Category Archives: Blog

The Whole Life Medicine blog, where our practitioners share their insights and expertise on health and wellness.

Outsmarting the Weight Loss Paradoxes

It is no secret that weight loss is challenging for many people. Why?  The short answer is our brain and behaviors tend to form paradoxes in the face of most weight loss attempts. Paradox #1 concerns some of the intentional and habitual behaviors that affect short-term weight loss, while paradox #2 concerns behaviors, hormones, and mindsets that affect long-term weight loss or weight maintenance.

Paradox #1:

The physics of weight loss is dependent on a discrepancy between calories consumed and calories burned but it is nearly impossible to consciously control how many calories are consumed or burned in a given day. This is because the majority of our behaviors during the day are not driven by conscious intentions but by habit, and habit is geared to maintain homeostasis.

The Max Per Meal recommendations for sugar, salt and oil.

Set points for energy intake and output can be hard to change.

i. We eat more than we realize when we are intentionally trying to limit our food intake. For example: plate portions can grow a little larger than usual, we “don’t count” the extra snack or bit of food we eat in passing between tasks.

ii. We reduce our energy expenditure in small ways when our energy intake goes down. For example: you might fidget less during the day or perform fewer household tasks or shorten the length of time you spend walking the dog; even while you may be consciously trying to increase your physical activity through intentional exercise like going to the gym or a yoga class. A 2012 study published in JAMA showed this effect in groups of adolescents following low-fat, low-glycemic or low-carb diets to achieve a 10-15% weight loss. Interestingly, in this study resting energy expenditure was most negatively affected by the low-fat diet.


Paradox #2:

In order to lose weight, one must have a healthy brain that maintains a balance between the limbic system, which houses the pleasure-reward pathway and is responsible for the generation of cravings in response to stress or need, and the prefrontal cortex, which houses our conscious decision-making, long-term planning and inhibition control (the ability to say no to something or ignore a craving). But the ability to maintain this balance is easily and quickly compromised by stress, including the stress of depravation and starvation.

The pleasure and reward circuitry of the brain. Image courtesy of the NIH.

The pleasure and reward circuitry of the brain. Image courtesy of the NIH.

1. Most dieting attempts are inherently stressful to the body because they rely on reducing food intake to the point that the body’s stress response is activated. Even the best quality food will only provide blood sugar to keep your body fueled for about 3-4 hours, then other hormonal mechanisms take over to manage the delivery of blood sugar to tissues. Those other hormones include adrenaline and cortisol, both of which can compromise the brain’s ability to manage decision-making and the ability to keep denying oneself food or the comfort derived from food.

2. Stress, particularly adrenaline stimulated by falling blood sugar levels and starvation, reduces the blood flow to the prefrontal cortex where conscious decision-making and inhibition control come from. This means that an unintended consequence of many weight loss attempts is that they actually leave us more vulnerable to food cravings by decreasing our inhibition control.

i. Different people will have different susceptibilities to this particularly mechanism. Genetics, the degree of stress a person is under, from both physical and emotional causes, and the diversity of an individual’s ability to manage their stress (e.g. those who use food as a primary coping mechanism will be more vulnerable than those who have experience and confidence using an array of stress coping mechanisms).

Sugar is more than just sweet. Photo by Moyan Brenn.

Sugar is more than just sweet, it’s stress-relieving. Photo by Moyan Brenn.

3. Sugar is not just a “treat” for many people. Sugar biochemically decreases the degree to which cortisol, one the stress hormones, affects this brain as was seen in a recent study published in the Journal of Clinical Endocrinology and Metabolism. This is a probable reason sugar and sweet things are used as a stress coping mechanism and why people crave sweets when they experience stress.  It can, quite literally, be a form of self-medication and stress management.

i. If an attempt at weight loss removes this coping mechanism, then not only may the individual attempting to lose weight experience more stress due to the nature of their weight loss strategy, but they will experience that stress more acutely and powerfully because one of the tools they had previously used to blunt the effect of stress on their brain is unavailable. And that in turn can set them up for sugar and food cravings.


So how do we outsmart the paradoxes?


Outsmarting Paradox #1

Awareness, planning and feedback

Awareness: Knowing that our habitual behaviors drives us towards homeostasis, keeping things just they way they are, it’s helpful to find ways to keep our decisions about food and what we eat in the sight of our conscious attention. Plenty of studies show that keeping track of what you eat with a food journal helps people lose weight and maintain weight loss more successfully than just winging it. This is because it enforces awareness about the choices you are making throughout the day and allows you to be accountable to yourself and others, if you are sharing this information with someone else who is supporting you in your weight loss efforts. And research suggests that using online food journals or apps is as effective as more traditional handwritten journals.

Cookbooks can be a source of inspiration when meal-planning. Photo courtesy of Lauren Friedman.

A trip to the library can do wonders for meal-planning inspiration. Photo by Lauren Friedman.

