The ZRT Laboratory Blog

Understanding Estrogen's Vital Role in Perimenopause

Wed, 06 Nov 2024 14:12:04 -0800

Perimenopause is the phase between a woman’s reproductive years and menopause, marking the end of monthly bleeding cycles. During this transition, hormone levels change significantly. There are fluctuations in progesterone, but mainly a decline in estrogen. This drop in estrogen can cause both physical and emotional symptoms.

Understanding how estrogen levels play a key role in perimenopause is crucial for managing symptoms. It can also help improve the quality of life for women experiencing this transition.

What is Perimenopause?

Perimenopause typically begins when women are in their 40s but some may begin to experience symptoms in their mid-30s. This early onset is considered premature menopause. During this time the ovaries gradually produce less estrogen until menstrual periods completely stop, signaling the arrival of menopause.

The common duration of perimenopause is about four years, but can vary for each person (1). However, women who experience premature menopause, or undergo surgical menopause (the removal of the uterus and one or both ovaries), are suddenly menopausal, and may experience symptoms of low estrogen (2). In these cases, some providers prescribe hormone replacement therapy (HRT) containing estrogen to help with menopausal symptoms.

Estrogen’s Role in the Body

Estrogen is a key hormone in the female reproductive system that regulates the menstrual cycle and maintains pregnancy. Beyond its reproductive functions, estrogen also plays a vital role in various body systems, including the cardiovascular, skeletal, and central nervous system (3).

In 2016, the Early Versus Late Intervention Trial (ELITE) was conducted. This study introduced a term called, “the timing hypothesis” (4). This hypothesis suggests that starting menopause hormone therapy (MHT) within 5 to 10 years of menopause is key. It helps estrogen protect the heart and support brain function.

Cardiovascular System: Estrogen helps maintain healthy blood vessels and promotes good cholesterol levels, reducing the risk of heart disease.
Skeletal System: Estrogen helps keep bones strong and protects against osteoporosis.
Central Nervous System: Estrogen influences mood, cognitive function, and overall mental health.

Hormonal Changes During Perimenopause

During perimenopause, the rise and fall of estrogen levels is unpredictable. These fluctuations lead to a range of symptoms, including mood swings, and irregular menstrual cycles (1). The drop in estrogen also affects the hypothalamic thermoregulatory center, which regulates the body temperature (1). This can cause symptoms like hot flashes and night sweats (1).

Symptoms of Estrogen Fluctuations:

Vasomotor Symptoms: Hot flashes and night sweats are among the most common symptoms experienced during perimenopause. These are directly linked to the fluctuating levels of estrogen and their impact on the body’s temperature regulation (1).
Mood Swings and Depression: Changes in estrogen levels can affect neurotransmitter systems in the brain, leading to mood swings, anxiety, and depression (1).
Sleep Disturbances: Many women report difficulties in sleeping, which can be attributed to night sweats and hormonal changes (1).
Cognitive Changes: Some women experience memory lapses and difficulty concentrating, often referred to as "brain fog" (1).
Physical Changes: Weight gain, particularly around the abdomen, and changes in skin firmness and hair texture are also common.

Estrogen Therapy in Perimenopause

Hormone Replacement Therapy (HRT) is a common treatment for reducing perimenopausal symptoms. HRT involves the administration of estrogen or a combination of estrogen and progesterone/progestin to stabilize hormone levels.

Benefits of HRT: HRT can significantly reduce vasomotor symptoms, improve mood sleep quality, and protect against bone loss.
Risks of HRT: While HRT is effective, it is not without risks. Potential side effects include an increased risk of blood clots, stroke, and certain types of cancer. It is essential for women to discuss the benefits and risks with their healthcare provider to make an informed decision.

Non-Hormonal Treatments

For women who cannot or choose not to use HRT, there are non-hormonal options available. These include lifestyle changes, maintaining a healthy diet, regular exercise, and stress management techniques. Additionally, certain medications, like selective serotonin reuptake inhibitors (SSRIs), can help manage mood swings and hot flashes.

Emerging Research

Recent studies have highlighted the complex role of estrogen in perimenopause (4). For example, research suggests that estrogen’s impact on brain pathways involved in inflammation may contribute to mood disorders during this transition. Another study found that the change in estrogen, rather than the actual levels, might be more strongly linked to perimenopausal symptoms.

Views on Menopause Throughout History

Historically, menopause was viewed as a disease. It was seen as needing medical and sometimes psychiatric help, and not as a natural part of a woman's life. In some cultures, or societies, menopause was kept secret, creating a sense of shame and isolation for women. By the mid-20th century attitudes were showing signs of change.

The development and introduction of HRT in the 1960s marked a significant turning point for women. However, it also led to the belief that perimenopause and menopause were due to a deficiency that needed fixing. This further framed a natural female life transition as a medical problem.

Interesting insights come from writer, and oral historian, Dr. Helen Foster (6). She presents the history of menopause, bringing to light the confusion and superstition about menstruation and menopause. Dr. Foster uses audio clips from interviews with modern women to explore the difficult and sometimes violent history of menopause (6). She also dives into the mythology, and taboos around periods and the onset of menopause.

In a podcast episode of The Happy Menopause, Dr. Foster talks about her project, “The Silent Archive Project.” She notes, “I found there was a real gap around women’s stories at midlife, particularly at the mention of menopause… What I couldn’t find was women sharing what their symptoms were and how they felt about them.” “(Menopause), doesn’t really feature in any historical accounts, or very, very few. When there is, they are from the roots of taboo” (6).

Advocating for Change

Right now, there is political legislation that aims to address women’s midlife health issues that are often overlooked (5). The legislation, backed by celebrity support, is set to increase federal funding over a five-year period. This will also provide professional training and resources for healthcare providers on early detection, diagnosis, and treatment of perimenopausal and menopausal symptoms. This initiative is a crucial step toward ensuring that women receive the specific care and attention they deserve.

Perimenopause and menopause are natural biological phases marking the changes toward the conclusion of a woman's reproductive years. Like the onset of menstruation, perimenopause and menopause as an individual feminine experience is culturally acknowledged and celebrated differently throughout the world.

In this article from The Women’s Journal, author Carmen Rodriguez Gonzales discusses how menopause is viewed around the world. She writes, “In many cultures, menopause is seen as a significant milestone in a woman’s life. It is often associated with wisdom, maturity, and the attainment of a new level of spiritual and emotional growth. Understanding the cultural nuances surrounding menopause is crucial to providing appropriate support and empowerment for women during this transformative phase” (7)

How we, as women, see the physical and emotional changes in our bodies is important. It is helpful to explore these feelings with female friends, family, or support groups. Talking about our fears and discussing changes in our bodies with other women can be healing. It benefits both ourselves and all women.

The unique experience of biological changes can be seen in light of a person's religious, cultural, and family background. This context can greatly impact how each of us anticipate the experience and navigate the changes for ourselves.

Were you able to experience your mother going through the perimenopause or menopause transition? If you were fortunate enough to have your mother during this time in her life, how did her experience shape your views? How did it affect how you want to go through your own transition?

Conclusion

Perimenopause is a challenging phase marked by significant hormonal changes, particularly in estrogen levels. Understanding the role of estrogen can help women and healthcare providers better manage the symptoms associated with this transition. While HRT remains a cornerstone of treatment, non-hormonal options and emerging research offer additional avenues for relief. As always, personalized care and informed decision-making are central in navigating perimenopause effectively.

Convenient at-home tests using saliva or dried blood spots can check ovarian hormone levels. These hormones include estrogen and progesterone. This testing can provide meaningful insights for supporting a woman's health as symptoms are being anticipated and experienced. Hormone testing can also help women feel more empowered in their bodies during this transitional stage of life.

References:

1. Dhalwani, N. N., Williams, D., McManus, R. J., & Gokhale, K. M. (2023). Mortality and cardiovascular outcomes with different classes of antihypertensive drugs: A population-based cohort study using electronic health records linked to the UK Biobank. BMJ, 382, e072612. https://doi.org/10.1136/bmj-2022-072612

2. Sohn, E. (2023). Surgical menopause: Estrogen after hysterectomy. WebMD. https://www.webmd.com/menopause/surgical-menopause-estrogen-after-hysterectomy

3. Mehta, M., Jaya, Chester, C., Rebecca, & Kling, M., Juliana. (2019). The Timing Hypothesis: Hormone Therapy Treating Symptomatic Women During Menopause and Its Relationship to Cardiovascular Disease. Journal of the American College of Cardiology, 74(17), 2167–2175. https://doi.org/10.1016/j.jacc.2019.08.1037

4. Russell, K., Jason, Jones, K., Carrie, & Newhouse, A., Paul. (2019). The Role of Estrogen in Brain and Cognitive Aging. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC6694379/

5. Murkowski, L. (2023, September 21). Senator Murkowski introduces historic new bipartisan legislation to boost menopause research, expand training and awareness around menopause. Senator Lisa Murkowski. https://www.murkowski.senate.gov/press/release/senator-murkowski-introduces-historic-new-bipartisan-legislation-to-boost-menopause-research-expand-training-and-awareness-around-menopause

6. Wellcome Collection. (n.d.). A bloody history of menopause. https://wellcomecollection.org/series/a-bloody-history-of-menopause

7. Rodriguez Gonzalez, C. (n.d.). Menopause in different cultures around the world. The Women’s Journal. https://www.thewomensjournal.co.uk/womens-life/health-wellness/menopause-in-different-cultures-around-the-world/

Vitex Agnus-Castus – Botanical Support for Female Hormone Imbalance

Fri, 21 Feb 2020 12:21:51 -0800

One of the most commonly used herbs in the botanical toolbox is Vitex agnus-castus, also known as chaste tree berry. During the Middle Ages the dried berries were used in monasteries as a peppery condiment that was said to help suppress libido. Additionally, in the mid-1900s, Vitex was often given to women for “sexual irritability,” nervousness and melancholia. Perhaps for these reasons the herb was regarded as a symbol of chastity and has been known by names such as monk’s pepper, Abraham’s balm and chasteberry. Through the years it was often used to support lactation and stimulate or increase menstruation. Today Vitex helps regulate menstrual periods, reduces symptoms of premenstrual syndrome (PMS) and helps to manage symptoms of polycystic ovarian syndrome [1].

Constituents found in Vitex include essential oils (monoterpenes, diterpenes and sesquiterpenes), flavonoids/flavones (casticin, vitexin) and iridoid glycosides (aucubin and agnoside). There is likely some benefit in using extracts from the entire herb, leaf and berries, due to the synergistic activity between the many active elements found in Vitex. Often there is a dose dependent aspect to herbal preparations for eliciting the desired effects. Larger doses of the whole plant may be needed to obtain the same or similar results as a smaller, more concentrated dose of an extract of a particular constituent. However, with research being done on herbs, their chemical components and effects, standardized extracts have evolved.

What Hormone Imbalances Are We Talking About?

Insufficient luteal progesterone production is a common denominator in menstrual cycle disturbances, whether anovulatory or ovulatory. Two factors that contribute to irregular cycles and/or luteal phase defect are inadequate development of the endometrium resulting in problems with implantation and an inadequately functioning corpus luteum. These situations have been correlated with increased prolactin production or hyperprolactinemia.

