1 Take 10 minutes to plan -- and save up to an hour each day!
2 Think with a pencil in your hand. Write everything down.
3 Learn the difference between "urgent" and "important," and make time for the latter.
4 Underpromise results, then overdeliver.
5 Let your actions spring from your personal goals and values.

6 Number your tasks in order of priority, and get started on #1.
7 If you're overwhelmed by a big project, cut it up into little projects.
8 Allow double the time you think a project will take. You'll be on time and avoid stress.
9 Know when to stop fine-tuning your work. Aim for excellence, not perfection.
10 Give yourself little rewards for finishing tasks.

11 Hold meetings standing up -- just before lunch or quitting time -- to wrap them up sooner.
12 To avoid workspace clutter, make an instant decision on EACH paper that crosses your desk.
13 Lay out what you need for the next day the night before.
14 Gift shop all year 'round to avoid the last-minute rush.
15 If you're feeling stressed, refresh yourself by taking a 10-minute mental vacation.

Have a Happy and Productive 2014 New Year!

The most important stimulus that triggers insulin release and synthesis is glucose (sugar).  As we age and gain weight, the ability of the cells to receive the insulin signal is disabled, resulting in higher and higher insulin production to achieve the same results. This is called Insulin resistance.

More insulin > more stress > more cortisol > more pre-diabetes and fat deposition in the middle abdomen. Insulin’s main function is to increase glucose transport into fat cells.

Cortisol is secreted in a normal daily rhythm, with the highest levels in the morning and the lowest at night.

Function of cortisol:

1. Promotes gluconeogenesis and thereby raises blood sugar and helps keep blood sugar levels normal between meals. (The fuel pump.)
2. Mobilizes fats for energy production.
3. Stimulates protein breakdown.
4. Helps the body handle stressors.
5. Anti-inflammatory.  

High cortisol occurs during intense and prolonged stress. (Imbalanced cortisol rhythm usually precedes hypersecretion.)

Effects of over production of cortisol:
1. Causes Insulin resistance.
2. Inhibits function of T3.
3. Decreases immune function.
4. Causes visceral weight gain and obesity.
5. Decreases DHEA.
6. Promotes mineral loss from bone and osteoporosis.

Excess insulin functions as a death hormone that devastates virtually every cell and organ in the body. Insulin overload increases the risk of heart disease, cancer, blindness, stroke, Alzheimer’s, and other age-related diseases. Insulin resistance is associated with development of abdominal obesity and health problems, such as atherosclerosis and impotence. Furthermore, Insulin resistance and obesity are risk factors for type II diabetes. Excess insulin, or high insulin, is predictive for type II diabetes. Decreasing excess insulin by enhancing insulin sensitivity and by improving the function pancreatic beta cells (the cells that produce insulin in the body), is crucial in the quest for longevity.

The best way to lower excess insulin is to lose weight. The relationship of fat to insulin is as follows: As fat accumulates, i.e., weight gain, it increases free fatty acids in the bloodstream, a process that promotes Insulin resistance. As cells lose their ability to respond to insulin efficiently, insulin levels rise. Insulin serves to shepherd glucose molecules from the bloodstream across cell membranes and into the cells, where the blood sugar molecules are then metabolized for energy. As Insulin resistance mounts, the body attempts to compensate by pumping out even higher amounts of insulin. Fat cells, (adipose tissue), release fatty acids and generate proteins and hormones that are associated with potentially deadly inflammation. As fat accumulates, especially in the abdominal area, insulin sensitivity and glucose tolerances worsen. Left unchecked, this can lead to type II diabetes. The combination of Insulin resistance leading to high blood pressure, abnormal cholesterol levels, abdominal obesity, and high blood sugar glucose is known as metabolic syndrome, or previously known as syndrome x.

Let me explain what Insulin resistance is and how it acts. Insulin is a hormone produced in the pancreas. Insulin’s major function is to regulate blood sugar, or glucose, levels. Insulin helps to shuttle glucose molecules from the blood into the cells of the body. When blood sugar levels increase, insulin output increases. Insulin resistance means that insulin does not work optimally at its target tissue, such as muscle, fat, or liver tissue, to drive glucose into the cells. As the body attempts to overcompensate for poor insulin action by pumping out more insulin from the pancreas, insulin levels rise. Eventually, over time, the pancreas can burn out and no longer produce enough insulin to control blood sugar. When insulin levels are not sufficient to bring blood sugars levels down to the normal range, type II diabetes can result.

