Women’s Health

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

The biggest health concerns for women and the diseases with the most female prevalence

When looking at Women's health issues, there are two main concerns: what are women most worried about, and what types of disease and chronic health problems affect women much more than men? We have to assume that these issues center on the problems with hormonal imbalances, the greatest physiological difference in health between the woman and the man. Of course, we now know that men do have a lot of health issues related to hormonal imbalances as well, with cardiovascular problems, prostate cancer, subfertility, and even andropause becoming issues related to male hormonal health. Hormonal problems affect us all. Changes in hormonal production and balance due to menstrual cycles and changes during perimenopause present great challenges to the female physiology, though, and maintaining a healthy hormonal homeostasis is very important. The big issues in Women's Health are what women should focus on to prevent disease and insure a better quality of life, especially with aging. Complementary and Integrative Medicine (CIM) offers much in the way of preventive medicine and homeostatic balance, and the combination of herbal and nutrient medicine with acupuncture stimulation provides a comprehensive treatment protocol in Women's Health. Whether one needs to treat a serious illness, disease or injury, or just wishes to restore a healthy balance to the skin, the endocrine system, or the metabolism, TCM and CIM provides the tools to achieve the goals.

Perhaps the most talked about issues of concern in women's health are breast cancer, menopause, infertility, osteoporosis, depression and anxiety disorders. The Mayo Clinic states that the top statistical threats to women's health, as evidenced from CDC data, are heart disease, cancers, stroke, chronic lower respiratory diseases (COPD), Alzheimer's disease, motor vehicle accidents, and type 2 diabetes (metabolic syndrome and insulin resistance). Added to this is the gender disparity in patients affected by autoimmune disorders, hypothyroidism, fibromyalgia, and post-traumatic stress disorder (PTSD). Of course, health problems related to gynecology are of great concern, and the prevalence of polycystic ovarian syndromes (PCOS), subfertility and infertility have been greatly overlooked in the past or increasing substantially in prevalence. All of these issues should be a concern, and women may find specific information on these health concerns, and others, in separate articles on this website. In this article, an overview of female health issues is presented, and a review of key systems in the body that indicate that problems with hormonal dysfunction are occurring, with emphasis on the pathophysiology of the skin, adrenal hypothalamic health and weight gain, and dysfunctions of the gastrointestinal system as indicators of hormonally related problems in women's health. Of course, the number one cause of death in females in the United States, heart disease, will also be discussed. Until relatively recently, heart disease in women's health was largely ignored, and increasingly as we study this subject, we see the hormonal relationship to the pathology. These areas present tangible signs and symptoms that indicate to the individual patient that their underlying health problems may need to be addressed holistically. The more study of these disorders, the more evidence we have of multifactorial causes and contributors that demand a more complex, thoughtful, proactive and holistic approach to treatment and prevention.

Hormonal deficiencies and imbalances in Perimenopause, Infertility, Pre-Menstrual Syndromes, Anovulation, Metabolic Syndrome, Insulin resistance, Polycystic Ovarian Syndrome, Subclinical Thyroid Pathologies, and related health problems

These last years have brought great clarity to the treatment of hormonal problems. The amount of knowledge from research in response to the failure of the synthetic hormone replacement therapy (HRT) has finally brought these problems and the effective restoration of hormonal balance, or homeostasis, into focus, in both standard medicine and Complementary and Integrative Medicine (CIM) specialties, such as Traditional Chinese Medicine (TCM) and Naturopathy. In addition, we now see exactly how the hormonal deficiencies affect a wide variety of disorders. Estrogen deficiencies are a primary cause for problems with short term memory and attention problems, poor tissue healing, inflammatory disorders related to tissue calcification, and a variety of calcium related problems, including osteopenia and osteoporosis, and even developmental scoliosis. Progesterone deficiencies create a relative estrogen excess even in estrogen deficient states, and are responsible for most menopausal and premenstrual (PMS) symptoms, and many cases of infertility, as well as the possibility of cancerous growth in tissues with abundant estrogen cell receptors. Hormone dysfunction is a prime contributor to metabolic disorders and creates an added stress that contributes greatly to insulin resistance, diabetes and weight gain. Hypothyroid and parathyroid imbalances often present as subclinical syndromes related to overall systemic hormonal, or endocrine, imbalance, as well. These effects of subclinical thyroid and hypothalamic imbalance (neurohormonal) are now strongly associated with obesity, Metabolic Syndrome, PCOS (polycystic ovarian syndrome) and subfertility. This term subclinical means that no serious overt signs and symptoms are occurring, and often these early stages of endocrine disease are not diagnosed, and no treatment in standard medicine is available, but this is the optimal time to treat, at an early stage. Restorative medicine to achieve hormonal and neurohormonal balance is all-important. The endocrine system is in constant flux, with a strong feedback regulation and diurnal patterns, and the issue is not strictly related to deficiency or excess of single hormones, but rather the balance of these hormones and hormone receptors, and relative excesses and deficiencies in paired hormones, such as estrogen and progesterone, insulin and glucagon, thyroid and parathyroid, cortisol and DHEA, etc. This is what we call hormonal homeostasis, and what ancient Daoist physicians in TCM called the balance of Yin and Yang.

Simple replacement of your hormones with synthetic analogs has created a complex web of endocrine dysfunctions that are threatening to your future health. At a point in time where we had limited understanding of the complex functions of the endocrine system, the concept of hormone replacement with synthetic drug analogs was a viable treatment option. Now that the decades have revealed a wealth of new knowledge of the complex interactions and holistic feedback system that our hormonal health depends on, and the complex interactions between inflammatory mediators, neurotransmitters and hormones at the local cell receptors, the viability of simple replacement of your hormones with a synthetic analog does not seem as sound.

What do we do with this wealth of medical knowledge? Has it resulted in simple herbal cures? The answer is no. A comprehensive and holistic treatment protocol is needed. The endocrine system is the most complex system in the body, and most hormonal problems are multifactorial. The endocrine system also acts in a feedback manner to achieve a constant complex regulation, and affecting just one aspect of this system with a single herb is usually not enough to restore your normal physiological homeostasis. Fortunately, there are medical practitioners, such as Licensed Acupuncturists and herbalists, with the knowledge and skills to utilize a holistic and individualized approach to these problems. The integration of simple laboratory saliva and veinous blood tests, topical herbal creams with bioidentical phytohormones, supplements and herbal formulas, with acupuncture, and guidance in your dietary regimen and lifestyle, has created a package of care that is phenomenally effective and tailored to the individual case. In the last decade this treatment protocol is now proven to work in human clinical trials as well as laboratory research, and the absence of adverse effects make it a type of treatment that should be tried before harsh drug regimens. Finally, the knowledge and treatment options have accumulated over time to give Complementary Medicine physicians a treatment plan with a great chance of success when integrating with standard care to correct hormonal imbalances and deficiencies. This safe and conservative approach may be tried before resorting to synthetic hormonal therapies that come with side effects and risks. Restoration of the endocrine balance when going off of synthetic hormonal therapies may also be achieved with Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM), and many of the side effects and long term risks with pharmaceuticals can be ameliorated with Complementary Medicine.

In the last decade many women have resorted to ART (Artificial Reproductive Technology) and the use of strong synthetic hormones to induce ovulation and increase the chance of fertilization, but these strategies often induce menopause-like hormone imbalances. Use of strong hormonally altering drugs in fertility treatment is now commonplace, and holistic hormonal balancing before and after taking these drugs may increase the chances of success and decrease the chances of long term negative health effects. These fertility medications do come with risks of adverse effects and even fetal mutations, as well as multiparity. Before resorting to these drug therapies, many women are now trying to correct underlying problems inhibiting fertility with a holistic approach. A wealth of research guides this therapeutic protocol, and many fertility experts are incorporating acupuncture, herbal and nutrient medicine into their practice, even medical doctors and clinical nursing specialists. Most problems in younger women may involve subfertility issues, and a normal, safe and healthy pregnancy will occur for most of these women when a few simple health issues are resolved. Taking a more natural approach to subfertility and fertility issues creates greater assurance that your baby will be born healthy and avoid many of the health problems associated with multiparity, ART, and drug therapies. This is just one of the growing areas of use of Integrative and Complementary Medicine in Women's Health.

In 2015, researchers at major University Medical Schools presented findings that women show a quicker progression from mild cognitive impairment (MCI) to Alzheimer's dementia, and that women are at significantly higher risk of long-term cognitive and functional problems following surgery than men. It has been known that women develop neurodegenerative dementia at much higher rates that men in the developed societies, and as research has increased, we now know that the occurrence of neurodegenerative decline is occurring at much higher rates than we had thought. Studies at Duke University Medical School in North Carolina, and the Oregon Health and Science University presented these new findings, and a number of studies sought to explain these findings, finding that women may present with much higher levels of amyloid protein than men, and that a complex field of hormonal interactions explain this faster progression of the diseases of dementia. Studies in the United Kingdom in 2014 found that twice the number of individuals are experiencing these syndromes of neurodegenerative decline and dementia before the age of 65 than previously thought, and that a nearly equal occurrence in the male and female populations was seen between the ages of 30 to 65. For women, perimenopausal and post-menopausal hormone imbalances were associated with the great majority of cases diagnosd before age 65. Common causes of neurodegenerative dementia in younger patients included high alcohol consumption, vascular dementia and increased accumulation of Lewy bodies, a type of protein deposit. Frontal-temporal dementia, which is still poorly understood, was seen in about 12 percent of early onset cases as well, presenting a type of disorder that is less responsive to standard pharmaceutical therapy, and impairs emotional control, communication, and reasoning, and is often misdiagnosed as a psychiatric disorder in women in the 40-60 age group. Since these types of neurodegenerative disease present a complex array of causative factors, metabolic and neurohormonal, a more holistic treatment protocol that addresses an array of factors is desperately needed at an earlier stage of the disease. Integrating preventive medicine with CIM/TCM as soon as signs of MCI are seen is a sound choice.

Hormonal imbalances lie at the heart of both metabolic and neurological disease in Women's Health. What do you do to correct your hormonal problems with integrative Complementary Medicine? You need to spend the time for a thorough history and consult with a knowledgeable practitioner, such as a Licensed Acupuncturist and herbalist that has the experience and expertise. You may try to find an endocrinologist or gynecologist that is open to integrative approaches. Specialized clinical nursing specialists now offer patients much expertise and are able to spend the time to individually utilize standard medicine optimally, as well as integrate with other specialties. When you and your health providers are on the same page you can expect to get great results. In Complementary Medicine you need to take a proactive approach to the therapeutic course and the adjustments in therapy that are needed. You need to gain an understanding and work with your physicians to insure that lasting success is obtained. Corrections of chronic hormonal imbalances often come with a changing set of symptoms, and the patient should take a proactive role in understanding this physiology and working closely with her physicians. A number of articles are provided on this website to help you gain a thorough understanding. You'll be glad you did in the long run.

The key aspects to hormonal health for women involve a number of intertwining aspects of endocrine physiology. A focus on melatonin, hypothalamic health, the adrenal (suprarenal) axis, cortisol, insulin, leptin, ghrelin, progesterone, estrogens, androgen precursors (DHEAS), the thyroid mechanisms, iodine, and hormonal Vitamin D are all important in women's health today. This may seem overwhelming at first, but a gradual understanding of your hormonal physiology and the way that it interacts with the neuroimmunological system will help you to take a proactive role in your health maintenance and restoration, and provide you with intelligent tools to age optimally. In my practice, I find that women are becoming educated to these important aspects of their health and finding satisfaction in this understanding and intelligent proactive role they can play in their own health care. The age of ignoring your health problems and hoping that modern technology will provide the insured health that was advertised but not quite delivered is over.