Prolactin is a hormone from the pituitary gland generally associated with stimulating breast milk production after childbirth. It’s also secreted in response to eating, ovulation, low dopamine levels and stress. Less common, prolactin can also be elevated due to a usually non-cancerous pituitary tumor or prolactinoma.

Vitex for Menstrual Problems

Vitex contains dopaminergic constituents that bind with dopamine D2 receptors in the anterior pituitary, leading to inhibition of prolactin. Two studies examined the effect of Vitex on hyperprolactinemia. In one study, 20 mg capsule of Vitex dried fruit extract was compared with placebo in 52 women with high prolactin. Therapies were administered every evening for 3 months. In contrast to placebo, the Vitex extract significantly reduced prolactin concentrations, lengthened the luteal phase by 5 days, normalized mid-luteal progesterone levels and increased estradiol. The other study consisted of one group of 40 women with mild elevations of prolactin and another group of 40 women with cyclic mastalgia. Both groups received 40 mg Vitex dried fruit extract daily compared to bromocriptine (5 mg), a medication used to treat high prolactin. After 3 months, significant drops in prolactin levels were observed in both groups. In addition, mastalgia was significantly decreased with both therapies, with no significant difference in effects between the 2 treatment groups. However, patients treated with bromocriptine experienced nausea and vomiting, whereas there were no adverse effects with the Vitex. Surprisingly, 2 women in the Vitex group became pregnant, which suggests the herb had additional impact on ovulation and the corpus luteum that the bromocriptine did not have [2,3].

Premenstrual syndrome (PMS) is a combination of symptoms that almost 90% of women experience in the week or two prior to the onset of their period. Symptoms may include mood swings, irritability, tender breasts, food cravings, fatigue, depression, headaches, and bloating or water retention. Symptoms of premenstrual dysphoric disorder (PMDD) can include those of PMS, but are usually more debilitating, affecting daily living. Specific PMDD symptoms can include anger, anxiety, poor concentration and sleep problems. Both PMS and PMDD are thought to be related to changes in hormonal levels during the cycle.

Several clinical trials using Vitex agnus castus as a treatment for PMS symptoms showed it to be superior to placebo.

Several clinical trials using Vitex agnus castus as a treatment for PMS symptoms showed it to be superior to placebo. Women with mild to moderate symptoms, including breast fullness, bloating, headache, menstrual pain, sleep disturbances, irritability and mood changes, felt significant improvement with the Vitex therapy compared to placebo. Slightly different formulations and dosages of the herb were used in each trial, over a 3-month course, with most of the benefit seen in the third month. The oral dosages commonly ranged from 20-40 mg of dried, ethanol extracted herb and were dosed either the week before the menses or once daily throughout the cycle. Unfortunately, most of the preparations used were not disclosed. Only 2 of the trials revealed standardized extract products. One was standardized for the constituent casticin, another standardized to agnoside [2,3,4,5,6,7,8,10,13].

Vitex was also investigated as a therapy for symptoms of PMDD, which often involves feelings of sadness and/or worthlessness, depression, anxiety and lack of interest in life, as well as some of the common symptoms of PMS. Two trials contrasted the performance of Vitex to fluoxetine (Serafem), a selective serotonin reuptake inhibitor (SSRI), advertised for the treatment of PMDD. After 8 weeks, the conclusion of both trials showed Vitex as a valid alternative to fluoxetine for many of the physical symptoms, although the latter may be slightly more effective for the psychological symptoms of PMDD [11,12].

Vitex for Menopausal Symptoms

Studies have assessed Vitex as a therapeutic option for alleviating some common symptoms of the transition of menopause.

Although most commonly used for symptoms and conditions in premenopausal women, studies have assessed Vitex as a therapeutic option for alleviating some common symptoms of the transition of menopause.

A Korean study with 2 groups of women were followed over 8 weeks using the Greene Climacteric Scale Questionnaire. One group was given a 30 mg capsule of Vitex extract and the second group was given an identical capsule containing a placebo. Both groups were dosed morning and night. At the end of the trial, the questionnaire scores for each group were evaluated and compared. The total scores for anxiety and vasomotor dysfunction were significantly reduced with the Vitex extract compared to placebo. However, depression, somatic complications (pain, fatigue) and sexual dysfunction did not show a statistically significant difference from the placebo [9].

Vitex therapies were generally well tolerated, with a good safety profile, during the treatment course in all studies. Reports of the few adverse events, such as nausea, acne, urticaria and headache, were mild and infrequent compared to placebo, bromocriptine or fluoxetine. It should be noted that Vitex may interfere with the effectiveness of oral contraceptives. And while Vitex has a history of support for breastfeeding, it may interfere with milk production through suppression of prolactin and is generally contraindicated during pregnancy and lactation [14].

With a long history of use and few undesirable outcomes documented with its use, Vitex agnus castus can be a valuable botanical alternative for some common female reproductive disorders, especially where symptoms and laboratory testing suggest luteal phase progesterone deficiency.

ZRT’s Menstrual Cycle Mapping test provides a detailed, multi-point map, that gives patients a complete picture of their hormone levels over the course of one menstrual cycle. This allows providers the ability to create more precise treatment plans to help their patients get back to balance. Order your menstrual cycle mapping test today.

Related Resources

References

[1] Principles and Practice of Phytotherapy, by Simon Mills and Kerry Bone, 2000, Churchill Livingstone.

[2] Milewicz A, et al. Vitex Agnus Castus Extract in the Treatment of Luteal Phase Defects Due to Latent Hyperprolactinemia. Results of a Randomized Placebo-Controlled Double-Blind Study. Arzneimittelforschung 1993;43:752-6.

[3] Kilicdag EB, et al. Fructus agni casti and bromocriptine for treatment of hyperprolactinemia and mastalgia. Int J Gynaecol Obstet 2004;85:292-293.

[4] Ma L, et al. Treatment of moderate to severe premenstrual syndrome with Vitex agnus castus (BNO 1095) in Chinese women. Gynecol Endocrinol. 2010;26:612-6.

[5] Ma L, et al. Evaluating therapeutic effect in symptoms of moderate-to-severe premenstrual syndrome with Vitex agnus castus (BNO 1095) in Chinese women. Aust N Z J Obstet Gynaecol 2010;50:189-193.

[6] He Z, et al. Treatment for premenstrual syndrome with Vitex Agnus Castus: A prospective, Randomized, Multi-Center placebo Controlled Study in China. Maturitas. 2009;63:99-103.

[7] Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo-controlled study. BMJ 2001;322:134-137.

[8] Van Die MD, et al. Vitex agnus-castus Extracts for Female Reproductive Disorders: A Systematic Review of Clinical Trials. Planta Med 2013;79:562-575.

[9] Naseri R, et al. Comparison of Vitex agnus-castus Extracts with Placebo in Reducing Menopausal Symptoms: A Randomized Double-Blind Study. Korean J Family Med 2019;40:362-367.

[10] Zamani M, et al. Therapeutic Effect of Vitex Agnus Castus in Patients with premenstrual Syndrome. Acta Med Iran, 2012;50:101-6.

[11] Ciotta L, et al. Psychic aspects of the premenstrual dysphoric disorders. New therapeutic strategies: our experience with Vitex agnus castus. Minerva Ginecologica 2011;63:237-45.

[12] Atmaca M, Kumru S, Tezcan E. Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder. Hum Psychopharmacol 2003;8:191-5.

[13] Wuttke W, et al. Chaste Tree (Vitex Agnus-Castus) Pharmacology and Clinical Indications. Phytomedicine 2003;10:348-57.

[14] Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Chasteberry. [Updated 2018 Dec 3].

Getting to the Heart of Estrogen

Thu, 14 Feb 2019 13:36:03 -0800

The American Heart Association has designated the month of February as American Heart Month to raise awareness about heart disease and the healthy choices we can make to prevent it. Every year, 1 in 4 deaths are caused by heart disease. And while some risk factors are out of our control, such as family history, genetics, and aging, most of the risk factors for developing heart or cardiovascular disease are more often than not within our control. For example, lifestyle habits and behaviors such as smoking cessation, physical activity, healthy food selection, and how we cope with mental and emotional stressors, like feeling angry, can be modified [1].

Cardiovascular disease (CVD) is the leading cause of death in women and the risk dramatically increases with menopause. Although there are many factors involved in the development of CVD, there is speculation that the hormonal shifts experienced during the transition into menopause may play a part. Estrogen is one of the key transitional hormones during this changeover and its low levels during menopause are strongly associated with increasing cardiovascular risk. For its role in several aspects of cardiovascular disease prevention, estradiol has been the subject of various investigations through the years.

What we know now is that estrogen replacement therapy actually decreases cardiovascular risk when prescribed early in menopause.

Estrogen Research Through the Years

Estrogen’s cardioprotective properties haven’t always been well understood. Early analysis of the Women’s Health Initiative (WHI) incorrectly attributed the negative cardiovascular side effects of co-administered medroxyprogesterone acetate to Premarin. This sent the field of hormone replacement therapy into a serious identity crisis. What we know now, after years of further analysis and from a great many follow-up studies to the WHI, is that estrogen replacement therapy actually decreases cardiovascular risk when prescribed early in menopause. This occurs by several different mechanisms, the physiology of which I will describe after a brief review of the research comparing the cardiovascular risks associated with oral vs. transdermal estrogens [2][3][4].

With further analysis of data from the Women’s Health Initiative-Estrogen Study (WHI-E) and comparisons with the earlier findings, researchers proposed the “timing hypothesis” which suggested there was a difference in outcomes when hormones were replaced at specific stages of the menopausal transition. For example, the data showed menopausal hormone replacement was cardio-protective if it was initiated in women who were perimenopausal or early postmenopausal, whereas starting estrogen replacement in late postmenopausal women (>10 years) showed either no benefit or detrimental effects on the cardiovascular system [5].

Another follow-up study of the Women’s Health Initiative clinical trial compared different types, doses, and delivery routes of hormone therapies in relation to cardiovascular disease outcomes. Specific types included oral conjugated equine estrogens (CEE), i.e., Premarin, with and without a progestin; oral estradiol (E2), with and without a progestin; or progesterone plus transdermal estradiol. Women within less than 5 years from the onset of menopause when CEE therapy was initiated had a lower absolute cardiovascular risk than women placed on CEE therapy more than 10 years from onset. While comparisons between oral CEE and transdermal estradiol were not significantly different for CVD outcomes, data suggested transdermal delivery lowered the risk of major coronary heart disease (CHD) compared to oral delivery [6].

A widespread type of coronary heart disease is also called coronary artery disease (CAD) or atherosclerosis [7]. Atherosclerosis is a disease of vascular aging in which changes to the endothelium, the inner lining of the blood vessels, contribute to formation of plaques, which are a combination of blood proteins, lipids and calcium that congregate and adhere to the walls of damaged arteries. Plaque build-up narrows or blocks arteries and decreases blood flow. In addition, the hardened plaques reduce the intrinsic, elastic nature of the arterial endothelium.

