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HEALTH CONCERN? BioHealth Health Concerns

Healthy Hormone Solutions for Women

Contributing Author: Kalish, Daniel D.C.

Daniel KalishFor two decades Daniel Kalish, D.C. has successfully treated patients with hormone imbalances, food cravings, fatigue, depression, digestive distress, and many other health complaints. Dr. Kalish founded The Natural Path Clinic California, where he led a staff of physicians, nutritionists, chiropractors, psychotherapists, physical therapists, personal trainers, massage therapists and acupuncturists for more than ten years. He currently maintains an active international phone consultation practice with patients and trains physicians in natural medicine. He has designed health programs for countless professional athletes including the world’s top skateboarders, hockey players, elite runners, tri-athletes, golfers, tennis players and world-class weight lifters. Download his ebook Your Guide to Healthy Hormones.

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During my first year of clinical practice, I became fascinated by technical manuals written by the great teachers of endocrinology in alternative medicine, and began to focus on using bioidentical (natural) progesterone. In the years since, I have studied with many of the top experts in natural hormone therapies — naturopaths, medical doctors, nutritionists, biochemists, directors of medical laboratories, and chiropractors. Over the last twelve years, based on work with more than 7,000 patients, I have been able to test the various theories taught to me. The product of this work is a system of diagnosis and treatment I call the Kalish Solution.

Although my practice has been oriented around female hormone programs, I have worked with many other types of patients using the same model to treat patients suffering from fatigue; weight gain; digestive problems such as bloating, heartburn, irritable bowel syndrome; and even autoimmune conditions. The reason for my success is simple: most chronic conditions involve problems with one or more of the body’s core systems.

Assessing and correcting the functioning of the three body systems can benefit a host of conditions by addressing their underlying causes. As a society, we have become so symptom-oriented, taking a pill for this and an herb for that, that we have lost sight of the interdependence of most body systems. Symptom in Latin means “signal,” and a symptom indeed signals that one of the body systems has stopped functioning properly. If  you ignore your symptoms for long enough, they worsen and may lead to disease. Even when diseases don’t develop, quality of life decreases.

This is a difficult situation for most physicians to address, because they are trained to treat either symptoms or diseases. For example, if a patient has hot flashes — a symptom involving a complex array of hormone fluctuations — most doctors prescribe estrogen. This stops the symptoms, but does not completely balance the body’s hormone system. Likewise, if a patient has a group of digestive symptoms, she may be diagnosed with irritable bowel syndrome and treated with medication. This does nothing to determine why the bowel is irritated or address the causes of discomfort.

The problem is by no means limited to practitioners of traditional western medicine. If someone with migraine headaches consults an alternative provider, an herbal formula may be recommended to relieve pain. Such treatments invite further problems down the road, since they are covering up the signals of a body system out of balance. This approach does not address the underlying cause, so the body eventually will develop another set of symptoms.

I do not treat symptoms or diseases. I simply use lab tests to determine which underlying system is not functioning properly and then use natural therapies to restore normal body function. In the course of this process symptoms are alleviated and conditions such as hormone imbalances or irritable bowel disease resolve themselves. This model is not symptom oriented or disease based.

Most of the health problems I work with do not require a prescription or surgery to correct. They are not acute conditions — not severe enough to warrant medical intervention. I do not treat “life-threatening” conditions, but “life-ruining” ones. In other words, if you are having a gall bladder attack or seizures, you require immediate medical attention and are not a candidate for the Kalish Solution. On the other hand, people with chronic health conditions who have been through a complete medical workup and been told they are fine, are ideal candidates for the Kalish Solution. These ideal candidates are the people who suffer from persistent, chronic health complaints ranging from perimenopausal symptoms to weight gain and fatigue. These issues can be addressed through reliable, consistently effective approaches based on sound science — without resorting to the conventional medical approach of drugs and surgery.

Changing Lifestyle
Lifestyle changes lead the list of practical and effective solutions. We can all improve our food choices, diets, take appropriate supplements, exercise properly, improve sleep and stress patterns, and devote energy to improving our emotional and spiritual lives. Thousands of studies demonstrate the healing benefits of food, supplements, sleep, emotional expression and stress reduction. For some people, such lifestyle changes are all that is needed to return to health, and the first stages of the Kalish Solution will guide you through them.

