of Mission Ignition: Sex Drive, a wildly popular online course for women to re-ignite their sex drive using her 3-Step Gottfried Protocol for natural hormone balancing, using nutraceuticals, botanicals and when needed, bioidentical hormones, along with some other esoteric practices. Dr. Gottfried has been featured in Yoga Journal, Glamour, Diablo and Natural Health magazines. She is also the medical expert featured in the award-winning film on women and yoga, YogaWoman.
Can I really get a genetic test that can determine why I am overweight or have terrible mood swings? If so, should I get it?
Dr. Sara Gottfried: Yes! Although genetics are not 100 percent of the story, they often determine whether you are eating the right foods, taking the best supplements and choosing the ideal strategy to optimize your mood. Your genes are inherited from your parents, and 50 to 80 percent of how the genes are expressed is determined by how you eat, move, supplement, sleep and think. In my integrative medicine practice, I find that people who struggle with their weight do better on a genotype-appropriate diet, and in fact, Stanford University proved that people who follow a genotype-appropriate diet (based on about 200 genes), lose double the weight over one year compared with a control group that followed a one-size-fits-all diet.
I'm exhausted all the time but can't seem to get enough rest. I've heard of adrenal fatigue. Is that for real?
Dr. Sara Gottfried: Many women have issues with adrenal fatigue and don't realize it. I happen to believe that it's underdiagnosed in the conventional medical world (and treated wrongly with antidepressants and sleeping pills) and overdiagnosed in the alternative medicine world. I like to diagnose it accurately based on either blood or saliva tests for cortisol and DHEA, the main stress hormones. Adrenal fatigue is for real -- I've had it myself! Back in 1999, I was a working mom and burning the candle at both ends. I was a textbook example, with sky-high cortisol most of the day, a muffin top, sugar cravings, prediabetes and crankiness. Once I figured it out, it took me three months to fix my own adrenal fatigue and now I am committed to helping women heal this swiftly. As they say, my mess became my message!
I've suffered from severe PMS for years and it's getting worse. Are there natural ways for me to get it under control?
Dr. Sara Gottfried: I recommend three natural solutions. Try vitamin B6, especially if you're genetically susceptible to PMS, chasteberry and St. John's wort.
My doctor told me I have thinning bones (osteopenia) but I have concerns about taking calcium supplements. What are your bone-strengthening recommendations in light of new research on calcium supplements being linked to heart attacks?
Dr. Sara Gottfried: After much research and immersion in the data of bones, I now believe bone loss is a problem of hormone imbalance and nutritional neglect. Certainly, osteoporosis is a problem of hormonal imbalance, plus a few immune issues thrown in for good measure. Put another way, bone loss is a message from the body that something needs to shift. Since the answer to whether or not a woman should take calcium supplements requires a lengthy conversation, I will share my short answer: Get your blood tested and make sure your vitamin D level is in the normal range, and get calcium from food sources.
I've read that the stress hormone cortisol can cause weight gain and mood swings. Can cortisol really make me fat and angry? If so, what can I do?
Dr. Sara Gottfried: Cortisol is the main hormone that helps you deal with threats in your life (such as a tiger chasing you) and has three main jobs. Cortisol will make your blood sugar go up (so you can run), raise your blood pressure (to help you think and run at the same time) and moderate your immune system. When cortisol is chronically high, it makes insulin rise, which is a fat-storage hormone that drives glucose into cells. High cortisol leads to fat deposits, mostly where it's easy to pick up the fat again and convert into energy, which is why cortisol leads to increased belly fat. In fact, fat at your belly has four times the number of cortisol receptors (like a lock that cortisol fits into as the key) as fat elsewhere. As I just explained, when you're under stress, adrenaline rises along with cortisol, but when adrenaline begins to drop and cortisol stays high, you get the "cortisol switch." It's like having a cup of coffee -- you feel great for about 20 minutes, and then shaky and irritable and often angry. The anger and other negative symptoms are a result of high cortisol and low adrenaline.
Monthly hormonal fluctuations are driving me crazy. Are there dietary changes I can make that will help balance my hormones?
Dr. Sara Gottfried: I find that the Paleo diet helps to keep cortisol, estrogen, thyroid and testosterone balanced and where they need to be so that they can best support women. It doesn't work for everyone -- for instance, women who are programmed genetically to eat a low-fat diet don't do well on it. But for women who struggle with their weight or cannot afford genetic testing (the test I use costs about $697), start with a Paleo diet plan.
What is your advice when it comes to hormone replacement therapy -- take it or leave it?
Dr. Sara Gottfried: Many women suffer through the symptoms of perimenopause, from night sweats and disrupted sleep to intrusive hot flashes and brain fog. Moods may dramatically worsen or anxiety may surface. PMS may become an order of magnitude more intense. Rather than presenting the view that hormones are bad -- the black/white or polarized thinking that dominates the media and traditional medicine -- I prefer to present women with options. I ask them if they want to try chaste tree Vitex, an herb for PMS proven in several randomized trials, or something else.
My work and family schedule is killing my sex drive. What can I do to lift my libido?
Dr. Sara Gottfried: Stress itself is not bad for sex drive -- unless you feel persistently overwhelmed and you rarely get out of the "alarm" mode. If you perceive that you're perpetually stressed (and perception matters far more than actual stress), you'll make too many stress hormones such as cortisol. This zaps your libido and happy brain chemicals, and it makes your blood sugar rise. Result? The dreaded muffin top as well as sex being the last thing on your mind.
Good news! Reclaiming your libido is easier than it might seem when you're overwhelmed. Believe it or not, a lingering hug and kiss, and even better, a toe-curling orgasm, reverses the damage from stress hormones. Orgasm raises oxytocin, which lowers cortisol, the main stress hormone. Managing stress more skillfully also helps you get your sex drive back to normal, [using stress-reduction methods] such as yoga, meditation, whole foods that stabilize blood sugar, targeted exercise, even eating a square of dark chocolate very slowly and mindfully. I'm a huge fan of leveraging tumescence -- where you build and store sexual energy but don't release it quickly (which is the tendency in our hurry-up world). Tumescence really fills the energy tank for women!
More expert health tips
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