Endothelial Dysfunction’s Role in Cardiovascular Disease

Vascular aging has elements of endothelial dysfunction and atherosclerosis development and is a major risk factor for developing CVD. The menopause transition seems to accelerate vascular aging, and estrogen decline contributes to this in several ways.

Known actions of estrogen include the following: raising high density lipoproteins (HDL), lowering cholesterol and low-density lipoproteins (LDL); dilating and relaxing blood vessels; and protecting endothelial function. Changes in blood lipid levels, vascular tone and the endothelial cells are major risk factors for developing cardiovascular disease.

The term “endothelial dysfunction” is used to describe defects in the production or bioavailability of endothelial-derived nitric oxide (NO) and the consequential damaging changes in vascular dilation or reactivity. Nitric oxide is produced throughout the body to promote various functions in different tissues. In the cardiovascular system, its primary role is to control vascular tone, dilate blood vessels, reduce blood pressure and inhibit platelet aggregation in arteries to prevent clotting and thrombotic events. Estrogen has been shown to enhance NO production through estrogen receptor (ER)α-mediated activation of nitric oxide synthase (eNOS) in endothelial cells. Extended times of lower estrogen can reduce ERα expression causing functional impairment of ERα/eNOS signaling [8].

Endothelial function is seen to gradually decline in men over 40, but the decline in women begins at 50 years of age and accelerates after menopause as estrogen levels plummet. Via ultrasound, brachial artery flow-mediated dilation (FMD) was used to measure endothelial-dependent vasodilation in healthy premenopausal, perimenopausal and postmenopausal women. Results for vasodilation were highest in premenopausal women, lower in perimenopausal women and lowest in postmenopausal women. Higher FSH and lower estradiol concentrations also correlated with lower brachial artery FMD measurements as women transitioned through menopause. Conclusions were made indicating endothelial dysfunction worsened in late menopause when ovarian function and estrogen deficiency were at their lowest [9].

Estrogen replacement in menopause can stimulate NO release to help regulate inflammatory cytokines.

Estrogen also displays antioxidant effects and protects against oxidative stress, which is another key mechanism of endothelial dysfunction. It may play an inhibitory role in the scavenging of reactive oxygen species (ROS) that can suppress or scavenge nitric oxide. Furthermore, with aging and estrogen deficiency, the inflammatory marker tumor necrosis factor alpha (TNFα), is up regulated. This in turn activates the expression of adhesion molecules and cells to attach to the walls of the blood vessels creating more inflammation and plaque formation. TNFα will also scavenge NO, decreasing its bioavailability and setting up a cascade of events increasing inflammation. Estrogen replacement in menopause can stimulate NO release to help regulate inflammatory cytokines [8][10].

Estrogen Replacement: Timing Is Key

The critical window for stemming cardiovascular or coronary heart disease has been shown to be the time when estrogen appears to begin its descent [11]. Trying to “re-estrogenize’ women who are already in late menopause with estrogen replacement may not result in the expected changes seen in early perimenopausal women. Perhaps this is because longstanding estrogen deficiency alters the epigenetic terrain to the extent that the body will no longer react as favorably to estrogen supplementation.

To that end, the importance of initiating estrogen therapy early in menopause for cardiovascular health cannot be overstated. Without estrogen’s role in modulating the vascular effects of nitric oxide and TNFα, and its influence on blood lipids, women are left at greater risk of a cardiovascular event and more likely to end up on a polypharmacy collection of statins, hypertension, and anti-inflammatory drugs which all carry their own risk of adverse outcomes. It’s time to consider the female physiology with the evidence on estrogen replacement if we want to stem the tide of cardiovascular disease.

To find out if you are estrogen deficient, ZRT offers estradiol testing in four body fluids for your convenience – saliva, blood spot, dried urine, and serum. Learn more about hormonal imbalances during menopause and order your next test kit today.

Related Resources

References

1. Centers for Disease Control and Prevention Fact Sheet: Heart Disease.

2. Grodstein F, et al. A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med. 2000;133:933-41.

3. Grady D, et al. Heart and Estrogen/progestin Replacement Study (HERS): design, methods, and baseline characteristics. Control Clin Trials. 1998;19:314-35.

4. Rossouw JE, et al.; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:321-33.

5. Phillips LS, Langer RD. Postmenopausal hormone therapy: critical reappraisal and a unified hypothesis. Fertil Steril. 2005;83:558-66.

6. Shufelt CL, et al. Hormone therapy dose, formulation, route of delivery, and risk of cardiovascular events in women: findings from the Women's Health Initiative Observational Study. Menopause. 2014;21:260-6.

7. National Heart, Lung, and Blood Institute Fact Sheet: Know the Differences. Cardiovascular Disease, Heart Disease, Coronary heart Disease.

8. Moreau KL, Hildreth KL. Vascular Aging across the Menopause Transition in Healthy Women. Adv Vasc Med. 2014;2014:204390.

9. Moreau KL, et al. Endothelial function is impaired across the stages of the menopause transition in healthy women. J Clin Endocrinol Metab. 2012;97:4692-700.

10. Clarkson TB. Estrogen effects on arteries vary with stage of reproductive life and extent of subclinical atherosclerosis progression. Menopause. 2018;25:1262-1274.

11. Giordano S, et al. Estrogen and Cardiovascular Disease: Is Timing Everything? Am J Med Sci. 2015;350:27-35.

ZRT’s Favorite Healthy Eating Summer Recipes

Tue, 03 Jul 2018 11:22:00 -0700

Hello summer! The ZRT docs and staff have compiled some tasty recipes to include for your family picnics or impromptu gatherings with friends. From a refreshing herbal beverage and a cool creamy soup to a zesty, peppery corn dip and tangy, nutty quinoa salad, the foods that make up summer fare can be simple to prepare as well as delicious. The addition of spicy, savory grilled chicken thighs boosts the protein up a notch. Then top these off with a delectable mini muffin containing nut butter and chocolate chips! What more could you want? Fruit sorbet, of course! Enjoy!!

Hibiscus and Mint Lemonade

Ingredients:

4 bags hibiscus tea (such as Celestial Seasonings Red Zinger tea)
2 cups fresh mint leaves, plus sprigs for serving
2 ½ cups lemonade

In a small saucepan, steep the tea and mint in 2 cups boiling water, using a wooden spoon to gently mash the mint; let cool. Discard the tea bags and mint. In a pitcher, combine the tea and lemonade. Serve over ice and garnish with the mint sprigs. Yields 4 servings.

Chilled Avocado-Cucumber Soup

Ingredients:

1 English cucumber, peeled and diced (reserve ¼ cup for garnish)
1 ripe avocado, pitted, peeled and diced (reserve ¼ cup for garnish)
½ teaspoon finely grated lemon zest
1 tablespoon fresh lemon juice
¼ cup coarsely chopped fresh cilantro, plus sprigs for garnish
1 scallion, white and pale-green parts only, coarsely chopped (about 2 tablespoons)
1 jalapeno, seeded and coarsely chopped
1 cup nonfat plain yogurt
1 cup cold water
1 ½ teaspoons coarse salt
¼ teaspoon freshly ground pepper

Puree ingredients in a blender. Divide soup and reserved cucumber and avocado among 4 bowls. Cover with plastic wrap. Refrigerate 30 minutes. Garnish with cilantro sprigs.

Mexican Corn Dip

Ingredients:

4 cups corn kernels, frozen and thawed or fresh (about 5 large ears fresh)
1 can (4.5 oz.) mild green chilis
1/3 cup plain Greek yogurt
1/4 cup crumbled cotija cheese
1/4 cup chopped fresh cilantro leaves
1/4 cup diced red bell peppers
1 diced jalapeno (seeds removed unless you like spice)
2 tablespoons mayonnaise made with olive oil
2 green onions, thinly sliced
Juice of 1 lime
1/2 teaspoon chili powder

Mix all ingredients together in a mixing bowl until well combined. Taste and season with salt and pepper as desired. Serve with chips.

Tahini-Lemon Quinoa with Asparagus Ribbons

Ingredients:

1 15 oz. can chickpeas, rinsed
Zest and juice of 1 lemon
1 cup quinoa, cooked
½ cup tahini
¼ cup fresh lime juice
1 tablespoon honey
1 cup packed fresh mint leaves
1 pound thick asparagus
¼ cup shelled pistachios, chopped
Salt and pepper to taste

Combine chickpeas, lemon zest and juice and a pinch of salt and pepper in a bowl. Let stand for 20 minutes or refrigerate overnight, then drain. Meanwhile, cook quinoa per package directions and season with salt. In a blender, puree tahini, lime juice, honey, mint, ½ cup of water and ¼ teaspoon salt until smooth, adding additional water if needed. Set aside. With vegetable peeler, shave asparagus into ribbons, peeling from woody end toward tip. In a bowl, combine cooked quinoa, asparagus ribbons and marinated chickpeas. Sprinkle with pistachios and drizzle with tahini dressing.

Grilled Chicken Thighs

Ingredients for Marinade:

2 cups white vinegar
1 cup Tamari soy sauce
4 tablespoons powdered ginger or grated fresh ginger
1 teaspoon ground cayenne pepper
1 tablespoon minced garlic
¼ cup olive oil

Marinate 18-24 chicken thighs (skin on, no real prep here) for at least 2 hours.

Ingredients for Glaze:

½ bottle Stubb's BBQ sauce
2 teaspoons minced garlic
2 tablespoons balsamic vinegar (finish to taste and thinness desired)
4 squirts Tabasco sauce (finish to taste)
2 tablespoons blackstrap molasses

While chicken is marinating, make up the glaze and mix it up to your taste. There are no hard rules here. Get creative. If you like spicy, you can add Sriracha or ghost pepper flakes. If you like sweet, add in some honey or brown sugar. At this point, save a little of this glaze for a dipping sauce if you’re so inclined.

Start your grill and get it hot. Remove your chicken thighs from the marinade. Cook chicken on medium heat if it’s a gas grill about 10 minutes on each side (5 minutes if boneless) or until done. Once just about cooked through, paint your chicken with the glaze and close the lid for about 30 seconds. Flip them and do the same on the other side. Pull off glazed, gingery chicken that’s so juicy and delicious, no one will believe how easy they were to make.

Peanut Butter Chocolate Chip Mini-Muffins

Ingredients:

½ cup thick, creamy peanut butter or almond butter (no-stir brand or mixed to incorporate oil and nut butter). Any kind that is not separated or thin would be ok. Thicker is better.
1 banana, roughly sliced
3 tablespoons honey or agave syrup
1 egg
1 tablespoon vanilla
¼ teaspoon baking soda
¼ + cup mini chocolate chips (to taste)

Preheat oven to 400 degrees. Grease or add cup liners to a mini-muffin pan. Put all ingredients except chocolate chips in blender and blend for a few seconds until smooth. Stir in mini-chocolate chips. Fill mini-muffin cups about ¾ full. Bake for 8-9 minutes at 400 degrees until tops look rounded and they pass the toothpick test. Makes about 2 dozen mini muffins. Easy-peasy! Keeps for a few days at room temperature or freezes well.