For many people with persistent complaints, however, lifestyle changes aren’t enough. For these patients, I start by doing a thorough assessment of the three body systems using functional medicine lab testing. This is a hybrid approach that relies on laboratory analysis, much like conventional medicine, but with a focus on uncovering the underlying causes of health problems prior to the onset of a specific disease. Such nontraditional lab tests are at the heart of the work that I do. The test results allow me to design highly effective individualized programs based on natural therapies, integrating the best of scientific knowledge with natural remedies.

Most of my patients who are experiencing menopausal symptoms have significantly abnormal hormone levels, with low levels of progesterone, estrogen, or both – and just how low can be determined from simple lab tests. Unfortunately, few women are offered testing for hormonal programs. Many are taking too much progesterone, often in the form of a natural cream they buy on their own. In some women, progesterone levels from these creams builds up so high that the hormone starts to convert to estrogen, creating the very problem the woman was trying to avoid. Overuse of these seemingly benign creams can induce estrogen-related problems and potentially estrogen-related cancers.

Bioidentical progesterone can be an effective treatment, provided it is used in an amount geared to an individual woman’s needs as determined by testing and follow-up and as part of a program that addresses overall health. Natural (bioidentical) estrogen in prescription form also can be of great benefit, if it is likewise administered on the basis of testing and follow-up and incorporated as part of a complete treatment program.

When assessing a patient’s overall health, I first review her personal health history and that of her family and then recommend the appropriate lab tests. I test for adrenal burnout, blood sugar irregularities, sex hormone levels, and food allergies; hair and urine analysis can determine mineral levels. For women with longstanding digestive problems, I often do more extensive testing for gastrointestinal tract infections caused by pathogenic bacteria, parasites and yeast.

Diet and Nutrition
Once the lab results come back, I design a diet and supplement program to correct any problems reported on the lab reports. I also have patients work with a nutritionist on dietary changes she will need to make. Typically, it takes three to four consultations over a six-month period to arrive at the optimal program, because there is no single formula for everyone. Different people require protein, fat, and carbohydrates in different proportions based on their genetic makeup, individual history of weight gain and loss, and lifestyle.

Not only are proteins, fats and carbohydrates needed in a particular combination to keep our hormones stable, nutrients within a food group can have vastly different effects. In the carbohydrate group, sugar leads to a sudden rise and rapid drop in blood sugar, whereas most vegetables, which are also carbohydrates, lead to a gentler rise and more sustained elevation of blood sugar. And remember it is the hormonal system that continually works to keep blood sugar levels even, responding to every meal we eat.

Every patient is different. For example a history of weight gain and loss through dieting generates hormonal problems that may require a healing diet for a period of time to restore metabolism. By the same token, a person who exercises frequently is going to have different nutritional needs than someone with a more sedentary lifestyle.

Creating an Adrenal Stress Profile
One of the first things I do when a woman comes to me with menopausal symptoms is to measure her stress response along with the female hormones– which means determining the impact of environmental, mental, emotional, and physiological stressors and whether she has had sufficient rest and recovery to balance out periods of high stress in her life. This profile includes tests for the hormones cortisol, DHEA, estrogen, progesterone, testosterone, and melatonin. It graphs hormone production over a 24-hour period, mapping out the daily rhythm of cortisol that is involved in virtually every body function, from getting a good night’s sleep to burning body fat. All these hormone tests are done from saliva samples, supplemented by more extensive tests if long-standing digestive problems appear to be contributing to an imbalance. The results from these initial tests become a baseline to determine the proper starting point for a therapeutic program and also provide a point of comparison against which to measure improvement during treatment.

Hidden Factors
Together, the functional medicine lab tests paint a detailed portrait of a patient’s physiological functioning. There are assessments to measure the health of your metabolism — whether you are in fat-burning or fat-storage mode.  There are also tests for food allergies available. Food allergies are an often-unrecognized health problem, and these are addressed as part of determining the most healthful diet for an individual patient, a cornerstone of every program. To create a truly customized supplement regimen, I also measure for mineral levels, B vitamins, and even specific antioxidants. Over many years of experience, I have discovered that the most common factor blocking a person’s ability to heal using natural therapies are digestive tract problems, either food allergies or infections from organisms such as yeast, bacteria, or parasites, and lab tests for these often prove to be the key to getting a hormone program to work.

