The world has been stunned by this new research paper exposing the presence of lead, arsenic and other heavy metals in tampons. Honestly, this is not surprising at all. This should have been figured out long time ago ever since our environment, soil and water has been increasingly contaminated with various types of contaminants that get absorbed into our food/ clothing/ drinking water etc etc.

How do heavy metals get into the tampons?

Lead and arsenic in your tampons? Well, guess what! Tampons are made with a mix of synthetic and cotton fibers.

Where does cotton come from?

It comes from soil!!

What happens in soil?

Soil contains a huge variety of heavy metals/ toxins/ pthlatates/ plastics – you name it!!

How does soil get all that?

From recycling/ percolating of waste water/ trash and what not!
A study published in the Environmental pollution revealed that lead and barium levels exceeded the health-based guidance values in 10-14% of NYC community garden
soil samples.

FDA states that lead has entered the environment from the past widespread use of lead in paint, gasoline, and plumbing materials, as well as many other products.

Ok, so soil has these contaminants! Where else are they?

Did you know that your beverages such as wine and beer can have higher than acceptable levels of heavy metals such as lead and arsenic? One of the mechanisms that these guys can get in your drink is through the filtration techniques used. This study showed measurable levels seen in various food products such as juices, wine and beer.

These are over simplified explanations for sure but that is what is happening in reality.

So, even if you are not going around licking old walls or ingesting lead from lead paints or bullets, lead and arsenic in tampons, there really is no way around to escape exposure to these heavy metals/ toxins/ plastics etc.

Even if you consume 100 % organic foods (likely grown in any of these gardens), wear 100% organic recycled clothing, triple filter your water… you may reduce the load that you are exposed to but you cannot get to zero!

So, what can you do as a consumer???

Here are some quick and dirty recommendations by the EPA on how to reduce your load and decrease the risk of inadvertent consumption.

What can we as health care practitioners do to help!!

FUNCTIONAL MEDICINE TO YOUR RESCUE!

Thanks to some really cutting-edge technologies, we can now:

– check the various toxin levels in your tissues and blood,
– check how your body is metabolizing them,
– check if you have any genetic combinations which do not allow proper processing and dumping of these metals and toxins in your body
– we can also check how the toxins may be altering the hormonal metabolism and possibly taking you down toxic pathways potentially increasing risks for breast or uterine cancers/ weight gain/ hair loss and so much more

Ok, now we know you have toxins or heavy metals, what next?

This is called precision medicine! We can now target specific issues and customize treatment plans which can help detoxify your body of these harmful toxins through chelation (oral or i/v) and other comprehensive strategies that help raise the anti-oxidant levels to remove the toxin load from not just lead and arsenic in your tampons but also from food and your environment.

And no, your insurance unfortunately will not pay for this!

What can you do immediately??

While you start saving to get a functional care plan, here is what you can start doing today to help curtail the exposure…

– Use organic tampons and change them frequently
– Can use menstrual cups if convenient
– Try and buy organic foods if possible and still wash them with water and vinegar and then rinse them again
– Look at EWGs clean 15 and dirty dozen lists
– Minimize use of plastic food containers or plastic bags
– Never heat food in plastics
– Use organic hair products if possible

And the list can go on and on!

Feel free to reach out to us if you want to get on to the path of true wellness with a little bit of our help!

Be strong, be safe, be prepared,

Dr. Adeeti Gupta

Ref:
https://www.sciencedirect.com/science/article/pii/S0160412024004355?via%3Dihub
https://www.health.ny.gov/environmental/outdoors/garden/docs/soilpaper.pdf
https://www.nyc.gov/content/leadfree/pages/soil

Leaded Soil Endangers Residents in New York Neighborhoods

https://www.sciencedirect.com/science/article/abs/pii/S1438463920305101
https://www.cbsnews.com/newyork/news/new-york-city-gardens-soil-lead-concerns/
https://www.atsdr.cdc.gov/csem/leadtoxicity/cover-page.html
https://www.epa.gov/lead/learn-about-lead
https://www.fda.gov/food/environmental-contaminants-food/lead-food-and-foodwares
https://research.library.fordham.edu/cgi/viewcontent.cgi?article=1113&context=environ_2015

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116460/

Disclaimer:

We do not have any financial affiliation with the testing companies. We have simply placed the links on our website for the ease of use.

The post Tampons- lead- heavy metals- VOCs- plastics and more!! appeared first on Walk In GYN Care.

We have compiled a list of valuable tips so you can arm yourself with facts! As always, we are here to help seven days a week!

What are hormonal birth control pills?

Combined estrogen-progestin oral contraceptives (COCs), also known as birth control pills, provide reliable contraception as well as several non-contraceptive benefits. COCs contain an estrogen component and one of a dozen different progestins. For healthy, nonsmoking women, COCs may be continued until the age of menopause. The type of pill selection should include a patient’s experience with COCs, patient preferences, clinical characteristics, insurance coverage, and cost. Shared decision-making improves adherence to any contraceptive method.

How does the pill work?

The COCPs suppress ovulation by inhibiting gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and the mid-cycle LH surge. This effect is mediated by the synergistic action of the COC’s progestin and estrogen components.

How effective is the pill?

When taken correctly, COCs are a highly effective form of contraception. Although the perfect-use failure rate is 0.3 percent, the typical-use failure rate is more typically approximately 7 percent, due primarily to missed pills or failure to resume therapy after the pill-free interval.

Who should avoid taking the pill, and when?

We call these absolute contra-indications (Unacceptable risks: CDC – category 4 rating)  because of the risk of blood clots, stroke, and death!

• Undiagnosed abnormal vaginal bleeding (Irregular cycles or heavy bleeding)
• Age ≥35 years and smoking ≥15 cigarettes per day
• Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and hypertension)
• Hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg)
• Venous thromboembolism
• Known thrombogenic mutations- genetic mutations that can cause blood clots.
• Known ischemic heart disease
• History of stroke
• Complicated valvular heart disease (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis)
• Current breast cancer
• Severe (decompensated) cirrhosis
• Hepatocellular adenoma or malignant hepatoma
• Migraine with aura
• Diabetes mellitus of >20 years duration or with nephropathy, retinopathy, or neuropathy.

When can you take the pill but under close supervision?

We call these relative contra-indications (CDC- Category 3 rating).

OCPs may be considered individually if no other acceptable alternative is available.

• Age ≥35 years and smoking <15 cigarettes per day
• Hypertension (systolic 140 to 159 mmHg or diastolic 90 to 99 mmHg)
• Hypertension adequately controlled on medications
• Past breast cancer and no evidence of current disease for five years
• Current gallbladder disease
• Malabsorptive bariatric surgery
• Superficial venous thrombosis (acute or history)
• Inflammatory bowel disease with risk factors for venous thromboembolism (active or extensive disease, surgery, immobilization, corticosteroid use, vitamin deficiencies, or fluid depletion)

I have a family history of breast cancer and/or have the BRCA gene-positive status.

A family history of breast cancer or BRCA-positive status is NOT a contra-indication. COCPs can help reduce the risk of ovarian cancer and colon cancer in such patients.

There are so many birth control pills; how do I know where to start?

Again, a healthcare professional knowledgeable about the types, side effects, and dosing can guide you properly.

Below is a primer to help you get armed with facts!

Types of Combination Oral Contraceptive pills and dosing.

There are three types of OCPs based on the dose of Ethinyl Estradiol in the pill.

Ethinyl Estradiol (Estrogen types)

• Ultra low dose (<20mcg)
• Low dose (20 mcg)
• Standard dose (30-35mcg)

Progestin types

• High androgenicity but low blood clot risk. – Norethindrone/ Levonorgestrel.
• Low androgenicity but slightly increased clot risk – Norgestimate/ desogestrel.
• Anti-androgenic – Drospironone/ dienogest/ cyproterone acetate

The overall effect of all COCs, however, is antiandrogenic (suppress testosterone), regardless of the type of progestin used

1. Oral Contraceptives (Mono-phasic)- these pills have the same dose of estrogen and progesterone throughout the cycle

First choice:

Low dose  – for routine use, low side effects

(Ethinyl estradiol/ desogestrel or levonorgestrel)

Generic –Microgestin Fe 1/20 x 28/ Junel Fe 1/20 x 28 days/ Alesse/ Mircette

Second choice: (if history of breakthrough bleeding)

Standard dose (30-35 mcg) –  Apri/ Microgestin – 1/30/ Junel 1/30

Ultra-low dose (10mcg) – Lo-loestrin.

This is usually preferred for patients unable to tolerate low-dose pills.

2) Oral contraceptives (Tri-phasic)

These pills have a different dose of estrogen and progesterone every week of the cycle. Below are some examples:

• Ortho-tricyclen Lo
• Camrese
• Tri-sprintec, regular or lo

Usually, these are not the first preference because of varying doses, but if you are already on one, there is no need to switch. 

3) Oral contraceptives – 3 monthly – Endometriosis/ chronic pelvic pain

Skipping the placebo in Monophasic pills is the best option.

Or

• Quattro (4 months)
• Seasonique ( 30mcg EE).
• Jolessa (3 monthly packs – 30mcg EE).
• Lo-loestrin – skip placebo.

4) Transdermal – These are the same as the pill but come as a patch.

If you have increased breakthrough bleeding / are forgetful/ have a busy lifestyle, you can miss pills/ have small kids/ shift workers/ PMS, etc.

XULANE patch 1 q weekly x 3 weeks, then one week off.

5) Transvaginal – If increased breakthrough bleeding / forgetful/ lifestyle – missing pills/ have small kids/ shift workers/ PMS

Nuvaring – 1 ring every three weeks in, one week off.

THERE is a LOWER  RISK OF THROMBOSIS WITH NUVA-RING -/ PATCH because it bypasses the liver, and there is constant absorption with stable serum levels. Avoids the peaks and troughs from oral absorption.

How should I start, and what should I watch out for?

