A Pill for Libido. Really?

As an internist who sees hundreds of women in the second half of life, I am all too familiar with women’s waning libidos.  Having gone through menopause myself, I have personally experienced the power that changing hormones have on many psychological and bodily functions that the younger me took for granted.  As an integrative physician, I am always searching for causes of symptoms and for natural and integrative ways to treat and heal them.  Our society sees a waning libido as a pathological symptom.  Viewing our aging bodies as pathological is where our problem truly lies.

Our collective maturity level in America can truly be seen as ‘adolescent’.  We are a society with many compulsions.  We seek fast ways to manipulate the body, to manage symptoms, and to regain youth. We want pills as substitutes for inner work, diets for rapid weight loss, and shots to stop menstruation considered inconvenient by many.  We are addicted to an ideology that has proven not to work over the past three decades.  Somehow, we are unable to make the shift to a more mature way of thinking.  Industries that support these compulsions make a lot of money.  The money itself becomes an incentive to keep the compulsions in place.

We have promoted the ‘anti-aging’ ideology for nearly 3 decades. We have yet to find a way to turn back the clock.  We are fearful of aging because we lack respect for process, and have not created a way to mark and consecrate our life stages from a place of reverence. Our society normalizes this. Mother Nature, in all of Her wisdom, marches on in time.  It is about time we find a way to gracefully honor the rhythms of the natural order of life and learn how not to resist aging due to our adolescent fear.

A woman’s libido has many facets that influence it – hormonal, psychological, emotional, and spiritual. Hormones have powerful effects on the biological nature of sexual desire.  When we are young and fertile, our hormone surges are aligned with the zeal to procreate.  In other words, the desire for sex is aligned with Nature. This is a powerful force that underlies our libidos when we are young.  As we age our hormones change, and we are less able to procreate - and Nature is less supportive of our libidos.  Women in their mid-40s complain about their waning libido, their changing body, and mostly their newly discovered need for balance.  They feel depleted after half a life of caring for others.  Energetic depletion, alongside changing biology creates less desire for sex. There is a greater desire for more intimacy, spiritual and emotional fulfillment, and the restoration of balance in both a woman’s body and life.

By our 50’s, most of us have experienced enough pain and difficulties to last us a lifetime.  These experiences are meant to serve as catalysts for inner growth and self-discovery. In midlife we must move out of the compulsion to ‘please the world’ and into an inner place of authentic connection.  We must learn how to be true to ourselves.  For us to find meaning and not feel victimized by our past requires hard work and a desire to seek.  The process of seeking itself deepens our ability to be intimate and fulfilled. In my medical practice, I find that women, who are committed to ‘seeking’ as they age, feel more fulfilled with intimacy, rather than the sex act alone. They are able to more readily accept their changing bodies. Sexual pleasure to them feels different, in some ways more fulfilling, even though their libidos may not be as heightened as in youth. The irony is that they are the ones who feel more sexual fulfillment than those who continue on the treadmill defined by the collective, with expectations of eternal youth.

Because our society has glorified youth and the sex act in favor of aging and intimacy, as we age, society expects us to perform both physically and sexually similar to when we were young, but with limited success.  Our aging bodies have different needs: the need for a pure diet, exercise, work/life balance, attention to inner process, and - one that we have not yet normalized in our society - a search for meaning. The spiritual aspects of ourselves call to us more powerfully and with greater zeal as we age.  Our physical bodies also require more attention.  Continuing the unhealthy diet of our younger years, does not nourish our changing bodies, and many of the lifestyle choices that have gained traction do not support our emotional or physical bodies.  This level of self-awareness needs to be paramount as we age if we desire to achieve a state of true health, which should no longer be defined by a ‘hard body’ or a ‘boundless sex life’.

For men, Viagra and Cialis do not fulfill these needs.  The ability to hold an erection for a longer time is not an adequate substitute for health, meaning, or intimacy.

