The Triple Whammy Cure: The Breakthrough Women's Health Program for Feeling Good Again in 3 Weeks

The Triple Whammy Cure: The Breakthrough Women's Health Program for Feeling Good Again in 3 Weeks

The Triple Whammy Cure: The Breakthrough Women's Health Program for Feeling Good Again in 3 Weeks

The Triple Whammy Cure: The Breakthrough Women's Health Program for Feeling Good Again in 3 Weeks

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Overview

Is this your life? You've been feeling just plain awful for far too long — depressed, exhausted, achy, stressed-out, bloated, and forgetful. In fact, you're beginning to find it hard to remember the last time you felt really well — or even just okay.

You may be suffering from what Dr. David Edelberg calls the "Triple Whammy" — a three-pronged assault on body and mind made up of unrelenting stress, low levels of the feel-good brain chemical serotonin, and your ever-shifting hormones. You can benefit from The Triple Whammy Cure, a simple but highly effective three-week plan that can stop this devastating attack and let you feel good again.

Author Dr. David Edelberg is a recognized pioneer in treating chronic illnesses and a practicing physician with thirty years of clinical experience. His Triple Whammy Cure is a natural program that provides powerful but easy solutions for each of the three whammies.

The Triple Whammy Cure is so simple that Dr. Edelberg's thousands of patients wondered how it would work — until they tried it themselves and felt so much better only twenty-one days later. Now, The Triple Whammy Cure can help you get back your life, too.

Product Details

ISBN-13: 9780743269087
Publisher: Atria Books
Publication date: 01/02/2007
Edition description: REPRINT
Pages: 336
Product dimensions: 5.50(w) x 8.44(h) x 1.00(d)

About the Author

David Edelberg, M.D., a practicing physician for more than thirty years, was chief medical adviser of WholehealthMD.com. In 1993 he founded American Wholehealth (AWH), a network of health care centers that combines conventional and alternative medicine. He teaches alternative and integrative medicine to medical students and residents from the University of Chicago. Visit his website at www.triplewhammycure.com.

Heidi Hough was editorial director of the American Medical Association Consumer Publishing Division for twelve years.

Read an Excerpt

Chapter One What Is the Triple Whammy?

Believe me, I tried to think of a more scientific name for what's going on here. But really, what would you call a health problem that affects tens of millions of women, and is caused by three separate but tightly connected factors that work together? Furthermore, it's a health problem that's not a disease but that does underlie women's most common medical conditions. Doctors certainly agree that any of the three components of the Triple Whammy taken separately can cause all sorts of unpleasant symptoms. But they'll also tell you things like, "You have to learn to live with it" or "There's not a lot that can be done."

What makes up the Triple Whammy? It's a devilish interaction among three factors: non-stop stress, low levels of stress-buffering serotonin (a brain chemical that is behind good moods), and imbalances in your female hormones. That's right. The situation that's making so many women feel anywhere from the euphemistic "less-than-well" all the way to the "utterly crummy" consists of stress, serotonin, and hormones. Here's why:

- Women are poorly protected against the ravages of stress on their bodies because they have less available serotonin, which acts as a buffer to damp down the physical effects of chronic stress.

- Women are genetically predisposed to low serotonin, one of the feel-good neurotransmitters in our brains. Women actually have more serotonin than men, but it doesn't work as efficiently.

- Women have shifting tides of hormones — which themselves control serotonin levels and function — monthly and throughout life.

And the result? These three factors conspire to make millions of women feel miserable, living their lives with Triple Whammy symptoms that often progress to one or more Triple Whammy disorders.

Triple Whammy Symptoms

Produced by the tangled influence of chronic stress, low levels of serotonin, and fluctuating hormones, Triple Whammy symptoms include feeling "beaten up" — tired, achy, anxious, depressed, forgetful, headachy, and lacking energy and focus. Forgetfulness and sleep problems are common, as is a bloated feeling, with constipation or diarrhea. Craving carbohydrates (a cry for the body to produce more serotonin) is another symptom. Women with these symptoms chug through life feeling less than well most of the time. When things get really bad, women with Triple Whammy symptoms go to their doctor and hear the discouraging refrain "all your tests are normal."

Here's something I want to repeat, because it's hopeful: your Triple Whammy is not a disease. But if you don't resolve its symptoms, one or more of the Triple Whammy disorders listed on page 24 usually develops. Each disorder involves a low level of serotonin aggravated by stress and is made worse by shifts in your female hormones, estrogen and progesterone.

To complicate matters, low-serotonin disorders run through families like fault lines in California. While all women have less serotonin than men, some women also carry the "depression gene," making them even more vulnerable to Triple Whammy disorders.

How you can feel well again Repeat after me: "Simple, fixable, not a disease. I can feel well again." Notice that I didn't lighten up the Triple Whammy by calling it "just an imbalance." Girl, this is an imbalance from hell.

In this book, I offer you some powerful ways to quell the effects of the Triple Whammy. The Triple Whammy Three-Week Cure is all-natural, easy to follow, and inexpensive. It produces results very quickly, clearing the vast array of symptoms you've been experiencing and restoring the good health that seems like a remote memory. So it's time to turn things around. Time to get your life back. So, now you can turn to Chapter 4 and begin the Three-Week Cure, or stay with me here while we look at the Whammies, so you can learn why the cure works.

The Whammies, Explained

Whammy #1: The Chemistry of Stress

What exactly is stress and why does it affect us so badly? Here's one definition: stress is any situation in which you've unwillingly relinquished the ability to control your life. The controlling force can be a person (a dictator of a country, a boss, a boyfriend) or something inanimate (a deadline, a tax audit, the "dark"). Adapting to stress in a positive way can lead to good things, like ambition, accomplishment, courage, and creativity. But stress can also be destructive.

