Healthy Concepts
Randi Mann, NP

Randi Mann, NP

Randi Mann, WHNP-BC, NCMP, is a board certified Women’s Health Nurse Practitioner, NAMS Certified Menopause Practitioner and is the owner of Wise Woman Wellness, LLC, an innovative, wellness and hormone center in De Pere. She is an integrative, functional medicine provider offering natural treatments and prescription medications for thyroid and hormonal imbalances including customized dosed, bioidentical hormones.

She combines the best of conventional, functional and integrative medicine to help women. Attend the introductory “End Hormone Havoc — Stay Sane, Slim and Sexy” seminar — offered monthly. Call 920-339-5252 to register. Visit for details.

If you are in your 20s, 30s or 40s, you might think your hormones won’t begin to change until you get close to age 50 or menopause. The average American woman reaches menopause (classically defined as a year without a period) around 51.2 years of age. You may not realize how well you feel today is strongly correlated to your hormone balance.

If you are experiencing fatigue, irritability, anxiety and insomnia, your provider may have told you these symptoms are not related to hormone imbalances because you are too young. You may also have asked your provider to check your thyroid levels or your blood count to make sure you are not anemic. If these tests came back normal, you may assume there is nothing else to be done to help you feel better. This is generally not the case, ladies! Please note! Hormone imbalances can affect you as significantly now as when you are your mother or grandmother’s age.

Unfortunately, younger and younger women are experiencing more symptoms of hormone imbalance today due to hectic lifestyles, high stress, and unhealthy diets and lifestyle choices.

Your hormone balance plays an important role in how you feel every day, in your overall health and in preventing premature disease. If your progesterone, estrogen and testosterone aren’t in balance you may experience many common symptoms: premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), polycystic ovarian syndrome, uterine fibroids, fibrocystic breasts or breast tenderness, belly fat, abdominal bloating, heavy bleeding, migraines, mood swings, irregular periods, fatigue, anxiety, difficulty concentrating, a decreasing sex drive and food cravings. If you feel like you are out of balance, eating a healthy diet and making simple lifestyle changes such as exercising regularly will definitely help. PMS symptoms can be managed with eating smaller, more wholesome meals (3 meals plus 3 snacks daily). Include in your diet lean sources of protein, legumes, foods with soy protein (unless you have a thyroid disorder), raw and leafy vegetables and fresh fruit, low fat milk, cheese and yogurt, whole grain breads, cereals, and pasta. Avoid food stressors such as refined sugars and fats, salty lunch meat, sausage, bacon, high fat cheeses such as brie, white bread, cake, cookies, jam, honey, molasses, high-salt snacks such as potato ships, caffeinated drinks, and alcohol.

You may also wish to consider having your hormone levels tested and the use of bioidentical hormones to alleviate symptoms. Using individualized dosing, bioidentical progesterone often helps women in their 20s, 30s and 40s feel better. Progesterone plays a vital role in helping many women feel calmer, less irritable and sleep more restfully.

What is progesterone?

Progesterone is one of three main female sex hormones in our bodies. It travels via the blood stream to trigger certain activities or changes in the body. Hormones work by binding to specialized areas of cells called receptor sites. There they start a chain of events in target cells or organs. For example, progesterone has been known to exert a calming effect in the brain, reducing anxiety. Each month progesterone prepares the uterine lining for pregnancy and progesterone levels rise after ovulation. Unless you become pregnant your progesterone levels then drop and this triggers menstruation. Progesterone also balances out the effects of other hormones in the body such as estrogen. When you have too much estrogen and not enough progesterone then you may experience many uncomfortable symptoms. This is often referred to as being “estrogen dominant,” a popular condition referenced in many books written about menopause but not an official medical diagnosis used in conventional medicine.

Is there a difference between “natural” or “bioidentical” progesterone and synthetic progesterone?

Progesterone is a hormone produced in your body. The term “natural” or “bioidentical” refers to progesterone that is chemically identical to the progesterone produced in a woman’s ovaries. Natural or bioidentical progesterone is produced from a plant source (Mexican wild yams or other plants) and is modified in a laboratory to become identical in chemical structure to human progesterone. Synthetic progesterone is called a progestin and does not have the same effects on various body receptors outside of the uterus. Many women today are choosing to take bioidentical hormones instead of synthetic hormones.

If you are not feeling your best, please seek appropriate answers and proper guidance for management of your hormone related symptoms and individual needs. Choose a knowledgeable provider who specializes in hormone care for women and is certified through the North American Menopause Society (NAMS) if possible. You may find a provider in your area listed online at or by contacting NAMS at 440-442-7550. 

Wednesday, 27 September 2017 01:43

Breast cancer and hormone replacement therapy

Much has been written about the connection between breast cancer and hormone replacement therapy (HRT). HRT is not new; it’s been around for many years. The first known experiments with hormone replacement therapy date back to the 1700s when scientists ground up the ovaries and testicles of animals and added them to potions in an attempt to cure the prevailing ills for the women of the time. Hormone therapy went through a series of transformations involving ingredients such as amniotic fluid from pregnant cows and urine from pregnant women, with little success. It wasn’t until 1949, when Premarin was introduced, that women had much hope of relief from hot flashes, mood swings, night sweats and low libido caused by menopause. Premarin soon became the standard treatment for combating the uncomfortable symptoms of menopause. 

In 1975, clinical trials discovered a link between Premarin and uterine cancer. Hormone replacement therapy began to be closely scrutinized by the scientific and medical communities. Then in 1993, one of the most publicized studies, called the Women’s Health Initiative (WHI), began studying the effects of estrogen and progesterone on the long-term health of menopausal women. The study involved 16,608 women and was to run until 2005. However, the study was stopped in 2002 because researchers were discovering an alarming increase in heart attacks, strokes, blood clots and breast cancer. When the results of this study were published, it justifiably set off alarms for women, and HRT became classified as dangerous in the minds of many. But this is not the whole picture of hormone replacement therapy.