The myth of exercising more has drawbacks in itself. People seeking to improve fitness and lose weight, often exercise vigorously in the hope that exercise will boost their metabolic rate. While this may burn calories slightly more rapidly, it also accelerates the production of dangerous “free radicals”. Free radicals are the inciting force of inflammation, which is the inciting force for high cortisol, which in turn produces weight gain. With metabolic syndrome the individual can drop dead from a heart attack, become crippled by a catastrophic stroke, or may have their limbs amputated as a result of peripheral vascular disease. These are among the frightening consequences of vascular disease, which itself is the #1 killer of Americans.

Our bodies are like cars with a main fuel tank and a reserve tank. When one tank runs dry, the engine draws fuel from the reserve tank to meet its needs. Our bodies run in a similar fashion. Say, for instance, a person walks on a treadmill for 20-30 minutes. During this time they have burned off their main fuel, such as the sugar in their blood, liver and muscles. Once that fuel is depleted, their body then turns to fat, which is your reserve fuel tank for additional energy. A healthy liver functions to support in burning fat for energy.

by Michael E. Greer, MD
Republished with permission from Holistic Primary Care, Sunday, 17 June 2012 21:26 By Michael Greer, MD, Contributing Writer - Vol. 13, No. 2. Summer, 2012 

Desperation, anxiety and urgent need knock at my office door for many reasons. One of them—and one that is increasingly common these days—is the inability to conceive a child. This can be extremely disturbing for couples that have chosen to attempt pregnancy.

Infertility in and of itself can be complex just on the physiological level; the emotions it stirs up add to the complexity.

In many cases, by the time an individual or couple have arrived at my office seeking help for infertility, they have already taken a big leap of faith in seeking a physician who works with herbal, nutritional and integrative approaches and in thinking that these approaches can help.

This article is based on my own clinical experience using herbal and nutritional approaches in the care of women who’ve had difficulty in conceiving. 

Ready in Mind & Body

Ideally, a woman who’s thinking about having children will contact me before she tries to start a family. That way we can do a thorough assessment of her body’s health status, both physically and nutritionally. I can alert her of her potential needs, including nutrient deficiencies, and determine active steps she can take to ensure her that her entire body is in optimal health for reproductive function.

Common reasons for reproductive health issues include age, problems with hormonal imbalances and irregular ovulation, and being overweight and its inflammatory consequences. Daily stress and environmental toxin loads are also factors to consider when a couple is having difficulty conceiving. In many cases, these circumstances may combine and make conception more difficult and elusive. This is why a thorough intake history is important.

A woman needs to be certain she is ready to have a baby and that she understands that it may take time to conceive. Some women become very discouraged if they have difficulty conceiving within a few months. If many of their friends are pregnant and having babies, and they may quickly feel excluded from their social circles, which can lead to a real sense of despondency.

These feelings are totally understandable, but unfortunately, they can create a lot of mental and emotional stress that only compounds the problem. Since the body’s systems are all interconnected, the disappointment, anxiety, fear and sense of social isolation can drain the body’s mental and emotional energy. The stress states will also adversely influence her endocrine, nervous and immune systems making it all the more difficult to conceive.

One of the most important things we can do in this context is to help our patients find healthy ways to relax their minds and ease their emotional stress. This is much more than a nicety; it can actually help a woman prepare for conception.

Over the years, I have found that a woman’s weight is usually a strong indicator of what changes needed to be made in her lifestyle before her body is ready for a pregnancy. Low body weight, or at the other extreme, obesity, are reflective of hormonal imbalances. So are large fluctuations in weight. In these cases, thorough hormonal evaluation can identify important issues that need to be addressed to optimize the chances of a healthy pregnancy.