Our society is struggling with the choices it has collectively made.  Frankly, our collective ideology is in contrast to the laws of Nature.  In other words, it goes against the laws of Nature.  Due to the decades of traction behind our unnatural ways of life, we continue to pump out pills as substitutes for what is missing at deeper levels of our being. The woman’s libido pill Addyi will not be able to offer what women consider as sexual fulfillment – namely:  intimacy, meaning, and a renewed relationship with themselves and their partners. The risk of life-threatening side effects alone is not worth taking a libido pill.

As we age and seek deeper levels of meaning, biology (not surprisingly) follows suit.  Not necessarily with the same intensity as it did during youth, but our aging physical bodies respond to emotional and spiritual depth differently than when we were young.  The zeal to live from depth is what Nature supports as we age, in favor of the zeal to procreate as in youth.

At this time we do not need yet another pill with more side effect casualties left at the altar of our flawed ideology.  We need to reframe our collective consciousness and normalize the necessity for healthy aging as defined by physical, emotional, and spiritual health.  This is a much more powerful way for us to live and will go much further in our level of fulfillment, both sexually and spiritually, than any pill can ever offer.

Midlife as a Gateway to Authenticity

Are you a midlife woman who doesn't understand what is happening to your body and your mind?
Have you told your doctor how you’re feeling and were dismissed with medications or hormone replacement therapy?

Do you feel overwhelmed by the volume of information available about managing midlife and peri-menopause?

I am not only a practicing internist but a midlife woman.  I have been helping midlife women for over two decades with their menopausal symptoms and have gained significant personal insight about how little support is currently available for us.

During my forties I noticed my body and energy level change. I began to feel tired and heavy.  I also felt restless and had trouble sleeping through the night.  I looked for answers to these symptoms in my medical books and journal articles. I even went to my gynecologist to understand why I was feeling this way.  All she had for me were prescription drugs and hormone replacement therapy.  She told me that this is peri-menopause and that I have entered this category in midlife.  “It’s downhill from here” she said.  My visit was a huge disappointment.  As a scientist and a problem solver, I was determined to understand why I was having these symptoms and what I could do to restore my sense of health and well-being.

I found a lot written on this subject.  What I read though was theoretical but not practical and it did not address the deeper aspects of what I was looking for.  Why did my soul feel restless?  Why did I feel emotional ‘heaviness’?  Why was my body changing in this way and why were issues resurfacing that I thought were solved?  I was forty-two when I began to feel this way. I was an intelligent and a dynamic woman who had lived a very healthy lifestyle.  I had also created a successful medical practice and on the surface,  appeared to be at the top of my game.  Deep inside, I felt empty and disconnected.  My marriage felt deeply unsupportive and I found myself less able to tolerate the disrespectful ways I was being treated.  It was as if I was not able to compromise myself in order to adapt anymore.   My tolerance for the superficial was receding.  I found myself being more reactive and angry.

What I discovered was that hormonal shifts in my body that were normal during this stage of life brought with them emotional and soul shifts that were offering me an opportunity to take a look at my life from a deeper perspective.  Since I was conditioned to pathologize this, it engendered a deep fear of aging and degeneration. It was anything but.

This time in a woman’s life holds immense transformational power.  When a woman arrives at this gateway, her hormones shift, recalibrating her identity.  She is meant to question who she has pretended to be and move her deep into her soul and her authentic self.  Our society deems this a ‘midlife crisis’.  I like to think of this as the alchemical process of becoming real.   Women need to learn how to take care of themselves through this gateway and beyond.  They need to learn how to use the framework of transformation to connect with their intrinsic power and truth.  At this juncture, women are in need of balance at all levels of their body, mind, emotions and soul.  Many have lived unbalanced lives up to this point, neglecting to take care of ourselves.  As their bodies change they are called to heal their self-neglect.

I would like to offer some simple solutions to support your midlife transformation:

1. Work with a physician who can help you balance your hormones, not replace them.  Bio-identical hormones are much safer alternatives to synthetic ones.  They can quickly restore your feeling of well-being when used correctly in small doses.  Most women are in need only of natural progesterone to balance the estrogen to progesterone ratio.  Taking estrogen in even natural form can aggravate many symptoms of the menopausal transition.  This needs to be customized by your physician to suit your biology and your sense of well-being.  There is no "cookie cutter" way to balance hormones.