A Systematic Approach to Health Maintenance and recognition of key signs and symptoms of Hormonal Dysfunction for Women

Physiological changes related to women's health are often rooted in hormonal mechanisms that are more specific to females, distinguishing them from the more prevalent problems that are focal to men's health. While attention to hormonal balancing may be at the root of health problems that are more related to women's health, there are also a number of specific areas of health that may be more important to women than men. Some of these key areas of concern in women's health are addressed in a number of other articles on this website, such as Endometriosis, Uterine fibroids, Ovarian cysts, Polycystic Ovary Syndrome, Perimenopause, Osteoporosis, Hypothyroidism and Hyperparathyroidism, Infertility, Subfertility and Fertility enhancement, Autoimmune Disorders, and others. Of course, a generalized approach does not address the individual health concerns, and sexual stereotyping is not the goal of this area of medicine, but a systems approach to common concerns may be helpful to a percentage of women. The following is by no means a complete listing of female health problems, but does address some of the systems of the body with emphasis on the uniqueness of the female physiology, and is a work in progress. We will start with the outer health aspects, and proceed to the more internal systems.

Signs and symptoms of female hormone imbalance include changes in the skin, with dryness, increased acne, or oily skin. Changes in sleep quality and mood, nervousness, irritability, poor concentration, memory lapses and night sweats are also well known symptoms. These changes in sleep quality and mood may also mean that hormones associated with appetite, weight gain, bloating and loss of muscle mass, such as insulin, leptin, adiponectin and cortisol are not being kept in balance. These same hormones are now linked to bone loss, decreased fertility, and fibrocystic breasts, increasing the risks of breast cancers.

Recognizing the signs and symptoms of female hormonal imbalance and taking a proactive approach to understanding and correcting these imbalances when they occur, either with perimenopausal changes or earlier in life, will be vitally important in addressing the most prevalent threats in women's health. During the menstruating years, increases in premenstrual symptoms such as breast tenderness or fibrocystic breasts, mood swings, irregular periods, heavy or painful menstruation, or menstrual migraines indicate increasing hormonal imbalance. While synthetic hormone contraceptives may alleviate some of these symptoms, this does not restore hormonal homeostasis, and in fact may create a greater risk for future hormonal imbalances and disease. Recognizing the signs and symptoms and taking a proactive approach to restoration will pay big dividends later in life.

In recent years, the pushing of synthetic testosterone replacement and other androgen therapies for women has suddenly become popular, now prescribed for any signs of adrenal insufficiency, a condition that until recently was even denied a real existence in standard medicine. The alarming prescription of synthetic androgen replacement in endocrinology has led to revised guidelines in 2015 discouraging this common practice, as all evidence show much greater risks than benefits. Once again, a failure to see that hormonal balance cannot be achieved by a standard dosing with steroid hormone analogs, already addressed by the alarming problems with hormone replacement therapy in menopausal women, and the health problems with synthetic hormonal contraceptives, is alarming. Obviously, a complex feedback system in constant fluctuation that is seen in the endocrine system needs a restoration of homeostatic controls, not just a filling up of the hormone tank. Scientific studies of hormone imbalance and pathologies continue to oversimplify these issues and focus on just estradiol and testosterone, in fact referring to estrogen deficiency and imbalance in all cases of estrogen metabolism, still equating the term estrogen with estradiol, even though the estrogen metabolism concerns at least 3 hormones, estriol, estrone and estradiol, and the complex enzymatic controls of local conversions of these one into the other, and other steroid hormones into estrogens. How much longer will we continue to pretend that female hormonal balance can be oversimplified is the question.

In 2015, after years of denial, the U.S. FDA finally approved a medication marketed to improve female libido, or the desire and appreciation for sex. While touted as a "female Viagra", this drug, Addyl, or flibaserin, is actually a type of antidepressant SSRI, and is an agonist for the serotonin 1A receptor and an antagonist for the serotonin 2A receptor, although researchers are still unsure how this drug actually affects the libido. Viagra is a drug that stimulates increased autonomic nerve stimulation of blood flow to create an erection, and women use Viagra as well to stimulate the clitoris. Addyl/flibaserin is a drug that alters the neurohormonal system. Serotonin and dopamine are paired neurohormones, which the body tries to keep in balance to maintain healthy function. With a relative deficiency of dopamine, we see that the libido and feeling of motivation and satisfaction are diminished. A relative excess of serotonin will create this relative deficiency of dopamine, and these imbalances may occur locally in the body, not systemically. Localized imbalances of serotonin and dopamine in areas of the brain result over time in imbalances of receptor expression and function. The widespread use of medications that affect the serotonin and serotonergic metababolism, such as SSRI and SSNRI antidepressants, and an array of atypical antipsychotics prescribed for many reasons, obviously may affect these imbalances. Over time, a variety of factors may lead to changes in the expression of different types of serotonin receptors, though, especially hormonal imbalances. We see this clearly by the array of symptoms associated with premenstrual imbalances, including mood disorders, menstrual migraines, etc., and in the symptoms of perimenopause. While fibaserin may alter the neurohormonal receptor balance and function and actually improve symptoms of low libido a little bit for some women, we see that this disorder can be addressed more completely by trying to restore neurohormonal balance, and the beneficial effects for this type of approach are great. The clinical trials of Addyl, or flibanserin, showed only an average increase of less than one satisfying sexual event per month, and produced an average of only 0.3 to 0.4 increase in sexual desire on a scale of 1.2 to 6.0. A restoration of the neurohormonal balance would obviously achieve so much more, and would not produce the adverse health effects of this drug, which in the short term included insomnia, fatigue, sleepiness, dry mouth, gastric dysfunction, hypotension, and fainting, which all increased in incidence when the patient also consumed alcohol or other medications that affected the neurohhormonal pathways. The long term adverse health effects will not be determined for some years.

The big question in Women's Health should concern a restorative approach rather than an allopathic set of approaches, and thus concerns the question of whether a holistic protocol with acupuncture, herbal and nutrient medicine, and soft tissue physiotherapies, along with professional guidance with individual choices in diet and lifestyle, actually works. Of course it works, and an abundance of evidence in scientific studies and human clinical trials proves that an array of therapeutic protocols achieves their goals, which need to be combined in individualized protocols for each patient. You only need to go to the sections of the numerous articles on this website to see hundreds of these studies, all with links to the study summaries on health databases, or the studies themselves in their entirety. This amount of evidence of effectiveness may be overwhelming, and thus the next question concerns how much time, effort and money will be needed to get this this therapy, and who to go to that is dependable. The beauty of Complementary and Integrative Medicine (CIM) is that it can be integrated a little or a lot, depending on patient choice, and it complements standard care. Any amount of access to this TCM holistic approach will help. Of course, the specialty is very complex, and each practitioner may offer different expertise and skills. A little research will help in this choice.

Skin: maintenance, hydration, aging and skin disorders related to female physiology and hormonal problems: the signs of hormonal imbalance may be seen in the mirror

The skin is actually an organ in our body, in fact the largest organ, and is very important to overall health. While the appearance of our skin is emphasized, the function is the most important aspect, and this is largely ignored. Restoring healthy function is the key to achieving the best appearance as well. Healthy skin function will also maintain important hormonal chemistry in the body, producing the prohormone that we mistakenly refer to as Vitamin D, and affecting the melatonin system of diurnal regulation indirectly. Healthy skin function will also improve overall immune function in the body, reducing immune stress, act to help maintain body temperature more easily, and protect us from the chronic effects of numerous pathogens, antigens, and environmental toxins.

The skin is structurally composed of layers, the epidermis, dermis and hypodermis, sometimes referred to as cutaneous and subcutaneous. Like the gastrointestinal membrane, the skin has an extensive symbiotic relationship with microbial colonies, which help to maintain the human skin cells and the immune function of the skin. With aging, skin cells often have a more difficult time with hydration, timely replacement and regeneration, replacement of cellular components, and maintenance of the genetic code and expression. A little knowledge of this physiology and anatomy goes a long way to helping one choose the most pertinent individualized treatments to maintain healthy skin function. Commercial skin care, of course, is based on a one-size-fits-all approach that generates more profit, but an individualized approach helps each woman choose the most efficient approach. With restoration of healthy function, beautiful skin will be one of the benefits, but other more important benefits will also be realized. The skin may a sort of window to your overall hormonal health.

Most of the emphasis on skin maintenance has focused on the arena of reactive oxygen species (ROS), which are commonly called oxidants, or oxidant free radicals. Radicals are atoms, molecules or ions (charged atoms, elements or molecules) with unpaired electrons. Oxygen free radicals are formed from unused oxygen when gaseous O2 (oxygen) and water, or H2O, are not metabolized into useful oxygen molecules (such as H2O2). The oxygen atom, or combinations of atoms (element) is the most reactive nonmetallic element in our bodies, and highly combustible, which is why we use it for fuel in our cells, and why it must be bound to other atoms to neutralize its reactivity. Reactive oxygen species (ROS) may be useful to our body, but too many create survival problems for our cells. As our cells die, the circulation clears them subcutaneously, and the cells in the epidermis are shed. This is why healthy skin circulation and exfoliation are helpful in skin maintenance. Antioxidants are created to clear excess reactive oxygen species, and the glutathione metabolism of cellular detoxification, as well as the coenzyme CoQ10, or ubiquitol, are important in clearing reactive oxygen species when they accumulate inside our cells. An article on this website entitled Antioxidants and Free Radicals more fully explains this subject and helps with intelligent choices of exogenous antioxidants when needed. The important point to remember in maintenance of skin health is that both circulation/exfoliation and help with antioxidant breakdown may be needed when there are problems with the health of the skin. Use of the right exogenous antioxidants when needed, and promotion of the right endogenous antioxidants, not only help the skin but insure that neurodegeneration is slowed or reversed, and that overall physiological stress is lowered.

ROS (reactive oxygen species) are both good and bad. Free radicals may have positive, negative or zero electrical charge, but are highly reactive chemically, creating cellular stress when they accumulate. These free radicals and reactive oxygen species (ROS) are not all bad, but imbalance and accumulation is. This is why the emphasis is placed on the healthy balance of yin and yang in the skin in TCM (Traditional Chinese Medicine), which maintains this reactive energy homeostasis, or skin qi balance. Superoxide and nitric oxide are two types of free radicals, or ROS, that play important roles in maintenance of skin function. Nitric oxide is used to regulate blood flow and blood vessel dilation, and is intimately tied to hormonal fluctuations, implicated in a wide variety of menstrually related pathologies, such as menstrual migraines. Another free radical is hydrogen peroxide, which is used to break down cellular debris and dysfunctional cellular components so that they may be removed, and the skin cells cleansed. Use of the right antioxidants when they are needed, and the right nutritional chemicals that are specific for individualized needs, are important in skin care. Both topical and food nutrient antioxidants may help clear excess ROS when the need arises, and herbal medicines provide a wealth of antioxidants as part of their chemical composition. While it is easier to just assume that each woman has the same needs concerning antioxidants and nutrient medicines, this is not the truth. Patients that gain understanding of their physiology make the best choices and achieve the best results.

ROS play key roles in a variety of physiological mechanisms related to skin health. They act as intermediate transmitters for processes of inflammatory regulation, neurotransmission, and fibrocyte activation. Fibrocytes are a sort of stem cell that may turn into cells active in the skin matrix, which produce the well-known collagen proteins, glucosamine, etc. Fibrocytes also may play an important role in tissue repair. This process of ROS signalling helps maintain both the human and microbial cells in the skin (biota), and reacts to physiological stress. The specificity of the ROS signaling actions that maintain skin health are controlled by local hormones and calcium signaling. The redox (reductive oxygen) signaling that is vital to skin cell maintenance and repair depends heavily on key amino acids, especially tyrosine and cysteine. Accumulation of heavy metal toxins in the skin, such as iron oxides, may inhibit these redox signalling activities, and chelation therapies may benefit the skin in this regard. While this physiology is very complex, basic knowledge helps us to understand how key nutrient and herbal medicines will help our bodies optimize skin maintenance and better replace old skin cells with new.

