Coming off of the holiday sugar rush, this month’s blog couldn’t have come at a better time: 5 ways to prevent pre-diabetes. With discipline, determination and an understanding, pre-diabetes can be controlled effectively with diet and exercise alone.
The Mayo Clinic defines pre-diabetes as, “The blood sugar level is higher than normal but not yet high enough to be type 2 diabetes.”
The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen.
- An A1C level below 5.7 percent is considered normal
- An A1C level between 5.7 and 6.4 percent is considered prediabetes
- An A1C level of 6.5 percent or higher on two separate tests indicates type 2 diabetes
Diet and exercise seems to be the go to answer for almost everything, right? When hitting the gym becomes a bore or tracking calories becomes a chore, it creates a slippery slope of frustration, discouragement and disappointment. How about making this time different by changing the way you look at health beyond the scope of calories in and calories out. Check out my five suggestions on how to prevent pre-diabetes.
- Become active in the community. Whether you join a book club, hiking group, or a cooking class, it doesn’t matter. Studies have shown when we are surrounded by happy people, we become happy. Being engaged in society provides a release of any stress you may be carrying from the burdens of daily life. When stress is controlled, cortisol maintains homeostasis. With normal cortisol levels, insulin regulation and glucose metabolism is optimal.
- Meditate. You don’t have to spend hours a day meditating. Quieting the mind for 5 minutes/day has shown to have dramatic effects on health. According to the July 10, 2017 issue of Time Magazine, “In a new study published in the journal Obesity, researchers from Penn State University randomly assigned 86 overweight or obese women to receive eight weekly sessions of either mindfulness-based stress reduction (MBSR), taught by a professional instructor, or general health education, taught by a registered dietitian. The MBSR group learned how to use mindfulness techniques—like meditation and breath awareness—to respond to stress. The health education group learned about diet, exercise, obesity-related health issues and general stress management. The goal of these sessions was not to help people lose weight, but to reduce stress and stress-related health problems. In that sense, mindfulness worked better. After eight weeks of training and eight more weeks of home practice, perceived stress scores for women in the MBSR group had decreased 3.6 points from the start of the study on a 10-point scale, compared to only 1.3 points for women in the health education group. Both groups experienced improvements in mood, psychological distress, and sleep-related problems. But only the MBSR group saw a decrease in fasting blood sugar levels—both right after training was completed and when the women were retested eight weeks later.”
- Increase water intake. According to an article in The New York Times, being too dry releases a hormone called vasopressin. Vasopressin tells your kidneys to hold onto water and tells the liver to release stored blood sugar. So what is the optimal amount per day? The jury is still out on that. Most health care providers advise looking at the color of the urine. A light yellow urine indicates adequate hydration. Dark concentrated urine implies insufficient water intake. So just keep drinking until you can see through the pee.
- Team up. Partner up with your friends, co-workers, gym buddies and create a challenge for yourselves or join an upcoming race. Being together in a positive environment helps keep us on track. It creates a foundational support and a matrix of resources to keep us accountable. If you ever feel yourself falling off the path, grab your teammate for a hand up. This incredible network ensures a higher success rate and plus, let’s face it, it is fun to do things together. As long as the competition remains healthy and the support unconditional, hormones work together in the same joy as teammates. The result equals a healthy you and happy you.
- Take a road trip. Let me explain. It is fascinating to see how other people in another city, state or country live. When we get caught up in the monotony of routine life, our creative flow halts in front of our faces. We don’t know what to cook. We get bored of the same route to work. We lose the zest for experience. Getting a fresh perspective on new ways of living can stimulate excitement and help pull you out of a rut. Drive along a country road and talk to local farmers. Visit local restaurants and try out new variations to age old dishes. Peek in on ways other communities stay healthy. Link up with different people in various geographical locations via social media. The scope of learning is endless. Seeing the world through another’s eye reminds us that life is good and health is good and together, all will be ok.
I know this list deviates from “conventional medical advice”, but I feel we are bombarded with one study after another and one statistic followed by the next. The problems of our health only seem to be growing deeper. The United States continues to lead the way in obesity. We spend incomprehensible amounts of funding trying to control a disease process that we have created.
Now is our chance! Our chance to take it back to simpler solutions. Putting the simplicity back into a complex life is where healing and prevention will occur. Don’t go looking outside for more research to come your way, more supplements to find their way into your medicine chest, more guaranteed diets that deliver unrealistic results or more promising science to undo what has been done.
Go back to what you already know: that everything you need is already within you.