2. Acupuncture can make a significant difference in your well-being particularly if you are having a difficult time with menopausal symptoms such as hot flashes and night sweats.

3. Have your thyroid levels checked.  Make sure your physician orders a thyroid panel to give her/him a better understanding of the status of your thyroid as it can become sluggish during midlife.  Make sure you have free T3 levels checked.  These commonly decrease in midlife resulting in weight gain, fatigue and foggy thinking.  Replacing your free T3 and normalizing your TSH to a value between 1 and 2 will make a big difference in your sense of well-being.  Moreover, low free T3 levels have been correlated to an increase in all cause mortality.

4. Clean up your diet.  Change your diet to one that is mostly organic and plant based.  A plant based Mediterranean diet has been shown to significantly lower the risk of heart disease, diabetes and cancer, three of the most common diseases in the U.S. that present in midlife and beyond.

5. Begin taking a therapeutic grade omega-3 supplement and vitamin D.  These will decrease inflammation and strengthen your immune system, reducing the risk of disease.

6. Make aerobic exercise a priority.  At least 20 minutes of exercise, 6 days a week is needed to decrease the impact of physiological stress and restore cardiac health.

7. Incorporate massage therapy, yoga and meditation in your life as ways to heal stress and bring you closer in contact with your authentic self.

8. Work with a psychotherapist to gain a better understanding of your real needs and desires and to dismantle the parts of you that no longer serve your life.  Many feel that they can do this alone and with the help of friends, but it is much more effective and efficient to engage a professional who is objective and can clearly mirror what you need to work on to connect to your authenticity.

9. Make a commitment to be true to yourself and seek for a deeper sense of meaning every day.  Stop compromising your real needs to be liked or accepted.  This is one of the hardest patterns for women to break.  Garner the courage to be true to yourself.  You will earn the respect of many around you.

I invite you to reframe midlife from a time of crisis to one of transformation.  The best years of your life are yet to come.  Grace them as a seeker with deeper meaning and understanding  so you can experience the power and sacredness of your authentic self and most of all experience a deeper sense of meaning now and for the rest of your life.

How to Get a Good Night's Sleep

Sleep is essential for health.  The lack of sleep stresses the adrenals and reduces vitality. It causes an acceleration of the aging process.  The three most powerful ways to promote health and slow down aging are:
1. A plant based wholesome diet rich in antioxidants
2. 6 – 8 hours of sleep per night
3. Regular aerobic exercise (at least 20 minutes 5 to 6 times per week)

Studies show that 8 hours of sleep per night are needed to produce enough melatonin and healthy neurotrasmitters to maintain health. Hormonal changes in women in midlife, particularly a reduction in progesterone can disrupt the sleep cycle. The lack of sleep has become a chronic problem of our time.  The stress of our fast paced life and constant busyness, coupled with fast food, brain stimulation with computers, texting and television, all contribute to insomnia and disturbed sleep.  The brain has a hard time shutting off and resting at the end of the day with all the over-stimulation it experiences.  The brain needs energy to function and needs a good 8 hours of sleep to replenish its circuits before another day of activity begins.  Deep breathing and meditation help immensely but most people do not take the time to do this.  Doing 10 minutes of abdominal breathing every night, or alternate nostril breathing (Pranayama), relaxes the brain enough to allow for its rest and rejeuvination.
The regular intake of alcohol, inflammatory fast foods (nutrient poor), caffeine and regular tv or computer use have an additive effect in overstimulating the brain.  I advise my patients who have difficulty sleeping when they first come to see me, to eliminate or minimize alcohol and wheat,  increase their intake of whole, plant based foods, omega -3 and exercise.  With these changes, the vast majority begin sleeping better.  Not watching television or using the computer before bed also helps as the glare from the screens has deleterious effects on brain activity before bed.