A balance of essential fatty acids is also important in maintenance of skin health. All membranes, including the skin, and cellular membranes in the skin, are composed of phospholipids, which are molecules composed of a charged (polar) chemical group and a pair of nonpolar fatty acid tails (fatty acids), connected via a glycerol linkage. The body is able to manufacture most lipids, and fatty acids, which are derived from triglycerides or phospholipids, but some of these fatty acids must be obtained from the diet, and are thus called essential. The two most studied of the essential fatty acids are linoleic acid and alpha-linolenic acid (ALA), which are widely distributed in plant oils. The human body has a limited ability to produce the omega-3 fatty acids EPA and DHA from ALA, and thus omega-3 (n-3) essential fatty acids in fish oil and krill oil have been much studied and found to be valuable in medical treatment and disease prevention. What is not publicized is the importance in maintaining homeostatic balance of omega-3, omega-6 and omega-9 fatty acids. Fatty acids have many important functions in the body, playing essential roles in hormonal and immune functions, and providing cellular energy, providing the main energy source when glucose or oxygen is lacking by yielding ATP when fatty acids are broken down (catabolized). Cells in skeletal muscles and the heart are thought to prefer fatty acids in energy production, and fatty acids are now found to be important sources for cellular energy in the brain. Gamma linolenic acid, or GLA, derived from plant oils such as those in black currant seeds, is an omega-6 essential fatty acid, which are important in maintaining a balance between anti-inflammatory and pro-inflammatory immune mechanisms. There are 11 omega-6 fatty acids that are highly studied, and production of some of these omega-6 fatty acids in relative excess to consumption of omega-3 fatty acids are linked to many chronic inflammatory diseases. What is essential to health is the balance of these fatty acids, and supplementation with both DHA and EPA omega-3, and GLA omega-6 may be important in many health problems, as well as including more plant and fish oils in the diet. Krill oil and black currant seed oil supplements will help supply these essential fatty acids when needed, but a more balanced diet is the best source.

The Linus Pauling Institute of Oregon State University, in the U.S.A., states that abundant scientific evidence points to the role of essential fatty acid balance in skin health. Both omega-6 and omega-3 polyunsaturated fatty acids (PUFAs) "play a critical role in normal skin function and appearance", and the omega-6 fatty acids "have a particular role in structural integrity and barrier function of the skin". Evidence is provided that both topical and oral supplementation with these essential fatty acids are effective in aiding and treating skin. Omega-6 fatty acids, such as GLA, may alleviate inflammatory skin disorders and sensitivity, including acne, and omega-3 fatty acids may reduce sun damage, aging and inflammatory skin responses to antigens and allergens. A link to this review of fatty acid research is provided by clicking here: http://lpi.oregonstate.edu/mic/micronutrients-health/skin-health/nutrient-index/essential-fatty-acids. Research in 2014, at the Seoul National University Hospital Department of Dermatology, noted that a 10-week course of supplementation with omega-3 fatty acids (krill oil) and/or GLA significantly decreased acne vulgaris in a randomized controlled human clinical trial (see study link in Additional Information). Such study clearly demonstrates the importance of fatty acid balance and intake for skin health.

When looking at aging skin, we often tend to think that it looks old because it is old. This is not entirely true. Skin cells constantly are in a state of renewal and replacement, like all cells and tissues in our bodies. With aging, the skin might not have the capacity to replace cells and matrix as efficiently, and hence it looks old. Wrinkles are the byproduct of repetitive stress that trains the skin to grow with a learned pattern of wrinkles. Dryness, dull skin tone, and sagging are signs that our health is not supporting the healthy regrowth of our skin, as are age spots and darkening under the eyes. By helping our cells maintain better life cycles, we improve the function and appearance of the skin. Focusing just on the superficial aspects of skin health while ignoring underlying health problems is not the ticket for success in maintenance and restoration of healthy skin. While we often look for the immediate results, the results down the road may be the most important. When we do the work to intelligently maintain skin function and hormonal health, eventually the skin will replace with healthier cells, and the appearance will reflect this.

One of the key factors related to skin health and aging is hydration. Moisturizing factors in the skin include free amino acids, lactic acid, urea and mineral salts, which act together to bind and hold water molecules. Utilizing essential mineral nutraceutical formulas may have a dramatic impact on skin hydration, and correcting metabolic concerns, particularly with kidney/adrenal health, may restore the chemistry that maintains skin hydration. When the skin is too dry, proteolytic enzymes act to break down filaggrin to the supportive amino acids to create better moisture binding. Use of proteolytic enzymes, such as serratiopeptidase, in nutrient medicine may be very useful when the body and skin are overly stressed. Filaggrin is a granular protein complex that combines with keratin protein to provide bioavailability for the skin to react to drying environments. We see that a number of issues may need to be addressed to provide efficient skin moisturizing function. The key molecule that holds moisture in our cells is hyaluronic acid (HLA or HA), and just a drop of pure HLA provides an amazing benefit to dry skin, attracting to HLA receptors as needed, and holding thousands of times its molecular weight in stored water in the cells. While HLA is now added to many skin products, research in 2015, at the Ludwig-Maximillians University, Freie University of Berlin, and the Charles University in Prague, Czech Republic, showed that for healthy normal skin that combined HLA and other topical nutrients is effective in delivery, but for barrier deficient skin the combination actually restricts delivery of nutrient biomacromolecules to the epidermis of the skin. For individuals with dry or unhealthy skin, the application of HLA pure serum first, restoring hydration, and then the introduction of healthy natural nutrients, such as bioidentical retin-A, essential fatty acids, and vitamins, is important for delivery of these skin nutrients (PMID: 25871518).

A holistic approach tries to provide for all of the important biological factors to insure optimal moisturizing function for our skin. Just one bionutrient may not have the desired effect. Lipid layers are also important in the function of hydration, acting as barriers to stop water from escaping. Essential fatty acids help as building blocks for these lipids, and hormonal regulation plays an important role in this process as well. Exposure to skin irritants will create excess stress on this elaborate hydration mechanism, as well as immune stress. Soaps act as mild irritants to help the body speed cleansing functions, and each individual needs to choose the soaps wisely, not creating unnecessary skin irritation. Some commercial soap ingredients, such as sodium laurel sulphate, are known to potentially cause hormonal imbalances. Utilization of key nutrient and herbal medicines, and attention to underlying health problems with Complementary Medicine, is the key to a comprehensive program to restore the health of our largest and very important organ, our skin. When the skin is healthy, this is a good sign that your overall health is sound.

Hyaluronic Acid (HLA) and its remarkable effects with skin hydration

Hyaluronic acid (HLA) is an anionic (no electrical charge) glycosaminoglycan (complex of sugar and amino acid) that is unique in that it is formed in membranes of cells and can be very large, potentially holding a large number of water molecules, with estimates of an HLA molecule holding up to thousands of times its molecular weight in water molecules. The average person has roughly 15 grams of total hyaluronic acid in the body, and one-third of this is replaced with degradation and new synthesis each day. As a person ages, or encounters stress on lubricating tissues with joint degeneration, this replacement of HLA is more difficult. With dry membranes, especially dry skin, there may be a deficiency of hyaluronic acid production for many of us. Other dry tissues, such as cartilage around the bones of the joints, may also lack the capacity to produce sufficient hyaluronic acid, and HLA is also an important component of synovial fluid, the moisturizing, lubricating and shock-absorbing fluid of the joint capsules. HLA is thus an important component of the elasticity and hydration of skin, and deficient production or increased needs for HLA may be a key reason why an individual's skin is dry, rough and nonelastic. HLA may also be an important nutrient medicine for dry hair and scalp, dry membranes of the mouth and eyes, dry vaginal membranes, gum and tooth degeneration, and dry degenerating joint capsules. Studies have shown that nutrient supplement with magnesium, resveratrol, Vitamin A retinoids, and bioidentical extracts from chicken cartilage may help with HLA production, and that zinc deficiency may contribute to HLA deficiency. Plant sources of HLA precursors such as retinoids include carrots, sweet potatoes, yams, squash, pumpkins, cantaloupes, apricots, peaches, and mangoes, as well as dark leafy greens, and foods rich in orange and yellow pigments. Patients taking higher dosages of cortisone, or corticosteroid, drugs may experience lowered production of HLA. A traditional source of HLA in the diet is found in slow cooked broth with chicken, or other fowl, bones, skin, and tendons, and this is still popular in China in the preparation of the congee, or traditional slow cooked porridge, which uses low heat to make both the broth and the congee, cooked for a long period of time. This is particularly nourishing, as the bones are broken and thus marrow is also a component of the broth. To make congees more accessible, many breakfast restaurants in China specialize in this popular food, saving the individuals the time in preparation. At home, congees can be easily prepared, though, if specialized cooking pots, similar to crock pots in the past in the U.S., or Asian rice cookers today, are used.

Skin that needs more tissue repair, such as with excess sun UV exposure, excess environmental irritant exposure, or in skin with challenges to skin maintenance, such as with eczematous and psoriatic skin conditions, may need help with HLA levels. In recent years, research has shown that HLA can be supplemented effectively, but that the greatest absorption may be from a pure serum applied to skin or over an artery, although some absorption in the gastrointestinal tract does occur, and may need a higher dosage of 100-200 mg in a pill form that delays breakdown until the HLA molecules reach the intestinal membrane. Aging skin is often in need of more HLA, and pure HLA serum applied directly to the skin will quickly spread and be attracted to cells with increased HLA receptors. To be effective, the HLA drops need to be applied directly to the skin, not spread with your fingers. When cells membranes do not produce enough endogenous HLA, they create more binding receptors to pick up circulating HLA. A single drop of HLA may supply an amazing amount of these molecules for your skin cells to utilize. HLA can be supplemented in the blood stream as well, and a single drop under the tongue, entering the blood vessels that are rich and superficial in this area, may quickly circulate to cells with increased need. Delivery systems, with HLA molecules encapsulated to insure better delivery are being researched at this time. While HLA is now in many expensive moisturizing and restorative creams and lotions, this type of delivery system is inefficient, and presently, pure HLA, delivered in uncontaminated drops, is a more likely form that will better fulfill any HLA needs related to deficient production or increased need. HLA is derived from bioidentical sources, such as chicken combs, a traditional source in Chinese history, or from specialized production by genetically engineered bacteria.

Systemic conditions related to melatonin, the hormone Vitamin D, kidney/adrenal, and liver/metabolic health may be intimately tied to, and reflect in, skin problems

Not only hormonal changes and imbalances affect the appearance and healthy function of the skin. Metabolic and nutritional imbalance may be the underlying cause or contributor to a variety of skin problems. Working to both create healthy skin appearance and the underlying systemic health holistically brings you to a state where topical moisturizers and skin care cosmetics are no longer needed to maintain healthy skin. Women spend an enormous amount of money each year in the United States on cosmetic skin care products, but a small portion of this spending is directed to underlying health problems, and Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) may have a more dramatic result in improving both skin appearance and the underlying causes of poor skin health. Ignoring the holistic outlook is a ticket for failure in this regard.

Systemic considerations in skin hydration, acne and discolorations are also a concern, and a holistic approach is important. For instance, the body utilizes water channel proteins, such as aquaporins (e.g. AQP3) that express in membranes throughout the body, but are especially important in the kidneys, lungs and gastrointestinal tract, and are found in red blood cells as well. Problems in these other organs may create dysfunctions related to aquaporin expresssion in the skin, an underlying cause of dry, inelastic skin. The aquaporin AQP3 is abundantly expressed in keratinocytes of the epidermis, and studies show that laboratory animals lacking AQP3 expression have dry skin and reduced hydration. This reduced hydration is related to the molecule glycerol, the backbone of triglycerides and phospholipids. Metabolic concerns may play a part in the hydration of the skin in a number of ways. Glycerol is thus used in soaps and other skin care products to improve dry or sensitive skin, and is a component of glycerin soap. Glycerol is also a useful component of herbal tinctures, capturing certain types of herbal chemicals not efficiently extracted with alcohol or water. Laboratory studies have shown that glycerol consumed orally significantly corrected problems with skin hydration in laboratory animals deficient in AQP3 expression, restoring skin elasticity. Use of herbal tinctures extracted with glycerol may improve problems with skin hydration more dramatically than use of water extracted herbal pills, and specific herbal tinctures can be created and individually prescribed by your herbalist.