As more and more research was completed and the medical and scientific world gained greater insight into the world of hormones and HRT, a clearer picture emerged on what is considered “responsible” hormone management and replacement therapy. This includes the use of bioidentical hormones and customized doses created by compounding pharmacies. Bioidentical hormones are plant-based hormones with the same molecular structure as the hormones naturally occurring in women’s bodies. Customized dosing means the hormone is dosed specifically for the individual. Compounding pharmacies are those with the ability and expertise to create customized-dosed medications in a variety of delivery applications, such as oral, topical, vaginal and sublingual (under the tongue). Traditional synthetic hormones, such as Premarin, are massed produced in pre-determined dosing with raw materials that do not mirror the molecular structure of our human hormones.

In 2005 new data began to emerge as the first results of the E3N French Women Prospective study were published. Part of the study followed 54,548 postmenopausal women for 6 years. These women had an average age of 53 and had not been on any kind of HRT for at least a year before entering the study. The study concluded that women using synthetic HRT had an increased risk of breast cancer, while women using bioidentical hormones had the same breast cancer risk as women who did not take hormones at all. 

Customized-dosing is another critical part of the equation for responsible HRT. In breast cancer survivors or women who are at a higher genetic risk for breast cancer, it is important to prescribe the lowest amount of estrogen necessary to achieve a positive physiological result. In other words, just enough to alleviate her symptoms. It is also important to obtain a proper estrogen to progesterone ratio. This is accomplished most easily by using customized-dosed hormones created by a compounding pharmacy. 

The route of delivery is also an important factor in responsible HRT. Topical estrogen and progesterone is one of the preferred methods of delivery because it is absorbed through the skin and directly into the blood stream for circulation and use in the body. Taking an oral estrogen means the estrogen must pass through the GI tract and is metabolized in the liver and kidneys. This can lead to metabolites, which have been associated with higher risks in some studies. 

The bottom line is that hormone replacement therapy can provide much needed relief from women who are suffering from things like hot flashes, night sweats, mood swings, low libido, painful sex and so much more, but it must be done right to provide the ideal physiological dose without causing harm to the patient. 

Randi Mann, NP and owner of Wise Woman Wellness, works with top breast cancer researchers and top laboratory hormone specialists to develop protocols for women who have survived breast cancer or who are genetically predisposed for breast cancer. There is relief for the unpleasant symptoms of menopause. To find out more information, please visit us on the web at


Thursday, 31 August 2017 01:50

Why food sensitivities should not be ignored

Society as a whole is starting to pay more attention to what we are feeding our bodies and considering the idea of food as a medicine. Food sensitivities have stepped into the spotlight as more and more people are identifying the direct connection between what we are eating and how our bodies are performing. Research has demonstrated the need to take food sensitivities seriously because left untreated, a food sensitivity can lead to chronic illness.

What is a food sensitivity?

As the body breaks down the food we ingest, protein fragments can be mislabeled as foreign invaders in need of being “destroyed.” This triggers an immune response, which creates inflammation in the body. This is a food sensitivity. You might experience bloating, gas, upset stomach or diarrhea as the body tries to eliminate these “invaders.” These symptoms pass relatively quickly, but your body is still experiencing inflammation caused by the immune response. When your body is exposed to a continuous inflammatory response (even low-grade inflammation), you are susceptible to disease and accelerated aging.

Food allergies versus food sensitivities

A true food allergy is characterized by an almost immediate response of the body, such as itchiness, runny eyes and nose, and trouble breathing. A food sensitivity will take longer to manifest itself and is often missed because the symptoms are usually cumulative and attributed to something other than a food you may have consumed hours or days prior. Food sensitivities often present themselves in the form of migraines or headaches, irritability, foggy thinking, bloated of puffiness, skin problems, and irregular bowel habits. Dr. David Blywiess, Chief Medical Officer at Cell Science Systems (the makers of ALCAT testing) estimates that over 80 percent of the human population has a food sensitivity of some degree. Only 5 percent of these people have a true food allergy.

Identifying the culprits

An elimination diet is one of the tools recommended in identifying foods that cause you issues. This means you eliminate certain foods for a period of time (usually 3 to 4 weeks) and then reintroduce them slowly and monitor symptoms to identify possible reactions. This is done by keeping a food journal. This is really helpful for identifying the big offenders such as gluten, dairy and soy. The elimination diet can be time consuming and difficult when you consider the dozens of other foods you eat that don’t fall into the “big offenders” category. This is when food allergy testing might be recommended. We have trusted the science behind the ALCAT testing for many years. They are considered the gold standard for testing allergies and sensitivities to food, chemicals and molds, because they use a live blood cell test instead of the typical IgG test. The live blood cell tests measures reactions as the various elements are introduced, while the IgG test is a dead blood test that measures antibodies and pieces together an incomplete picture of possible food sensitivities based on the number of antibodies found in that particular blood sample. If the patient hasn’t been exposed to a certain food, chemical or mold for an extended period then it can be missed.

Good nutrition is crucial for health and wellness. Feeding your body what it needs to thrive is important to how we feel and age. That is why it is part of each patient’s customized wellness plan at Wise Woman Wellness. To find out more, please visit us on the web at

Many of the articles available on hormones and hormone replacement therapy focus on the obvious and uncomfortable symptoms of imbalanced hormones: hot flashes, night sweats, foggy brain, erection dysfunction and moodiness. These symptoms are really “in our faces” and they demand attention because of their uncomfortableness. However, there are foundational systems and processes in our body that can be silent until big damage is done. The reality is that every cell in our body requires hormones. They are the chemical instructions our body creates to tell individual cells and groups of cells what they are supposed to be doing. Here are three major systems in the body and how our sex hormones — estrogen, progesterone and testosterone — affect these systems.