• Start on the first Sunday after the period or Day 1 of the period. If start on Day 1 of period, will be protected in the same cycle. If Sunday start, use additional contraception in the first cycle. We do not recommend an early start or immediate start (even though many other providers do, we want to be safe).
• Take bedtime after meals (Never on an empty stomach).
• Initial few days – nausea/ increased appetite – body develops quick tolerance.
• Very low dose ones like Loestrin/ lo loestrin – you may have irregular spotting throughout the cycle for the first three months. Just wait it out. No need to change the pill.
• Some of you may have decreased libido, hair fall, and weight loss.

I want to get pregnant; how long should I wait after stopping the pill?

COCPs do not cause infertility. There is no waiting time recommendation.

Always complete the pack when you stop the pills; otherwise, you can get irregular cycles.

I am 50 years old and on the pill. How do I know I am in menopause?

• If you need to check for menopause, stop OCPs for at least six weeks and then get blood work done with your provider to check for FSH and Estradiol levels.

I am on the pill. Can I still get STDs?

No, OCPs do not offer protection against STDs.

I have severe PMS. Will the oral pill help?

NO! That’s a myth!!!

Check out our PMS blog to learn more!

Do pills help with Acne?

Yes, if the acne is from high testosterone

Prefer Low androgenic and monophasic types.

Example: Junel 1/20 ( Desogestrel containing).

*https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf

How do I know if any other drugs that I am taking can affect the pill?

It’s hard to know! That’s why you should consult your healthcare provider. Still, we have compiled some interactions to watch for:

DECREASED EFFICACY (High chance of failure)

The efficacy of COCPs may be decreased by any drug that increases liver microsomal enzyme activity.

Anticonvulsants :

Anticonvulsants that reduce the efficacy:

Phenytoin, carbamezapine, barbiturates, primidone, topiramate, felbamate, or oxcarbazepine.

If using OCPs with above anticonvulsants:

• Use a standard dose OCP with a minimum of 30 mcg of ethinyl estradiol + progestin with a longer half-life (drospirenone, desogestrel, levonorgestrel).
• Skip placebo or preparation with a four-day hormone-free interval.

Anticonvulsants that do not appear to reduce contraceptive efficacy:

Gabapentin, levetiracetam, valproate, zonisamide, and tiagabine.

Lamotigrine and OCP’s

COCs can result in a decrease in plasma lamotrigine concentrations by 45 to 60 percent. This can increase the risk of seizure.

• Consult with neurology to adjust dosing.
• To avoid fluctuating lamotrigine levels, continuous dosing of the COC rather than cyclic is recommended.

Antibiotics

Rifampin is the only antibiotic proven to decrease serum ethinyl estradiol and progestin levels in women taking COCs (due to enzyme-inducing effects).

Antiretrovirals – Refer to current texts.

 St. John’s wort –May increase the risk of ovulation.

Useful things to remember:

1. If you have irregular cycles or bleeding between cycles or after sex, it’s essential that you see a GYN for a complete evaluation, including an ultrasound and blood work!
2. If you are obese or overweight patients – please get blood work to rule out pre-existing elevated liver enzymes.
3. NEVER do an immediate start.
4. If you miss one pill, take two the next day and finish the pack. If you miss two, finish the pack but use additional protection in that cycle.
5. With many pills, your periods may get lighter and may even go away, but please do a pregnancy test to confirm.
6. Try and take the pills at the same time every day – set an alarm on your phone.
7. Pills do not cause weight gain by themselves, but if your body is not a good estrogen metabolizer, you may experience bloating breast tenderness, and water retention.

Overall, it’s great to have easy access to hormonal birth control, but please remember to be well-informed!

Be safe, be strong, and be prepared!

Dr. Adeeti Gupta and the lovely team at Walk In GYN Care

The post Oral Contraceptive Pills!! Must know facts! appeared first on Walk In GYN Care.

Yes!!!

Here are 4 easy daily health tips  (or hacks) that reap great rewards!

D: Diet

• Eat 2-3 servings of green and colored vegetables daily.
• Eat protein in the form of eggs, lentils, peas or fish.
• Drink 10-15 glasses of water a day.
• Avoid artificially sweetened drinks/ sodas.
• Avoid simple or processed carbs
• Note if you have gluten or dairy sensitivity – beat the bloat!

A: Attitude

• You are awesome, and you deserve awesome.
• Give positive vibes and take only positive vibes.

R: Routine

• Having a regular routine as much as possible helps keep your cortisol, melatonin and other brain chemicals happy.
• Keep a regular sleep-wake routine as much as possible
• Do not skip meals
• Have a healthy supplement routine.
• Have a work start time and a stop time. Do not carry over that stress to your sleep.
• If you are a stay-at-home Mom, then create room for “me-time” in your routine.
• Develop a ritual before you sleep…
  • • Reflect on your day and plan for tomorrow – this helps you get clear your mind of the day’s negativity and helps streamline those “thoughts” playlists!

OR

• • • just breathe but put the electronics in sleep mode.

E: Exercise

45 minutes of aerobic exercise 3-4 days a week can go a long way to keep your brain, heart and body happy and healthy.

It doesn’t have to hard… do something fun if you hate the gym. Dance, walk, bike, swim, run.. whatever works!

These daily health tips (or hacks) are all about consistency and don’t require a lot of commitment. Just make a habit of these. We also have support groups that can help you stay on track!

HERE’S TO A HEALTHIER, HAPPIER AND SANER YOU!!

Be safe, be strong and be prepared!

Your fun and caring Walk In GYN Team

The post 4 – Daily Health Tips! appeared first on Walk In GYN Care.

1. What are probiotics? What does the term even mean?

Probiotics, specific health-promoting microbes, have multifactorial benefits to human health and some may have been part of daily diet for centuries in the form of traditional fermented foods or beverages.

Typically, these products will contain freeze-dried (lyophilized) or live bacteria or yeasts, most commonly from the genera Lactobacillus and Bifidobacterium.

The original definitions of probiotics were inclusive of traditional fermented foods such as yogurt (nonmedicinal varieties), sauerkraut, and kefir, but the most recent interpretation of the definition has, somewhat controversially, excluded these traditional ferments. These are now considered food sources of “live and active cultures” but not probiotics.

2. How do they work?

Probiotics may exert their beneficial effects in various settings by different mechanisms.
These include:
– production of antimicrobial factors such as bacteriocins,
– making it difficult for the bad microbes to bind to the lining by competing for the surface
– competing for nutrients
– conditioning the inner lining (mucosal epithelium) and tissues just beneath.
– modulation of the immune system (T -cell proliferation)
– They can also send molecular signals to the host (human in this case) body so the body can recognize the good vs bad guys through special receptors called TLRs (toll like receptors) present on the surface of certain cells.
– antimicrobial activity and suppression of bacterial growth

3. Which ones are some common “good” probiotic microbes relevant to vaginal health?

o Lactobacillus acidophilus
o Lactobacillus casei
o Bifidobacterium longum
o Bifidobacterium bifidum
o Lactobacillus ruterii
o Lactobacillus johnsonii
o Bifidobacterium lactis
o Lactobacillus plantarum

4. What is present in a normal healthy vagina?

Normal healthy vagina is a smorgasboard of bacteria, cells, immune cells, debris, secretions and immune antibodies.

5. Does the normal composition of the vaginal microbiome change naturally?

Yes, several factors affect the above composition.

Age, menstruation, estrogen level, smoking, intercourse, hygiene habits and other practices have been shown to significantly impact the VMB composition (Hickey et al., 2012).

During the menstrual cycle the vaginal composition is more stable when estrogen levels are high. Good levels of estrogen support a healthy vaginal environment through increasing the glycogen content in the vaginal epithelial cells. Glycogen, which is a storage form of glucose, has been shown to promote growth of lactobacilli.

6. How is the vaginal microbiome classified?

Due to the complicated nature and a huge variety of different microbial populations, several attempts have been made by researchers to classify or group the organisms. One of the commonly used ones is described below. It classifies the various states of the microbiome as a “community state”. These groups or states have been identified through PCR based 16S rRNA sequencing

Five different community state types (CST) were proposed by Ravel et al. (Ravel et al., 2011).

Good (Lactobacilli are the dominant species).

CST I- Lactobacillus crispatus
CST II- Lactobacillus gasseri
CST III- Lactobacillus iners
CST V- Lactobacillus jensenii

CST I and III are the most common.
Women with these Lactobacillus-dominant CSTs also exhibit low vaginal pH (typically < 4.5).

Bad CST IV: less lactobacilli and dominant anaerobic and microaerophilic bacteria.

This state is correlated with higher vaginal pH (> 4.5).
Two subdivisions of CST IV have been identified:
1) CST IV a: some lactobacilli, with some Anaerococcus, Corynebacterium, Finegoldia, or Streptococcus
2) CST IV b: high proportion of Atopobium, with the below microbes:
Prevotella, Parvimonas, Sneathia, Gardnerella, Mobiluncus, Peptoniphilus and other taxa (Gajer et al., 2012). Several bacteria present in the CST IV-B are associated with bacterial vaginosis (BV).

7. Other than hormones and age, what else influences the vaginal microbiome?

Different ethnic groups have been shown to have different CSTs.

The Lactobacillus-dominant CSTs are widely prevalent in Asian and White/Caucasian women (80%–90%), however only 60%–70% of African American or Hispanic women have Lactobacillus-dominant CSTs.

8. What are the harmful effects of being in the CST IV state?

– recurrent vaginal infections called Bacterial Vaginosis (BV).
– has been associated with adverse reproductive and obstetric health outcomes
– increased risk of acquiring sexually transmitted infections
– pelvic inflammatory disease, endometritis, preterm birth, and spontaneous abortions (Martin and Marrazzo, 2016).

9. How do lactobacilli keep the vagina healthy?

– lactobacilli produce lactic acid, which acidifies the vaginal microenvironment and provides protection against genital infections.
– lactobacilli also do not allow many pathogens to live in the vaginal environment by competing for resources in the vaginal microenvironment with other microorganisms.
– the protective effect of Lactobacillus-dominant states has also been attributed to hydrogen peroxide.

Overall, Lactobacillus-dominant states are associated with vaginal health, and the disruption of this healthy state leads to a disturbed state of health.