Keratinocytes are the most abundant of skin cells, and are responsible for making keratin, a protein that gives strength and vitality to skin. Keratinocytes are balanced in the skin with melanocytes, the cells that provide protective skin pigment. With increased sun exposure, more melanocytes are created, but with aging the percentage of enzymatically active melanocytes decreases by about 10-20 percent per decade. In typical skin, one epidermal unit will have 36 keratinocytes for each melanocyte, and with aging, the thickening of these complexes cellularly may occur, but the function and hydrating capacity may be diminished. Health problems in a number of areas of the body may affect the function of the keratinocyte/melanocyte complexes. Research in recent years has found significant relationships between the diurnal melatonin neurohormonal system and the production of melanin, both of which are rooted in the same dark pigmenting chemicals. Problems with sleep, adrenal health and diurnal cortisol mechanisms, and neurodegenerative disorders may thus play a significant role on the health and hydration of the skin as well. While these systems are indeed complex, scientific investigation implies that attention to holistic health is important in maintaining healthy skin. Traditional Chinese Medicine, of course, has always pointed to these considerations, and they are part of the treatment theory and protocol in maintenance of healthy skin and skin hydration.

Problems with regulation of melanocytes and circulating melanin are also well known to create age-related skin changes such as dark spots. Age-related skin color changes may be the result of accumulations of cellular waste products known as lipofuscin, or to dysfunctional regulation of melanocytes with overproduction of melanin pigment. Research into herbal chemistry has found a number of topical aids that help clear these melanin age-spots, and a patented product called Phytallume has shown considerable effectiveness. The herbal extracts in Phytallume include melissa (lemonbalm), mallow (althea, or Yao shu kui), primula veris (primrose, or Xi yang ying cao), achillea milefolium (yarrow), green tea extract, xantham gum, and chamomile extract.

Hormonal imbalances with perimenopause have been proven to be causative of accelerated age-related skin changes in hydration and elasticity. Laboratory studies have shown that ovariectomy accelerates these skin changes as well, by causing estrogen deficiency and hormonal imbalance. Studies in 2011 (cited below) showed that the nutraceutical genistein, an isoflavone, significantly improved skin structural integrity and functional capacity, collagen thickness, and increased deficient growth factors and cellular signals related to hormonally-induced age-related skin changes. Genistein, and several related isoflavones are found in the Chinese herb Psoralea coryfolia (Bu gu zhi), and the herb Red Clover, as well as the foods soy, green bean, alfalfa sprout, mung bean sprout, kudzu (Ge gen), chick pea, and peanut. These flavonoids are considered to be phytoestrogens, or plant chemicals with estrogenic effects. Often, an alcohol tincture of Red Clover and Psoralea coryfolia will have a significant effect in reducing menopausal symptoms, but could also prove to aid skin health as well.

One well known skin problem that affects us at any age and is hormonally related, is acne. In 2011, a systematic review of scientific studies published in Clinical Biochemistry (cited below) found that a number of hormones in the body are related to acne. Serum estrogens were consistently low in patients with more extreme acne vulgaris, and levels that were often increased from normal included testosterone, progesterone, glucocorticoids (cortisol et al), insulin, and insulin-like growth factors. A number of endocrine disorders had acne as a symptomatic feature, including polycystic ovary syndrome and various adrenal hypothalamic disorders. Steroid medications and prednisone, as well as testosterone therapy caused acne as well. Working to achieve a balance of hormones in the body with Complementary Medicines may help problems with aging skin, dry skin, skin disease, and acne. In addition, professional herbal soaps, lotions, glycerol extract tinctures, and nutraceuticals may be used to achieve healthier skin with various hormonal problems.Taking a more comprehensive and holistic approach to acne and other skin problems insures a better lasting outcome and better overall health. Trying just one medicine, or approach, at a time may be the cause of poor success.

Scientific study of herbal medicines to treat hormonal acne has been conducted for decades, although standard medical journals have not accepted most of these studies for publication. An example of an early study conducted in Germany (Amann W. Acne vulgaris and agnus castus (agnolyt). Z Allgemeinmed 1975;51:1645-1648) found that the herb Vitex agnus proved very effective in treating hormonal acne. In 1997, a controlled, double-blinded study versus pyridoxine was conducted to further demonstrate the hormonal modulating effects of Vitex (Lauritzen C, Reuter HD, Regpes R, et al. Phytomedicine 1997;4:183-189), and found that this herb was more effective in reducing PMS symptoms than standard drug regimens. In recent years, in China, a number of human clinical trials have evidenced efficacy in treating hormonal acne with Chinese herbal formulas. In 1997, Dr. Lit-Hung Leung performed a successful study of 100 men and women with serious acne vulgaris, utilizing mega-dosing of Vitamin B5, pantothenic acid, to clear acne more successfully than the hormonally inhibiting pharmaceuticals commonly prescribed (Acutane). This short course of therapy was free of adverse effects, pore size was reduced long-term, and the acne did not return after stopping the supplementation of pantothenic acid. A small maintenance dose was recommended to insure a long-term success. Dr. Leung found that the acne was related to increased demands for pantothenic acid to manufacture sexual hormones in hormonal imbalances, and was diverted from its function to help metabolize fat, which accumulated in growing skin pores, causing acne. Despite these successful human clinical trials, this simple remedy is not incorporated into standard treatment.

The hormone that we still euphemistically call Vitamin D, or D3, is now shown to be tied to many aspects of the health, including calcium regulation, bone health, insulin regulation, regulation of cell apoptosis (programmed cell death), and immune regulation. Hormone Vitamin D is created in a cascade of biochemical conversions that starts in the liver with cholesterol metabolism, proceeds to the skin, where melanocytes convert the precursor to the prohormone cholecalciferol, and then to the kidney/adrenal complex, where this prehormone is converted to a number of versions of the hormone D3 calcitriol. Skin health and the melatonin pathway is thus very important to this all important hormone pathway. Many studies now show that the incidence of hormone Vitamin D deficiency with aging is much more pronounced in women than men, with some areas of the United States showing an incidence of deficiency in women over the age of 50 up to 80 percent. While we may supplement with Vitamin D when circulating levels are low, numerous studies over decades have shown that such supplementation, even with higher dosages, does not restore and maintain the hormone Vitamin D metabolism, and circulating levels will quickly fall again when stopping the supplementation. This is because we must produce the hormone precursor in the skin, and the skin and the cholesterol metabolism must be healthy, as well as the adrenal health, to achieve a hormone Vitamin D restoration. To see how important this hormone Vitamin D is to our health, refer to this overview published in a European Medical Journal in 2014: http://www.ncbi.nlm.nih.gov/pubmed/25526571

Common nutraceutical medicines applicable to the health of the skin and the underlying hormonal and metabolic health

Some nutrient medicines that are well studied to benefit skin health include: OPCs (oligomeric proanthocyanidins) found in whole pomegranate extract, which are potent antioxidants and also stabilize collagen and maintain elastin; micro-algaes such as spirulina, chlorella and blue-green algae, which are high in Vitamin A and essential fatty acids; B5 Pantothenic acid, which may clear acne at a high dose and aids fatty acid metabolism; B7 Biotin, which aids fatty acid metabolism, and is essential for cell growth and repair (biotin deficiency symptoms include dry skin and brittle nails); and the aforementioned L-tyrosine and N-acetyl-cysteine. These supplements not only aid the skin, but help maintain endocrine health as well. Of course, HLA may be a valuable nutrient medicine as well, and a number of topical nutrients have been well researched and increasingly available in Complementary Medicine. Essential fatty acids may play a significant role in improving skin membranes, resolving inflammatory stress, and building better hormones. Lipid based nutrients can be beneficial both internally and topically, and Vitamin E tocopherols, the hormone Vitamin D, Vitamin A retinoids, and lecithin metabolites such as phophatidylcholine are well known to aid skin health and function. Phosphatidylcholine has been shown to be a skin-permeating oil, not only benefiting cell membranes, but able to carry other nutrients and herbal chemicals efficiently through the epidermis to benefit the subcutaneous levels of the skin. Phosphatidylcholine has been shown to be a beneficial treatment topically for psoriasis, eczema and acne in human clinical trials. A companion to phosphatidylcholine is phosphatidylserine, which is created on the inside of the cell membranes, while phosphatidylcholine is acting on the outside of the membrane. Consulting a professional for individualized prescription and insurance of quality may actually save money, as these commercial health products for the skin are often incredibly expensive and need not be.

Weight gain and cortisol imbalances related to changes in the insulin metabolism, leptin and adiponectin

Cortisol is a critical adrenal glucocorticoid hormone with many actions in the body, and ties together the symptoms of weight gain, sleep disturbances, changes in mood, and problems with chronic inflammation. Cortisol is called a glucocorticoid because it stimulates insulin release and maintenance of blood sugar levels, not only in times of acute stress, but every day and every minute of every day. Cortisol is released in a diurnal pattern, varying according to the needs of metabolic activity during waking and sleeping periods. Adrenal stress syndromes, hypothyroid syndromes, and neurohormonal imbalance, as well as syndromes of chronic inflammation may affect this diurnal cortisol release and affect a wide array of systems in the body. Hormonal changes with aging, insulin resistance, and polycystic ovary syndrome are all associated with adrenal dysfunction, and it may be fruitless to try to determine which causes which. When hormonal dysfunctions occur, there is a widespread problem, as the endocrine system operates in an elaborate feedback mechanism. Recognizing and solving these problems in women's health holistically is vitally important.

Cortisol has been called the 'stress hormone' because increased cortisol is secreted by the adrenal (suprarenal) gland in response to physical or psychological stress, but like many chemical messengers in the body, it is a neurohormone, affecting both the endocrine and nervous systems. This stress that triggers cortisol may be acute or chronic, and often goes unnoticed in chronic stressful situations. Physiological stress does not necessarily mean that one feels emotionally stressed, but may be the result of too much stress put upon the individual's capacity to handle an increased physiological workload. One needs to realize their limits in life and when we exceed those limits, the most important task is to get healthier and increase our capacities. Problems with overwork, ill health, aging, gastrointestinal dysfunction, excess loss of blood with heavy menstrual periods, excess sweating, and chronic inflammatory states may all be types of excess physiological stress that we take for granted and do not adjust to accordingly. The demands of raising children and work, coupled with emotional stress, tend to make us overlook our capacities physiologically and live with chronic excess stress. The resulting excess cortisol demands may eventually create an altered diurnal pattern of cortisol release. This is usually attributed to an adrenal stress syndrome, and sluggish hormonal feedback responses. Once this happens, excess cortisol at night and deficient cortisol during the day, or a diurnal cortisol imbalance, creates an array of health problems.

As stated, cortisol is more than a simple 'stress hormone', though, and is critical to maintaining our daily metabolic rate and blood sugar metabolism. It is a glucocorticoid neurohormone. Cortisol levels affect insulin secretion, insulin resistance, and an array of metabolic hormones such as leptin and adiponectin, that in recent years have proven to have a wide array of effect in the body at various cell receptors. The time is past where modern science defines these hormones strictly by their chief action in the body. Such narrow minded thinking has gotten us into a lot of difficulty in finding ways to both diagnose and effectively and holistically treat these systemic hormonal imbalances. One of the key signs of cortisol imbalance is a slow weight gain and inability to lose the weight, and slowly changing patterns of appetite and eating behaviors. Women often do not realize that there is anything unusual going on with their bodies until the situation becomes more severe, and often there is then a denial that a physiological problem is occurring. Dieting usually results in temporary and insignificant weight loss, and gradually the decline in sleep quality and mood changes increase the chronic stress as well. This is what we call a self-perpetuating cycle of dysfunction. One part of this cycle feeds the other, until gradually it seems out of control.

