Journal

Overview

Acne is most prevalent in teenage years, and when it continues into adulthood it can cause can cause much ongoing distress. In addition to permanent scarring and disfigurement, acne has long-lasting psychosocial effects that affect quality of life.

Acne often presents in rhythm with menstrual cycles, particularly before the onset of menstruation in combination premenstrual syndrome (PMS), indicating hormonal involvement.

There are many natural approaches to consider that have been shown to be effective for helping women resolve their acne and PMS, but are not always understood by primary healthcare practitioners where topical drugs, antibiotics or the pill are the current medical treatments.

Introduction

BA was 33 years old and working as a solicitor when she came to see me saying:

She said:

“Since the age of 13 I have been suffering from what I think is cystic acne. At that age, once every 6 months or so, I would get one massive spot on my face. As the years have progressed, this has become much more frequent and appear to be more prevalent on my cheeks and jawline. Now, about 10 days before my period, massive cysts develop under my skin. Sometimes they are solid and other times they pop. It causes me severe anxiety and has had had an affect on my mood, social life and confidence.

I’ve been taking antibiotics every other month for the last 4-5 years but they’re not helping.

I also find that 7-10 days before my period I go completely bonkers – my mood, tolerance and anger levels are beyond my control. I feel out of control and unable to deal with my emotions rationally. As soon as my period starts, I have a sense of relief. This is having a negative impact on my husband and my children. I am struggling with my relationships.”

Health history

• Cystic acne started a 13
• She was prescribed Lymacyline (a tetracyline antibiotic), Clamidamice (an antibiotic which is given to treat serious bacterial infections), Roaccutane (a vitamin A derivative with multiple side effects), and Yazmin (a contraceptive pill). None of these were effective and her acne was getting progressively worse.
• 20: began a stressful career and started feeling anxiety, low patience, irritability, feeling angry, emotional and tearful. She had bouts of severe mood swings and uncontrollable anger.
• Her periods were very heavy in the first 2 days and then flow was normal.
• Painful periods
• Ovulation was painful
• She experience bloating after carbohydrates.

Nutrition history

• BA’s diet was high in sugar and carbohydrates, and she frequently had sugar cravings, especially on her period.
• Her nutrition was was low on protein and water
• She ate dairy 2-3 times a month.

Significant test results

MARKER	LEVEL	INTERPRETATION
Vitamin D	Severe deficiency	Low immune function Oestrogen too high
Creatinine	Low	Impaired methylation and liver detoxification of oestrogen
Bilirubin	High	Impaired liver function
Ferritin	High	Inflammation
Haemoglobin	Low	Iron deficiency
HbA1c	High	Insulin resistance / pre-diabetes

Root cause analysis

Acne

• Acne is mediated by high testosterone levels, stimulated by insulin resistance/spikes mediated by high sugar/starch intake, and dairy via Insulin Growth factor.

PMS

• BA’s oestrogen was too high as evidenced by heavy bleeding and ovulation pain.
• Excess oestrogen symptoms additionally include premenstrual anxiety, acne and mood swings.
• Vitamin D is vital modulator of immune and hormonal function, and black women are particularly susceptible to deficiency. Low levels of vitamin D increase susceptibility to PMS.

Protocol

NUTRITION

• I recommended a low carbohydrate, moderate protein, high fat nutrition plan which was rich in fish and eggs, with a high level of vegetables and beneficial fats, and personalised to BA’s requirements.
• Avoidance of all cow’s dairy foods.
• BA was asked to follow my 7 food rules as closely as possible.

LIFESTYLE

• BA was recommended to use pumpkin seed oil as a cleanser twice a day, applying a teaspoon of the oil to her face and removing with a damp microfibre cloth. After cleansing I recommended she apply vitamin B3 serum.

