Chapter 2

Where Are You Now? Test, Don’t Guess!

You are beginning a beautiful, healing journey—all at a time when your hormones are fluctuating wildly. You know your destination: to have optimal health and longevity, be in shape, get back in the swing of sexual desire, energize yourself, and be free of hot flashes, night sweats, bad moods, brain fog, and other symptoms. In short, you want to feel better fast! So before we dive into my program, I want you to take a little time to find out where you are right now—in terms of your hormones, health, and emotions.

Toward that end, you’ll take a series of eye-opening self-tests that:

  • Decipher your levels of key hormones

  • Identify symptoms that help point to the underlying causes of illness

  • Assess your sexual and pelvic health

  • Check how positive you are about yourself, your life, and your future

  • Measure your waist and hip circumference

  • Measure ketones and pH of your urine

These tests provide valuable information that even expensive blood tests can’t tell you. My patients and the women in my online Magic Menopause program love to test and retest themselves. The reason is that they see quantifiable progress. A typical example is Joanie. She was in great health until her second son was born. From there, she spiraled downhill with all sorts of hormonal imbalances and resulting symptoms. Joanie took my Medical Symptom Toxicity Questionnaire (one of the self-tests below) and scored 82. Unlike the tests you took in school, a high score is bad. The lower your score, the better! A score of 82 indicated that she had a lot of negative health issues going on in her body. But after one month of following my program, she retested and scored 32—a remarkable change. What she saw on paper mirrored how she felt. Joanie told me, “I feel like I have my healthy body back for the first time in twenty years.”

My hope is that you will feel encouraged and inspired by using these tracking tools and seeing your own numbers go down. Having your own unique baseline information is important so you can see your changes over time. You may be amazed at your starting scores! But you’ll be so excited to see your progress. Taking time to assess yourself will make sure you aren’t overlooking anything—plus it helps you fine-tune and manage your progress as you implement healthy changes. I always say: What is measured gets managed.

You’ll notice that I have reprinted the following checklist and tests in the back of the book so that you can more easily tear them out and really use them. In addition to testing at the onset of the program, I recommend that you test again after one month and after two months. (See dranna.com/resources.)

Hormonal Review of Symptoms Checklist

This is a helpful checklist that shows you what is likely happening to your key hormone levels, based on a variety of symptoms. It helps you see the linkages among all sorts of hormones.

Look at each symptom, listed in the far-left column. Then rate each symptom on a scale from 0 to 3 (0 = no symptoms; 1 = mild; 2 = moderate; 3 = severe). Record your rating in the far-right column under Symptom Score.

Compare your Symptom Score with what is going on with your hormones. For example, let’s say you rated your hot flashes as a 3 (severe). Checking the Hormonal Relationship column, you see that your estrogen levels may be going up or down (↑↓E); your progesterone levels are declining (↓P); and your testosterone levels are declining too (↓T).

This scoring system is not quite as accurate as any blood test—but you don’t have to pay for it. I’m not saying blood tests aren’t valuable; they are, and they have their place, especially for fine-tuning hormonal balance. Just the same, this test gives you an accurate snapshot of where you are right now. Retake it after a month and after two months, and you will be surprised and delighted to see improvements not only in black and white, but also in how you look and feel.

Visit http://prhlink.com/9780525621652a001 to download and print a copy of this checklist.

Medical Symptom Toxicity Questionnaire

This assessment identifies symptoms that help point to the underlying causes of possible illness.

Using the point scale below, rate each of the following symptoms based on your symptoms over the last thirty days. For each symptom category, total your points.

Finally, add up the totals from each category to come up with your grand total.

Visit http://prhlink.com/9780525621652a002 to download and print a copy of this questionnaire.

POINT SCALE

0 = Never or almost never have the symptom

1 = Occasionally have it; the effect is not severe

2 = Occasionally have it; the effect is severe (it interferes with my life)

3 = Frequently have it; the effect is not severe

4 = Frequently have it; the effect is severe

SCORING

OPTIMAL: < 10

MILD TOXICITY: 10–50

MODERATE TOXICITY: 50–100

SEVERE TOXICITY: > 100

The Eve Questionnaire

Eve was the original woman in the Bible. By most accounts—and judging from Adam’s supposed fall from grace in her presence—she was seductive, confident, and sexual. I say, good for her! And therefore what better name to use for a questionnaire that aims to assess your sexual and pelvic health?

