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.

The beginning of each year brings about resolutions of eating better, exercising more, ending unhealthy lifestyle habits and basically hitting the “reset button” on our health. One of the tools many consider to help kick-start a fresh healthy way of life is a detox program.

Why we detox

Detoxification programs are intended to cleanse the body of toxins and other substances that are of no use to the body. Today we are exposed to more and more toxins and they are found practically everywhere: our food, water sources, beauty and hygiene products, cleaning products, and more. It’s hard to escape exposure and the buildup of toxins in our body and tissue can impact all of our body functions. Toxin overload can lead to maladies such as headaches, acne, foggy thinking, fatigue, fertility complications, gastrointestinal problems and a suppressed immune system, among other things. Ridding the body of toxins allows it to function properly and maintain a healthy state.

What is metabolic detoxification?

Metabolic detoxification is multi-phased and involves chemical processes to convert the toxins into molecules that are flushed out of the body. Metagenics, one of the leading authorities on science-based nutrition and supplements, explains the three phases:

  • Phase I (Functionalization) — Cytochrome P450 enzymes in the liver break down harmful substances, generating highly reactive molecules and free radicals.
  • Phase II (Conjugation) — Large molecules are conjugated with newly modified substances, producing more water-soluble, less harmful substances.
  • Phase III (Elimination phase) — Protein transporters export conjugated substances from the cell for eventual elimination. Toxins are mainly eliminated from the body via urine, feces and sweat.

Benefits of a metabolic detoxification program

Although, results and health benefits will vary from individual to individual, metabolic detox programs have been shown to improve liver function, hormone metabolism, the cardiovascular system, diseases of the joints, muscles and bones, along with gastrointestinal diseases such as Crohn’s and irritable bowel syndrome. The benefits are far reaching and affect every system in the body.

Starting a metabolic detox program

A true metabolic detox program should not be confused with other “fad” detox programs such as juice fasts or clear liquid diets. It should be monitored by a trusted health professional. Each phase of the metabolic detoxification should be supported with the proper nutrition and nutrients. There are lifestyle changes required as you detox in order to help your body move through the phases comfortably. 

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

Thursday, 30 November 2017 05:01

Protect yourself from stress!

The holiday season brings many joys and it also brings a good deal of stress, so it is an appropriate time to discuss stress, its damaging effects on the body, and what you can do to protect your body and mind from stress. Research has demonstrated time and time again that chronic stress is very bad for us. Stress has been directly linked to heart disease, weight gain, low libido, a weakened immune system and premature aging, amongst others. Unrelenting, constant stress interrupts critical hormone processes that affect us in obvious ways: emotional, depressed, can’t sleep, crying and sad; and not so obvious ways: suppressed hormone production, inflammation in the body, and constricted blood vessels.

Stress happens

There are unmistakable stressors we encounter in our lives, such as divorce, death of a loved one, loss of a job or diagnosis of a terminal illness. Our bodies are designed to react to these stressors for a limited amount of time by producing cortisol to help us ramp up our ability to deal with the situation. In prehistoric times, we needed this “fight-or-flight” response to survive our environment and not become prey. The body then produces DHEA to help neutralize the cortisol and bring the body back down to a state of “all clear.” Chronic stress interrupts this cycle and can throw the body into a state of HPA (Hypothalamic Pituitary Adrenal) Axis Dysfunction. A tricky aspect of stress is the everyday stressors we have come to accept as part of our daily life, such as being late for a meeting or stuck on the highway. Our body does not distinguish between the obvious and not-so-obvious stressors and responds in the same manner, whether you are late for your daughter’s dance recital or you just got into a car accident.

Protection is the key

It is important to be mindful of the stress in your life so you can make healthy choices to reduce your exposure and create healthy habits to counteract the effects of stress. Below is a list of suggestions to help you combat the negative effects of stress and create a buffer between you and the stress you encounter as you move through your day.

Stress recovery suggestions:

  • 10-12 hours of sleep per night for 14 nights (in bed by 9 p.m., stay in bed until 7 a.m.)
  • Lounge, eat good food, get a massage, listen to relaxing music, meditate
  • Reduce work hours and workload (32-40 hours or less per week)
  • 4 hours a week to do what you want — “it’s fun to play”
  • Get rid of clutter, organize and batch cook and clean so your environment is soothing
  • Breathing exercises
  • Take days off for a vacation or “stay-cation” — stay in your hometown but explore and enjoy new areas
  • Gentle muscle building exercise (yoga, Pilates, walking)
  • Ask for support from family (emotional and physical)
  • Journal, practice mindfulness, appreciate beauty, kindness, good things
  • Regularly eat healthy, low glycemic meals and snacks (to balance blood sugar) — NO junk or processed foods!
  • Take an Epsom salt bath daily
  • Reduce inflammation — stress reduction, food choices, supplements (yoga, gluten-free diet, turmeric, fish oil)
  • Adrenal appropriate exercise (yoga, Pilates, walking)
  • Fix leaky gut (GI testing, remove reactive foods, take aloe, L-glutamine, zinc, vitamin A)
  • Replenish important nutrients and start adaptogenic herbs (professional-grade vitamin and mineral high in B vitamins and magnesium, vitamin C, selenium, ashwagandha, rhodiola, etc.)
  • Remove gluten, dairy, sugar, soy, caffeine and alcohol from diet
  • Try Paleo diet – fruits, vegetables, grass-fed, pasture-raised, free-range meats, eggs, night shades, nuts, healthy fats and pea protein powder (no grains, hot peppers, dairy or seaweed)
  • Have fats and protein at each meal and reduce carbohydrates
  • Repeat positive thoughts in the form of affirmations daily: “I am healing,” “I am loved,” “Every day in every way I am getting better and better”
  • Kick the caffeine habit 

Randi Mann, WHNP-BC, NCMP, is the owner of Wise Woman Wellness LLC, an innovative wellness and hormone care center at 1480 Swan Road, De Pere. Mann is the author of the eBook: A Guide to Gluten and Going Gluten Free. She is a board certified Women’s Health Nurse Practitioner and certified NAMS Menopause Practitioner, one of a handful in Wisconsin and less than 700 worldwide to achieve this distinction. She combines the best of conventional, functional and integrative medicine to help women with female, thyroid and adrenal hormone issues to live healthier, more abundant, joy-filled lives using a blend of compassion, cutting edge science, practical guidance and humor. Please contact her at 920-339-5252 or via the Internet at

Reference: “Hashimoto’s Protocol.” Izabella Wentz PharmD, FASCP.

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.

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