There is no miracle herb or nutritional supplement that will quickly get this elaborate system of hormonal feedback and diurnal cortisol regulation back on track quickly. Neither will simply exercising miraculously result in a balanced cortisol release. While combinations of nutrient and herbal chemicals are being marketed as cortisol 'blockers' to affect weight loss, these chemicals may be beneficial, but are not a simple solution to the problem. A thorough diagnostic assessment and individualized treatment protocol is needed to get the adrenal hypothalamic axis back on track, and a persistent and complete holistic regimen may be needed. While no one wants to hear that restoring their healthy function is going to be difficult and time consuming, this is the case with cortisol and hormonal imbalances that express themselves with an array of systemic signs and symptoms. While a vast number of web articles and webpages of all sorts are now coming up to either sell you something or deter you from taking some course of action to correct your problem, the intelligent patient will cut through all of this hype and simply learn about their physiology and what modern research tells us is needed to fix it.

Understanding Cortisol

Cortisol (hydrocortisone) is a steroid hormone that is classified as a glucocorticoid, and produced by the adrenal glands, properly called the suprarenal, because these glands are situated atop the kidneys and are part of the kidney system. The suprarenal, or adrenal, endocrine glands are unique in that they have a close constant feedback regulation with the brain, specifically the pituitary gland, which is part of the hypothalamic neurohormonal complex at the top of the brainstem, and just under the main regulatory center in the brain, the thalamus. The hypothalamus is the neural part of the hypothalamus-pituitary complex, and is considered the command center of many key aspects of our health, including our metabolism and temperature regulation. While most medical sites state that cortisol is released in response to stress and low levels of circulating glucocorticoids, this is a misleading and simple explanation of this important root hormone. Many things in the body will stimulate changes in the constant cortisol levels, which must be maintained in a diurnal pattern for our bodies to function normally.

Glucocorticoids are steroid hormones that bind to glucocorticoid receptors, which are found on almost every human cell, and also react to stimulation from other chemicals in the body that may stimulate what we call glucocorticoid receptors. Hormone receptors, as well as the receptors for immune cytokines and neurotransmitters are not specialized, but react differently to the various chemicals that may trigger the receptor. Glucocorticoids were called this because they were found to have an important role in regulation of the metabolism of glucose. Now, when we research the natural glucocorticoids, we find usually that only cortisol is listed, but a look into a medical dictionary tells us that a glucocorticoid is "any steroid-like compound capable of significantly influencing intermediary metabolism such as promotion of hepatic glycogen deposition (e.g. triglycerides), and of exerting a clinically useful anti-inflammatory effect." (Stedman's Medical Dictionary). In effect, insulin, leptin, and adiponectin are glucocorticoids. A persistent reluctance to adopt this simple and direct classification confuses research, physicians and patients today, as research in recent years has turned up the surprising array of cross-effects from these glucocorticoid hormones.

Adding to the confusion about cortisol is the fact that so many types of synthetic cortisol have now been created and are in alarmingly widespread use. Some of these variations on the cortisol synthetic analogs are shown to have greater affinity to certain glucocorticoid receptors than natural cortisol itself. Prednisone, hydrocortisone, pridnisolone, methylprednisolone, dexamethasone, betamethasone, triamcinolone, beclometasone, fludrocortisone, and synthetic adosterone are now used in pharmaceutical preparations. These medications are often combined with other medications and are now even showing up in over-the-counter drugs and sometimes even in nutritional and herbal products. These synthetic cortisols are found in asthma inhalers, topical skin creams, localized injections, and oral medications. In syndromes of adrenal insufficiency, these synthetic glucocorticoids are used in low dosage, while in various allergic, asthmatic, inflammatory and autoimmune disorders, the dosage is much higher. Even short term moderate to high dosage of these synthetic cortisols will effectively shut down the normal cortisol metabolism, impairing natural immune responses and altering metabolic regulation. If these moderate to high dosage synthetic cortisols are suddenly withdrawn after even 2 weeks of use, without gradual tapering, an alarming rise in blood sugars and depressed immune responses may result that are dramatic and potentially life-threatening. Nevertheless, modern medicine has increased its use of these synthetic cortisols dramatically, and little public education or regulation has followed this trend. Of course, when a number of lower dosage synthetic cortisols are taken, this may make the overall circulating level higher. When synthetic cortisols are taken in asthma inhalers, this dosage may vary depending on the perceived need for use of the inhaler to control symptoms. The use of these synthetic cortisols in various forms is now a major cause of adrenal suppression.

Glucocorticoids, such as cortisol, have a wide variety of effects in the body, and this explains why such signs and symptoms as inexplicable weight gain, mood changes, poor quality sleep and chronic inflammatory pain and irritation occur, as well as changes in the function of the stomach and intestinal function. Fluctuating cortisol is a daily occurrence for all humans. This fluctuation, which is both set to diurnal patterns and reactive to stress and hormonal feedback regulation, is normally controlled by a neurohormonal system that tries to maintain homeostasis. A variety of problems can throw off this complex homeostatic mechanism, though. Excess fluctuating glucocorticoids depress immune and inflammatory responses, increase the synthesis of glucose, increase the breakdown of amino acids, increase the taking of amino acids from muscle and organ tissues, inhibit glucose uptake in muscle, and normally stimulate fat breakdown in adipose storage. Cortisol excess, though, may have a fairly quick effect on the insulin receptors, both in function and expression, on these fat cells, and both cortisol excess and deficiency may not have the optimal desired physiological effect on stored fat, or adipose, when the glucocorticoid receptors are altered. We call such altering insulin resistance. Hence, cortisol dysregulation has a complex effect on gaining unwanted fat that is hard to take off. Simply stimulating more cortisol is not the solution. Bringing the system back into homeostatic balance is.

In 1999 researchers at the University of Edinburgh, Scotland, UK, Robert C. Andrews and Brian R Walker, wrote: "Insulin resistance has been proposed as a mediator of the association between risk factors for cardiovascular disease in the population. The clinical syndrome of glucocorticoid excess (Cushing's syndrome) is associated with glucose intolerance, obesity and hypertension. By opposing the actions of insulin, glucocorticoids could contribute to insulin resistance and its association with other cardiovascular risk factors...we describe evidence from human studies that glucocorticoids make an important contribution to the pathophysiology of insulin resistance in the population." (Clinical Science 1999 (96), 513-523). These experts stated that cortisol deficiency is characterized by hypoglycemia and postural hypotension, while cortisol excess is characterized by central obesity, glucose intolerance and hypertension, and that the mechanism for these effects depends on opposing the actions of insulin, or inducing a state of insulin resistance. Over time, these abnormal cortisol imbalances create a state of chronic insulin resistance, and disrupted insulin pulsatile release.

Probably the most telltale sign of diurnal cortisol imbalances lies with the symptoms of restless sleep and insomnia, due to excesses of cortisol at night, and sluggishness and fatique during the day, due to deficiencies during the day, when cortisol is normally stimulated and at its peak. This is thought to be due to slow reaction of the adrenals and adrenal dysfunction. Adrenal syndromes often occur gradually, and in three stages. Androgen deficiency may produce symptoms of low energy by the early evening, decreased libido, muscle weakness and diminished feeling of well being. Adrenal fatigue syndromes may produce symptoms of low energy and fatigue by the mid-afternoon, waking after a few hours of sleep and not being able to fall back asleep, increased fatigue after a stressful day, difficulty holding mental concentration and focus, craving for salty and sugary foods, and worsening allergies and chemical sensitivities. Adrenal stress syndromes may produce symptoms of difficulty falling asleep, feeling constantly stressed, midsection weight gain, anxiety, craving for sweets, doing your best work under pressure, and craving excitement that stimulates adrenaline. Often, patients do not realize that they are experiencing these changes until the symptoms are more severe.

The esteemed Cleveland Clinic states that adrenal insufficiency is seen in two forms, primary and secondary (caused by other disorders in the body). The experts at the Cleveland Clinic write: "Secondary adrenal insufficiency is a more common type of adrenal insufficiency and is due to a lack of adrenocorticotropin (ACTH). ACTH is a hormone secreted by the pituitary gland, which, in turn, stimulates adrenal glands to produce cortisol, but not aldosterone. The lack of ACTH leads to a drop in the production of cortisol. Abruptly ending treatment with glucocorticoids, such as prednisone, is usually the most frequent cause of secondary adrenal insufficiency." The pituitary is the hormone secreting half of the hypothalamus-pituitary complex in the brain. Hypothalamic disorder is becoming a focus of research in recent years as the problems of subclinical adrenal insufficiency and adrenal stress syndromes are being recognized as the cause of many syndromes of chronic fatigue, pain, and gastrointestinal dysfunction, and are related to insulin resistance, sublinical hypothyroidism, anxiety disorders, and even polycystic ovarian syndrome (PCOS). Diagnosing of adrenal insufficiency includes laboratory measurement of diurnal cortisol levels, assessment of the cortisol imbalance with a hormonal panel and analysis, and then more detailed testing involving MRI of the brain, measurement of cortisol response (cortrosyn test of ACTH challenge), and an insulin tolerance test. To rule out adrenal lesions or tumors, a CT scan of the adrenal glands may be performed, although this involves a heavy dose of radiation to a critical endocrine gland and should be performed only when absolutely necessary. Findings of an adrenal lesion or tumor (pheochromocytoma) indicates a primary adrenal insufficiency. If signs and symptoms of primary adrenal insufficiency are not evident, the CT scan of the adrenal gland may not be indicated.

While secondary adrenal insufficiency is finally being recognized by the standard medical authorities such as the Cleveland Clinic, there is still a great deal of continuing denial that syndromes of secondary adrenal insufficiency due to adrenal stress syndrome exists. The Mayo Clinic states that proponents of the adrenal stress theory, defined as a syndrome where excess physiological stress results in chronic adrenal fatique and sluggish dysfunction, are operating on an unproven theory, and that current blood tests are not sensitive enough to detect smaller declines in adrenal function. In some ways, this is true, but in the last decades, scientists have collected an enormous amount of supporting data and proven that active hormone metabolites may be assessed with saliva and veinous blood spot samples to accurately and objectively assess and diagnose subclinical hormone imbalances such as adrenal stress and fatique syndrome. Unfortunately, the industry continues in its failure to adopt this type of testing, and sticks with standard circulating blood testing, which is inadequate to objectively assess and diagnose adrenal stress and fatique syndromes with abnormalities in diurnal cortisol patterns. To objectively assess this syndrome of diurnal cortisol imbalance, the abnormalities of the diurnal rhythm of cortisol secretion are compared to the active metabolites of DHEAS and testosterone, as well as the other related endocrine hormones estradiol and progesterone, utilizing simple saliva samples and measurement of active hormone metabolites. To fully assess the potential hormonal factors that could contribute, testing of the thyroid hormones, the pituitary TSH, sex hormone binding globulin (SHBG), thyroid peroxidase antibodies (TPO), and perhaps even the prehormone called Vitamin D3 may be assessed, which may now be accurately measured in veinous blood samples. In this way, objective and accurate hormone testing will point to the various endocrine dysfunctions that could be contributing to adrenal stress and fatique syndromes, and be compared to signs and symptoms to make an accurate diagnosis and suggest what measures the patient and physicians may take to restore balance and function to the endocrine axis, a feedback system of hormonal regulation that includes neurohormonal health (hypothalamic/pituitary), metabolic regulation (thyroid/parathyroid), hormonal receptor function, hormonal carrier function, immune function, and adrenal function.

Patients continue to wonder why standard medical authorities such as the Mayo Clinic discourage the diagnosis and treatment of adrenal stress and fatique syndromes. Like many of the medical problems commonly experienced by the patient population but poorly addressed with standard care, these subclinical adrenal syndromes are not able to be treated yet with standard pharmaceutical and surgical options. When standard treatment protocols are not applicable to the specific patient health problem, the patient has been routinely told that they do not have a real medical problem, that they should try antidepressants and antianxiety drugs, and that medical doctors that have assessed their problem as a syndrome that requires the treatment with Complementary and Integrative Medicine (CIM), such as nutrient and herbal prescription, and acupuncture, are in effect "quacks". A classic example of this strategy involves the problems of fibromyalgia and Chronic Fatigue Syndromes. For years, standard medical authorities stated that these were unproven theories supported by quack doctors. As soon as the pharmaceutical industry got FDA approval for drugs to treat fibromyalgia, standard medical authorities suddenly acknowledged this diagnosis, which was obviously a cynical approach to patient care. More and more patients today are looking at this scenario with dismay, and increasingly, turning to the Complementary and Integrative Medicine specialties to assess and effectively treat their conditions.