Once you know your starting number (from 0 to 70; lower is better), it’s much easier to track your progress as you change your diet and implement lifestyle changes. Read through each question, and check off your response. (Many of the questions refer to symptoms with sex; if you’re not sexually active, answer “never” or give your best guess.)

(Your response should reflect your sexual feelings and activity during the past ninety days.)

1. Do you lack energy?

□ Never

□ Some of the time

□ Quite often

□ Always

2. Do you find yourself making up excuses to avoid having sex?

□ Never

□ Some of the time

□ Quite often

□ Always

3. Do you find yourself sexually undesirable?

□ Never

□ Some of the time

□ Quite often

□ Always

4. Is the thought of sex distressing for you?

□ Never

□ Some of the time

□ Quite often

□ Always

5. Do you have discomfort during or after sex?

□ Never

□ Some of the time

□ Quite often

□ Always

6. Is vaginal or vulvar dryness troublesome?

□ Never

□ Some of the time

□ Quite often

□ Always

7. Would you consider yourself frustrated about your sex life?

□ Never

□ Some of the time

□ Quite often

□ Always

8. Do you find it very difficult to become aroused?

□ Never

□ Some of the time

□ Quite often

□ Always

9. Do you lose urine when you cough or sneeze?

□ Never

□ Some of the time

□ Quite often

□ Always

10. Do you use pads or panty liners due to urine leakage?

□ Never

□ Some of the time

□ Quite often

□ Always

SCORING

Review your answers. For every “Never,” assign 0 points. For every “Some of the time,” assign 3 points. For every “Quite often,” assign 5 points. For every “Always,” assign 7 points.

Record your total points: _____

Interpretation

If you scored between 0 and 10, you are doing extremely well. Your desire is healthy and intact, with normal vaginal and orgasmic function. But if you scored closer to 15, you may be experiencing some symptoms that could worsen over time, unless you take steps to improve them.

If you scored between 15 and 30, you are having a few arousal, vaginal health, and orgasmic functioning issues that are standing in the way of vibrant sexual health and vitality. Making lifestyle changes now will begin to lower your score.

If you scored between 31 and 50, your decreased interest in and enjoyment of sex may be due to a number of factors—vaginal pain problems, arousal issues, or urinary problems, among others. But these are all reversible with the right lifestyle changes.

If you scored above 50, your reduced interest in sex, your ability to become aroused, vaginal pain, or other sexual health issues are interfering with the quality of your sex life and pelvic health. These problems, though discouraging, can be improved or completely resolved with proper lifestyle actions, consistently followed.

If you answered number 5 positively at all, that is, you experience discomfort before or after sex, please follow up with your gynecologist or other qualified health care provider right away. It is important to rule out any other pathology, such as cervical, uterine, and/or ovarian cancer. Any symptoms that don’t improve with my recommendations in this book should be evaluated by your doctor.

Positivity Self-Assessment Questionnaire

Although hot flashes grab most of the attention, mood swings are an equally common symptom not only among menopausal-age women but also among women in their thirties due to PMS and those in their forties as a result of perimenopause. Common complaints include irritability, depression, crying, anxiety, fatigue, sadness, tension, difficulty concentrating, and loss of interest in sex.

There’s no need to despair, however—or to rely solely on antidepressants or tranquilizers, which are commonly too often prescribed. You can restore normal hormonal balance with natural methods you’ll learn about throughout this book. When all your hormones are in sync, you’re on your way to a happy, energized, and content life.

You’ll notice that the questions below work with positive statements instead of negative inventories. This way, the questionnaire is not only diagnostic but also therapeutic: the more you say the statements to yourself silently or out loud, the better you feel about you.

Don’t worry if you can’t rate many (or any) of these statements with a high score (in this quiz, the higher the overall number, the better you are feeling). I had one client, Mandy, who was thirty-six at her first visit. She was struggling with moodiness, fatigue, and relationship issues. I gave her the Positivity Self-Assessment Questionnaire; she returned it with zeros all the way down! This showed me that she had a lot more than physiology to heal. And she did.

With this assessment, you can see how your moods respond to the natural approach in a quick and fun way. Record your feelings (as well as information about your menstrual flow and libido) at least weekly, according to the directions. You’ll be surprised that in as soon as one month, you’ll feel much better emotionally.