Hormones and bones

Sex hormones are very important in regulating the growth of our skeletal system and maintaining mass and strength of our bones. Estrogen stimulates bone formation and plays a crucial role in closing the growth plates. (Growth plates are areas of growing tissue near the ends of long bones in children and adolescents. When they stop growing, the growth plates are “closed” and replaced by solid bone.) Testosterone stimulates muscle growth, which puts greater stress on our bones and also increases bone formation. Testosterone is also converted into estrogen in our fat cells, creating a secondary source of estrogen in our bodies to help strengthen the bones.

Hormone imbalance effect on bones

Osteoporosis, probably the most recognizable of the bone diseases, is more common in post-menopausal women because of their lower estrogen levels. Lower testosterone levels are also connected to osteoporosis. Osteoporosis is characterized by a weakening in bone strength that leads to a higher risk of bone fractures. Osteoporosis also causes loss of height, loss of mobility and can be painful.

Hormones and your heart

When it comes to our heart and cardiovascular system, balance of sex hormones is key. Each of these hormones provides benefits at the appropriate level, but higher or lower than the physiologic dose can lead to big trouble. Estrogen has been known to increase HDL (the good cholesterol), lower LDL (the bad cholesterol) and relaxes and dilates blood vessels, increasing blood flow and reducing the risk of a heart attack. Progesterone reduces the risks of blood clots and heart attacks by normalizing blood clotting and constriction of the blood vessels. Testosterone helps to widen blood vessels and improve vascular reactivity and blood flow. It is important to note that testosterone has had some controversial research results when levels of testosterone get too high. This is when balance is crucial. Too much testosterone can lead to metabolites that are dangerous and can actually increase the risk of heart disease. According to The North American Menopause Society, age and time since menopause are critical considerations of the effect of hormone therapy, with more favorable effects noted for women between age 50-59 and within 10 years of time of menopause when starting hormone therapy.

Hormone imbalance effect on your heart

According to the World Health Organization, cardiovascular disease is the number one killer of both men and women worldwide. It is related to the process of atherosclerosis in which plaque builds up in the arteries, the artery walls become thicker and blood flow is reduced. There are many lifestyle and nutritional factors involved in heart disease, and balance hormones definitely play a role, as well.

Hormones and your brain

Estrogen in women is known to work on the hypothalamus in the brain, affecting ovulation and reproductive behavior. Estrogens maintain the function of key neural structures and the production of serotonin and dopamine. It affects mood, memory, emotions and motor skills. According to Advances in Pharmacology, estrogen therapy provided at the right time (before the onset of Alzheimer’s) also has been shown to reduce the occurrence of Alzheimer’s. Progesterone plays an important role in protecting and repairing the brain. In fact, progesterone is classified as a “neurosteroid” because of its critical functions in the nervous system. Progesterone actually promotes the growth of the insulating layer called the myelin sheath that protects the nerve fibers and are essential to a properly functioning nervous system. It is a standard treatment in traumatic brain injuries. Progesterone also eases anxiety and facilitates memory and improved cognitive function. Properly balanced testosterone in males has been associated with improved cognitive performance and verbal and visual memory. It has also been shown to increase brain tissue preservation and reduce the risk of Alzheimer’s and dementia.

Hormone imbalance effect on your brain

Low estrogen leads to a decline in cognitive function, declarative memory and motor coordination, and there is an increased risk of Alzheimer’s. Low progesterone levels in pregnant women can lead to developmental problems for the child. According to the National Center for Biotechnology Information, low levels of testosterone can lead to cognitive decline and increase the risk of neurodegenerative diseases such as Parkinson’s and Alzheimer’s.

As you can see, the natural decline of our sex hormones as we age has a greater effect on our bodies than most people realize. The obvious symptoms of hot flashes, moodiness and erectile dysfunction are just the tip of the iceberg. Even if you don’t have the obvious symptoms of imbalanced hormones, damage can be occurring to essential body functions without your knowledge. This is one of the reasons hormone testing is recommended as part of an accurate diagnosis. It helps to develop a clearer picture of what is happening inside your body. Visit a provider who can help you decide what is the best treatment for your hormonal health! 

References: “Cardiovascular diseases (CVDs).” World Health Organization.

“Estrogen regulation of mitochondrial bioenergetics: Implications for prevention of Alzheimer’s disease.” Advances in Pharmacology. Yao J Brinton RD.

“Increased Risk of Dementia in Patients with Erectile Dysfunction.” National Center for Biotechnology Information. Chun-Ming Yang, MD.

To find out more, please visit us on the web at

Because insulin is a major hormone, it is impossible for the body to balance its minor hormones (estrogen, progesterone and testosterone, for example) until insulin metabolism is balanced first.

Being insulin resistant puts a woman at a much greater risk for many other conditions including diabetes, hypertension, heart disease, breast cancer and Polycystic Ovary Syndrome (PCOS). Our metabolism developed thousands of years ago when our diet included fewer and more complex carbohydrates. Blood sugar imbalances, now rampant in our society, can become chronic and progressively serious, eventually leading to diabetes.

The first step of this progression is the development of insulin resistance, a state in which the muscle and fat cells no longer accept glucose. The body’s demand for fuel varies but the brain requires our blood sugar to remain stable. Getting the cells in the body the energy they need without changing our blood sugar level is a critical function played by insulin as it signals the cells to absorb glucose from the bloodstream. The body monitors what we have ingested, blood sugar level and cell demands, then releases insulin in the correct amounts. This process represents a healthy body that is “insulin sensitive.”

Many women’s diets are low in healthy fats and consist of an excessive amount of refined, processed carbohydrates from sugar and other processed foods, most notably those containing high fructose corn syrup. Some of these foods are marketed as “healthy,” such as some breakfast cereals, low fat yogurt, diet soda, white bread, bagels, pasta, etc. Consuming these foods causes a rapid rise in blood sugar. The body manages this high blood sugar with a compensatory rapid rise in insulin. The overproduction of insulin causes a rapid and drastic reduction in blood sugar for a short period of time. (The brain can only last a few minutes without a steady supply of its fuel: glucose.)