10. How do probiotics help in vaginal health?

To clarify, here we are focusing on the probiotics that include most of the above listed “good” lactobacilli.

Their role in vaginal health has been extensively investigated especially in the context of vaginal infections in premenopausal women (Borges et al., 2014; Petrova et al., 2015).

Increasing evidence shows that specific probiotic strains or their combinations elevate vaginal lactobacilli counts in healthy women or women with BV and/or vulvo-vaginal candidiasis (VVC).
Probiotics also help and support natural health vaginal state during/after recovery from antibiotics/antifungal treatment (Xie et al., 2017; Li et al., 2019).

A meta-analysis that involved 10 RCTs with a low or moderate risk of bias, suggested that the treatment with probiotics alone was more effective in the therapy of BV for both short- and long-term; however, the probiotics used after antibiotic treatment was effective only for a short term.

According to another meta-analysis of 13 studies by Hansen et al, probiotic interventions were effective for treatment and prevention of BV, prevention of recurrences of candidiasis and UTIs, and clearing HPV lesions. No study reported significant adverse events related to the probiotic intervention.

11. So, what happens to the vaginal microbial balance after menopause?

The decline in estrogen levels affect the vaginal health in multiple ways. We won’t discuss the thinning and lack of lubrication aspect here.

The vaginal pH increases and that can allow growth of harmful microbes such as Escherichia coli, Candida spp., and Gardnerella spp. leading to increased risk of BV and VVC [reviewed by Kim and Park (2017)].

12. How can you build a health vaginal microbiome? Which lactobacilli should you be looking for?

Below are some names and specifications that are required for a healthy community state as described above. So, pay attention to the exact concentration and names of the lactobacilli in your probiotic?

– Lactobacillus rhamnosus GR-1
– Lactobacillus reuteri RC-14
– Lactobacillus crispatus LMG S-29995
– Lactobacillus brevis
– Lactobacillus acidophilus
– Lactobacillus crispatus LbV 88
– Lactobacillus gasseri LbV 150N
– Lactobacillus jensenii LbV 116
– Lactobacillus rhamnosus LbV96
– L. brevis (CD2),
– L. salivarius subsp.salicinius (FV2)
– L. plantarum (FV9)

Among the lactic acid bacteria, L. plantarum attracted many researchers because of its wide applications in the medical field with antioxidant, anticancer, anti-inflammatory, antiproliferative, anti-obesity and antidiabetic properties.

13. How do probiotics help in BV?

There is increasing evidence that probiotics are effective in the treatment of BV. In a meta-analysis of 30 studies (Jeng et al., 2020), BV patients were followed up after treatment and found that probiotic intervention:
– reduced the recurrence rate of vaginitis (OR = 0.27, 95% CI: 0.18-0.41, P<0.001),
– improved the cure rate of vaginitis (OR = 2.28, 95% CI: 1.20-4.32, P = 0.011).

(Selis et al. (2021) proved through in vitro experiments that Lactobacillus plantarum Lp62 could significantly inhibit the growth of Gardnerella.

In another meta-analysis of 18 studies (Liu and Yi, 2022) with 3-month follow-up, the combination of antibiotics and probiotics was found to significantly reduce the recurrence rate of BV compared with antibiotics alone.

L. plantarum can reduce the pathogenicity of G.vaginalis by repressing the expression of the genes related to virulence factors, adhesion, biofilm formation, metabolism, and antimicrobial resistance (Qian et al., 2021).

L. gasseri can reduce viable G. vaginalis numbers, inhibit sialidase activity, regulate TNF-α and IL-1β expression, and decrease myeloperoxidase activity in experimental mouse models (Zhang et al., 2022).

14. Which route is the best? Vaginal or oral?

This is still a huge field of research. So far, vaginal placement of probiotics has not led to any conclusive benefits. More studies are underway, though!

Through a mechanism that we may call, “gut-vagina” axis, oral ingestion of high doses of beneficial lactobacilli has been showed to improve the vaginal microbiome state as discussed above.

One study of 39 patient who received vaginal preparations of 3 different lactobacilli did show an improvement in BV symptoms.

15. Does HPV affect the vaginal microbiome and can probiotics help?

There is some data showing oral Lactobacillus curlicus can change the state of CST and increase HPV clearance.

HPV can destroy the vaginal microecological balance, reduce the number of Lactobacillus and increase the adhesion and colonization of abnormal flora. This can lead to increased expression HPV protein leading to the development of cervical intraepithelial neoplasia (CIN), and even leads to the occurrence of cervical cancer.

Inflammation is considered to be a predisposing factor for tumorigenesis and development.

(Curty et al., 2019). Gao et al. (Gao et al., 2013) were the first to systematically evaluate the relationship between vaginal microbiota and HPV infection and found that vaginal bacterial diversity in HPV-positive women was more complex and the composition of vaginal microbiota was different. A study (DI Pierro et al., 2021) demonstrated for the first time that oral Lactobacillus curlicus can change the state of CST and increase HPV clearance.

16. How can lactoferrin help with BV?

Lactoferrin can act as an immune modulator in situations where low amounts of vaginal lactobacilli and increased levels of endogenous anaerobic bacteria are present.

17. What else can lactobacilli do?

There is some evidence that L. crispatus can decrease the adhesion and invasiveness of N. gonorrhoeae through reducing the expression of genes responsible for pro-inflammatory cytokines like TNF-α and CCL20 in N. gonorrhoeae-infected epithelial cells (Płaczkiewicz et al., 2020).

There is a lot of research on the benefits of lactobacilli in fertility, obesity, metabolic syndrome and weight control, HIV, HPV and HSV infections. We can go into these details another time.

18. Can the probiotics do harm?

Since probiotics contain micro-organisms they can cause infections in susceptible individuals and this can happen in very sick patients.

19. I have been taking probiotics forever, why don’t I have any lactobacilli in my vagina?

Yes, that is indeed the million-dollar question. Multiple factors could be involved. Only some are listed below:

– The bad guys are so determined to be there that you need stronger and long term suppressive regimens while the health bacteria can take over.
– Your body’s immune system may be suppressed or under attack through inflammation or autoimmune conditions that are allowing the bad guys to linger.
– Your hormonal balance may be off. See above.
– You may have diabetes or high sugar. Bad guys love sugar and so does inflammation.
– Your lifestyle may not be allowing your vagina to breath.
– You many not be taking the right stuff (see above again) in appropriate quantities and consistently. We recommend multiple strains over atleast 50 billion CFUs twice a day with multiple strains for almost a year until you can see any noticeable changes.

Here is the Plea from you V that can serve as a guide for you!!

Be safe, be strong and be prepared.

Dr. Adeeti Gupta

References:

1. Wang Z, He Y, Zheng Y. Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis. International Journal of Environmental Research and Public Health. 2019; 16(20):3859. https://doi.org/10.3390/ijerph16203859
2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9024219/#:~:text=Increasing%20evidence%20show%20that%20specific,et%20al.%2C%202019).

3. Hanson L, VandeVusse L, Jermé M, Abad CL, Safdar N. Probiotics for Treatment and Prevention of Urogenital Infections in Women: A Systematic Review. J Midwifery Womens Health. 2016 May;61(3):339-55. doi: 10.1111/jmwh.12472. PMID: 27218592.

4. Arasu MV, Al-Dhabi NA, Ilavenil S, Choi KC, Srigopalram S. In vitro importance of probiotic Lactobacillus plantarum related to medical field. Saudi J Biol Sci. 2016 Jan;23(1):S6-S10. doi: 10.1016/j.sjbs.2015.09.022. Epub 2015 Oct 9. PMID: 26858567; PMCID: PMC4705246.

5. Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SS, McCulle SL, Karlebach S, Gorle R, Russell J, Tacket CO, Brotman RM, Davis CC, Ault K, Peralta L, Forney LJ. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A. 2011 Mar 15;108 Suppl 1(Suppl 1):4680-7. doi: 10.1073/pnas.1002611107. Epub 2010 Jun 3. PMID: 20534435; PMCID: PMC3063603.

6. https://ami-journals.onlinelibrary.wiley.com/doi/10.1111/jam.13438

7. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/vagina-flora

8. Mei Z, Li D. The role of probiotics in vaginal health. Front Cell Infect Microbiol. 2022 Jul 28;12:963868. doi: 10.3389/fcimb.2022.963868. PMID: 35967876; PMCID: PMC9366906.

The post Probiotics and vaginal health? Do they help and how! appeared first on Walk In GYN Care.

Read on as we break down the what, why, and how of this impressive herb and who can benefit from it.

What is Berberine?

Berberine is a plant alkaloid with a long history of medicinal use in both Ayurvedic and Chinese medicine. It is present in Hydrastis canadensis (goldenseal), Coptis chinensis (Coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric). The berberine alkaloid can be found in the roots, rhizomes, and stem bark of these plants.

When was it discovered and what has been going on since?

 The earliest record of Rhizoma Coptidis as a medicinal herb was in A.D. 200 in The Herbal Classic of the Divine Plowman (Shen Nong Ben Cao Jing). In about A.D. 500, the anti-diabetes activity of Rhizoma Coptidis was recorded for the first time in a book titled “Note of Elite Physicians.”

Most berberine used in medical practice is not extracted from this herb because of its high cost. Usually, it is prepared from other herbs such as Berberis amurense Rupr. and Phellodendron amurense Rupr. Among many chemical forms of berberine, i.e., berberine hydrochloride, berberine sulfate, berberine citrate or phosphate, berberine hydrochloride is the most common form.

A literature search of Berberine, its uses, mechanism of action, new developments, and delivery systems revealed over 10,000 results. I will try to narrow down the most relevant and easily digestible fragments to inform you of its uses, side effects, and much more.

What are some proven benefits of Berberine?

Recently, basic research has proven that berberine can be used to lower the blood glucose level (Liang et al., 2019), improve insulin resistance (Lou et al., 2011), improve hyperlipidemia (Li et al., 2016), and prevent mild cognitive impairment (Kumar et al., 2016). This feature improves the shortcomings of the combination of statins and metformin and shows potential as a new first-line treatment drug.