Homemade Fruit Sorbet

Ingredients:

3+ cups fresh or frozen fruit, cut up
1-2 tablespoons honey (or to taste)
1 teaspoon lemon juice (lime juice may go better with some fruit)
¼ cup warm water, as needed

Arrange fresh fruit on a rimmed baking sheet lined with parchment paper. Freeze until solid (3-4 hours or overnight). Frozen fruit can be used straight from the freezer. In a food processor or blender, add frozen fruit and lemon or lime juice. Process until smooth, adding the warm water as necessary to help blend. Serve immediately or place in a freezer for 3-4 hours or until firm. Makes 4 servings.

Fruits ideas: raspberries, peaches, strawberries, watermelon, blueberries, mangos, cantaloupe, honeydew and oranges.

Other ZRT Recipes

When to Choose Menstrual Cycle Mapping vs Fertility Testing

Mon, 23 Apr 2018 10:08:00 -0700

In 2008 ZRT Laboratory introduced the Fertility Profile to assist women in identifying possible hormonal causes of infertility. More recently ZRT launched the Menstrual Cycle Mapping (MCM) test that allows women to map time points throughout their menstrual cycle, measuring levels of estrogen, progesterone and luteinizing hormone (LH).

Since the MCM test was introduced there has been some confusion as to which test is best to evaluate fertility/infertility. The aim of this blog is to clarify the differences between the two tests and when best to use each.

Menstrual Cycle Mapping

The MCM profile measures estrone-3-glucuronide (E1G), pregnanediol-3-glucuronide (PDG) and luteinizing hormone (LH). E1G and PDG are the primary metabolites of estradiol and progesterone excreted in urine. ZRT employs dried urine samples, collected on filter paper, as a more convenient way of measuring these metabolites over several days in a menstrual cycle.

For those women wanting to get pregnant, the MCM profile can provide useful fertility information - answering questions such as:

Does estrogen rise enough to proliferate a uterine lining for implantation?
Did ovulation occur during the cycle?
Is ovulation delayed or different from what is anticipated?
Did progesterone rise adequately after ovulation?
Did progesterone drop too early after its peak in the luteal phase?
Is there a wide LH peak, suggestive of diminished ovarian reserve?

While the MCM profile may provide information about fertility, there are other reasons for selecting this test.

Mapping the rise and fall of menstrual hormones at specific time points within the cycle can assist in solving the mysteries of cyclic symptoms, both physical and mental/emotional. Tracking imbalances of estrogen and progesterone can provide insight for cyclic headaches (migraines), fatigue, bloating, breast tenderness, heart palpitations and hair loss, just to name a few. Being aware of certain hormone changes during the cycle may also explain symptoms of moodiness, irritability, difficulty concentrating, anxiety and depression.

Contraceptive medications suppress natural production of hormones. When the decision is made to discontinue these medications hormones can be imbalanced, attempting to return to a natural cycle. Mapping a menstrual cycle may be helpful in pinpointing where help is needed to get back on track.

Many women are just curious about their menstrual cycles and want to know more about their individual hormonal patterns. MCM can offer a glimpse of their personal physiology.

The Fertility Profile

In contrast, ZRT’s Fertility Profile, provides information about all the sex steroids including estradiol, progesterone and testosterone, but additionally tests markers for other fertility-associated body systems: adrenal, thyroid and pituitary, to identify the myriad of imbalances that can contribute to infertility. This profile tests cortisol’s diurnal rhythm, luteal phase estradiol (E2), progesterone (Pg), testosterone (T), sex hormone binding globulin (SHBG), DHEAS (DS), free T3 (fT3), free T4 (fT4), TSH, TPOab, and early follicular FSH and LH.

Aside from adrenal health, DHEA levels can play a part in improving ovarian reserve (capacity for production of egg cells).

The stress hormone, cortisol is tested via saliva, collected at the traditional times: morning, noon, evening and night, yielding a circadian pattern. Other tests are through dried blood spot with one sample card collected on day 3 of the menstrual cycle for testing FSH and LH and a second card collected in the luteal phase of the cycle, usually day 19, 20, or 21 of a 28 day cycle.

The adrenal hormones, cortisol and DHEA(S), are useful indicators of the hypothalamic-pituitary-adrenal axis (HPA). How a person is affected by stress is often reflected in cortisol and DHEA(S) levels. High, low or fluctuating cortisol levels due to stress can have a direct negative impact on the ovary's production of E2 and Pg and the thyroid’s production of thyroid hormones. Aside from adrenal health, DHEA levels can play a part in improving ovarian reserve (capacity for production of egg cells).

Obviously, estradiol and progesterone levels are important for preparing the uterine lining for implantation and the continued growth of the fertilized egg. Deficiencies of either of these hormones can be problematic. Differing from the MCM Profile, the Fertility Profile looks at only 1 time in the month for these hormones, mid luteal phase. For some, a single E2 & Pg level at the right time of the month can provide important data for ovarian insufficiency and/or luteal phase deficiency. For others, that single time point could miss the bigger picture.

Androgen levels, DHEA(S) and testosterone, can indicate possible problems with insulin resistance or polycystic ovarian syndrome (PCOS) which can result in anovulatory cycles. Since the sex hormones are tested in dried blood spot, the test measures both free and protein-bound hormone levels; SHBG is tested so that free (bioavailable) testosterone levels can also be calculated.

Collected on day 3 of the menstrual cycle, when estradiol is lowest, an FSH and LH level will show if there are enough eggs in reserve and adequate stimulation of those ovarian follicles for optimal fertility. In addition, an imbalance of these pituitary hormones, higher LH than FSH levels, may also indicate a PCOS condition. Elevated FSH values on day 3 will likely be a result of a lower quantity of viable eggs or possible transition to menopause.

Too much or too little thyroid hormone can impact fertility leading to anovulatory cycles, but also problems during pregnancy including miscarriage, poor fetal growth and premature births. Elevated TPO antibodies indicate an autoimmune thyroid disease affecting the ability to conceive and to carry the pregnancy to term.

Which to test?

To conclude, the MCM Profile is more straightforward in the information gathered. Although the data can be useful in helping to assess some causes of infertility, it is also ideal for assessing cyclic symptoms like migraines or bloating. In comparison, the Fertility Profile generates a more diverse and comprehensive interpretation of the fertility picture with which to develop a treatment strategy for women with unexplained infertility.

Related ZRT Resources

5 Spices to Warm Your Soul During Winter

Fri, 12 Jan 2018 10:14:00 -0800

Spices are the delightfully aromatic plants whose warming scents are a characteristic element of the winter season. In fact, there are five spices that evoke memories of sitting by the fire on cold nights, weekends of playing in the snow, and social gatherings that feature rich seasonal desserts and mulled wine.

A spice is harvested from the root, bark, seed or dried fruit of a tropical plant or tree. The aroma or flavor comes from essential oils. Many spices contain similar essential oils but in different proportions. These oils are released through the physical process of grinding, grating or crushing. The essential oils begin to evaporate after processing and the flavors of the spices will fade over time. In contrast, the original bark, seeds, or berries can often stay fresh for years.

But there is more to these exotic plants than just their sweet or pungent flavors. In ancient times spices were used in almost every aspect of life whether in flavoring and preserving food, to freshen one’s breath, or to being applied or ingested as medicine. Let’s look in more detail at those well-known spices associated with the winter season: allspice, cinnamon, cloves, ginger, and nutmeg.

Allspice

Allspice (Pimenta dioica) comes from the dried berries of a tree native to Jamaica, Mexico and Central America. The name “allspice” was coined by the English because it has the combined flavor of cinnamon, nutmeg and cloves. With its peppery flavor it is a common component of Caribbean cuisine and Jamaican jerk seasoning, and in mole sauces, curries and in pickling. In the United States it’s mostly used in spiced cider or mulled wine and in seasonal desserts.

While most other spices came from Asia, allspice was exclusively grown in the Western hemisphere. Imported to Europe it became quite popular. In the cosmetic industry the pimento oil, distilled from the leaves of the allspice tree, is used to boost the scents of fragrances and as a natural deodorizer.

Allspice is a digestive and carminative due to the volatile oil, eugenol. Similar to other spices containing the oil, allspice also has anti-bacterial and anti-inflammatory properties. As a folk medicine, allspice was applied topically for bruises, muscle aches, and rheumatism due to its vasodilating effects on blood vessels. Recent investigations have focused on the constituents of allspice – eugenol, quercetin and gallic acid – for their antioxidant activity and possible beneficial effects on the incidence of cancer.

Cinnamon

Cinnamon (Cinnamomum zeylanicum and C. cassia), is harvested from the inner bark of several trees of the genus Cinnamomum, native to India. Cinnamon’s characteristic taste and smell is due to its primary constituent, cinnamaldehyde, an essential oil. Eugenol, copane, cinnamyl acetate and camphor are found in smaller amounts. Used to flavor meat and curry dishes in the East, in the West cinnamon is more typically added to sweet dishes and desserts.

Rich in antioxidants, cinnamon helps reduce free radicals, exhibits anti-inflammatory properties, aids in stabilizing lipids and blood sugar, and may have beneficial effects on neurogenerative diseases. Several clinical trials have shown cinnamon cassia to improve glycemic control in patients with pre-diabetes and with high pre-treatment HbA1c levels. These studies show the potential for cinnamon as an add-on therapy for managing type-2 diabetes. However, the zeylanicum species of cinnamon may be a safer alternative to cassia, because it has lower levels of coumarin, a blood thinner.

Cloves

Cloves (Syzyium aromaticum) are the dried flower buds of a tropical, evergreen tree from Indonesia. Historically clove was one of the most prized spices in Europe. A pomander ball, usually an orange studded with cloves, is a traditional Christmas ornament and New Year's gift. Clove is a curious ingredient in the widely smoked Indonesian cigarettes, “kretek,” which lends a distinctive aroma and flavor when smoked. Commonly used in traditional Indian dishes, clove’s strong, pungent flavor can sometimes overpower other flavors and should be used sparingly.

On the medicinal side, clove's volatile oils, one of which is eugenol, impart anti-inflammatory and antiviral/antibacterial properties. Frequently employed for a toothache, clove is also helpful for other oral conditions such as gingivitis and halitosis, due to its antibacterial effect. The spice has been used in respiratory conditions, as an expectorant for coughs and to sooth sore throats. Clove is also a rich source of antioxidants supporting the immune system [1].

Ginger

Medicinally, ginger was used for digestive ailments and is known for its calming, carminative effect.

Ginger (Zingiber officinale) is a plant whose root or rhizome is commonly used cooking as well as in medicine. Originating in Southeast Asia it has become widely cultivated in other countries. Often considered an herb, ginger is technically a spice since it’s the root that’s used. Ginger is one of the main ingredients in the seasonal favorite gingerbread or ginger cookies. Its culinary uses include traditional Indian recipes such as masala chai and curry dishes. Pickled or candied ginger is quite common in Japan and China. And ginger ale was America’s favorite beverage for many years.