Planning: Knowing that our ability to make decisions supporting our long-term goals rather than our short-term cravings is compromised by hunger and depravation, it’s beneficial to minimize the number of decisions you need to make about what to eat. This is where meal planning comes in. If you know what and when you are going to eat ahead of time, you will feel more secure exercising your inhibition control when a craving arises and have fewer opportunities for making spontaneous stress-driven decisions that are at odds with your weight loss goal.  For low-glycemic recipes and meal-planning ideas geared towards supporting brain health and decision-making visit my Pinterest boards.


Photo by Ian Dick.

A fitbit can track the number of steps taken throughout the day. Photo by Ian Dick.

Feedback: Knowing that we can subconsciously decrease our daily activity levels in response to decreased energy intake, it is helpful to have a way of measuring what our daily activity levels are on a regular basis. This way our efforts to increase our physical activity, such as going to the gym, are not in vain. One simple way to do this is to use a pedometer to keep track of your daily step count to make sure it is not subtly falling over time. It can also be helpful to log other types of small activities, such as gardening or housework, that might not be well captured by a pedometer.


Tips for the busy person: Programs that provide specific eating plans, or even provide specific meals and snacks, can be a reasonable strategy for out-smarting this paradox, at least in the short term. If you don’t feel as though you have the time and energy to create your own meal plans and do daily journaling, there are a number of programs that can do some of that work for you to get your started. These can be particularly helpful for people who feel overwhelmed by decision-making or do not feel they have a good instinctual sense of how to create and then follow a specific meal plan.

Outsmarting Paradox #2

Pushing the boundaries of pleasure, strengthening your stress response, and tackling trauma.

Pushing the boundaries of pleasure:  people use food to reward themselves on a regular basis, whether it’s at certain times of day, like a 2 PM cookie to get you through an afternoon of work, or in response to certain events, like watching a favorite show on TV or celebrating a birthday. The pleasure-reward pathway in the brain is schedule- and event-driven, you can’t just take away rewards or alter your reward schedule and expect this part of the brain not to notice.  For long-term weight loss  the brain needs to be experienced in receiving pleasure from a variety of activities. We are reward-driven beings; it is part of our nature.  And developing a sense of reward from activities can take practice. That might sound odd, because it seems that rewarding behaviors are inherently rewarding. But the truth is the more we practice something, the better we like it. So if you are shifting your reliance on reward for food, you need to develop a schedule or program for building reward in other areas of your life.

i. One big mistake people make when they substitute food rewards for other rewards during a weight loss program is that they withhold their new reward from themselves until they meet a particular weight loss goal. For example, someone might decide the will use an hour-long massage as a reward for losing 5 lbs.  This is a mistake because that’s not how the old reward system worked, instead it’s doubling down on depravation: you can’t have the thing you want (massage) until you finish denying yourself the other things you want (food rewards). The only thing this reinforces is that depravation is hard and ultimately untenable. That’s not the lesson most people are meaning to teach themselves.

Scheduling rewards is essential. Photo courtesy of Oliver Symens.

Scheduling rewards is essential. Photo courtesy of Oliver Symens.

ii. The key to learning to experience more pleasure is to practice often. If you like massage, for example, practice receiving it on a regular schedule so that it supports your reward center on a regular basis and keeps you from feeling acute depravation from your changing behaviors around your food rewards. That is how you teach your brain that there is an abundance of ways to be nourished and rewarded outside of food.

Strengthening your stress response: this similar to the concept of strengthening your reward pathways. In fact, many of the reward activities can become stress response activities. A stress response activity is something  you know will help you feel better in the face of stress.  You know it will because you have practiced it enough to know it provides pleasure under normal circumstances, and then practiced it more while under stress until it becomes a reflexive response to stress, something that your body craves to make you feel better.

Walking for 5-10 minutes is enough to improve stress levels and reduce cravings. Image by Peter Blanchard.

Walking for 5-10 minutes is enough to improve stress levels and reduce cravings. Image by Peter Blanchard.

i. One of my favorite examples of this is exercise.  I make myself get up and take a 10 minute walk when I’m feeling a little stressed at least once a day, even if I don’t necessarily feel so stressed that I need to (or necessarily want to) take a break from work. Why? Because habitually walking when I experience a little trains my brain to make a connection between walking and stress relief. And the consequence of that is that later on, when something really stressful happens, my reflex response is to want to move to release the stress. How do I know this works? One, because my body has done this type of training before with chocolate and I successfully (and unintentionally) trained myself to want chocolate when I am stressed. And because I know intellectually that there are multitudes of ways that exercise improves mood and attenuates stress. If you are interested in knowing more about the ways that exercise benefits the brain, I cannot recommend the book Spark by John Ratey, MD highly enough.  Dr. Ratey is a psychiatrist whose practice and research focuses on how exercise supports mental health. Anytime I need motivation to move or exercise more, I can read a chapter and then next thing I know I absolutely cannot wait to exercise again. You can listen here to a free reading of the audiobook.

ii. Biofeedback is another powerful tool for redirecting how your nervous system responds to stress. Over a series of 4 – 8 visits you can learn to use your breathing and your posture to send calming signals to your brain, which can keep your long-term plans in sight even when events around you are stressful. Check out our biofeedback page for more information.

