Much has been made of the health issues we can control with lifestyle changes, mainly by eating less, exercising more and eliminating factors like cigarettes and harmful UV rays. But there are plenty of niggling problems that are tougher to tackle. Things like hormonal changes and thyroid conditions can’t be managed simply by cutting calories or adding a few hours at they gym. See what docs say about getting a handle on some of these common issues.
[your hormones]
“As a society, we need to rethink hormones,” says Dr. Theresa Knight, an obstetrician/gynecologist at Women’s Health Specialists of St. Louis in Creve Coeur. Some studies on hormone replacement therapy following menopause have highlighted only the health risks, not the benefits, but Knight says there is a place and a time for HRT in treating women.
sanity, not vanity
“Most of the general public thinks of hormone replacement therapy as a vanity— to have better skin or better sexual function. I strongly disagree,” Knight says. “When women lose hormones, they have weight gain, joint pain, headaches, hot flashes, night sweats and changes in sexual function.” Those are real, and really problematic, symptoms, she adds.
“In addition, women have permanent physiologic changes that cause an increase in cardiovascular disease, bone loss, the risk of osteoporosis, high blood pressure and diabetes,” Knight adds. “We need to be talking about how to prevent those physiologic changes.” She says the issue of hormone therapy is important to resolve due to increasing lifespan. Menopause happens around the age of 52, which until very recently in human history was near the end of a woman’s life. “Now we are hoping that 50 years will be half our lifetime, and we have to think about how we are going to function with the loss of our hormones,” she points out.
cautious use
But HRT may not hold all the answers. “The thinking now is that unless the symptoms are bad, it is best to minimize or avoid hormone replacement,” says Dr. Jodie Rai, an obstetrician/gynecologist with Women’s Healthcare Consultants at Missouri Baptist Medical Center. “If the symptoms are bad, or if the patient really wants to try it, then we should do it for the shortest period possible. The data suggests that if you do it for five years or less there is minimal risk.”
Rai asks her patients to weigh in on whether this therapy makes sense for them. “With some patients, it may be to improve their sex life, make their skin feel less dry or help them feel sharper mentally. For others, it could be used for debilitating hot flashes. They may be unable to sleep, have night sweats or suffer strain in important relationships due to moodiness.” She also respects the patient’s feelings about length of treatment. “If they want to take it longer and understand the risks, I may prescribe it for longer than five years.”
form & function
Systemic hormone replacement is used by about a quarter of Rai’s patients who have postmenopausal symptoms. “At least half of sexually active women use topical vaginal estrogen,” she says. Knight prefers topical estrogen, when appropriate, for this purpose. “Then we don’t have to worry about putting the estrogen through the digestive system and the liver.”
Some women experiment with ‘natural’ approaches to hormone replacement. “The word ‘natural’ is often a marketing term,” Rai says. “For some it means something non-hormonal. For others, it means something from a plant source or tailored to your hormone levels.” She encourages her patients to try herbal preparations: melatonin to assist sleep, or Brisdelle, a non-hormonal, FDA-approved prescription, for hot flashes.
Knight says she often is asked about plant estrogens. “These are totally different chemical compounds. Plant estrogens can have a positive effect on one organ and a negative effect on another. We can use them if they work for the patient.”
another option
Women also are interested in dissolving hormone pellets placed under the skin. “They require an incision and need to be replaced three to four times a year,” Rai explains. Available through compounding pharmacies, they have not been FDA-approved for human use, she point out.
“Many doctors, including myself, have seen patients who have had complications with pellets—bleeding, uterine fibroids and a possible link to heart attacks, strokes and dangerous blood clots. Uterine or breast cancer risks may be higher than with FDA-approved products,” Rai cautions. The best plan, both doctors agree, is to consult an open-minded physician to find the right solution for your unique circumstances.
[irritable bowel syndrome]
The human body is a complex system that depends on precise function, from stem to stern. However, 10 to 15 percent of American adults are troubled by bothersome and confounding symptoms in the stern section. Irritable bowel syndrome (IBS) is the current name for symptoms that have alternately been known as mucous colitis, spastic colon, nervous colon and spastic bowel, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
what’s the problem?
IBS is “a group of symptoms—including pain or discomfort in your abdomen and changes in bowel movement patterns—that occur together.” Unfortunately, it also means the GI system is behaving abnormally without evidence of physical damage. “There are true biological differences between men and women that may play a role in IBS,” says Dr. C. Prakash Gyawali, professor of gastroenterology at Washington University School of Medicine. “Some people believe female hormones play a role in increasing symptoms.”
For frequent or debilitating symptoms, doctors may prescribe medications that “alter gut reactivity and function,” he says, or that target the hypersensitivity and abnormal processing of sensations. “There is evidence that other anti-depressants and anti-anxiety drugs also can work.”
a moving target
Because IBS is categorized as a “functional gastrointestinal disorder,” meaning the GI system is behaving abnormally without signs of physical damage, it can be tricky to treat. Over-the-counter treatments may be recommended. “Polyethylene glycol, or Miralax, is a safe, mild laxative that can help constipation in mild to moderate IBS,” Gyawali says. “But increasing dietary fiber can exacerbate bloating. The choice between these approaches depends partly on the severity of symptoms.”