Ginger is a good source of vitamin C and minerals including magnesium, copper and manganese. Medicinally, ginger was used for digestive ailments and is known for its calming, carminative effect. Due to its ability to stimulate saliva flow, ginger has been studied as an antiemetic, alleviating motion sickness and morning sickness, and reducing the side effects associated with chemotherapy. Ginger promotes sweating and helps reduce body temperature during fevers. Its stimulating property improves peripheral circulation which may be helpful for high blood pressure. Ginger’s anti-inflammatory activity is potent. Gingerol, its volatile oil compound, is a better inhibitor of prostaglandin biosynthesis than a commonly prescribed non-steroidal anti-inflammatory drug (NSAIDS), indomethacin [2]. Additionally, recent research is exploring ginger as an anti-obesity agent.

Nutmeg

Nutmeg (Myristica fragrans) is taken from the fruit kernel of a tropical evergreen tree native to Indonesia. Nutmeg has a special affinity for use in dairy dishes such as custard or pudding, but also in soups and other desserts. Historically this seed was used for stomach ailments, headaches and fevers.

A high-mineral spice, nutmeg is a source of manganese, copper and magnesium in beneficial amounts. Potassium and zinc, as well as several vitamins, are found in smaller quantities. The essential oils of nutmeg have been studied for their antioxidant properties and anti-angiogenic activity. Further investigations revealed anti-bacterial effects from ethanol extracts of nutmeg.

There is a caution in taking nutmeg in a large amount as it has psychoactive effects, acting as a hallucinogen. Although poisonings are rarely fatal, too much nutmeg can have the consequence of convulsions, palpitations and generalized body pain.

Usually spices are consumed from cooking and baking and not taken in large quantities. However, at this time of year, the amounts of confections devoured may constitute a medicinal dose. It's just a good thing many of the spices are beneficial for the digestion!

Related ZRT Resources

References

[1] The Encyclopedia of Medicinal Plants, Andrew Chevallier
[2] Principles and Practice of Phytotherapy, Simon Mills and Kerry Bone

Herbal Remedies for Sleep Disturbances & the Nervous System

Wed, 29 Mar 2017 11:39:00 -0700

O sleep, O gentle sleep,
Nature's soft nurse, how have I frighted thee,
That thou no more wilt weigh my eyelids down
And steep my senses in forgetfulness?

William Shakespeare, Henry IV

A good night's sleep is important to health. During sleep the body is in an anabolic state when energy conservation, tissue repair and growth take over. The body temperature drops, growth hormone is secreted and immune cell production is increased. Thus sleep is essential for a healthy body and a peaceful mind.

Insomnia is defined as difficulty falling asleep or staying asleep and affects roughly 50% of all adults. It may resolve and return intermittently or it may become chronic. As many as 10% of adults with sleep problems have chronic insomnia, defined as disrupted sleep occurring at least 3 nights per week and lasting 1-3 months. While there are numerous and varied reasons for sleep disturbances, a common denominator is physical, emotional or mental stress to the nervous system.

Nervines are the botanical world's answer to insomnia, with actions that have a beneficial, and sometimes tonic, effect on the nervous system. Some of the herbs promote relaxation supporting a natural sleep, while others act as a sedative or hypnotic (promotes deep sleep). Still other nervines nourish and restore balance to the nervous system. Nervines also have antispasmodic and analgesic properties, if muscle tension or pain is the reason for sleeplessness. While nervines act primarily on the nervous system there is a close interface with the adrenal glands. So nervines can also be a key component of adrenal support formulations.

California poppy

The California poppy (Eschscholtzia californica), considered a non-addictive alternative to its Papaveraceae family member, the opium poppy, is used for its anxiolytic, anodyne and sedative (hypnotic) properties. One of the oldest North American remedies for stress-induced maladies, Native Americans used the leaves to ease toothache and colic pains.

A German prescription drug, Phytonoxon N, containing California poppy was found to interact with opioid receptors which may explain some of the plant's medicinal actions. A specific indication of the poppy has been as a sedative and hypnotic (sleep promoter) for children where there is "over-excitability and sleeplessness." Another study showed a key alkaloidal constituent, chelerythrine, acting as an inhibitor to pain neurons in the spinal cord, significantly reducing nociceptive responses.

California poppy should be used cautiously, as the herb can interact with CNS depressant drugs and sedative medications such as benzodiazepines, potentiating the sedative effect.

German Chamomile

German Chamomile (Matricaria chamomilla) has been mainstreamed into several commercial tea formulations. In Mediterranean countries chamomile can be ordered in restaurants and bars in a concentrated 'espresso' form. Its reputation as a gentle sedative for children is well-known and commonly used for anxiety and insomnia. Having carminative properties, the herb is often used to settle the stomach in bouts of indigestion or gastritis.

Apigenin and luteolin, flavonoid constituents of chamomile, have demonstrated anti-anxiety and slight sedative activity without muscle relaxant effects in mice, likely due to modulating the GABA A receptor. The sedative effect may also be elicited due to very small concentrations of GABA found in the plant. Significant sleeping-time-potentiating effects were only observed at the two highest doses (160 and 320 mg/kg). A rat study also showed a reduction of stress-induced plasma ACTH after inhaling chamomile oil vapor, revealing a normalizing effect on cortisol production.

In a clinical trial chamomile extract produced a significant reduction in generalized anxiety disorder (GAD) symptoms over an 8-week period. The response rate using the herbal extract was comparable to conventional anxiolytic drugs without the adverse side effects.

Hops

The hop plant (Humulus lupulus) is in the Cannabaceae or Hemp family. In Europe hops have been grown commercially for beer brewing since the 11^th century, and in certain areas of the US brewing specialty beers using hops has become very popular.

Traditionally hops, the flower of the Hop plant, were used to strengthen and stimulate the digestion, but also as a valuable remedy for sleeplessness and excitability. A sachet of hops placed inside a bed pillow releases an aroma thought to calm the mind. The herb is used extensively for the treatment of insomnia having a marked relaxing effect upon the central nervous system. It acts to ease tension and anxiety, especially where tension leads to restlessness, headache and possibly indigestion. In one study hops in combination with valerian has been found to improve sleep latency and quality of sleep. However, hops should be used cautiously in people with a marked degree of depression.

Kava

Kava (Piper methysticum) was discovered in the Pacific Islands. Traditionally the kava root was cut into pieces, chewed or ground up, then mixed with coconut milk or water and decanted into a community bowl or cups. Historically used for religious ceremonies to help worshippers reach higher states of consciousness, today the concoction is served at social gatherings. Its key constituents are resins known as kava lactones, kavain, and dihydrokavain (DHK). Primary effects of kava are a decrease in anxiety and relaxation of the body without loss of mental acuity. There is also a mild anesthetic effect specifically on the mucous membranes. While a remedy can be standardized for the lactones, often the total extract of the kava rootstock can have more activity than its isolated constituents.

Studies suggest kava lactones can bind to GABA-A receptors. Tissue studies imply kava lactones may have a mechanism of action via modulation of N-methyl-D-aspartate (NMDA) receptors. In a placebo-controlled trial, the efficacy of a kava extract to induce sleep was investigated. With kava extract (150-300 mg extract, containing 105 mg – 210 mg kava lactones respectively) the ability to fall asleep and the light sleep phase were shortened, the deep sleep phase was lengthened, the duration of REM sleep was not influenced and the duration of wakeful phases in sleep EEG recordings was decreased. Kava has also been shown to decrease anxiety and improve cognitive performance without causing sedation.¹

Some precautions with kava use include liver toxicity. However, investigations into the events have revealed toxicity is likely due to products made from parts of the kava plant other than the root and/or use of solvents to extract the lactones. Water extracts have not exhibited hepatotoxic effects in any of the products tested. Overdoses of kava aqueous extract has been reported in the Aboriginal communities, but doses ranged from 100-500 g/week. Long-term use of an equivalent dose of 400 mg or more of kava lactones per day may cause a scaly skin rash in some subjects.

Lavender

As a gently strengthening nervous system tonic lavender is used to relieve states of nervous debility and exhaustion. It also soothes and promotes natural sleep.

Lavender (Lavendula officinalis) is better known for its sweet-scented aroma than for its medicinal properties. It has a long history: it was popular during the late Middle Ages and was also one of the medicinal herbs taken to the New World by the Pilgrims. Its many volatile oils are key to its effectiveness.

As a gently strengthening nervous system tonic lavender is used to relieve states of nervous debility and exhaustion. Effective for headaches especially those related to stress, it also soothes and promotes natural sleep. One study compared the inhalation effects of lavender essential oil on the equality of sleep for shift nurses. Another study demonstrated improved feelings of well-being and energy as well as a statistically significant improvement in sleep quality in 79 college students with self-reported sleep issues. An animal research using an oral lavender extract at doses of 400-800 mg/kg were investigated for sleep onset and sleep duration. The extract was comparable to diazepam in reducing sleep onset latency, but was slightly less effective than the drug for increasing sleep duration. A human trial using 80 mg oral lavender oil showed beneficial effects on disturbed sleep and somatic complaints in patients with GAD. This same study's results also reported a significant anxiolytic effect.

Lemon balm

Lemon balm (Melissa officinalis) is a member of the mint family. A calming herb, it was historically used to reduce stress and anxiety and promote sleep. The herb has a long tradition as a tonic remedy that "raises the spirits and comforts the heart." People in the Middle Ages steeped lemon balm in wine to lift the spirits and help heal wounds. Like other members of the mint family, lemon balm aids digestion and can ease the pain and discomfort of indigestion or colic. Today its uses include insomnia, anxiety, GI complaints and menstrual cramps, with more recent research exhibiting lemon balm's effect in the treatment of cold sores (herpes simplex virus).

A 2011 pilot trial summarized the lemon balm extract as demonstrating a significant improvement in anxiety manifestations and associated symptoms and insomnia. After 15 days of treatment insomnia was reduced by 42%. In a study assessing an herbal combination for sleep disruption accompanying menopause, 100 women were evaluated. Half were given placebo and half were given a remedy containing both lemon balm and valerian. The intervention group revealed a significant improvement in their sleep quality compared to the placebo group.

Oatstraw

Oatstraw (Avena sativa/officinalis) has been used historically as a remedy for nervous debility and exhaustion, where the nervous system needs 'feeding' or strengthening due to stress. As a tonic nervine it's almost nutritional in its effect and is considered to be extremely safe. Indicated for insomnia where "waking in the small hours of the night after going off to sleep easily" is the problem. Oats has a specific indication for fatigue in convalescence and neurasthenia.

Milky oats are the tops of the green oat plant. They are harvested in their milky stage, after flowering but before the seeds harden. Often made into a tincture milky oats are generally believed to work quickly in an acute situation. They have been used in withdrawal from nicotine and other addictive substances. Oatstraw is the stem of the plant and has more of a tonic effect, supporting the nervous system over time. Oatstraw is considered safe for everyday use; however, people with celiac disease should be cautious with its use due to possible cross-contamination with gluten cereals.

Passionflower

Passionflower (Passiflora incarnata) has a long history of use for insomnia, epilepsy and mania in Central and North America. It is considered by many herbalists as the herb of choice for unyielding insomnia and aids the transition into a restful sleep without a 'narcotic' hangover. Passionflower is useful as an anti-spasmodic when required for tension and effective for nerve pain such as neuralgia and shingles.