Here is a brief list of the purported and proven benefits of Berberine. In the following section, I will elaborate on the mechanisms that lead to these benefits.

1. Lower blood sugar – improve glycemic control in diabetics.
2. Improve metabolic syndrome parameters (weight, waist circumference, blood pressure and lipid profile).
3. Improve Polycystic Ovarian Syndrome (PCOS).
4. Antimicrobial properties that assists in fighting bacterial and other microbial gut and skin infections.
5. Improve lipid profile, especially LDL, HDL and Triglycerides.
6. Improvement in NAFLD (nonalcoholic fatty liver disease).
7. Reduce cognitive impairment in diabetics.

How does Berberine do the magic?

Glycemic control:

Several animal and human studies have shown Berberine’s unequivocal effects on glucose control. Here is how it helps:

1. Berberine activates AMP-activated protein kinase (AMPK).

AMPK is a key energy-sensing/signaling system in the cells and acts as a fuel gauge by monitoring cellular energy levels.

2) It has an insulin-independent hypoglycemic effect that is related to inhibition of mitochondrial function, stimulation of glycolysis and activation of AMPK pathway. In the newly-diagnosed type 2 diabetic patients, berberine is able to lower blood insulin level via enhancing insulin sensitivity. However, berberine may improve insulin secretion in patients with poor β-cell function by resuscitating exhausted islets.

This study confirmed that administration of berberine (0.5 g three times daily) at the beginning of each meal was able to reduce fasting blood glucose (FBG) and postprandial blood glucose (PBG) in patients with newly-diagnosed type 2 diabetes. Hemoglobin A1c (HbA1c) levels were dropped by 2.0%, comparable to the effect of metformin. In poorly-controlled diabetic patients with insulin injection, berberine reduced HbA1c by 0.8%.

In the first in vitro study using hepatocytes (HepG2 cell line), berberine was shown to stimulate glucose consumption in an insulin-independent manner, and the activity was similar to that of metformin. Several studies have confirmed the insulin-independent activity of berberine in other cell models e.g., muscle cells (L6 and C2C12 cell lines) and adipocytes (3T3-L1 cell line). In the presence of insulin, berberine exhibited a synergetic effect on insulin-induced glucose consumption and glucose uptake. It is unclear if Berberine acts through the GLUT receptors.

3) The antioxidant and aldose reductase inhibitory activities of berberine may be useful in alleviating diabetic nephropathy.

Oxidative stress and aldose reductase activities are closely related to diabetic complications. Several groups have explored the obvious beneficial effect of berberine in this field. In STZ and high-carbohydrate/high-fat diet induced diabetic rats with hyperlipidemia, berberine markedly decreased malondialdehyde level and increased catalase, superoxide dismutase, glutathione peroxidase, and glutathione activities. Berberine also improved cognitive performance, lowered hyperglycemia, oxidative stress, and choline esterase activity in diabetic rats.

4) Berberine was shown to protect against endothelial injury, enhance the endothelium-dependent vasodilatation, and downregulate proinflammatory responses through activation of the AMPK signaling cascade.

5) Berberine also acts as an α-glucosidase inhibitor. α-Glucosidase is an intestinal enzyme that breaks down carbohydrates into monosaccharides. Inhibition of the enzyme will lead to diminished absorption of dietary carbohydrates.

6) Berberine may have extra beneficial effects on diabetic cardiovascular complications due to its cholesterol-lowering, anti-arrhythmias and nitric oxide (NO) inducing properties.

Cholesterol-lowering effects

Berberine (BBR) was reported to improve lipid metabolism in both animals and human subjects. Two clinical trials showed that berberine decreased triglycerides by 35% and 22%, serum cholesterol by 29% and 16%, and LDL-C by 25% and 20% in patients with dyslipidemia.

Reduction of cholesterol with berberine is related to the induction of LDL receptor (LDLR) expression in liver, which may be due to extended half-life of LDLR mRNA via activation of extracellular signal-regulated kinases (ERK) by berberine.

The results in this study showed that Berberine (BBR) supplementation can significantly lower TC, TG, LDL, Fasting blood glucose (FBG), insulin, HbA1c, HOMA-IR, SBP, weight, BMI, and waist circumference (WC) and can elevate HDL. According to the subgroup analysis, Berberine supplementation in participants with normal BMIs (18.5–24.9) was ineffective for changing TG, TC, LDL, HDL, insulin, SBP, weight, BMI, and WC. The significant effects of Berberine on HDL and WC were only seen in doses of more than 1 g/day, on FBG and HOMA-IR in the durations of more than 8 weeks, and on HbA1c and weight in both mentioned higher subgroups of dose (>1 g/d) and duration (>8 weeks). Moreover, BBR was significantly effective in alleviating cardiovascular risk factors, mainly in subgroups with impaired metabolic health such as NAFLD, type 2 diabetes, and metabolic syndrome. In addition, BBR was effective for the improvement of LDL, HDL, and FBG only in subgroups with abnormal ranges (HDL ≤ 40, LDL > 100 mg/dl, and FBG > 100 mg/dl). The optimum dose for BBR was 1 g/day for TG, TC, and weight, 1.8 g/day for insulin and HOMA-IR, and 5 g/day for HDL. The most effective duration was 40 weeks for FBG and 50 weeks from the beginning of BBR supplementation for DBP and WC.

BBR is suggested to upregulate the expression of LDL receptors in the human hepatoma cell line (HepG2) and to inhibit both cholesterol and TG synthesis in the liver, dose-dependently. This effect of BBR on lipid synthesis is mediated by the mitogen-activated protein kinase (MAPK/ERK) pathway, and can also be owing to the decrease in proprotein convertase subtilisin/kexin type 9 (PCSK9) mRNA. PCSK9 downregulates the LDL receptor (LDLR) and BBR acts against it. Another mechanism of action for BBR could be that it is an agonist for AMPK, a fuel gauge. This activation leads to the inhibition of cholesterol and TG synthesis by inactivating two enzymes, β-Hydroxy β-methylglutaryl-CoA (HMG-CoA) and ACC (acetyl-coenzyme A carboxylase). AMPK activation also increases energy production hence normalizing the imbalance between glucose, lipid, and energy. This activation can also impose anti-inflammatory effects and can speed up the transport of glucose in the serum by promoting glucose transporter type 4 (GLUT4) translocation, although GLUT4 involvement is still unclear.

Antimicrobial and antioxidant activities of Berberine

 The antimicrobial activity of berberine is well-established in treatment of infection caused by bacteria, viruses, fungi, protozoans and helminthes.

This study showed a significant effect of Berberine against Staph Aureus. In this study, Berberine showed antimicrobial activity against all tested strains of MRSA. Minimum inhibition concentrations (MICs) of berberine against MRSA ranged from 32 to 128 µg/mL. Ninety percent inhibition of MRSA was obtained with 64 µg/mL or less of berberine.

The authors concluded that BBR reduced the antioxidant capacity of S. aureus. Accumulation of the precursors (UDP-GlcNAc, CDP-ribitol, and CDP-glycerol) and downregulation of the key metabolite D-Ala-D-Ala suggest the inhibition of cell wall synthesis, especially the peptidoglycan synthesis. Metabolites involved in the shikimate pathway (such as 3-dehydroshikimate) and downstream aromatic amino acid synthesis were disturbed.

Improvement in NAFLD (Non Alcoholic Fatty Liver Disease)

Since liver plays a central role in glucose metabolism, numerous studies focused on effects of berberine, especially in fatty liver disease. In newly diagnosed type 2 diabetics with nonalcoholic fatty liver disease as comorbidity, berberine obviously ameliorated liver steatosis in ultrasonic images, decreased AST and ALT, reduced hemorheology indicators, and improved lipids profile. Similar results were obtained in another study. Berberine lowered FBG effectively in chronic hepatitis B and hepatitis C patients with T2DM or impaired fasting glucose. Liver function was improved greatly in these patients as indicated by the reduction of liver enzymes. This data showed that hepatic steatosis was alleviated by berberine through inhibition of fatty acid synthase (FAS) expression. Berberine decreased fasting blood glucose by direct inhibition of gluconeogenic genes, phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G6Pase) in liver.

Complex I of the electron transport chain is the major place of superoxide production, and is the target of berberine.  The antioxidant activity of berberine may directly result from complex I inhibition.

Mitochondrial inhibition may play a key role in the activities of berberine such as preventing fatty liver, reducing blood glucose and decreasing blood lipids. The details of the regulation remain to be explored.

Evidence for effects on inflammatory markers and liver enzymes has been conflicting.

Improvement in Metabolic Syndrome

 The metabolic disorder includes a spectrum of conditions such as nonalcoholic fatty liver disease (NAFLD), type 2 diabetes, impaired glucose tolerance (prediabetes), polycystic ovarian syndrome (PCOS), and hyperlipidemia. Previous studies have demonstrated that metabolic disorders are prone to diabetic encephalopathy and atherosclerosis (Barenbrock et al., 1995), which will generate Alzheimer’s disease and coronary heart disease (Razay et al., 2007). NAFLD is closely related to type 2 diabetes and dyslipidemia (Marchesini and Babini, 2006). Characteristic changes in patients with metabolic disorders include a decrease in serum high-density lipoprotein (HDL) or an increase in serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), fasting plasma glucose (FPG), and homeostasis model assessment-insulin resistance (HOMA-IR).

In this study, the authors showed that berberine significantly reduced waist circumference and waist/hip ratio significantly in the absence of weight change. Similar results were also reported by other groups. It was indicated berberine may inhibit visceral fat accumulation. In diabetic rats, adipocyte size and the ratio of white adipose tissue to body weight were decreased, and adipocyte number was increased with berberine treatment.

Although berberine was shown to suppress fat accumulation, the current evidence on mechanisms is controversial.