Visit http://prhlink.com/9780525621652a003 to download and print a copy of this questionnaire.

SCORING

In the boxes below, rate your moods according to these scores.

0 = Not at all

1 = Minimal

2 = Some

3 = Extremely

Also, on the dates you score your moods, note your menses too. Record one of the following letters under the date:

S = Spotting L = Light flow M = Average H = Heavy

For sexual activity, draw a smiley face under the date.

Date I am happy and joyful. I am content. I am energetic. I am productive. I am social and friendly. I am alert; my mind

Your Waist and Hip Measurements

One of the best indicators of your overall health is decidedly low-tech: putting a cloth measuring tape around your waist and hips to come up with your waist-to-hip ratio. It says a lot about your health. If you carry more weight around your middle than your hips, you may be at a higher risk of developing certain health conditions, including heart disease.

Prior to beginning my program, find your waist-to-hip ratio and record it and the date:

  • Stand and place a tape measure around your bare middle, crossing your navel.

  • Make sure the tape is horizontal and snug around your waist, but without compressing or digging into your skin.

  • Breathe normally.

  • Read the tape. Your waist measurement will be at the place on the tape where the zero end meets the slack end of the tape measure.

  • For your hip measurement, stand with your feet together and place a tape measure around the widest part of your buttocks.

  • Double-check. Repeat the measurements to make sure they are accurate. If different from the first time, measure a third time and take the average of the three numbers.

To calculate your waist-to-hip ratio, divide your waist measurement by your hip measurement (W ÷ H). For example, if you have a 27-inch waist measurement and a 38-inch hip measurement, your waist-to-hip ratio is .71. For women, a ratio of .80 or less is considered to be healthy or safe. (For men, a ratio of .90 is ideal.)

Just as your weight can fluctuate during the day, so can waist and hip measurements. For the most accurate comparisons, take your measurements at the same time each time. Repeat these measurements weekly or monthly.

Urine Testing

It is essential to make sure that your diet and lifestyle produce an alkaline effect on your body, and that you’re in ketosis. Although it’s not required, I highly recommend that you test your urine daily. You can do this through separate pH strips and ketone strips, available at your pharmacy. Or you can obtain dual-purpose (ketone and pH test strips) on my website at dranna.com/resources. Unlike blood tests, you can do a urine test at home and without the pain of a pinprick.

Test your urine first thing in the morning, and periodically throughout the day (especially to check pH).

To use the dual-purpose strips:

  • As you urinate, pass the test end of the strip through your urine in midstream, or collect your urine in a clean, dry container or paper cup and dip the test strip in it.

  • Blot excess drops of urine off the strip.

  • Lay the strip flat on toilet paper or other absorbent paper.

  • The test strip will change color to indicate whether or not ketones are being produced, and to show if your body is in an acidic or alkaline state.

  • After 40 seconds, match to the ketone color chart.

  • After 60 seconds, match to the pH color chart.

  • Record your results on your Daily Tracker (see below).

Your urine pH goal should be in the 7 range in the morning. Don’t worry if this takes you a while to achieve. Testing is a process of discovery. Some people will have lower pH to start with. That’s okay as long as you are measuring it at the onset of this program; this is your baseline. You can track your pH from there in order to see what is happening over time and throughout the day. Patterns will emerge and show you how the food you eat and the way you live trigger changes in your pH.

The easiest way to monitor your progress to ketosis is through urine testing. A limitation of urine testing for ketones, however, is that urine tests measure the ketone acetoacetate, and less acetoacetate is spilled into the urine over time when we are consistently using fat for fuel or are keto-adapted. (Typically, this condition takes several weeks to develop.)

People ask me about blood testing for ketones. Yes, you can also test your blood for ketones (beta hydroxybutyrate is the ketone measured in blood) using a meter like the one diabetics use, along with special strips. The disadvantage to this method, however, is that some people don’t like pricking themselves with a lancet. Also, the test strips are considerably more expensive, usually $2 to $5 per test. This can add up if you are testing often to track changes in ketone levels. Given all this, in my opinion urine testing is the best way to start; then use blood or even breath ketone testing for fine-tuning if needed.

Your Daily Tracker

The tracker I created below serves as a journal and accountability tool, where you’ll record your feelings, weight, hours of sleep, ketones, pH, water intake, and other stats. It is important to keep track of these items, because they indicate your progress and help you stay the course. Don’t worry about where you are starting, just think about where you are heading!