This drop in blood sugar levels triggers a compensatory rise in cortisol level (responsible for moving sugar out of storage and into the bloodstream), which generates more of the same cycle including cravings for more carbs and sugar. Extra insulin travels with the new rise in blood sugar to transport the glucose into the cells for storage or energy production. Over time, however, the cells lose their ability to take in large amounts of glucose and this state is called insulin resistance. The cells in the body literally alter the shape of their insulin receptors so the insulin no longer fits the receptor and insulin can no longer transport glucose across the cell membrane. Both the insulin and the glucose are left to circulate in the bloodstream.

The body is not designed for prolonged high levels of insulin. It disrupts cellular metabolism and spreads inflammation. Insulin disrupts fat metabolism. When the cells can’t absorb the extra glucose any more, the liver converts it into fat. Fat cells are loaded with glucose receptors so this is a vicious cycle. Ironically, while the insulin-resistant woman is gaining weight, her cells are actually “starved” for glucose so she feels exhausted and tends to eat carbohydrate heavy foods in search of energy.

The fat cells are now considered a metabolically active endocrine organ. The extra fat cells are little factories producing estrogen. This contributes to estrogen dominance, which causes multiple symptoms in the perimenopausal transition for women.

This cycle of glycemic stress places a great burden on the hypothalamic-pituitary-adrenal axis (HPA axis). Elevated cortisol interferes with the function of estrogen, progesterone and testosterone, and leads to increased progesterone conversion to cortisol and hence decreased progesterone, resulting in a state of relative estrogen dominance.

Anyone can become insulin resistant — even if they are thin. The more processed and refined foods we eat, the more insulin we require to metabolize it. The more insulin in our blood, the less responsive our cells become. As we age, this continual exposure wears out our tolerance for refined carbohydrates and reduces our sensitivity to insulin.

Women with the greatest risk for developing insulin resistance and progressing into Metabolic Syndrome are those who suffered from gestational diabetes, have hypertension, are seriously overweight or have a family history of Type 2 diabetes.

Women who are apple-shaped, carrying their weight around their abdomen, show less tolerance for insulin. If a woman’s waist/hip measurement is > 0.8 (divide waist measurement in inches by hip measurement in inches) she is at risk for developing insulin resistance.

A skin change called acanthosis nigricans, warty-like darkened patches of skin at the neck and armpits also indicates insulin resistance in over 90 percent of women.

The good news is that glucose metabolism is highly responsive to lifestyle changes and can be supported through dietary modification and supplementation. Weight loss improves insulin resistance. Specifically, losing abdominal fat is key. Also, to sustain weight loss, preserving muscle and lean mass is critical.

Diet and Lifestyle Interventions

Keys to an effective dietary prescription include:

  • Eat a balanced breakfast and eat foods with a low glycemic impact. Eat on a regular basis every 3-4 hours to keep blood sugar levels stable.
  • Reduce total calories while maintaining regular protein intake — consume some type of protein with each meal and snack throughout the day. Avoid dairy and meat that may have added hormones.
  • Shift carbohydrate intake from sweets and wheat and flour containing products to whole foods: primarily organic vegetables, fruits, nuts and seeds such as chia, hemp and quinoa and home cooked cereals (not instant or refined), and less starchy vegetables and grains.
  • Select healthy fats and include small fatty fish such as sardines, mackerel, herring and wild caught salmon, flax seed, nuts, olives and cold-pressed extra virgin olive oil, avocado, macadamia and coconut oils. Avoid all oils that are called “vegetable” and all corn, soy, safflower, sunflower and canola oils, and foods made with partially hydrogenated and trans fats.
  • Avoid all sweetened drinks: soda, fruit juices, sports and energy drinks.
  • Avoid all artificial sweeteners, high fructose corn syrup and foods with preservatives and food colorings.
  • Eat foods high in fiber to slow the absorption of glucose into the bloodstream. Include hard-shell beans such as kidney beans, navy beans and chickpeas. Adding a half cup of beans to a meal will significantly increase fiber intake or add other fruits, vegetables, nuts and seeds.
  • Regular exercise is key but patients need to recognize that exercise without dietary changes is not going to be effective. Resistance exercise and aerobic exercise are both necessary. Exercise improves the sensitivity of the insulin receptors independently from diet.
  • One last note, never eat carbohydrates in isolation except for fruit. Fruit will not spike your glucose if you are not already insulin resistant. This depends on how insulin sensitive you are — fruit is a complex food that we evolved eating! 

Forefront Dermatology

Why gluten-free is imperative for thyroid sufferers

By Randi Mann, NP

Hypothyroidism is one of the most common thyroid disorders. The American Thyroid Association estimates 20 million Americans have some form of thyroid disease and women are 5 to 8 times more likely than men to develop thyroid problems. Hypothyroidism is characterized as a deficiency of thyroid hormone. And since nearly every cell in our body has receptors for the thyroid and requires sufficient thyroid to function properly, there is a myriad of symptoms associated with hypothyroidism.

Sufferers can experience:

  • Weight gain
  • Fatigue
  • Cold hands and feet
  • Constipation
  • Thinning of the outer eyebrow
  • Mental slowness
  • Dry skin
  • Hair loss
  • Hoarse voice
  • Muscle stiffness and pain
  • Depression and mood swings
  • Dementia
  • Menstrual irregularities
  • Infertility
  • Carpal tunnel syndrome
  • Loss of balance
  • Peeling, splitting fingernails
  • Joint pain
  • Frequent muscle cramps
  • Low sex drive
  • Puffy hands and face
  • Unsteady gait and bumping into things

Thyroid hormones play a role in the most basic aspects of body function. They directly impact the brain, metabolism, the cardiovascular system, gall bladder and liver function, and body temperature regulation.

There are different reasons a thyroid gland will stop producing the desired level of thyroid hormones (hypothyroidism). It is now believed that approximately 90 percent (possibly up to 97 percent) of hypothyroidism cases are caused by an autoimmune response. This means the body has mistakenly identified the thyroid as “foreign” and starts attacking it. Hashimoto’s and Graves’ (also thyroid diseases) are autoimmune diseases. At the heart of autoimmune diseases is inflammation, which leads to thyroid tissue destruction and continued autoimmune responses from the body.

