CHAPTER 1
Achieving Hormonal Balance
What we feel and think and are, is to a great extent determined by the state of our ductless glands and viscera.
— Aldous Huxley
The sudden drop in progesterone levels following birth is a major cause of PPMD. Not all women are hormonally sensitive, but for those who are, this biochemical shift can be quite dramatic. Women who have experienced PMS symptoms with their menstrual cycles are more susceptible to PPMD.
During pregnancy, the placenta produces high levels of progesterone to sustain the pregnancy. Once the placenta (the afterbirth) is delivered, the progesterone levels plummet. For this reason, it's important to look at progesterone levels first. A physician who specializes in complementary and alternative medicine (CAM) is your best choice. He or she may be a naturopathic doctor (ND), medical doctor (MD), or osteopathic doctor (DO) trained in natural or bioidentical hormone therapies.
Progesterone Deficiency
Signs and symptoms of a progesterone deficiency may include amenorrhea (not resuming a period), anxiety, hot flashes, night sweats, insomnia, confusion, depression, and dizzy spells. If the period has returned, the signs will be similar to premenstrual syndrome (PMS) and may include irritability, abdominal bloating and cramping, headaches before the period, moodiness, hopelessness, food cravings, sadness and crying easily. Some women will not have PMS before the pregnancy but will develop it after giving birth. Severe PMS is called PMDD or premenstrual dysphoric disorder and is sometimes treated with antidepressant medications.
Progesterone Testing
Progesterone testing may initially be conducted using saliva or blood samples. If the woman is not cycling and menses has not returned, only one sample is necessary. If she is cycling, a single blood or saliva sample may be taken on the twenty-first day. The chart below shows a series of multiple saliva samples taken for an entire month. This report gives the most complete information about the cycling of women's hormone levels.
Excessive estrogen in the body can cause similar symptoms even when progesterone levels are normal. This is called estrogen dominance and should be ruled out when taking blood or saliva samples.
Natural Hormone Therapy
Natural hormone therapy (HT) uses progesterone derived from fermented wild yam. These hormones are bioidentical, meaning that chemically they are exactly the same as the hormones produced by a woman's body. There are many forms of administration available, including sublingual drops, pellets or troches, topical creams, gels, patches, or oral capsules. I have found the sublingual forms to act the quickest. The dosage is easy to control and generally provides symptom relief within 24–48 hours. They wash out of the body quickly, allowing for simple dose changes.
If the woman is not menstruating, progesterone is used daily until her menses returns. This dosing is also appropriate if she has severe symptoms of PMS that persist through day 1 of the menstrual cycle beginning. Women with estrogen dominance may often need to take the progesterone all month long until their bodies are properly supported. It's safe to take progesterone throughout the cycle. Be aware that some women will not begin menstruating until the progesterone is stopped. I advise women to watch for days 28 through 30, and if the menses does not begin, I recommend stopping the progesterone supplementation for a couple of days to see if the flow begins. If a woman has a strong return of symptoms, it's acceptable to resume the progesterone at any time, even while menstruating. When first beginning HT, it's important to keep track of the menstrual cycle.
In menstruating women, the decision of when to begin supplementation with progesterone is based upon symptoms. Most often, a woman will use the progesterone starting on days 12 through 18, until she begins bleeding. Discontinuing the use of progesterone from day 1 (first day of bleeding) till day 12 (ovulation) follows the body's natural rhythm. (see chart above)
As previously stated, if her symptoms begin early in the cycle or do not end with the beginning of menses, she may use the progesterone daily. It's important to follow the advice of a trained physician and monitor blood levels after beginning therapy.
Some women take a smaller dose of progesterone on days 5 through 12 and then increase throughout the month as their period approaches. This cycling mimics the natural rhythm of progesterone in a menstruating woman.
Benefits of Natural Progesterone Therapy
The benefits of natural progesterone therapy include the stabilization of mood, decreased PMS symptoms, and protection from endometrial and breast cancer. Do not use synthetic progestin found in the birth control pills, Provera, or PremPro. These can cause depression, cancer, and heart disease.
Progesterone also reduces estrogen dominance and decreases anxiety. It's very helpful for treating sleep disorders, night sweats, excessive crying and sadness, delay of menstruation beginning postpartum, or periods that are irregular — either coming too frequently or not at all. It also helps with menstrual cramping and breast discomfort.
Too much progesterone can cause nipple tenderness, and in women who are blood type A, it may cause bloating. Anytime HT is given to a woman, close monitoring of her symptoms and blood levels is important until she has stabilized. It is also important that she is seen by her practitioner weekly until the mood has stabilized. This is especially important if she is having violent thoughts.
