The Importance of Weight & Metabolic Balance in Female Reproductive Health

By Leigh Lewis NMD, L.Ac., FABORM, RYT

The role of weight in all aspects of female reproduction has been validated by science for several decades with both underweight and overweight body habitus causing problems.  Being underweight has been linked with a relative hormone deficiency what can lead to thin uterine lining and irregular ovulation and menses, therefore interfering with fertility.  Adipose tissue, most notably abdominal fat, has been linked to excess production of estrogen which can also lead to issues with ovulatory and cycle irregularity and decreased fertility.  Once pregnant, body weight should increase for most patients by 25-35 pounds, however, women who are underweight at the time of conception may need to gain more, with overweight women needing to gain less or sometimes, simply maintain their pre-pregnancy weight.  Pregnant women who are underweight are at a higher risk for having a miscarriage, an underweight baby or a preterm birth.  Being overweight confers an increased risk for miscarriage, gestational diabetes and hypertension, preeclampsia, C-section, and an overweight baby. There are also increased risks to the baby born to an overweight mother: diabetes and metabolic syndrome (high cholesterol, blood sugar imbalances, hypertension, overweight) in child- and adulthood. In a recent study, the CDC concluded that 50% of American women gain too much weight in pregnancy.  Oftentimes, excessive weight gain during pregnancy is difficult to lose in the post-partum and can be further compounded by subsequent pregnancies. Finally, many women gain weight during the months or years of hormonal fertility treatments…this weight can be the most difficult to lose.

In general, recommendations are for women to maintain a “normal body weight” as indicated by a body mass index between 18.5-25, although individual variability may dictate otherwise.  This would be a weight between 120-140 for a woman who is 5’6”. However, there are individual issues that might change this recommendation; for example, a female body builder will have a higher muscle to fat ration and since muscle weighs more than fat, she would likely have a higher healthy body weight. Your provider can help determine your ideal weight range.

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Diet and exercise are often the first recommendations made to women and while this is typically good advice, many women are frustrated because usually they have tried it all before.  An important and often neglected first step is to make sure there aren’t any underlying metabolic issues that might predispose one to having weight issues.  Lab analysis of Vitamin D, thyroid function, cholesterol, glucose and insulin can provide insight to underlying factors that could make weight loss or gain more difficult.  Radical diets may help one achieve initial goals, but are difficult to maintain for the long-term and may lead to nutritional deficiency.  In fact, most current research suggests that a sensible, whole-food, Mediterranean-style diet is the best for promoting and maintaining both a healthy weight as well as general health, including fertility and pregnancy.  Some individual variations may be necessary; women with PCOS for instance often fair better with a higher protein/lower carb diet.

In general, one does not have to even achieve a “normal” body weight to see improvement in ovulation, menses and fertility, including improving the success of in vitro fertilization treatments: improvement can be seen with as little as 5-10% weight change.  This is good news, but can seem daunting to many nonetheless, and getting assistance from a team of professionals at least initially may be the best course.  As many of us know, what to eat is only part of the issue for most…we all know less sugar and alcohol and more fruits and vegetables would be beneficial, portion size matters, exercise is important. You likely have heard it all before and could probably tell your best friend or daughter or mom the keys success. The issue isn’t so much how to eat better and exercise more, it is why can’t we implement what we already know we should be doing.  There are several studies that illustrate the positive impact individual or group therapy can have in changing lifestyle behaviors is a way that can have long-lasting health impacts.  In addition, while it may seem like a luxury to have a personal trainer, a series of 4 weekly sessions or joining small group trainings geared for women can set you up to have success with your workouts instead of just grinding out miles on the treadmill.  Some trainers can also help set up individual meal plans.  Finally, stress, both physical and mental can play havoc with the hormones that affect both weight and fertility, adding a mind/body practice to any regimen is a great place to start, whether it be as part of a group or as a home practice.

The bottom line is if you are concerned that your weight may be negatively impacting your reproductive health and fertility or you simply are trying to re-establish your pre-pregnancy weight for general health reasons, consider making an appointment to discuss your individual goals with one of the practitioners here at ilumina and please see resources below for other specialists offering programs to help you meet your goals.


Farrah Hauke, PsyD – offering individual therapy and a 4-week workshop series on psychological strategies to lose weight & keep it off. 480.659.5107; www.arizonapsych.com

Lindsey Cusey & McKenzie Smalley - Personal Trainers/Nutrition Consultants *offers a discount to ilumina patients; www.fithappygirl.com

Donation-based Yoga + Mindfulness classes for women @ Kinfolk Chiropractic, Tuesdays 6:30pm, to RSVP email leighklewis1@gmail.com

Lets Talk About Vaginal Tissue Health

By Leigh Lewis, ND, L.Ac.