Berberine may also reduce the risk of developing metabolic syndrome through its beneficial effects on the gut microbiota. In the last decade, many studies have indicated that the composition of gut microbiota is associated with the regulation of the host’s health and metabolism. Dysbiosis, defined as an alteration in the quality and/or quantity of the intestinal microbiota, can affect the host’s physiology and may be a factor that leads to the onset of various diseases, including obesity and T2DM, as well as cardiovascular diseases, Crohn’s disease, and cancer

 Berberine and cancer treatment

 Berberine has exhibited ability to suppress tumor metastasis (Lin et al., 2006; Serafim et al., 2008; Cai et al., 2014). Matrix metalloproteinases (MMPs) degrade the tissue matrix, allowing tumor cells to break through the normal tissue barrier and invade the surrounding normal tissue and distant organs. Berberine inhibits the release of MMP-2 from tumor cells and thus inhibits tumor cell destruction of the tissue matrix.

In vitro studies have demonstrated that the inhibition of FAK, IKK, NF-kB, u-PA, MMP-2, and MMP-9 significantly reduced metastasis.

How is Berberine absorbed in the human body?

Berberine exhibits poor absorption, efflux and extensive metabolism in the human gut.  The absolute bioavailability of berberine is far less than 1%. Accordingly, one of the approaches for improving berberine’s efficacy is through studying the a variety of formulations to improve its bioavailability from the gut.

Which formulations of Berberine are the best?

Honestly, we don’t know. Berberine HCL is the most commonly available preparation. There is explosive research in progress to figure out the best way to increase the bioavailability of Berberine.

One groundbreaking area is of nanoparticles. Nanoparticles are fat-loving particles that help in protecting a drug from the breakdown of gastric enzymes and transport the drug to the bloodstream. Various nanoparticle formulations are being used in cancer treatments.

Nanoparticle formulations that encapsulate berberine for sustained release and improved bioavailability include the use of polymeric natural (e.g., chitosan) and synthetic (PLGA, PLGA-PEG, etc.) agents. Others include a self-micro emulsifying berberine-phospholipid complex of polyethylene glycol 1000 succinate (TPGS 1000) and SiO₂, phytosomes loaded with berberine-phospholipid complex, solid lipid nanoparticles, micelles, liposomes of various nature, etc.

Berberine NPs produced by both APSP and EPN methods have shown promising activities against Gram-positive and Gram-negative bacteria, and yeasts, with NPs prepared through the EPN method showing superior results compared to those made with the APSP method and the unprocessed drug.

So, now we know that Berberine is a magical herbal supplement. What are the negatives or side effects?

Berberine is clinically safe and well-tolerated by the human body. Few adverse reactions are reported, and no negative effect is observed on participants’ diet.

In this study, none of the patients suffered from severe gastrointestinal adverse events when berberine was used alone. In combination-therapy (Metformin + Berberine) the adverse events disappeared in one week after reduction in berberine dosage. The data suggest that berberine at dosage of 30mmg three times daily is well tolerated in combination therapy. Liver and kidney functions were monitored in this study. No significant changes in plasma ALT, γ-GT and creatinine were observed during the 13 weeks of berberine treatment.

It is recommended that Berberine be taken with food and if possible use gastroprotective coated formulations.

As always, please consult your health care practitioner who has knowledge about the mechanism of action of such herbal preparations and their possible interactions with any medications that you might be on. The quality of the preparation that you decide to take also matters.
Feel free to orders yours through this link to take advantage of our patient discount codes.

If you need a functional (holistic) approach to your PCOS, weight or any related or unrelated issues, feel free to schedule a functional consult here.

As always..

Be safe, be prepared and be ready,

Dr. Adeeti Gupta

References:

Yin, J., Ye, J., & Jia, W. (2012). Effects and mechanisms of berberine in diabetes treatment. Acta Pharmaceutica Sinica B, 2(4), 327-334. https://doi.org/10.1016/j.apsb.2012.06.003

Yin, J., Ye, J., & Jia, W. (2012). Effects and mechanisms of berberine in diabetes treatment. Acta Pharmaceutica Sinica B, 2(4), 327-334. https://doi.org/10.1016/j.apsb.2012.06.003

Zamani M, Zarei M, Nikbaf-Shandiz M, Hosseini S, Shiraseb F, Asbaghi O. The effects of berberine supplementation on cardiovascular risk factors in adults: A systematic review and dose-response meta-analysis. Front Nutr. 2022 Oct 14;9:1013055. doi: 10.3389/fnut.2022.1013055. PMID: 36313096; PMCID: PMC9614282.

Ye Y, Liu X, Wu N, Han Y, Wang J, Yu Y, Chen Q. Efficacy and Safety of Berberine Alone for Several Metabolic Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Front Pharmacol. 2021 Apr 26;12:653887. doi: 10.3389/fphar.2021.653887. PMID: 33981233; PMCID: PMC8107691.

Front. Pharmacol., 15 January 2020
Sec. Ethnopharmacology
Volume 10 – 2019 | https://doi.org/10.3389/fphar.2019.01461

Comincini S, Manai F, Sorrenti M, Perteghella S, D’Amato C, Miele D, Catenacci L, Bonferoni MC. Development of Berberine-Loaded Nanoparticles for Astrocytoma Cells Administration and Photodynamic Therapy Stimulation. Pharmaceutics. 2023; 15(4):1078.

Wu S, Yang K, Hong Y, Gong Y, Ni J, Yang N, Ding W. A New Perspective on the Antimicrobial Mechanism of Berberine Hydrochloride Against Staphylococcus aureus Revealed by Untargeted Metabolomic Studies. Front Microbiol. 2022 Jul 13;13:917414. doi: 10.3389/fmicb.2022.917414. PMID: 35910599; PMCID: PMC9328669.

Och A, Och M, Nowak R, Podgórska D, Podgórski R. Berberine, a Herbal Metabolite in the Metabolic Syndrome: The Risk Factors, Course, and Consequences of the Disease. Molecules. 2022 Feb 17;27(4):1351. doi: 10.3390/molecules27041351. PMID: 35209140; PMCID: PMC8874997.

Jun Yin, Jianping Ye, Weiping Jia: Effects and mechanisms of berberine in diabetes treatment, Acta Pharmaceutica Sinica B, Volume 2, Issue 4, 2012.

Zhao, J., Wang, Z., Karrar, E., Xu, D., & Sun, X. (2022). Inhibition Mechanism of Berberine on α-Amylase and α-Glucosidase in Vitro. Starch – Stärke, 74(3-4), 2100231. https://doi.org/10.1002/star.202100231

Xing, L., Zhou, X., Li, A., Li, H., He, C., Qin, W., Zhao, D., Li, P., Zhu, L., & Cao, H. (2021). Atheroprotective Effects and Molecular Mechanism of Berberine. Frontiers in Molecular Biosciences, 8, 762673. https://doi.org/10.3389/fmolb.2021.762673

Ma, X., Chen, Z., Wang, L., Wang, G., Wang, Z., Dong, X., Wen, B., & Zhang, Z. (2017). The Pathogenesis of Diabetes Mellitus by Oxidative Stress and Inflammation: Its Inhibition by Berberine. Frontiers in Pharmacology, 9. https://doi.org/10.3389/fphar.2018.00782

Koppen, L. M., Whitaker, A., Rosene, A., & Beckett, R. D. (2017). Efficacy of Berberine Alone and in Combination for the Treatment of Hyperlipidemia: A Systematic Review. Journal of Evidence-based Complementary & Alternative Medicine, 22(4), 956-968. https://doi.org/10.1177/2156587216687695

Yu HH, Kim KJ, Cha JD, Kim HK, Lee YE, Choi NY, You YO. Antimicrobial activity of berberine alone and in combination with ampicillin or oxacillin against methicillin-resistant Staphylococcus aureus. J Med Food. 2005 Winter;8(4):454-61. doi: 10.1089/jmf.2005.8.454. PMID: 16379555.

Koperska, A., Wesołek, A., Moszak, M., & Szulińska, M. (2022). Berberine in Non-Alcoholic Fatty Liver Disease—A Review. Nutrients, 14(17). https://doi.org/10.3390/nu14173459

Ye Y, Liu X, Wu N, Han Y, Wang J, Yu Y, Chen Q. Efficacy and Safety of Berberine Alone for Several Metabolic Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Front Pharmacol. 2021 Apr 26;12:653887. doi: 10.3389/fphar.2021.653887. PMID: 33981233; PMCID: PMC8107691.

Lou T, Zhang Z, Xi Z, Liu K, Li L, Liu B, Huang F. Berberine inhibits inflammatory response and ameliorates insulin resistance in hepatocytes. Inflammation. 2011 Dec;34(6):659-67. doi: 10.1007/s10753-010-9276-2. PMID: 21110076.

Petrangolini, G., Corti, F., Ronchi, M., Arnoldi, L., Allegrini, P., & Riva, A. (2020). Development of an Innovative Berberine Food-Grade Formulation with an Ameliorated Absorption: In Vitro Evidence Confirmed by Healthy Human Volunteers Pharmacokinetic Study. Evidence-based Complementary and Alternative Medicine : ECAM, 2021. https://doi.org/10.1155/2021/7563889

Javed Iqbal, M., Quispe, C., Javed, Z., Sadia, H., Qadri, Q. R., Raza, S., Salehi, B., Abdulwanis Mohamed, Z., Sani Jaafaru, M., & Abdull Razis, A. F. (2021). Nanotechnology-Based Strategies for Berberine Delivery System in Cancer Treatment: Pulling Strings to Keep Berberine in Power. Frontiers in Molecular Biosciences, 7, 624494. https://doi.org/10.3389/fmolb.2020.624494

Yin, J., Xing, H., & Ye, J. (2008). Efficacy of Berberine in Patients with Type 2 Diabetes. Metabolism: Clinical and experimental, 57(5), 712. https://doi.org/10.1016/j.metabol.2008.01.013

Zhang, C., Sheng, J., Li, G., Zhao, L., Wang, Y., Yang, W., Yao, X., Sun, L., Zhang, Z., & Cui, R. (2020). Effects of Berberine and Its Derivatives on Cancer: A Systems Pharmacology Review. Frontiers in Pharmacology, 10, 481416. https://doi.org/10.3389/fphar.2019.01461

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We know how frustrating it is to get those bills that we were not expecting. Yes, we know…You pay almost $900 per month for your insurance plan and you just got hit by a $1000 bill! WHY???