For most patients, a life-changing program calls for integrating nutritional counseling with lab testing of the three body systems, nutritional supplement programs and well-designed personalized exercise programs. These treatment options, along with emotional and spiritual change, are essential for the healing process to begin. Many studies have shown the connections between “emotional intelligence” — skill at handling and expressing emotions — and physical health. A well-known book on this is Emotional Intelligence: Why It Can Matter More than IQ, by Daniel Goleman.

Emotional and spiritual well-being has played a primary role in the health of every one of the patients I have treated. Our feelings play a larger role in individual health than most of us realize. The importance of emotional health, loving relationships and a rich and rewarding spiritual life are often overlooked. Many people reach their health goals for a good diet, proper exercise and sleep habits and realize they simply are missing somebody. These lifestyle changes are not enough to achieve and maintain optimum health.

I recently realized that the most important question I ask each new patient is, “Around the time your symptoms first developed, what was the major emotional stress going on in your life?” When this question is pursued thoroughly, I inevitably discover the death of a loved one, a divorce, the birth of a child, a job change, or some other highly charged and emotionally challenging situation. When we are under intense emotional stress, our immune system and hormonal system weaken and we become more likely to develop a health problem, or a minor problem that is already present may suddenly be exacerbated.

In our culture, calling someone intelligent is a compliment, while calling someone emotional is usually considered disparaging. This reflects confusion as to what is most important in our lives and to our health. We are essentially emotional and spiritual beings. As the saying goes, “We are spiritual beings having a human experience.”

For all of us, this is a vitally important topic. One of the key physiological effects of emotional health is reduced production of stress hormones. Stress is a natural response to many events in our lives, and the tools we use to handle it play a significant role in the development of disease.

Our emotional health revolves around our ability to communicate with others and maintain intimacy with those we love. In our culture, very few people are highly skilled and focused on developing truly intimate relationships. It requires practice and hard work. Our spiritual connection depends on our ability to see the bigger picture and realize that there is more happening around us than meets the eye. Some people discover the spiritual part of themselves through organized religion; others find it through a less formal belief system or practice.

We all benefit from exploring these areas, through attending classes or religious services, meditating, reading inspirational literature, or meeting with psychological or spiritual counselors. Achieving satisfying emotional and spiritual health will directly affect your physical health and well-being. For most of us, this is the most important and challenging step toward optimum health.

In addition to improving your diet and exercise, one of the most important things you can do for yourself is to get adequate sleep, which is crucial for physical repair and regeneration. Among my patients, I find that this is the most overlooked and neglected lifestyle change. Lack of sleep makes you tired! Lack of sleep also contributes to weight gain and poor moods. In fact, sleep, rest, and recovery are directly linked to our 24-hour adrenal hormone cycle. When the sun rises, cortisol levels peak; they taper off as the sun sets, reaching their lowest level three hours after dark. This daily fluctuation is intended to help our bodies know when to be active and when to rest.

Ideal rest occurs between 10 p.m. and 6 a.m. Sleep during the hours of 10 p.m. and 2 a.m. repairs our bodies. Immune cells are released to seek out and destroy cancer cells, bacteria, viruses, and other harmful agents. If cortisol levels are elevated during this phase, maximum recovery will not be achieved. Between 2 and 6 a.m., sleep lets our bodies enter a stage of psychic regeneration, and the immune system is supported by chemicals released by the brain.

Rapid eye movement (REM) is a deep dream state. The alternation of REM and non-REM states throughout the night allows our minds to process emotional events from the previous day and mentally clear the slate for the next day. Without proper rest, our bodies suffer physically and emotionally. It is therefore crucial to get adequate sleep, especially during the hours of 10 p.m. to 6 a.m.

Creating a Premenopause Hormone Profile
Most of the women who come to my office are pre- or peri-menopausal, typically under the age of 55. Their menstrual cycles may not have ceased entirely, but they are undergoing hormonal changes and often experience many of the same symptoms as women in menopause. As I mentioned, when estrogen levels begin to drop in peri-menopause, the stress hormone cortisol rises in response, putting pressure on the adrenal glands. A woman with weakened adrenal glands who enters peri-menopause is invariably faced with a difficult transition.