Many women experience changes to their libido and sexual function due to changes in hormones that occur throughout life. Post-partum and perimenopause are frequent times when hormones plummet and this can causes lower desire and changes to the vaginal tissue that can cause discomfort with intercourse.  Other hormonal, like thyroid, or nutritional, like iron, deficiencies can contribute to this issue as well and should be screened for.

Medications can be a cause of sexual function issues, notably birth control and antidepressants, and there may be alternatives that have less impact. Alcohol and marijuana use can have negative impacts as well. Finally, it is important to consider relationship factors that may be playing a role; a couple of sessions with a qualified therapist can greatly help investigate & address this area. If discomfort is deep in the pelvic area, a specialized physical therapist may be able to assist you.

There are several ways you can address these issues on your own before consulting a physician:
For vaginal dryness or pain with intercourse: RepHresh or Replens, both available OTC at many pharmacies. These products are not lubricants, but actually restore vaginal tissue health without hormones. Try for twice a week for one month and see if the improvements decrease your symptoms.
For low libido: Maca (Femenessence) is a Peruvian herb that has been used traditionally to improve libido. Try 1000mg per day for a month to see if you notice an effect.

If these do not help, consider making an appointment here at ilumina to discuss pharmaceutical options. After ruling out any contributing factors, we can discuss possible hormonal therapies like bio-identical estrogen, testosterone or DHEA. These hormones have all been shown to be helpful for improving libido, orgasm and/or decreasing vaginal discomfort by improving tissue integrity. There are topical and oral forms available and some options are covered by insurance.  If vaginal tissue atrophy is the main concern, I have been very successful using both hormonal & non-hormonal compounded combinations.  Finally, a brief word about safety: most low dose topical hormone formulations used to treat local vaginal issues are not absorbed systemically and therefore are not considered to carry the same risks as menopausal hormone replacement therapy, even for breast cancer survivors.

Another pharmaceutical option is Addyi (flibanserin), a daily medication that has been shown to improve sexual desire. The side effects are generally minimal and it should not be taken with alcohol, but it may be good options for those women for whom none of the above has been helpful.

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Most importantly, seek help:

though this is a sensitive topic, we are here to help you with all facets of your health and that includes sexual health & wellbeing.

 

 

Misconceptions of Preconception

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Photo by {artist}/{collectionName} / Getty Images

By Leigh Lewis ND, L.Ac, Naturopathic Doctor

Are you hoping for pregnancy in 2018?  If so, keep reading for information that may help you reach you goals.  You may be surprised to learn that the conception rate for any one act of intercourse at the right time of the month, when the stars are aligned and without any fertility issues, is only about 25%.  Yet, even knowing this, many couples expect to be able to conceive easily without much forethought or planning.  This may be in part because we, especially as women, have spent most of our lives trying NOT to get pregnant.  As such, it is not surprising that many couples are blindsided if they are not pregnant within the first several months of trying.   However, there are a few simple things you can do to increases your chance for a timely & healthy pregnancy.
 

Preparation is Key:  General Recommendations for All

Prenatal lifestyle & supplements: As with many goals in life, the path to a successful conception and a healthy pregnancy is planning.  Lifestyle factors, including cigarette, alcohol & caffeine consumption, and marijuana and other recreational or prescription drug use in either partner can increase time to conception and increase risk of miscarriage & chronic health issues in children.  Current research suggests that even if you have very regular and normal cycles starting a prenatal vitamin with adequate methylfolate several months prior to intended conception has numerous benefits in decreasing the risk of nutritional deficiencies, decreasing time to conception, preventing birth defects and decreasing risk of miscarriage as well as decreasing the risk of future autism spectrum disorders and other learning disabilities.  While a prenatal helps correct nutritional deficiencies, some women may need additional vitamin D, B12 and iron depending on lab levels.  These nutrients, if low, can interfere with one’s ability to get and maintain a healthy pregnancy.  The  omega 3 fatty acid derived from fish oil, DHA, has been found to benefit brain development and should also be part of the pre-conception plan.  Finally, finding prenatal supplements that are well-tolerated prior to pregnancy can help avoid problems with consistency if nausea and vomiting are an issue early in pregnancy.  A well-rounded multivitamin and mineral can also improve many aspects of sperm health when taken for at least 3 months prior to planned conception.  First pregnancy and want to improve chances?  Be sure to seek help on tracking ovulation and cycle via basal body temps or apps combined with timing intercourse (see resources below).
 

Pre-conception weight: Another recommendation that can decrease time to conception and increase probability of a healthy pregnancy is a normal weight.  Being overweight or underweight can interfere with fertility by decreasing ovulatory cycles.  Being overweight can also predispose to gestational diabetes and hypertension that can increase the risk of both conditions for mother and baby later in life.  Normal weight has also been found to improve the success of fertility treatments like IVF.  In short, it stands to reason that taking 3-6 months to address any weight issues can go a long way to improving health parameters for both mother and baby.  Special diets or intense exercise can also cause some deficiencies that can be ruled-out with simple blood tests.
 

