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.

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 and a massage therapist 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.

Each provider will have their own scheduling page that allows patients to view all of their available appointment times and submit requests online. Once a request has been received, it will be approved and verified by email or phone call by our office staff.

Here’s what you can expect to see when you schedule online:

An example what you will see when using our online scheduling system.

How do I access the online scheduling?

As soon as our online scheduling system goes live, we will send you an email with links to our providers’ scheduling pages . We also intend to incorporate them directly into our website for easy access.

In order start scheduling your appointments online, we need a verified email on file.  If you have received an appointment reminder email from Practice Fusion (our scheduling system), then your email has been verified.

If you haven’t or if you’re not sure if you have, please send us an email using the contact form below or give us a call so we can make sure you’re ready to go!

Will gynecology appointments be available online too?

Not at this time. It is our goal to have Dr. O’Connell’s appointments available for online scheduling in the near future. Scheduling gynecology appointments is tricky because of the need to balance the timing of all of the different types of visits that may occur in a single day, such as annual exams, ultrasound appointments and procedures like cryoablation.

So for now please direct all scheduling requests for Dr. O’Connell to our front desk by phone, email or in-person. We’ll let you know as soon as her online scheduling becomes available.

You are always welcome to reach us by phone.

The online scheduling is available as convenience, but you are always welcome to contact us by phone for scheduling assistance at 425-398-9355. Our front desk staff is available by phone during regular office hours and we will continue our after hours messaging and on-call services as usual.

This blog post is courtesy of Dr. Miranda Marti.

Contact Us:

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 balancinghealth@frontier.com

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 3^rd 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.

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 balancinghealth@frontier.com

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.

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

Digestion

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.

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.

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.

Photo courtesy of Masahiro Ihara under Creative Commons license.

This post on the evolution of nutrition science comes courtesy of Registered and Certified Dietitian Cheryl Decker.

Check out the following slideshow from Eating Well Magazine’s Blog for an excellent synopsis of nutrition science promoting healthy eating patterns with succinct & valuable tips for optimal health: 10 Health Lessons Learned

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

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

Probiotics, the microbial organisms that facilitate our digestion, have become a profitable and rapidly-growing industry. From the sides of yogurt containers in the dairy aisle of the grocery store to the pages of major medical journals, probiotics are recommended for improving digestion, preventing and treating gastrointestinal diseases, and a whole host of other reasons.

The emerging understanding of what role our gut flora plays in not just our digestive health, but also in the workings of our metabolism and immune system, is fascinating and full of clinical promise. It is not far-fetched to suggest that many of major chronic health concerns today, including obesity, type II diabetes, allergic reactions and autoimmune disease, may one day be treated in part by the cultivation of desirable gut flora.

One of my favorite explanations of the role of gut flora in health, as well as the rationale for using probiotics, is this YouTube presentation by Dr. Gerald Lewis, a cardiologist and GP practicing in New Zealand. My caveat is that I can’t endorse any treatment recommendations he makes in the presentation. My professional opinion is that our understanding of how and when to dose probiotics is constantly evolving as new research is published and each person’s case deserves individual consideration prior to making a specific treatment recommendation.

I also like this shorter cartoon animation of gut microbes and their role in our health. I especially like that this clip raises important questions at the end about what remains to be seen in probiotic research.

And for an entirely non-animated approach to the discussion, the National Institute of Health maintains a thorough page on probiotics use and research.

At present, the predominant message in the media and in health care settings is that the primary way to cultivate one’s gut flora is to take probiotic supplements. Traditionally this is accomplished through the intake of fermented food such as yogurt and kimchee. More recently it is done through the intake costly supplements, packaged microbes grown in labs and tested for purity and number.

As a naturopathic physician, however, the constant replacement of gut flora into a biological system (our gut) that is largely self-sustaining seems like an inadequate approach to long-term health. To focus solely on supplemental probiotics is akin to constantly sowing seeds into a garden bed but not tending them once they begin to grow.

So, how do you tend your gut flora and help it thrive on its own? The answer has everything to do with diet. Stay tuned for Part II of this post: Prebiotics – Feeding Your Gut Flora.

A full meal screenshot from the award-winning Smash Your Food app.

This health app review is courtesy of Registered and Certified Dietitian, Cheryl Decker with contributions from Dr. Miranda Marti.

An award winning children’s app about making healthy food choices

A new food app named Smash Your Food, designed by a NW Nutritionist and her husband, was chosen as a recent winner in Michelle Obama’s Apps for Healthy Kids contest.  This app is an educational, interactive and fun way to teach children to cultivate the habit of paying attention to what they choose to eat. Huh? Isn’t that what parents attempt to do every single day? So, as a registered dietitian, I love this game!

Smash Your Food starts with the pull of a lever to initiate food-smashing.  The smasher makes a gooey and messy splat with vivid sound effects that pop, fizz, squish and plop, all the yuck sounds that kids will love and giggle at. There are also ‘crazy foods’ (meaning crazy large portion sizes) with enormous amounts of sugar, salt, & fat. After graphically smashing foods, you level up by correctly guessing how much sugar, salt and fat are in each food presented in each level (perfect score).

The game offers five levels and a total of 40 foods that are “easy to reach but far from healthy.”  The smasher only takes on individual foods up until reach Level 4. At that point,  commonly consumed unhealthy meals make their appearance illustrating how they are big contributors to excessive calorie intake.  As nearly 2/3 of folks in the U.S. are considered either overweight or obese, this game is a great way for kids to have fun & learn more about the scary side of inexpensive fast foods.

Sugary ambiguity

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

My primary suggestion is that the app clearly state that sugar is not recommended in any amount. The Max Per Meal (screen shown to the left) for sugar, salt and oil is ambiguous in it’s  intake recommendations: are these the maximum amount of necessary or discretionary nutrients? It’s hard to tell based on the presentation but it shouldn’t be. Sugar is a discretionary nutrient that should only be consumed in very small amounts (known as discretionary calories). If we over-consume our discretionary calories by even 100 calories a day it could lead to a 10 pound or more weight gain in one year – yikes!

What about healthy foods?

In it’s current incarnation, Smash Your Food, focuses on traditional junk foods. The developer has, however, added a blog to highlight healthier foods such as smoothies and recipe ideas for snacks and meals, as well as a section for parents.

A future enhancement that I would welcome is for an optional healthy substitute that could be smashed to show kids the difference between food choices they have each day. Currently the app focusing on smashing unhealthy foods, but does not offer the opportunity for kids to compare their new-found knowledge of the nutritional information of hamburgers and chips to healthier food options, like ants-on-a-log (celery sticks w/ nutbutter and raisins). Smashing good foods could also shows the micronutrients of value to growing kids such as calcium, iron and zinc.

Overall impression: a fabulously creative and thoughtful game. Parents, your kids are going to LOVE this!