There comes a point in our lifespan where the hormones biologically begin to slow down production and we begin to consider hormone therapy. When our body senses the slowing of stressors in our crazy lives, it has no need to keep up with the high demands of life. While this is a good thing, the decrease in quantity of the hormones results in a potpourri of symptoms. While more intricate endocrine pathways are being discovered, the global hormonal function remains constant. We feel fantastic when all hormones (estrogen, progesterone, testosterone, thyroid, adrenals, insulin) are in a synchronized balance.
We all know the body WILL change. We may long to feel like we did in our 20’s. I am here to tell you, we can feel even better. There truly is no great mystery to understanding aging. Mid–life and menopause doesn’t have to be the “dreaded” era. In fact, if approached correctly with love and patience, it can be some of the best times of life.
Another thing to keep in mind is that hormonal changes don’t occur just in women. Men can experience the same degree of symptoms. We’ve all heard and some have experienced these symptoms. The symptoms of hormonal changes are extensive and exhaustive. Most of which we are all well aware.
The only thing that needs to be understood is SYMPTOMS OCCUR BECAUSE OF HORMONAL IMBALANCES. Each hormone plays a role in contributing to various symptoms. So how do you know if hormones are right for you? Before answering, ask yourself, “Are your symptoms debilitating enough that it is affecting quality of life?”
If the answer is yes, then hormones maybe what you need.
Hormone supplements are not a forever thing. You may only need them for a certain duration when life feels off balance. The goal should be to use the lowest dose possible for the shortest time possible. Do not depend on only hormones to help you. Stay committed to healthy nutrition, regular exercise and optimal sleep.
If you do choose to begin hormone therapy, continue to work towards creating a healthy lifestyle so that you may begin the process of weaning off of the hormones as soon as the body is able to hold its own.
What are the pros and cons to beginning Hormone Replacement Therapy?
- Alleviates hot flashes and night sweats
- Helps with vaginal dryness
- Helps maintain or restore bone strength
- Improves sleep
- May aid in weight loss
- Possible cardiovascular benefit but evidence is still unclear
- Possible decrease risk of colon cancer
- Helps in restoration of skin, hair, and nails
- Improves mental clarity and mood
- Small increase risk in breast and uterine cancer
- Increased risk of DVTs
- Slight increase in cardiovascular disease and strokes (The WHI study found a 29 per cent increased risk of coronary heart disease in those taking combined HRT)
- Small increase in gall bladder disease
The decision to start HRT (Hormone Replacement Therapy) should be well thought out. Having an extensive discussion with your physician can alleviate any anxiety about the uncertainty of hormone therapy. Each case is unique with varying factors. Listening and honoring your body will lead you to the right decision.
Remember, the minute you decide to start HRT, do everything you can to get off of them as quickly as possible. Use hormones as a crutch, not a permanent companion.
These truly can be the best years of your life! Aging is inevitable. Aging gracefully is optional. That is why I never tire of this topic. Embrace this passing cloud of inconvenience because the rainbow is waiting on the other side.
Dr. Raman’s Concierge Medical Practice is focused on holistic care and good health maintenance. For more information on healthy eating habits and achieving and maintaining OPTIMAL health, CONTACT our office today to schedule your appointment. You can also learn more by following Dr. Raman on Facebook, Twitter, LinkedIn and Pinterest.
A common question I get in my practice is “How much sleep should I be getting?” This is a very important question. Last year, the Centers for Disease Control called insufficient sleep a public epidemic. It is estimated that nearly half of all American adults get less than the minimum recommendation of seven hours of sleep per night. With that many people operating on inadequate sleep, fatigue is so common that it’s easy to overlook the serious nature of the issue. However, with insufficient sleep being cited for auto and industrial accidents and increasing a person’s risk of chronic disease, the case for getting enough sleep should be heard.
Sleep and Reaction Time
Sleep studies have consistently shown that “function” (identified by reaction time measured in a variety of tests) is almost 100 percent impacted by sleep. In fact, a NASA-funded study at the University of Pennsylvania showed that people who self-identify as being able to fully function on less sleep actually experienced more substantial delays in reaction time than people who self-identified as needing (and finding a way to get) eight to 10 hours of sleep per night.
While these reduced reaction time results on controlled tests are alarming, the reality is even worse. Lack of sleep by key personnel has been cited in nuclear power plant disasters, the Exxon Valdez oil spill, and the Challenger space shuttle explosion. Maybe your job doesn’t require intense focus, but a lack of sleep can impact the results of everyday activities just as drastically. Law enforcement agencies across the U.S. consider driving a car under the effect of extreme fatigue identical to driving while drunk.