Assessing and Restoring Diurnal Cortisol Regulation

Assessing cortisol dysregulation is now simple. A saliva test kit may be obtained and samples taken at various times of the day and night will be analyzed by a competent laboratory. This test usually also tests the pertinent steroid hormones that may contribute to cortisol dysregulation and adrenal syndromes, such as the androgens (testosterone and DHEAS), progesterone, estradiol, and the ratio between active metabolites of the progesterone and estradiol (PGE2). If thyroid problems are suspect, veinous blood stick samples may be obtained to accurately assess the various thyroid parameters and assess where the thyroid dysfunction is occurring. Subclinical thyroid problems may occur in the hypothalamus, thyroid itself, or at the thyroid receptors, and adrenal dysfunctions often contribute to these syndromes. Competent laboratories, such as ZRT (Zava Research Technology) in Portland, Oregon, will also provide a complete and individualized assessment of the overall hormonal pathology and explain how the various imbalances relate and relate to symptoms and signs.

Once the assessment is obtained, the work begins. Each individual will need a specific set of treatment protocols to restore the balance in the whole system. Without such an individualized restoration, results will be difficult, since the endocrine system is a feedback system, and stimulating or correcting one part of a cycle of dysfunction will not reset the entire homeostatic mechanism. This is why claims of one-size-fits-all miracle formulas should be suspect, and why standard allopathic medicine is not able to come up with a workable solution. Allopathic medical doctors will usually try to alter some part of this equation without restoring the whole natural cycle. A truthful and intelligent medical doctor will diagnose and assess, and then integrate with workable Complementary Medicine physicians to restore the whole mechanism. This realistic medical doctor will realize that his or her time is too costly to fully direct this holistic therapy, and refer out to a knowledgeable Licensed Acupuncturist or Naturopath to accomplish the course of therapy with a realistic cost. The Licensed Acupuncturist, of course, provides not only the individualized herbal and nutrient evidence-based therapy, but acupuncture as well, and some may also provide deep tissue massage, which itself is proven to help correct cortisol imbalance (read the article on this website entitled Deep Tissue Massage and its many benefits).

Gastrointestinal function is perhaps the root of a healthy hormonal system, and has much to do with neurological and immunological health

The classic medical texts of Traditional Chinese Medicine outline the theories of functional health to guide the physician. The fundamental text, Huang Di Nei Jing (the Yellow Emperor's Canon of Corporeal Medicine) states that a balance of ying qi (nutritive energy) and wei qi(immune function) lies at the heart of our health and homeostasis. This text states that the spleen system is in charge of the wei qi and the kidney/adrenal supports it. The text states that upon waking, the wei qi circulates more in the yang portion of the body, the tai yang, and at night circulates more in the yin portion, the shao yin. These concepts are true to modern physiology. The spleen is the largest lymph organ in the body, cleansing the blood circulation with a concentration of lymphatic immune cells and removing old and dysfunctional cells from circulation. The adrenal glucocorticoid hormones, especially cortisol, support this constant immune function by quickly responding to immune and inflammatory needs. During the day, our immune responses are more concentrated in the skin, respiratory membranes and outer tissues, while at night, the immune responses are more active in the internal organs and tissues. The diurnal changes in cortisol regulation reflect the role of the kidney/adrenal system in this regard. The ancient Daoist Chinese physicians were astute in their observations and theories. The spleen system, which includes the functions of the pancreas, are also at the heart of our digestive function, and these ancient physicians were astute in understanding the intimate relationships between our digestive and immune systems, and between these systems and the adrenal/hypothalamic endocrine axis. The point of these theories was to emphasize that a holistic approach is needed to maintain and restore health and function.

While allopathic medicine has scoffed at the ancient ideas of holistic medicine regarding the importance of gastrointestinal function and health as a root concern in all disease, research in the last decades has revealed an amazing amount of evidence that supports this view. For instance, the gastric hormones, such as ghrelin, which is found to be a complement of leptin (forming a yin yang balance), and was formerly thought to be a simple hormonal regulator of hunger, have been found to have an array of systemic effects on cell receptors that make them an important part of the overall health. Hormonal imbalances outside of the stomach are found to have profound chronic effects on these gastric hormones as well. Science has realized that only a holistic approach to hormonal balance will positively correct these gastric dysfunctions, and that an allopathic approach, such as inhibiting histamine to decrease gastric acid production, not only does not restore function, but effectively creates increased dysfunction that may lead to harmful malabsorption of nutrients. Some of the key nutrients that are poorly resolved with these strategies include calcium and Vitamin B12, leading to osteoporosis and hormonal stress, and with B12 both neurological problems and common anemia. Patients today are taking a more proactive approach to insuring that they restore gastrointestinal function while treating their symptoms, and more and more patients and physicians are adopting a restorative holistic approach incorporating patient education and changes in habits and diet to achieve these goals.

While understanding that this complex subject of gastrointestinal function and related hormonal mechanisms is at first daunting, patients that educate themselves bit by bit find that they are obtaining a useful education that may have profound effects on their future health. While we might assume that putting food in the stomach and digesting it is a simple process, and have, as a population been told as much, with food in, acid produced, food broken down and emptied into the small intestine, no big deal, the truth is that this chemical process of eating such a variety of chemicals and utilizing them properly in the body, is extremely complex. When this process becomes dysfunctional, we might still digest food, but a variety of health problems arise. This is because of the elaborate feedback mechanisms involved. Control of the gastric function occurs not only with local nerve signals from the enteric nervous system, but reflexes from the brain, hormonal reflexes, and metabolic responses that signal a variety of neurohormonal reflexes themselves. Added to this is the complex biota, or symbiotic microbial responses, that work with our human system to manufacture useful chemicals in response to specific food demands.

Gastric hormones and their broad array of effects in the brain, ovaries, bone and cardiovascular system

The hormones that are important to gastric function include ghrelin, pepsinogen, intrinsic factor, gastrin, somatostatin, and even histamine, which can act as a hormone receptor stimulator. Ghrelin is a hormone produced by the cells in the upper portion, or fundus, of the stomach, and also by endocrine cells in the pancreas, called epsiolon cells. Ghrelin is also produced in the hypothalamus, where it stimulates the secretion of growth hormone, regulates the life cycle of neurons, and also plays a significant role in the hippocampus, affecting cognition, learning and adaptation. In addition, ghrelin has recently been found to affect the production of nitric oxide in the vascular endothelium, regulating the dilation of blood vessels and the flow of nutrient blood. This hormone, like leptin, was considered a simple regulator of appetite not long ago, but now we see the complexity of its effects in the brain as well as the digestive system. The endocrine cells of the pancreas, an organ coupled with the spleen and nestled in the crook of the stomach, produce insulin, glucagon, amylin, somatostatin, pancreatic polypeptide, and ghrelin. While insulin is the most well known of these pancreatic hormones, these other pancreatic hormones act in concert with insulin to regulate many functions in our body, and depend on a balanced homeostasis to keep us functioning in a healthy manner. Gastric dysfunction upsets this homeostasis.

Ghrelin is considered the counterpart to the hormone leptin, which is produced in fat cells, and is now known as a key regulator of energy, appetite, metabolism, immune responses to atherosclerosis, and angiogenesis (the generation of new blood vessels via stimulation of VEGF, or vascular endothelial growth factor). Leptin has also more recently been found to be integral to both male and female fertility, bone metabolism, and an array of inflammatory effects. We see already that most of the important health issues in women's health are regulated in part by the gastric hormone ghrelin and its counterpart leptin, a sort of yin yang pairing. Ghrelin responsiveness in the hypothalamus is sensitive to both insulin and leptin sensitivity, and syndromes of insulin resistance and leptin resistance negatively affect the hypothalamic responses to ghrelin. As these syndromes develop, the negative effects on the whole body include obesity, inability to lose weight, cognitive dysfunction, neurodegeneration, osteoporosis, and cardiovascular pathology. Ghrelin is also found to activate the reward mechanisms in the central brain, where acetylcholine and dopamine control the mechanisms of reward and addiction, linking emotional satisfaction to desires for certain foods, alcohol, drugs, and even activities.

In the stomach and intestines, ghrelin balances with leptin and insulin to regulate appetite and satiety, but also may act as a hormone that promotes intestinal cell proliferation and inhibits programmed normal cell death (apoptosis) during periods of increased inflammatory and oxidative stress. Inhibition of apoptosis may lead to an increased cell life and possibility of excess cell mutations that cause cancer. Ghrelin may also suppress pro-inflammatory mechanisms and augment anti-inflammatory mechanisms that contribute to chronic intestinal inflammation, colitis, and inflammatory bowel disease (IBD). Ghrelin also has been found to enhance the motility of the gastrointestinal tract, contributing to diarrhea and functional disease. Studies show that patients with gastric dysfunction acquire functional intestinal disorders at a very high rate, and that patients with functional intestinal disorders acquire functional gastric disorders at a high rate as well. These hormones may play a central role in these health problems, often creating chronic irritable bowel syndrome (IBS), a poorly understood condition linked to many other health problems, such as fibromyalgia (50 percent of women with fibromyalgia have IBS), chronic fatique syndrome (50 percent of women with CFS have IBS), chronic pelvic pain syndrome (50 percent of women with chronic pelvic pain syndrome have IBS), and temporomandibular joint disorder (64 percent of women with TMJD have IBS). Many women will recognize that these disorders affect women disproportionately. Restoring gastric function may thus indeed be a root focus in the holistic protocol of health restoration and maintenance in women's health.

How closely are ghrelin levels tied to other gastric hormones and central nervous system effects? A 2007 study in Sweden found that laboratory animals with higher anxiety had lower circulating ghrelin and higher gastrin secretion, measured in both the fasting and fed states (PMID: 17470515). Normally, ghrelin secretion in the stomach is increased in response to food deprivation to stimulate appetite, but numerous studies show that psychological stress also raises circulating ghrelin levels. This is easy to see in our lives, as nervous stress often stimulates us to nervously snack. A subsequent study by the pharmaceutical company AstraZeneca in 2009 found that with stress-induced higher gastrin secretion, lower gastric acidity resulted, or gastric hypofunction (PMID: 19089754). A 2008 study at the University of Miyazaki in Japan found that a close synergistic relationship exists between gastrin and ghrelin (PMID: 18611393). Administration of either gastrin or ghrelin alone directyly induced significant increase in gastric acid secretion, but simultaneous treatment with both hormones resulted in a synergistic, rather than additive increase. Normally, administration of gastrin induced an increase in ghrelin secretion, but it the studies cited above, stress and anxiety induced lower ghrelin in circulation, but higher gastrin secretion. Obviously, stress and anxiety, among other health problems, such as chronic inflammation and hormonal imbalances affecting either the hypothalamic function or the insulin resonse, will negatively effect normal gastric hormonal triggering and result in gastric hypofunction. In turn, gastric hypofunction will have a negative effect on circulating ghrelin levels, and consequently may induce negative effects in the brain.

Since ghrelin acts as a complement to leptin, and leptin acts as a complement to insulin, and insulin acts as a complement to cortisol, etc. it is clear, even to a person without a vast scientific knowledge, that these hormonal imbalances create a vicious cycle of dysfunction. This is evident when we see the high percentages of women with associated disorders. It is highly evident to a physician in clinical practice that address the whole picture of health. When taking thorough histories and looking at the holistic relationships of paients and their health problems, one sees a high percentage of women with the same array of health problems, one leading to another, and worse with aging. For women, it is time to take a look at the big picture, see this vicious cycle of health problems, and work with a holistic physician, such as a Licensed Acupuncturist and herbalist, to correct the problems around the whole cycle.