Tackling trauma: There is a complex relationship between trauma and weight gain, some of which is mediated the brain’s relationship to stress and food detailed above. One of the most important studies to shed light on this relationship is the ACES study. It’s received a lot of attention in the media for providing insight into the relationship between adverse childhood experiences, including common events such as the loss of a parent through death or divorce/separation, and health concerns later in life. The ACES study was started after clinicians running a weight loss program realized that an unexpectedly high number of participants started dropping out of the trial after successfully losing weight and wanted to find out why.  If you are interested in knowing more about the ACES study or seeing what your ACES score is, I recommend reading the ACES Too High News.

Miranda Marti is a naturopathic physician who specializes in the mind-body relationship and supporting long-term recovery from chemical and behavioral addictions, including complicated relationships with food and eating.  She is an advocate for body positivity and believes in health at every size.

Is plastic disrupting my estrogen?

The investigative journalism magazine, Mother Jones, just published a compelling story on the presence of xenoestrogens in BPA-free plastics.

BPA-free plastic food containers and utensils remain ubiquitous in our kitchens. Photo by Miranda Marti, ND.

BPA-free plastic food containers and utensils remain ubiquitous in our kitchens. Photo by Miranda Marti, ND.

Xenoestrogens, synthetic chemicals that are capable of stimulating estrogen receptors in human (and other animal) bodies, are a growing concern worldwide. Exposure to xenoestrogens can come from the food supply, as they accumulate in the fat of animals that are exposed to some to them, primarily through herbicides and pesticides (atrazine is the most notorious), and then find their way into milk, butter, and meat. They can also come from direct contact with certain plastics, or from food  stored in plastic containers. The now-banned BPA-containing plastics were the most notorious offenders, but now we have strong reason to believe that they are not the only ones.

This topic is of significant interest to those of us at Whole Life Medicine who care for women with diseases of estrogen-dominance, such as PCOS, fibroids, endometriosis.  Is part of what’s driving these disease processes environmental exposure from plastics? And if so, how can we limit that exposure to protect our health?

I have a personal stake in this game. I am one of those estrogen-dominant women. I even have genetic test results that show my body is a slow estrogen metabolizer. What this means is that I don’t make a full compliment of the enzymes that break estrogen and estrogen-like chemicals down and inactivate them, so they spend a longer time in circulation with the opportunity to stimulate my estrogen receptors, which in the long run can cause tissues that are sensitive to estrogen to be overactive and create health problems.

I’d also like to state very clearly that I am not “anti-chemical” by any stretch of the imagination. I’ve had too many years of chemistry, organic chemistry and biochemistry education to fear “chemicals” or even “synthetic chemicals” generally; I understand that chemicals generally speaking make up pretty much everything we are and interact with and do not inherently pose a threat to health. But as an Environmental Studies-Biology major at Whitman College, I began getting curious if some of the synthetic chemicals we interact with on a daily basis like plasticizers, specifically phthalates, might not be interacting with our bodies’ hormone system in ways that could be harmful to our health.

Years after undergrad, my interest was reignited after reading Nena Baker’s The Body Toxic. In this book Baker, an investigative journalist, considers the evidence about what is and isn’t known about common industrial and synthetic chemicals that haven’t been subjected to rigorous safety screening; and whether multiple exposures from daily living might lead to a “chemical body burden” that is beyond the scope of individual safety profiles to comprehend. For example, if over the course of the day I am exposed to ScotchGuard and food heated in plastic and the  plastic in my toothbrush, those exposures together could accumulate to levels  that are dangerous, even if individually each exposure would be considered safe by the safety data on ScotchGuard, the plastic in my tupperware and the plastic in my tooth brush. Xenoestrogens feature prominently in the book as a case study for chemicals needing further human safety data.

What I took away from The Body Toxic is that BPA-contianing plastic is worth avoiding, but that BPA is probably not the end all and be all of  my xenoestrogen exposure because all plastic may be suspect, which is indeed the point that the recent Mother Jones article makes. And that foods that are moist or have an appreciable fat content are the ones most likely to leach xenoestrogens from their plastic containers into the food I would consume, so those are the foods I can prioritize creating, storing and consuming from non-plastic containers. I also read labels of all products that I put on my skin to avoid those containing “phthalates.”

To the right is a picture of my stash of containers for storing left-overs, prepared foods and things I don’t want to wilt in the refrigerator.

My glass food storage collection. Photo by Miranda Marti, ND.

My glass food storage collection. Photo by Miranda Marti, ND

And after making those changes around 4-5 years ago, which proved to be sustainable in my life in terms of time and money spent on them, I considered myself reasonably protected. Certainly I still receive exposures to xenoestrogens but my goal isn’t 100% avoidance, it’s harm-reduction.

