The patterns and rhythms of our world clearly affect the cycles of women's lives. Finding Grace and Balance in the Cycle of Life provides a fresh perspective on women's health and explores the beauty and complexity in the hormonal conversation that takes place within women's bodies every day. Whether it's fibroid tumors, PMS, fertility, or menopausal complaints, author Dr. Claudia E. Harsh offers a holistic approach to women's health that augments traditional Western medical care with the ancient traditions of Eastern medicine. Finding Grace and Balance in the Cycle of Life explores: • Nutrition and lifestyle choices • The phases of a woman's life • The integrative medicine toolbox including acupuncture, energy medicine, and craniosacral therapy • Stress management • Fertility • Menopause Finding Grace and Balance in the Cycle of Life provides practical information that combines the science of traditional medicine with the ancient teachings of Chinese medicine, acupuncture, and other alternative medicines to help you reconnect to your inner wisdom and find that emotional, physical, and spiritual balance that brings you to optimal health.

Finding Grace and Balance in the Cycle of Life

Exploring Integrative GynecologyBy Claudia E. Harsh

iUniverse, Inc.

Copyright © 2010 Claudia E. Harsh, MD
All right reserved.
ISBN: 978-1-4502-1584-8

Contents

Acknowledgments...................................................................xiIntroduction......................................................................xiii Lifestyle Choices and Habits.....................................................1Resolving to Change...............................................................3Nutrition and Supplements.........................................................7Quality Standards for Vitamins and Nutraceuticals.................................13You get a "D" in Health...........................................................15Strategies to Combat Free Radicals................................................18Cruciferous Vegetables: What, Why and How Much?...................................21Organic Thoughts..................................................................24Sugar and Artificial Sweeteners: How Sweet It Is..................................27Good Fats: Something Fishy Is Going On............................................30Exercising Options for Health.....................................................35 Stress Management................................................................38Fear, Stress and Anxiety, Oh My!..................................................38Finding Light in the Darkness-Seasonal Affective Disorder.........................41 The Integrative Medicine Toolbox.................................................44Acupuncture.......................................................................44Energy Medicine-Healing Touch, Reiki..............................................48Craniosacral Therapy..............................................................50Guided Imagery and Health.........................................................51 Understanding the Cycle of Life..................................................54The Conversation of Menarche......................................................54Premenstrual Syndrome or PMS......................................................57Personal Growths: An Integrative Approach to Uterine Fibroids.....................61Ovarian Cysts and the CA-125 test.................................................64Endometriosis.....................................................................66 Fertility........................................................................70A Burst of Life-Preparing the Soil................................................70Integrative Fertility Baby Steps..................................................73Integrative Treatments for Pregnancy..............................................76The Business of Being Born-At Home!...............................................79Breastfeeding and Breast Health...................................................82The Ins and Outs of Contraception.................................................85Pap Smears and the HPV Vaccine....................................................88 Menopause........................................................................92Aging Gracefully..................................................................92Nonhormonal Treatments for Common Menopausal Symptoms.............................94Hot Flashes.......................................................................95Libido and Sexuality..............................................................97Menopause with Hormones...........................................................100The Bioidentical Hormone Controversy..............................................103Estriol, Wyeth Pharmaceuticals and the FDA........................................107 Grace and Balance in the Cycle of Life-a Postscript..............................111References........................................................................113About the Author..................................................................119Index.............................................................................121

Chapter One

Lifestyle Choices and Habits

Everyone should be his own physician. We ought to assist and not force nature. Eat with moderation and with what agrees with your constitution. Nothing is good for the body but what we can digest. What medicine can produce digestion? Exercise. What will recruit strength? Sleep. What will alleviate incurable ills? Patience. Voltaire (1694-1778)

This chapter contains the basics for women's health and wellness. If you browse through no other part of the book, take this one to heart. It has become clear that nutrition, stress management and exercise are the keys to emotional, mental, physical and spiritual health. I fully believe that the majority of gynecological disorders are imbalances that can be prevented or corrected with attention to these areas.