When faced with stress of any kind, our bodies are hardwired to respond in a series of ways that are designed to protect us. This series of events, called the stress response, allows us to either fend off stress (fight) or escape it (flight), leading to its common name, the fight-or-flight response. The system is triggered when the adrenal glands, a pair of walnut-sized glands sitting one each atop your kidneys, receive distress messages from your brain. The adrenals then release the hormone adrenalin, which in the right situation — such as escaping a mugger — can be lifesaving.

As these hormones pour into your system, they kick up your heartbeat, raise your blood pressure, churn your intestines, increase your blood sugar, tighten your muscles, and rechannel the blood flow in your body so that you're primed to respond physically, either with a swift kick to the crotch or the fastest hundred yard dash imaginable. Fleeing (or fighting off) the mugger is followed by panting relief, shakiness as your body processes the wash of hormones, and ultimate recovery. But let's say the person you thought was a mugger turns out to be a friend. You didn't have to fight or flee, it turns out, but your body, in preparation, would have undergone the stress response anyway, and now you feel utterly drained. Even though you "did" nothing — your body simply got you ready to do something — you're exhausted. Remember this "exhausted" part, because it becomes very important later on.

Our truly elegant, primitive response to an actual threat was designed to be turned on and off. It was not built to accommodate chronic stress. Our bodies simply can't cope with the jolts of one stress response after another. Repeated bursts of adrenalin tighten muscles painfully ("I carry my stress in my neck"), change the way blood circulates in your body ("my hands and feet are always cold"), and throw digestion out of whack ("I get diarrhea whenever I'm nervous"). When stress shifts from being an occasional isolated event into a way of life, additional symptoms begin to appear. Chronic stress makes you feel anxious, depressed, and tired all the time, interferes with sleep, causes you to eat carbohydrates to generate stress-buffering serotonin, and bollixes up concentration and short-term memory.

But in modern life, chronic stress does enter our lives. And let's face facts. During the past fifty years, the day-to-day stresses faced by women have multiplied exponentially. As the many women I treat tell me, they are stretched so thin that they feel as if they're always avoiding the spinning blades of a Cuisinart. Contemporary women are, in the vast majority of families, responsible for meeting the needs of partners, children, and aging parents while maintaining the house, paying the bills, and organizing their own and their family's life. Many also hold a paying job. And single women have a different range of stressors that are just as valid.

Of course, each of these factors in itself is no mugger with a gun, but taken together they're extraordinarily stressful. With constant stress, though, you don't have a rush of adrenalin alone. Unrelenting stress stimulates a different system in your body — your endocrine glands. Constant stress will turn some of these glands to "high," ultimately exhausting them, while deliberately suppressing your ovaries (also endocrine glands), which interferes with sex drive, ovulation, and the timing of your periods. This shows the body's common sense: it's not a good idea to get pregnant when the world is sending a constant stream of stressful messages. What happens next is that chronic stress sends alarm signals to a small section of your brain called the hypothalamus, which in turn relays volleys of stress information on to your pituitary gland. A cherry-sized little thing, the pituitary is the "master" gland in your body, tucked safely out of harm's way on the underside of your brain, resting royally in a curve of bone whose Latin name translates to "Turkish saddle." (Try to imagine your master-gland pituitary sitting there, piloting you around like a Boeing 747.)

The back end of the pituitary releases a single hormone, vasopressin, which jacks up your blood pressure and speeds up your heart. The front end controls your other endocrine glands: the thyroid (essentially your body's gas pedal); a portion of your adrenal glands (called the adrenal cortex), which release the hormone cortisol; and your ovaries (which produce sex hormones).

Endocrine activation and chronic stress

In the chronic stress of your harried life, it will be endocrine activation that dominates your stress response. Your adrenaline fight-or-flight response never gets turned off during chronic stress, however. Rather, during a particularly bad week it will pepper your constant-stress endocrine response with adrenalin bursts during especially stressful moments. As each of your glands gears up in response to chronic stress, you may feel any of the following sensations, each of which represents a physical change in your body trying to resist the stressor:

- Thyroid: nervousness, excessive sweating, tremulousness. Obviously this is very similar to an adrenalin rush but slower, and more prolonged.

- Adrenal cortex (the outside part of the adrenal glands): elevated blood sugar, fuzzy thinking, rise in blood pressure, fall in awareness of pain (the hormone cortisol acts as an antiinflammatory, similar to aspirin or ibuprofen), gas and bloating, constipation and diarrhea.

- Ovaries: diminished sex drive, change in menstrual cycle.

Again, your body wasn't meant to be hit with a bevy of stressors without some downtime in between. As it tries to cope with the various stressors of your day, your body turns your endocrine gland system to high — and holds it there. You don't have to know much about cars to realize that if you put the gears in neutral and keep the gas pedal pressed to the floor, you'll burn out your motor before too long. And if your stressors continue unchecked, that's precisely what will happen to you.

Both stress responses, acute and chronic, are meant to be temporary, the acute for a few minutes (the mugger); the chronic for a few hours or days (final exam week, finishing a board report). Each of these responses is meant to come to an end. The human body simply cannot tolerate a nonstop stress response of any kind.