The new news on BPA-free plastic, however, has me wondering if that is enough. While the data on exposure to plastics and causation of estrogen-related diseases is not strong enough for me to offer much proscriptive advice. What I will say is probably in everybody’s best interest to avoid xenoestrogen exposure from plasticizers is:

  • Store moist or fat-containing foods in metal, ceramic or glass containers, not plastic.
  • Do not heat foods in plastic containers, no matter how microwave safe.
  • Check labels in grooming products to avoid anything with “phthalates.”
  • Be aware anything listed as “fragrance” may be diethyl phthalate (DEP).
  • Avoid air fresheners: many brands contain phthalates but are not required to list them on the label.
  • Choose ethylene vinyl acetate (EVA) over PVC plastics in toys and building materials, as EVA does not require plastic softeners, polyethylene or other plastic polymers.
  • Read the Mother Jones article on BPA-free plastics and other well-researched work on the issue, and check to make sure they cite their sources if they make strong claims about risk or safety.

Beyond that, I think it’s up to the individual to decide what’s right for them in terms of time and money costs, as well as availability. Here are some of the issues I’ve started thinking about in my pantry, which currently looks like this:

My plastic-filled pantry. Photo by Miranda Marti, ND.

My plastic-filled pantry. Photo by Miranda Marti, ND.

What amongst this plastic-wrapped shelf must I worry about? The reality is, I don’t know that I can make the switch for everything that comes in plastic packaging. So here are the top three daily-consumed foods I’m considering making changes for re: purchasing and storing habits:


  • I love sunflower seed butter and use it almost every morning with breakfast, but the brand I’ve been buying lately from Trader Joe’s is in a plastic container, which is concerning because of the product’s high fat content. Perhaps it’s time to switch to a brand that comes in glass. This should be easy to do with the occasional trip to another store, such as PCC or Whole Foods.


  • For the past few years I’ve used coconut flour, which is high in fiber, to make my morning waffle. Ordinarily I wouldn’t worry too much about grains or flours in plastic packaging because these products are generally dry and have very little fat that could leach xenoestrogens, but coconut flour is an exception due to it’s fat content. I’d like to buy and store it in non-plastic packaging, but I don’t recall ever seeing it offered outside of a plastic bag. Perhaps there is a bulk buying option at PCC where I could bring my own glass or paper container….but honestly, will I? Those are extra steps to take that I might not be motivated to actually take, but I will at least explore my options.


  • Almonds are another food I consume frequently, going through at least a pound per week. I usually buy a 1 lb bag from Trader Joe’s or a 3 lb bag from Costco. Almonds are not moist, but they do have a considerable fat content. I know for sure I could buy the in bulk in a non-plastic container, but the price difference for doing so would be considerable compared to what I’m used to paying.


As I continue to peruse my pantry over the next several days, I’m sure I’ll come across many more oft-consumed items that are packaged or stored in plastic to consider. It’s an on-going process, and I’ll be sure to let you know if I come up with any brilliant ideas to avoid plastics without great inconvenience cost or inconvenience.

This post is courtesy of Dr. Miranda Marti.

The Hormonal Poetry of Sex and Love

Photo courtesy of the Orange County Archives.

Photo courtesy of the Orange County Archives.

The hormones most directly related to love, bonding, romance and sexual arousal can be remembered through the apt acronym POET: prolactin, oxytocin, estrogen and testosterone.

While both men and women respond to these hormones, they do so in different ways and with different results.  There is currently a great article on Medscape on the topic, Miriam E. Tucker. Hormonal ‘POETry’ Key to Valentine’s Day Romance. Medscape. Feb 13, 2014 (note: to access the full article a medscape log in is required, but an account is free to set up and open to anyone over the age of 18).

If you don’t have time for the log-in, however, here is a quick run-down of the role these hormones can play in men and women.


Prolactin “generally has no effect on libido in normally cycling women, but it can suppress sexual desire when levels are too high, such as in women who are breastfeeding, have prolactin-producing tumors, or are taking medications that affect dopamine pathways.”

Oxytocin, “the ‘cuddly hormone,’ induces uterine contractions and facilitates milk ejection after childbirth. Elevated levels appear during orgasm, but its role in female sexual desire isn’t as clear as it is with men.”

Estrogen “directly affects vaginal engorgement and lubrication, and it regulates female genital tissues’ “receptivity” to sexual activity.”

Testosterone ” also correlates with female sexual desire and satisfaction.”


Prolactin  “likely is responsible for the immediate decline in sexual desire and the onset of sleepiness following orgasm” and may be an indicator of satiety.

Oxytocin “recent studies suggest that oxytocin in men increases their empathy for and speed of response to facial expression cues; increases activity in brain areas associated with arousal, reward, memory, and social bonding ; and increases their willingness to share emotions.”

Testosterone, contrary to popular belief “high testosterone levels do not correlate with sexual function. However…small decreases in testosterone can affect sexual desire and satisfaction, as can visual cues and relationship issues.”

This blog post comes courtesy of Dr. Serena McKenzie.


Which Exercises Improve Major Depression?

