Ask Dr. Carm

Hello Dr. Carm,

I recently read the article “Balance your hormones with food” in the current issue of Clean Eating that you contributed to. I was very intrigued by the article! In December of 2011 I was finally diagnosed with Hereditary angioedema, or HAE, a rare disease of the immune system. Have you ever worked with and/or treated HAE patients? If you have, have you found that a hormone balancing diet has worked for them?

- Nikki

Nikki:

First, thank you so much for the question. This diagnosis is very rare and I do not have experience with treating it. What I can tell you though is that you are definitely on the right track. Everything that we put in our body, including food, preservatives and environmental pollutants, effects how we respond to genetic predisposition, especially involving the immune system. You cannot go wrong is eating a balanced diet that is rich in whole foods (unrefined) and as “clean” as possible, meaning free of toxins. I would suggest exercise as long as it does not bring on an attack, maintaining a normal BMI and looking into meditation and other means of relaxation. Avoiding stress as you know is critical.

It sounds as if you have found physicians who are familiar with treating this disease. That is great. If you ever feel that a second opinion would be helpful, don’t hesitate to seek one out. An allergy specialist who sees patients with this disorder would be preferable. In addition, a little trick that I do is use Google or a health site like WebMd and ask about HAE and newer treatment or holistic treatment or management with diet. This will produce articles and studies that have been done in the major academic centers. Take a look at the authors and where they are located. You may find a center near you that is on the cutting edge. Sometimes, physicians will consult with your doc and they can be 1000 miles away. The HAE Association will have names of docs also. I do see the rationale behind offering you androgens as a treatment but I also understand your reluctance to use them or other steroids.

The goal should be to maintain as healthy a body and mind as possible so that flares will be limited and the use of meds will be only after all else fails.

I wish you the best of luck. Please let me know how you are doing!

Dr. Carm

Dear Dr. Carm, 

I am 39 years old and worrying about when I will experience peri-menopause. My friend who is 40 has had symptoms already and she says it is terrible.

-Worried in Ohio

Dear Worried:

Peri-menopause is the transitional period from normal menstrual periods to no periods at all. Don’t kill the messenger but this transition can take up to ten years. There is no specific age when a woman will start this transition. The closest correlation may be to your mom. If you can, find out when she started, that may give you an indication of when you may start. Also, see your GYN. She can do blood tests that may indicate if you are entering this period of time or already through it.

During peri-menopause you may experience PMS symptoms, menopausal symptoms or no symptoms at all. In the last three years, I have been “lucky” enough to have experienced each and every symptom there is including but not limited to: mood swings, hot flashes, dry skin…everywhere, insomnia and loss of energy. I have friends who tell me that they don’t have any symptoms other than a change in their bleeding. The bottom line is that the timing and the experience are different for every woman.

Always remember that in every stage of life, a balanced diet and plenty of exercise can help with the symptoms. Good luck.

Dear Dr. Carm,

I need to find a new doctor. What should I be looking for to make sure that t this will be a doctor for me?

-No MD in Denver

Dear No MD,

The doctor-patient relationship is one of the most important that you will have in your life. We all deserve to have a doc who understands us, has great communication skills as and is up on the latest medical know-how.

Before you even call for an appointment, check the doctor’s credentials on-line. Is the doctor board certified? Is the doctor liked and respected by hi/her other patients? There are websites that allow patients to rank doctors on all of these criteria. Depending on where you live, there may be local magazines that do an annual “best doctor” issue.

Also, ask around. If you respect a person, ask them what doctor they use and why. As a doctor myself, I get this question a lot and usually answer it more from a consumer’s  perspective.

Once you’ve done your research, call the doctor’s office and make an appointment for a consultation. This is also known as an interview. You are not going in to talk about your current health status or issues, but to see what the doc is like and if you have good chemistry. An initial interview will also will give you the opportunity to see how organized or disorganized the office is. Disorganized office = bad sign.

Find out if she/he recommends second opinions. If the answer is no, it’s not a good sign. You want a doctor with an open mind who encourages second opinions.

Try to get a beat on the office staff, as you’ll spend a great deal of time dealing with them. Are them pleasant and efficient? Helpful and respectful? How do they interact with other patients? A good vibe in the office suggests the overall experience will be positive.