We are reluctant to believe this as a culture. There has been a push for "evidence-based medicine" that is often more aptly described as "intervention-based medicine." A study from Australia, for example, showed that the "lap band" (laparoscopic adjustable gastric banding-a form of bariatric or weight loss surgery) was a "better" treatment for patients with type 2 diabetes than expectant and routine management (Dixon, 2008). The thirty control patients were treated as any typical patient in the United States is treated; they were told to walk 10,000 steps a day and participate in a regular structured exercise program. There was a nod to nutrition guidelines but no discussion of stress management or life pacing or counseling. The common denominator for remission in both groups was successful weight loss.

I wasn't surprised to learn that 73 percent of the patients who had the surgery achieved remission of their diabetes within two years, versus 13 percent of the control group. The surgical group had a higher percentage of people with weight loss, so they had a higher percentage of people with diabetes remission. Six of the thirty patients in the surgical group had some type of surgical complication. One band had to be surgically removed two weeks after it was placed.

Besides the concern that there was no "active management" control group where health coaching, stress management and aggressive nutrition counseling was in place, I'm left wondering why we are drawn to forces outside ourselves for solutions to our health problems. What causes us to overeat foods that increase our weight and our diabetes risk? Why isn't there more public outcry when giant food processing companies subvert health and nutrition with marketing and glitz that cover up empty calories and dangerous fats? There's no doubt we're addicted to sugar as a culture; I'm hopeful we can explore this addiction and awaken to its dangers. It's all brain chemistry-pleasure chemicals are triggered and exploited. We get the "why"-now let's problem-solve for solutions.

Resolving to Change

As the New Year comes each year it brings with it a sense of renewal and optimism. It's natural to look at the stretch of days unfolding before us and dream. What do we want to bring into our lives? What do we want to remove? Setting intentions is the best way to transform our lives. Yet, it is depressing to read that over 60 percent of New Year's resolutions are broken within the first half of the year. Whether it's addictions to cigarettes, or broken promises to eat healthy or exercise, we haven't quite found the strategies as a culture to control our urges and impulses. (I'm frequently asked for that special acupuncture needle that will control sugar cravings! Guess what? It's more complicated than that.)

Three psychologists, James Prochaska, John Norcross and Carlo DiClemente, studied "self-changers" or people who had successfully stopped smoking or lost weight or started an exercise program and recognized that all successful behavior changers pass through six stages of change that are distinct and measurable. Their book Changing for Good (Prochaska, 1994) should be a guide for anyone interested in setting intentions or resolutions. The six stages of change are:

precontemplation

contemplation

preparation

action

maintenance

termination

The authors describe the process of change as a spiral-not a linear step-by-step progression. We'll review the stages below and discuss how to apply them in your own life to habits you'd like to change.

Precontemplation: People who are in the precontemplation stage of change are usually not making New Year's resolutions. They don't see their health habits as problems, and if they show up in therapy or at an exercise class, for example, it's usually because they were pushed to go by a spouse or friend. As you can imagine, if you or someone you know are in the precontemplation stage, you're not going to change your behavior successfully without insight and education. Sometimes the impetus to change is a health scare. A patient, Betty (not her real name), has smoked for over thirty years. She's quit smoking a few times for six months or so but always picks up the habit again in response to the stress in her life. She is intelligent and insightful and knows intellectually that smoking is unhealthy. Her hands and ankles are swollen and she's been short of breath. She has stopped smoking as of this week after she developed dizzy spells and fell in her house. In Betty's case, she was moved out of precontemplation by a health scare. She knew intuitively how to stop smoking and immediately and successfully quit. I'm hopeful she'll continue on the path to becoming a nonsmoker and hope to be one of her cheerleaders as she changes this habit.