In treating these women, I begin by creating a pre-menopausal hormone profile that maps the menstrual cycle through its follicular, ovulatory and luteal phases. The follicular phase describes the first two weeks of the menstrual cycle, when estrogen is the dominant hormone. At mid-cycle, ovulation occurs and estrogen levels peak, followed quickly by a sudden rise in progesterone, which dominates the second half of the menstrual cycle. Premenopausal hormone mapping graphs each day of the menstrual cycle, showing the rise and fall of hormones and thus providing specific indicators for hormone therapy.

Using this map, I can gauge the amounts of estrogen and progesterone a woman is producing, and compare them with established norms. I can also look at symptoms such as migraine headaches or mood swings, and correlate them with moments in the cycle when estrogen and progesterone are low, high, or dropping. Once the abnormal hormone levels are detected, the solution becomes obvious, and the guesswork is eliminated from treatment.

Another benefit of this type of precise treatment program is that it facilitates resetting of the normal rhythm. I can recommend a program that exactly matches that individual woman’s lab profile. After five to six months on a program, the ovaries start to produce the hormones in a normal rhythm on their own, because we have taken the time to thoroughly establish a healthy monthly cycle and normalized ovarian output. Testing of the monthly cycle also can detect double ovulation, early or late ovulation, deficiencies in the overall production of hormones, and many other subtle shifts in hormone production that are missed by other types of tests.

Since every woman is unique, her test results are like fingerprints. Even if you take a thousand women with 28-day cycles who ovulate on the same day of the month, their progesterone and estrogen levels will vary daily. So treatment needs to be tailored to each individual woman.

The month-long hormonal profile requires that the patient take eleven saliva samples throughout one full menstrual cycle. (Salivary hormone tests are not used in conventional medicine, although they correlate highly with blood levels.) A simpler test consists of taking one sample on a specific day of the month and comparing the result to the norm. The estrogen-progesterone ratio is then rebalanced using the simplest natural products, such as vitamins, minerals, and plant-based natural hormones, along with support for the digestive and detoxification systems when indicated. My patients are then monitored with follow-up testing.

Testing Menopausal Women
Menopause is usually defined as beginning one year after a woman’s final period, but years of lab testing have shown that women continue to cycle internally for one and a half to seven years after their periods have ceased, having menstrual symptoms at certain times of the month even though they are no longer bleeding. Many of my menopausal patients can relate to this since they have symptoms that remind them of when they were cycling, which appear only at certain times of the month. In such cases, responses to HRT can be poor, since it is difficult for doctors to determine how much of a given hormone a woman may need; her internal production of hormones is still varying from day to day. But with accurate lab data, I can adapt an optimal treatment program for a patient as she moves through peri-menopause and the first years of menopause to meet her body’s changing needs.

Tailoring Treatment to the Individual
In sum, there are three important differences between the conventional medical approach to menopause and the Kalish Solution. The first major shift is toward viewing the symptoms as evidence of a systemic imbalance rather than viewing them in a vacuum, and addressing a woman’s total health picture rather than just her hormonal symptoms. The second is the switch from prescribing synthetic hormones, which have been proven to be harmful, to far safer, plant based, natural products. Finally, my approach focuses on the individual woman and her unique hormonal needs, recognizing that they change over time.

Viewing and responding to menopause in this way takes more time and effort on the part of both doctor and patient than prescribing one size fits all pills to alleviate pain and discomfort. So it is not terribly surprising that doctors have been slow to move in this direction. That is likely to change, however, as more women concerned about the risks of HRT educate themselves about the alternatives and come to recognize the benefits of lifestyle changes in conjunction with natural therapies.

As patients begin to heal, one subject that always looms large is exercise. When I start to work with patients, most are too busy and tired to exercise. Predictably, however, after a period of healthy eating, stress management and the initial improvements that come from hormone balancing, people sleep better, have more energy and are more productive at work. This opens up time and enthusiasm for exercise.