Serotonin is your factory-installed buffer against stress — your resistance

This is a good time for me to introduce serotonin briefly, although I discuss it in more detail on page 12. Serotonin is a brain chemical called a neurotransmitter, and for the time being, consider it your factory-installed buffer against stress — your resistance. The more you have, the better you're able to tolerate stress, both sudden and chronic. But women have less available serotonin than men, so you're poorly protected, and your susceptibility to stress is much greater. To give you a sampling of serotonin's effect, consider what many people say when, by means natural or pharmaceutical, their serotonin levels rise. They'll say "What used to really stress me out doesn't anymore" or "I simply don't feel as anxious as I once did." On the surface, it may sound as if they've been handed a tranquilizer. But serotonin isn't a tranquilizer; it's simply a chemical already present in your brain that increases your resistance to stress. And if you follow the steps in this book to increase your serotonin, within no time it will soar. As it does, your mood, energy, and sex drive will improve, your cravings for junk carbs and sugar will disappear, and you'll feel like a new woman.

Exhaustion leads to Triple Whammy disorders

Let's talk about the exhaustion of chronic stress. As your body becomes overwhelmed by the relentless task of resisting multiple constant stressors, your protective mechanisms start to fail. Understanding how the stress response goes awry and wreaks its destructive effects on the body is key to understanding the Triple Whammy. The whole array of Triple Whammy symptoms and disorders is triggered by unrelenting stress that is able to attack your body freely because you're unprotected by adequate serotonin and buffeted by shifts in your hormones. But let me quickly add that, if you're going through any of this, you can get out of it and have your health restored to normal.

Emotionally, as your systems crash under constant stress, you may get tired, moody, irritable, and withdrawn and ultimately develop depression. Your level of anxiety about relatively minor stressors may increase so much that you're not even sure what's making you anxious anymore. You just feel anxious all the time, and may even experience surges of panic. Some women might fall back to an old abnormal behavior pattern or develop a new one. If you had an eating disorder as a teen, it may resurface. You may find yourself repeatedly checking the locks on your doors or whether you turned off the stove, working over and over in your mind the same negative thoughts, first signs of what may be later diagnosed as obsessive-compulsive disorder.

Moving on to physical symptoms, your muscles may remain so constantly tight that you can no longer relax them. Certain spots within your muscles become so tender that a massage therapist can feel hard, painful knots. If the muscle pain persists, you may go on to develop fibromyalgia (which means simply "muscle pain"). This is not a disease, but rather a reaction of your muscles having become "stuck" trying to resist chronic stress.

Your internal organs will suffer from stress, too. The intestinal churning from stress may proceed to the cramping, bloating, pain, nausea, and diarrhea/constipation that defines irritable bowel syndrome. Surges of hormones — adrenalin from your adrenal gland and vasopressin from your pituitary — contract blood vessels throughout your body and may affect an especially vulnerable blood vessel in your brain. As it pulsates, you feel the throbbing of a migraine approaching.

Always tense and irritable, you may clamp your jaw tight, and if it fails to relax, you're stuck with chronic pain in your temporomandibular joint (TMJ). Part of the stress response includes racing thoughts, triggered by the cortisol that's secreted by your adrenal gland. Over a period of time, this cortisol washing through your body actually blocks short-term memory and your ability to focus on details or fully concentrate fades. Hormones from your stress-driven pituitary cause a shift in your sex hormones that can change your periods, impair your fertility, or trigger symptoms of premenstrual syndrome (PMS).

Finally (and, fortunately, only rarely), overwhelmed with unchecked stress, you may collapse into an exhausted heap, first for days, then for weeks or even months, staggering into your doctor's office, to learn that you have all the signs of chronic fatigue syndrome (CFS), again not a disease, but one of the most dramatic outcomes of stress.

How the Triple Whammy is a reflection of the stress response

Triple Whammy symptoms and Triple Whammy disorders are actually intense exaggerations of all the body changes that occur during the stress response. Please read that sentence again. The stress response is central to all these Triple Whammy problems. But stress plays a commanding role in the onset of many diseases. For instance, researchers recently discovered the so-called depression gene and found that people born with it are more likely to develop depression after exposure to stress.

Fatigue and exhaustion of the thyroid, adrenal glands, and ovaries

All doctors don't agree, but I'm convinced that the demands of chronic stress on these three endocrine glands impairs their function — first overstimulating them and then exhausting them. In fact, some Triple Whammy symptoms may well be caused by this glandular fatigue. Your thyroid, adrenals, or ovaries aren't "diseased" in any way, but with exhaustion (depletion) simply produce less of their hormones.

Symptoms of stress-related thyroid fatigue and exhaustion include fatigue, dry skin, intolerance to cold, mild constipation, and fuzzy thinking. These are the very same symptoms caused by an underactive thyroid due to thyroid disease, and if you tell your doctor you have these symptoms she'll probably (and possibly correctly) diagnose you as having an underactive thyroid. To verify, she may do a test to check your levels of thyroid-stimulating hormone (TSH), which, if high, indicates an underactive thyroid gland. (As an aside, TSH does not come from the thyroid gland, but rather is a stimulant sent from your pituitary gland to get your thyroid to produce more hormone. A high level of TSH indicates a low level of thyroid function, a fact that endlessly confuses medical students, because the pituitary keeps sending out TSH in an effort to get the thyroid to function properly.)

If your test results come back showing normal levels of TSH, both you and your doctor may be surprised, given your symptoms. But these normal test results do not (repeat, do not!) necessarily indicate that your thyroid is functioning normally. There are two reasons for this:

- The so-called normal range for TSH is currently questioned by leading endocrinologists. Now it seems that many people who'd been told in past years that their thyroid was normal may need treatment. For years, any TSH above 5.0 was interpreted to mean the person had an underactive thyroid. Now an increasing number of physicians will begin treating those with a TSH of 3.5 or higher if they show other signs of underactive thyroid.

- Some doctors (myself included) are beginning to question altogether the value of a normal TSH. We're asking "What happens to our patients who have all the symptoms of an underactive thyroid (hypothyroidism) but a completely normal TSH test result?"