SUPPLEMENTS

• Vitamin D: calibrated dose of emulsified vitamin D drops
• Drink 1.5 litres of water a day with additional vitamin C, sulphur and potassium.
• NAC as a liver booster
• Iron supplementation
• Niacinamide to calm acne lesion inflammation
• Minerals and vitamins: including high dose B vitamins, and zinc, selenium, molybdenum, copper, manganese, chromium and boron
• Active DIM to increase oestrogen detoxification
• Saw palmetto complex to reduce testosterone levels

SYMPTOM TRACKING

Symptom	Score out of 6
	Initial score
Acne There are massive cysts on her face for 10 days before her period and she can still feel them after period. They are painful when sleeps and wears glasses. She won’t go out if has cysts on her face.	5
Number of cysts	6
Mood disturbance Premenstrual anger, explosive irritability and crying.	6

Results – follow-up 1 (+4 weeks)

• No acne – for the first time since she was 13 (and now is 33 years old)
• Irritability drastically reduced, only had a few moments of feeling annoyed
• No period pain
• No flooding, normal menstrual flow.
• No pain with ovulation
• She struggled a bit with the required nutritional changes, especially with adding vegetables to every meal, but has now made it part of her usual diet.

SYMPTOM TRACKING

Symptom	Score out of 6
	Initial score	Score after 4 weeks
Acne	5	0
Number of cysts	6	0
Mood disturbance	6	2

I’m really happy with what Sandra has done for me. My skin and mood have completely transformed, to the point where I am so happy.

BA

My review

I was delighted with the quick response that BA had to the protocol, and particularly with how happy and confident she became in her life.

Acne and PMS are so incredibly responsive to focused nutritional interventions, and BA ‘s experience is a perfect example of how having the know-how to balance hormones leads to such a positive results.

Overview

Many women experience premenstrual anxiety and depression in a moderate or severe form. Typically these are hormonal imbalances which are driven by nutrient deficiency and/or excess, which when resolved can lead to calm, uneventful, natural cycles.

Introduction

OT was 33 years when she got in touch with me seeking help for her long-standing daily anxiety and depression, which became much worse before her period. She felt low 80% of the time and even worse in the week before her period, where she would have an emotional meltdown. She had tried all kinds of approaches to manage her low moods including counselling, anti-depressants and hormonal birth control, none of which were successful.

She said:

“I have suffered with anxiety and low grade depression for as long as I can remember although I only realised that there was a name for how I felt when I was in my late teens. Whilst at college, I hit my lowest point and had some counselling but I think i only had a few sessions. The counselling did not work for me as it felt very “standardised” rather than looking to help me work through my own personal issues. I struggled with my mental health all through university but managed to distract myself with friends and work.

Recently I made positive changes to my diet, but I still suffer with anxiety and depression. I started taking sertraline as I again hit rock bottom. I stopped taking sertraline around 8-12 months ago as I was having bad side effects including severe night sweats. My anxiety and depression is also heightened a week leading up to my period and I am now looking for a more natural way to manage my symptoms as I hate how I feel most of the time. This state of being can be so frustrating at times as I know that I am very fortunate in my life but my mood is always low.

I believe my menstrual cycle has an effect as I have a few days around the time I am ovulating where I feel “normal” or better than I usually do.”

Health history

Gynaelogical:

• regular cycles every 28-29 days
• severe premenstrual anxiety, irritability, crying spells, mood swings, depression and lethargy
• premenstrual food cravings, fatigue, headaches and breast tenderness
• periods are light
• periods last 2-3 days,
• feels much better once period has ended for the next 3-4 days
• then mood goes back to baseline, low but functional
• mood better around ovulation
• vaginal dryness

Digestive:

• stomach upset by greasy foods
• cravings for fat and meat before her period

Nutrition history

• High carbohydrate breakfast e.g. apple and cinnamon porridge with oat milk
• Low on protein
• Low on vegetables
• Low on fat
• Has 3 meals a day but they are quite small

Test results

• Vitamin D deficiency
• Vitamin B12 deficiency
• Folate deficiency
• Low iron
• Omega 6 too high
• Omega 3 too low
• Blood sugar too high

Root cause analysis

OT’s mood was low in general, which indicates a deficiency of serotonin and dopamine, and this was confirmed by a neurotransmitter questionnaire.