For people with frequent and severe symptoms, he says, “multiple approaches may need to be used together in conjunction with cognitive and behavioral therapy, stress reduction, hypnosis, acupuncture and other non-pharmacological approaches.” Worry and anxiety can exacerbate IBS, which is why “stress reduction, eating a balanced diet and regular exercise are helpful,” Gyawali adds.
keep an open mind
“Food can be our medicine, and food can be our poison,” says Eva Stottler, a certified integrative nutrition health coach in Town & Country. Figuring out what is right for your body is crucial.” She say IBS sufferers oftentimes eat foods that do not agree with their bodies, albeit unknowingly. “We want to avoid trigger foods that cause inflammation and eat clean, whole foods.”
She suggests avoiding processed and artificial foods, as well as artificial sweeteners. “Those are known to create inflammation and increase the pH level in the intestines, which causes us to be more acidic. That reduces the good bacteria in our intestines,” she explains. Grains and dairy products also can be difficult for some people to digest, Stottler says. She advises patients with digestive issues to avoid gluten. “It may not be forever, but at least while the gut has a chance to heal.” Standard cooking oils also are “hard on the system,” she says. “The only three oils I use in my home are grapeseed oil, olive oil and coconut oil.”
On the recommended side of the ledger she lists omega 3s— things like salmon, flaxseed, nuts and fish, “which are very restorative and good for lubricating the system,” she says. “Leafy greens are naturally detoxifying, and fermented foods are always good.” Stottler recommends a daily probiotic supplement to maintain good intestinal bacteria.
[thyroid]
Your tiny thyroid gland, residing at the base of the neck, produces a couple of hormones that contribute to the regulation of just about every bodily function, including metabolism, digestion, the heart and aging. “It is the master gland—the conductor of the symphony,” says chiropractic physician Darren Kirchner of The Institute of Natural Health in Brentwood. But after years of hard work, that little gland is subject to aging itself.
the implications
“Everything tends to slow down because the stresses in life have accumulated,” Kirchner says. “Women tend to be more prone than men.” Cardiovascular problems might be one factor in the thyroid’s decline in later years. “The thyroid is one of the most vascular tissues in the body per its size,” Kirchner says. “And since it is one of the most blood-supplied tissues, a circulatory problem will significantly affect the thyroid.”
Thyroid disorders become more common as we age, reported a 2012 paper published in Thyroid Research. ‘Subclinical’ hypothyroidism (a low thyroid hormone level) is estimated to affect 3 to 16 percent of people who are 60 or older. Subclinical means patients may not exhibit symptoms of overt diseases.
“We know that thyroid lab results can look slightly abnormal as we age, but we are learning that we don’t necessarily have to treat them until they reach a certain point,” says Dr. Deepashree Gupta, an endocrinologist at SLUCare and Saint Louis University. The most common cause of hypothyroidism in the U.S. is Hashimoto’s thyroiditis, which causes the immune system to attack the thyroid gland. “This autoimmunity runs a bit more frequently in women than men,” Gupta says.
of more concern
Hypothyroidism plainly makes its presence known when it passes the subclinical level. “The classic symptoms of an under-active thyroid include feeling tired all the time, constipation, cold intolerance, hair loss and dry skin,” Gupta says. “The fatigue can be quite significant, and there can be weight gain and depression associated with that. Many symptoms can be going on simultaneously.”
About 8 percent of people over age 65 experience the opposite problem: subclinical hyperthyroidism, or elevated hormone levels, according to Thyroid Research. “These patients typically present with fast heart rate, palpitations, tremors, weight loss, diarrhea and heat intolerance,” Gupta explains. “Hyperthyroidism typically does not have an association with aging except for the fact that it can have more devastating effects on aging women.”
taking action
Low thyroid levels are easily treated, Gupta says. “An oral thyroid replacement will maintain levels in the normal range. Most people do very well. This is a simple replacement we have been doing for decades.” Thyroid replacement is monitored closely in post-menopausal women due to risk factors they already face, she says. “We have to make them feel better, but if we over-treat we can put them at risk for cardiac disease and bone loss,” Gupta says. Hyperthyroidism can also be treated with oral medications, or with radioactive iodine and, less commonly, surgery.
Lifestyle changes also can help the thyroid, Kirchner says. “It can be as simple as stress management tactics. People with irregular sleep patterns can put more stress on the thyroid. A regular sleep schedule is going to be beneficial.” Exercise will boost circulation through that highly vascularized thyroid gland, he adds. “If you have a very sedentary lifestyle, starting to integrate aerobic exercise will be very helpful.” And healthy nutrition, of course, permits the whole body to function better, he adds. “Eating the right foods can have a dramatic effect on the quality of thyroid function. Green, leafy vegetables are very beneficial.”
On the other hand, a couple of seemingly inconsequential changes in dietary habits have created some thyroid issues in the U.S., Gupta says. People who have given up salt or switched to non-iodized sea salt are showing up with enlarged thyroid glands. “Iodine deficiency is making a comeback in our society, which is interesting because we have had iodized salt for a long time,” she says. “Even if we eat just a little bit, it is better to use iodized salt.”