So, what does all of this have to do with gluten? The protein portion of gluten, called gliadin, is problematic. No human can digest the gluten proteins found in barley, wheat, rye and triticale. “Our human digestive system is perfectly able to digest every protein we eat except gluten. Gluten is a ‘weird’ protein and we don’t have the enzymes to dismantle it completely, leaving undigested peptides that can be harmful. The immune system may perceive them as the enemy and mount an immune response,” states Alessio Fasano, MD, professor at the University of Maryland School of Medicine and the Director of the Center for Celiac Research. In other words, gluten proteins survive the harsh environment of the stomach and make their way into the intestine where they permeate the intestinal walls into the blood stream. In fact, celiac disease is the autoimmune destruction of the villi in the gut. (Villi is the finger-like projections of tissue in the small intestine, which increase the surface area and help with nutrient absorption into the bloodstream.)

Once in the bloodstream, the gliadin protein is flagged for destruction by the immune system.

Unfortunately, gliadin has a molecular structure similar to that of thyroid tissue, which means the antibodies to gliadin also cause the immune system to attack the thyroid. This is called molecular mimicry. Immune responses to gliadin can last up to 6 months each time you eat gluten, even a little bit. If you have a thyroid problem and you are sensitive to gluten, each time you eat foods containing gluten you are initiating an autoimmune response that goes after your thyroid. Even if you don’t currently have a known sensitivity to gluten, gluten makes you vulnerable to developing autoimmune diseases. A person suffering from one autoimmune disease is more prone to develop additional autoimmune diseases. It is estimated that 4 to 6 percent of people with Hashimoto’s thyroiditis also suffer from celiac disease. This number is much higher when you consider hypothyroidism and non-celiac gluten sensitivities. The autoimmune inflammation wreaks havoc in the body.

So how do you determine if you are sensitive to gluten? There are blood tests available for gluten and other food sensitivities, such as ALCAT and other blood tests for antibodies to gluten and its many proteins. Many experts recommend the elimination diet as a reliable test for gluten intolerance. This involves completely removing gluten from your diet for a period of at least 30 days and up to 3 months. If your symptoms improve during the elimination time and return after reintroducing gluten into your diet, you are gluten intolerant and should avoid gluten indefinitely.

Understanding how gluten acts in the body, we can see how dangerous this protein can be for the human body. An argument can be made that everyone would benefit from a gluten-free diet. Gluten is a destructive protein that cannot be fully digested by humans and there are no nutrients found in gluten-containing food that you cannot get from non-gluten foods. If you are suffering from an autoimmune disease such as hypothyroidism, it is imperative to your health to lead a gluten-free lifestyle.

In the September and November 2016 Northeast Wisconsin issues of Nature’s Pathways we began a discussion of adrenal dysfunction: what happens to your body when you experience a stressful event or have ongoing, unrelenting stress. Too much stress can wreak havoc with your stress response system called the Hypothalamic/Pituitary/Adrenal (HPA) axis. Some people may be familiar with a different erroneous name for this dysfunctional response and call it adrenal fatigue or exhaustion.

We also discussed adrenal dysfunction symptoms and stages, how to test for imbalances of the adrenal hormones (please refer to for more information) and the four key stressors of the human body:

  1. Blood sugar control
  2. Mental and emotional stress
  3. Insomnia/sleep cycle disturbances
  4. Inflammation

The following are ideas to help you take control of each of these four KEY stressors:

Keep your BLOOD SUGAR balanced:

  • Eat a balanced breakfast to start the day with balanced insulin and blood sugar levels.
  • Eat balanced meals - high quality protein, some fats, vegetables and fruits rare simple carbohydrates.
  • Eat 2-3 healthy snacks in between meals - protein, fiber, healthy carbohydrates and fat as well. Carbohydrates eaten alone quickly increase your blood sugar and insulin levels.
  • Avoid refined carbohydrates and simple sugars (soda, candy, cookies, cakes, juices, white and whole wheat bread and white rice are examples).
  • Eat protein at every meal and snack.
  • Eat 2-3 servings of fish 2-3 times per week as their omega 3 content is effective for helping to restore normal insulin levels.
  • Eat foods high in fiber to slow the absorption of glucose into the body. Try adding ½ cup of beans to a meal and include fruits, vegetables, nuts and seeds.
  • Avoid saturated fat and processed foods. Read the labels on your food and skip those with any “hydrogenated” or “partially hydrogenated” vegetable oils.
  • Eat a healthy fat at each meal such as olive oil, flax seeds and oil, walnuts, almond, sesame, grape seed and avocado oils.
  • Limit your consumption of starchy vegetables (potatoes, corn, carrots and peas) which rapidly increase your blood sugar.
  • Keep well hydrated and drink 8 glasses of filtered water or more daily.
  • Avoid all artificial sweeteners.
  • Exercise 5-7 days per week to maintain healthy weight and insulin sensitivity, blood sugar levels and adequate muscle mass.

Suggestions to relieve EMOTIONAL AND MENTAL STRESS:

Identify your stressors. Identify the causes, change what you can and consciously make the effort to stop negative thought patterns when they happen. Your perception of the event is within your control.

Work hard to simplify your life.

  • Practicing saying “no” more often instead of agreeing to too many demands.
  • Find and maintain a healthy balance between work and play. Schedule down time every week.
  • Connect with friends and family instead of being isolated. Find others who can offer you support and engage in activities that you find enjoyable.
  • Laugh often as this helps relieve tension and frustration and lowers cortisol levels.
  • Stop putting off tasks that remain uncompleted as procrastination increased your stress levels.
  • Exercise regularly and focus on breathing more deeply. Exercise that increases your heart rate also helps release endorphins and neurotransmitters such as serotonin, which increase mood.
  • Spend time in nature and enjoy sunlight.
  • Start a gratitude journal and record experiences for which you are grateful. Elaborate on the details to have a greater impact on your mood.
  • Start nutrients and adaptogenic herbs o help to calm the nervous system and improve your ability to respond to stress and your mental outlook.