Contraception: It should be noted that it may take up to 12 months to re-establish normal ovulation and cycles after discontinuing hormonal contraception.  That said, some women may be able to conceive the month after stopping contraception.  The best course of action is to stop any hormonal contraception a year prior to intended conception, using non-hormonal forms (i.e. condoms) until conception is desired, to allow the body to re-set.  This would also be a good time for both partners to start their respective supplements mentioned above.  For those that are trying to avoid or delay pregnancy, remember prevention is the best medicine…there are several safe and effective forms of contraception to choose from.  Finally, a word about lactation:  While breastfeeding can help to space babies, it is not fool-proof and many women will return to fertility while breastfeeding, some even before regular menstruation resumes.  For some women however, even breastfeeding infrequently can delay another conception. Please keep this in mind whether hoping for a pregnancy or to prevent one.

For those with fertility problems:

According to the CDC, American infertility statistics between 2011-2015 were as follows:

  • 12.1% women aged 15-44 with impaired fertility
  • 7.3 million women aged 15-44 who have ever used infertility services

While as many as 30% of couples never find the cause of their infertility, we do know several possible contributing factors that may play a role:

  • Age: fertility rates within one year decrease & time to conception increases after 30 years of age

30s:  75% chance
At 40:  40% chance
By age 43: 1-2%

  • Underweight, overweight and nutritional deficiencies (see above).
  • Hormonal imbalances: thyroid disorders, endometriosis, polycystic ovarian syndrome, low estrogen and/or progesterone.
  • Stress, anxiety, & depression: evolution may have set us up to delay conception at times of emotional stress
  • Structural issues: blocked tubes from prior infections, uterine fibroids/polyps, adhesions or scarring from endometriosis or previous pelvic surgery
  • Chronic illness such as autoimmune conditions

Infertility is diagnosed as no conception within 12 months of trying if under 35 years and 6 months if over 35 years. It helps to recognize the importance of these definitions as further lab testing, semen analysis, pelvic imaging and consultation may be recommended at this time.  

Couples with any of the above issues should consider when they ideally would like to conceive and give themselves at least 6-12 months to get healthy by following the above general recommendations and seek guidance from a practitioner who specializes in women’s health and fertility to address specific issues in particular.  The same could be said for women in between pregnancies in order to prep selves for a future conception as pregnancy, breastfeeding and caring for a growing family can take a toll on the body and mind.

If ovulatory, menstrual, or hormonal irregularities are suspected, addressing them by ruling out underlying factors is key.  Research shows that acupuncture and specific herbal formulas and supplements may help normalize hormones and cycles, facilitate conception and improve the health and wellbeing during pregnancy and increase the success of conventional fertility treatments.

Fertility issues can be stressful, especially when combined with pre-existing insomnia, depression, or anxiety, and this can interfere with fertility and exacerbate emotional issues; truly a vicious cycle.  However, there are safe ways to address these issues through meditation, yoga, acupuncture, herbs and supplements.  In some cases medications may be the safest option with several studies showing that medications are preferable to “white-knuckling it” through depression and anxiety.

We here at ilumina are here to help you at any stage: from pre-conception and prenatal to postpartum and beyond, we offer diet & lifestyle counseling, mental health support, acupuncture, western & oriental herbs and supplements, massage and medications to address these issues.  Please feel free to contact us today to get started on your pre-conception health & wellness plan.

Resources:
1. Taking Control of Your Fertility
https://www.tcoyf.com
2. RESOLVE: The National Infertility Association
http://www.resolve.org
3. American Society for Reproductive Medicine (ASRM)
http://www.asrm.org
4.  American Board of Oriental Reproductive Medicine (ABORM)
http://www.aborm.org
5. Clue: Menstrual/Fertility Tracker App
https://itunes.apple.com/us/app/id657189652

Skin Cancer Awareness

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We in AZ are probably more attuned to issues related to sun damage and skin cancer than our friends in Northern climes, but I am frequently amazed how few people use a daily SPF and reapply as recommended to truly prevent pre-cancerous changes.  People usually are good about applying and reapplying when on vacation at the beach or the lake, but it the daily ultraviolet exposure driving to work, walking the dog or working in the garden that adds up over time and causes skin cell damage that can cause discoloration, wrinkles and skin cancer. Over 5 million new cases of skin cancer are diagnosed each year in America, with nearly 90,000 of those attributed to melanoma, which is the cause of almost 10,000 deaths.  