Exercise helps take off weight, increase energy and prevent depression. It also can be a source of stress if not done properly. Cardiovascular exercise reduces stress, which can be helpful when done as part of an integrated health program. However excessive cardiovascular exercise, along with a highly stressful lifestyle, can make hormone problems worse. It also can lead to more body fat by stimulating the stress response. Resistance training, on the other hand – strength training with weights – increases human growth hormone production and lean muscle mass. The increased muscle mass will in turn burn fat 24 hours a day. Therefore, your individual exercise requirements will depend on your hormone status and how much body fat and lean muscle you have right now.

I tell patients that designing your own exercise program is like deciding to represent yourself in court. Being an attorney requires specialized knowledge that is acquired over many years of intensive study and practice. Designing your optimum exercise program also requires extensive training in a variety of areas and includes an assessment of your overall health to create an exercise program specific to you. Your current physical conditioning, percentages of body fat and lean muscle mass, cortisol/DHEA ratio, daily activities, and overall goals for fitness will all come into play.

Not all trainers have the knowledge to design exercise programs properly. Along with learning how to exercise, you will need basic advice on water consumption, sleep cycles, and stress-reduction exercises.

Paul Chek, founder of the CHEK Institute, has developed an educational program for trainers. CHEK practitioners pass rigorous exams to qualify for different levels of certification, and are trained to design corrective exercise programs and general fitness programs, and to do nutrition and lifestyle coaching. The CHEK Institute Web site has listings of practitioners by geographic area, so you can locate a highly trained exercise specialist near you.

A properly designed exercise program will include relaxation exercises if you are stressed, resistance training if you need to improve your strength, stretching to resolve muscle tension patterns, and cardiovascular exercise to improve overall fitness. If you have any history of injuries or musculoskeletal pain, you may require a corrective exercise program before initiating more rigorous exercise. If you are in Stage 3 of adrenal burnout, you may require some time healing your adrenal glands before you do heavy cardiovascular exercise. Also, specific sports such as tennis, golf, running, or cycling benefit from specific stretches and strength training to improve performance and prevent injury.

When I was in my 20’s I practiced yoga five hours per day. It was the only activity I found that eliminated all my neck and back pain. I assumed that the more yoga I did and the more flexible I became the healthier I would be. Now twenty years later I do some yoga every week, regular strength training and bicycling and running for cardiovascular health. I am flexible, strong and have excellent cardiovascular health. In my twelve years of treating patients, I have worked with all types of bodies, including professional football players, hockey players, weight lifters, runners, cyclists, tennis players, skateboarders, and golfers. I have also worked with tai chi practitioners, meditators, yoga instructors, and professional ballet dancers. There is no one type of exercise that suits everyone. People are born with different body types and require different types of exercise depending on their activity levels and overall fitness goals.

Some people are inflexible and stiff. They have many muscle groups that are overly contracted and tight, and need to increase flexibility to remain healthy. This body type is at risk of pulling a muscle from excessive tension, and needs a great deal of focus on increasing flexibility and mobilization of joints. Some people have musculoskeletal systems that are too loose. They are “hypermobile” and have greater risk of injury from a trauma or an activity like running that puts a lot of impact forces on the joints. These people lack the strength to stabilize their joints. Most of us have some areas of the body that move too little and some that move too much. Clearly, someone who is stiff needs more stretching exercises, while a person who is hypermobile needs to increase muscle strength for support by using weight training resistance exercises. A comprehensive exercise program takes all this into account. Many people also have pain and injuries that need to be addressed through a corrective exercise program.

Once a person is free of pain and structurally balanced, he or she can start to achieve a high level of fitness using exercise. Physical activity has powerful effects on both mood and energy. Research shows exercise to be as effective as medication for many common types of depression. After studying thousands of lab reports, I have come to see the importance of exercise with my patients. I have treated many elite athletes who have the same lab profiles as patients with chronic fatigue. While both patients may suffer identically on paper from multiple infections, heavy-metal poisoning, adrenal burnout and food intolerances, the athlete’s main complaint may be slower run times or waking up a little tired. In the patient who does not exercise, the same lab profile may result in chronic fatigue, obesity, depression, and a hormone problem. It is the amount of physical activity they do that keeps their three body systems running relatively well despite multiple insults.