Photo by USAG-Humphreys

Photo by USAG-Humphreys

News we’ve been waiting for years to hear is finally in! A study in the May Journal of Psychiatric Practice has pinpointed what type of exercises are best for improving symptoms of major depression.

Exercise is seen to improve the symptoms of depression, such as low mood and sleep and appetite changes, both as a solo therapy or as an augmentation to other treatments, like counseling, nutrients or medications.

Here is a summary of the findings on using exercise to alleviate depression:

  • Aerobic and resistance (e.g. weight training) exercises are both beneficial, though aerobic exercise was found to be MOST helpful for alleviating depressive symptoms
  • Aerobic intensity needs to reach 50% to 85% of the maximum heart rate, and in resistance training, patients need to do 80% of one repetition maximum, the maximum weight that can be lifted at a single time.
  • Three to five exercise sessions weekly for 10 weeks are needed.
  • Each session should be 45 to 60 minutes.

Keeping an exercise journal can be a great way to keep track of your progress and keep you motivated until you cross that 10 week (or 1350 – 3000 minute) threshold for improvement.

Bear in mind that these findings are specific to the diagnosis of major depression and may not apply to all types of low mood and depression. While this study is provides helpful guidance for type of exercises, and length and duration of use for alleviating symptoms of major depression, it should not be extrapolated that exercise is a panacea or silver bullet for treating all depressive symptoms; response to exercise as a treatment for depression may be variable. If you have depressive symptoms or low mood or a diagnosis of major depression, please talk with your doctor and/or mental health provider about how exercise might fit into your individualized treatment plan.

This blog post is courtesy of Dr. Miranda Marti. She has a strong interest in the mind-body connection and the organic (physical and biochemical) contributors to mental health and well-being.

Unmanageable periods? Could be endometriosis.

Sites of endometriosis in the pelvis and abdomen.

Common sites of endometriosis in the pelvis and abdomen.

March is Endometriosis Awareness Month. 

Do you know someone whose life becomes unmanageable around the time of her period due to intense pain or strange symptoms, like allergic reactions, digestive problems or fatigue? The problem could be endometriosis.

Endometriosis is a painful condition that can cause digestive symptoms, abnormal menstruation and infertility. It occurs when the tissue that lines the uterus, the endometrium, starts growing elsewhere in the body. This most often occurs within the pelvis around the ovaries, but can happen anywhere – even the brain!

Pain that is suggestive of endometriosis includes pelvic and lower abdominal pain or low back pain that occurs:

  • during menses that does not feel better with the use of anti-inflammatories, like ibuprofen, or other types of conservative pain control, like heating pads
  • between periods but feels likes menstrual cramps
  • before, during or after sex
  • with bowel movements and urination, especially during menses

Other unusual symptoms of endometriosis are:

  • allergies, migraines or fatigue that are worse during menses
  • difficult bowel movements or alternating constipation and diarrhea that does not respond to standard IBS treatment or dietary changes
  • bloating, nausea and vomiting during menses

The pain and other symptoms associated with endometriosis have a reputation of being hard to diagnose and treat through conventional medicine alone. That’s why all of our physicians are trained to view the body holistically and treat not just the symptoms of endometriosis, but the underlying cause of hormonal imbalance and inflammation.

One of the major reasons endometriosis occurs is due to an imbalance of estrogen levels in the body. Many doctors address this imbalance primarily through the use of additional hormones, such as birth control pills, and pain management medications. This treats the symptoms of endometriosis, but it doesn’t treat the cause.

Broccoli and other members of the Brassica family of vegetables help promote healthy estrogen balance.

Broccoli and other members of the Brassica family of vegetables help promote healthy estrogen balance.

Estrogen Balance and Nutrition:  

One important avenue for treating endometriosis is to focus on foods that support efficient hormone metabolism and avoiding non-organic vegetables. meats, dairy and other foods that may be a significant source of hormone exposure.

“It’s not just the hormones in the cows, but the pesticides on the fruits, vegetables and grains that can influence estrogen levels in endometriosis. You have to focus on the diet to treat the disease.” – Dr. Mary O’Connell, gynecologist

There are also a number of herbal protocols that can help the body balance estrogen and progesterone levels on its own to reduce symptoms and progression of endometriosis.

For pain management, our doctors provide guidance on how to develop an anti-inflammatory eating plan, how to effectively use supplemental anti-inflammatory oils and herbs for long-term pain management. Our clinic also has acupuncturists who are skilled in treating pelvic and low back pain.

If you know someone whose life becomes unmanageable around the time of their menses, share this blog post or have them schedule an appointment to evaluate their symptoms and assess their hormone balance.

This post is courtesy of Dr. Miranda Marti.

Picture of common sites of endometriosis courtesy of Tsaitgaist via the Creative Commons Attribution-Share Alike 3.0 Unported license.

Picture of broccoli courtesy of La Grande Farmers’ Market via Creative Commons Attribution 2.0Generic license.

January is Cervical Cancer Awareness Month

Do you know when you’re due for your next annual exam?  Your next Pap smear?             Is your appointment already scheduled?

