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Doctor’s Perspective

Without hormones, we cannot live

hormones cant live withoutLife expectancy increased by 5 years between 2000 and 2015, the fastest increase since the 1960s. 

With this being said, we can expect to live a substantial part of our lives in a state of hormonal deficiency.

Hormonal decline and imbalance during the states of menopause and andropause are associated with experiencing mildly annoying to completely debilitating symptoms as well as an increase in diseases such as heart disease. Effects of insufficient hormones include bone loss, cognitive decline, loss of muscle mass, thinning of skin and much more.

Without hormones, we cannot live. So why is there often so much confusion about bio-identical hormone therapy? We experience misunderstanding often between our patients and their family physicians.


There are two main reasons why:

  1. Exogenous chemicals (drug hormones; i.e. Provera, Medroxyprogesterone, Premarin, etc.), different from the actual hormone they are meant to replace, are used interchangeably in clinical practice, the popular press, and inprestigious medical journals, producing much of the controversy that surrounds hormone replacement.
  2. Billions of dollars can purchase a lot of advertising to sway the public and manipulate sponsors for physician educational events.


The article “Point Counterpoint bioidentical hormones published in the Journal of American Physicians and Surgeons speaks well to answer why there is so much confusion around human hormone therapy. It is also a great reference article available for you to print out and bring in to your family doctor.

It is a priority for us to help you get started on the road to *feeling better* with bioidentical hormones. Through knowledge, support and education about bio-identicals, you will be empowered to get the natural treatment you are looking for to eliminate the difficult symptoms of PMS, peri-menopause, menopause, postmenopause and andropause. 

Schedule your follow up appointment or new patient appointment with Dr. Sinda today.


Importance of a Healthy Body Composition

work out bmiThere are many benefits of having a healthy body composition.

By reducing your overall amount of body fat, you can improve your body composition and overall quality of life, as well as extend your lifespan.




Here are just some of the benefits of having a healthy body composition:

  • Normal blood pressure level
  • Improved quality of sleep
  • Improved mood and self-confidence
  • Increased energy and endurance throughout the day
  • Reduced pain in joints, hips, and lower back
  • Improved blood circulation — leading to lower risk for heart disease
  • Improved breathing, respiration, and lung function
  • Improved glucose tolerance and insulin sensitivity

In our office, we measure Body Composition by Bioelectrical Impedance Analysis (BIA). Our body composition analyzer provides an estimated measurement based on body type for the values below:

  • Weight
  • Body Fat % – Fat % is amount of body fat as a proportion of body weight.
  • Fat Mass – Total weight of fat mass in the body.
  • Fat Free Mass (FFM) – Fat Free Mass is comprised of muscle, bone, tissue, water and all other fat free mass in the body.
  • Water Mass – The amount of water retained by the body. Water plays a vital role in many of the body’s processes and is found in every cell, tissue and organ. Maintaining a healthy total body water percentage will ensure the body functions efficiently. It is important to look for long-term changes in total body water percentage and maintain a consistent, healthy total body water percentage. Average ranges for healthy adults are: Female 45 – 60%;  Male  50 – 65%.
  • Basal Metabolic Rate (BMR) – The minimum level of energy (i.e. calories) your body needs when at rest to function effectively including your respiratory and circulatory organs, neural system, liver, kidneys and other organs. About 70% of calories consumed every day are used for your basal metabolism. Having a higher basal metabolism will increase the number of calories used and help to decrease the amount of body fat. A low basal metabolic rate will make it harder to lose body fat and overall weight. BMR is the first step in getting an idea of how much fuel you need to keep your engine roaring all day long – It is the minimum number of calories you should eat on a daily basis.
  • Body Mass Index (BMI) – BMI can be used to indicate if you are overweight, obese, underweight or normal. A healthy BMI score is between 18.5 and 25.Use this Online BMI calculator

How can a machine measure all of this Information?

The machine is able to get this information by measuring bioelectrical impedance in the body. Fat within the body allows almost no electricity to pass through, while electricity passes rather easily though water, much of which is found in muscles. The degree of difficulty with which electricity passes through a substance is known as the electrical resistance, and the percentage of fat and other body constituents can be inferred from measurements of this resistance.