Supplements:

1. Magnesium 250 mg before bed.

2. Lavender oil pills, Lavela, which have shown similar efficacy as prescription sleep aids (available at The Ommani Center)

3. Melatonin 5mg.  No more than 5mg should be used as a sleep aid, only on an as needed basis as melatonin is a hormone.  Any hormone taken by mouth regularly will suppress the production of the body’s natural hormone production.  It has been shown to help people that work night shift as melatonin production is reduced with lack of darkness during night hours (even a night light in the bedroom at night will reduce the brains production of melatonin).  A decrease in melatonin production by the body has been correlated with increase in the incidence of cancer. The data on melatonin supplementation is mixed and this should not be taken on a long term basis as a sleep aid until conclusive evidence demonstrates its safety.

4. Valerian is an herb that is commonly used for insomnia.  The data on its effectiveness and my experience of it with my patients remains mixed.

5. Omega-3 Fish oil. Omega 3 and the amino acid tryptophan together increase serotonin in the brain.  Seratonin is a precursor to melatonin which aids in sleep.  Salmon, sardines, oily cold water fish and eggs all increase serotonin in the brain.  Make sure your omega-3 supplement is of pharmaceutical grade, mercury free, micro-distilled and supplies at least 300 mg of DHA and 300 mg of EPA per capsule.  2 to 3 capsules per day are needed for a therapeutic effect.

6. Bio-identical progesterone is extremely effective to restore sleep in midlife women whose hormones are out of balance.  This must be done with the aid of a physician skilled in hormone balancing, who also monitors blood levels of hormones to ensure safety.


Foods:

Bananas, almonds, warm milk, cherries, decaf green tea, oatmeal, salmon, cold water fish and eggs are all recommended to enhance sleep.

I always tell my patients to try eliminating the unhealthy foods and behaviors they are engaged in for a few weeks and then resume them.  See what happens.  Experimenting in this way releases the pressure that they may feel of ‘being deprived.’  Instead, they approach this experiment with curiosity and take cues from their body instead of my directive.  The majority of patients who have approached it in this way have successfully resumed a healthy sleep pattern.

Complementary Medicine:

1. Acupuncture is a very successful modality in restoring sleep patterns.

2. Massage relaxes the muscles and produces serotonin in the brain and body.

It takes time to develop an unhealthy sleep pattern so it takes some time to develop a healthy one.  Food takes time to restructure the cells and re-calibrate the good chemicals in the brain and body that promote health.

Food is Medicine.  It is not a quick fix.  It is however a lasting one.  Supplements are just that – supplements to our diet and lifestyle, not substitutes for healthy food and exercise.

Nature has everything within it we need to support our health.  If we live a balanced life from its basic principles, we can minimize disease and maximize our body’s regenerative potential.  The good news is that we always have a choice to do this.  The fun of trying healthy behaviors and see how our body responds. This is the basic premise of any scientific study.  We can do our own study and learn from our body’s wisdom at any time.

The choice is always ours.

http://www.elephantjournal.com/2013/03/5-ways-to-get-old-fast/

http://www.yogajournal.com/practice/220

http://www.tatianasadak.com/userfiles/2607091/file/LavelaBrochureFull.pdf

http://www.ncbi.nlm.nih.gov/pubmed/16162447

http://www.cbn.com/health/naturalhealth/drsears_depression.aspx

http://www.ommanicenter.com/bookstore - Becoming Real by Rose Kumar M.D.

http://www.ommanicenter.com/womens-health

The Need to Transform the Existing System of Healthcare

There is a movement underfoot in our country that is provocative and exposing. Our shadow is up and it is unraveling itself in all of our institutions. When I left the medical system at age 36, I did so because the corporate intent that I was expected to enable – sick care, felt ‘unethical’ to me. Sick care was not what I was trained to serve. It was not what my heart and soul went into medicine for. But it was required of me by the medical system to generate profit. I was required to keep people sick in order to keep my job.

Deep inside, I knew I was a problem solver. This is what I loved about Internal Medicine. I wanted to uncover the causes of symptoms and ease suffering by working with people to figure out the causes for their illness and how to tap into it to find solutions with them. If our premise is that life is full of precision, then we should be able to figure out the purpose and meaning behind our symptoms and suffering. Our suffering can also help us become real. It has an alchemical effect on our ego that strips it from being ‘all knowing’ to becoming a student of life.