What I do is this: if your TSH test results are normal but you have the symptoms (fatigue, dry skin, cold intolerance, mild constipation, muddled thinking), we recheck your thyroid gland using an old-fashioned screening test that measures basal body temperature (p. 75) for several days. If temperatures average 97.6 or lower after testing for a number of days, I prescribe a small dose of thyroid replacement hormone, usually 30 mg (one half grain). This basal temperature diagnostic test was used by conventional doctors for more than fifty years and is extremely accurate.

Interestingly, stress-related thyroid exhaustion can reverse itself after stress is addressed, your serotonin is increased, and your body starts functioning smoothly again — unlike other forms of thyroid underactivity. For this reason, taking thyroid replacement hormone for stress-induced thyroid fatigue/exhaustion is rarely a lifetime commitment, as it is when you have actual thyroid disease. In other words, you likely won't have to stay on the small hormone dose forever.

Symptoms of stress-related adrenal fatigue or exhaustion include fatigue, low blood pressure, and feeling especially lightheaded when you rise suddenly from a stooped position. And just as the symptoms of stress-related thyroid problems are the same as low thyroid caused by a thyroid disease, adrenal fatigue symptoms are the same as an uncommon adrenal gland disorder called Addison's disease. As you might suspect, the treatment for Addison's disease is to take adrenal hormones.

To diagnose adrenal fatigue/exhaustion, doctors measure levels of cortisol (an adrenal hormone) and DHEA (a building block of adrenal hormones), collected via blood or saliva during one twelve-hour period. If you have adrenal fatigue or exhaustion, you may need to take a short course of adrenal gland hormones along with nutritional supplements to restore proper function to your adrenal gland.

Therapies I use, and which you can request from your doctor, include 5 mg of hydrocortisone (cortisol) once or twice a day, 10-25 mg daily of DHEA, and other nutritional supplements combined and sold as adrenal support products. Again, these are not permanent therapies and usually you can discontinue them in fewer than four months, once you get a handle on your stress and take steps to improve your serotonin levels.

Symptoms of stress-related ovarian fatigue include changes in your menstrual cycle and PMS, which is triggered by an imbalance between estrogen and progesterone, and almost always worsens during periods of stress. The interplay of pituitary hormones affects the maturation of an egg and its release for fertilization, as well as the amount of estrogen and progesterone produced by your ovaries. In addition, the adrenal gland is a secondary source of sex hormones, DHEA being a building block of progesterone.

The effects of chronic stress on your ovaries may also contribute to infertility. Doctors are beginning to appreciate that infertility caused by the ominous-sounding "ovarian failure" may have a lot to do with the effect of unchecked stress on ovulation. It is possible that women could avoid the need for many extraordinarily stressful (and expensive) infertility treatments if they reduced their stress.

Whammy #2: Serotonin, Powerful Stress Buffer

Serotonin is needed in the brain to allow nerve cells to communicate with each other. Without neurotransmitters, the billions of nerve cells that make up your brain would sit idle and you'd be unable to think or even move. Depression is perhaps the best-known low-serotonin disorder, but serotonin is also intimately involved in the action of your intestines, blood vessels, and blood clotting. That's a pretty broad role for a single molecule, so you can see why serotonin might be involved in such seemingly unrelated Triple Whammy conditions as depression, migraines, and irritable bowel syndrome.

A genuinely annoying fact about serotonin is that it is unfairly distributed between the sexes. Women actually have more serotonin in their brains than men, but it simply doesn't work as well. Men's levels of serotonin operate much (much!) more efficiently than women's. And because women's brains are deprived of adequate serotonin, they're poorly equipped to handle stress. To make matters more complex, serotonin levels are influenced by your hormones.

To understand how neurotransmitters like serotonin work, consider this sequence of events: you remember you need to add milk to your grocery list, see the list on the fridge, grab a pen, and write down the word "milk." Sounds simple enough, but your family dog will never master this. Fetching the pen and writing the word gives the illusion that there's a single thread-like nerve traveling from your brain to your fingertips. But this isn't the case. Picture instead that your brain consists of billions of nerve cells, each separated from hundreds of its neighbors by extremely tiny gaps, called synapses. When information — an electrical impulse, actually — in one brain cell needs to get to the next cell, the particle of information needs to jump the gap. I use the phrase "one brain cell" only to describe the mechanics of the process, because just to think of the word "milk" and then picture the container, you're actually activating millions of brain cells.

Neurotransmitters and recycling?

Here's how jumping the synapse gap works. When information reaches the transmitting end of one nerve cell, it's carried by neurotransmitter molecules across the gap to the receiving end of the next nerve cell, where it locks onto a receptor site and transmits the information. The neurotransmitter molecule is then recycled back into the first nerve cell for reuse. (Remember this recycling process because it's very important when we talk about how antidepressants work.)

Every thought you have, every emotion, perception (like hearing, seeing, or feeling), and movement — whether voluntary, like reaching for the pen, or involuntary (your beating heart) — involves your nervous system and requires neurotransmitters. Without them every aspect of your existence would come to a screeching halt.

Researchers have identified several different neurotransmitters working inside the brain, each involved in different activities. Serotonin is predominant; others are norepinephrine, acetylcholine, and dopamine. Part of serotonin's predominance comes from the idea that it seems to control the release of other neurotransmitters, and can attach itself to a greater variety of nerve cell receptor sites than the others. Large amounts of serotonin are also located elsewhere in your body, including your gastrointestinal system, blood vessels, and platelets (small particles in your blood needed for clotting).

The other neurotransmitters play significant roles, too. Norepinephrine is involved with focus and concentration (the treatment of attention deficit disorder includes increasing the levels of norepinephrine). Acetylcholine is linked to memory, and the new drugs for slowing Alzheimer's disease increase its levels. Dopamine is involved in movement, and is the mainstay of Parkinson's disease treatment.