Depressive, anxious syndromes can be caused by nutritional deficiencies from poor diet, including

• 5HTP derived from animal protein which creates serotonin
• tyrosine derived from animal protein which creates dopamine.
• magnesium
• calcium

Additionally, it was very clear that her low mood was cyclical, improving at ovulation when oestrogen is higher, and crashing premenstrually. It was also clear that her oestrogen was too low in general and progesterone was too high premenstrually, as evidenced by

• light periods
• short periods – 2-3 days
• breast tenderness
• vaginal dryness

Factors contributing to low oestrogen in OT included

• inadequate fat intake: steroid hormones such as oestrogen (and vitamin D) are made from cholesterol which is derived from dietary fat, which she could not digest and absorb
• inadequate B vitamins which prevents the synthesis of oestrogen from testosterone

Protocol

NUTRITION

• I recommended a low carbohydrate, moderate protein, high fat nutrition plan which was rich in fish and eggs, with a high level of vegetables and beneficial fats, and personalised to OT’s requirements.
• OT was asked to follow my 7 food rules as closely as possible.

SUPPLEMENTS

• Vitamin D: calibrated dose of emulsified vitamin D drops
• Gynovite: a multivitamin with high doses of B vitamins targeted for low oestrogen
• 5HTP to increase serotonin
• L-tyrosine to increase dopamine
• Body balance oil to increase fat intake

LIFESTYLE

• I recommended that OT purchase a Seasonal Affective Disorder lamp and expose her eyes the bright light every morning. Bright light therapy has shown to help with winter blues, regulating energy in the daytime and the sleep cycle at night.

SYMPTOM TRACKING

Symptom	Score out of 6
	Initial score
Daily depression	4
Daily anxiety	4
Depression before period	6
Anxiety before period	3-4
Meat cravings before period	5
Craving for fat before period	5

Results – follow-up 1 (+4 weeks)

• 4 weeks later OT, for the first time, did not have the usual pre-menstrual emotional meltdown of breaking down and crying, and was feeling emotionally well during the month.
• She did have 2 short depressive episodes, but said that at the same time her workload was excessively stressful.
• Her anxiety had improved slightly, and she was still finding it difficult to fall asleep.
• Her skin had improved a lot.
• Pre-menstrual fat and meat cravings had reduced.
• She was enjoying eating more vegetables and protein, she wasn’t hungry between meals and most significantly she wasn’t having any mid-morning cravings for food.
• The Gynovite supplement caused digestive issues so I switched it to Optivite PMT.

SYMPTOM TRACKING

Symptom	Score out of 6
	Initial score	Score after 4 weeks
Daily depression	4	2
Daily anxiety	4	3
Depression before period	6	2
Anxiety before period	3-4	3
Meat cravings before period	5	2
Craving for fat before period	5	2

Results – follow-up 2 (+8 weeks)

• 4 weeks later and all of OT’s symptoms had resolved.
• Again she had no breakdown before her period and her day-to-day emotional life was absolutely fine.
• She had a couple of anxious moments related to work stress, but that was all.
• All her cravings had gone. She was still having a little anxiety before sleep and I adjusted her protocol to help with that.
• She was finding it difficult to stomach the oil so I switched the oil to capsules instead.

SYMPTOM TRACKING

Symptom	Score out of 6
	Initial score	Score after 4 weeks	Score after 8 weeks
Daily depression	4	2	0
Daily anxiety	4	3	1
Depression before period	6	2	0
Anxiety before period	3-4	3	0
Meat cravings before period	5	2	0
Craving for fat before period	5	2	0

OT’s review

“Within weeks of starting my supplement plan, I noticed a significant positive shift in my mental health and I am confident that this will continue going forward.

I can honestly say that with Sandra’s help, my life has changed for the better.”

I have struggled with anxiety and depression for as long as I can remember. Having tried everything from counselling, antidepressants and even Reiki, I was beginning to feel as though I would have to live with my anxiety and depression forever.

I made contact with Sandra following a recommendation from a friend and I am so glad I did. During the initial call, Sandra made me feel at ease straight away.

Within weeks of starting my supplement plan, I noticed a significant positive shift in my mental health and I am confident that this will continue going forward. I can honestly say that with Sandra’s help, my life has changed for the better.

Thank you Sandra!

My review

Despite the fact that I see significant improvements in client’s health every day in my work, it still sometimes takes my breath away when I see the power of functional medicine in action.

I always expect to see results within 4 weeks, and OT’s progress was no different. She was committed to the process right from the start and did an incredible job of following her plan.

As she said to me, and I agreed – “I wish I could have done this years ago, and I dread to think what my life would have been like if I hadn’t done this work with you”. It saddens me to think of all the women that are suffering through their cycles and not getting the help they need, and I am so pleased to have seen OT recover so quickly.