Recheck your Body Composition

Remember — when it comes to health, every little bit counts, and even a modest weight loss of 5 to 10% of your body weight significantly lowers your obesity-related disease risk. If you’re not sure where to begin, consult nutrition and fitness professionals for help with your diet and exercise regimens.

We would be happy to recheck your body composition at any time, stop in or call to set up an appointment with our Nurse to monitor your progress.


Symptoms of Estrogen Dominance

estrogen-dominance2-pdDid you know that a main cause of hormone-related health problems in women is not due to the deficiency of estrogen or progesterone but rather the ratio of estrogen to progesterone?

BioIdentical Hormone replacement therapy with estrogen alone without an opposing progesterone should be avoided.

It is important to have both your estrogen and progesterone levels tested at the same time.

Some Symptoms of Estrogen dominance are:

  • Decreased sex drive
  • Irregular / abnormal menstrual periods
  • Bloating
  • Breast swelling and tenderness
  • Fibrocystic breasts
  • Headaches (especially during PMS)
  • Mood swings
  • Weight and/or fat gain (around the hips)
  • Sluggish metabolism
  • Trouble sleeping/insomnia
  • PMS

If you are interested in exploring your options to decrease estrogen dominance or would like a second opinion if you are being treated with only estrogen, contact our clinic to set up a consultation with Dr. Sinda. 

Choose Quality Over Convenience

Choose QualityDr. Sinda and our staff recommends quality products from professional supplement and skincare companies who share the same commitment to your health – optimizing your health and skin. The medical grade products we offer meet rigid testing standards to ensure scientifically-backed ingredients at clinically appropriate dosages. We trust these companies because they are accountable for the results we get with our patients.

What can go wrong when you buy supplements online? 

Many of our patients often take our supplement recommendations and turn to internet sites for convenience of online shopping. While we understand the desire to save time and money, there are some risks that patients are often unaware of when purchasing supplements online. Please read further.

Quality Control

Supplements purchased on sites like Amazon may sit in large, uncontrolled warehouses not intended to store medications or supplements. Unregulated for temperature and humidity control, these conditions can have a significant impact on product potency and viability. Read more: http://www.businessinsider.com/brutal-conditions-in-amazons-warehouses-2013-8

Tampered Product

To conceal their identity, internet resellers often deface product labels and alter important tracking information. They will rub off expiration dates, manufacturer lot numbers and bar codes all of which are crucial for the manufacture to guarantee its efficacy. Read more:  http://patch.com/connecticut/oxford-ct/why-you-should-never-buy-supplements-on-amazon-or-ebay_d0e64f41

Counterfeit Product

As professional supplements grow in popularity, so does the prevalence of cheap, imitation products camouflaged as professional line supplements. While these products will look the same as the ones in our office, they use inferior raw ingredients that virtually never have correct amount of the active ingredients they are supposed to contain.  Read more:  http://www.cbsnews.com/news/amazon-struggling-to-keep-counterfeits-off-market-retailer-says/


Please be sure you are purchasing from reliable sources. For your convenience, we offer shipping on all supplements and skincare products. We also can make arrangements for pick up if you can’t get here during office hours. If you are running low, feel free to email, call (952)922-2345 or use this form.


How do I dispose of used Prescriptions and Needles?

Medication Disposal

Are you unsure what to do with your unused, left-over, expired prescriptions, vitamins, supplements or injectables, syringes or needles?


There are proper disposal guidelines for medicines and injectables to help reduce harm from accidental exposure or intentional misuse after they are no longer needed.

Here are some guidelines on how to dispose of unused medication and sharps in a way that ensures it won’t fall into the wrong hands or contaminate the groundwater in your area.



Sharps (Needles) Disposal

Some common medications we prescribe for Men such as Pregnyl, HCG, Novarel, and Testosterone, etc. use a needle to administer.