Women, evolution, and serotonin

Doctors know that the rates of depression, anxiety and panic disorder, obsessive-compulsive disorder, eating disorders, fibromyalgia with chronic fatigue, irritable bowel syndrome, and migraines are always higher among women than men. They knew this even before they knew the chemistry behind these disorders. When doctors discovered the relationship between low serotonin and emotional disorders, they started comparing the serotonin levels between sexes and found that women simply were not making enough and that it can be plentiful in certain parts of your female brain, but not in others — at least not enough to protect you against stress.

But nobody is exactly positive why this is. One guess — and it's only a guess — shifts us back to our prehistoric days, when men were hunter-gatherers and women stayed back at the cave or camp and took care of the kids. Out in the woods, their lives perpetually at risk, men needed to develop some adjustment in their brain chemistry to avoid having a panic attack when they heard something crunching the twigs behind them. Hence, they evolved an increased amount of serotonin, a stress buffer. Women, on the other hand, didn't need this same protection until relatively recently, during the past several generations, when the playing field for women changed considerably, and their lives underwent tremendous transformation. Even though you face more stress than ever, more than your ancestors, today's women rely on a serotonin buffer little changed from tens of thousands of years ago.

Some years ago, doctors first began to note a link between low levels of serotonin and depression when studies showed that reserpine (a drug for high blood pressure no longer used) could trigger depression to the extent that suicide was actually a possibility among users. Then it was discovered that reserpine depleted serotonin inside the brain, so researchers began measuring serotonin in the spinal fluid of previously depressed patients. They found that serotonin levels were consistently low and that serotonin levels could be increased using medication. This eventually led to serotonin's nickname as the "feel-good" neurotransmitter.

Discovering this biochemical cause for disorders like depression and anxiety is indeed one of the miracles of twentieth-century medical research. As recently as fifty years ago, a woman with severe depression might have found herself committed to a state mental hospital, often for years. Some of my interest in women's health came about when I gained access to the medical records of my grandmother, years after she'd died in one of these hospitals. Because of the stigma associated with mental illness, I'd been told she had died as a young woman, when in fact she'd spent virtually her entire adult life institutionalized. I had not even known she was alive when I was young. Years later, as I looked through her doctor's notes, I realized sadly that she could have lived a real life if only antidepressants had been invented a few decades earlier.

How serotonin buffers stress and what occurs if you don't have enough

Research during the past few years has taught us a lot about serotonin and other neurotransmitters. For example, a combination of serotonin and norepinephrine (which helps us focus and concentrate) regulates how well we react in response to both positive and negative stress. A soldier preparing to defend her comrades or a high school senior taking her SATs becomes more focused, even hyperalert, as levels of norepinephrine rise, helping her concentration and attention in the face of an impending task. But both women also need adequate levels of serotonin to prevent — buffer, actually — their hyperalert state from intensifying into a panic attack or despair. For both soldier and student, stress can escalate even further in one of two ways:

- In the first case, stress escalates because the stress itself actually increases. In other words, the actual event triggering the stress can get more intense: a bombing begins or the test booklet is opened.

- In the second case, the stressor itself is unchanged, but without an adequate serotonin stress buffer, the perception of stress escalates.

In both situations — actual stress or stress perceived — the result can be the same. With escalating stress of either type, the brain sends a distress signal to the adrenal glands to release additional stress hormones: epinephrine and, to a lesser extent, cortisol. These hormones flood into the soldier and the student, putting their bodies into overdrive, speeding up their hearts, tensing their muscles, racing their thoughts. Obviously, the stress response is a two-edged sword, helpful for the soldier if the bombing is actually under way, but definitely the wrong reaction for the student to feel ten minutes (or ten hours) before the exam even starts — or after it's over.

When faced with a stressful situation, whether actual and dangerous or created by unrealistic worry, if you don't have enough serotonin, two things can happen: your mood may plummet and you'll become apathetic or you'll become anxious in the extreme, sometimes to the point of panic.

Although you need the hyperalert state of norepinephrine and the stress response of epinephrine, you also need serotonin to act as a buffer against those situations. Triple Whammy disorders are not diseases as we usually define disease, but rather the emotional and physical symptoms of stress unchecked by sufficient amounts of serotonin.

Serotonin's role in pleasure and pain

Serotonin is also involved with our appetites. Our enjoyment of the scents and flavors of food correlates to levels of serotonin. For depressed people, for example, food often loses its taste and scent and instead they may crave substances that either mimic neurotransmitters (like alcohol, tobacco, or caffeine) or change the levels of neurotransmitters in the brain (like sugar, carbohydrates, and other comfort foods).

People with low levels of serotonin also perceive pain more strongly than those with normal levels because they have an increased sensitivity to a chemical called Substance P (for Pain). People with chronic pain disorders have reduced levels of serotonin and are more susceptible to depression. Serotonin also causes the smooth muscles of your intestines to contract, and increasing serotonin levels alleviates the symptoms of irritable bowel syndrome (p. 103). Likewise, changes in serotonin levels affect our susceptibility to migraine headaches (p. 136), triggered by stressful spasms of blood vessels.

Serotonin and estrogen: the roller-coaster effect

The relationship between serotonin activity and your sex hormones is complex. Estrogen increases the amount of all neurotransmitters, including serotonin, and also increases the number of receptor sites for them. With more receptor sites, you can make more connections in your brain. To put it simply, with higher levels of neurotransmitters and more receptor sites for them, you're smarter, and can think faster and more creatively.