Contemplation: Contemplators are at the stage of change where they are aware that they have a problem and may have a degree of frustration with feeling stuck. People at this stage are not quite ready to change; perhaps if they read just one more book or just one more Web site they will find that there's a dream therapy that will curb the urge to smoke or a new supplement that will burn fat. (Marketing people love contemplators. They are most likely to buy their product but will not necessarily put in the time and energy to actually change their behaviors.) Contemplators are essentially stuck in the interminable research phase of understanding their problem and aren't stepping forward yet with an action plan. Preparation: On the other hand, if you're in the preparation stage, you've chosen an action plan and have set a time frame within the next month to begin. You're more likely to be successful with your New Year's resolutions if you couple the resolution with a strategy for success. (For example, if weight loss is your goal, clear out all those empty-calorie foods from your house and make sure those cookbooks with fast and easy organic vegetable and whole grain foods are read and marked with bookmarks! Have your shopping list made up and ready. Enlist the support of your family or roommates.) My patient Darine (not her real name) has thought about instituting an exercise program. She joined a gym a few years ago but after about six months didn't attend regularly and got frustrated every time the monthly charge came in. Her strategy this year is to enlist a neighbor who has a similar schedule. They have set up exercise dates and clear concrete goals together. So far, her buddy system is working well and she is pleased with her energy level and stamina. Action: In the same way, the action stage is a result of planning and effort, and it is when our behavior is outwardly changing. This stage works hand in hand with the maintenance stage because slipping into old habits will happen unless we're aware of how stresses and pressure in our lives pull us back to old habits. Alcoholics in twelve-step programs such as Alcoholics Anonymous use the awareness of a daily choice and recognize that even one drink is too much ever. On the other hand, many of us know someone like Betty who has quit smoking and started again. Changing behaviors is a lifetime daily choice. Maintenance: Behavior change is a daily choice combined with strategies that individually apply to who we are and what we need to be successful. Betty knows what some of her triggers are for smoking. She knows that if she sits down in the morning to read the paper she will want a cigarette. She has changed her morning routine as part of her smoking strategy. Darine knows that her exercise program slips when she becomes busy or stressed. Both women recognize their habits require constant attention and vigilance. Until the chosen habit is ingrained and automatic they stay in the maintenance phase of change. Termination: No life changing habit is easy. On the other hand, I know several people who are ex-smokers or who have maintained weight loss or exercise programs. The termination phase of the psychology of change is only noticed in retrospect. More than likely, most successful changers remain vigilant and committed to their choices.

Rather than looking out at the horizon, I encourage people in the action stage of change to make weekly goals and then assess the goals at the end of the week and either celebrate or forgive prior to setting the next week's goals. This deceptively simple strategy keeps the intention or the goal at the forefront of our awareness and makes it easier to avoid relapse. We are so prone to self-judgment; if we recognize this at the outset, we will be more able to acknowledge the power of choice in our lives. Changing behaviors that we've had for years is not easy. There's a reason we fell into the behavior in the first place (it feels good, it tastes good, etc.). But that doesn't mean we can't change the behavior with intention and commitment.

Nutrition and Supplements

Are you confused about what to eat for optimal health? Just check out the nutrition section of your local bookstore and look around in confusion. Grapefruit? Blood type? Paleolithic? The variety and level of complexity is mind-boggling. The argument about macronutrients (carbohydrates, fat and protein) has captured our attention in the last decade. Two approaches to nutrition championed by Dean Ornish, MD, (low low fat) and Robert Atkins, MD, (low low carbohydrates) are examples.

Is there a perfect meal and supplement plan for each person on the planet? The science of nutragenomics is exploring this; I expect we'll have better answers within the next five to ten years. At least for now we know that the work of many researchers including Walter Willett, MD, DrPH, of the Harvard School of Public Health is a good starting point. It's clear to me that the modified Mediterranean diet is currently the best approach for all of us for now. The Mediterranean diet uses daily exercise as its base and then recommends whole grains, vegetables, fruit and lean protein (in that order). An excellent resource for information on nutrition is www.oldwayspt.org. In addition to reviewing the Mediterranean diet, this Web site explores traditional cultures and their healthy diets including groups such as vegetarians, Asians, Latin Americans and even modifications for children.