I love medicine. It excites me and it stimulates my thinking at many levels. As physicians, we need to use our knowledge from a context that serves the vocation of medicine.  We also need to use it responsibly and humanistically. This is what we have lost and must regain in health care today. We must open the currently closed system of medicine while maintaining a high standard-of-care. An open system grows and evolves.  A closed system stays stagnant and is based in fear.  Today’s health care system uses fear to keep patients coming.  Its revenue depends on this.

An open system will of medicine is cost effective and patient centered. Its context examines what is wrong but also “what is right about what is wrong”. When we explore symptoms and illness from this framework, we can heal our patients at causal levels. We can use the pathological model within the larger context of a healing model, seeing pathology as a symptom rather than an end.

This context is transforming medicine and evoking health at The Ommani Center for Integrative Medicine. This is a prototype of an ‘open system’.  This was a way I could make medicine REAL and restore and reclaim its SOUL. Becoming Real is the calling of our time. This is our collective path. This can transform our medical system and restore it to what it was originally intended to be.  This will involve physicians who are open to working from this context and patients who expect it.

Midlife as Alchemy

What is Midlife? What is Menopause? What is at stake?
What is our Conditioned-Self?  What is our Authentic-Self? How do they differ?
In my 22 year history as a physician who has worked with thousands of brave and courageous men and women with stories of wounding, suffering and healing, I can say that I have been able to identify the differences between these selves and the intrinsic power that emerges when one leaves the Conditioned for the Authentic Self.  The Conditioned-self is who you were told you SHOULD BE. The Authentic-Self is WHO YOU ARE.   For the first half of our lives, the Authentic-Self is buried beneath the Conditioned.  In the second half, we must re-emerge Authentic.
There is a powerful shift that occurs in midlife when our physiology and soul intersect at this gateway to make room for the REAL to emerge.  This creates a felt space between the Conditioned and Authentic selves.  The traction of the conditioned one pulls at us, urging us to behave from familiarity based in FEAR.  All the ‘shoulds’ fear us into staying stuck.  Fear is the feeling that adapts us in the first half of our lives.  We adapt to be accepted.  Adaptation conditions us. It creates a shell around our Authentic –self that waits patiently for us to awaken.  We learn to withhold our truth; we say ‘yes’ when we want to say ‘NO’. We over-ride our true feelings to be accepted and loved.  For decades we live this way.  We construct our lives from choices that emerge through our conditioning.  We become part of society’s ‘herd’.   We normalize this identity and close our eyes.
When we turn 40, something changes.  A soft whisper fleets through our body and mind, suddenly with no warning.  Sometimes we don’t really hear it, sometimes we try not to.  It beckons us to awaken, to bring LIGHT to our choices.  It says, ‘Who are you really?’  This frightens us.  If we don’t listen, it moves in deeper, rises stronger – as fire, as density -anxiety, depression –in our bellies, pulling us in.  We begin to sweat, to hot-flash; we awaken at 3 am with minds racing and fear coursing in this unknown place.  In the middle of the dark rises a whisper of comfort, the voice of our Soul pulling us in – to connect, to open, to awaken and deliver us finally to our Voice and our Truth.
If we do not listen, it may call to us as cancer, divorce, tragedy, devastation, that forces us inward to evaluate, deconstruct and  make ourselves new.
All this sorting and sifting, transforming and reinventing – THIS is midlife.
This is menopause.
This is not a sickness or a  deficiency. This is NOT a pathology.
This can NOT be medicated away.
This is HERE to stay and it will offer us the fire of alchemy into which we must step to make ourselves WHOLE.
The voice of the Authentic-Self will rise from ashes of the conditioned one as adaptations fall into the fire to be transformed.  If we willingly lean into this, our voice will emerge – FINALLY- the TRUE voice we will use to heal the world.
We will spread our wings and fly out from this fire into life again with wisdom and an inner eye that can never be closed.

Becoming Real Video