Health care financial FAQs

Read on as we attempt to simplify and break down the complicated world of health insurance…..

What does a covered service mean?

This simply means that your insurance carrier has agreed to cover the service. It can be confusing because “covered” statement can imply that you are no longer responsible for the charges associated with the service. “Covered” simply means that your insurance carrier agrees that the service provided is within the scope of the contract between the insurance carrier and the practice.

How come I still got a bill from the practice even though the services are stated as “covered”?

The bill that you receive could be due to any of the below reasons despite the service being covered.

Co-pay: Your particular plan may have a certain amount of co-pay associated with different types of visits. For example, you may have differing co-pays for an office visit with a specialist, a primary care physician, an ER visit or a hospital visit.

Co-insurance: This is another caveat that you may not know about. Certain plans pass on a portion of financial responsibility to you as a subscriber in the form of co-insurance. This amount may also vary according to the type of visit as above and according to the type of plan.

Deductible: Most insurance carriers have a certain amount of deductible that is required to be met before they start paying out towards your visits. Just like when you have car insurance and you get into an accident. For example, if your plan has a deductible of $5000 and your car repair bill comes out to be $15,000. You will need to pay $5000 out of your own pocket first and then the insurance carrier will be the remaining $10,000. This seems unnerving and scary. However, that’s how the insurance industry works and tries to give you low-cost plans by keeping high deductibles.

You can choose to keep your deductible low by paying a higher monthly premium. It is a choice that you have to make. If you are a healthy young person who might not need a lot of visits with your doctor, you may choose a low premium, high deductible plan.

On the other hand, if you have multiple health conditions that require frequent visits, multiple medications etc., then you may choose a high premium, low deductible plan.

Ultimately, there are no free lunches in the world and you will be financially responsible for some portion either way unless you are eligible for a completely government funded plan such as straight Medicaid. Eligibility for straight Medicaid depends on your income level, number of dependents and your particular state.

My employer pays for my insurance. Why do I still get a bill?

The affordable care act made it mandatory for your employer to contribute a certain amount towards your health care costs. The employer responsibility varies from the size of the company, the type of company and may also depend on state specific laws.

Most employers will cover a portion of your health care premium and deduct the employee portion from your salary. You will see that as a line item in your pay-stub. Remember to ask your HR department at the time of onboarding to understand your contribution vs. your employer’s contribution.

I received a “bill” from my insurance? It states that this is an EOB. What is an EOB?

Insurance company never sends you a bill. They send you something called an EOB.

An EOB stands for “Explanation of Benefits”. Read carefully, at the bottom of that statement, there will be something that states, “This is not a bill”.

It is simply a statement explaining the below items:

• Charges billed by your provider to the insurance: These are sometimes quite high but this does not indicate how much the provider gets paid.
• Amount the plan paid your provider.
• Amount not covered by the plan (you may or may not be responsible for this portion depending on your particular plan).
• Amount you owe your health care provider: Again, this depends on your particular plan.

Remember this is only a statement; you will receive a separate bill from your health care provider or the lab if you owe something according to your specific plan. Do not pay the insurance carrier for this. Wait for a bill. If you have questions regarding your EOB, you should call your insurance carrier directly.

Why do I get surprised by these high amounts of extra charges coated in the guise of copay, co-insurance and deductible even though I pay a huge amount of premium towards my health insurance every month?

Well, that’s because the insurance companies are trying to offer you a range of plans that you can afford. Unfortunately, everything comes with a cost. If you have a low-cost plan with a low monthly premium, your deductible and co-insurance might be very high. In such cases, you better hope that your car doesn’t get into accident or you don’t get sick. However, health care can be tricky and almost all of us will require to seek care at some point in our lives. All you can do is be fully aware of the fine print that states the charges that you might be responsible for in addition to your monthly premium.

Sample insurance worksheet. Pay careful attention to yours.

I was told that I get a “free” visit once a year. What does that mean?

During the implementation of the Affordable Care Act, there was heavy emphasis on coverage of a preventative care visit or a wellness visit for all patients. All insurance carriers were required to build coverage for these visits in their plans.

An annual/ free or a wellness visit with a gynecologist usually does not have an associated co-pay. It covers only below items:

• Pap test

• Contraception counseling (counseling only – actual birth control may or may not be covered).

• STD testing.

The biggest thing to remember is that the “free” part only applies to the visit, not to the cost of your prescription, lab tests etc.

You may still have co-insurance or deductible applicable towards the lab fees or prescription costs. Your health care provider has no way of knowing which lab charges will or will not be paid for by your carrier.

If you have any additional problems that require attention such as fibroids, irregular periods etc., you will be required to pay a co-pay and may require a separate visit.

Why can’t the healthcare provider bill my visit as a “preventative visit” so that my insurance can cover it a 100%

As mentioned above, any issue other than a pap, STD testing and contraceptive counseling is not a part of the preventative visit. The provider cannot commit fraud by not billing appropriately for the services rendered.

Each problem and each service has certain codes and the insurance company will decide reimbursement accordingly.

In fact, many health care providers may not address any additional problems at the time of a preventative visit and ask you to make a separate appointment since they may not get reimbursed for the additional issues discussed.

I keep getting bills. Where are they coming from?

You just went to the doctor or were at the hospital. You can get bills from many places.

Doctor’s office or the hospital bill

This will be an actual bill that you will need to pay. The breakdown of charges, insurance payments, adjustments may or may not be listed there. You may see a high amount listed under “charges”. That is not what the doctor or the hospital got paid. You will see the service fees listed usually in the far right column.

Lab Bill

The lab gets paid by your insurance separately. The lab has nothing to do with your doctor’s or the hospital bill. Your insurance plan may have different copays and deductibles for lab tests. You need to be aware of these costs yourself. Do you own research. A Covered test does not mean that you will not be responsible for your plan’s deductible or co-insurance.

I have a large bill. I asked my doctor to give me discount but they said they can’t. Why?

The health care provider has a contract with each insurance company. The insurance company decides the exact amounts that they will pay the provider based on that contract. It doesn’t matter what the provider charges, the insurance will pay only the contracted amount.

It is the responsibility of the health care provider to collect the contracted amounts (as applicable via the copay or deductibles). If the provider does not collect the balance payment, the insurance company and the law can construe that as a bribe. That is illegal and a breach of contract. Hence, once the insurance company has been billed, the claim has been processed and the bill has been generated, the health care provider cannot waive the bill.

The health care provider can help you with a payment plan depending on their rules.

How can I avoid large bills if I have a high deductible?

You have a choice to use your insurance or not. If you do not want to get a large bill due to a high deductible, you can choose not to use the insurance and just pay cash for the services.

Why doesn’t the doctor take my insurance?

The in-network participation status of your health care provider depends on many factors. Some insurance companies have a lot of providers so they close the networks for new providers. In other cases, the health care provider may not want to be in-network with certain insurances due to low reimbursements, delayed payments, denials etc. There is not much you can do but find an in-network health care provider if you want to use your insurance. You cannot force this on your provider.

I have out of network benefits. Can I see whoever I want?

If you have out of network benefits then you may be able to see the provider you want. In that case, you may receive the reimbursement check directly. It is your legal responsibility to provide that check to your provider. Alternatively, the health care provider may take fees from you upfront. Then you will get reimbursed either the entire amount or a portion from your insurance company.

Why does my insurance require prior authorization for certain drugs or tests?

The insurance carriers place limits on various tests and prescriptions to keep their costs low. They will want you to have tried generic or lower cost medications before they can approve more expensive or branded medications.

Same applies to diagnostic testing. For example, even though your plan may state that they cover annual mammograms, they might not cover breast sonograms (or ultrasounds) which may be needed if you have dense breasts or a suspected mass on a screening mammogram. In that case, they will require prior authorization for that additional testing.

Whose responsibility is it to get prior authorizations?

Some practices will assist in obtaining prior authorizations as a courtesy to their patients. However, it is not entirely under their purview to do so. You as a patient may have to get the test or medication approved by your insurance carrier yourself by providing proof as requested.

Why do I have to pay when I go to pick up my prescription even though I paid a co-pay at my doctor’s visit and pay a monthly premium?

Again, these are fine print costs that many are not aware of when signing up for a plan. Your pharmacy benefits may be entirely different from your office visit benefits.

How can I be a more informed consumer?

• READ: Read your entire benefits plan.
• LOOK: Be on the look-out for each of the below fees or percentages associated with each type of visit. Build your own cheat sheet as below.
• SHOP: Shop the market place and compare the below items and not just go for the lowest monthly premium.
• ASK: Ask questions: You are paying for your plan. You have the right to ask questions and reach out to your carrier.

We are living in a very confusing place. There are hundreds of insurance carriers and each one of them have hundreds of sub-plans. Last year on NY market place alone, there were 1700 plans to choose from. It is almost impossible for you to be able to understand the fine print and nuances for each of them. However, having some basic knowledge will make you a more informed consumer and prepare you for this mind-boggling arena.

Be safe, be strong and be prepared,

Dr. Adeeti Gupta and the Walk IN GYN Team

The post Co-Pays – Deductibles – Well visits.. Insurance FAQs appeared first on Walk In GYN Care.

WHAT

The symptoms of PCOS vary from zero to a hundred. PCOS is a spectrum and the pendulum swing can be controlled by the correct combination of natural, lifestyle and pharmaceutical approaches.

Various national and American educational societies have several classification criteria for PCOS diagnosis. The most commonly used criteria used are the Rotterdam Criteria. If any two of the three symptoms or signs are present then a diagnosis of PCOS can be made. The three criteria are hirsutism (excessive hair growth in unwanted areas), irregular periods, and polycystic ovaries on ultrasound.

That being said, PCOS is a syndrome and is always on a pendulum. The pendulum can swing from no symptoms to all the symptoms.