A Pap smear evaluates the cervix, an annual exam evaluates the entire reproductive system.

A Pap smear evaluates the cervix.
An annual exam evaluates the entire reproductive system.

If you don’t know or aren’t sure:      call or email us today!

Phone: 425-398-9355

Email: you can use the contact form below or write to us at



When to screen for cervical cancer

Recommendations for how most women should be screened for cervical cancer have changed in the past year. For some women, this means getting a Pap screening every 2-5 years instead of every year.

But there are exceptions to every rule! Women who are at high risk for cervical cancer or have other health concerns may still require yearly screening. Contact your PCP or gynecologist to make sure you know which screening schedule you should follow.

Risk factors for cervical cancer include:

  • Early onset of sexual activity
  • Multiple sexual partners (2x risk with 2 partners, 3x risk with 6 or more partners)
  • Sex without condoms
  • Smoking
  • Personal history of  sexually transmitted infections: chlamydia, herpes, high-risk HPV
  • Low immune system function (e.g. HIV)
  • Family history of cervical cancer

Cervical cancer is the 3rd most commonly diagnosed cancer of the female reproductive system. The average age at time of diagnosis is 48. For detailed information about cervical cancer, check out this information from the National Cervical Cancer Coalition and Planned Parenthood.

 An annual exam covers much more than just a Pap screening!

Though Pap screening recommendations have changed, recommendations for annual exams and check-ups haven’t. Unless otherwise specified by your doctor, you should still have an annual screening with to evaluate other aspects of your reproductive health, such as the size of your uterus and ovaries, and to discuss other important preventative medicine topics related to hormones & reproductive health, like bone density.

This post is courtesy of Dr. Miranda Marti and Dr. Serena McKenzie from the offices of Balancing Health Integrative Medicine in Bothell, WA.

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The Balancing Health Holiday Guide

Image by Mark Skrobola.

This post on navigating the holidays in health and happiness is courtesy of Dr. Miranda Marti and the rest of the staff at Balancing Health.

Between now and the New Year you’re likely to encounter many demands on your time and attention. With that in mind, here is a selection of local services you may find worthwhile to help you maintain a healthy balance between the joys and challenges of the holiday season.

Entertaining yourself, your kids or your guests

Fresh Picked Seattle is a fantastic day-by-day calendar of food and nature-related activities going on throughout the Seattle area. Best of all? Many of them are FREE!

We find Fresh-Picked Seattle to be an essential resource for finding fun, natural and affordable activities throughout the year, but particularly so during holidays when we have out-of-town guests or out-of-school kids to entertain.

From cooking classes for toddlers to jewelry making for teens to beer, wine, whisky and chocolate tasting for adults, Fresh-Picked Seattle has an option to keep everyone entertained and in good spirits.

Finding living trees, local and sustainably made gifts

Living tree image courtesy of Our Living Forest

Woodinville’s own Molbak’s Garden & Home is our favorite place to find living trees for seasonal indoor and outdoor decor. They also feature many local, sustainably made gifts, including hummingbird feeders, bamboo kitchenware, gardening gloves and ornaments.

One of our favorite living gift ideas are Molbak’s beautiful herbal topiaries that will keep in your kitchen during the holidays and can later be planted in your garden for year-round enjoyment.

Also check out the Chick N Coop Crafts Holiday Bazar and many other holiday events at Country Village, a collection of over 40 locally owned small businesses in Bothell.

Keeping your inner peace during the holidays

Do you have acupuncture or massage benefits that are due to expire at the end of the year? Now is the time to schedule in some self-care with acupuncturists Janna Rome and Miranda Marti. Acupuncture can do wonders for promoting relaxation, improving sleep and focusing energy.

Avoiding holiday weight gain

It’s not just the holidays themselves that tempt us with more alcohol and snacks, not to mention leftovers – it’s the entire holiday season from now until New Year’s. And for some of us, that can lead to an average 1-5 pounds permanent weight gain, according to the New England Journal of Medicine.

Join us on Tuesday, November 27th at 7 pm at the Balancing Health office for Dr. Mona’s Guide to Avoiding Holiday Weight Gain. Dr. Mona Fahoum provides advice and practical tips on how to avoid unintentional weight gain this holiday season while still enjoying a delicious holiday season. This event is free and open to the public. Please RSVP at 425-398-9355 or via email at

Finding a new balance point in the New Year

Yoga image courtesy of Tom Mooring.

Looking to find a new balance point in your life?  Need a positive antidote to the onslaught of body-shaming gym promotions that capitalize on the traditional New Year’s resolution to lose weight?

Come January, consider joining Insideout Yoga’s Realize Your Radiance Group for Women as an avenue for regaining or reinforcing a healthy mind-body balance after the holidays. Instructor Kim Trimmer offers yoga and meditation classes and workshops for individuals at any experience level in a body-positive environment.

Or if you’re looking to kick your yoga practice into high gear, consider signing up Balance Yoga Studio’s 30-Day Challenge: 30 classes in 30 days, starting January 2nd.