The relationship between estrogen and feel-good serotonin is so sensitive that I think of it as a two-car roller coaster, with estrogen the front car, pulling serotonin behind. When estrogen is high, as it is during pregnancy or during the two weeks after your period, most women feel pretty good because their estrogen and serotonin levels are both moving upward. The drop in estrogen during PMS days can make you cry at a Hallmark commercial or bite the head off your partner. That same estrogen-serotonin drop is also responsible for the misery of postpartum depression and the increased frequency of mild depression in women going through the menopause transition.

This relationship between serotonin and estrogen is fundamental to how you'll be treating Triple Whammy symptoms and disorders. The mild depression of perimenopause can respond quite well to the natural serotonin-boosters in the Three-Week Cure; sometimes you'll also need small doses of either bioidentical hormone replacement, serotonin-boosting herbs, or prescription serotonin-raising antidepressants. Likewise, you can resolve any moodiness you feel during PMS days by following the serotonin-boosting steps in the Three-Week Cure, taking herbs that increase serotonin, antidepressants, or (sometimes) birth control pills.

Here's another statistic to consider: it's estimated that some 40 percent of the population has a genetic susceptibility to serotonin-related disorders and that a majority are female. This means almost half of us have been born with a trait that prevents us from having enough serotonin when the situation calls for it — on top of the fact that all women have less available serotonin. This is why you need to know how to make more for yourself.

How to make serotonin without taking a pill

Since serotonin is so thoroughly useful, it would be handy if we could just "take some" to build up our stress barrier, ease pain, and get quick relief from Triple Whammy disorders. Currently, we just can't do this. Serotonin is a delicate molecule and would be destroyed by your stomach acid before it could be absorbed. And even if you could get serotonin into your bloodstream, it wouldn't be able to cross the internal shield known as the blood-brain barrier, a specialized system of cells designed to keep any but the most essential nutrients away from your vulnerable brain. Even though serotonin is necessary to the brain, the molecule itself is too large and too complex to pass through this guardian barrier.

You might be asking yourself, "But what about antidepressants — don't they contain serotonin?" We're coming to that, but first let me say that it's not particularly difficult to increase the serotonin in your brain without drugs. And since we can always use some extra protection from the stress in our lives, having above-average serotonin levels is almost always a good idea. There are three immediate steps you can take to help your brain make more serotonin and they're outlined in the Three-Week Cure: sunlight, exercise, and carbohydrate timing. There are also two bonus serotonin boosters: laughter and kindness. Learn jokes, visit comedy clubs, rent only comedies from your video store. And perform acts of kindness. People who regularly volunteer to help others have measurably higher levels of serotonin.

How SSRI antidepressants increase serotonin

With the help of your doctor and her prescription pad, you can increase serotonin by taking prescription antidepressants. They work by increasing the levels of serotonin (and other neurotransmitters) in the synapse gap between two nerve cells — specifically by blocking your brain's neurotransmitter recycling system. Remember on page 13 we discussed that neurotransmitters jump the synapse gap between nerve cells to move information from one brain nerve cell to another, and are then recycled back into the first nerve cell for reuse. This recycling is how today's antidepressants work. Older antidepressants, like amitriptyline, simply made more serotonin. These are still in use, but side effects like drowsiness and dry mouth have made them less popular. The newer antidepressants — Prozac, Paxil, Lexapro, and others — are called selective serotonin reuptake inhibitors, SSRIs for short. These drugs block the reentry (reuptake) of released serotonin. SSRIs keep the serotonin from getting back inside the original brain cell, leaving serotonin in the gap, where it accumulates, causing levels in the gap itself to rise and work their magic.

The process of recycling released serotonin by blocking reentry takes from two to six weeks. It takes that long for enough serotonin to build up in the gap to make a noticeable difference.

Other antidepressants, like Effexor and Wellbutrin, work with other neurotransmitters and thus are not SSRIs.

There's a difference between the sexes when using antidepressants. For many women, a tiny dose — as little as one-fourth the dose used for men — works nicely. Pharmacologists believe that women in general are more drug-sensitive than men, again possibly because of low serotonin levels. It's best for women to start with a small dose and work slowly upward to avoid side effects. Everyone, but especially women, must be cautious when stopping antidepressants. Your brain has grown accustomed to the added neurotransmitters and doesn't want the boat rocked. Unless you gradually taper off your dose (your doctor can tell you the best way), you can experience headaches, dizziness, problems walking, and a return of your depression and anxiety. These effects almost never occur when your dose is reduced gradually.

Nutritional supplements that increase serotonin

Now that you understand the two ways of increasing serotonin — making more on your own and recycling it using antidepressants — you'll see how nutritional supplements can be helpful. Because nutritional supplements are generally safe and simple to take, I often recommend that my patients first try the make-your-own-serotonin steps and these supplements before turning to an antidepressant.

- St. John's wort This herb crosses the blood-brain barrier and acts in the brain like a mild version of an SSRI antidepressant, allowing serotonin to accumulate slowly in the synapse gap. Because it works like an antidepressant, you shouldn't take both St. John's wort and a prescription antidepressant simultaneously. Doing so can make you feel nervous, "wired," and can interrupt your sleep. A February 2005 study in the British Medical Journal finally put to rest the effectiveness of St. John's wort as an antidepressant for people with moderate to severe depression. Half the study's partcipants took the antidepressant Paxil (paroxetine); the other half took a minimum 900 mg daily of St. John's wort. After six weeks on these regimens, one third of those taking the Paxil felt less depressed; but one half of those taking St. John's wort were less depressed. The well-designed study also showed that St. John's wort caused fewer side effects than Paxil.