The picture can range from irregular periods, weight gain, excessive hair growth in unwanted areas, trouble losing weight, infertility, depression, low libido, pelvic pain, bloating, and much more.

WHY

 An imbalance between estrogen and progesterone with or without high testosterone levels can occur during PCOS. This, in combination with insulin resistance puts you at a higher risk of diabetes, causes difficulty in losing weight, and makes you lose your body shape.

What comes first? We still don’t know.

New research shows that these imbalances can be caused by some inherent changes in our genome. On top of that several environmental toxins called Xenoestrogens may either trigger PCOS or make things way worse. Xenoestrogens are chemicals that are commonly found in plastics, detergents, pesticides, perfumes, and even food. They go into our body and cause symptoms of excessive estrogen which in turn worsens PCOS.

WHO

Any female can be affected by PCOS. Some ethnicities or populations may have a higher incidence than others.

WHEN

Many females may start having symptoms as they go through puberty while many others develop symptoms later on in life at any age.

HOW

How can we fix it?

There are several strategies. It can be controlled or reversed but needs a multi-pronged approach. The superstar of this approach has to be a lifestyle and diet change.

In addition, there are several alternative herbal therapies and branded medications that can help.

What is Metabolic Syndrome and how do I know I have it?

Metabolic syndrome is a group of clinical findings. You do not need to have all of the characteristics to have it. However, a person with one clinical sign is more likely to have others. Most expert groups define metabolic syndrome as the presence of three or more of the following characteristics in a person:

• Obesity, especially in the abdominal area (defined by some groups as a waist size greater than 94 to 102 cm (38 to 41 in) in men or greater than 80 cm (32 in) in women)
• Impaired fasting glucose (fasting blood sugar of 100 to 125mg/dLor 5.6 to 7 mmol/L)
• Increased blood pressure(130/85or higher) or if you take medicine for high blood pressure
• Increased fasting levels of triglycerides (bad cholesterol).

What increases my risk of developing Metabolic syndrome? Can I avoid it?

The following factors are thought to increase the risk of developing metabolic syndrome:

• Being overweight (body mass index of 25kg/m²or more)
• Menopause (in women)
• Increasing age
• Smoking
• Eating a high carbohydrate diet
• Lack of physical activity
• Family history of diabetes or metabolic syndrome.

Yes, by carefully monitoring your diet and having an active exercise regimen, you may be able to avoid the florid clinical manifestation of metabolic syndrome.

What are the long-term health risks of metabolic syndrome?

Diabetes — Type 2 diabetes is much more likely to develop among people with the metabolic syndrome. Healthy lifestyle changes, such as weight loss and exercise, can help to reduce the risk of developing type 2 diabetes.

Heart disease— People with metabolic syndrome are at increased risk for developing cardiovascular disease. Cardiovascular disease includes coronary artery disease (collections of fatty plaques inside the heart’s blood vessels), cerebrovascular disease (collections of fatty plaques inside the blood vessels leading to the brain), and high blood pressure. Cardiovascular disease can lead to heart attack, stroke, or angina (chest pain).

Can I get tested for PCOS or metabolic syndrome? How do I know I have it?

The metabolic syndrome is diagnosed based upon a physical exam and a blood test of your fasting (before breakfast) blood sugar, cholesterol, and triglyceride levels.

Your doctor will check your weight, blood pressure and perform a full physical exam

Your doctor will also run some blood tests to check your fasting cholesterol, blood glucose, liver function and HbA1c. Checking fasting Thyroid hormone levels is also helpful because sometimes-slow thyroid (hypothyroidism) can look clinically like metabolic syndrome. Slow thyroid can be easily fixed by thyroid hormone supplementation. We may also check other hormones such as estrogen, progesterone, cortisol, DHEA and 17 hydroxy progesterone.

Remember that many times, especially if you are in the early stages of PCOS your blood work may be completely normal. In that case, you still need to proceed with the full-service approach to avoid progression into full-blown PCOS with advancing age.

Is one exercise regimen better than another?

Endurance exercise is an effective strategy to prevent muscular insulin resistance. A new study published in the Journal of Physiology demonstrates that exercising in the fasting state is more effective than exercising after eating a meal. Again, it’s all about balance. Several strategies can be used to assist with endurance and aerobic exercise that can increase longevity and improve insulin sensitivity.

I have a very busy schedule and I don’t have time to exercise, can I just get liposuction?

Removal of abdominal adipose tissue with liposuction does not improve insulin sensitivity or risk factors for coronary heart disease, suggesting that the negative energy balance induced by diet and exercise is necessary for achieving the metabolic benefits of weight loss.

PHYSICAL, SOCIAL AND MENTAL WELLNESS PLAY KEY ROLES IN HELPING WOMEN GAIN VICTORY OVER PCOS

We and designed a comprehensive approach called the ‘LAMPS” approach.

L- Lifestyle: Diet/ exercise and routine

Studies have shown that even 10-15 lbs. of weight loss can help regulate the periods. Lifestyle changes such as diet, exercise and weight loss will help regulate periods even without medical therapy.

A-Alternative medicine: Herbal and natural supplements

A customized plan incorporating natural herbal remedies can help you in swinging the pendulum to the left. The process can seem daunting and slow at first. We specialize in a comprehensive functional approach to PCOS and we have seen amazing results without the use of medication while avoiding the side effects of traditional pharmaceutical drugs.

M- Mental wellness:

Reducing stress, increasing mindfulness, and focusing on self-care go a long way. Remember, our brains are connected intricately with the ovaries and adrenals. Stress and elevated cortisol can affect the delicate hormonal balance and influence the estrogen/ progesterone balance.

P-Pharmacological approach:

Medications such as oral contraceptive pills, metformin and spironolactone are the traditional medical approaches to managing PCOS.

S-Social wellness:

You are not alone. Surrounding yourself with friends and family who bring positivity into your life is key. Get out of negative situations if it is safely possible. And if it is not possible then at least start planning and taking baby steps towards a better situation. Feel free to utilize our framework tool kit to assist you with your journey.

WHERE SHOULD I START?

• Get your regular GYN check up and talk to your provider.
• Functional approach: If you are suffering from multiple symptoms and can’t figure out why, feel free to reach out to us for a holistic consult here.
• Support group: If you are already getting care and are in need of a support group, we host monthly sessions where we get a cohort together to try and assist you with the complexities of PCOS.
• Custom packages: Because PCOS has multiple causes, it cannot be fixed by one approach. Hence, we have designed customized packages that include a multipronged approach so you can achieve good outcomes with a guided journey.

As always, we are here to help. Here is a quick video where I explain the basics of PCOS.

Be safe, be strong and be prepared.

Dr. Adeeti Gupta

The post PCOS Explained! appeared first on Walk In GYN Care.

In the past few years, I have been researching simple tools that can assist me, my team, and my patients in getting objective feedback. Years of rigorous research, participation in stellar leadership programs, and many workshops have led me to the same conclusion.

Honest self-reflection is our superpower.

Journaling is a release but also a form of self-feedback. There are a million journaling tools and self-help books out there. However, in today’s busy world, the thought of sitting down to pen (or type) your thoughts seems like a daunting task. After experimenting with variations of daily, weekly, monthly notes, feedback sessions, and goal settings, etc., I adopted this simple check-in system for myself and my team. Varying schools of philosophy have inspired the tools in the upcoming pages. The common theme aligns with the core concept that the “power of self” is key!!

Whether you are a CEO, manager, coach, student, or someone who simply needs a little structure to your life, you will find this a powerful ally.

This simple, easy three-step self-feedback loop is a formidable instrument in your journey to be a better leader, partner, coworker, or a saner, more peaceful you!

I have used it every day before bedtime for over three years, as have many of my friends and coworkers. Because it takes less than two minutes and has been so potent, I decided to formalize the system and share it with the world. This toolkit does not bind you by dates or years. You can pick it up and start anytime.

Just be transparent with yourself! Take a day to look back at a random page. If you have already overcome that obstacle, then celebrate that win. If the primary challenge still lingers, let this toolkit assist you with “solutionizing.”

You will find weekly quotes. Many are from traditional texts, philosophers, or my favorite books. Those that do not have any labels are my creations or adaptations of life mantras that have helped me thus far.

You can order your copy here  or at https://www.amazon.com/Reflection-REFLECT-YOUR-SANER-STRONGER/dp/B0BW23B57X/ref=sr_1_3?

Or simply ask our front desk for one if you plan to visit any of our offices.

So, please enjoy the path to freedom, success, and peace.

…………Dr. Adeeti Gupta

The post REFLECTION: Reflect your way to a saner, stronger you! appeared first on Walk In GYN Care.

• What is really going on?
• What is PMS?
• When do you need to seek help?
• How to manage it?
• Are anti-depressants the answer??

Read on to learn what PMS or PMDD is and how you can feel better so you can go on and be the rockstar that you are!

What is PMS?

PMS is a basket full of physical and emotional symptoms that are;

• cyclical
• appear 7-10 days before your period and then resolve when the period comes.
• symptoms can vary anywhere from;
  • bloating
  • weight gain
  • fatigue
  • depression
  • irritability
  • mental fog
  • sleeplessness,
  • low sex drive
  • worsening migraines
  • stomach issues
  • acne
  • allergies and so much more.

What is PMDD?

 Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS that affects your lifestyle and interferes with your ability to function and perform your daily activities.

 Who gets PMS or PMDD?

• Over 70% of cycling women report some symptoms of PMS.
• However, clinically significant symptoms of PMS occur in nearly 30% of women and 2-3% of women suffer from clinical PMDD.
• The symptoms are often underreported because women often suffer in silence.

Who is at risk?

Everyone and anyone who gets periods can get these symptoms since PMS symptoms are associated with menstrual cycles. Read on as we explain the mechanism below.

• Overweight or obese women may have a slightly higher risk.
• Life changing events such as child birth, the loss of a loved one, a job or a significant change can also trigger the onset of PMS symptoms.

Why does PMS happen?