Although regarded as an effective nervine, passionflower has not been well researched. One study investigating its effects on sleep quality suggests consumption of an aqueous extract showed a benefit to sleep quality in those people with mild sleep problems. This herb often works synergistically when combined with other nervines.

Skullcap

Skullcap (Scutellaria laterifolia) is a classic nervine tonic, traditionally used for menstrual problems by Native Americans. In 19^th century America the herb became well known as a treatment for rabies and was assigned the common name of "mad dog." Its sedative and anti-spasmodic properties helps relax nervous tension while revitalizing the central nervous system. Useful for pre-menstrual tension, skullcap has a specific indication for the treatment of seizure disorders. While other varieties of the scutellaria family have been researched, there has been limited investigation on the laterifolia species. Though one study using skullcap indicated a significant enhancement of mood, the authors stated that further assessment of the herb’s anxiolytic effects was warranted to determine clinical value.

Valerian

Valerian (Valeriana officinalis) has a long been used as a mild sedative and is one of the most effective relaxing nervines. Valerian's medicinal value has been known since the 1^st century AD. Its distinctive odor is due to the volatile oil, valerenic acid and often described as "dirty socks." Valerian's actions include anxiolytic, mild sedative, hypnotic and spasmolytic effects. Traditionally used for certain kinds of epilepsy, valerian was also useful as a sedative in conditions of nervousness, stress and neuralgia. Viewed as a cerebral stimulant it was often used in conditions of mania with mental depression, despondency and nervous headache. For its sedative effect, Valerian can safely be used to reduce tension and anxiety, inducing a natural, healing sleep. Several studies have established valerian as a successful treatment for insomnia. In a German trial of over 11,000 patients, ingestion of an aqueous extract of the herb aided participants in falling asleep, improving the continuity of sleep and decreasing restlessness and tension. Although outcomes were positive, best results were seen after 2 weeks of use.

Another trial showed improvement in sleep latency time and sleep quality in elderly patients with symptoms of sleep disturbance. Results indicated valerian increased slow-wave sleep (SWS) but did not alter REM sleep. For those people who have low baseline values valerian increases SWS and reduces stage 1 sleep, differentiating the mode of action from that of benzodiazepine-type drugs.

While sleep hygiene and lifestyle changes are sometimes necessary for treating insomnia, herbal remedies can be an integral part of the treatment plan. If you're interesting in testing for sleep-related difficulties, take a look at the Sleep Balance profile.

More ZRT Resources

References

The Encyclopedia of Medicinal Plants, by Andrew Chevallier
The New Holistic Herbal, by David Hoffmann
Principles and Practice of Phytotherapy, by Simon Mills and Kerry Bone
Principles and Practice of Phytotherapy, 2^nd Edition, by Simon Mills and Kerry Bone
1. Emser W and Bartylla K. Improvement of sleep quality. Effect of kava extract WS 1490 on the sleep pattern in healthy subjects. Neurologie/Psychiatrie 1991;5(11):636-642.

Adaptogens: Herbs for Healthy Living

Mon, 26 Sep 2016 10:05:00 -0700

The adaptogens represent a category of herbs that is almost commonplace for those individuals seeking to be healthier in today’s stressful environment. These remarkable herbs focus on helping the body resist the complex biological reactions that arise from the stressful events we daily encounter.

Adaptogens work to increase the body’s resistance to physical, biological, emotional, and environmental stressors while promoting a return to normal physiologic function. Stress-related disorders have become one of the major health concerns so that practitioners need preventive concepts and new medicines.

Used by healers for thousands of years, current practitioners are reviving adaptogen use to modulate individual responses to stress.

Asian ginseng

One of the first herbs to be studied and the most commonly used is Asian ginseng or Panax ginseng. With its stimulating property it improves the body’s general performance under stress and prevents fatigue. As a tonic, Panax can be used in energy deficient situations where there is a state of exhaustion. Research has shown energy improvement in conditions such as chronic fatigue syndrome and multiple sclerosis. The herb has a sparing action on the adrenal cortex, modulating the general adaptation syndrome (GAS) to be more efficient and normalizing glucocorticoid levels more rapidly when stress decreases. In addition Panax has neuroprotective and immune modulating actions.

American ginseng

American ginseng (Panax quinquefolius) is not considered a true ginseng. Belonging to the same Arailacea family as Panax ginseng, Panax quinquefolius has some of the same constituents but is not as stimulating. American ginseng is useful for mild to moderate depletion of adrenal function and hypothalamus-pituitary-adrenal (HPA) axis impairment. It can also be of benefit for allergies, worsened by a depleted state, for jet lag, and has been shown to help control hyperinsulinemia (metabolic syndrome) and type 2-diabetes.

Ashwagandha

These herbs aid in normalizing many physiologic mechanisms such as regulating blood pressure, blood sugar, cellular energy production and immune alterations in the day-to-day management of stress.

Ashwagandha (Withania somnifera) is becoming one of the most popular adaptogenic herbs. Although it has an energizing effect, it possesses a more calming action than other adaptogens. This makes it useful for anxiety, stress-induced insomnia and nervous exhaustion. As an anti-proliferative herb it’s been used in the treatment of cancer. Ashwagandha contains a significant amount of iron supporting its benefit in treating iron deficient anemia.

Eleutherococcus

Eleutherococcus senticosus (Siberian ginseng) was one of the first adaptogens to be researched. The herb's ability to withstand the hardship of a cold climate symbolizes its actions. Russian scientists used it in numerous clinical trials to increase physical endurance and performance in Russian athletes and military personnel, hence the common name Siberian ginseng. Increasing endurance and stamina, enhancing mitochondrial activity and improving recovery from overtraining make Eleutherococcus an attractive adaptogen for athletes. In the general adaptation syndrome, Eleutherococcus exerts a sparing effect on the adrenal cortex allowing the body to better resist prolonged stress.

Rhodiola

Rhodiola (Rhodiola rosea) is an herb that has undergone serious scientific study and has been shown to have a significant benefit for the nervous system. Helping to calm anxiety and aid with insomnia Rhodiola also enhances alertness and improves memory. The herb protects the cardiopulmonary system influencing catecholamine levels that affect the heart. It works to prevent damage to the heart from stress induced arrhythmias and strengthens the heart muscle. Rhodiola acts on the body to prevent injury from excessive physical training and balances blood sugar.

Licorice

Licorice (Glycyrrhiza glabra) has a wide range of clinical uses. It’s considered an effective adaptogen, but is also an excellent antiviral, expectorant and gastrointestinal remedy. Commonly given for gastritis and peptic ulcers it reduces irritation and inflammation of the GI tract. Licorice has also been found useful in adrenal insufficiency and works synergistically with prescribed cortisone. A specific indication for licorice may be “general fatigue, especially with difficulty waking up in the morning.” Through its constituent glycyrrhizinic acid, licorice inhibits the enzyme 11-beta-hydroxysteroid dehydrogenase (11B-HSD) type 2 that converts cortisol to its inactive metabolite cortisone. This effectively increases circulating cortisol which binds to mineralcorticoid receptors in the kidneys with an effect similar to aldosterone. Through this action, licorice, in large doses can contribute to sodium and water retention and excretion of potassium resulting in elevated blood pressure. Consequently, caution should be used when considering licorice for susceptible individuals.

Holy basil

Holy basil (Ocimum sanctum) is another herb that has been extensively studied. Besides the normal adaptogen properties holy basil can protect against the damaging effects of ionizing radiation. It reduces cortisol levels when elevated by stress and lowers blood sugar in type 2-diabetes. With its neuroprotective properties it enhances circulation to the brain helping with memory and foggy thinking. Combined with ginkgo, holy basil is indicated for mental cloudiness and poor memory during the menopausal transition.

These herbs are representative of the more commonly used adaptogenic herbs. In response to perceived stress, adaptogens balance the HPA axis as well as influence other body systems including the immune, neurologic and reproductive systems. Research shows adaptogens also have antioxidant activity, protecting the body from oxidative stress and free radical formation. These herbs aid in normalizing many physiologic mechanisms such as regulating blood pressure, blood sugar, cellular energy production and immune alterations in the day-to-day management of stress. Augmenting the body’s own physiologic processes, adaptogens function to maintain homeostasis.

References

Adaptogens: Herbs for Strength, Stamina, and Stress Relief, by David Winston and Steven Maimes
Principals and Practice of Phytotherapy, by Simon Mills and Kerry Bone
“Nutrients and Botanicals for Treatment of Stress: Adrenal Fatigue, Neurotransmitter Imbalance, Anxiety, and Restless Sleep,” Kathleen A. Head, ND and Gregory S Kelly, ND, Alternative Medicine Review, Volume 14, No 2, 2009

Related Resources

Celebrating ZRT's Hormone Laboratory Professionals

Fri, 29 Apr 2016 13:27:00 -0700

It may come as a surprise to most people that each year, the last full week of April is dedicated to recognizing and celebrating laboratory professionals.

This year Medical Laboratory Professionals Week falls on April 24-30. Setting aside one week a year to acknowledge these experts is a perfect opportunity to increase public awareness of, and appreciation for, clinical laboratory personnel.

Just who are these hormone laboratory professionals? They are the skilled individuals whose expertise is vital to laboratory testing. At ZRT, state-of-the-art testing equipment is the norm and each instrument has an experienced specialist or team of specialists at the controls.

Under the guidance of the lab director, the laboratory manager oversees the daily operations. The laboratory/logistics supervisor assists her to keep things running smoothly. ZRT’s unique means of collecting body fluids and testing them is performed through multiple methods. Lab personnel are divided into five teams: specimen processing, saliva, blood spot, urine, and research. Many of the people that make up each team have worked together for years. Cross-training between teams is typical and provides continuity of sample processing.

Specimen Processing Team

The Specimen Processing department consists of specially trained individuals who receive the saliva, blood, and urine samples returned to the lab. In a nutshell, their responsibilities include opening the return envelopes and checking the contents. Then they individually bar code all lab requisitions and samples. They enter the pertinent information provided on the lab form into the computer system and initiate the reporting process. This includes the complex task of entering medication, hormone, and other supplement information the tester has provided and which is needed to complete the report. All samples are then sent to the lab for testing.

Saliva Team

ZRT's unique means of collecting body fluids and testing them is performed through multiple methods.

For saliva testing, the process of preparing, extracting and measuring hormone levels is performed both manually and by advanced, precision, automated instruments. The basic saliva tests are performed by four of the specialists, using immunoassay. Estriol and estrone saliva samples are processed through liquid chromatography-mass spectrometry (LC/MS), which is a highly sensitive method of measurement particularly suited to analytes at very low concentrations.

Dried Blood Spot Team

Blood spot testing, using capillary blood from a finger-stick is less invasive than the venous blood draw employed for serum and effectively equivalent for many analytes. Analogous to saliva testing, blood spot samples are tested by immunoassays with the exception of vitamin D, which is tested by LC/MS, a method regarded as the gold standard for accuracy.

