Video Blog: Dr. Bal Pawa discusses women's health as we age
Hello, I'm Dr. Bal Pawa. I'm the co-founder of Westcoast Women's Clinic, an integrative medical clinic, specializing in hormonal health. We have a reputation in this community for about fifteen years. We pioneered the clinic, we were one of the first in BC. Women come to us because we are MDs who look at healthcare in a very holistic way. We look at wellness rather than the illness model. We offer a personalized health approach. We look at lifestyle, we look at diet, mind-body medicine. We look at sleep. Sleep is a crucial part of health, as well. We look at investigations and state-of-the-art testing for hormones.
Women come to our clinic for many reasons. They often are looking for answers that they have not found at any of their other healthcare providers. They're often feeling depressed, they're having hot flashes, fatigue is a big one. Insomnia is a big one. Women age differently in their lifespan. You can get a thirty-year old who is reaching premature menopause, for example, or you can get a fifty-five year old who is still having periods. Across their reproductive life span, they'll present differently and have many symptoms, and they find that going to walk-in clinics is not meeting their needs.
They're looking for a clinic that is offering integrative approach to hormonal health. Somebody who's credible. As you know, hormones are very controversial issue. They're looking for doctors that are medically trained and have special expertise in this area.
When we look at holistic, or integrative medicine, as it's called, we're looking at medicine through a wellness model, not just an illness model. An illness model is where a patient goes into a doctor and they have a symptom, and they say, "Okay, I have heartburn," and the doctor prescribes a drug. We're looking at causes of that symptom, we're looking at the body as a whole. That's how usually the human body works, as a system, not fragmented parts. We look at through lifestyle, stress, sleep, nutrition, and also we do prescribe. Going to a drug or a medication is not our first go-to.
How do we create perfect health is what I'd like to address. I think it's a partnership. When you get a patient who is advocating for their health, they're motivated, they want to make difference, and then they find a doctor who has expertise in that area and who's passionate about making a difference. I think that's a winning combination. When we create a partnership, we're actually creating a health plan that is personalized. We look at how motivated the patient is, and we're willing to go the full ante to find out what's causing their symptoms, how we can best help them, and create a personalized health plan.
Creating health means creating knowledge, creating good habits and routines, and creating a database of credible information. We offer seminars, one-on-one meeting with the nurse, with the doctor, with the team ... We're looking at ways that we can educate the patient, and that helps their journey and sustain their compliance.
As women age, they're often very concerned about bones and joints. These are two different disease process. Bone is a live tissue, and as bones age, they often get softer with age. That's called a disease, osteoporosis. Joint disease is a disease of aging where it's wear and tear. It's often accompanied by tendons and ligaments and bone-on-bone surfaces, like a ball and socket. That's a wear and tear, and that's called osteoarthritis, so two different processes.
Both do involve inflammation, so our principles for looking at joint and bone health are, one is to promote exercise: movement, agility, weight-bearing is especially good for bones, but movement such as swimming and cycling is great for joints. Looking at lifestyle such as smoking, alcohol, or caffeine intake. Those three factors impact how the joints are working, and also how bone tissue responds to these toxins. Looking at diet, for example, having things that are anti-inflammatories in your diet, such as omega-3. Vitamin D is a crucial part of bone health, and vitamin D is also great for absorption of calcium. It's very important to get calcium in your diet. When we're talking about bone and joint health, we often tell women to look at cross-training. We often tell them to look at a very whole diet, and of course you have to recognize that genetics play a role, as well.
A woman should get her hormone levels checked when she's having symptoms. The first hallmark of perimenopause is when she's missing periods. Around age forty, forty-five, she may notice that her periods are becoming irregular. She may have two periods in one month, or she might have two or three months of no periods. That is the first hallmark that menopause is approaching. If you define menopause, that's a milestone that women reach. It's not something they go through. The average age is fifty-one in North America.