  • Talk to your pharmacist about disposal options.
  • Subscribe to a regular safe collection service of used needles from your household or use a mail-in program to send in used sharps. Some are listed here:
  • Destroy needles at home by purchasing a needle destruction unit available online, in health care stores, and at pharmacies.
  • It is still legal in Minnesota, but NOT recommended, to place needles and syringes in a hard puncture proof container, tightly seal the container (duct tape), label the container sharps or needles, and place the container in your household trash. The container cannot be placed in the recycling as the needles and fluids are hazardous waste and pose a danger to the people sorting the material by hand. Some County’s like Washington County accept sharps to be collected at their Environmental Center. Please check with yours.

Disposal of Prescription Medicines & Vitamins

Dispose of unused / left-over prescriptions (bio-identical  Progesterone, Estrogen, Testosterone and other prescription meds), over-the-counter medications, vitamins, supplements, and pet medications in the green containers provided in the lobby at various locations in Hennepin County. Needles and syringes not accepted at these locations.  Some disposal locations nearby are:

  • Edina Hennepin County Library – Southdale, 7009 York Ave. S., Edina
  • Minnetonka Hennepin County District Court Ridgedale –  12601 Ridgedale Drive, Minnetonka
  • Brooklyn Park Hennepin County Sheriff’s Patrol Headquarters – 9401 83rd Ave N, Brooklyn Park

For more information and rules on disposals, check your County’s website. Here are a few links:

Thank you for your effort for making our communities safer!

Staff at Innovative Directions in Health


Waking up Feeling Refreshed

good morningIf you are in the stages of perimenopause or menopause, you may be experiencing symptoms such as not being able to sleep at night or waking up having no energy because you are totally exhausted!

Night sweats may be preventing you from going back to sleep because you wake up drenched and have to change the sheets and your clothing. Now getting back to sleep is another problem. You are not alone. These symptoms often are mostly likely the result of a progesterone hormone deficiency.

Bio-Identical progesterone comes in different forms such as a troche (lozenge you suck on like a cough drop), triturate (sublingual tablet), cream, capsule, etc. Your body will recognize bio-identical progesterone as it is exactly made to be like your own hormone.  Progesterone can also be formulated into several different flavors. Common flavors are peppermint, tangerine, tea berry, chocolate raspberry. If you are currently taking progesterone, ask your pharmacist which flavors they carry.

Progesterone should be taken in the evening or at bedtime (usually 30 minutes before bed) as it may cause drowsiness. Here are two forms of the types of progesterone Dr. Sinda uses most often:


  • Depending on the dose prescribed, you will use either one or ½ of a troche. If your dose is ½ troche; the troche is scored on one side and can easily be cut it into equal halves.
  • The dosage is placed between the gum and the cheek, so the hormones are dissolved slowly into the blood stream. It is very important that you do not swallow or chew the troche while it is dissolving. The goal is to have the hormone enter your system through your oral mucosa (skin) rather than being swallowed. It usually takes about 10-15 min for the troche to dissolve and 30 min for a dose to be fully absorbed.
  • It is a good idea to brush your teeth about 30 minutes after taking your troche.
  • Troches are stored at room temperature between 60 and 80 degrees F or in the refrigerator. Troches can melt so protect from heat and moisture.


  • A progesterone triturate is sublingual, meaning it is placed under your tongue to dissolve. Depending upon the pharmacy making the triturate it takes about 5 to 15 minutes to dissolve. Sublingual progesterone is not destroyed by stomach acid or broken down by the liver. It fully enters the bloodstream where it can be fully utilized by your organs. Do not chew or swallow the tablet to let it fully absorb.
  • Triturates can be compounded up to 100mg so if you require a higher dosage you may consider changing to a troche which can contain a higher dose.
  • It is a good idea to brush your teeth about 30 minutes after taking your triturate to avoid dry mouth during the night.
  • Triturates are stored at room temperature. Patients often leave them on their night stand to help with compliance. Avoid keeping any medications in the bathroom due to moisture.

Current patients, if you have questions about your progesterone flavoring or dose method, please call your local compounding pharmacy. Progesterone can be customized to meet different needs such as sugar free, gluten free, etc.