For any woman who has struggled with reproductive health issues, it is best to start first with cleansing the body. A detoxification program can clear out external toxins from the body’s system by stimulating specific detoxification organs such as the liver, kidneys and intestines. Through the program, patients often learn healthier eating habits and lifestyle choices, which in turn help to maintain a healthy weight, improve digestion, and increase energy, all of which are necessary for a healthy pregnancy.

I pay careful attention to glucose levels and thyroid function in my patients wishing to become pregnant. Women with healthy glucose metabolism and optimal thyroid hormone levels are more likely to be able to conceive and maintain a pregnancy (see Thyroid Problems Often Underlie Infertility, Pregnancy Complications).

A daily multivitamin supplementation, including ample amounts of folate, is a good idea.A 2010 study published by the Department of Health & Human Services, looked at folate intake among American women from the years 2005-2008. The data indicated that only 32% were consuming the recommended daily allowance of folate. The majority of women are not getting the folate they need from their diets. 

Herbs to Support Reproductive Health

Evidence dating back for centuries documents the safe and effective use of herbal remedies to promote optimal reproductive health, though this is not generally taught in conventional medical schools.

I have found that herbs can play a valuable role in supporting reproductive health. Several can act as hormone-like compounds interacting with multiple receptor sites throughout the body. Herbs can help establish normal hormonal function, nourish and tone the uterus, help reduce stress level, relax the nervous system, and balance sexual desire.

There are many different herbs to choose from, and it is important to choose carefully. It is important to keep in mind that certain herbs may present some degree of toxicity to the prospective mother and fetus (Mills S, Bone K. The Essential Guide to Herbal Safety. 2005: 89). One certainly does not want to increase the risk of miscarriage or long term negative effects on the health of the child through the use of herbal remedies aimed at facilitating a healthy pregnancy!

I advise women against experimenting with herbs before and during pregnancy without full consultation with all of their health care professionals, and a thorough review of all medications and herbs they may already be taking. This is the only way to identify contraindications, minimize potential for toxicity, and optimize outcomes.

Since conception occurs somewhat unpredictably, it is important as a practitioner to prepare in advance and to gather information on the herbs that your reproductive-aged patients are taking. It is standard practice among most clinicians that any herbs used to support reproductive health should be discontinued upon confirmation of conception. Talking in advance with patients about this will establish peace of mind and keep cortisol in check.

In my practice, I opt to use the following herbs to support female reproductive health: Shatavari, Chaste Tree, Tribulus, Rhodiola, Ginger, and Dong Quai. These herbs can be taken in liquid form, capsules, tablets, and even powdered teas. Obtaining professional grade herbal medicines from a well-established manufacturer is essential for assuring purity, quality, and efficacy. 

Shatavari (Asparagus racemosus): is used widely in traditional Ayurvedic medicine to promote overall health, and is particularly revered for its effects on the female reproductive system and its ability to promote reproductive function. Shatavari contains steroidal saponins that can help maintain balance in the female reproductive system (Lad V, Frawley D. The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine, 1988). A formula with 600 mg of Shatavari root three times daily is the preferred dosage. This herb combines well with herbs such as Chaste Tree and Tribulus to promote hormonal balance.

Chaste Tree (Vitex agnus-castus): Diterpenes found in Chaste Tree interact with a dopamine receptor known as the D2 receptor, resulting in the inhibition and normalization of prolactin levels (Wuttke W, Jarry H, Christoffel V, et al. Phytomedicine 2003; 10: 348-357). Normal prolactin release plays an important role in maintaining healthy ovarian function and supporting healthy progesterone production in order to promote normal menstrual cycles (Ben-Jonathan N, Hnasko R, Endocrine Reviews. 2001: 22(6):724–763).

Two German studies on women with low progesterone treated with Chaste Tree showed significant improvement in 39 of 45 cases (Propping, D, Katzorke, T H; Z Allgemein Med. 1987:63, 932, and Propping, D et al. Therapiewoche. 1988:38, 2992). A dose equivalent to 500 mg of dried Chaste Tree fruit per day is effective in the majority of cases.

Tribulus (Tribulus terrestris): supports normal ovulation and promotes healthy estrogen levels. Tribulus also has properties for promoting vitality, stamina and overall feelings of well-being.