Heart Health, Cardiovascular Maintenance and Treatment in Relation to Women's Health

The number one cause of female death in the United States is now Heart Attack and Heart Disease. Often ignored in Women's Health, and considered a male problem, until the last decade, more and more scientific study has shown that we systematically excluded women from the study of heart disease, and that many female health issues relate to this pathology.

For instance, a 2009 multicenter study at the University of North Carolina and the University of Pittsburgh Schools of Medicine showed that women who breast fed their babies for longer period of time had a dramatically reduced risk of cardiovascular disease, hypertension, lipid imbalance (Metabolic Syndrome), and diabetes (Obstet Gynecol 2009 May; 113(5): 974-982). The reasons for this include the fact that the hormonal balance is drastically altered in pregnancy, and is rebalanced by breastfeeding for at least 4-6 months, and optimally for at least 10 months. Such study clearly shows the importance of maintaining hormonal homeostasis. Studies in recent years are also identifying an array of hormonal imbalances that clearly are associated with cardiovascular risk in women, such as subclinical thyroid disorders, hyperthyroidism, cortisol imbalances, and prolactin and gonadotrophic hormone imbalances in subfertility and PCOS. To see a report on these endocrine associations and relation to cardiovascular disease in women, especially in relation to thrombi and atherosclerosis, and fibrinolysis, or the ability to resolve atherosclerosis, click here: http://www.ncbi.nlm.nih.gov/pubmed/25753252 . Obviously, the hormonal balance and proper function is intimately tied to cardiovascular health in women, and the real question for individuals is how to deal with this association. While standard medicine is still exploring an array of hormone replacements and endocrine altering drugs to treat this broad subject, this course of allopathic treatment of hormonal imbalance is not progressing very fast, and the reason is that synthetic hormones and hormone altering drug mechanisms have been consistently shown to create large adverse health effects and dramatic risks to health. The obvious way to deal with hormonal imbalance is to restore hormonal homeostasis, and the way to do this is by integrating holistic protocols to achieve this restoration.

One aspect of women's cardiovascular health concerns heart attacks, or myocardial infarctions, without coronary artery disease, or narrowing of the arteries. These types of heart attack, referred to now as MINCA (myocradial infarction with angiographyically normal coronary arteries) occur in women much more than men, and some estimates show that up to 12 percent of all heart attacks involve normal coronary arteries. A broad study of this subject in 2015, at the Karolinska Institute, in Stockholm, Sweden, showed that atherosclerotic factors of endothelial function and arterial thickening (IMT) were not different between the groups with coronary artery disease and those without evidence of coronary artery disease, and by and large, the lipid profiles were generally healthy in the MINCA group, with high HDL and low LDL. The main risk associations were psychological disorders, chronic inflammatory disorders, diabetes and impaired glucose tolerance (IGT), and hypertension. These experts noted that the one risk factor that appeared to be different in the two groups was the high prevalence of emotional stress reported before the hospital admission for the heart attack in patients without coronary artery disease (PMID: 26251000 - American Journal of Cardiology 2015, June 25, published online). The term for this syndrome of Stress Cardiomyopathy is Takotsubo Syndrome, coined in the 1990s in Japan, and emerging as a diagnostic classification in the United States in 1998. Initially dismissed in cardiac science, and criticized for an apparent sexual stereotyping of women as more emotional than men, scientific study has shown that this Stress Cardiomyopathy is real, and in 2010, nearly 300 studies were published concerning Takotsubo Syndrome. The syndrome symptoms start unpredictably with chest pain and shortness of breath following an emotionally or physically stressful event, and occurs in women 90 percent of the time, usually in women older than 50. In the past, it was assumed that with tests showing nothing wrong with the coronary arteries, that the patients were having a "hysterical" episode. Studies in the last decade noted that the left ventricle of the heart was ballooned in the lower section and narrowed at the top, resembling the Takotsubo ceramic pot traditionally used to trap octopi. It is now recognized that this abnormal heart function is seen in a majority of female patients with heart attacks without coronary artery disease.

The question that arises in the study of heart attacks without coronary artery disease that affects women much more than men, is what actually causes this phenomenon, and how do we prevent it. So far, standard medicine has no clear conclusion concerning the health factors underlying Takotsubo Syndrome, but the autonomic nervous system and associated stress effects, strongly related to adrenal stress and cortisol imbalances, are the focus of study. Such study shows that a holistic protocol focused on neurohormonal health needs to be adopted to prevent this now prevalent cause of female heart attacks, which have become the number one cause of death for women in the United States, when not considering iatrogenic cause. A 2013 report by experts at the University of Toronto School of Medicine, in Canada, showed that estrogen dominance has negative effects on cardiac muscle function and particularly the ventricles, reducing calcium ion channels, and that supplementation with testosterone has been found to contribute to stiffening of the ventricle with increased collagen synthesis, directly contributing to the Takotsubo Syndrome of lower left ventricle enlargement that is the cause of many female heart attacks in the absence of coronary heart disease (PMID: 23404619). It is believed that in the past, may women were dismissed with signs and symptoms of heart attack because tests did not show this coronary artery disease, and the heart attack was termed hysterical. This study in Toronto outlines the fact that since data has been compiled and published, with clear evidence of the dramatic changes in cardiovascular function and health during perimenopause, that we must discuss healthy hormonal homeostasis and its effect on the autonomic nervous system, or neurohormonal health, when preventing female cardiovascular disease, and that the one-size-fits-all approach we now have is indeed obsolete.

In 2015, experts at the University of Auckland School of Medicine, in Auckland, New Zealand, reported that such cardiovascular disease as seen in the Stress Cardiomyopathy is caused by pathophysiological changes in the the sympathetic aspect of the autonomic nervous system that involve vagal and sympathetic reflexes that are chemosensitive to steroidal and ovarian hormones. These experts conducted studies of laboratory animals with a mimic of menopause, or induced menopause by removal of the ovaries. This menopausal-like change in hormonal balance "significantly attenuated the cardiac vagal afferent reflex mediated inhibition of renal (kidney and adrenal) SNA (sympathetic nerve activity) and augmented cardiac sympathetic afferent reflex mediated sympathoexcitation, so that overall increases in reflex driven sympathoexcitation were significantly enhanced." The conclusions were that this hormonal imbalance clearly creates the potential for Stress Cardiomyopathy, and heart attacks that are seen in female cardiovascular disease, such as Takotsubo syndrome (PMID: 25810130). The hormonal imbalances in menopause involve first progesterone deficiency with relative estrogen excess, and then a drop in estrogens, with corresponding feedback imbalances that typically involve cortisol imbalances and dysfunction of the hypothalamic-adrenal axis. We see from such study that an array of neurohormonal effects occur that lead to a repeated and chronic overexcitation of the vagal and sympathetic nervous system responses, and that this involves a cycle of dysfunction, as these same nerve reflexes modulate the neurohormonal responses of the kidney and adrenal system and the adrenal hypothalamus axis. Consequently, such phenomena as the Takotsubo Syndrome with an enlarged growth of the bottom part of the left ventricle of the heart occur.

Complementary and Integrative Medicine provides an array of evidence-based therapy to resolve these dysfunctions. Much research has shown that the nutrient molecule taurine, along with enzymes and anti-oxidants, as well as specific Chinese herbs, modulate these vagal and sympathetic reflexes, and benefit heart health and function greatly. Short courses of targeted acupuncture stimulation, hormonal balancing with bioidentical hormones, and individualized herbal formulas and tinctures (e.g. Red Clover and Bu gu zhi mentioned above), will greatly help to regain neurohormonal balance and prevent these stress-related heart attacks. Clearly, the focus in standard medicine has been on a standard model of heart attacks that relate to the pathology seen predominantly in men, with coronary artery disease and patterns of hypertension seen in the male predominantly. In studies of female hypertension, we often see diurnal patterns of high blood pressure, particularly high blood pressure at night, and blood pressure that changes within the menstrual cycle. Clearly, these have been ignored as standard medicine and research has looked for one-size-fits-all strategies of treatment and focused on male patterns in the pathology. CIM/TCM offers women the chance to integrate therapies that fit the female and are individualized.