Herbal and Homeopathic Remedies
Herbal therapies may be substituted for natural, bioidentical hormones. Vitex agnus-castus (Vitex) or chaste tree berry is an excellent choice for younger women. Depending on the severity of the postpartum mood disorder, it may be advisable to begin with HT, and once the symptoms have stabilized, a change to Vitex can be made safely.
Vitex is similar to progesterone in its effect but is not the same as giving progesterone. It takes longer (usually four to six weeks) for the postpartum mood disorder to improve. For this reason, if a woman is severely suffering from PPD or PPMD, regardless of her age, it may be better to begin with HT.
Regarding the use of homeopathic medicines, it would be valuable to have a complete homeopathic intake with a skilled practitioner. Although women may have the same diagnosis, they may need different remedies based on their homeopathic constitution.
In Conclusion
Generally, hormonal imbalances are caused by a deficiency in progesterone levels postpartum. This is not the only reason, but it is the most common cause. Other hormonal imbalances play a part depending on the woman's age and medical history. By finding a competent practitioner to work with you, outcomes can be improved.
It's valuable to look at results from blood tests and rule out other causes. Low blood glucose or iron levels can lead to fatigue and irritability. Other hormone levels — such as estrogen and testosterone — are important for women over thirty-five. When there is severe fatigue or anxiety, testing for the Epstein-Barr virus — as well as DHEA and cortisol levels — may rule out more causes for the symptoms. The thyroid may also be affected postpartum, and thyroid testing will be important in some cases. If the symptoms warrant it, testing for the possibility of Hashimoto's disease or another autoimmune disorder is vital. If the birth experience was very stressful or the home situation is difficult, the adrenals may be taxed by pregnancy. It is important to also conduct adrenal function testing if the new mother isn't feeling better after two weeks of beginning treatment.
CHAPTER 2
Nutritional Program
Let food be thy Medicine and let Medicine be thy food.
— Hippocrates
The goal of a healthy nutritional program is to insure proper nourishment, keep blood sugar levels stable, and improve digestive function. Organic foods are always preferred over those commercially grown. Incorporating the blood type diet by Dr. Peter D'Adamo will improve results, as will the avoidance of all processed foods and any know allergens.
The Plan
The use of whole foods, which are minimally processed and do not contain preservatives or chemicals, is critical. In all cases, organic is preferred over nonorganic. This will avoid the use of genetically modified (GMO) foods.
Meat: Consuming animal flesh may be helpful for some women to restore health, but is not a necessity. Select free-range, grass-fed, organic, or non-farmed animal products preferably not cured nor smoked.
Vegetables and Fruits: Choose fresh, local and organic if possible. When necessary, choose frozen over canned.
Whole grains and cereals: The label must say whole grains. Avoid processed and refined grains. For example, choose brown rice over white rice. Making half brown and half white rice makes it easier to start eating healthier grains. Whole grain pastas, breads, and cereals are widely available at health food stores.
Dairy products:: Consume organic whole milk, yogurt, and natural cheeses (avoid low-fat and nonfat). Yogurt naturally sweetened with fresh fruit or honey and vanilla — no sugar or artificial sweeteners. Try goat cheeses and goat yogurts for variety as well as soy, almond, or rice milk. When using dairy, it's important to purchase organic products because of the hormones used in producing nonorganic milk.
Nuts and nut butters: Consume raw nuts, not honey -roasted or sugar-coated. Nuts should be soaked overnight, rinsed, and dried in an oven or dehydrator. This will release enzymes which help with digestion of nuts.
Beans and legumes: For all types of beans and legumes, soak overnight and then rinse in fresh water before cooking to reduce gas or bloating.
Pure water: Drink half your body weight in ounces every day. If you weigh 130 pounds, drink sixty-five ounces of pure water daily. If you are nursing, you will need to drink water more often and in greater quantity.
Herbal teas and sparkling water: These may help you increase your water intake and may be counted as water if only sweetened naturally with honey or stevia.
Getting Started
Begin by eliminating white flours (bread, crackers, and pasta), white rice, and white sugar. The standard American diet (SAD) includes excessive amounts of processed foods made from refined wheat and sugar. The revised food plate promoted by the USDA now encourages adding whole grains in addition to processed and refined carbohydrates. By reading the labels on everything you buy, you can eventually learn what to purchase and what to avoid. Look for the words whole grains,organic, and non-GMO certified when shopping.
What to Avoid
• alcohol, caffeine, nicotine, any street drugs, colas/sodas, coffee, "diet" pills or teas
• white flour, white sugar, white rice, artificial sweeteners, fast food, junk food, chips, cookies, and candies
• hydrogenated oils and preservatives
• GMO, nonorganic, or foods that have been shipped long distances which are often sprayed with chemicals
How to Plan Meals
Eating four to six mini-meals a day reduces the time needed to prepare food. This also keeps the appetite and blood sugar more stable. Many women do not have the patience to eat or cook formal meals. Eating mini-meals allows for meals that can be quickly prepared and eaten upon arising and every few hours through the day.