Skin cancer can be present anywhere on the body and with little to no signs or symptoms, however, most can be caught through the simple process of monthly self-check and annual dermatologist skin exams. Early detection, like in all health concerns, is key, and knowing your body’s specific moles and freckles and other marks is the best way to notice a new lesion or change in a previously existing one.

The “ABCDE Rule” of skin cancer detection is simple to follow when conducting monthly self-check skin exams and should be a sign to see a dermatologist:

ASYMMETRY: if one half is different from the other half of a lesion
BORDER: irregular edges to a mole
COLOR: any multicolored lesion or growth that contains blue, pink, white, red or black shades
DIAMETER: a growth that is larger than ¼ inch across or increases in size
EVOLUTION: any changes to a pre-existing mole

In terms of prevention, The American Cancer Society recommends people “SLIP on a shirt, SLOP on sunscreen, SLAP on a hat, and WRAP on sunglasses” to prevent the negative effects of UVA and UVB radiation from the sun.  Understandable, people worry about the chemicals found in sunscreens, but there are ways to find which sunscreens are the safest by researching the Environmental Working Groups website and/or app http://www.ewg.org/sunscreen/

Even with this information, many are confused by the array of sunscreens on the market.  Physical sunscreen formulations are made up of minerals like titanium and zinc oxide that create a barrier on the skin, blocking & reflecting both UVA rays (cause wrinkles & cancer) and UVB rays (responsible for sunburn). Mineral sunscreens are effective once applied, unlike chemical sunscreens which require approximately 30 minutes to become effective.  In addition, chemical sunscreens not only are less effective than physical forms, but have been found to accumulate in the body and have even been linked hormonal disruption and breast cancer. Chemical sunscreens may also oxidize in the sun, causing potential free radial formation which could increase the risk for premature aging and skin cancer.  Some companies have added minerals to their chemical sunscreens as a marketing tool, but the risks of the chemicals stay the same.

I personally have been very impressed with TiZo, a mineral sunscreen that is free of oils, parabens, fragrances and dyes and unlike the pallor imparted by many similar products in the past, these blend well and are very comfortable to wear.  Since these products are only available through licensed professionals, mention it to your ilumina practitioner and we can get some ordered for you.

Need a Resolution? Personal Responsibility for Proactive Health Care in 2017

No matter your personal feelings about the outcome of the election, one thing is sure to be true: health care as we know it is changing. Actually, there has been a slow, but steady change in premiums, deductibles, covered benefits and out-of-pocket expenses over the past decade with the net effect that patients are shouldering more and more of the financial responsibility. On the other hand, care seems to be less personal, with less provider continuity and less time allocated for patient appointments and follow-up. This has led many government officials, providers, and patients to call for reform. Unfortunately, there appears to be little consensus on how to fix the problems and more concerning is the question as to whether our current system can even be fixed?

 

One thing that seems to be clear is that most of the illnesses Americans are struggling with are those related at least partially to lifestyle and thus potentially preventable. By modifying our habits and keeping an eye towards prevention, we can significantly decrease our risk of the most expensive and debilitating illnesses. Recently, the CDC named “heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis as the most common, costly, and preventable of all health problems”. For example, according to the American Diabetes Association, diabetes is the 7th leading cause of death in the US, affecting over 30 million adults and a growing number of children. These figures relate to what is known as Type 2 diabetes, a largely preventable condition that also significantly impacts the risk of cardiovascular disease. Another nearly 100 million Americans have pre-diabetes. Medication to control diabetes can exceed $250 per month and combined with the costs of regular doctors visits, and related medication for blood pressure and cholesterol, it may be possible to spend $5000 per year to manage this one condition.

 

On the other hand, what would happen if this money were spent on improving individual general health and wellness; efforts to improve diet, manage weight, and decrease stress. In doing so, we can decrease our risk for all the aforementioned conditions named by the CDC and therefore improve overall health and quality of life, maybe even avoiding medications altogether.

 

This is a laudable goal and not an easy one to achieve. It requires us to shift our focus from a reactive, treatment-focused approach to health care to a proactive, preventive approach where the patient takes responsibility for her own health, utilizing the medical system for support and guidance along the way. It is important to acknowledge that even with our best efforts, not all disease can be prevented, but by taking an active role in partnering with providers to improve health as much as possible, significant progress can be made. By addressing symptoms early, being informed about family medical history and disease risks, screening for blood pressure, glucose, weight, and nutritional deficiencies, and following recommendations for cancer screening, you can significantly impact your risk for chronic disease in the face of the changing health care landscape.

 

2017 is the year of the fire rooster, a sign of dawn and awakening, of triumph and success, only achievable through hard work and patience. We at Ilumina are committed to prevention and proactive care, happy to help guide you to improve your general health and address specific concerns through our naturopathic and Chinese medicine services with diet, exercise, and supplement advice, acupuncture, massage, and meditation. Together, we can work to make 2017 your healthiest year yet.