I tell my patients to avoid "white food"-white sugar, white rice, white flour and white pasta. All are associated with increased inflammation in our bodies. I suggest they avoid the middle portion of the grocery store-the canned and processed foods with long shelf lives live there! In order to have a long shelf life, these foods are more likely to have preservatives and additives. Stay on the outside circuit for the fruits, vegetables, lean protein and other healthier choices. I encourage my patients to slow down and relax while they're chewing and to use small plates whenever possible.

Our government has stepped in with opinions through the U.S. Department of Agriculture (USDA). The government's food guide pyramid makes recommendations on the types and amounts of food to be eaten every day. It was updated in 2005 to include not only variety, proportionality and moderation in selecting foods, but also regular physical activity. There is a stick figure climbing stairs on the side of the pyramid to illustrate the point.

In addition to the general recommendations, the USDA has also made specific recommendations for micronutrients (vitamins and minerals) for specific groups of people:

People over age 50. Consume 25 mcg of vitamin B12 in its crystalline form (i.e., fortified foods or supplements). Women of child bearing age who may become pregnant. Eat foods high in heme-iron and/or consume iron-rich plant foods or iron-fortified foods with an enhancer of iron absorption, such as vitamin C-rich foods. Women of childbearing age who may become pregnant and those in the first trimester of pregnancy. Consume adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet.

Older adults, people with dark skin, and people exposed to insufficient ultraviolet band radiation (i.e., sunlight). Consume extra vitamin D from vitamin D-fortified foods and/or supplements. (We will explore vitamin D more thoroughly in a later chapter.)

Most of my clients are confused about their supplement regimen. I have seen "vitamin habits" run the gamut from never or rarely taking vitamins to taking upwards of twenty or thirty vitamins and supplements a day. I have mapped out spreadsheets with patients so they can see what their vitamin regimen looks like.

Outcomes from an NIH State of the Science Conference in 2006 stated that Americans spend about $23 billion on vitamins and supplements. As a culture we're bombarded with marketing promises and supplement company research that can provide conflicting and confusing suggestions. More than half of the adults in this country take supplements with the expectation that they will feel better, have greater energy, improved health and less chronic disease because of them. Most of us in the healing professions have had little or no training in nutritional supplements and our knowledge has to be self-taught. Ideally our education comes from sources other than the companies that have a vested interest in our prescribing patterns.

Most vitamins are isolated from plants; in fact, there is a lot of data to support the many benefits of a diet that is high in vegetables and fruits. The problem is that commercially grown vegetables have been shown to have lower and lower levels of minerals and vitamins. A Rutgers study in the 1990s compared commercially grown produce to organic produce and noted a marked difference in nutritional value (Smith, 1993). The products themselves have been bred to look nice in the store and have a long shelf life; nutritional concerns are often secondary. So the need for supplemental nutrition in the form of capsules and tablets is probably here to stay.

The term vitamine was coined in 1912 by a Polish biochemist Casimir Funk from the Latin vita meaning life and amine because the vitamin that he isolated, B1 or thiamine, was an amine-a chemical derivative of ammonia. He isolated the vitamin from the husks of rice. He followed in the footsteps of Dr. William Fletcher who noted that 25 percent of asylum inmates in Kuala Lumpur who were fed "polished" rice with the husk removed developed beriberi while only 2 percent of the inmates who were fed "unpolished" rice developed the disease. Similar research in this era resulted in the discovery of ascorbic acid or vitamin C in the prevention of scurvy and other deficiency diseases such as pellagra (niacin or vitamin B3) and rickets (vitamin D).

By definition then, a vitamin is an organic compound found in food that results in a deficiency disease if it is removed from the diet. Large-scale fortification of the food supply here in the United States started in 1924 with the addition of iodine to salt to prevent goiter, followed by the addition of vitamin D to milk in 1933 to prevent rickets and the addition of thiamin, riboflavin, niacin and iron to flour in 1941. It is rare to see overt deficiency diseases here in our country.

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