If you are wanting to confirm that you have a hormone imbalance it is important to have your hormone levels measured and reviewed by a qualified doctor who prescribes bio-identical hormones and monitors levels and symptoms throughout the year.


If you have any questions about getting started with hormone replacement or your current regimen give us a call at (952) 922-2345 or contact us, we are always happy to help and answer any questions you may have!

Staff at Innovative Directions in Health


Bio-Identical Hormone Therapy Studies


Are there any studies on BioIdentical Hormone Replacement?


Yes! We often are asked by patients for information that can be sent to their OBGYN or insurance company regarding bio-identical hormone therapy for menopause, perimenopause or PMS.


Dr. Mahmud published a study in the journal of Gynecological Endocrinology where 97% of the patients experienced relief of menopausal symptoms. The article is called “Natural Hormone Therapy for Menopause”. A summary of the article can be read here. If you would like to receive a copy of the full article, contact us.

Dr. Mahmud’s book, Keeping aBreast, Ways to PREVENT Breast Cancer also contains a lot of great information explaining the different hormones and how bio-identical hormone replacement plays a role in helping to prevent breast cancer. A copy of Dr. Mahmud’s book is available for purchase in our clinic.


Additional studies for women Dr. Sinda often references can be looked up via the links below:


What is a Low FODMAP Diet?

headacheDo you eat the same foods every day?  
Health problems such as: digestive, headaches, low energy, depression, skin irritations, joint aches, difficulty losing weight and more may be related to a specific food or foods you eat frequently.

Many people with food sensitivities don’t even realize how awful they feel until the “trigger” foods are removed from the diet. Food reactions are a frequently overlooked cause of chronic health issues. Some reactions occur immediately after eating the food (called “food allergy”), but in other cases, symptoms may be delayed by several hours or even days (referred to as “food sensitivity” or “food intolerance”). Removing specific foods from your diet will allow your body to recover and begin to function efficiently again.  

So what is FODMAP?
FODMAP stands for Fermentable Oligo, Di, and Mono-saccharides, And Polyols. The acronym is used to describe a specific group of carbohydrates that are poorly absorbed in the small intestine and often cause symptoms such as excess gas, bloating, and diarrhea in certain individuals with irritable Bowel Syndrome (IBS) and other functional bowel disorders.

What carbohydrate foods are FODMAPs?
FODMAP carbohydrates include:

  • Certain sugars (lactose and fructose) found in foods such as mile and dairy products, fruit, honey, and high-fructose corn syrup.
  • Artificial sweeteners (polyols), especially sweeteners containing sorbitol and mannitol.
  • Certain types of fiber (fructans and galactans) found in wheat, beans, and some vegetables.

FODMAP tolerance:
All FODMAPs have the potential to cause unwanted symptoms. Yet, the degree in which FODMAPs are tolerated varies from person to person. An individual’s physical response to certain FODMAPs depends on their own person level of sensitivity. Therefore, some FODMAP groups may trigger symptoms while others might not.

Think of the small intestine as a bucket. Each person has their own size bucket, or unique tolerance for FODMAP carbohydrates. FODMAPs have a cumulative effect. That is, the amount, not just the type of FODMAP consumed matters. When FODMAP intake exceeds the amount the “bucket” can hold (the small intestine’s capacity for digestion and absorption), it overflows into the large intestine. This may lead to gas, bloating, and diarrhea.

The FODMAP approach:
It is important to understand that IBS and other functional bowel disorders are not caused by eating FODMAPs, therefore eliminating FODMAPs from the diet will not cure the disease. However, removing certain FODMAPs from the diet may greatly improve symptoms.

The FODMAP approach takes into consideration tolerance to all FODMAP carbohydrate groups, not just specific foods. Often times in an attempt to ease symptoms, individuals tend to be overly restrictive with their diet. This leads to nutritional deficiencies. The goal of the FODMAP approach is to manage symptoms while allowing for the most varied and nutritious diet possible.