Monthly Migraines: Causes and Cures

Image courtesy of Pierre Willemin, Creative Commons.

This post on the role of estrogen in monthly migraines is courtesy of Dr. Miranda Marti.

For many women a monthly migraine is an estrogen-associated migraine.  Particularly if the timing of the migraine is predictable, such as around the start of menses.

Estrogen-associated migraines occur because of the effects a sudden withdrawal of high estrogen levels has on serotonin levels and blood vessels. This can be a natural occurrence within a woman’s menstrual cycle, it can be a scheduled withdrawal from estrogen-containing medications (such as the placeholder pills in an package of oral birth control) or it can be accidental from a missed dose of any estrogen-containing medication, including hormone replacement therapy.

Stopping the pain

So, what can be done about monthly migraines?  Quite a lot, from symptom relief to cure. Our doctors, including gynecologist Mary O’Connell and our naturopath physicians, all specialize in balancing hormone levels to stop the pain of monthly migraines.

For women using any form of hormonal birth control, one of the first places to start is to ask: does it contain estrogen? Is there a lower dose estrogen or estrogen-free option that could work for me?

There are also many non-drug approaches to managing estrogen-related migraines that can provide pain relief, some as simple as supplemental magnesium taken during specific times of the menstrual cycle.

Curing the pain

To address the root cause of why a woman’s body is responding to estrogen this way, one must look at her body as a whole and evaluate not just how much estrogen is being delivered, but how the estrogen is being processed and eliminated.

This is holistic medicine and it is something that our naturopathic physicians excel at.

For all women with estrogen-associated migraines, the question to ask is: how efficient is my estrogen metabolism? Factors affecting estrogen metabolism and breakdown include the liver detoxification, digestion, and possibly estrogen receptor stimulation via pesticide exposure.

Liver Metabolism

Many women don’t realize that their body has to break down estrogen in the liver the same way it does many other biologically active chemicals, like caffeine and alcohol. Some people have an inherently lower capacity to do this than others because of their genetics, and some people have a lower capacity to do so because their liver has a high burden of exposure to many substances needing detoxification.

Signs that your estrogen metabolism could be improved:

  • Sensitivity to or intolerance to: caffeine, alcohol or medications
  • Other symptoms of high estrogen levels, particularly PMS: premenstrual weight gain or bloating, mood swings, cramping, breast tenderness


After estrogen has been broken down into metabolites in the liver, the body moves these waste products via bile into the intestines so that they can be eliminated from the body in a bowel movement. Constipation or sluggish digestion can interfere with this process significantly because it gives the body time to reabsorb some of the estrogen metabolites back into circulation. Laxatives are not a long-term solution to this problem.

Women with monthly migraines and infrequent bowel movements (fewer than 5 per week) or frequent bouts of constipation could benefit from addressing their digestive concerns. Our approach is to focus on healthy non-laxative stimulation of digestive function, primarily using foods and fiber.

Pesticide exposure

Some pesticides are suspected to have the ability to stimulate our estrogen receptors and disrupt our distort our normal hormonal function, as is discussed in my blog post on organic foods.

Effectively treating and eliminating monthly migraines is about more than hormone and medication management. It is about being able to look at the body as a whole and recognize which systems can bring the body back into a stable and sustainable homornal balance.

Food and Health: Organic Still Matters

Photo courtesy of Masahiro Ihara under Creative Commons license.

This post comes courtesy of Dr. Miranda Marti, a naturopathic physician who has been following organic food research for over ten years.

There are a lot of sensational headlines in the media this week about organic food. Some of them imply that a recent study from Stanford proves there are no health benefits from eating organic food. This is an unfortunate overstatement of the study’s findings.

The study, which is itself a meta-analysis of many studies, provides us with important information that is primarily about the food itself (nutrient content, incidence of pesticide contamination, etc.) from organic and conventionally grown sources.

For example, because they found that organic foods were no more or less likely to be contaminated with bacteria associated with food-borne illnesses, like E. coli. So, we can be reasonably sure that our risk of getting food poisoning from organic foods is about the same as it is from non-organically grown food.

It also helps confirm something that has been long suspected, that the nutrient profiles of organic produce are virtually the same as those of their conventionally grown counterparts. [Personal anecdote: a full decade ago when I was working on my senior project at Whitman College for my Environmental Studies-Biology major, I would have loved to study the differences in nutrient content of conventionally and organically grown foods. But even back then it was fairly apparent that there was little or none to be seen, so instead I ended up doing field work that involved measuring soil level of nitrogen and phosphorus and the biomass of earthworms on Hawaiian coffee farms utilizing conventional and organic agricultural practices.]

The New York Times does a lovely job of covering these aspects of the study, complete with an interview with someone from the Environmental Working Group, the organization which regularly compiles the Dirty Dozen and Clean Fifteen lists of which fruits and vegetables bear the most and least pesticide contamination.