How to restore sleep and overcome INSOMNIA:

  • Try to get 7-8 hours of sleep each night and try not to get upset if you do not receive this much.
  • Maintain the same sleep schedule and go to bed and wake up at the same time including the weekends. Avoid sleeping or taking naps if you can. If you must nap, sleep no more than 30 min.
  • Avoid caffeine altogether or stop consumption by noon. We have found women whose hormones are out of balance are often more sensitive to caffeine and one cup of coffee at 8am can disrupt her sleep up to 20 hours later.
  • Minimize use of electronic devices for 3 hours before bed. Keep your lights low before bedtime to allow for the release of melatonin, the hormone that helps set your sleep/ wake cycles.
  • Avoid monitoring your clock and how much you are not sleeping. Keeping track of time spent not sleeping is stressful and can make your sleep problems worse.
  • Write down important thoughts on a pad of paper at your bed side during the night if they come up so you can release them and sleep worry free.
  • Make your room cool, quiet and dark. Make sure your bed, pillows and sheets are comfortable.
  • Exercise on a regular basis but no closer than 3 hours before bed.
  • Take melatonin or nutrients including amino acids, minerals and adaptogenic herbs to help promote healthy sleep cycle.

Dietary and lifestyle recommendations to help decrease INFLAMMATION:

  • Avoid inflammatory foods such as red meat, processed meat, fast food, sweets and other refined and heavily processed foods. I repeat, please AVOID sugar!
  • Avoid common food allergen was including wheat, dairy, corn and corn byproducts, soy and for some people, eggs. Get tested for food sensitivities.
  • Maintain a healthy level of vitamin D and supplement with 2000 international units or more of vitamin D 3 with K2 daily. Get your vitamin D level tested yearly.
  • Increase use of anti-inflammatory herbs and spices including ginger, garlic, rosemary, parsley, curry, cinnamon, oregano, mint, thyme, cinnamon, basil, chilies and cayenne peppers.
  • Eat foods high in omega 3 essential fatty acids including fish such as salmon, mackerel, herring, tune and sardines. Put ground flaxseed, chia seed, hemp seed, sesame seeds into smoothies or sprinkle on salads and yogurt.
  • Maintain good GI health and support digestion with probiotics, digestive enzymes and Betaine HCL with Pepsin if needed.
  • Eat many colorful cooked or raw fresh fruits and vegetables daily as they contain high level of vitamins and enzymes to help reduce inflammation, booster antioxidant levels and help reduce free radical damage.
  • Exercise at least 4 days per week to help return fat and reduce inflammation.
  • Avoid toxins including cigarettes, smoke, household chemicals, cleaners, cosmetics and lotions unless made of natural ingredients, unfiltered water, perfumes and over-the-counter pain medications as much as possible.
  • Take vitamins and herbs to help reduce inflammation such as curcumiin, quercetin, vitamin D and fish oil.

So now you know that stress is caused by more than mental and emotional issues. With this information, stress hormone testing, supplements, diet and lifestyle changes you can take better control of your stress! It’s up to you! Don’t let stress be your silent killer!

Please attend our End Hormone Havoc seminar to learn more about stress and its effects on the HPA axis and treatment options.

References: “The Role of Stress and the HPA Axis in Chronic Disease Management.” Thomas Guilliams, PhD. 2015.

“Patient Stress Recovery Program” handbook. Lifestyle Matrix Resource Center. 2014.

In the September 2016 Northeast Wisconsin issue of this magazine we began a discussion of what happens to your body when you experience a stressful event or have ongoing, unrelenting stress. Too much stress can wreak havoc with your stress response system called the Hypothalamic/Pituitary/Adrenal (HPA) axis. Some people may be familiar with a different erroneous name for this dysfunctional response and call it adrenal fatigue or exhaustion. Actually it is much more complicated than your adrenal glands getting too tired so they can no longer produce the stress hormones called cortisol and DHEA. Low cortisol and DHEA levels may be caused by stress and most likely reflect HPA axis adaptation (down-regulation) to protect the body from excess cortisol and have little to do with the continued ability of the adrenal glands to produce hormones.

We also discussed the symptoms and the stages of adrenal dysfunction caused by too much stress and how to test for imbalances of the adrenal hormones. Please review Part 1 of this series if interested.

In this article we will review the four key stressors of the human body:

  1. Blood sugar control
  2. Mental and emotional stress
  3. Insomnia/sleep cycle disturbances
  4. Inflammation

When most people think of stress they usually define it as related to an emotional or mental event such as job loss, death in the family, financial difficulties or suffering from marital discord. There are 3 other key drivers of stress in the body as well: blood sugar imbalances, inflammation and inadequate sleep. Each of these are potent stimulators of the stress hormone called cortisol. For example, you may have very little emotional stress in your life and you may be getting 8 hours of restful sleep each night but if you are eating a poor diet filled with soda, alcohol and sugary foods, then your cortisol and your insulin levels will be going up and down too often and too quickly. Another example is someone who is eating healthy but has a high level of inflammation in his or her body. That inflammation is communicating to the brain/HPA axis to put out cortisol in order to squelch the inflammatory fire. The specific cause of the HPA axis activation may be different from person to person. The end result is that if the HPA axis is required to continually work hard, then your cortisol and its counter balancing hormone, DHEA, will eventually become unbalanced and so will other systems in your body.

Questions to help get to the root cause of your HPA axis dysfunction:

Blood sugar imbalance:

  • Do you experience symptoms of hypoglycemia such as dizziness, shakiness, brain fog between or following meals?
  • Do you frequently miss or delay meals?
  • Do you frequently crave sugar or carbohydrates?
  • Do you consume excessive sugar or refined carbohydrates?

Are you diabetic or pre-diabetic?