Sleep Habits and Risks for Disease
Lack of sleep’s effect on overall health is also of great concern. Inadequate sleep is known to increase the risk for the following:
- Heart disease
- Heart attacks
- High blood pressure
- Colon cancer
There also seems to be a link between lack of sleep and a higher risk of developing dementia and Alzheimer’s disease. Reduced testosterone levels have been measured in men who reported getting six hours of sleep per night or less.
Not getting enough sleep also negatively affects the immune system. That’s why a person might find oneself coming down with a cold or flu after an extended period of reduced sleep. Studies have shown that T-cell count (which is often used to measure immune system function) is relative to a person’s average amount of sleep. Likewise, there’s a reason your doctor recommends rest when you’re ill: fever response is better while we sleep.
Sleep deprivation can also lead to muscle loss and fat gain. With too little sleep, the body is also more likely to produce the stress-response hormone, cortisol. After sleep deprivation, subjects in several studies had higher levels of cortisol later in the day, a time when it should be tapering off to prepare the body for rest. Heightened cortisol prompts the body to store more fat and be more inclined to use other soft tissue, such as muscle, as energy which means that sleep-deprived dieters lose more muscle and gain more fat than do those who are well rested. One study found that after two weeks of minor calorie restriction (10 percent less than their daily energy expenditure), subjects who were getting 5.5 hours in bed a night lost just 0.6 kilogram of fat but 2.4 kilograms of other tissue, such as muscle. Subjects who got 8.5 hours slumber each night lost 1.4 kilograms of fat and 1.5 kilograms of other tissue. “Some of these metabolic effects occur pretty quickly,” Dr. Mehra – Journal of the Academy of Nutrition and Dietetics.
Oversleeping: Too Much of a Good Thing?
Just as not getting enough sleep is unhealthy, getting too much sleep isn’t a good thing either. There may be times (such as with illness or during periods of excess stress) when your body may feel an increased need for sleep, and this is normal. However, oversleeping on a regular basis should be watched carefully. Researchers acknowledge a strong association between frequent oversleeping and depression and/or other underlying health concerns like heart disease.
Children up to age 12 should aim for about 10 hours of sleep per night, teens should get 9-10 hours per night and adults should get 7-8 hours per night. Naps can occasionally supplement shortened overnight sleep, but sleep cycles depend on a specific chunk of time, so it’s still important to focus on getting a good night’s sleep.
Discuss Your Concerns with a Trusted Physician
Dr. Raman’s Concierge Medical Practice is focused on caring for each patient with comprehensive, individualized treatment options and health programs. Our office is committed to helping find the best solutions for you and your particular needs.
Like many other conditions, sleep disorders affect each person differently and require a very personalized approach to care. For more information on healthy sleep habits, please contact us today or schedule an appointment with Dr. Raman.
Estrogen and progesterone are hormones that play a significant role in women’s health. These two hormones are most commonly understood as they relate to menstrual cycles, but they affect so many other areas of wellbeing, especially as women age.
Both estrogen and progesterone are primarily produced by the ovaries. From adolescence until perimenopause, estrogen and progesterone levels rise and fall related to a woman’s menstrual cycle.
Progesterone and Estrogen Changes During Perimenopause and Menopause
As a woman ages and enters perimenopause, both estrogen and progesterone levels change. In the early stages of perimenopause, progesterone production declines, resulting in estrogen dominance. During this time, many women feel they are in a constant state of pre-menstrual syndrome, experiencing:
- Mood swings
- Tender breasts
Estrogen production declines in the second phase of perimenopause. This drop in estrogen levels often results in symptoms such as:
- Hot flashes
- Night sweats
- Memory problems
- Heart palpitations
- Sleep disturbances
- Vaginal dryness
Eventually, both estrogen and progesterone decline to very low levels and most symptoms are relieved, although some women continue to experience discomfort through menopause.
As estrogen and progesterone production decline, symptoms can range from easily manageable to negatively life-altering. Additional changes that result from the varying levels of estrogen and progesterone include:
- Reduction in skin thickness and elasticity
- Increased risk of heart attack due to increased rigidity of the blood vessels in the heart
- Reduced calcium absorption leading to decreased bone density
- Increased bladder infections
Although these lists of symptoms may sound daunting, having a sound relationship with your physician can make all the difference!
Healthy Aging IS Possible
Confusion and stress often accompany the wide variety of symptoms related to estrogen and progesterone imbalance. The inevitability of aging combined with limited information and treatment options add to a sense of frustration and helplessness. However, healthy aging is possible and women should not only survive this time of transition, but can actually thrive.