Perimenopause is the few years leading up to menopause. Hormone testing at that point is very limited, because your hormones are changing every month. There is some more comprehensive testing that we do send away, and we're looking at stress hormones, and we're looking at thyroid, and we're looking at other hormones that we can do locally, and some that we send to the states. The menopause testing is done here in Canada and it's very easy to do. You can do an FSH, and you can go to your doctor and get an FSH done when you stop your periods. When you've had a few months with no periods, you can go and get an FSH level done and that will determine whether you have crossed over into menopause.
Natural supplements, and whether we should consider them or not has been an ongoing question. One of the most important things to know is that our nutrition, which is a vital piece of health, is changing. If you look at broccoli from 1960 to broccoli now, and you analyse the selenium content, it's very different. We are very depleted in our trace minerals. Twenty-five years ago doctors were told, "You don't need to supplement vitamins for your patients if they eat a healthy diet."
Now we say "Well you know, you want the patient to have a very healthy diet, full of phytonutrients from vegetables, of having whole foods and not processed foods, and good source protein, of course; but we have to recognize that we are still depleted in certain trace minerals, and also vitamin D is something that you just don't find in your diet readily." There are some things that you will need to supplement. Vitamin D is a big one. That would be about a thousand to two thousand units a day. I would want patients to have omega-3. I would want now, with the new research, also looking at fermented foods in our diet, to improve our micro-biome and to improve our health of the gut. Having foods that have variety of pre-biotics and pro-biotics in them, that would be things that you could supplement with. Along with a very healthy diet.
Then there are patients that are special cases, who have compromised absorption. Inflammatory bowel disease, for example; or you can get patients that are elderly, or they've gone through some medical problems. Even vegans, they may need extra supplementation with B12 or iron, as well.
The most important thing that women have to realize, there is so much information out there. They should know what information applies to them. Having good, credible information is key. I feel that having good resources of websites ... You can go to Westcoast Women's website, we offer websites for osteoporosis, for menopause. We also offer seminars through the clinic, with physicians. We just want patients to get good, credible information so we can empower women to make their own decisions and be informed about their health.
The other important feature for creating health is a woman who advocates for herself. She puts herself as a priority, and makes health a very top priority in her life. We love the ripple effect. That means that when we get a woman back on her feet and she's healthy, then she creates health for others. Women are great at networking, and they'll tell their friends what they did differently for their exercise or for their vitamins. Then they'll tell their friends, and their family. We find such a ripple effect with getting women back on their feet. We love that, and that's what keeps us as doctors passionate about this healthcare in women's health.
Another critical component for women and men as well, is the management of stress, and how the mind-body connection is so powerful. I've done a lot of research in this in the last fifteen years, and it is profound. Stress hormones are the big players in the body. They contribute to inflammation, they contribute to gut health. The gut is so vital. If you have a healthy gut, eighty percent of your immune system is made in the gut. Seventy percent of your serotonin, which is your happy hormone, is made in the gut. Keeping your gut healthy is so vital to health.
If you look at the father of medicine, Hippocrates, "Let food be thy medicine." That was such a profound statement, because we're not paying enough attention to what we're putting in our mouth. The micronutrients that we want to absorb, first of all the choices we make in food are very important, but then keeping the gut healthy. Why is our gut not healthy as it used to be? Why is our micro-biome different than it was? We look at the processed food we're consuming, we look at the toxins in our diet, we look at the GMO foods we're consuming. We look at the stress that our body is facing, the schedules that we keep. All of that contributes to gut health.
There's a lot of research now, looking at gut health and how it impacts the brain, as well. In our lifetime as physicians, I never thought that we would see probiotics being recommended for mood disorders. A psychiatrist, a very prominent psychiatrist, feels that if we were able to correct the micro-biome, we could actually impact diseases such as autism and inflammatory diseases of the brain, and depression and mood disorders. That is a huge area of research and I'm fascinated by it.