Do you regularly consume alcohol or caffeine?

Mental and emotional stress:

  • Do you frequently experience anxiety?
  • Do you suffer from depression?
  • Do you suffer from mood swings?
  • Do you have difficulty getting motivated?
  • Do you frequently experience feelings of agitation, anger, fear or worry?

Sleep cycle disturbances:

  • Are you experiencing problems falling asleep?
  • Are you experiencing problems staying asleep?
  • Are you not sleeping enough hours?
  • Are you not able to fall into a deep sleep?
  • Do you suffer from light cycle disruption or shift work issues?
  • Do you frequently feel drowsy throughout the day”?


  • Musculoskeletal: Do you suffer from headaches, muscle, back or joint pain?
  • Gastrointestinal: Do you suffer from IBS, Crohn’s disease or diverticulitis?
  • Dermatological: Do you suffer from hives, eczema or psoriasis?
  • Respiratory: Do you suffer from asthma, bronchitis, seasonal allergies or hay-fever?
  • Auto-immune: Do you suffer from any auto-immune condition such as MS, lupus or rheumatoid arthritis?
  • Immunological: Do you suffer from food allergies, chronic infections or frequent illness?

Once you have identified your top stressor(s) you can begin to focus on strategies to lessen them. Part 3 of this series of articles will address ways to help you regulate your blood sugar through diet and lifestyle change, support your mental and emotional health, improve your sleep and lessen your body’s inflammatory burden.

With the right information, stress hormone testing and lifestyle changes you can take control of your stress! Your health depends on it!

Please attend our End Hormone Havoc seminar to learn more about stress and its effects on the HPA axis and treatment options.

References: “The Role of Stress and the HPA Axis in Chronic Disease Management.” Thomas Guilliams. 2015.

“Patient Stress Recovery Program handbook.” Lifestyle Matrix Resource Center. 2014.

Your body was designed to respond to short bursts of stress followed by many days of rest and relaxation. For almost all of our patients this is not their reality. Many of them have been dealing with the effects of long-term stress for many months or years.

Too much stress can wreak havoc with your stress response system called the Hypothalamic/Pituitary/Adrenal (HPA) Axis.

Symptoms of HPA Axis dysfunction include:

  • Difficulty falling and staying asleep
  • Feeling tired or exhausted later in the afternoon or after dinner
  • Tired but wired at night
  • Nervous energy or jittery
  • Irritable and unable to control temper
  • Forgetful
  • Crying for no reason
  • Unexplained weight gain around the middle
  • High blood sugar
  • Heart palpitations
  • Fatigue
  • Anxiety and depression
  • Food cravings for salt or sugar
  • Sensitive to noise
  • Very difficult to get out of bed in the morning
  • Experience energy crashes during the day
  • Need for caffeine or other stimulants during the day
  • Feeling stressed out almost all of the time
  • Falling asleep when you don’t wish to such as when watching a movie or reading
  • Sleep is no longer refreshing
  • GI symptoms such as gas, bloating, constipation, nausea, heartburn
  • Weakened immune system and get sick more easily and frequently
  • Worsening menopause or andropause (name of “male menopause”) symptoms

In the past some may have erroneously called this condition “Adrenal Fatigue” or “Adrenal Exhaustion.” Actually it is much more complicated than your adrenal glands getting too tired so they can no longer produce the stress hormones called cortisol and DHEA. Low cortisol and DHEA levels may be caused by stress and most likely reflect HPA Axis adaptation (down-regulation) to protect the body from excess cortisol and have little to do with the continued ability of the adrenal glands to produce hormones.

Your body makes many other hormones out of DHEA

DHEA is a precursor hormone (the raw material) used to make many other hormones in your body. Your adrenal glands act as the “backup team” for a woman’s ovaries by producing lower levels of sex hormones after she reaches menopausal symptoms. Very low levels of DHEA begin to deplete many other hormones in your body including estrogen and testosterone. Once this happens a woman’s menopausal symptoms may return or worsen. For example, symptoms of hot flashes and night sweats may start or become more intense.

Your stress response system includes three endocrine glands (hypothalamus, pituitary and adrenal) and the sympathetic nervous system. These glands and your nervous system work together to regulate your body’s stress response. This is called the flight-or-fight response. This is needed when you are in imminent danger to quickly respond to any threat. The limited release of the hormones cortisol and adrenaline into the blood stream prepares the body to react to the danger. Chronic stress, however, causes a continuous release of these hormones, which can be damaging to the body.

Under normal circumstances, cortisol is produced when needed and DHEA, another adrenal gland hormone, acts to counter balance it. It is important that your cortisol and DHEA ratio remain balanced. The brain “feel good” chemicals serotonin and gamma-amino butyric (GABA) help as well to buffer your stress response and are important counterparts to the fight-or-flight chemicals epinephrine (adrenaline) and norepinephrine. Too much stress over time depletes these relaxing neurotransmitters. Maintaining cortisol to DHEA ratios as well as ample amounts of serotonin and GABA, is vital to keeping a positive mental outlook.

It is possible to assess your stress response system with lab testing. Testing your cortisol and DHEA levels can be very helpful to determine if your HPA Axis is functioning properly and to assess what stage of HPA imbalance you are in.

At Wise Woman Wellness we order baseline Cortisol and DHEAS testing to be done before your first visit so we can review the results with you at your visit.

Cotrisol is tested in saliva four times during the day — when you awaken, before lunch, before dinner and before bed — to assess your circadian or diurnal rhythm. It is expected that you will have the highest amount of cortisol in the a.m., shortly after awakening and your levels will fall progressively until their lowest during the first few hours of sleeping. DHEA is measured in a form called DHEAS in saliva from your first morning saliva collection. Both cortisol and DHEAS are tested from saliva that you collect in the privacy of your own home.

**Hint: it can take up to 15-30 minutes for some patients to collect the recommended amount of saliva needed each time. Please drink at least 8 glasses of water the day before and the day that you plan to test so you will be well hydrated!