- 5HTP Along with St. John's wort, to increase serotonin further you can add the amino acid 5HTP (5-hydroxytryptophan). Although serotonin can't pass the blood- brain barrier, 5HTP can, and once it's in the brain it converts to serotonin, making 5HTP a building block for new serotonin.

- B vitamins and fish oil These are needed to grease the wheels for smooth serotonin production, which is why they're an integral part of the Three-Week Cure.

Whammy #3: The Biology of Hormones

Women can only guess how mysterious they are to men. I was highly impressed when I learned that menstrual cycles and moon cycles were the same length. And women's bonding impresses men, too. Men have buddies and pals, but generally we tackle life alone, rarely experiencing the degree of intimacy women share with friends, endlessly supportive. Sisterhood implies a man-free barrier, the "we'll talk about it later" look that passes between women when a man enters the room. The menstrual cycles of women living together start synchronizing, so it could be said that women are not only connected by emotional and spiritual bonds, but their bodies are magically linked together as well. Very, very impressive.

Hormonally speaking, every day something different is happening within you. With periods, PMS, pregnancy, and the menopause transition, there's a lot going on. Your body produces three sex hormones. Most familiar are your female hormones, estrogen and progesterone, mainly made in the ovaries. The third is the male hormone testosterone, a small amount of which is secreted from your ovaries and adrenal glands. Levels of estrogen and progesterone are controlled by your pituitary gland, the body's master gland, which controls your ovaries, thyroid, and adrenals. The pituitary affects your ovaries by releasing two hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH). How much of each is secreted depends on two separate factors:

- First, your pituitary "reads" the amount of estrogen and progesterone circulating in your blood at any given moment and then pumps up or turns down FSH and LH.

- Second, your pituitary responds to emotional information relayed from an area of your brain called the hypothalamus, a key command center for the interaction between your mind and body. The hypothalamus is very sensitive to stress. Most women have had their periods thrown off cycle by stress at one time or another.

Here's an example of how the control system works: during the menopause transition, when the amounts of estrogen and progesterone being produced by the ovaries are very low, your pituitary responds by pumping out large amounts of FSH and LH in an attempt to get the ovaries started up again. This is fruitless because your ovaries are pretty much done producing these hormones. (Women who want to confirm that they're in the menopause transition sometimes have their levels of FSH and LH tested, and very high readings confirm the diagnosis. The same holds true for women undergoing infertility testing; doctors measure FSH and LH levels to see if the ovaries are functioning. If they're not, FSH and LH levels will be high.)

Your hormones fluctuate day to day, month to month, and year to year in a cycling system that kicked in when you were about twelve. Your brain and pituitary gland are always working to control your cycle. This constant hormonal shifting gives you an idea why "measuring" your hormone levels on any given day, or even during a single month, may not be all that helpful. Smaller amounts of your hormones were around several years before puberty, making you decidedly different from your brother but not enough to get your period started. Most women have sufficient hormones to keep their periods going until their late forties or early fifties, when things change and your periods become irregular and scantier because levels of uterus-stimulating progesterone are in decline. Ultimately, your periods will stop altogether, although your ovaries will continue to produce some hormones for the next few years.

Two hormone shifts...and possible imbalance

There are really two separate hormone shifts throughout the course of your life. You have your monthly rise and fall of estrogen and progesterone, as well as a lifetime s-l-o-w rise and fall of these hormones. The situation is not unlike how the earth itself cycles, rotating on its axis as it travels around the sun. Ideally, this lifetime of hormonal tides should proceed without any problems, uninterrupted except by pregnancy. What generally causes trouble — meaning uncomfortable symptoms rather than disease — are imbalances in the system.

Stress is a frequent source of this hormone imbalance. The entire hormonal system is highly sensitive, and when your pituitary gland receives stress-laden messages relayed from the hypothalamus, the changes in FSH and LH that follow can throw off your cycle or interfere with ovulation. Stress reduction becomes a key factor in getting your hormones back on track when dealing with PMS, the menopause transition, and even infertility. You might also be surprised by the extent that unhealthful food choices play in hormonal imbalances. Junky diets are a recipe for PMS. The Triple Whammy Food Plan is an easy eating program that can help bring everything back into alignment, sometimes without any other therapies at all.

You may unwittingly bring upon yourself one of the most common hormone problems. If you ever took birth control pills and simply couldn't stand how they made you feel, you were experiencing one of those imbalances: too much estrogen. Side effects were a real problem with the first generation of oral contraceptives because the estrogen content was so high. Now birth control pills contain synthetic estrogens in microgram-sized doses (that's one ten-thousandth of a gram), and side effects are less common. But despite these minuscule doses, many women continue to report nausea, breast swelling and tenderness, bloating, headaches, and vaginal yeast infections, all symptoms of excessive estrogen that stop abruptly when the pill is discontinued. On the other hand, many women report feeling much better when taking the pill. They simply do better when an outside influence runs their hormonal system, correcting any subtle imbalances.

If the symptoms of excessive estrogen sound suspiciously like another common hormone problem, premenstrual syndrome (PMS), you're absolutely right. During the second half of your cycle, after you ovulate, estrogen falls slowly as progesterone rises. In the days before your period, progesterone falls as well. But for many women, the estrogen does not fall quickly enough, bringing about estrogen-dominant (or progesterone-deficient) PMS, along with breast tenderness, bloating, and fluid retention. This can be easily treated (see PMS, p. 153) using the herb chasteberry, which acts on the pituitary and balances the two hormones. Or you can simply increase your progesterone levels by applying a progesterone-containing skin cream or taking capsules of progesterone itself.