Make sure you understand how the doctor works and how much access you’ll have to her / him. Does she / he use a Physician’s Assistant for other non-MDs for routine matters? Will you be able to reach the doctor via email or phone if you have a medical question that does not require an office visit?

Consider whether the doctor listens and is responsive to your questions or whether she / he is rushed or brusque.

If you’ve ever hired anyone, whether a high level employee at work, a painter or plumber for your house or a baby sitter for your children, you know the drill. Stay focused. Clearly express your needs and expectations. Ask questions. Ask again, if you don’t understand the answer. This is one of the most important hires you will ever make. This person’s job is to take care of you!

Dear Dr. Carm,

I am only 29 and don’t have the interest in sex that I used to have. My husband is frustrated. I am, too. Is something wrong with me?

-Not hot or Bothered in Jacksonville

Dear Not Hot or Bothered,

First of all, you are completely normal. It’s typical to have times when we’re not feeling as interested in sex as we once did. I know that this is very frustrating for both of you. Lots of things can contribute to diminished interest in sex.

Consider the three “C’s” – change, check-up, communication. Have there been major changes in your life, stressful or otherwise? When was your last check-up? How well do you communicate with your partner?

• Job change or layoff, overload between work and family responsibilities, worries about an elderly parent, financial problems are the kinds of change agents that can impact your interest in sex.
• Other than your diminished interest in sex, do you have physical symptoms like fatigue, insomnia, sensitivity to cold or heat, sudden weight gain or loss? Make an appointment for a check up with your GP or gynecologist. Make sure you don’t have the beginning of thyroid or adrenal gland problems and that all is in order with your body.
• Communication with your husband (or partner) is important in all matters. When it comes to sex, even when you’ve been together for years, talking about it can be awkward for some people. Even so, sit down together and talk. If stress or overload or fatigue is your issue, tell him. Try to find ways to be tender with each other until your sex drive returns – and it will. Maybe you need to shake things up in the bedroom…work at making them more interesting…rekindling that original spark you had.

Whatever the answer may be, know that it is perfectly normal for couples to have ups and downs around sex. See this as an opportunity to increase communication, get a check-up, handle the stress in your life and spend some time on you. Good luck!

Dr.Carm,

 I never lost my “baby weight” after my third child was born a year ago. I am so busy with 3 kids, a full time job and management of my household, I don’t have time to exercise or energy to follow a diet. Are there a few easy changes that I can make that will help me lose the weight without starting a formal diet or buying a gym membership?

-Busy with Baby in Chicago

Dear Busy with Baby,

I gained 40 pounds with my first child and 50 with my second one. I was fat everywhere…my back, my thighs, even my knees, And yes, it was hell to take it off. I know that you are super busy but remember if you don’t take care of yourself, you can’t take care of anyone else!

I am a firm believer in individual wellness potential and taking small steps to reach yours. In addition to reading that area of my blog,

Here are some small steps and effective strategies that won’t take any time at all.

• Replace soda and other sugary drinks with water (not only easy but will save you money!)
• Replace cookies and sugary desserts with fresh fruit or a small scoop of fat-free frozen yogurt.
• Treat yourself and your family to whole grains instead of white rice, pasta and processed bread. (REMEMBER: white is not right!)
• Cut processed foods (like packaged cookies, potato chips, etc.) out of your diet – they are full of hidden fat, salt and sugar.
• Have a salad meal once a day. Fill your bowl with color – dark, leafy greens, red beets, orange carrots. Sprinkle a few nuts for crunch. Drizzle a squeeze of lemon or orange and a bit of olive oil and toss.
• If you snack, snack on fresh or dried fruit, a handful of nuts or munch-worthy vegetables. Stay away from calorie-laden energy bars, sweets and processed munchies.
• Use the stairs instead of taking the elevator.
• Park your car as far as possible from the entrance to your destination so you can grab a short walk.
• Instead of taking a coffee break, take a walking break or a stretching break.

All of this adds up and can lead to significant weight loss within a year. Don’t forget that my mother’s major exercise routine was cleaning the house. Every little bit of moving helps.

Enlist your family and friends to support and encourage you. Good luck! You’ll get there.