Deviation from the expected results means that you are experiencing HPA dysfunction and your levels help us to identify what stage of dysfunction you are in. Each stage requires different treatments.

The 3 stages of HPA dysfunction are typically defined as follows:

  • Stage 1: Alarm phase (hyper-cortisol) or activation phase — ”Tired and Wired” — “Tired and Wired” – agitated, anxious, restless, difficulty falling and staying asleep, weight gain, insulin resistance
  • Stage 2: Resistance phase (cortisol - dominant) or adaptation phase — “Stressed and Tired” — May be due to years of mild stress without adequate relaxation and recuperation. Moderately stressed and tired. May feel driven or overreactive. May increase alcohol and tobacco use.
  • Stage 3: Exhaustion phase (hypo-cortisol) or depression phase” – Neurotransmitters are burned out, depressed, exhausted all the time and especially in the evening, low pulse, may suffer from pain, allergies, less able to handle stress and may shake in times of even small stress or crisis, anxiety, irritability, slow wound healing, other hormonal imbalances.

Stress is caused from more than mental or emotional stressors. When most people think of stress they usually define it as related to an emotional or mental event such as job loss, death in the family or going through a divorce. There are 3 other key drivers of stress in the body as well: blood sugar imbalances, inflammation and inadequate sleep.

Four key human body stressors

  1. Mental and emotional stress
  2. Blood sugar imbalance
  3. Sleep cycle disturbances
  4. Inflammation

At Wise Woman Wellness we assess your specific stage of HPA dysfunction and key driving stressor(s) and determine specific actions for you to take to improve your symptoms and your overall health.

By getting to the root cause(s) and formulating your personalized treatment plan, we can significantly decrease your recovery time and help you feel much better!

Please attend our End Hormone Havoc seminar to learn more about stress and its effects on the HPA Axis and treatment options.

Rekindle your desire, your passion and your sex life by keeping your hormones balanced — and if needed, try a little testosterone! Nearly all women experience a loss of sexual desire at some point in their lives. For many women this happens in their late 40s and 50s. When looking for love we want all of our hormones at optimal levels. A change in a woman’s vaginal moisture and elasticity, lowered self-esteem due to weight gain and a lack of emotional intimacy with their partner can contribute to low libido (sex drive). A woman’s body shape may be changing in her 40s and 50s as her hormones change, resulting in more belly fat and loss of muscle mass depending on her diet and exercise. At midlife she may temporarily feel less attractive and undesirable and therefore less interested in sex. A caring partner can make a world of difference and can help a woman to accept these as normal changes that all women go through. After all, each day a woman gets older her partner is also getting older too!

If a woman is feeling unhappy, unlovable, angry or unfulfilled, it is difficult for her to feel loving and connected with her partner. Counseling may be helpful for couples who are having sexual problems as this may represent deeper issues in their relationship. Satisfying sex involves sharing love, warmth and connection. This is difficult to do if you are not feeling connected to yourself and filled with love. You cannot share something that you don’t feel.

A common cause of low sex drive for women can be related to her hormone levels: falling progesterone, fluctuating estrogen and low testosterone. Changes in estrogen level can influence the vaginal lining causing dryness, loss of elasticity and thinning of the tissues. This can lead to painful intercourse, especially if attempted without the use of additional sensual lubricant. A small amount of topical estrogen used vaginally two to three times per week can easily remedy this complaint if additional lubricant is not enough. Being overtired, too stressed or not feeling well certainly can make an enormous difference in a woman’s desire to be sexual. As a woman ages, her ovaries begin to produce less testosterone. This “hormone of desire” for women influences her thoughts and fantasies about sex as well as her sensations of pleasure and orgasmic response.

If a woman is very stressed, no matter what her age, she likely will not feel the urge to have sex. Perhaps this is Mother Nature’s way of helping to avoid a pregnancy at a perceived bad time to bring a child into the world. For many women (but not all) testosterone therapy does appear to increase sex drive along with energy, muscle tone and size, and bone strength. Recent research has also shown taking the hormone called oxytocin 30 minutes prior to sex can increase a woman’s desire to be held, to cuddle and feel less distracted, in turn helping her to feel more connected to her partner. One of my patients reports it helps her to feel more playful and stops her from thinking of her to-do list in her head long enough to relax and enjoy being sexual.

According to the North American Menopause Society there are no FDA-approved testosterone products currently available for women in the United States and Canada. In Europe, a testosterone patch has been approved for treating low sexual desire associated with distress in surgically menopausal women who are also on estrogen therapy. Interestingly, there are several different FDA-approved testosterone medications for men available by prescription in traditional pharmacies manufactured in standard doses from pharmaceutical companies.

Fortunately testosterone is available for women in America through compounding pharmacies (these are pharmacies where customized medications are prepared to meet each patient’s specific needs). These specialized pharmacies can create customized testosterone doses for women as ordered by their medical provider. It is best to seek help from an expert who is skilled at prescribing bioidentical (some call these natural) hormones such as estrogen, progesterone and testosterone.

I prefer to prescribe only bioidentical hormones for my patients, guided by symptoms and hormone testing before and during treatment. This helps me to know a woman’s baseline level of hormones prior to starting and how well she is absorbing and responding to her hormone therapy after start of treatment. It helps to ensure that she is getting the proper amount of hormone supplementation, not too much medication or too little. It is helpful to use a symptoms chart to track your symptoms to see if they are related to your menstrual cycle and bring this in to your medical visit to discuss with your provider.

Low libido and fatigue may improve with a small dose of testosterone (along with estrogen and progesterone when needed) and a personalized program for better self care and attention. Many women feel better in general and sexually when they learn to eat a better diet, exercise 3-4 times per week and manage their stress better. Don’t’ settle for not feeling your best — enjoy your sexuality no matter what your age! Don’t let something as simple as a hormone imbalance rob you and your partner of a satisfying sex life!

Page 1 of 2
Subscribe Today
Community Partners Directory
Find a Newsstand
Community Calendar