Dried Urine Team

Dried urine testing for elements includes essential nutrients such as iodine and selenium, as well as heavy metals like mercury, arsenic and cadmium. These analytes are measured by inductively coupled plasma mass spectrometry, or ICPMS, one of many state-of-the-art instruments used at ZRT Laboratory. Urinary steroid metabolites are also measured from dried urine. For the metabolites profiles another specialized piece of laboratory equipment, gas chromatography-mass spectrometry, GC/MS, is used, as well as LC/MS, depending on the metabolite being tested.

Research Team

Research is at the heart of ZRT as the initials signify, Zava Research and Testing (read more about Research at ZRT here). Under the lab director’s supervision the group is charged with overseeing test method development, validation, and implementation of quality control. They continually work on process improvement and developing new, innovative tests. ZRT’s Research Team is committed to the advancement of testing capabilities and innovative methodology, which is the hallmark of ZRT.

Clearly, ZRT Laboratory takes lab science seriously. With the variety of testing methods we use, quality lab personnel are crucial for keeping ZRT in the forefront of hormone and wellness testing. So although we appreciate our team of laboratorians every day, they deserve special kudos for jobs well done during this special week. Happy Medical Laboratory Professionals Week, ZRT lab staff!

Guide for Interpreting Testing Levels for Hormone Contraceptive Users

Fri, 11 Mar 2016 09:00:00 -0800

Interpretation of hormone testing using saliva, dried blood spot, or serum can be tricky when women are using oral, patch, or other hormonal contraception methods.

The types of hormones in these contraceptives are synthetic, and although they may be close to the molecular structure of our body's own estradiol or progesterone, they are not bioidentical. While bioidentical hormones used as supplements react in the same way as our endogenous hormones to the specific antibodies used during hormone testing, non-bioidentical hormones aren’t recognized by these antibodies so they are not measured by the same test.

How does hormonal contraception affect test results?

Birth control pills, patches, and vaginal rings contain a combination of synthetic estrogen-like and progesterone-like substances, usually ethinyl estradiol and a variety of progestins respectively. A progestin-only formula for contraception is available as a pill, injection, IUD or a subdermal implant. The mechanism of action for these hormone analogs is to suppress the pituitary’s production of follicle stimulating hormone (FSH) and luteinizing hormone (LH). FSH stimulates the process of ovarian egg maturation and the LH surge triggers the mid-cycle ovulation. Suppression of these hormones prevents the ovarian development and release of an egg.

In patients using hormonal contraception, therefore, ZRT hormone testing assesses the amount of hormone the body is producing endogenously in its suppressed state. Since ovarian function is blocked, the body’s production of estradiol and progesterone will usually be low. ZRT Laboratory has established ranges for measuring estradiol and progesterone levels when women are using hormone contraceptives. In addition, testosterone levels can also decrease because ethinyl estradiol raises levels of sex hormone binding globulin (SHBG), which ties up free testosterone.

What are the treatment implications if test results are low?

Supplementation of any additional hormones is not usually warranted and should be considered cautiously due to risk of complications.

Although hormone testing when a woman is using a hormonal contraceptive shows low results, it should not be assumed there is a low hormone activity at the tissue level. Ethinyl estradiol and progestins do have an effect on cell receptors. Because of this effect, results may not be helpful when deciding on treatment: supplementation of any additional hormones is not usually warranted and should be considered cautiously due to risk of complications. This is because symptoms experienced are not likely to be a consequence of the deceptively low hormone levels. More commonly, a woman will experience side effects related to the tissue action of the non-bioidentical hormones. Giving bioidentical hormones to replace the artificially low results can lead to further hormonal imbalance and can increase adverse effects due to excessive hormonal influence at the tissue level. This is particularly important in considering estrogen replacement which can potentially increase risk of blood clots and/or stroke.

When should the sample be collected?

If the decision is made to test saliva or blood spot while using synthetic hormones, the sample can be collected at any time during the cycle, except during the "period." While ZRT doesn't recommend discontinuing hormonal contraceptives just for the purpose of testing, if cessation is determined for clinical reasons, the appropriate protocol for testing through ZRT is as follows:

Discontinue the contraceptive as directed for the specific method. This will usually bring on a period.
Wait until she has a spontaneous period, counting the first day of bleeding as day 1 (usually the next month after discontinuing).
Counting from day 1, collect the test sample on day 19, 20, or 21 of this second cycle (generally the second month after discontinuing the contraceptive).

With the withdrawal of some contraception methods or in perimenopausal women, this protocol may need to be adjusted due to shortened or lengthened cycles or irregular bleeding. ZRT Customer Service Representatives can provide further information if the situation doesn't seem to fit the protocol.

Related Resources

New Oregon Law Allows Women to Bypass Physicians for Contraceptives

Thu, 28 Jan 2016 11:44:00 -0800

From the time menses begins, to the time it ceases, a woman must make decisions that affect her fertility. Whether it's viewed as a gift, a curse or just a responsibility, a woman’s right to choose when, how and if a pregnancy occurs is a relatively new experience.

Over the last 50 years a woman's access to birth control methods, whether oral, patch, or IUD, has greatly increased. However, such a prescription usually requires a visit to a doctor along with a pelvic exam.

Oregon House Bill 2879 has changed this as of January 2016. Under the new law, women can bypass their physicians and go straight to their local pharmacist for an oral or patch contraceptive prescription.

Increased Accessibility the Answer to Unintended Pregnancies?

Driving this ground-breaking legislation is the rising rate of unintended pregnancies. Medical experts and reproductive health advocates have pushed for a change in the accessibility of birth control methods to help curb the growth. There are significant social and economic consequences of unplanned pregnancies and experts claim that increased accessibility is the answer.

Considered safe by most medical experts, any health concerns in using hormonal contraceptive methods take a back seat. The American College of Obstetrics and Gynecology has even suggested that oral contraceptives be available over-the-counter. Can you imagine going into a drug store and choosing a packet of birth control pills off the shelf? With the number of different medications on the market and the potential side effects unique to individuals, how will a woman make that decision?

New Requirements for Pharmacists

For years women have been fighting for more control over their reproductive lives. Does this legislative step move them closer to that goal?

Of course the new Oregon law is not without controversy. This new task for pharmacists invokes the question: are they qualified to make and oversee these prescriptions?

The Oregon Pharmacy Board says that although the bill has passed, implementation is likely to be slow. Educational requirements and specific practice guidelines need to be defined to ensure pharmacists are qualified. Then they will need to complete the specialized training and update their license for the new prescriptive rights. Also the logistics of how best to incorporate the increased service into a pharmacy’s current workflow needs to be addressed.

Educational requirements for Oregon pharmacists are already impressive and include classroom and direct patient care experience. To prepare for the added task of issuing prescriptions, pharmacists will be expected to complete specialized training on contraception methods. In addition, they can access the Standard Procedures Algorithm to aid in prescribing the pills or patches.

All women seeking a prescription for contraception from a pharmacy will be expected to complete a self-screening questionnaire assessing their health risks and eligibility for different birth control methods. But will this prepare pharmacists for the complications inherent to many contraceptive medications? Will they be expected to manage these complications or end up referring women back to their health care practitioners?

Will Refusal of Service Become an Issue?

Another concern for women regarding the recent law may stem from a non-health care related issue, refusal of service. While some states limit what services or prescriptions can be refused, other states, such as Oregon, have a "conscience and refusal clause" written into the law. The clause allows pharmacists to refuse to write or fill prescriptions for birth control based on moral or religious beliefs. However, pharmacies will still be legally responsible for referring the customer to another pharmacist or pharmacy that will provide service. The referral may not be a problem in more populated areas but could decrease access in rural areas with fewer pharmacies.

For years women have been fighting for more control over their reproductive lives. Does this legislative step move them closer to that goal? Will Oregon pharmacists be able to fulfill the task set before them with the new law? Will personal beliefs be a stumbling block for fulfilling the law? Will unintended pregnancy rates decline?

Only time will answer these questions. But for now, the plan has been set in motion for women to have a little more control over their fertility.

What thoughts do you have about this groundbreaking legislation?

Related Resources

How to Use a Symptom Checklist to Choose a Hormone Test

Tue, 12 May 2015 11:30:00 -0700

Symptoms of hormonal imbalance can often be challenging to assess.

Is your patient exhibiting signs of estrogen dominance because her estrogen is too high or is it due to the progesterone being too low?

Is his fatigue because he’s not making enough testosterone or that his adrenal glands are working over-time?

Are her imbalanced sex steroids the cause of her depression or is it the low thyroid hormone?

The good news is that testing hormones through saliva and/or dried blood spot can help differentiate these scenarios. The question I often get asked is “which tests should I order?” My answer is always consistent, look at the symptoms to understand what might be out of balance. This process is made easier by a ZRT resource, the Symptom Checklist for Women or Men. These handy documents include an inventory of symptoms, categorized in an easy-to-use format. They provide an idea of where to start with testing.

Have the patient fill out their symptoms in the four different categories. Having the patient rate the severity of the symptoms (mild to severe) helps to further specify testing. Finally review the checklist.

At the bottom of the Symptom Checklist is a “key” to explain how to go about assessing the symptoms marked. If most of the checkmarks are in Category 2 and they seem to be the most important, I test for adrenal gland function. The minimum testing suggested is the Adrenal Stress Profile in saliva. If most of the important checkmarks are in Category 3 the minimum testing should be the Essential Thyroid Profile in blood spot. The preferred test, the Comprehensive Elements Thyroid Profile adds iodine, selenium, bromine, and arsenic tested in dried urine. When symptoms are scattered throughout all 4 categories and range from moderate to severe, I consider more comprehensive testing such as the Comprehensive Female or Male Profile I or II. I might also consider adding-on the CardioMetabolic Profile to be more thorough.

This testing “key” suggests a Minimum and a Preferred test for each category. I consider a few different factors when deciding to order a basic profile (Minimum) or a more comprehensive profile (Preferred).

Questions to take into account:

Is this the patient’s first test with ZRT? With initial ZRT testing I suggest getting a baseline of all the hormones (maybe more than just the minimum). This is beneficial, particularly if considering hormone supplementation.
Does the patient have limitations for a certain method of testing? Saliva testing is great for testing hormones, but some patients have difficulty with their saliva production. In this scenario, consider blood spot or for diurnal free cortisol, dried urine testing is a good option. Other special patient circumstances are addressed in this table.
Has the patient had recent testing performed through another lab? Depending on what tests were completed, I might choose some of the minimum tests to augment the current lab values. In other situations the tests may not be as complete as I would like. Then I order the preferred ZRT tests.
Have symptoms recently changed? Patients who are moving through hormonal transitions such as perimenopause and menopause may need more frequent monitoring or a deeper workup.
Has the hormone supplementation changed? Most of the time the minimum testing is adequate. For those patients not responding to treatment I often have to rethink my assessment strategy.
Is stress a major factor in the patient’s life? The pressures and anxieties of our daily lives impact the adrenal glands but think thyroid hormones and sex steroids as well. The preferred test to choose is the Comprehensive Female or Male Profile I or II.

Consequently, the process of evaluating a patient’s hormonal status doesn’t have to be overwhelming or complicated. Use of the Symptom Checklist for Women or Men, and the ZRT testing they suggest, can make an assessment much easier. Keeping in mind the few questions noted, and then reviewing the symptoms, you will soon become proficient with ordering hormone testing.