But the study cannot, and was not designed to, tell us anything about the long-term consequences of eating organic foods or long-term exposure to pesticides from food sources. The studies included in the meta-analysis that involved human health outcomes had, at most, a two year period of data collection. So, it cannot tell us whether or not pesticide residue on foods over time influences our hormonal activity or our immunity, or how it contributes to our liver’s burden of detoxification.

These are important issues to address because we have reason to suspect that pesticide residue on food has the potential to do all of those things, and that for some people it can have long-term health consequences. For example, here is a link to the EPA program that is in the process of studying whether many chemicals, including pesticides, that people in the US are exposed to have the ability to disrupt human hormones.

So, what about organic food and health?

My clinical recommendations, which have always been aimed at minimizing pesticide exposure, have not changed. In light of all the unanswered questions on the long-term health effects of pesticide residue on foods, I suggest that the prudent approach is to minimize our exposure to the worst of it. Beyond that, the degree of investment in organic produce, meat or dairy depends on personal preference and health status.

I recommend that everyone prioritize eating foods on the EWG’s Dirty Dozen list that comes from organic sources, be that your own garden or an organic CSA or the grocery store, and primarily eat organic dairy and meats.

This is especially true for women who have gyn conditions related to high levels of estrogen activity, such as PMS, fibroids, PCOS or fibrocystic breast disease. As I tell my patients with these conditions: Some pesticides, such as atrazine, stimulate aromatase, the enzyme that creates active estrogen from hormonal substrates, pesticides can monopolize your liver’s detoxification pathways and keep them from efficiently metabolizing your estrogen, and can even be converted in the body to estrogen-like substances (xenoestrogens). In other words, exposure to certain pesticides may make estrogen-related symptoms or conditions worse.

Recommended Reading

To learn more about the potential long-term health consequences of pesticide exposure from foods, I recommend the book The Body Toxic by Nena Baker.

Baker, an investigative journalist, does an excellent job examining many environmental and health concerns associated with common chemicals, such as pesticides, phthalates and flame-retardants, that we are exposed to every day. She also gives a devastating overview of how, from a legal standpoint, all of this is allowed to continue without much public outcry. And, perhaps most importantly, she gives sound advice about what people can do to learn more and to protect themselves until more definitive information about the health risks are known.


Getting to Know Your Gut Flora Part II – Prebiotics

Photo courtesy of agriculturasp under Flickr Creative Commons-licensed content.

This post on the role of prebiotics on health is courtesy of Dr. Miranda Marti.

Prebiotics are carbohydrates that are not absorbed by the human digestive system, leaving them available to selectively feed and promote the activity of colonies of healthy gut bacteria, particularly most Lactobacillus and Bifidobacteria species.

Please see Part I for more detailed information about the ways healthy gut bacteria benefit us, but in a nut shell they help keep our immune system in check, promote healthy metabolism and appetite control, help us absorb nutrients from our food, and directly provide us with certain vitamins and anti-inflammatory fatty acids.

What you eat directly affects your gut flora

Eating vegetables high in prebiotic fibers promotes the growth of beneficial gut bacteria. Conversely, eating meats and simple sugars can actively promote the growth of non-beneficial bacteria and promote inflammation throughout the body.

To INCREASE your good gut flora and discourage the growth of bad or pathogenic gut flora: eat a healthy diet high in fiber, especially prebiotic fiber, and moderate your intake of meat and simple carbohydrates, like sugar and white rice.

Prebiotic Foods

All prebiotics are fibrous, but not fiber-containing foods are prebiotic. The types of fiber specifically that have prebiotic effects are pectin, inulin and fructo-oligosaccharides.

Foods that are highest in prebiotic fiber are:

  • Chicory root
  • Garlic
  • Jerusalem artichoke
  • Raw dandelion greens
  • Garlic

A chart of the inulin and oligofructose content of these foods, and many others found in the American diet, can be found here.

How meat and saturated fats can affect your gut flora

To DECREASE your good gut flora and preferentially promote the growth of bad gut flora and systemic inflammation: eat a diet high in refined carbohydrates, simple sugars and saturated fats or meat.

Why is saturated fat a problem?

Diets high in meat and saturated fat also tend to contain high levels of lipopolysaccharides (LPS). LPS is a molecule that is on the outside of most gram-negative bacteria, including E. coli. It is recognized by the human immune system as an endotoxin, so exposure to LPS in the diet triggers an immune response that creates inflammation in the gut that can be spread throughout the body. This happens regardless of whether or not a toxic threshold of LPS exists, like it does with food poisoning.

Studies that look at diet and bio-markers for metabolic syndrome (triglyceride levels, insulin resistance, and inflammation) show a positive correlation between levels of LPS and those markers.

Chronic intake of a high-fat diet appears to alter the intestinal environment by influencing the type of gut flora that thrive, as well as by increasing the permeability of the intestines (leaky-gut), which then allows for the absorption of more LPS into general circulation.

For more a more detailed look at the physiologic mechanisms involved, check out this excellent review article on Metabolic Diseases and Pro- and Prebiotics.