Information Resources and Additional Information

  1. A 2015 study of adrenal insufficiency, a condition that was long denied in standard medicine until recent years, by the renowned Cleveland Clinic, in Cleveland, Ohio, U.S.A. reveals that this is a life-threatening condition at its worst, and is caused either by a primary hypothalamic-adrenal axis impairment or dysfunction, adrenal cancerous growth or hyperplasia, autoimmune polyendocrine syndrome, or is secondary to exogenous corticosteroid therapy, with poor adherence to the gradual tapering of administered corticosteroids. The study also reveals, though, that the early clinical presentation of adrenal insufficiency is commonly vague and undefined by laboratory analysis, signs and symptoms. The potential consequences related to cardiovascular and hemodynamic insufficiency should suggest that the acknowledgement of cardiovascular and cardiac risk for women in the last decade, long ignored in standard medicine, probably has much to do with poorly defined and difficult to diagnose adrenal insufficiency: http://www.ncbi.nlm.nih.gov/pubmed/25733761
  2. A 2012 study at the VU University Medical Center, in Amsterdam, The Netherlands, noted that treatment with standard synthetic glucocorticoids, or synthetic cortisols, such as prednisone, often resulted in suppression of the hypothalamic-adrenal axis and adrenal insufficiency. While these synthetic corticosteroids are important and effective drugs for serious disorders, the over-prescription of these drugs in standard medicine presents quite the remarkable potential for adrenal insufficiency: http://www.ncbi.nlm.nih.gov/pubmed/22592733
  3. A 2015 study in Thailand, at the Chulalongkorn University School of Medicine, showed that the prevalence of adrenal insufficiency treated at hospitals in the last year had reached a crisis level, and could be attributed to synthetic corticosteroid drugs found in over-the-counter medications bought from the drugstore: http://www.ncbi.nlm.nih.gov/pubmed/25614534
  4. A 2013 study at the University of Oxford and the Oxford Centre for Diabetes, Endocrinology and Metabolism, in the UK, found that conventional hormone replacement has not had a significant impact on resolving adrenal insufficiency, with increased risk of death from all causes and decreased quality of life despite treatment in standard medicine. That in 2013 the field of endocrinology is still in denial concerning the intrinsic problems with synthetic hormone analogs, and are still suggesting that new drugs may be created to better mimic normal cortisol levels and be more convenient. The basic inattention to the subject of complex homeostatic feedback mechanisms in endocrine control is astounding, and the persistent belief that glucocorticoid mimics can be administered at a standardized dose to replace a complex fluctuating feedback control reveals much about the state of standard medicine and hormonal balance: http://www.ncbi.nlm.nih.gov/pubmed/24031090
  5. A 2014 study by pharmaceutical companies, referring to recent data from the European Union Adrenal Insufficiency Register noted that increased morbidity and mortality is still associated with conventional glucocorticoid replacement therapy, mainly due to the inability of this drug treatment to reproduce the normal circadian rhythms and fluctuations in diurnal adrenal cortisol levels. Glucocorticoids are glucose-based steroid hormones produced in the adrenal glands of the kidneys, and synthetic glucocorticoids include prednisone, prednisolone, cortisone and other drugs increasingly used in standard medicine despite the risks of adverse health effects: http://www.ncbi.nlm.nih.gov/pubmed/24884782
  6. A 2004 review of the pathology of testosterone, or androgen, insufficiency in the premenopausal woman, by experts at the Monash University School of Medicine, in Australia, and printed in the Oxford Journals, provides a detailed explanation, revealing that testosterone levels do not fall significantly with menopause, but gradually decline in aging, and that half of human testosterone is created peripherally by conversion from other hormones, especially progesterone, and a fourth from the ovaries and a fourth from the adrenals. The various causes for female androgen insufficiency include deficiency of the hypothalamus-pituitary, premature ovarian failure, hysterectomy with removal of the ovaries, damage to the ovaries with radiation or chemotherapy, Turner's syndrome (inherited deficiency of the X chromosome, diagnosed at any age), autoimmune disease, or a primary adrenal insufficiency. Causes from medication include use of progestins in birth control, corticosteroid use, thyroxine use in hypothyroid disease, and newer estrogen dominant contraceptive patches or implants with IUD, which raise sex hormone binding globulin (SHGB). Such information shows that a careful individualized diagnosis is needed, and that simple T replacement is not a good idea: http://humupd.oxfordjournals.org/content/10/5/421.full
  7. A 2015 study at the Tokyo Metropolitan Police Hospital noted that adrenal insufficiency causes life-threatening arrhythmia by prolongation of the QT interval in the absence of electrolyte imbalance or other causes, and that increased stress in patients with adrenal insufficiency is a considerable risk: http://www.ncbi.nlm.nih.gov/pubmed/25771803
  8. A 2014 reappraisal of guidelines for treating women with adrenal insufficiency with synthetic testosterone and DHEA, by 7 major university health colleges in the United States, Canada, Australia and the UK, as well as prominent medical centers such as the Mayo Clinic and Massachusetts General Hospital, calls for a cessation of the widespread prescription of testosterone and DHEA for women with a diagnosis of androgen deficiency based on infertility, sexual dysfunction, diminished libido, osteopenia, cognitive decline, cardiovascular problems, or metabolic syndrome, with risks outweighing benefits. Common prescriptions with synthetic androgens after surgical menopause (hysterectomy and ovarectomy), with a finding of low circulating testosterone, or after administering synthetic corticosteroid drugs was also found inappropriate. Obviously, a more holistic and restorative protocol is needed: http://www.ncbi.nlm.nih.gov/pubmed/25279570
  9. A 2008 randomized controlled study from the National Institute of Nursing Research, in Bethesda, Maryland, U.S.A. found that an imbalance of cortisol and DHEA was associated with excess TNF-alpha and IL-6 pro-inflammatory cytokines and PTSD in women. The effects of traumatic stress and chronic stress resulted in low cortisol levels in circulation and consequently higher stimulation of the adrenal axis and excess production of DHEA, resulting in Th1/Th2 imbalance and chronic inflammatory states. The diurnal cortisol levels in female PTSD patients was also flattened. These results differed from studies of male PTSD: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829297/
  10. A 2003 study at the University of California San Francisco found that aquaporin-3 deficiency caused a lack of skin hydration and inelasticty, which was significantly reversed with oral consumption of glycerol. The researchers concluded that medicinal tinctures utilizing glycerol, as well as topical glycerol application improved skin moisture, elasticity and barrier properties.: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC165880/
  11. A 2011 study at the University of Messina, Department of Biochemichal, Physiological and Nutritional Sciences in Italy found that age-related skin changes of structural integrity and functional capacity were related to inadequate estrogen levels, and that the phytohormonal nutrient genistein, an isoflavone found in soy and other herbs and foods, significantly benefited the skin, increasing collagen and functional integrity, and increasing growth factors and cellular signaling related to improved skin health: http://www.ncbi.nlm.nih.gov/pubmed/21827449
  12. A 2011 review of more than 1000 scientific studies by the Canadian Society of Clinical Chemists found that a number of hormone imbalances were associated with acne, including deficiency of serum estrogens, and excesses of testosterone, progesterone, glucocorticoids, insulin and insulin-like growth factors.: http://www.ncbi.nlm.nih.gov/pubmed/21763298
  13. A 2009 study at the State University of New York Department of Dermatology found that hormonal imbalances as well as medications were well known potential causes of acne. Excess production of androgens, growth hormone, insulin-like growth factor, insulin, corticotropin releasing hormone, and glucocorticoids (cortisol and prednisone) cause increased acne by triggering excess sebum production and sebaceous growth and differentiation, and medications such as exogenous testosterone, steroids, lithium, phenytoin, and epidermal growth factor inhbitors caused acne. Acne was a feature of a number of endocrine disorders, including polycystic ovary syndrome, Cushing syndrome of adrenal excess, and other adrenal disorders: http://www.ncbi.nlm.nih.gov/pubmed/19932324
  14. A 2002 study at the Aartius University Hospital Department of Endocrinology and Metabolism in Aartius, Denmark, found that glucocorticoids such as predinisolone disrupted the normal high-frequency insulin release and glucose-insulin feedback mechanism: http://www.ncbi.nlm.nih.gov/pubmed/11845223
  15. A 2015 study at Southern Cross University in Lismore, Australia, School of Environment, found that synthetic estrogen pharmaceuticals did not break down in the environment and were causing significant environmental problems with accumulation in soils and water, with endocrine disruption for humans and animals: http://www.ncbi.nlm.nih.gov/pubmed/25804658
  16. A 2013 study at the Tsinghua University School of Environment in Beijing, China, noted that the long-term risk of endocrine disrupting chemicals in treated wastewater presented considerable risk, with synthetic estrogen drugs presenting the greatest risk as measured in water treated by municipal water treatment, and phenolic compounds and phthalate esters presenting less risk than these drug compounds: http://www.ncbi.nlm.nih.gov/pubmed/23735815
  17. A 2014 randomized controlled clinical study at Seoul National University, in South Korea, found that both omega-3 essential fatty acid supplement (krill oil) and GLA supplement (black currant seed oil) provided significant reduction in acne for patients by both improving inflammatory regulation and membrane health: http://www.ncbi.nlm.nih.gov/pubmed/24553997
  18. A 2015 multicenter study in European universities showed that the common practice of combining hyaluronic acid (HA) serum in skin cosmetics with bionutrients may inhibit the delivery of the topical natural nutrient molecules in dry or unhealthy skin. For normal health skin, HA did not inhibit transport of nutrient molecules, but in unhealthy skin it did. The sensible approach would be to first use pure HA serum on the skin, and later to apply the nutrient lotion: http://www.ncbi.nlm.nih.gov/pubmed/25871518
  19. A 2014 study at the University of Kansas School of Medicine, in Kansas City, Kansas, U.S.A. and the South University of Science and Technology, in Shenzhen, China, found that the estrogen estriol sgnificantly inhibited eczema, or contact dermatitis, induced by environmental benzenes, which were found to be associated with an antibody humoral immune response. Such study elucidates that xenoestrogen and xenohormonal aspects of such environmental chemicals and the relationship to the rise in eczema and skin disorders, as well as the potential for bioidentical estriol creams to counter this type of eczema: http://www.ncbi.nlm.nih.gov/pubmed/25150251
  20. A 2009 multicenter retrospective study by the University of North Carolina and University of Pittsburgh Schools of Medicine, involving 139,681 women followed through menopause, shows clearly that more prolonged breastfeeding achieves a rebalancing of the neurohromonal system and a dramatic reduction in risk for cardiovascular disease, hypertension, diabetes and Metabolic Syndrome: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714700/
  21. Statistics provided by the American Lung Association show that incidence of Chronic Obstructive Pulmonary Disease (COPD) in women has appeared to quadruple since 1980 in the United States, with 70,000 female deaths in 2012, a number that has risen yearly in the last decade. Since this slowly progressing disease, like heart disease, was long considered a disease of men, the research and treatment protocols largely ignored the female for decades in relation to COPD, and even today, with the incidence and mortality greater in women than men, diagnosis of COPD in the female population is often ignored or delayed until it is too difficult to treat: http://www.lung.org/assets/documents/publications/lung-disease-data/rise-of-copd-in-women-full.pdf
  22. A 2011 study of the incidence and prognosis of COPD in Europe, by the Erasmus University Medical Center, in Rotterdam, The Netherlands, found that COPD incidence in Europe, unlike the U.S., was higher in men than women, and the risk of developing COPD with aging after age 40 was 8.3 percent for women, and greater in the male population. The study showed that in patients diagnosed with very severe COPD, that the prognosis of death within one year was 26 percent, whereas in the non-COPD population after age 40, the incidence of death within one year was just 2.8 percent, indicating that a more integrative and holistic approach to lung health should be initiated at an early age for those a risk of this slowly developing disease: http://www.ncbi.nlm.nih.gov/pubmed/21852081
  23. A 2011 study from the Minneapolis Heart Institute explains that phenomenon of Takotsubo Stress Cardiomyopathy, which is seen in women in 90 percent of diagnosed cases, and is now believed to be involved in a high percentage of cases of female heart attacks where no evidence of coronary artery disease is found: http://circ.ahajournals.org/content/124/18/e460.fullhttp://circ.ahajournals.org/content/124/18/e460.full
  24. A 2013 review of the pathophysiology of female heart attack, by experts at the University of Toronto School of Medicine, in Canada, shows that estrogen dominance, seen in perimenopause and with PMS, has negative effects on the heart muscle function, and that testosterone supplementation, promoted for its benefits to heart function in women, is shown to contribute to stiffness and enlargement of the heart ventricles, as seen in Takostubo Stress Cardiomyopathy: http://www.ncbi.nlm.nih.gov/pubmed/23404619
  25. A 2015 study from the University of Chieti and University of Cagliari, in Italy, showed that an array of sex hormones is integral to female cardiovascular health, and is closely intertwined with the autonomic regulation of the heart function. While estrogens were the theme in the past, these experts are focusing on the relationship between progesterone, androgens (e.g. cortisol) and the autonomic and vagal nervous systems. Clearly neurohormonal homeostasis is the key, and allopathic approaches are not going to address these concerns without some integration of holistic medicine: http://www.ncbi.nlm.nih.gov/pubmed/25845675
  26. A 2015 study from the University of Auckland School of Medicine, in Auckland, New Zealand, outlines new focus on the neurohormonal aspects of cardiac disease that is related to types of heart attack seen predominantly in the female. This study of laboratory animals with induced menopause clearly shows how the cycle of hormonal changes and neurohormonal feedback clearly causes the stress-induced heart attacks without coronary artery disease. Obviously, a more holistic protocol is needed to address this complex problem, and integration of Complementary Medicine provides great potential: http://www.ncbi.nlm.nih.gov/pubmed/25810130
  27. A 2015 review of the role of a variety of sex hormones on female cardiovascular disease, by experts at the University of Chieti, in Italy, show that not only estrogens (estradiol, estriol and estrone), but progesterone and adrogens especially have a direct relationship to this pathology, although this has been largely ignored in study: http://www.ncbi.nlm.nih.gov/pubmed/25845675
  28. A 2002 review of the role of steroid hormones and hypertension, published in the esteemed Oxford Journals, shows that imbalances of estrogen and progesterone, perimenopausal changes, and the use of synthetic hormones in contraceptives and HRT in menopause dramatically impact high blood pressure, and that the normalization, or balancing of steroid hormones, as in the discontinuation of contraceptive synthetic hormones, also normalizes the blood pressure. While the effects of synthetic hormone replacement have been shown to increase cardiovascular risks dramatically, the balancing and stimulating of natural hormones with bioidentical plant hormonal creams and holistic therapy in TCM would not incur these risks: http://cardiovascres.oxfordjournals.org/content/53/3/688
  29. The continued disconnect in Women's Health issues is evident from this well meaning comprehensive study of hypertension in women by researchers at Morehouse School of Medicine, in Atlanta, Georgia, U.S.A. This study starts out with the premise that since women were finally included in studies of cardiovascular pathology, since few women were even enrolled in these studies by the pharmaceutical industry for decades, that we now know that women seem to respond to blood pressure medications about the same as men, and so the guidelines for treatment should be the same, and "sex should not play a role in decisions about whether to treat hypertension or about the choice of agents". Such backward logic presumes that if the drugs work the same in lowering blood pressure that that is the end of the evaluation. On the other hand, the research goes on to show the numerous ways that issues in Women's Health effect the blood pressure, and medications for contraception and menopausal treatment raise the blood pressure in studies, but this should not be assessed for the women, or integration of healthy treatments to improve the neurohormonal health be included, because the drugs appear to work the same for men and women: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919822/
  30. A thorough assessment of the differences in blood pressure metabolism and factors between men and women is presented here, showing the profound effects in hormonal changes and fluctuation on the blood pressure, and how average blood pressures are different between men and women, and between young and old women, and even during the menstrual cycle: http://press.endocrine.org/doi/full/10.1210/jcem.84.6.5724