To some degree, every woman experiences hormonal imbalance when she goes through menopause. Unlike PMS and its estrogen excess / progesterone deficiency, in menopause your body encounters an overall estrogen lack. Potential symptoms (not all women experience them) include hot flashes, night sweats, vaginal dryness, headaches, fatigue, and urinary incontinence. Virtually all can be eliminated in a few weeks with hormone replacement therapy. But I know you might not be thrilled with that idea. So in the Menopause Transition healing path (p. 120) we'll talk about alternative approaches to menopause, including easy changes in your eating habits, herbs like black cohosh, and bioidentical replacement hormones.

Testosterone and sex drive

Women joke that men, primed with testosterone, are capable of having sex with anything that moves. And indeed that's the purpose for the tiny amount of testosterone in your female body — to give you a sex drive. Doctors prescribe testosterone to men and women to enhance declining sexual energy and interest. But too much testosterone can make you one of the guys, giving you a masculine voice, more facial hair, even some acne. Obviously, a woman's dose needs to be an exceedingly small one. The ever-helpful pharmaceutical industry provides several forms of estrogen-testosterone products for menopausal women to boost libido.

The roller coaster that is serotonin + hormones

Your hormones demand attention and respect. They are powerful, with a capital P. Many women are well aware of the mood-related hormone symptoms: mental fuzziness, poor focus and concentration, depression, anxiety, moodiness, irritability, panic attacks, anger, and flares of rage. Hormone imbalance can also occur during the vulnerable weeks after delivering a baby, when susceptible women can be plunged into deep depression or develop obsessive-compulsive tendencies.

All these symptoms are examples of the intimate relationship between Whammy #2, low serotonin, and Whammy #3, your hormones. As I will remind you throughout this book, estrogen and serotonin are intimately related. When estrogen rises, as it does in the two weeks after your period and also during pregnancy, up goes serotonin, and with it your mood. But when estrogen falls, as it does before your period and also during the menopause transition or after delivering a baby, so does your mood and life can get difficult.

Add to all this Whammy #1, stress. Remember that serotonin is not only a neurotransmitter allowing brain cells to talk to each other, but also a buffer against stress. When you realize that you as a woman have only a fraction of the amount of serotonin available for stress-buffering as men, stressful events can have life-shattering consequences. When a stressful event happens during PMS days or perimenopause, when serotonin is even lower, your Triple Whammy symptoms (p. 4) and disorders can get a lot worse.

Copyright © 2006 by David Edelberg, M.D., and Heidi Hough

Table of Contents

Contents

A Note to You, the Reader: Why I Wrote This Book

I. Understanding the Triple Whammy

1. What is the Triple Whammy?

2. Triple Whammy Questionnaire

3. Looking for Clues in Your Life Story

II. Triple Whammy Three-Week Cure

4. The Triple Whammy Three-week Cure

Week One: Keep a Stress Journal, Walk in the Light, Start the Triple Whammy Food Plan

Week Two: Work Out Stress and Overcome Worry, Add B Vitamins and Fish Oil, Add Chasteberry or Black Cohosh; St. John's Wort and 5HTP if needed

Week Three: Manage Anger and Cultivate a Positive Attitude, Time Your Carbohydrates, Progesterone Cream if Needed

III. Triple Whammy Cure Plus: Healing Paths for Triple Whammy Disorders

5. Anxiety Disorders

6. Chronic Fatigue Syndrome

7. Depression

8. Fibromyalgia

9. Irritable Bowel Syndrome (IBS)

10. Memory Loss and Brain Fog

11. Menopause Transition

12. Migraine Headaches

13. Postpartum Depression

14. Premenstrual Syndrome (PMS)

15. Seasonal Affective Disorder (SAD) and Wintertime Blues

16. Sleep Problems

17. Smoking

18. Temporomandibular Joint Disorder (TMJ)

19. Weight Loss Agonies

IV. Triple Whammy Resources

20. Stress Less

Lifetime Lessons: Learning to Limit Stress

Stress-Relief Menu

21. the Triple Whammy Food Plan

22. Using Alternative Medicine to Heal Your Whammies

Appendix

Notes

Index

What People are Saying About This

From the Publisher

"The Triple Whammy Cure is destined to become a commonsense health classic. The advice Dr. Edelberg offers in this book reads like nutrition for the body/ mind/spirit. This is one book all mothers should give their daughters."

— Caroline Myss, author of Invisible Acts of Power and Anatomy of the Spirit

"Dr. Edelberg's book provides a wonderful, timely solution for women today who have figured out that medicine alone won't heal their stress. If you are stressed, and who isn't these days, you need this book."

— Mona Lisa Schulz, M.D., Ph.D., author of The New Feminine Brain and Awakening Intuition

"A game plan for getting better from the doldrums of life. This sensible program helps you rediscover your hidden vitality."

— Mehmet Oz, M.D., author of Healing from the Heart and coauthor of YOU: The Owner's Manual

"The Triple Whammy Cure is a godsend for women. Dr. Edelberg has done a masterful job distilling years of keen clinical insight with the latest research on hormones, stress, nutrition, and lifestyle. The end result is a highly readable and utterly practical, user-friendly program that promises to transform the lives of millions of women."

— Christiane Northrup, M.D., author of Women's Bodies, Women's Wisdom, and Mother-Daughter Wisdom

"David Edelberg is an educator, an entertainer, and a wise guide lighting a path toward healing in The Triple Whammy Cure. He clearly explains why women of today feel tired and stressed, and gives them a step-by-step approach to feeling better, quickly. I will give this book to all of my women patients, and I know that they will thank me for it."

— Glenn S. Rothfeld, M.D., medical director, WholeHealth New England, assistant clinical professor, Tufts University School of Medicine, Boston

"This is a wonderful program, easy to follow and implement. I highly recommend it to any woman who has been hit by the 'Triple Whammy.'"

— Frank Lipman, M.D., author of Total Renewal

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