It's important to incorporate some protein in each snack. Simple examples are:
• rice cake, celery stick, or apple with some nut butter or cheese, tuna, or egg salad on it;
• yogurt or a glass of milk with whole grain granola and fruit. Dairy is a good source of protein if a food allergy doesn't complicate digestion; and
• smoothies made with frozen fruit, coconut water, and protein powder are quick, easy, and nutritious. Check your blood type recommendations or food allergy restrictions before choosing a protein powder. Eggs, whey, and soy are common allergens. If those are problematic, look for protein powders made from sprouted brown rice, hemp, or pea.
A fresh supply of hard boiled eggs, cooked chicken, organic luncheon meats (turkey, beef, or chicken), canned tuna, nut butters, brown rice cakes and crackers, celery and baby carrots, apples, pears and other fruits, raw nuts, sliced soy cheese, yogurt, and healthy granola bars may be kept on hand. Mix and match all these items for quick and easy snacks.
A carafe of herbal tea may be prepared nightly by soaking four tea bags in a quart of water and refrigerating. Keep sparkling mineral water, purified drinking water, and pure juices in stock.
Not all meals must be of the mini variety. For some women, making one meal a day may rarely be possible. However, when time and mood allow, the preparing of a good dinner of protein, salad, and steamed vegetables, with fruit for dessert — or a big breakfast omelet stuffed with meat, sautéed vegetables, and cheese with salsa on top and a whole grain bagel — can be therapeutic. Otherwise, the small snacks will be just fine and adequate for good health.
Eating out requires some planning. Order the protein grilled, baked, or blackened, with a side of steamed vegetables. Hold the starch unless quinoa, brown rice, or sweet potato is available, and of course refuse the bread basket; it is doubtful these items will be whole grain. Another option is to order a salad with protein and the dressing on the side; dipping the fork in the dressing instead of pouring it over the salad will reduce intake of dressings that may contain hydrogenated oils, MSG, sugar, or preservatives. Ordering sparkling water with some cranberry juice or a non-alcoholic beer and skipping the dessert or having fresh fruit is recommended.
Once or twice a week, having something enjoyable that is off the diet will help you stick to the plan better by not having to be perfect. Long-term health and happiness may be better served by taking a break for a day. If a small indulgence triggers binge eating or food cravings, it's best to skip this suggestion.
Remember that what a person does 90 percent of the time is what counts! Three meals a day add up to twenty-one meals per week. Ninety percent adherence to the plan allows for two meals per week off the diet.
Perfection is an illusion and a dangerous one at that. Strive to do well and feel well, not to be perfect.
Why does this diet work?
1. It stabilizes blood glucose (sugar) levels. Eating mini -meals prevents the ups and downs of hypoglycemia (low blood sugar). It will keep the metabolism going and reduce feelings of hunger. Eating every few hours rather than waiting to be hungry is the key.
Avoiding refined carbohydrates and sugar will also stabilize the blood glucose levels. Eating sugar gives an initial boost that is followed by a crash as insulin levels increase. Over time, this can cause insulin resistance and prediabetic conditions.
Repairing the metabolic damage from unstable blood sugar and hypoglycemia, will stabilize mood and improve energy. Over time, it will no longer be necessary to eat so often. As mood stabilizes and energy improves, eating as often may not be as important.
2. Fueling the metabolism contributes to weight loss. It's a proven fact that by starving the body, it will hold onto weight. However, by keeping the metabolic fire burning, you will actually lose weight. Most women want to lose weight after giving birth. This is motivation for sticking with the nutrition plan.
3. Hydration is important for good health. Drinking two to three liters of water and herbal teas every day will keep the milk supply flowing and prevent dehydration. Dips in blood sugar and dehydration both contribute to depression!
4. Fats can be healthy. The increased consumption of healthy fats called essential fatty acids is important to good health; the body needs them. Adding one tablespoon of flax oil to a smoothie or pouring it on a salad or steamed veggies just before serving will be beneficial. Flax oil should not be heated. Olive oil is best for cooking and can also be used in salad dressing.
5. It eliminates pesticides, hormones, preservatives, and other harmful chemicals from the diet. Removing these toxins will not only restore health, but also it will bring it to a new level. Eating food in its more natural form is the goal and is an easy way to avoid refined and processed foods. This is a lifestyle change to work toward; it's not a temporary fix. Eating more healthfully impacts the health of the entire family and the planet.