Protodioscin, a furostanol saponin found in Tribulus, promotes follicle stimulating hormone (FSH) release, and appears to bind with estrogen receptors (Milanov S, Maleeva E, Taskov M. MBI: Medicabiologic Information. 1985; 4:27). A good quality Tribulus extract should be made from the leaf and stem of the plant, and should contain at least 100 mg of the key active compound: furostanol saponins as protodioscin. A recommended protocol is to take the extract thrice daily, on days 5 through 14 of the menstrual cycle. 

Rhodiola (Rhodiola rosea): has exceptional adaptogenic and tonic properties. This herb is helpful for women who are experiencing preconception anxiety, those who have difficulty taking things in stride, and those in whom emotional or mental stress is negatively impacting reproductive function (Brown, et al. HerbalGram. 2002: 56:40-52. American Botanical Council).

A good quality Rhodiola extract is standardized to contain at least 4.5 mg of rosavins and 1.5 mg of salidroside per dose. An optimal daily intake would be two to three tablets per day, as needed.

Ginger (Zingiber officinale) is a warming herb that stimulates blood flow to the female reproductive organs. It is also a very good digestive aid and anti-inflammatory herb. A small amount, 10 to 20 drops, of ginger in liquid form in a tablespoon of honey added to a cup of tea or warm water and sipped as needed is advisable. (Keating A, Chez R.Alternative Therapies. 2002; 8(5):89-91).

Dong Quai (Angelica sinensis): has a long history of use in traditional Chinese medicine to restore women's reproductive balance, by nourishing the blood, harmonizing vital energy, and balancing the menstrual cycle. Western herbal practitioners also view it as an excellent herb to promote a healthy female reproductive function and to prepare for pregnancy. I recommend taking Dong Quai in a tablet form that contains 1 g of root equivalent twice per day. 

I also suggest to many of my patients struggling with fertility issues, to make a tea of raspberry leaf and nettle leaf steeped together. This is an enjoyable and health-promoting beverage.

Along with the other vitamins and minerals found in the leaf, nettle is used to strengthen and maintain the normal integrity of blood vessels. Poor vascular integrity can increase the risk of developing varicose veins, leg cramps and increased bleeding (Hudson T.Women’s Encyclopedia of Natural Medicine. 1999: 235). Women taking this tea have consistently reported an improvement in their hair and nails, as well (Romm A. The Natural Pregnancy Book. 2003: 90).

Red raspberry leaf, which many herbalists consider a “true women’s herb,” has a long history of use for supporting women’s reproductive health. It is rich in iron and vitamins C and E. It strengthens pelvic and uterine muscle tone. 

Exercise & Relaxation

When working with women who are dealing with infertility, I try to educate them about the body’s innate mechanisms for lowering cortisol by mentally relaxing. I also stress supporting the adrenal gland and getting enough sleep. These three—relaxation, adrenal support, and getting enough rest—will go a long way to increasing the odds of conception.

Patients should feel free to engage in any healthful form of stress reduction they enjoy. I do encourage patients to create specific times each day to unwind and let the stress leave their body, both mentally and physically. Exercising at least 30 minutes a day is a helpful way to relax. It also lowers estrogen, enhances testosterone and reduces cortisol.

Some degree of stress is inevitable in life, but I try to counsel my patients to choose their encounters with stressors to whatever extent they can. 

Herbal medicine is a deep and complex discipline. If you are not personally knowledgeable with how to use herbs, seek out a qualified naturopathic physician. Many NDs/NMDs are very well-versed in the use of herbal and nutritional interventions not only for improving reproductive function, but for optimizing health in many domains. 

While it would be a stretch to say that botanical medicines and nutritional interventions represent “cures” for infertility, they certainly can contribute greatly to improving general health and female reproductive function. They are far less expensive than conventional pharmaceuticals or in vitro fertilization interventions, and well worth exploring before resorting to these more intensive medical interventions.

Michael Greer, MD, is an integrative medicine specialist focused on holistic, herbal, homeopathic, and naturopathic solutions for health. He incorporates the best of conventional medicine with natural medicine products and philosophies. Following a 20-year career as a Board Certified (1984) OB/GYN, Dr. Greer is retired from the practice of medicine and is now focused exclusively on educating physicians about integrative medicine.