Low FODMAP diet:
A low FODMAP diet aims to minimize gastrointestinal symptoms by removing common high FODMAP foods and replacing them with low FODMAP alternatives. It is intended to be a short-term diet and is usually followed for six weeks or less. It is not to be used as a permanent diet solution. After symptoms improve, high FODMAP foods are gradually added back into the diet in smaller amounts.

FODMAP Elimination diet:
A more aggressive approach is a FODMAP elimination diet. It should not be attempted without the help and supervision of either a Registered Dietitian or healthcare provider. An elimination diet is a temporary learning diet that is used to identify troublesome FODMAPs. It consists of three phases:

  • Elimination phase: all FODMAPs are eliminated from the diet for approximately 3 weeks.
  • Challenge phase: the body is challenged by reintroducing FODMAPs into the diet in an organized way. Symptoms are observed and problematic FODMAPs are identified.
  • Final phase: problem FODMAPs are incorporated back into the diet as tolerated.

Rather than excluding all FODMAPs from the diet, the goal of both diet methods is to eliminate only the FODMAPs that are problematic. With proper management, few, if any foods must be removed from the diet permanently.

Is a low FODMAP diet right for you?
A low FODMAP diet may not be appropriate for everyone. Before beginning a low FODMAP diet, first consult your healthcare provider to eliminate other causes of your symptoms. Low FODMAP diets have shown to be most successful for persons who have:

  • An official diagnosis of Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD) or other functional bowel disorder with symptoms of excess gas, bloating, abdominal pain, diarrhea/constipation, etc.
  • Tried and failed standard therapy (high-fiber diet, increased fluid intake, increased exercise, etc.)
  • Ruled out celiac disease as a possible diagnosis. This is important as restriction wheat from the diet will affect the accuracy of future celiac testing.
  • Regular or irregular intake of high FODMAP foods.
  • The desire and ability to modify their diet.

**Additional testing such as lactose and/or fructose breath tests is helpful (bot not essential) prior to beginning a FODMAP diet.

Enlist the help of a Registered Dietitian:
If it is determined that a low FODMAP diet would be beneficial to you, consulting a Registered Dietitian (RD) who specialized in gastrointestinal nutrition can increase the likelihood of your success. The RD will help to identify major FODMAP culprits in your diet and develop an individualized diet plan centered around your eating habits and food preferences to improve both symptoms and quality of life.


Try these low- FODMAP foods


Fruit Vegetables Grain Foods Milk Products Other
Banana, blueberry, boysenberry, cantaloupe, cranberry, grape, grapefruit, honeydew melon, kiwi, lemon, lime, mandarin oranges, orange, passion, fruit, raspberry, rhubarb, strawberry *Eat dried fruit in small quantities Alfalfa,
bamboo shoots,
bean shoots,
bok choy,
carrot, celery,
green beans, potatoes,
summer squash, sweet potato,
Gluten-free bread or cereal,
100% spelt bread, rice,

Lactose-free milk and yogurt, oat milk*, rice milk, soy milk*
*Check for additives

Hard cheeses, brie and camembert

Yogurt: Lactose-free varieties

Ice Cream Substitutes
Gelato or sorbet

Olive oil

Sugar* (sucrose)
artificial sweeteners not ending in “-ol” 

Honey Substitutes
Maple syrup*, molasses

*small quantities 



Avoid these foods containing FODMAPs


Fruit Vegetables Grain Foods Milk Products Other
Apples, apricots,
canned fruit,
cherries, mango, nectarines, peaches, pears, plums,
prunes, watermelon, large amounts of dried fruit or fruit juice
Artichokes, asparagus, beets, broccoli, Brussels sprouts, cabbage cauliflower, eggplant, fennel, garlic, green bell pepper, leek, mushroom, onion, snow peas, sugar snap peas, sweet corn Wheat and rye,
in large amounts
(i.e. bread, crackers,
cookies, pasta)
Milk from cows,
goats or sheep, custard,
ice cream and yogurt, soft cheeses such as cottage cheese, cream cheese and ricotta
Fructose, high fructose corn syrup, honey isomalt, maltitol, mannitol, sorbitol, sylitol 

Baked beans, chickpeas, kidney beans, lentils 



More information about FODMAP can be found here