• Record your weight, waist measurement, and hip measurement at the beginning of each week.

• Start off each day by writing down what you are grateful for.

• Set your intentions for the day—in other words, what you want to accomplish, enjoy, experience, or improve in your life.

• Choose a “cheer word.” This is a word that when you say or think of it it brings a smile to your face. Maybe it is a word like “jiggle,” or the name of your child, love, or pet, or even the word “smile.” Say this word many times throughout the day to bring a smile to your face, instead of a “resting witch face.”

• Write down what or whom you have connected with this day.

• Write what oxytocin activity you did or plan to do. Did you laugh, play, share intimacy, or enjoy friendships, for example? These positive activities bring more oxytocin into our lives, which can be so fruitful.

• Next is a brief positivity self-assessment questionnaire, which I shared earlier. Where an item is marked with a double asterisk (**), fill in the daily blanks with one of the following scores:

0 = Not at all

1 = Slightly

2 = More often

3 = Absolutely

For example, for “body love,” say “I love my body” and assess how that statement makes you feel. Hopefully you are answering with an “absolutely” and recording a 3. If you’re not yet, take heart—you will be soon.

Next are vital signs, because they will give you more clues as to how your body is responding to what you are doing.

See dranna.com/resources for a helpful video that walks you through this tracker.

Visit http://prhlink.com/9780525621652a004 to download and print a copy of this tracker.

Laboratory Testing

You’ve probably done it lots of times in your life: rolled up your sleeve and given a sample of blood, or urinated in a cup at your doctor’s office. A week or two later, you receive a lab report with a long list of measurements, ranges, and numbers. The whole process can seem a little confusing, but all that information helps your doctor paint a picture of your overall health. So your lab results are essentially a checkup on how your organs are operating, as well as an assessment of your risk for cardiovascular disease, diabetes, and other conditions. If you’re basically healthy, you can probably have lab work done every two to three years. But if you have coronary artery disease, diabetes, or risk factors for them, you should probably have lab tests done more often.

My patients and participants in my online menopause program always ask me about lab testing. In my experience, time, money, and worry can be saved by performing the self-tests in this chapter regularly. These provide a guide to what you need to know about your midlife health and hormones. Lab testing is completely optional and not a part of this program.

That said, if you are interested in optional lab testing, there are four key and inexpensive blood tests that I do think are worthwhile and cost-effective. They give you critical information that I believe every adult should know and follow periodically. Why these four? From an economical and informational standpoint, these tests clue you in to your immune resilience, inflammation status, blood sugar control, and hormonal status—basically a comprehensive overview of what is happening in your body. They also enable us to measure improvement as you work to optimize these values. (These four tests typically cost under $125 total; see dranna.com/resources page.)

25-hydroxy vitamin D. This blood test monitors vitamin D levels in your body and can determine if levels are too high or low. It is an important indicator of bone weakness or strength, immunity, mood, and more. Vitamin D and your vital hormone progesterone work together to support T cell immunity and sex hormone functions. Higher vitamin D levels are associated with reduced cancer risk (including breast cancer), better mood, better memory, brain health, and strong bones. A normal reading is 30–80 ng/mL; optimal is 50–100 ng/mL.

hsC-reactive protein test (also known as cardio-CRP and highly sensitive CRP). This blood test is a sensitive marker of inflammation and is used to help diagnose infection, cancer, and immune system disorders such as lupus and arthritis, as well as to help screen for heart disease. Normal CRP levels are below 3.0 mg/dL; optimal levels are below 1.0 mg/dL.

Hemoglobin A1c. This blood test shows your average level of blood sugar control over the past two to three months. People who have diabetes need this test regularly to check their progression or improvement of disease. We can use it to show that our nutrition and lifestyle choices are working. While the hemoglobin A1c (HbA1c) test is used to diagnose diabetes when it is 6.5 percent or higher, much research has shown that every 0.1 percentage point above 5.3 percent significantly increases your risk for Alzheimer’s disease, brain shrinkage, and cancer. HbA1c levels between 5.7 and 6.4 percent mean pre-diabetes. The normal range is between 4 and 5.6 percent; optimal is under 5.3 percent. Everyone should know their number and get it optimal.