General recommendations regarding a healthy diet and adequate exercise are more important than ever as estrogen and progesterone production declines. Fresh, leafy greens, colorful fruits and vegetables, healthy fats and lean protein support the body as it adjusts to new hormone levels. Additionally, regular weight-bearing exercise builds muscle to support aging bones, while cardiovascular workouts strengthen the heart and lungs and improve circulation.
Hormone replacement therapy (HRT) and bioidentical hormone therapy are common treatments for the side effects of estrogen and progesterone decline. HRT is not without risks, however. A thorough health history review is necessary before beginning treatment and continual monitoring is required during treatment.
Vitamin and mineral supplements, topical estrogen, focused nutritional therapy and prescription medications have all been shown to support healthy aging and offer relief of symptoms related to estrogen and progesterone imbalances. The correct combination for each woman is best determined over time in collaboration with her doctor.
The concept of hormonal pathways, including thyroid and adrenals, has to be understood to seamlessly get through this transition phase. While the scope of menopause is much more extensive than this article allows for discussion, Dr.Raman teaches, counsels, and treats once each women has understood why she is experiencing the symptoms she is.
Dr. Raman is focused on holistic care and good health maintenance. Patients at her Concierge Medical Practice may benefit from bioidentical hormone therapy and a medically supervised weight management program to help ease the symptoms associated with progesterone and estrogen changes.
- Extreme fatigue
- Weight gain
- Muscle aches
- Rapid hair graying
- Decreased libido
- And too many other “little issues attributed to aging”
These little issues could be caused by a small gland with some big responsibilities. That gland is your thyroid.
The thyroid gland produces and stores hormones through an integral and complex pathway that is directly linked to your hormones and adrenals. The thyroid plays a part in EVERYTHING AND EVERY CELL IN YOUR BODY. It is butterfly-shaped and is found in the lower part of the neck, wrapped around the trachea.
Hypothyroidism: A Common Condition, But Frequently Misdiagnosed
Hypothyroidism is a condition where the body, for various reasons, doesn’t produce enough thyroid hormone or is unable to utilize the thyroid at a cellular level. No matter what the cause, this diagnosis has debilitating and frustrating consequences.
Being diagnosed with hypothyroid myself in 2002, I have spent the last 13 years researching, studying,
and understanding the complexity of this “little gland.”
According to the U.S. Department of Health and Human Services, about 4.6 percent of the U.S. population (approximately 18 million people) age 12 and older has hypothyroidism. As prevalent as hypothyroidism is, most people are not correctly diagnosed when they first present symptoms to their doctors because there is not a standard interpretation criteria for screening tests—meaning that one doctor may think a slight dip below the normal range is acceptable while others would argue otherwise.
Your thyroid can be affected if your adrenals are not balanced or if your hormones are constantly fluctuating. Due to the minute-to-minute variability of ALL the hormones in your body, patients are often under-diagnosed.
A single thyroid level test is insufficient to make the determination of hypothyroidism.
Many other thyroid levels also need to be checked. These could include TSH, Free T4, Free T3, Thyroid Peroxidase Antibody, Thyroglobulin Antibody, Magnesium, Iron, Zinc, Vitamin D, Hormones and Cortisol.
A patient who self-educates and self-advocates is in the best position to work collaboratively with his or her doctor to determine the best course of treatment for the symptoms and diagnosis of hypothyroidism. Self-advocacy is much easier when you choose a doctor who has experience in recognizing the symptoms of hypothyroidism as well as other hormonal conditions such as diabetes and adrenal gland issues.
Treatment of Hypothyroidism
Once hypothyroidism is diagnosed, there are many treatment options that need to be considered. Synthetic thyroid (Synthroid or Levoxyl) medication is not the only option. There are T3-only medications such as Cytomel or combination of T4 and T3 medications such as Armour Thyroid or Nature Thyroid. Patients even have the option of having their thyroid medication compounded with an accredited compounding pharmacy.
Hypothyroidism is not a cookie-cutter diagnosis and neither should be the treatment.
It is extremely important to work closely with your physician to monitor symptoms and continue to regularly check your thyroid levels.
The discussion of thyroid disease is more extensive than I can capture in a single blog post. In my 15 years of practicing primary care, I have diagnosed and corrected misdiagnoses of many patients with hypothyroidism. I understand and have experienced every symptom you may be having. I know the frustrations, I understand the suffering and I continue to live with this diagnosis everyday.
If you are suffering from any symptoms that are interfering with your life, Please contact our office today to schedule an appointment.