Related Resources:

The Phenomenon of Vitamin D

Mon, 12 Jan 2015 22:49:00 -0800

Early in the 20th century, research in the nutritional arena was blossoming. Scientists were swiftly realizing that the nutritional requirements to "support life, growth and reproduction" in both animals and humans were more than simply proteins, carbohydrates, fats and minerals, as commonly believed. And, all scientists working in the field knew that this missing knowledge was key to relieving a host of common afflictions.

In 1912 one scientist, Casimir Funk, isolated a substance found in the hulls of rice that cured beriberi, a nutritional disease linked to thiamine (B1) deficiency. From this revelation, he theorized that other diet-related ailments such as pellagra, scurvy and rickets could also be a consequence of deficiencies of yet unidentified substances. He further hypothesized that these substances would have the same basic property of a protein, and called them "vital amines" or "vitamines" Later this term was embraced (with the ‘e’ omitted) and became a major focus of nutritional research for the next 30 years, yielding discovery after discovery of essential nutrients.

In 1917, building on previous research, Elmer V. McCollum began experiments with rats fed modified diets resulting in another diet-related health condition, rickets. This malady was prevalent in Europe, particularly in Scotland , and the northern US. McCollum fed rats a diet with an imbalanced ratio of calcium to phosphorus, a mixture which created rickets. He knew that Cod liver oil had been shown to prevent rickets. Having already isolated vitamin A in cod liver oil, McCollum speculated this nutrient was the factor responsible for reversing rickets. However, he found that after using oxygen to destroy the vitamin A in the cod liver oil, it still retained the ability to cure rickets. This meant that another factor was responsible for the curative effect.

Exposing an infant to sunlight was a traditional folk remedy in Europe for the treatment of rickets. Experiments using ultraviolet (UV) lamp exposure to rachitic patients were also known to be effective. A breakthrough occurred when it was found that not only was the irradiation of the rachitic rats curative, but irradiation of the imbalanced mineral rations that caused rickets was also curative. This contradiction led to many researchers trying to isolate the factor triggered by the UV waves. Little did they know that the process was generating vitamin D2 (ergocalciferol). Rapid progress led to separation of a lipid, then to a sterol fraction and finally in 1931 vitamin D was crystallized.

Today we know that vitamin D3 (cholecalciferol) is synthesized in our skin through exposure to sunlight. We also know that vitamin D has a complex regulatory effect upon calcium in our bodies and in the mineralization of our bones. But that’s only skimming the surface of this vitamin’s function. Further exploration has generated knowledge of the effects of vitamin D on many disease processes including breast, colon and prostate cancer, heart disease, both type 1 and type 2 diabetes, and depression, to name a few.

The winding road in the identification of vitamin D, as well as each individual vitamin, is a comparatively recent phenomenon in nutritional history. Yet one hundred years later, our understanding of vitamin D’s wider role is still embryonic. New associations to health are in the news almost daily. But thanks to pioneers like Casimir Funk, E.V. McCollum and many others, nutritional research and its importance to overall health continues to evolve.

Related Resources

Controversy Surrounds an Upsurge in Thyroid Cancer Detection

Thu, 25 Sep 2014 00:09:00 -0700

September was Thyroid Cancer Awareness Month. It's October now, but the increasing incidence of thyroid cancer makes it a timely topic for any time of the year.

In fact, something that every healthcare provider should know is that there's an expectation that 2014 will see a record number of papillary thyroid cancers being diagnosed, and the corresponding awareness campaign promotes a "neck check" for early detection and treatment. Additionally, it's hoped that heightened public awareness will encourage research leading to a cure for all types of thyroid cancer (TC).

My review of the research literature for thyroid cancer reveals a controversy around the upsurge of this common endocrine cancer. Are more frequent and sophisticated detection methods identifying the tumors at an earlier stage than in the past? Or is thyroid cancer really dramatically increasing in incidence?

The answer may surprise you.

TC is Among the Top 10 Most Common Cancer Types

National Cancer Institute statistics show a striking rise in the incidence of thyroid cancer worldwide in the last few decades. From 2007 to 2011, it has increased an average of 5.5% each year. It affects approximately 12.9 per 100,000 men and women per year, with deaths occurring at the rate of 0.5 per every 100,000 people.

An estimated 62,980 new cases of thyroid cancer will be diagnosed in 2014 – ranking it ninth in the top ten most common cancer types. Affecting women three times more often than men, the median age of diagnosis for thyroid cancer is 50. However, younger people are not exempt. And sadly, the highest percentage of deaths occurs among those people between 75 to 84 years of age, most often from medullary thyroid cancer.

Despite the numbers, some experts maintain that the explanation for the increase is due to diagnostic intensity as opposed to a true increase in disease occurrence. As one JAMA Network article declares, "...the increased incidence...is not an epidemic of disease but rather an epidemic of diagnosis."

One reason given for this perspective is that the escalation of thyroid cancer detections is primarily due to the most common type, papillary cancer, with no significant increase to follicular, medullary or anaplastic cancers. Moreover, mortality rates have remained stable since 1992, with only a slight rise in 2006. In an epidemic, an increase in mortality would be expected over time.

Is There an Issue of Over Detection?

Although this is a broad position, the concern by some is that over-diagnosis catches small tumors that may not cause problems for decades. In fact, autopsies frequently confirm small, undiagnosed thyroid cancers in patients who had died from other causes. In general, thyroid cancer has a slow progression, is symptomatic only when it's advanced, and it rarely causes death. So, it's unsurprising that it might be perceived to be overly diagnosed.

Critics claim early detection may result in unnecessary treatment, possible adverse consequences and unavoidable economic costs without any change in mortality. Because of this the American Thyroid Association has proposed new recommendations that only those with thyroid nodules >1 cm should be evaluated, if no additional risk factors are present.

Such risk factors include the following elements:

being between age 40-50 (women) or age 60-70 (men)
history of childhood head and neck irradiation
total body irradiation for bone marrow transplantation
family history of thyroid carcinoma or thyroid cancer syndrome in a first degree relative
exposure to ionizing radiation from fallout in childhood or adolescence

Other experts agree the growing number of incidental thyroid tumors diagnosed is due to the frequent use of ultrasound, cytology examinations and diagnostic procedures for different diseases. Nevertheless, these same authorities suggest improved detection may not represent the only source of the elevated incidence of thyroid cancer – environmental and lifestyle changes may also be a possibility.

Signs Point to Environment & Diet as Leading Causes

Although the incidence of papillary carcinomas has had the most increase, researchers maintain that thyroid cancers of all types and stages have shown an upsurge, and this can't be explained by detection alone. Indeed, the incidence of thyroid cancer has risen in other parts of the world where medical imaging is less common, which suggests additional factors are responsible for frequency of occurrences worldwide.

Environmental concerns, dietary deficiencies and environmental exposures, are also factors for the development of thyroid cancer. Dietary risk factors consist mainly of iodine deficiency. Follicular thyroid cancer is higher in areas where iodine is deficient in the soil and not replaced in the diet via iodized salt or other iodine containing foods.

Environmental exposure is probably the chief factor in the incidence of thyroid cancer. Types of exposure consist of radiation through atmospheric sources (i.e., nuclear power plant accidents), ionizing radiation treatments for medical conditions unrelated to thyroid cancer, and diagnostic procedures such as medical and dental x-rays and CT scans.

For example, thyroid cancers peaked in the Ukraine after the accidental release of radioactive debris from the Chernobyl power plant in 1986. It must be noted that many radiologic diagnostic procedures involve the head and neck, which exposes the thyroid to risk. Head and neck CT scans and dental x-rays provide a measurable amount of radiation, which increases the risk for cancers in these areas. Consequently, thyroid shielding has been instituted by many dental offices to reduce the risk of thyroid radiation, especially for children.

Clearly the reason(s) for the increased number of thyroid cancer occurrences needs to be determined for better prevention, but raising awareness of thyroid cancer during the month of September – and, frankly, throughout the rest of the year – is a welcome step in this direction.

The ZRT Laboratory Blog

Understanding Estrogen's Vital Role in Perimenopause

Vitex Agnus-Castus – Botanical Support for Female Hormone Imbalance

What Hormone Imbalances Are We Talking About?

Vitex for Menstrual Problems

Vitex for Menopausal Symptoms

Related Resources

References

Getting to the Heart of Estrogen

What we know now is that estrogen replacement therapy actually decreases cardiovascular risk when prescribed early in menopause.

Estrogen Research Through the Years

Endothelial Dysfunction’s Role in Cardiovascular Disease

Estrogen replacement in menopause can stimulate NO release to help regulate inflammatory cytokines.

Estrogen Replacement: Timing Is Key

Related Resources

References

ZRT’s Favorite Healthy Eating Summer Recipes

Chilled Avocado-Cucumber Soup

Mexican Corn Dip

Tahini-Lemon Quinoa with Asparagus Ribbons

Grilled Chicken Thighs

Peanut Butter Chocolate Chip Mini-Muffins

Homemade Fruit Sorbet

Other ZRT Recipes

When to Choose Menstrual Cycle Mapping vs Fertility Testing

The Fertility Profile

Aside from adrenal health, DHEA levels can play a part in improving ovarian reserve (capacity for production of egg cells).

Which to test?

Related ZRT Resources

5 Spices to Warm Your Soul During Winter

Allspice

Cinnamon

Cloves

Ginger

Medicinally, ginger was used for digestive ailments and is known for its calming, carminative effect.

Nutmeg

Related ZRT Resources

References

Herbal Remedies for Sleep Disturbances & the Nervous System

California poppy

German Chamomile

Hops

Kava

Lavender

As a gently strengthening nervous system tonic lavender is used to relieve states of nervous debility and exhaustion. It also soothes and promotes natural sleep.

Lemon balm

Oatstraw

Passionflower

Skullcap

Valerian

Adaptogens: Herbs for Healthy Living

Asian ginseng

American ginseng

Ashwagandha

These herbs aid in normalizing many physiologic mechanisms such as regulating blood pressure, blood sugar, cellular energy production and immune alterations in the day-to-day management of stress.

Eleutherococcus

Rhodiola

Licorice

Holy basil

References

Related Resources

Celebrating ZRT's Hormone Laboratory Professionals

Specimen Processing Team

Saliva Team

ZRT's unique means of collecting body fluids and testing them is performed through multiple methods.

Dried Blood Spot Team

Dried Urine Team

Research Team

Read More About ZRT

Guide for Interpreting Testing Levels for Hormone Contraceptive Users

How does hormonal contraception affect test results?

What are the treatment implications if test results are low?

Supplementation of any additional hormones is not usually warranted and should be considered cautiously due to risk of complications.

When should the sample be collected?

Related Resources

New Oregon Law Allows Women to Bypass Physicians for Contraceptives

Increased Accessibility the Answer to Unintended Pregnancies?

New Requirements for Pharmacists

For years women have been fighting for more control over their reproductive lives. Does this legislative step move them closer to that goal?

Will Refusal of Service Become an Issue?