DHEA-sulfate. This blood test measures the amount of DHEA-sulfate in the blood. DHEA-sulfate is a biomarker of aging and a way to assess the functioning of the adrenal glands and the effectiveness of communication along the body’s hypothalamic-pituitary-adrenal (HPA) axis. It is also a precursor hormone to estrogen and testosterone.

Low levels are associated with insulin resistance, poor memory, immune disease, and atherosclerosis. Optimal DHEA-S levels are associated with protection against cardiovascular disease and cancer, decreased risk of osteoporosis, healthier bones and immune system, better memory, better cognition, and better sexual function.

Typical normal ranges for women are:*

Ages 30 to 39: 45 to 270 µg/dL or 1.22 to 7.29 µmol/L

Ages 40 to 49: 32 to 240 µg/dL or 0.86 to 6.48 µmol/L

Ages 50 to 59: 26 to 200 µg/dL or 0.70 to 5.40 µmol/L

Ages 60 to 69: 13 to 130 µg/dL or 0.35 to 3.51 µmol/L

Ages 69 and older: 17 to 90 µg/dL or 0.46 to 2.43 µmol/L

Other Lab Tests Worth Considering

The four tests discussed above are really important in determining your hormonal and overall health. This chart shows other common and specialty tests that your doctor may want to order. All are good and helpful, and I regularly use them in my private practice.

TEST

Comprehensive metabolic and hormone panel

WHAT IT TESTS

Complete blood count (CBC), complete metabolic panel, cortisol, DHEA-sulfate (if not done separately), estrogen, progesterone, testosterone, hemoglobin A1c, C-reactive protein, blood lipids, red blood cell magnesium, vitamin D, and thyroid hormones (free T4, free T3, and thyroid antibodies, among others). Additional tests, depending on individual needs, might include a ferritin and iron panel.

METHOD

Blood test

TEST

Comprehensive stool analysis (such as GI Effects or GI-Map)

WHAT IT TESTS

This test gives a comprehensive look at the overall health of the gastrointestinal tract. It can reveal important clinical information about common symptoms such as gas, bloating, indigestion, abdominal pain, diarrhea, constipation, and the possible presence of parasites, yeast, and small intestinal bacterial overgrowth known as SIBO.

METHOD

Stool sample

TEST

Gluten-associated cross-reactive foods and food sensitivity (Array 4) and epithelial permeability test (Array 2) from Cyrex Labs

WHAT IT TESTS

Array 4 is my favorite panel for gluten sensitivity testing. This test measures your body’s immune response to various gluten-containing foods. Two antibodies are usually measured: IgA and IgG.

Array 2 measures certain proteins and can be an earlier and less expensive indicator of disease and leaky gut, reasons for chronic fatigue syndrome, and immune disease.

METHOD

Blood test

TEST

Food sensitivity test from Cell Science Systems

WHAT IT TESTS

This is a comprehensive test I have used to uncover which foods and other substances might be triggering inflammation and related issues such as digestive problems, metabolic disorders, and chronic inflammatory symptoms such as fatigue, migraines, eczema, autoimmune disorders, and joint pain. This test measures reactions to more than 450 substances (food, chemical, and environmental substances).

METHOD

Blood test

TEST

Adrenal stress index

WHAT IT TESTS

This test gives a more comprehensive understanding of adrenal hormone balance by assessing cortisol and DHEA throughout the day. It is an ideal evaluation for those under chronic stress with known or suspected endocrine abnormalities. It tests for six different hormones and immune markers that may be affected by chronic stress and stress-related conditions.

METHOD

Saliva test

TEST

23andMe Ancestry and Health

WHAT IT TESTS

This test provides genetic health risk reports, wellness reports (sleep, weight, lactose intolerance, and so forth), carrier status for a variety of conditions, including late-onset Alzheimer’s disease, celiac disease, Parkinson’s disease, and various genetic-related disorders. This health data can then be evaluated by a knowledgeable health care provider for guidance.

METHOD

Saliva test

TEST

Urinary testing for hormones and nutrition from Precision Analytics or Genova

WHAT IT TESTS

This test identifies hormones and their metabolites over a full 24-hour period. Especially important if there is history of breast cancer or you are on HRT.

METHOD

At-home urine testing

Take these self-discovery assessments diligently—and discuss these lab tests with your physician. The information you’ll gain will help you on your journey of mastering your midlife hormones and claiming optimal health for the rest of your life.

* Optimal ranges are 100–250 µg/dL in women over 40.