There are many proposed theories. Recent studies suggest some of the below mechanisms:

• High estrogen throughout the cycle or an improper fall in the cycle.
• Improper rise of progesterone in the second half of the cycle after ovulation.
• Serotonin imbalance happening due to abnormal FSH and LH pulses controlling the menstrual cycle.

What happens in a normal menstrual cycle and what happens in PMS?

A normal full menstrual cycle is counted from the day the period starts until the beginning of the next period. Normally, it can range from 25-35 days.

Days 1-12

The first day of bleeding is counted as Day 1:

• As the period starts, the estrogen levels slowly start to rise under the influence of the brain hormone called FSH.
• The estrogen helps prepare the uterine lining develop a nice cushy base in case a pregnancy may occur in the cycle.
• The estrogen also tells the premature eggs in the ovary to start prepping and getting one of the eggs ready for ovulation.
• This goes on for about 12-14 days (depending on the cycle duration).

Days 12-14

Around day 12, the other hormone called LH starts to rise:

• This is a signal for the ovary to get ready for ovulation.

Days 14-28

Around day 14, both the LH and FSH levels drop:

• This triggers ovulation.
• Ovulation simply means that the one fully developed egg is released from the ovary into the pelvis.
• Some women may experience a sharp pain called mittelschmerz at this time and some may not experience anything.
• This is the time that the sperm will need to find the mature egg and go and fertilize it. Hence, timing is critical in case you want to conceive.
• Once the FSH and LH levels drop, the egg is released.
• Simultaneously, the estrogen levels also drop.

This takes us into the second half of the menstrual cycle.

• At this point, the progesterone levels start to rise slowly.
• The progesterone peaks at around day 22-24 and then declines slowly.
• At the same time, estrogen rises slowly again but this time, it’s levels are much lower.

Around Day 25 to Day 28:

• The estrogen and progesterone levels drop suddenly.
• The sharp drop in the levels, triggers the period and the soft and cushy uterine lining sheds which forms your period.

Then cycle starts all over again….

So, what happens in PMS?

Any of the steps in the above sequence may be off…meaning they may not be happening enough or may not be in sync.

You may experience PMS symptoms if:

• If the progesterone in the second half of the cycle not enough or;
• The progesterone does not rise at the right time or;
• Estrogen does not fall correctly;
• Estrogen dominance symptoms include, weight gain, bloating, breast tenderness and mood changes etc.

Why do the above abnormalities in the hormonal patterns occur?

This is because our bodies are an intricately connected web system. Hormones are produced by the brain, adrenals, fat cells, ovaries etc. can be affected by any small change.

Small changes can be such as;

• physical or emotional stress
• dietary imbalances
• medical conditions
• genetic imbalances (SNPs)
• nutrient deficiencies and so much more
• Incorrect timing or strength of hormonal rhythm can create messy cacophony instead of a well synchronized musical orchestra.

How can we diagnose PMS or PMDD?

Mainly by symptoms!

If the symptoms are:

• Cyclical
• Relieved with the period
• Strong enough to affect your day-to-day function, relationships and productivity then you probably have something going on!

What tests can be done to diagnose or confirm PMS?

1. Hormone testing

Saliva test:

• Doing a full 28-day hormonal testing through the saliva can provide us with a window into what might be happening your body.
• This test is specialized and is still not a “mainstream” test.
• It is done by specialized labs and is mostly not covered by your insurance.

Blood test:

• A baseline blood test to check all the hormones including thyroid hormones helps find anything else that might be causing similar symptoms.
• However, a blood test only gives us a very tiny glimpse into the hormonal complex.
• One test cannot show if you have estrogen – progesterone – LH – FSH imbalance.
• Blood test results will vary depending on when the tests were done in you cycle as described above.

How can we fix PMS?

As always, we recommend a full comprehensive LAMPS approach? There is no one size fits all wonder drug. It requires a customized approach for each and every one of you.

Let’s break down the components of the LAMPS approach that will help you kick the PMS butt!

• L- Lifestyle
• A- Alternative medicine
• M- Medications
• P- Physical health
• S – Social health

L-LIFESTYLE

Foods

1. Magnesium rich foods help regulate the smooth muscle relaxation and blood flow thus relieving some PMS symptoms. These include:
   • Green leafy vegetables such as spinach.
   • Avocadoes
   • Lentils
   • Green beans
   • Wheat germ
   • Oat bran

2) Diuretic foods help reduce swelling, water retention and improve bloating and breast tenderness.

• • • Parsley
    • Strawberries

3) Estrogen dominance fighting foods help promote healthier processing of estrogen in our liver and gut. These include:

• • Cruciferous vegetables such as cauliflower, brussels sprouts and cabbage etc.
  • Cilantro
  • Thyme

4) Caffeine restriction and reducing salt intake helps with PMS symptoms such as bloating and swelling.

Eating patterns

1. Do not skip meals.
2. If practicing intermittent fasting, have a healthy, high protein (or fat) breakfast.
3. Drink 10-15 glasses of plain water all day.
4. Have consistent eating patterns.
5. Develop consistent sleep-wake cycles.

A-ALTERNATIVE APPROACH

Various herbal regimens and supplements can assist with the symptoms of PMS.

Below are some specific recommendations that have shown to assist with relief of PMS symptoms:

1. Evening primrose oil
2. Magnesium glycinate or threonate
3. Omega 3
4. Vitamin D
5. Calcium
6. Vitamin A
7. Chasteberry
8. Black cohosh
9. B- vitamins
10. Folate, specifically methylated folate

Please do not take the herbal supplements without supervision since some of them may interact with your medications or cause other symptoms such as abnormal bleeding etc.

We can assist and customize the list for you.  

M- MEDICATIONS

1. Progesterone (Bio-identical)

• Progesterone supplementation during the second half of the cycle (after ovulation) can help markedly relieve symptoms such as mental fog, irritability, fatigue etc.
• A full 28-day salivary test can help customize exactly how much you need and when.

2. Antidepressants

• Antidepressants such as Lexapro, Zoloft or Wellbutrin etc. can give you short term relief.
• We do not recommend these for relief of PMS or PMDD due to long term side effects such as;
  • Dependence
  • Weight gain – which can lead to more estrogen production and which can worsen the underlying hormonal imbalance.
  • Water retention
  • Mental fog
  • Fatigue
  • Low libido

P – PHYSICAL HEALTH

1. Rest and relaxation is key.
2. Get at least 8 hours of sleep if possible.
3. Do a meditative practice 3 days a week.
4. Practice slow, contemplative exercise such as yoga 2-3 times a week.
5. Aerobic exercise 3 times a week has been shown to improve the symptoms of PMS.

Need a guided weekly plan?  We can help!

S – SOCIAL HEALTH

• Think positive.
• You are not alone.
• Get a PMS buddy and have daily – weekly- monthly check-ins.
• Have a shutdown protocol.
• Have a wake-up ritual
• Try a consistent sleep-wake cycle.

Key take aways!!

PMS is not a disease

You are not broken

You are not crazy

You are not alone

There is help out there. We can assist you with a custom functional medicine and lifestyle approach. Just ask!! Watch the full video here. 

Be safe, be strong and be prepared!

Walk In GYN Team

The post PMS – PMDD: No! You are not crazy!! appeared first on Walk In GYN Care.

Do we stock IUDs or order them?

In the United States, IUD’s are considered a pharmaceutical drug. Hence, they are only stocked or dispensed through either pharmacies or designated medical facilities.

What is “buy and bill”?

This means that the medical facility will buy the IUD from the manufacturer and then bill the patient’s insurance.

Why don’t all offices buy and bill for IUDs?

The approximate costs of IUDs vary from between $800-1000. If we purchase the IUDs upfront then we first have to pay this amount to the manufacturer without any guarantee of reimbursement.

To complicate things further, the insurance company may not cover the full cost of the IUD or they may apply a portion to you as a co-pay, co-insurance or a deductible. Either way, the medical office has a high chance that they will lose money in this process.

Hence, due to already tight financial conditions being faced by us in an effort to keep our doors open, we do not participate in the “buy and bill” program.

Why does my plan cover only “buy and bill” and not allow the pharmacy to purchase the IUD and deliver it to the medical office if the cost to the insurance is the same?

That’s a great question and that is something you can totally ask your insurance company.

What can I do if my insurance covers only Buy and Bill and I need an IUD?

There are some other medical offices that might participate in the plan, you can through your insurance website and call other GYN offices to see who can provide that service to you.

In addition, there are federally and state funded health centers such as FQHCs and Planned Parenthood who can provide the IUDs on site since they receive grants for such programs.

What are the next steps after I get an IUD inserted?

 You may experience some cramping, pain and bleeding for 2-3 days. OTC medications with food should help relieve the pain.

When should I come back for a follow up?

 We recommend one follow up six weeks after the insertion so that we can examine and visualize the strings. We also highly recommend an ultrasound at 6 weeks and then annually to ensure that the IUD is still in place.

Does my insurance cover an ultrasound after the IUD insertion?

Again, it depends on your plan. Most insurances do. However, some don’t. We offer a discounted self-pay pricing for an IUD check sonogram because your safety is important to us.

How often should I monitor my IUD?

Since there is a 1-2 percent chance that the IUD can get expelled or may move, we definitely recommend a 6 week and an annual sonogram to confirm the location.

Why can’t I get an IUD inserted at any time?

1. Because we want to make sure that you are not pregnant.
2. If you are in the luteal phase (right before your period), you may be pregnant but the urine and blood tests can still be negative, hence we ask that you come in for an IUD insertion during your period.
3. Lastly, when you are on your period, then the os (the mouth of the cervix) is slightly open and softer. This allows us to place the IUD safely and you may suffer from less pain.

I would like to get my pap with the IUD insertion? Why do I have to come twice?

Your insurance does not cover a visit with a procedure on the same day. They will deny one or the other. In that case you may end up being responsible for the cost of one of those.

You can find more clinical details and preparation instructions here.

Please know that we are here 7 days a week to care for you. Your health is important to us. Thank you for trusting us with your health.

Be safe, be strong and be prepared.

Walk In GYN Team

The post IUDs : Ordering, placement and insurance FAQs appeared first on Walk In GYN Care.